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Purpose: To evaluate the performance of one- and two-piece ceramic implants regarding implant survival and success and patient satisfaction. Materials and Methods: This review followed the PRISMA 2020 guidelines using PICO format and analyzed clinical studies of partially or completely edentulous patients. The electronic search was conducted in PubMed/MEDLINE using Medical Subject Headings (MeSH) keywords related to dental zirconia ceramic implants, and 1,029 records were received for detailed screening. The data obtained from the literature were analyzed by single-arm, weighted meta-analyses using a random-effects model. Forest plots were used to synthesize pooled means and 95% CI for the change in marginal bone level (MBL) for short-term (1 year), mid-term (2 to 5 years), and long-term (over 5 years) follow-up time intervals. Results: Among the 155 included studies, the case reports, review articles, and preclinical studies were analyzed for background information. A meta-analysis was performed for 11 studies for one-piece implants. The results indicated that the MBL change after 1 year was 0.94 ± 0.11 mm, with a lower bound of 0.72 and an upper bound of 1.16. For the mid term, the MBL was 1.2 ± 0.14 mm with a lower bound of 0.92 and an upper bound of 1.48. For the long term, the MBL change was 1.24 ± 0.16 mm with a lower bound of 0.92 and an upper bound of 1.56. Conclusion: Based on this literature review, one-piece ceramic implants achieve osseointegration similar to titanium implants, with a stable MBL or a slight bone gain after an individual initial design depending on crestal remodeling. The risk of implant fracture is low for current commercially available implants. Immediate loading or temporization of the implants does not interfere with the course of osseointegration. Scientific evidence for two-piece implants is rare. Keywords: ceramic implants, implant survival, marginal bone level, systematic review, titanium implant

Xenogeneic-derived biomaterials are among the most routinely employed bone substitutes for immediate grafting of extraction sites as a modality of alveolar ridge preservation (ARP). The deproteinized bovine bone material is widely used and documented around the world. The present pilot clinical trial evaluated and compared the clinical and morphologic alterations of extraction sites after ARP using two commercially available yet differently processed bovine bone grafts. A total of 20 adjacent extraction sites in 10 patients were included. All sites received the exact same ARP therapy except for the type of bovine bone graft, which was randomly assigned between two adjacent extraction sockets in 10 patients (Group A received Bio-Oss particles and Group B received Cerabone particles). At all sites, healing was monitored at the time of surgery and at 1, 2, 3, and 4 months postoperative. All of the augmented extraction sites achieved successful implant therapy regardless of the bone graft material used for ARP. Six weeks after implant placement, second-stage/uncovering procedures were performed without complications. Intergroup comparisons of the crestal gingival healing process (CGHP), mean transversal crestal ridge resorption (MTRR), and mean implant primary stability (MIPS) were in favor of Group A sites (treatment with Bio-Oss particles). 

Digital dentistry has contributed to the evolution and simplification of dental implantology over the last decade. The incorporation of intraoral scanners, CBCT, 3D implant-planning software, and CAD/CAM systems makes prosthetically driven implantology a straightforward process. Such digital resources for treatment planning and execution, following evidence-based concepts, have the ability to improve the long-term esthetics and function of implant-supported restorations as well the long-term survival of dental implants. Dental implants are frequently considered as the first treatment option for replacing failing or missing teeth. However, their use in the esthetic zone remains a challenge for many clinicians. The present article provides clinical guidelines for ideal implant positioning employing computer-guided surgery and chairside CAD/CAM-fabricated provisional and definitive restorations with titanium (Ti)-bases for successful prosthetic outcomes, optimizing gingival architecture, and decreasing overall treatment duration. (Int J Comput Dent 2023;26(1):75–0; doi: 10.3290/j.ijcd.b3818287) Keywords: Dental implant, implant restoration, chairside, CAD/CAM, titanium base, implant position, immediate provisional, guided implant surgery

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.

Hintergrund und Ziel: In vielen Fällen ist nach einer Implantation ein zweiter Eingriff zur Freilegung der Implantatfixtur notwendig. Ziel der vorliegenden prospektiven Studie war ein Vergleich der klinischen Ergebnisse bei Anwendung folgender Freilegungstechniken an benachbarten Seitenzahnimplantaten: vestibulärer Teilschicht-Rolllappen (vestibular split rolling flap, VSRF) und Doppeltür-Mukoperiostlappen (double door mucoperiosteal flap, DDMF). Material und Methoden: Insgesamt 44 gedeckt eingeheilte Implantate bei 10 gesunden Patienten wurden bei einem Zweiteingriff freigelegt. Die jeweils mesialen Implantate wurden der VSRF-Technik (Gruppe A), die distalen der DDMF-Technik (Gruppe B) zugeteilt. Zur Bewertung des Weichgewebes wurden während eines Jahres an vier Zeitpunkten die Breite der vestibulären keratinisierten Mukosa (KMB) und die Dicke der vestibulären Mukosa (MD) gemessen. Ergebnisse: Die Heilung verlief an allen Implantaten unauffällig. Während der gesamten Studiendauer gab es keine Studienabbrüche. Im klinischen Vergleich der benachbarten Implantate ergaben sich nach 12 Monaten höhere MD-Werte in Gruppe A (2,5 ± 0,2 mm) als in Gruppe B (1,00 ± 0,3 mm) und höhere KMB-Werte in Gruppe A (2,5 ± 0,2 mm) als in Gruppe B (2,0 ± 0,3 mm). Schlussfolgerungen: Die im vorliegenden Artikel beschriebene VSRF-Technik ist ein zuverlässiges chirurgisches Verfahren zur Implantatfreilegung. Wird diese Technik indikationsgemäß und nach einem minimalinvasiven Protokoll angewendet, liefert sie im Gegensatz zu anderen konventionellen Freilegungstechniken ein größeres Weichgewebevolumen um Implantate. Dies wirkt sich günstig auf die Gesundheit, Ästhetik, Funktion und langfristige Stabilität des periimplantären Gewebes aus.

The purpose of this study was to investigate the effects of various titanium and zirconia polishing protocols on the colonization of oral bacteria. Titanium and zirconia discs were divided into five groups: unpolished (control, UNP) and polished with Brownie only (BRO), Brownie plus Greenie (BPG), Brownie plus Greenie plus Supergreenie (BGS), and CeraMaster Coarse plus CeraMaster polishing tips (CER). The samples were sterilized and immersed in unstimulated saliva, then incubated in a liquid suspension of Streptococcus gordonii (S gordonii). The number of attached bacteria were counted 48 hours after the diluted suspensions were inoculated. Data were analyzed with ANOVA and Tukey test (P < .05). For titanium discs, the average number of bacteria from each group (CFU/mm²) was 1.51 x 10³ for UNP; 3.71 x 10³ for BRO; 5.65 x 10³ for BPG; 8.99 x 10² for BGS; and 8.49 x 10² for CER. For zirconia, the averages were 2.87 x 10² for UNP; 3.16 x 10² for BRO; 3.50 x 10² for BPG; 1.83 x 10² for BGS; and 8.73 x 10¹ for CER. Inadequate polishing roughens surfaces and promotes microbial adhesion to titanium and zirconia. Sequential polishing to the finest-finish polishing tips minimizes bacterial adherence to abutment surfaces. Zirconia exhibited less bacterial adhesion than titanium.

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