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

Introduction: Placement of an implant in the maxillary anterior region is challenging due to the angulation of bone in this area. Angled abutments may be used to achieve proper restorative contours. The present study was undertaken to examine and compare the stress levels of implants in the maxillary anterior region having different types of internal connections and different abutment angulations.

Material and methods: Implants with three types of abutment connections, internal conical, Morse taper, and internal hex, were modeled using SolidWorks software. Three abutment angulations of 0, 15, and 30 degrees were used for each type of implant. A 100 N axial load was applied to the implants, and the stresses on the implant, abutment, and bone were analyzed by finite element analysis.

Results: Among the straight abutments, the most stress was in model 3A (62.60 MPa). The stress value among angled abutments was highest with 30-degree angled abutments. The value was highest in model 3C (94.83 MPa). Internal hex connection showed the highest stress levels in all degrees of angulation of the abutment, and Morse taper connection showed the least amount of stress in all three abutment angles. The most stress concentration was seen in the cortical bone on the buccal surface in the implant-abutment junction.

Conclusion: The Morse taper design of implant exhibited the least-highest stress levels on the alveolar bone. The stress levels increased with the increasing angulation of the implant or implant-abutment connection.

The socket-shield technique is a clinical procedure aimed at preventing both hard- and soft-tissue collapse following immediate implant placement. The technique can be challenging as multiple factors influence the precision of this treatment. Selective preservation of tooth (SPOT) is a standardized, reproducible tooth-guided preparation protocol for achieving a socket shield and for immediate post-extraction implant site preparation and placement. SPOT emphasizes the utilization of osseodensification burs in both forward (ie, clockwise) rotation, to allow for simultaneous precise root apex removal and shield preparation, and reverse (ie, counterclockwise) rotation, to allow for implant site preparation with further compaction-autografting of bone and dentin, thereby improving implant primary stability and its subsequent early healing. This article presents SPOT in a step-by-step protocol for socket-shield and implant site preparation with immediate post-extraction implant placement. The article describes the stepwise application for single-rooted teeth.

With increased awareness, both in the dental literature and by the general public, of peri-implant disease, a growing trend in dentistry is to save teeth with a "questionable" periodontal prognosis. This prospective study involving such patients was designed to evaluate the effects of combining a bioactive barrier and graft, not on the socket but to augment adjacent periodontal conditions on teeth with severe periodontal bone loss at the time of extraction of an adjacent tooth. Fifteen patients were selected; teeth were extracted, ground, prepared with a pH 11 cleanser, partially demineralized, and made into a graft. This mixture was used to augment socket volume and perform periodontal regenerative surgery. The graft was covered with a bioactive amnion-chorion barrier membrane. Bioactive membranes can stimulate host cells in the surrounding gingival and periosteal tissues to accelerate site closure and healing, simultaneously exerting positive effects on the underlying bone and graft material not observed to the same extent with other membranes. This can improve healing and site regeneration as shown clinically and radiographically in this report. Use of these bioactive barrier membrane and dentin graft materials may have additive effects and provide stimulus for conversion to host bone after site healing. The combination of an amnion-chorion membrane with autologous dentin graft appears to maximize the benefits of the individual materials, improving guided tissue regeneration results and the prognoses of periodontally involved teeth.

In the past decade, the shifting of dentistry into the digital world has become obvious to any dentist or dental specialist. Many restorative dentists now consider themselves "digital dentists," performing all their crown and bridge restorative planning and fabrication in a digital environment. In preparation for this article, the author asked both a prosthodontist and the owner of a large state-of-the-art dental laboratory with whom he has worked closely the following questions: "These days, what percentage of your crown and bridge cases are being done fully digital?" Then, "What is the answer to the same question 5 years ago?" The prosthodontist answered that for crowns and bridges (with some exceptions for bridges), including implants (but not full arches), "close to 100 percent" of cases are now fully digital, while "maybe 25 percent" were 5 years ago (personal communication with Jason Sauer, DDS, of Westchester Prosthodontics, White Plains, New York, March 29, 2024). The dental laboratory owner answered, "My lab is different than others. We're about 60 percent digital, but digital is rapidly increasing. I'd say the majority of labs are 80 to 90 percent digital. Five years ago, we were 70 to 80 percent hand (analog.) We went from three mills pre-Covid to 30 different machines post-Covid (printers, mills, and scanners)" (personal communication with Steven Pigliacelli, MDT, of Marotta Dental Studio, Farmingdale, New York, March 29, 2024). It's fair to say that these comments show that the implementation of digital technologies in dentistry has been dramatic and will continue to expand.

