This investigation was designed to evaluate crestal bone stability and soft tissue maintenance to Laser-Lok tapered tissue-level implants. Twelve patients presenting with an edentulous site adequate for the placement of two implants were recruited from four dental offices (2 to 4 patients per office). Each patient received two Laser-Lok tissue-level implants placed with a 3-mm interimplant distance according to a surgical stent. The implants were placed so that the Laser-Lok zone sat at the junction between hard and soft tissues. A total of 24 implants were placed, and all achieved satisfactory crestal bone stability and soft tissue maintenance 1 year after receiving the final prosthetic restoration.

Thirty-eight patients (aged 25 to 74) requesting extraction-socket and sinus augmentation procedures (27 and 11 patients, respectively) prior to implant placement volunteered to participate in this case series protocol. Surgical sites were grafted with either biphasic calcium phosphate (BCP) + collagen (for extractionsocket augmentation) or BCP with a collagen barrier membrane (for maxillary sinus augmentation). All patients completed the 1-year postloading follow-up, which consisted of clinical and radiographic evaluations. No implants were lost, and both healthy soft tissue support and good radiographic evidence of supporting bone were found around implants. The result of this short-term evaluation of implants placed in areas grafted with alloplasts seemed to be favorable and promising.

Purpose: To evaluate whether there are aesthetic and clinical benefits to using a newly designed abutment (Curvomax), over a conventional control abutment (GingiHue). Materials and methods: A total of 49 patients, who required at least two implants, had two sites randomised according to a split-mouth design to receive one abutment of each type at seven different centres. The time of loading (immediate, early or delayed) and of prosthesis (provisional crowns of fixed prosthesis) was decided by the clinicians, but they had to restore both implants in a similar way. Provisional prostheses were replaced by definitive ones 3 months after initial loading, when the follow-up for the initial part of this study was completed. Outcome measures were: prosthesis failures, implant failures, complications, pink esthetic score (PES), peri-implant marginal bone level changes, and patient preference. Results: In total, 49 Curvomax and 49 GingiHue abutments were delivered. Two patients dropped out. No implant failure, prosthesis failure or complication was reported. There were no differences at 3 months post-loading for PES (difference = -0.15, 95% CI -0.55 to 0.25; P (paired t test) = 0.443) and marginal bone level changes (difference = -0.02 mm, 95% CI -0.20 to 0.16; P (paired t test) = 0.817). The majority of the patients (30) had no preference regarding the two abutment designs; 11 patients preferred the Curvomax, while five patients preferred the GingiHue abutments (P (McNemar test) = 0.210). Conclusions: The preliminary results of the comparison between two different abutment designs did not disclose any statistically significant differences between the evaluated abutments. However the large number of missing radiographs and clinical pictures casts doubt on the reliability of the results. Longer follow-ups of wider patient populations are needed to better understand whether there is an effective advantage with one of the two abutment designs. Schlagwörter: abutment design, aesthetics, dental implants Conflict of interest statement: This research project was originally partially funded by Biomax (Andover, MA, USA), the manufacturer of the Curvomax abutments evaluated in this investigation. Biomax, under pressure from some investigators, asked to modify the original agreed protocol. In a following phase, Zimmer-Biomet (Palm Beach Gardens, Florida, USA), the manufacturer of the implants and the GingiHue abutments, took over the funding of this project. Data belonged to the authors and the sponsors did not interfere with the publication of results.

Subgingival margins are often required for biologic, mechanical, or esthetic reasons. Several investigations have demonstrated that their use is associated with adverse periodontal reactions, such as inflammation or recession. The purpose of this prospective randomized clinical study was to determine if two different subgingival margin designs influence the periodontal parameters and patient perception. Deep chamfer and feather-edge preparations were compared on 58 patients with 6 months follow-up. Statistically significant differences were present for bleeding on probing, gingival recession, and patient satisfaction. Featheredge preparation was associated with increased bleeding on probing and deep chamfer with increased recession; improved patient comfort was registered with chamfer margin design. Subgingival margins are technique sensitive, especially when feather-edge design is selected. This margin design may facilitate soft tissue stability but can expose the patient to an increased risk of gingival inflammation.

Autogenous bone harvesting is a well-documented surgical procedure. Autogenous mandibular bone harvesting carries a risk of anatomical structural damage because the surgeon has no three-dimensional (3D) control of the osteotomy planes. The aim of this case series was to describe the results of mandibular bone block harvesting applying computer-guided surgery. A sample of 13 partially dentate patients presenting bone deficiencies in the horizontal and/ or vertical plane were selected for autogenous mandibular bone block graft. The bone block dimension was planned through a computer-aided design (CAD) process, defining ideal bone osteotomy planes to avoid damage to anatomical structures (nerves, teeth roots, etc) and to generate a surgical guide that imposed the 3D working direction to the bone-cutting instrument. The bone block dimension was always related to the defect dimension to be compensated. A total of 13 mandibular bone blocks were harvested to treat 16 alveolar defects (9 vertical and 7 horizontal). The mean planned mesiodistal dimension of the bone block was 24.8 ± 7.3 mm, the mean height was 8 ± 1 mm, and the mean thickness was 4 ± 2 mm. None of the treated patients experienced neurologic alteration of their alveolar nerve function. The preliminary data from this case series suggested that computer-guided bone harvesting could be a concrete opportunity for clinicians to obtain an appropriate volume of autogenous bone in a safe manner.

