The International journal of periodontics & restorative dentistry最新文献

After over a decade of use, there are persistent misunderstandings about monolithic zirconia (MZ) with respect to its characteristics and appropriate management. This leads to errors in its application that can negatively affect not only the efficiency and predictability of clinical workflows, but also the long-term outcome for the patient. This article discusses the physical properties, manufacturing and production of MZ restorations. Recommendations for their use based on currently available laboratory and clinical evidence and concerns regarding current trends are provided.

The integrity of periodontal soft tissues during healing plays a critical role in the success of surgical periodontal regenerative therapy. Wound dehiscence can lead to compromised regenerative outcomes and gingival recession. This manuscript introduces the use of the partial-full-thickness (PFT) tunnel for periodontal regeneration of multiple adjacent infrabony defects. The PFT tunnel technique maintains intact interdental papillae, enables access to defects, and facilitates coronal advancement of the soft tissue. When combined with palatal vertical incision this approach also enables treatment of bony defects that extend toward the palatal aspect. Placement of biomaterials in osseous defects displaces the overlying soft tissue coronally, thereby creating and maintaining space for clot stabilization and tissue regeneration. It also leads to significant enhancement in interproximal clinical attachment levels, probing depth reduction, and root coverage. Preliminary clinical outcomes indicate that this technique could be an alternative option for treating multiple infrabony defects.

Objectives: The aim of this study was to evaluate the success rate and marginal bone loss (MBL) of 6 mm wide-diameter (WD) implants placed in mandibular and maxillary molar sites with immediate non-functional provisionalization with cement-retained single crowns in posterior molar sites up to 10.5 year follow up.

Materials and methods: a retrospective case series on 48 patients receiving 53 WD implants in healed molar sites. Implants were provisionally restored with cement-retained acrylic crowns within 48 hours and followed for an average of 6.3 years. Marginal bone levels were measured at implant insertion, final prosthesis and at follow up using calibrated periapical radiographs. Statistical analyses, including survival analysis and descriptive statistics, were performed to assess implant success and MBL.

Results: Most implants were placed in the mandible (67.3%), and flap-based techniques were used more frequently (56.5%). Of 53 implants, 2 (3.77%) failed: one due to osseointegration failure and one to peri-implantitis after 7.1 years. Mean MBL change was -0.89 mm over the follow-up period. Patients demonstrated high implant stability and minimal complications.

Conclusions: Immediate provisionalization of 6 mm WD implants in molar sites demonstrates high survival rates and minimal bone loss, supporting their use as a reliable alternative to delayed loading protocols. These results reinforce the predictability and biomechanical advantages of wide-diameter implants for posterior restorations.

The incorporation of artificial intelligence (AI) into digital technology has profoundly enhanced the field of dental implantology in all phases of treatment from diagnosis through planning, surgery and restoration. With specific attention to planning and surgery, static computer-aided implant surgery (sCAIS) has become a widely accepted workflow by streamlining implant placement and restoration. However, during the placement of immediate implants, users of sCAIS can often experience specific limitations due to the anatomical complexity of post-extraction sockets, including their morphology, angulation, and the heterogeneity of surrounding bone density in relation to the planned implant position. These clinical factors can adversely influence the trajectory and stability of the surgical drill leading to its deflection resulting in deviations from the planned implant path. Such inaccuracies can lead to suboptimal implant positioning, compromising primary stability, esthetic outcomes, and ultimately, long-term clinical success. This article introduces an AI-assisted modification to the traditional sCAIS guide design workflow by introducing a pilot drill surgical guide (SocketFit Guide (SFG)) to minimize these risks when working with immediate implants. The design of the SFG incorporates the use of AI-driven virtual segmentation of anatomical structures during the digital planning phase. Through virtual tooth extraction, the AI algorithm accurately delineates the alveolar socket boundaries, enabling the design of the SFG with an extension and more apically positioned guide sleeve. Moving the pilot drill closer in proximity to the planned osteotomy site allows for more control over the drill trajectory minimizing deflection.

