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Background and aim: Dental implant patients are frequently required to undergo a second-stage/uncovery procedure to expose the implant fixture. The aim of the present prospective study was to evaluate the clinical outcomes of the vestibular split rolling flap (VSRF) versus the double door mucoperiosteal flap (DDMF) techniques at adjacent posterior implant sites during the second-stage procedure. Materials and methods: A total of 44 uncovered posterior dental implants in 10 healthy patients were treated at the second stage. All the mesial implants were assigned to the VSRF technique (group A) and the distal implants to the DDMF technique (group B). Soft tissue measurements were performed as vestibular keratinized mucosal width (KMW) and vestibular mucosal thickness (MT) over a period of 1 year, assessed at four different intervals. Results: Healing was uneventful at all sites. There were no patient dropouts in the entire study time frame. The clinical comparison of the adjacent implants showed overall higher MT measurements at 12 months for group A (2.5 ± 0.2 mm) compared with group B (1.00 ± 0.3 mm), and for KMW measurements for group A (2.5 ± 0.2 mm) compared with group B (2.0 ± 0.3 mm). Conclusions: The VSRF technique described in the present article is a reliable method for performing an implant uncovery. If the technique is applied according to the indication and with a minimally invasive protocol, it is preferable to other conventional exposure techniques due to its ability to provide enhanced soft tissue volume around the implant, which can in turn benefit the health, esthetics, function, and long-term stability of the peri-implant tissue.

Implant position and soft tissue thickness have a direct influence on implant abutment design. The goal is to place the implant in the optimal spatial position to maintain the adjacent bone and soft tissues. When the implant is not placed ideally, prosthetic variations to abutments and restorations must be made, which may limit the esthetic appearance of the final restoration or alter the biologic environment of the bone and tissues. This article illustrates and explains the effect of different implant positions on the emergence profile design in order to assist the clinician with treatment planning and selection in various clinical situations.

New digital tools facilitating data acquisition, team communication, computer-assisted diagnostics, and treatment planning as well as the design and fabrication of restorations, guides, stents and devices in general have fundamentally altered key clinical and laboratory steps. The number of new technologies and the amount of new equipment used today to acquire patient data, the software to manipulate this data, and the machines to manufacture devices from it drastically increases all the time, as do the challenges of integrating these systems into a feasible, realistic, and practical workflow. Creating a simple complete digital workflow is key to taking advantage of these digital opportunities and offering their benefits to all patients. Making digital workflows the routine rather than the exception is fundamentally important in order to grow a dental practice in this new environment. This article presents a new complete digital workflow that changes and improves the process of treating a comprehensive case from diagnostics to execution and maintenance.

Neue digitale Möglichkeiten für die Datenakquise, Kommunikation im Team, computergestützte Diagnostik und Behandlungsplanung sowie Design und Herstellung von Restaurationen, Schablonen, Schienen und Apparaturen im Allgemeinen haben zu grundlegenden Veränderungen bei den zentralen klinischen und zahntechnischen Arbeitsschritten geführt. Täglich erhöht sich die Anzahl neuer Techniken und Geräte, die mittlerweile für die Erhebung von Patientendaten eingesetzt werden. Es gibt stetig neue Software für die Verarbeitung dieser Daten und es entstehen neue Geräte, die anhand dieser Daten Restaurationen und Apparaturen herstellen. Damit wachsen jedoch auch die Herausforderungen, diese Systeme in sinnvolle, realistische und praktikable Arbeitsabläufe einzubinden. Die Etablierung eines einfachen volldigitalen Workflows ist der Schlüssel dazu, die digitalen Möglichkeiten sinnvoll und zum Vorteil der Patienten einzusetzen. Um eine Zahnarztpraxis vor diesem neuen Hintergrund erfolgreich zu führen, müssen digitale Workflows von der Ausnahme zur Regel gemacht werden. In diesem Artikel wird ein neuer volldigitaler Workflow vorgestellt, um das Management komplexer Fälle von der Diagnostik über die Behandlung bis zur Nachsorge zu verändern und verbessern.

Zähne, die durch Erosion und Bruxismus geschädigt sind, können mit fließfähigem Komposit in Verbindung mit einem prothetischen Okklusionskonzept und einem ästhetischen Ansatz restauriert werden. Der Beitrag zeigt die klinische Anwendung der Injektionstechnik mit fließfähigem Komposit. Dabei handelt es sich um eine neuartige Methode für minimalinvasive Rehabilitationen des gesamten Gebisses. Keywords: Komposit, Injektionstechnik, Ästhetik, Veneer, Okklusionskonzept

Das Slim-Konzept ist eine Methode, Weichgewebevolumen zu generieren. Die Autoren zeigen in ihrem Beitrag, welche Arbeitsschritte bei diesem Konzept notwendig sind, um für den Oberkiefer-Frontzahnbereich Implantatkronen und Veneers optimal herzustellen. Zum Einsatz kommen ein konservatives internes Bleaching, direkte Kompositrestaurationen, Einzelzahnimplantate mit krestalem Bindegewebetransplantat zur Verbesserung der Weichgewebesituation sowie Keramikveneers, klassische Kronen und festsitzende Zirkonoxidrestaurationen. Keywords: Weichgewebe, Slim-Konzept, Frontzahnrestauration, Veneer, Implantatkrone

Aims: This review assessed the available evidence on the performance of CAD/CAM monolithic implant-supported restorations bonded to titanium (Ti) inserts and bases, which has become a popular concept. Materials and Methods: An electronic and manual search of PubMed databases was conducted to identify studies published in English between 2000 and 2016 on the performance of monolithic ceramic implant restorations with Ti inserts. Results: The initial search revealed 505 titles. Full-text screening was carried out for 70 studies, yielding 25 articles that met the inclusion criteria. No clinical studies could be identified regarding the performance of monolithic ceramic restorations bonded to Ti inserts. Laboratory studies on selected aspects and studies on similar prosthetic designs indicate that Ti inserts improve the overall fracture strength of ceramic abutments and crowns, protect the implant connection from wear, and offer a better marginal fit when compared with all-ceramic abutments. Conclusions: While laboratory studies and evaluations of similar designs indicated promising outcomes, clinical studies that evaluate the performance of CAD/CAM monolithic implant-supported restorations bonded to Ti inserts and bases are needed. Keywords: CAD/CAM fabricated implant restorations, hybrid abutments, hybrid abutment crowns, implant hybrid restorations, resin bonding to titanium, TiBase, titanium implant insert, two piece CAD/CAM abutments