Objective: Placement of a dental implant during early adolescence may result in an unesthetic outcome or even loss of function. The presented case describes the treatment of infraoccluded dental implants and the esthetic complications for a young adult female who had received two dental implants in the canine positions when she was 16 years old. Clinical considerations: After examination and diagnosis, a multidisciplinary approach was implemented, including the removal of one infraoccluded implant, followed by hard and soft tissue reconstruction prior to implant replacement into an ideal three-dimensional position. On the contralateral side, a subepithelial connective tissue graft was performed, in conjunction with the modification of the emergence profile of the abutment and definitive crown. The anterior sextant was treated as a comprehensive esthetic rehabilitation that involved two additional laminate veneers and two all-ceramic crowns. Conclusions: This multidisciplinary approach successfully managed the complication that resulted from infraoccluded dental implants. The final esthetic outcome satisfied the patient's chief complaint, and was documented to be stable at the 1-year follow-up.

Ziel: Werden Implantate schon in früher Jugend gesetzt, kann dies langfristig ästhetische Probleme oder sogar einen Funktionsverlust zur Folge haben. Der hier vorgestellte Fall beschreibt die Behandlung infraokkludierender Implantate und der resultierenden ästhetischen Komplikationen bei einer jungen Frau, die im Alter von 16 Jahren zwei Implantate in den Eckzahnpositionen erhalten hatte. Klinische Überlegungen: Nach der Untersuchung und Diagnose erfolgte eine multidisziplinäre Behandlung. Eines der infraokkludierenden Implantate wurde entfernt und nach einer Hart- und Weichgewebsrekonstruktion durch ein neues Implantat in idealer dreidimensionaler Position ersetzt. Am Implantat auf der Gegenseite wurde ein subepitheliales Bindegewebstransplantat in Kombination mit einer Korrektur des Emergenzprofils von Abutment und definitiver Krone durchgeführt. Der Frontzahnbereich wurde zusätzlich mit zwei Veneers und zwei vollkeramischen Kronen ästhetisch rehabilitiert. Schlussfolgerung: Mit diesem multidisziplinären Behandlungsplan wurden die Probleme, die wegen der Infraokklusion der Implantate bestanden, erfolgreich behoben. Mit dem ästhetischen Endergebnis war die Patientin sehr zufrieden. Es erwies sich bei der Kontrolle nach einem Jahr als stabil.

The aim of this prospective randomized clinical study was to evaluate, by means of an image analysis system, the efficacy of two different surgical procedures for the treatment of Miller Class I and II maxillary gingival recession. Patients treated for maxillary gingival recession were recruited and randomly divided into two groups: patients who received a coronally advanced flap with connective tissue graft (CAF + CTG) or CAF alone. Outcome parameters included complete root coverage, recession reduction, and keratinized tissue amount. Twenty-five patients completed the 12-month follow-up period. Patients in the CAF + CTG group showed a better primary outcome- gingival recession at 12 months-than CAF patients (P = .0001). Gingival recession at 12 months had a median of 0.5 (interquartile range [IQR] 0.5 to 0.6) in the CAF + CTG group and a median of 1.0 (IQR 0.9 to 1.1) in the CAF group. CAF + CTG and CAF groups had similar complete root coverage at 6 and 12 months. Recession and keratinized tissue width significantly decreased over time (P < .0001), with no effect of treatment or of treatment over time. Buccal probing depth had similar values over time (P = .28) and in the two groups (P = .52). Buccal clinical attachment level had similar values in the two groups (P = .87); moreover, mesial and distal clinical attachment levels did not show any variation over time (P = .88 and P = .68, respectively). By means of a computerized image analysis system better outcomes in terms of recession reduction after 12 months of follow-up were measured for maxillary gingival recessions treated with CAF and CTG. Adjunctive application of a CTG under a CAF increased the probability of achieving complete root coverage in maxillary Miller Class I and II defects (61.5% versus 83.3%; P = .38). Both treatments were equally effective in providing a consistent reduction of the baseline recession.

This investigation was designed to evaluate the histologic healing pattern of two Miller Class III recession defects associated with noncarious cervical lesions (NCCLs) treated with a connective tissue graft (CTG) and coronally advance flap (CAF). One patient presenting with two teeth predetermined to be surgically extracted was enrolled and consented to treatment. One month after phase I treatment, a full-thickness flap was reflected and the NCCLs treated with a compomer restoration; at the same time, a CTG was harvested from the palate and positioned over the compomer restoration. The flap was then coronally repositioned. After 4 months of healing, an en bloc biopsy extraction of the two teeth was executed. The teeth were analyzed histologically to assess the periodontal wound healing. A long junctional epithelial attachment was noted throughout the major portion of the restored surface. Only minimal signs of connective adhesion and new bone formation could be seen in the apical portion of the restored area, without signs of root resorption or ankylosis. This report provides evidence that the presence of a compomer restoration allowed the formation of a long juctional epithelium after CTG and CAF treatment. (Int J Periodontics Restorative Dent 2014;34:39-45. doi: 10.11607/prd.1921)