Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)最新文献

Peri-implantitis is a biofilm-mediated inflammatory condition associated with progressive loss of supporting tissue and poses a significant challenge to clinicians worldwide. Because limited efficacy is associated with nonsurgical therapy, surgical intervention is often required to manage this disease. This article focuses on operator factors when treating peri-implantitis and presents a stepwise approach to eight essential keys for successful regenerative/reparative treatment of peri-implantitis defects. These keys are aimed at optimizing clinical outcomes for diverse patient needs and defect anatomies. They include evaluating operator experience, risk assessment, and implant restorative design, as well as nonsurgical and surgical therapies such as the use of biologics and biologic derivatives, the postoperative protocol, and a patient-specific periodontal maintenance program. By adhering to these eight keys, clinicians can achieve successful long-term outcomes in the regenerative treatment of peri-implantitis defects.

This case report details the use of a cellular bone matrix (CBM) and custom titanium mesh (TM) scaffold for vertical bone augmentation in the posterior mandible of a 78-year-old patient. The patient presented with vertical bone deficiency, necessitating augmentation for dental implant placement. The customized titanium scaffold, designed based on CBCT data, provided a precise fit, minimizing the risks associated with traditional TM. During surgery, CBM was used in conjunction with the custom scaffold to enhance bone regeneration. Postoperative recovery was uneventful, with 6-month CBCT scans showing mature bone formation. Histological analysis confirmed successful osseous regeneration. The case demonstrates the effectiveness of combining CBM and custom TM for complex bone augmentation, offering a predictable and stable foundation for dental implants. Future studies with larger sample sizes and longer follow-up times are needed to validate these findings further.

The story of Alpha Omega International Dental Society began in the early 1900s, when Jewish dental students were barred from forming social groups. Unbeknownst to each other, students at two dental schools independently established their own organizations to combat discrimination and advocate for equal access to dental education. A year later, the groups discovered one another and merged to form the Alpha Omega Dental Fraternity. Today, Alpha Omega has evolved into a global organization that fights antisemitism, supports dental schools and centers in Israel, and fosters a community that helps dental students and professionals excel in their profession.

This article presents a clinical case involving a necrotic molar with apical periodontitis (AP) that was successfully treated with appropriate root canal therapy. As supported by dental literature and clinical experience, in most cases of AP a favorable outcome can be achieved when the root canal system is properly cleaned, shaped, and obturated, followed by placement of a well-sealed restoration. The high success rate is directly related to the quality of the clinical procedure. Therefore, clinicians must implement evidence-based strategies, utilize effective techniques, and select high-quality materials to consistently deliver optimal results for patients.

Peri-implantitis is a biofilm-mediated inflammatory condition associated with progressive loss of supporting tissue and poses a significant challenge to clinicians worldwide. Because limited efficacy is associated with nonsurgical therapy, surgical intervention is often required to manage this disease. This article focuses on operator factors when treating peri-implantitis and presents a stepwise approach to eight essential keys for successful regenerative/reparative treatment of peri-implantitis defects. These keys are aimed at optimizing clinical outcomes for diverse patient needs and defect anatomies. They include evaluating operator experience, risk assessment, and implant restorative design, as well as nonsurgical and surgical therapies such as the use of biologics and biologic derivatives, the postoperative protocol, and a patient-specific periodontal maintenance program. By adhering to these eight keys, clinicians can achieve successful long-term outcomes in the regenerative treatment of peri-implantitis defects.

Caries prevention and enamel remineralization are two critical facets of oral health that involve a multifaceted approach. Prevention strategies reduce the incidence of new caries, whereas remineralization treatments address existing caries in early stages of mineral loss. Fluoride in different forms, such as water fluoridation, toothpaste, rinses, varnish, and trays, can prevent caries and remineralize affected tooth structure but may have potential health considerations at high dosages. Hydroxyapatite is added to some toothpastes with limited evidence of prevention but possible advantages for remineralization. Additionally, antimicrobial agents can be used to reduce caries-causing bacteria and may prevent caries development and progression. Non-operative methods for remineralization or repair of incipient lesions offer conservation options for restoring teeth.

The conventional denture fabrication process normally requires at least five visits, taking up considerable chairtime, encompassing multiple laboratory steps, and demanding that patients return to the office every time for treatment. Furthermore, if the denture breaks or gets lost, the fabrication process to make a new one will likely need to be started from the beginning. Today, providers can incorporate digital technology into many of the clinical steps to minimize the number of visits and procedure time needed to fabricate a complete denture. In addition, the materials are more patient friendly as there is less residual monomer in CAD/CAM milled resins. This article presents case studies that exemplify the combination of traditional clinical practices and digital methodologies to maximize efficiency in the denture fabrication process. Intraoral scanning was used to produce a denture prototype, and a traditional myofunctional impression technique was employed with the generated prototype, which was then scanned before a new, properly fitted denture was milled using 3D technology. This process is expedited in a predictable workflow that minimizes laboratory steps and chairtime, offers improved infection control, and leads to higher patient satisfaction.

Precision is key to the success of indirect dental restorations. Accurate impressions that capture complex hard- and soft-tissue details are paramount to ensure optimal anatomical shape, marginal fit, and overall restoration success. Impression-making techniques have continuously evolved from basic physical casts to the sophisticated digital scans of today.

Full-arch implant therapy with immediate provisionalization is a popular procedure. Conventionally, chairside conversion of a prefabricated prosthesis or an abutment-level impression is usually required. This case report describes a novel approach to picking up a prefabricated full-arch prosthesis utilizing various digital techniques. After implant placement and bone reduction was performed using a customized surgical guide, a provisional restoration was seated on a stackable guide and relined with a lightcured material (the "liquid pin"). This material is strong enough to hold the titanium bases in place during the relining procedure yet can be quickly and completely removed from the titanium bases and multi-unit abutments following the pick-up. The liquid pin technique enables the provisional prosthesis to maintain its structural integrity, eliminates the need for a postoperative impression, and allows for minimal adjustment before delivery. Together with digital preplanning of the prosthesis, this technique streamlines the workflow for immediate full-arc provisionalization.

The socket-shield procedure focuses on soft- and hard-tissue preservation of the extraction socket in an immediate implant procedure. Selective preservation of tooth (SPOT) is a tooth-guided protocol for socket-shield preparation for both anterior and posterior teeth. It allows for consistent apex removal as well as shield preparation, implant site preparation, and immediate implant placement. The use of osseodensification burs in the guided SPOT protocol allows the clinician to incorporate a sequential clockwise rotation for simultaneous precise apex removal with shield preparation. In addition, a counterclockwise operation is implemented for implant site preparation with compaction-autografting of bone and dentin into the alveolus trabecular bone to improve implant primary stability and, subsequently, early healing. Guided SPOT enables improved drilling accuracy, enhances reproducibility, and reduces chairside time through the implementation of two static surgical guides to produce two separate trajectories: one for guided apex removal and shield preparation and the other for guided implant site preparation. This facilitates the prefabrication of a provisional restoration or custom anatomical healing abutment. This article presents a fully guided protocol for the SPOT procedure and immediate implant placement for a single-rooted tooth.