International Journal of Periodontics & Restorative Dentistry, 02/2011

A technique for restoration of decayed and fractured teeth with composite inlays or onlays is presented. This approach conserves the tooth structure, requires less preprosthetic periodontal surgical intervention, and provides excellent functional results, while minimizing the incidence of post-therapeutic endodontic involvement. Two thousand seven teeth were restored using this technique over a period of 120 months, with a mean time of 59.6 months in function. The technique is described, and the advantages of this treatment modality are discussed.

The purpose of this retrospective radiographic study was to analyze the thickness of the facial bone wall at teeth in the anterior maxilla based on cone beam computed tomography (CBCT) images, since this anatomical structure is important for the selection of an appropriate treatment approach in patients undergoing postextraction implant placement. A total of 125 CBCT scans met the inclusion criteria, resulting in a sample size of 498 teeth. The thickness of the facial bone wall in the respective sagittal scans was measured perpendicular to the long axis of the tooth at two locations: at the crest level (4 mm apical to the cementoenamel junction; MP1) and at the middle of the root (MP2). No existing bone wall was found in 25.7% of all teeth at MP1 and in 10.0% at MP2. The majority of the examined teeth exhibited a thin facial bone wall (< 1 mm; 62.9% at MP1, 80.1% at MP2). A thick bone wall (>= 1 mm) was found in only 11.4% of all examined teeth at MP1 and 9.8% at MP2. There was a statistically significant decrease in facial bone wall thickness from the first premolars to the central incisors. The facial bone wall in the crestal area of teeth in the anterior maxilla was either missing or thin in roughly 90.0% of patients. Both a missing and thin facial wall require simultaneous contour augmentation at implant placement because of the welldocumented bone resorption that occurs at a thin facial bone wall following tooth extraction. Consequently, radiographic analysis of the facial bone wall using CBCT prior to extraction is recommended for selection of the appropriate treatment approach.

The aim of this multicenter, randomized controlled trial was to compare the clinical outcomes of a connective tissue graft (CTG) alone or in combination with enamel matrix derivative (CTG + EMD) in the treatment of Miller Class I and II gingival recessions. The 56 selected defects were evaluated for probing depth, recession depth, keratinized tissue width, and probing attachment level, and were measured at baseline and 12 months after treatment. The mean recession reduction was 3.9 ± 0.8 mm for EMD-treated sites (test) and 3.6 ± 1.5 mm for the control group (P = .22), corresponding to a mean root coverage of 90% and 80% for test and control groups, respectively (P = .05). Complete root coverage was obtained in 62% of test sites compared to 47% in the control group (P = .27). Both procedures provided good soft tissue coverage. The better results of the test group did not achieve a statistically significant level.

The spreading system is an alternative technique to the Summers osteotome. The crest expansion technique is a less invasive procedure in which the facial wall expands after the medullary bone is compressed against the cortical wall. It improves the density of the maxillary bone, which allows for greater initial stability of implants. A specific screw instrument, the "spreader," achieved a controlled and standardized dilation of the bone horizontally. The use of spreaders to enhance the dental implant site is a highly predictable procedure.

Periodontal defects involving either interproximal horizontal bone loss or furcations continue to challenge the regenerative capabilities of the oral cavity. The following case presentations show the successful treatment of these challenging periodontal defects with a novel cellular allograft that contains native mesenchymal stem cells and osteoprogenitor cells.

An investigation was conducted to evaluate the clinical and histologic results of bone and soft tissue healing around a two-piece zirconia dental implant in a human model. A healthy female patient requiring tooth replacement with dental implants received a two-piece zirconia implant together with conventional titanium implants to be implemented in a prosthesis. Clinical and radiographic evaluations at 6 months revealed stable osseointegrated zirconia and titanium dental implants. Light microscopy and backscatter scanning electron microscopic analyses confirmed the biocompatibility and achievement of osseointegration, in addition to maintenance of the crestal bone level. The findings suggest that the bone-to-implant contact with a zirconia implant surface is sufficient to provide clinical and histologic evidence of osseointegration. The biopsied two-piece zirconia dental implant with platform switching demonstrated osseointegration occlusal to the implant-abutment junction, eliminating the significance of the microgap.

Covering exposed roots becomes more and more difficult as the gingiva becomes thinner and the vestibule becomes more shallow. Also, the outcome becomes less predictable. In addition, where there is high frenal attachment or muscle pull, such as the mentalis muscle in the mandibular anterior region, secondary retraction of a coronally advanced flap will likely occur. Therefore, a transplanted connective tissue graft may not completely cover the recession. This case series presents a technique where the roots are covered with a combination epithelializedsubepithelial connective tissue graft. The epithelialized portions of the graft are positioned directly over the exposed roots to aid in resistance to the environment of the mouth, and there is no displacement of the mucogingival junction or flattening of the vestibule.

The aim of this research was to explore the performance of a flapless surgical approach for immediate implant placement, simultaneous alveolar ridge augmentation, and immediate provisionalization in patients with complete loss of the facial bony lamella resulting from long-axis root fracture. Eighteen NobelPerfect implants were placed in 16 patients (follow-up, 13 to 36 months) who had sustained complete loss of the facial bony lamellae. Implants were inserted simultaneous to subperiostal bone augmentation with autogenous bone chips and underwent immediate provisionalization. Outcome variables included implant success, marginal bone levels, and pink esthetic score (PES). All implants achieved excellent primary stability. There were no implant losses. On average, interproximal marginal bone levels stabilized at 1.0 to 1.3 mm above the first thread. Postoperative cone beam computed tomography scans were available for 16 implant sites and confirmed restoration of the facial lamella in the vast majority of patients. Marginal esthetics, as assessed by the PES, was by and large preserved (mean postoperative PES, 12.5). Oral hygiene was highly predictive for the esthetic result. Survival rates, marginal bone levels, and esthetic results suggest a proof-of-principle for the new flapless immediate implant placement technique in patients with complete loss of the facial bony lamella. Oral hygiene status may be considered as a negative prognostic factor for the esthetic outcome.

Anterior restorations represent a great challenge for both the clinician and dental technician. Long-term provisional restorations can be used to test a new restorative design and to improve the predictability of the definitive restoration with regard to shape, shade, occlusion, and soft tissue interface. To improve the clinical outcome and reduce costs, a new treatment strategy was developed. Teeth were restored with long-term provisional crowns fabricated from a polymer material using a computer-aided design/computer-assisted manufacture (CAD/ CAM) system. Definitive all-ceramic restorations fabricated by the same CAD/ CAM system were cemented as duplicates of the individualized provisional crowns after 3 months.

Assessment of the smile or lip line is imperative when implant therapy is carried out in the esthetic zone. The smile is generally defined as high, average, or low. Females are reported to have higher lip lines than males, which means that they are at greater risk when placing and restoring implants in the esthetic zone. Maximum upper lip elevation, usually observed during a strained posed smile, should be assessed. This paper discusses some clinical observations and concepts in relation to smile line assessment for implant therapy in the esthetic zone.