International Journal of Periodontics & Restorative Dentistry, 5/2022
DOI: 10.11607/prd.6055Pages 577-585, Language: English
Severe alveolar ridge deficiencies in concomitance with periodontal attachment loss can represent a serious clinical challenge in the context of implant therapy. The present case report describes the management of a complex defect in the esthetic zone via ridge augmentation and periodontal regenerative therapy using a biologic material. A systemically healthy 55-year-old man diagnosed with peri-implantitis around an implant in the maxillary left central incisor position and with severe bone loss on the mesial aspect of the maxillary left lateral incisor underwent several surgical interventions to achieve simultaneous vertical ridge augmentation and periodontal regeneration. These interventions included implant removal, bone augmentation using a composite bone graft (autogenous bone + xenograft particles), and a bioactive protein (recombinant human platelet-derived growth factor), soft tissue augmentation using connective tissue grafts, and peri-implant keratinized mucosa width augmentation via a labial gingival graft strip and a xenogeneic collagen matrix. Substantial gains in vertical bone and clinical attachment were achieved, which allowed for delayed implant placement and subsequent completion of tooth replacement therapy with an implant-supported prosthesis. The present case report demonstrates how simultaneous vertical ridge augmentation and periodontal regeneration can be achieved to manage a challenging clinical situation. Key factors to consider in this type of scenario are proximal bone level, tooth mobility, surgical flap design and management, biomaterial selection, and proper treatment sequencing.
International Journal of Oral Implantology, 3/2022
PubMed ID (PMID): 36082660Pages 265-275, Language: English
The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed.
Keywords: consensus, dental implants, maxillary sinus, nasal fossae
Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.
The International Journal of Prosthodontics, 5/2021
DOI: 10.11607/ijp.7170Pages 567-577, Language: English
Purpose: To evaluate the incidence of ultrathin ceramic veneer fractures with different preparation protocols over a period of 36 months and the possible relationship with local- and patient-related factors.
Materials and Methods: Adult patients who received ceramic veneers for improvement in smile esthetics were selected from a private practice pool. Restorations were grouped as conventional (prep) or ultrathin ceramic veneers following either a minimal preparation (min-prep) or no tooth preparation (no-prep) protocol. After veneer bonding, all patients were followed up at intervals of 6 months up to 36 months. A panel of clinical outcomes was recorded, and patient satisfaction was assessed at 36 months.
Results: The study sample was formed by 49 patients who received a total of 194 veneers. Twelve veneers were prep, 125 were min-prep, and 57 were no-prep. Total fracture occurrence was 9.8% in 13 participants. No fractures were observed in prep veneers, while 16 out of 125 min-prep and 3 out of 57 no-prep veneers had fractures. Most fractures (13 out of 19) occurred early, within the first 12 months after bonding. Out of 194 veneers, only 1 had a catastrophic failure (0.5%), 3 had large (≥ 1 mm) chippings (1.5%), and 15 had minor (< 1 mm) chippings (7.7%). A generalized estimating equation model revealed that the odds of veneer fracture were significantly higher in men (odds ratio [OR] = 11.29), in patients who exhibited tooth wear at baseline (OR = 5.54), and in central (OR = 13.56) and lateral (OR = 10.43) incisors compared to canines and premolars. All participants indicated that they would not change to a different restorative protocol in order to have a thicker restoration and possibly less risk of fracture.
Conclusion: Ultrathin ceramic veneers are a viable cosmetic dentistry treatment option that involve minimal or no tooth preparation. However, a tendency for increased early fractures was observed in the min-prep group.
International Journal of Oral Implantology, 3/2021
PubMed ID (PMID): 34415131Pages 321-333, Language: English
Purpose: Simplified and predictable immediate single-tooth replacement therapy can be optimised by leveraging recent advances in digital workflows that combine static surgical guidance and customised prosthesis design and fabrication. The present case report illustrates a novel approach to successfully executing immediate single-tooth replacement therapy via static computer-aided immediate implant placement and digital provisionalisation utilising angulated screw access, with a 1-year follow-up after delivery of the definitive restoration.
Materials and methods: A healthy 27-year-old woman with congenital agenesis of the mandibular second premolars and who required replacement of the mandibular left second premolar underwent immediate single-tooth replacement therapy via computer-aided, restrictive implant placement and provisionalisation using custom prosthetic components designed prior to the surgical intervention being performed.
