International Journal of Periodontics & Restorative Dentistry最新文献

Dental implants are currently the preferred choice to restore function and esthetics. Nonetheless, explantation is sometimes inevitable in cases with advanced bone loss, implant fracture, or improper implant position. This study aimed to propose an algorithm for reimplantation at sites of previous failure. There is limited evidence on the replacement of failed implants, most of which are case reports or clinical trials with a small number of patients. To the best of the authors' knowledge, this is the first study proposing a clinical-decision algorithm to help clinicians manage implant failures with new implants. There are a variety of reasons contributing to implant failure: The etiologic factor of failure and the morphology of the residual defect have paramount importance on implant removal techniques and subsequent treatment modalities. There is no consensus on a distinct protocol to replace failed implants. However, the clinicians and patients should know that placing a new implant in an area with a history of failure, regardless of early or late implant failure, may have a lower survival rate.

Diode lasers are increasingly being utilized as an alternative to conventional soft tissue surgery. Diode lasers originally referred to wavelengths ranging from 810 to 980 nm, but a visible diode laser with a 445-nm wavelength has emerged as an additional wavelength for soft tissue surgery. The goal of this case series was to demonstrate the clinical results of both visible and near-infrared (NIR) wavelengths when utilized for stage-two implant surgery. Ten patients with 23 implants were treated at Stony Brook University, Department of Periodontology, for implant uncovering using both visible and nonvisible (NIR) diode lasers. The uncovering was performed utilizing 445-, 970-, and 980-nm wavelengths at a power setting of 2 W in either continuous or pulsed modes. The fiberoptic tips were initiated using blue articulating paper. Either topical benzocaine or infiltration anesthesia was utilized prior to soft tissue removal with the initiated tip. All patients healed uneventfully without any postoperative complications. Visible and NIR diode lasers provide an alternative and safe method to uncover submerged implants at stage-two surgery.

An accurate assessment of the disease extent and lesion size is needed for appropriate therapy decisions of endodontic-periodontic (endo-perio) lesions. CBCT imaging with less radiation and high spatial resolution can provide a comprehensive evaluation of endo-perio lesions. A total of 71 teeth with endo-perio lesions were assessed using CBCT. Periodontal bone defects were studied for bone loss pattern (horizontal/vertical) along with bone loss levels on mesial and distal sides in association with furcation involvement. The periapical lesions were studied for their prevalence and extent based on CBCT PAI Score. Horizontal and vertical bone loss were detected in 54 teeth (76.1%) and 17 teeth (23.95%), respectively. Mean crestal bone loss levels on mesial and distal aspects were 4.80 ± 3.21 mm and 5.74 ± 3.91 mm, respectively. The mean height, width, and depth of furcation defects were 3.19 ± 2.99 mm, 1.94 ± 0.98 mm, and 4.44 ± 1.92 mm, respectively. Periapical lesions were recorded in 55 teeth (77.5%). A CBCT PAI score of 5 was scored in 35 teeth with a mean lesion diameter of 11.3 ± 2.83 mm, while 16 teeth had healthy periapical tissues (scores of 0 and 1). CBCT is a valuable diagnostic tool that can help assess endo-perio lesions by providing morphometric measurements of periodontal bone defects and the extent of associated periapical lesions.

Tooth loss or extraction is associated with significant reduction in alveolar ridge volume, extensively expressed in the anterior zone, and immediate implant placement is insufficient to overcome this problem. The proposed approach combined immediate implant placement with buccal tissue enhancement by applying a crosslinked collagen matrix hydrated with crosslinked hyaluronic acid (xHyA). All 10 cases presented with a retained but narrow buccal socket wall, so immediate implant placement with the "tunneled sandwich" technique was performed after tooth extraction. The tunneled sandwich technique helped create a subperiosteal pouch for insertion of the collagen matrix buccal to the alveolar bone crest. The implants healed transmucosally by receiving either a gingiva former or an immediate temporary restoration. Ten sites in 10 patients demonstrated stable, noninflamed peri-implant conditions and suitable ridge volume at the implant neck and achieved high pink esthetic scores 6 months after implant loading. The tunneled sandwich technique is a suitable method to preserve buccal volume, which biologically and esthetically contributes to favorable long-term results.

This pilot case series histologically and histometrically investigated the influence of implant surface hydrophilicity on early osseointegration and peri-implant bone formation around simultaneously grafted immediate implants. Core biopsies of the hydrophilic test (SLAactive®) or hydrophobic control (SLA®) implants immediately placed in maxillary molar extraction sites and simultaneously grafted with mineralized cancellous bone allograft (MCBA) obtained at 3 weeks post-placement were histometrically compared for bone to implant contact, the quantity of graft material, new bone formation, tissue reaction, and inflammatory scores. Test implants showed a more pronounced implant-bone apposition, peri-implant bone formation and bone aggregate than control implants. Trabecular bone formation and maturation were also qualitatively advanced around test implants. These results indicate that the implant surface bone graft combination may affect peri-implant bone formation.

