Disconnection and reconnection of abutments multiple times have known to affect the mucosal barrier around implants leading to marginal bone loss. This clinical report describes a novel technique that amalgamates the benefits of digital technologies encompassing the fabrication of surgical guides for implant placement, customized hybrid zirconia abutments and all ceramic lithium disilicate crowns prior to implant placement. A correct 3-dimensional implant positioning along with immediate placement of the definitive hybrid customized abutment and a lithium disilicate crown has the potential to reduce treatment time, visits and costs while delivering optimal esthetic outcomes.

Background: Maxillary premolars have a unique anatomical location. This is an CBCT based study where the suitability of maxillary premolars for immediate implant placement (IIP) is evaluated. Based on prosthetically driven treatment treatment planning a simple classification system is put forth. Materials and Methods: 150 CBCTs of maxillary first premolars were analysed in BlueskyBio software. The topographic position of the tooth was determined by analysing the dimensions of the buccal and lingual cortical plates, the distance between the bucco-lingual plates and the residual bone height from the root apex to the floor of the sinus. Virtual placement of an implant was carried out such that the implant would be positioned 1 mm apical to the buccal bone crest, would engage 3 mm of bone apical to the root apex, and would have a trajectory so that the abutment access was from the central fossa. Four categories were identified and the classification was proposed. Results: It was observed that 74% of cases had buccal bone<1mm,26% had buccal bone >1mm. 79% cases had an average distance >3mm between root apex and maxillary sinus, 21% had an average distance of root apex and maxillary sinus <3mm. The categorizations of implant placement were as follows -Type 1- 24%, Type 2- 56.6%, Type 3-43.3%, Type 4- 0%. Conclusions: In majority of maxillary 1st premolars an IIP is possible with the implants to be placed in the palatal sockets or the furcation area. In cases were the buccal plate thickness is inadequate, simultaneous grafting should be considered between the implant position and buccal plate.

Aim: To evaluate the fracture load and type of failure of two different monolithic restorative materials bonded to standardized titanium bases and fabricated by two different procedures regarding the bonding interface. Materials and methods: All screw-retained implant crown specimens (n = 40), subjected to fatigue by thermomechanical loading, differed in the restorative material (lithium disilicate [LDS] or polymer-infiltrated ceramic network [PICN], referred to as ‘hybrid ceramic’ [HYC]) and the interface type between the restorative material and the titanium base abutment (prefabricated ex-factory or produced during a CAM-milling procedure). This resulted in the following groups (n = 10/group): 1) LDS-M: lithium disilicate crown with a CAM-milled interface; 2) LDS-P: lithium disilicate crown with a prefabricated interface; 3) HYC-M: PICN crown with a CAM-milled interface; and 4) HYC-P: PICN crown with a prefabricated interface. Aged specimens underwent static fracture load testing. The load (N) at which the initial crack occurred was denoted as Finitial, and the maximal load (N) at which the restorations fractured as Fmax. All specimens were examined under a stereomicroscope to determine the failure mode. Results: The median Finitial values were 180 N for LDS-M, 343 N for LDS-P, 340 N for HYC-M, and 190 N for HYC-P. The median Fmax values were 1822 N for LDS-M, 2039 N for LDS-P, 1454 N for HYC-M, and 1581 N for HYC-P. The intergroup differences were significant for Finitial (KW: P = 0.0042) and for Fmax (KW: P = 0.0010). The failure types also showed differences between the restorative groups. Conclusions: The choice of restorative material had a stronger influence on the fracture load than the abutment interface workflow. Lithium disilicate showed the highest load for initial crack appearance (Finitial) and for complete fracture of the restoration (Fmax). Keywords: lithium disilicate, dental materials, polymer-infiltrated ceramic network, thermomechanical aging, fracture load, failure mode, prosthetic dentistry, restorative material, abutment interface

