A previous case study reported periimplantitis and concomitant perigraftitis of a second implant placed at a site that had alveolar ridge preservation three decades earlier. Infection at the site persisted 4 months after implant removal by flapless implant reversal. A flap was subsequently reflected, the grafted bone was removed, and a second alveolar ridge preservation was performed with a freeze-dried bone allograft. The publication reported infection resolved, and the site healed uneventfully. However, it is unknown if placement of another implant at the site would be successful. The purpose of this paper is to report on the findings at surgical reentry and outcome of the third implant.
Eleven months after the second alveolar ridge preservation, the site was reentered. The bone graft was found to be partially soft tissue encapsulated. All encapsulated graft materials and soft tissue were removed. An implant was placed, and the alveolar defect was grafted with a demineralized bone allograft. Seventeen months after implant placement, a buccal free gingival graft was performed during which the crestal bone adjacent to the implant was found to be hard and corticated. The implant was deemed to be osseointegrated and restored after soft tissue healing.
Twenty-five months after implant placement, the third implant remained functional and asymptomatic with the peri-implant bone exhibiting normal trabeculation.
Implant therapy can be successful following treatment and resolution of perigraftitis.
Perigraftitis may play a contributing role in the biologic complications of implants that have been placed into grafted bone.
Perigraftitis may be successfully resolved by completely removing all grafted bone.
Once perigraftitis has been eliminated, an implant may be successfully placed.
Background: Reduced alveolar ridge volume is an often consequence after tooth loss, compromising implant placement and prosthetic rehabilitation. The digital customization of bone block allografts (BBA) is an alternative that incorporates advantages such as intimate contact with the recipient bed, increasing graft stability and reduced surgical time. In addition, enamel matrix derivate (EMD) has attracted interest for its effect on osteogenic gene expression and cell adhesion; few studies have focused on the benefits of bone regeneration with EMD. The aim of this case report is to present the reconstruction of a severely atrophic alveolar ridge defect with a digitally customized bone block allograft (CBBA) in combination with EMD as an adjuvant for bone regeneration and soft tissue healing.
Methods: Initially, the digital planning and manufacture of the BBA was performed based on an initial cone beam computed tomography (CBCT) scan. EMD was applied to the recipient site and to the CBBA before graft fixation. After 6 months, bone biopsies were obtained on re-entry surgery for prosthetically guided implant placement.
Results: Clinically, bone block showed good integration with the adjacent tissue and no signs of rejection or necrosis were found. On the histological evaluation, new bone was observed in intimate contact with the allograft and showed viable osteocytes and osteoblasts along its entire length. Residual allograft particles were observed to be highly osteoconductive.
Conclusion: According to the clinical and histological results presented, the digital customization of the BBA allows an ideal graft fit to the recipient bed with excellent results in bone regeneration.
Objective: To introduce a novel digital workflow to replace a terminal or a complete edentulous arch with a complete-arch implant-supported fixed prosthesis.
Clinical considerations: A novel fully digital protocol provides an interim and definitive prosthesis by integrating extraoral dental photogrammetry with intraoral scanners.
Conclusions: The described technique has great potential to deliver a complete-arch implant-supported fixed interim and definitive prosthesis in edentulous patients in an efficient way.
Clinical significance: In the era of digital dentistry, using a fully digital workflow in full arch implant rehabilitations might be beneficial to replace multistep conventional methods.
Key points: Why is this case new information? To the author's knowledge, this article illustrates the first step-by-step technique that combines intraoral scanning with dental photogrammetry to provide a full-arch implant-supported interim and definitive prosthesis. What are the keys to successful management of this case? Well-defined presurgical planning and adequate primary stability of the dental implants. Accurate digital impressions of the scan bodies. A dental laboratory that is familiar with digital workflow for complete-arch rehabilitations. What are the primary limitations to success in this case? The learning curve of the scanning procedure. The cost barriers to acquire intraoral and photogrammetry scanners. Limited clinical studies that investigated the accuracy of intraoral scanning and dental photogrammetry for complete-arch digital implant impression.
Background: This case report involves a 38-year-old male who presented to the clinic after experiencing complications from a tooth extraction, including a dislodged root segment in the sinus, a sinus wall fenestration on the palate, a residual bone height (RBH) of 3 mm, and inadequate healing of the soft tissue. He presented for implant placement.