Immediate implant placement in the anterior maxilla remains complex, particularly when the labial cortical plate of the socket is deficient and there is an associated class IV ridge defect with both hard- and soft-tissue deficiencies. This case report describes a novel combination of polydioxanone (PDS) suture tenting to support a synthetic bone graft with simultaneous implant placement with implants featuring a body-shift design and subcrestal internal angle correction. In addition, the implants were immediately loaded with a four-unit provisional bridge at the time of surgery, thus reducing morbidity, costs, and total treatment time.

The placement of immediate dental implants in the esthetic zone is a highly successful procedure, however it requires careful case selection. Depending on the structural integrity of the alveolar socket and the gingival level, either an implant can be placed immediately and provisionalized or its insertion may need to be delayed. If the extraction site is compromised, implant placement should be deferred to allow bone or soft-tissue grafting or a combination of both to facilitate esthetic implant placement. In addition, two other treatment factors need to be considered with regard to immediate placement: (1) if the implant has low primary stability (ie, low insertion torque value), a custom healing abutment should be fabricated to maintain tissue contour and retain bone placed into the buccal gap; (2) if there is high primary stability (ie, high insertion torque value), fabrication of an immediate fixed provisional will preserve tissue contour, hold a buccal gap bone graft in place, and provide an esthetic result. At sites where the implant will be placed, factors favoring immediate placement include the following: coronal position of the gingiva compared to adjacent teeth, a type I socket classification, and class I or II sagittal root position. The purpose of this article is to present clinical guidelines that can aid in the decision-making process for delayed versus immediate implant placement.

The anatomic proximity of maxillary posterior teeth to the maxillary sinus provides a natural conduit for the spread of dental pathology into the maxillary sinus. This diffusion results in the development of sinus disease attributable to endodontic pathology, and is termed "maxillary sinusitis of endodontic origin" (MSEO). Ultimately, suspicion of odontogenic causes of sinus disease should come as a relief to the provider and patient alike as the conditions are very treatable by noninvasive means with high expected success. This article reviews the diagnosis and management of odontogenic sinusitis with an emphasis on CBCT imaging as part of the interdisciplinary diagnostic workup. Illustrative cases documenting the treatment of MSEO are also presented.

According to the American Dental Association Principles of Ethics and Code of Professional Conduct, dental professionals hold a special position of trust and privilege within society, and thus are bound to adhere to the highest standards of conduct. This code of ethics defines key tenets, including veracity, patient autonomy, beneficence, nonmaleficence, and justice. Maintaining these ethical principles goes beyond the competent delivery of operative care and requires up-to-date, evidence-based knowledge and practices on the part of clinicians.1 With pain management being a key component of endodontics practice, clinicians must maintain their knowledge on the most effective evidence-based pain management strategies to ethically care for their patients.

Treatment planning for cracked teeth can be quite challenging for clinicians, as various outcomes-related clinical parameters must be considered. Historically, extraction was recommended for cracked teeth with radicular extensions due to their poor prognosis. Recent literature, however, suggests that these teeth may be saved with careful case selection and appropriate treatment. This article closely examines Davis and Shariff's 2019 study, which demonstrated a promising prognosis for treating cracked teeth with radicular extensions following a specific treatment protocol. This literature review discusses current findings regarding cracked teeth and suggested treatment modalities to optimize outcomes.

Direct composite restorations are among the most common and useful in dentistry, but shade matching can present challenges. Shade matching with direct composites is often labor intensive and technique sensitive. Utilizing a single-shade composite can simplify the process, reducing the time spent and skill required as well as overall stress on the clinician. In the case presented, which involved multiple restorations in all four quadrants, a single-shade composite was utilized to streamline the workflow and achieve an excellent outcome.