Die wissenschaftliche Evidenz für Zirkonoxidimplantate ist in den letzten Jahren erheblich gestiegen. Mittlerweile liegen Daten aus klinischen Studien vor, die eine Beobachtungszeit von 5−7 Jahren umfassen. Dennoch fehlen weiterhin randomisierte klinische Studien, die den Einsatz von Zirkonoxidimplantaten in verschiedenen klinischen Indikationen vergleichen. Es gibt bislang keine Studie, die den direkten Vergleich zwischen kurzen und längeren Zirkonoxidimplantaten untersucht. Ebenso fehlen klinische Daten über den Einsatz von kurzen Zirkonoxidimplantaten. Als kurze Implantate sind Implantate mit einer Länge von 6 mm oder weniger definiert. 8 mm „kurze“ Zirkonoxidimplantate können jedoch erfolgreich verwendet werden. Zudem zeigen Ergebnisse aus Kohortenstudien, dass die Implantatlänge keinen Einfluss auf das marginale Knochenniveau hat. Kurze Zirkonoxidimplantate könnten im Kieferkamm mit einer reduzierten vertikalen Höhe eine kostengünstige Behandlungsoption mit geringerer Morbidität darstellen, wenn dadurch eine aufwendige Knochenaugmentation verhindert werden kann. In Situationen, in denen ausreichend vertikale Höhe vorhanden ist, scheint die Verwendung von Implantaten mit Standardlänge die sicherere Option zu sein. Manuskripteingang: 08.07.2023, Annahme: 18.08.2023 Keywords: Zirkonoxidimplantate, vollkeramische Restaurationen, metallfreie Restaurationen, kurze Implantate, wissenschaftliche Evidenz

Ziel: Ziel der vorliegenden retrospektiven Fallserie war die Einführung eines minimalinvasiven zweistufigen lappenfreien Verfahrens für die Kronenverlängerung, das die Gingivektomie vermeidet oder minimiert, indem die Reduktion der Knochenhöhe mithilfe einer Tunnelpräparation vorgenommen wird. Material und Methode: In diese Studie wurden neun Patientinnen und ein Patient (Altersmedian: 46,6 Jahre, Bereich: 26,9 bis 71,6 Jahre) eingeschlossen. Die Indikationen für die Durchführung der Kronenverlängerung waren: ästhetisch zu kurze Kronen (n = 5), Asymmetrie der Gingivahöhen (n = 2) und die Kombination aus diesen Indikationen (n = 3). Alle Behandelten wiesen einen dicken gingivalen Phänotyp auf, und die mittlere Anzahl der in den Eingriff einbezogenen Zähne betrug 3,7 (Bereich: 2 bis 8 Zähne). Drei Teilnehmende erhielten sechs Wochen nach der Kronenverlängerung eine zusätzliche Gingivektomie. Ergebnisse: Die Ergebnisse erfüllten in ästhetischer und funktioneller Hinsicht die Erwartungen der Behandelten und des Zahnarztes. Schlussfolgerung: Das minimalinvasive zweistufige Kronenverlängerungsverfahren unter Anwendung einer Tunneltechnik kann auch ohne offenen Lappen und zusätzliche Gingivektomie vorhersagbare ästhetische Ergebnisse liefern. Prospektive klinische Studien sind nötig, um die Technik zu validieren.

Aim: The purpose of the present retrospective case series was to introduce a minimally invasive two-stage flapless crown lengthening procedure where a gingivectomy was avoided or minimized by reducing the bone height through a tunneling technique. Materials and method: Ten patients (median age 46.6 years, range 26.9 to 71.6 years) were included in the study. The indications for performing a crown lengthening procedure were esthetically short clinical crowns (n = 5), asymmetry of the gingival margin level (n = 2), and both esthetically short clinical crowns and asymmetry of the gingival margin level (n = 3). All the patients presented a thick gingival phenotype, and the mean number of operated teeth per patient was 3.7 (range 2 to 8 teeth). Three patients underwent an additional gingivectomy 6 weeks after the crown lengthening procedure. Results: The esthetic and functional outcome of the treatments fulfilled the patients’ and dentist’s expectations. Conclusion: A minimally invasive two-stage crown lengthening procedure applying a tunneling technique has the potential to achieve predictable esthetic outcomes without an open-flap approach and an additional gingivectomy. However, prospective clinical studies are needed to validate this technique.

Wenn bei Patientinnen und Patienten restaurativer Bedarf besteht, so macht es aus biologischer Sicht Sinn, möglichst substanzschonend zu arbeiten. Nebst konventionellen Herstellungsverfahren stehen heute auch subtraktive und additive Verfahren für die Herstellung von minimal-invasiven Restaurationen zur Verfügung. Besonders im Zusammenhang mit minimal-invasiven dünnen Restaurationen zeigen subtraktive Fertigungstechniken ihre Limitationen. Die additive Fertigung von Keramiken für minimal-invasive Restaurationen birgt deshalb großes Potenzial. Erste In-vitro-Versuche liefern hoffnungsvolle Ergebnisse. Diese müssen jedoch noch weiter in vitro und später klinisch bestätigt werden. Keywords: additive Fertigung, minimal-invasive Restaurationen, Lithiumdisilikat, Passung, Belastbarkeit