Methods: Recombinant human platelet-derived growth factor-BB (rh-PDGF-BB) was applied to a wound dressing material and placed in the sinus cavity alongside a 4.8 × 10 mm dental implant (Straumann SP, Straumann, Andover, MA, USA.). As documented in the literature, a graftless sinus lift via a lateral window was performed using a split-thickness flap technique to elevate the sinus membrane, re-establish its integrity, and restore its barrier function.
Results: An 8-month cone beam computed tomography assessment showed a 6.2 mm vertical bone gain and complete implant coverage.
Conclusion: This approach provided a successful alternative to shorten treatment duration and achieve favorable radiographic outcomes during early healing.
Key points: The use of rhPDGF-BB and a collagen matrix in a sinus lift procedure emerges as a practical therapeutic option when grafting might lack predictability and notably consume more treatment time, while also achieving the desired bone height when used with a simultaneously placed implant.
The tunnel technique (TUN) preserves the integrity of the papilla by creating envelope flaps that allow for the insertion of a connective tissue graft, and/or biomaterials.
(1) A comprehensive overview of tunneling flap procedures in the treatment of gingival recessions (GRs) for soft tissue coverage is presented and (2) A classification system for soft and hard tissue anatomy of GR sites which may aid the clinician in determining the surgical complexity is being introduced.
A novel clinical classification system is proposed to illustrate complexity levels determined by soft and hard tissue anatomy of GR sites such as the mucogingival junction proximity to the gingival margin, bone morphotype, and mucosal margin thickness.
TUN is highly effective in treating single/multiple GRs. Its limitations are related to variability in surgical site anatomy and operator expertise. A classification system based on anatomical soft and hard tissue variations has been proposed to help identify complexity levels encountered during tunneling procedures.
Site-related factors directly impact the surgical variables related to tissue trauma, flap tension, soft tissue management, muscle pull, and wound stability during the healing of gingival recessions (GRs).
The achievement of expedited and favorable wound healing is crucial to obtaining quantitative and qualitative success in the treatment of GR and the long-term stability of root coverage.
A classification system based on anatomical soft and hard tissue variations has been proposed to facilitate tunneling procedures while respecting surgical principles.
Treating peri-implantitis with reconstructive means has been largely unpredictable due to access limitations for surface decontamination, unfavorable bony topography, difficulty in achieving wound stability, and inferior soft tissue qualities. A microsurgical approach with the use of the operating microscope (OM) that provides adjustable higher magnification (∼5–30 times) and coaxial illumination, coupled with the use of microsurgical instruments, may overcome, or alleviate some of the abovementioned obstacles, resulting in more predictable outcomes.
Three patients received reconstructive therapy for correcting peri-implant defects under OM in private practice settings. After precise incisions to preserve soft tissue volume, the flaps were dissected prudently from underlying granulomatous tissues, which were subsequently removed, followed by controlled flap releasing under ∼10–15x magnification. Surface decontamination was performed using a piezoelectric ultrasonic device, air polishing, and hand instruments at ∼30x magnification. The biomaterial selections were dehydrated human de-epithelialized amnion-chorion membrane with mineralized allograft particulates in two cases and xenografts in one case, based on the surgeons’ preference. Wound closure followed the non-submerged approach.
These cases demonstrated uneventful soft tissue healing, favorable radiographic bone fill, and disease resolution with follow-ups ranging from 2 to 4 years.
Preliminary data suggest encouraging outcomes after the microsurgical approach following biological as well as biomechanical principles for peri-implant defect reconstruction.
The physiologic bone remodeling accompanying tooth extraction is a phenomenon well described in the dental literature. Extraction sockets severely compromised by local infection, trauma, iatrogenesis, or other factors may exhibit enhanced reduction in alveolar dimensions during healing. The purpose of this report is to present an alveolar ridge preservation (ARP) protocol specifically intended for use at severely compromised sites.
Seven patients presented to the Department of Periodontics, Army Postgraduate Dental School, Fort Gordon, Georgia, requiring extraction of teeth with partial or near-complete loss of the facial/buccal cortex. At each site, a cross-linked bovine collagen membrane was used to prevent collapse of the facial/buccal soft tissue and maintain space, a freeze-dried bone allograft was applied in the socket, and a dense polytetrafluoroethylene membrane covered the occlusal aspect.
All sites healed uneventfully and resulted in favorable alveolar ridge dimensions for implant placement.
Few authors have proposed specific ARP methods for managing severely deficient extraction sockets. The predominant recommendation has been staged reconstruction of the site applying hard and soft tissue augmentation. Observations reported herein suggest that staged reconstruction is avoidable at some extraction sockets exhibiting severe alveolar compromise. Controlled clinical investigation of this protocol appears warranted.
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