The aim of this retrospective study was to evaluate the performance of implants placed with the All-on-4 technique after a mean time in function of 9 years. A total of 34 patients with 156 implants were selected for this study: 18 patients underwent tooth extraction on the day of implant placement (Group D), and 16 patients were already edentulous (Group E). A periapical radiograph was taken at a mean follow-up of 9 years (range: 5 to 14 years). Success and survival rates and the prevalence of peri-implantitis were calculated. Statistical analysis was used to assess comparisons between groups. After a mean follow-up of 9 years, the cumulative survival rate was 97.4% and the success rate was 77.4%. The difference between the initial and final radiographs resulted in a mean marginal bone loss (MBL) of 1.3 ± 1.06 mm (range: 0.1 to 5.3 mm). No differences were seen between Groups D and E. Peri-implantitis affected 15 implants (9.6%) in 9 patients (26.5%). This study shows that the All-on-4 technique is a reliable treatment method for both edentulous patients and patients requiring tooth extractions, with results maintained over a long follow-up period. The present MBL results are similar to those around implants in other rehabilitation types.

The management of horizontally fully edentulous atrophic ridges is a common problem in dental implantology. This case report describes an alternative modified two-stage presplitting technique. The patient was referred for an implant-supported rehabilitation of their edentulous mandible. CBCT scans showed a mean available bone width of about 3 mm. At the first stage, four linear corticotomies were performed using a piezoelectric surgical device. At the second surgical stage 4 weeks later, bone expansion was performed, and four implants were placed in the interforaminal area. The healing process was uneventful. No fractures of the buccal wall and no neurologic lesions were observed. Postoperative CBCT scans showed a mean bone width gain of about 3.7 mm. Implants were uncovered 6 months after the second surgery, and 1 month later, a fixed provisional screw-retained prosthesis was delivered. This approach could be used as a reconstructive technique that avoids using grafts and reduces treatment times, possible complications, postsurgical morbidity, and costs by exploiting the patient's native bone as much as possible. Considering the limitations of a case report, randomized controlled clinical trials are needed to confirm the results and validate this technique.

Partial extraction therapy (PET) is a group of surgical techniques that preserve the periodontium and peri-implant tissues during restorative and implant therapy by conserving a portion of the patient's own root structure to maintain the blood supply, derived from the periodontal ligament complex. PET includes the socket shield technique (SST), proximal shield technique (PrST), pontic shield technique (PtST), and root submergence technique (RST). Although their clinical success and benefits have been demonstrated, several studies report possible complications. The focus of this article is to highlight management strategies for the most common complications associated with PET, including internal root fragment exposure, external root fragment exposure, and root fragment mobility.

Objectives: Alveolar bone crest level is essential in determining the need for bone removal in subjects with altered passive eruption (APE). This study assessed the validity of Cone Beam Computed Tomography (CBCT) and transgingival probing.

Methods: Patients presenting with APE were assessed. Transgingival probing was performed to clinically assess the distance between the cementoenamel junction (CEJ) and the crest of the bone at the mid-point of upper anterior teeth. CBCT was used to assess this distance at the same point. Upon reflection of a full mucoperiosteal flap the actual distance was measured.

Results: Similar actual and CBCT measurements of the distance between the CEJ and bone crest at upper right 3, upper left 2 and upper left 3 (P>0.05) were recorded. However, in upper right 2, upper right 1 and upper left 1 the distance was significantly greater on CBCT (P<0.05). No significant difference was detected between transgingival probing and the actual distance at all teeth assessed.

Conclusions: Careful transgingival probing provides an accurate measure of the distance between the CEJ and crest of the Bone. CBCT gives an accurate estimate, However, it might not be justified for each patient in the presence of safer methods.

Horizontal and vertical ridge augmentation via the bone shell technique provides predictable outcomes. The external oblique ridge is the most-used donor site for bone plate harvesting, followed by the mandibular symphysis. The lateral sinus wall and the palate have also been described as alternative donor sites. This preliminary case series reports a bone shell technique that used the coronal segment of the knife-edge ridge as a bone shell in five consecutive edentulous patients (20 sites) with severe mandibular horizontal ridge atrophy and adequate ridge height. The follow-up period was 1 to 4 years. The average horizontal bone gains at 1 mm and 5 mm below the newly formed ridge crest were 3.6 ± 0.76 mm and 3.4 ± 0.92 mm, respectively. Ridge volume was sufficiently restored in all patients to enable implant placement in a staged approach. In 2 of the 20 sites, additional hard tissue grafts were required at implant placement. The advantages of utilizing the relocated crestal ridge segment are as follows: The donor and recipient sites are the same, no major anatomical structures are compromised, periosteal releasing incisions and flap advancement are not required for primary wound closure, and the risk of wound dehiscence is minimized due to reduced muscle tension.