Results: After a 6-month healing period, the provisional crown was replaced with the definitive restoration. After 1 year, the peri-implant keratinised mucosa demonstrated vertical gain in the mid-buccal portion and stability in the interproximal aspects, and no changes in marginal bone level were observed.
Conclusions: The present case report demonstrates the successful application of novel digital tools to facilitate both surgical and prosthetic aspects of immediate single-tooth replacement therapy. Digital workflows can optimise the clinical efficiency and predictability of tooth replacement therapy with dental implants by reducing surgical and restorative chair time and increasing patient satisfaction.
Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.
Keywords: CAD/CAM, computer-aided surgery, dental implant, digital dentistry, guided implant surgery, immediate loading, immediate placement, prosthetic procedure, prosthodontics
International Journal of Periodontics & Restorative Dentistry, 3/2021
Pages 335-345, Language: English
This study evaluated a panel of clinical, dimensional, volumetric, implant-related, histomorphometric, and patient-reported outcome measures (PROMs) following reconstruction of dehiscence defects in extraction sockets with a minimally invasive technique using particulate bone allograft and a nonresorbable dense polytetrafluoroethylene (dPTFE) membrane. Subjects (n = 17) presenting severe buccal dehiscence defects at the time of single-rooted tooth extraction participated in the study. The mean vertical dimension of the dehiscence defects at baseline was 5.76 ± 4.23 mm. Subjects were followed up at 1, 2, 5, and 20 weeks postoperatively. The dPTFE barrier was gently removed at 5 weeks. CBCT and intraoral scans were obtained at baseline and at 20 weeks. A bone core biopsy sample was harvested at 24 weeks (before implant placement). Linear radiographic measurements revealed a mean increase in buccal bone height from baseline to 20 weeks (5.66 ± 5.1 mm; P < .0001). A total alveolar bone volume gain of 9.12% was observed. Although approximately half of the sites required some degree of additional bone augmentation at the time of implant placement, all implants were placed in a favorable restorative position with adequate primary stability. Histomorphometric analyses revealed a mean mineralized tissue area of 31.04% ± 15.22%, and the proportions of remaining allograft material and nonmineralized tissue were 16.23% ± 10.63% and 52.71% ± 9.53%, respectively. All implants survived up to 12 months after placement. PROMs were compatible with minimal discomfort at different postoperative stages and a high level of overall satisfaction upon study completion. This study demonstrated that the reconstructive procedure employed was successful and predictable in treating large, postextraction alveolar ridge deformities to optimize tooth replacement therapy with implant-supported prostheses.
International Journal of Periodontics & Restorative Dentistry, 1/2021
Pages 141-148, Language: English
This study aimed to characterize extraction sockets based on indirect digital root analysis. The outcomes of interest were estimated socket volume and dimensions of the socket orifice. A total of 420 extracted teeth, constituting 15 complete sets of permanent teeth (except third molars), were selected. Teeth were scanned to obtain STL files of the root complex for digital analysis. After digitally sectioning each root 2.0 mm apical to the cementoenamel junction (CEJ), root volume was measured in mm3 and converted to cc. Subsequently, a horizontal section plane was drawn at the most zenithal level of the buccal CEJ, and the surface area (in mm2) and buccolingual and mesiodistal linear measurements of the socket orifice (in mm) were computed. Maxillary first molars exhibited the largest mean root volume (0.451 ± 0.096 cc) and mandibular central incisors the smallest (0.106 ± 0.02 cc). Surface area analysis demonstrated that mandibular first molars presented the largest socket orifice area (78.56 ± 10.44 mm2), with mandibular central incisors presenting the smallest area (17.45 ± 1.82 mm2). Maxillary first molars showed the largest mean socket orifice buccolingual dimension (11.08 ± 0.60 mm), and mandibular first molars showed the largest mean mesiodistal dimension (9.73 ± 0.84 mm). Mandibular central incisors exhibited the smallest mean buccolingual (5.87 ± 0.26 mm) and mesiodistal (3.52 ± 0.24 mm) linear dimensions. Findings from this study can be used by clinicians to efficiently plan extraction-site management procedures (such as alveolar ridge preservation via socket grafting and sealing) and implant provisionalization therapy, and by the industry to design products that facilitate site-specific execution of these interventions.