Festsitzender Zahnersatz, der von oralen Zahnimplantaten getragen wird, ist in der täglichen Praxis zu einer zuverlässigen Behandlungsoption geworden. Dennoch stellt der Ersatz von zwei benachbarten fehlenden Zähnen insbesondere bei ungünstigen anatomischen Verhältnissen eine klinische Herausforderung dar. Um diese Herausforderung zu meistern, hat die Verwendung von implantatgetragenem festsitzendem Zahnersatz mit einem Anhänger an Popularität gewonnen. Dies ist vor allem darauf zurückzuführen, dass keine oder weniger chirurgische Primäreingriffe erforderlich sind, die Kosten geringer ausfallen und somit die Morbidität des Patienten reduziert wird. Ziel der vorliegenden Übersichtsarbeit ist es, den aktuellen Stand der Erkenntnisse über die Verwendung von implantatgetragenem festsitzendem Teilzahnersatz mit Freiendverlängerung zusammenzufassen. Der Artikel befasst sich sowohl mit dem Seitenzahn- als auch mit dem Frontzahnbereich, wobei die Vor- und Nachteile der einzelnen Behandlungen hervorgehoben und die verfügbaren mittel- bis langfristigen Ergebnisse dargestellt werden. Manuskripteingang: 13.05.2022, Manuskriptannahme: 27.07.2022 Keywords: Zahnimplantate, Freiendverlängerung, klinische Studie

This study aimed to simultaneously assess hard and soft tissues alterations and their proportions after alveolar ridge preservation (ARP). Participants (n = 65) who were previously enrolled in a clinical trial investigating ARP healing were selected. The CBCT DICOM (Digital Imaging and Communications in Medicine) and the cast STL (stereolithographic) files of each subject were imported, segmented, and superimposed. A cross-section view of the superimposed image presented the outlines from each DICOM and STL file. The center of preserved ridge was selected in the superimposed image and used to draw the reference lines to realize the measurements. Horizontal linear measurements determined ridge width (RW) and its respective hard/soft tissue proportion (H:S) at 1, 3, 5, and 7 mm below the buccal bone crest immediately after ARP and at the 4-month follow-up. At 1 mm, the baseline RW was 11.6 mm and reduced to 10 mm after 4 months. The baseline H:S was 65%:35% and was 43%:57% at the 4-month follow-up. Considering only the buccal half of the ridge, baseline H:S was 77%:23%, while after 4 months it shifted to 58%:42%. A similar pattern was observed at 3, 5, and 7 mm but with decreased resorption degree. The present study showed that hard tissue is mostly responsible for RW loss after healing, especially in the first 3 mm below the buccal bone crest. Soft tissue partially compensated for the hard tissue shrinkage, gaining thickness in the analyzed areas.

Purpose: To assess the clinical, technical, and esthetic outcomes of directly veneered zirconia abutments cemented onto nonoriginal titanium bases over a 3-year follow-up. Materials and Methods: A total of 24 healthy patients with a single missing tooth in the maxilla or mandible (incisors, canines, or premolars) received a two-piece implant with a screw-retained veneered zirconia restoration extraorally cemented onto a titanium base abutment. Baseline measurements and follow-up examinations were performed at 6 months, 1 year, and 3 years following loading. Radiographic, clinical, technical, and esthetic parameters were assessed. Wilcoxon signed rank test was used to analyze the data. Results: Mean marginal bone levels measured 0.54 ± 0.39 mm (median: 0.47 mm, range: 0.07 to 1.75 mm) at baseline and 0.52 ± 0.39 mm (median: 0.39 mm, range: 0.06 to 1.33 mm) at 3 years. Mean probing depth around the implants increased from 3.0 ± 0.6 mm at baseline to 3.8 ± 0.8 mm at 3 years (P = .001). Bleeding on probing changed from 27.1% ± 20.7% at baseline to 51.5% ± 26.1% at 3 years (P = .001). The mean plaque control record amounted to 11.1% ± 21.2% at baseline and 14.4% ± 13.89% at 3 years (P = .261). Two implants were lost at 3.5 and 30 months postloading due to periimplantitis, resulting in a 91.7% implant survival rate. Patient satisfaction was high at 3 years. Conclusion: Zirconia restorations cemented onto the tested nonoriginal titanium bases should not be recommended for daily clinical use, as they were associated with significant increases in BOP and PD values and varying marginal bone levels 3 years after placement.