International Journal of Periodontics & Restorative Dentistry, 5/2020
DOI: 10.11607/prd.4789, PubMed ID (PMID): 32925996Pages 667-676, Language: English
Orthodontic extrusion (OE) is an orthodontic tooth movement in a coronal direction to modify the tooth position and/or induce changes on the surrounding bone and soft tissue with a therapeutic purpose. Evidence emanating from clinical reports and case series studies indicates that OE is a predictable treatment option to manage a variety of clinical situations. Common indications include traction of impacted teeth, exposure of teeth presenting structural damage to facilitate restorative therapy, treatment of periodontal bony and papillary defects, and implant site development. Unfortunately, there is a paucity of established protocols and guidelines for its application in clinical practice. Controversy exists in regard to the definition of rapid and slow OE, use of circumferential supracrestal fiberotomy, and tooth stabilization protocols during and upon completion of orthodontic movement. This article provides a concise perspective on the topic of OE by discussing key biologic principles and technical aspects that are translated into guidelines for the management of different clinical scenarios.
International Journal of Oral Implantology, 3/2020
PubMed ID (PMID): 32879927Pages 213-232, Language: English
Purpose: The evidence pertaining to the contribution of the sinus membrane to new bone formation following maxillary sinus augmentation procedures is equivocal. The purpose of this study was to analyse the evidence currently available on the osteogenic capacity of the sinus membrane following maxillary sinus augmentation procedures, and the effect of local delivery of recombinant human bone morphogenic proteins (rhBMPs) on the bone-forming potential of the sinus membrane.
Materials and methods: An electronic search was conducted using six different databases to identify controlled trials, prospective and retrospective cohort studies, case series and case reports, as well as preclinical (animal) studies reporting on new bone formation in close proximity with the sinus membrane after maxillary sinus augmentation procedures, assessed through histological and/or histomorphometrical evaluation, on the basis of pre-established eligibility criteria.
Results: No clinical studies were identified. Twenty-six preclinical studies were included in the review. Nine of them supported the osteogenic potential of the sinus membrane, while eight reported no evidence of osteogenicity from the sinus membrane. The nine remaining studies reported on the local effect of rhBMPs. The majority of these nine studies reported enhanced new bone formation in the sinus membrane region.
Conclusions: The sinus membrane contains pluripotent mesenchymal cells with the capacity to differentiate and participate in the process of new bone formation. However, the findings from the studies selected in this systematic review do not consistently support that the sinus membrane significantly contributes to new bone formation following maxillary sinus augmentation procedures.
Keywords: osteogenic, sinus elevation/graft, sinus membrane, systematic review
Conflict-of-interest statement: The authors declare no conflicts of interest.
International Journal of Periodontics & Restorative Dentistry, 5/2019
Pages 611-612, Language: English
International Journal of Periodontics & Restorative Dentistry, 1/2018
DOI: 10.11607/prd.3227, PubMed ID (PMID): 29240202Pages 34-40, Language: English
Vertical ridge augmentation in the posterior mandible is a technique-sensitive procedure that requires adequate anatomical knowledge and precise surgical skills to minimize the risk of complications. One of the most important but also challenging aspects of the surgical technique is proper flap management to allow for passive flap closure and reduce the chances of postoperative complications affecting deep anatomical spaces. This article presents a detailed description of a novel lingual flap advancement technique and its validation via a split-mouth, comparative study using a cadaver model. A total of 12 fresh cadaver heads presenting bilateral posterior mandibular edentulism were selected. Sides were randomized to receive a classic lingual flap release technique (control) or the modified technique presented here, which involves the intentional preservation of the mylohyoid muscle attachment to the mandible. Vertical flap release was measured at three different zones using standard forces. The mean difference between the test and control group in zones I (retromolar pad area), II (middle area), and III (premolar area) was 8.273 ± 1.794 mm (standard error of the mean [SEM] = 0.5409 mm), 10.09 ± 2.948 mm (SEM = 0.8889 mm), and 10.273 ± 2.936 mm (SEM = 0.8851 mm), respectively, reaching very strong statistical significance (P