The multiple coronally advanced flap (MCAF) and the modified coronally advanced tunnel tech-nique (MCAT) are the most commonly used methods for treating multiple gingival recessions. However, treating multiple defects is very complex due to various biologic and anatomical factors, and there is no clear guideline on the major or minor determinants that influence surgical decisions. The aim of the present article is to discuss a decision tree to suggest to clinicians the most relevant anatomical factors to consider when evaluating the choice between an MCAT and an MCAF. In the proposed decision-making process, the first crucial step involves the evaluation of the interdental clinical attachment loss according to the new EFP/AAP classification. The next step is to assess the dimensions of the lateral keratinized tissue (LKT)-that is, the keratinized tissue located later-ally to the recession defect. When the amount of LKT is insufficient, the interdental papillae size, including base, height, and coronal width, must also be evaluated.

Several treatment-oriented classifications for the management of peri-implant marginal mucosal defects (PMMDs) have been published to date. While each classification provides valuable insights into key diagnostic and therapeutic aspects, there is a marked heterogeneity regarding the rec-ommended clinical guidelines to achieve success in specific scenarios. The purpose of this review was to critically analyze and organize the similarities and differences enclosed in the available classifications linked with treatment recommendations on the management of PMMDs at nonmolar single-implant sites with the purpose of providing an overview of recommended interdisciplinary treatment options to facilitate clinical decision-making processes.

This study aimed to characterize gingival thickness (GT) and determine correlations with other local phenotypic features. CBCT scans from adult subjects involving the maxillary anterior teeth were obtained to assess buccal GT at different apicocoronal levels, periodontal supracrestal tissue height (STH), the distance (CEJ-BC) from the cementoenamel junction (CEJ) to the alveolar bone crest (BC), and buccolingual tooth dimensions. A total of 100 subjects and 600 maxillary anterior teeth comprised the study sample. Variations in mean GT values were observed as a function of apicocor-onal level, tooth type, and gender. GT progressively increased apically. Maxillary central incisors and men generally exhibited thicker GT. Contrarily, women exhibited thinner GT and shorter STH. Tooth dimensions were negatively correlated with GT, as a narrower tooth crown/root in the buccolingual dimension indicated thicker gingiva. GT at the CEJ level was dichotomized to differentiate between thin (< 1 mm) and thick (≥ 1 mm) gingival phenotypes (GP). Teeth with a thin GP displayed great er CEJ-BC and buccolingual tooth width dimensions. Conversely, teeth with a thick GP generally exhibited taller STH and narrower tooth dimensions.

This case report shows how to place and restore dental implants in just 6 months in a patient re-quiring vertical and horizontal hard and soft tissue augmentation, including a lateral window sinus elevation. It highlights the utilization of pure autogenous bone, including the sinus elevation, to shorten the reentry time to just 3 months, as well as the subsequent soft tissue grafting during im-plant placement to avoid a third surgery. After the bone augmentation, the soft tissue thickness was inadequate for implant placement and the mucogingival line was distorted due to flap advancement. Understanding the available hard tissue grafting techniques and biomaterials is essential for proper treatment planning. Incorporating soft tissue management protocols into implant placement surger-ies will reduce the number of surgeries and overall treatment time.

A 45-year-old woman presented with a lack of interimplant papilla after a partially edentulous ante-rior area was rehabilitated with dental implants. The soft tissue phenotype and interimplant papilla were augmented using the 'iceberg' connective tissue graft (iCTG), followed by a second surgical procedure wherein a strip gingival graft was combined with a CTG inserted underneath a pouch prepared into the previous iCTG at the level of the crest (the garage approach), further enhancing soft tissue volume in that region. This technique aims to improve mucosal thickness and supra- crestal tissue height while addressing esthetic concerns associated with multiple implants placed in the anterior region. The final esthetic outcome was excellent and achieved harmonious soft tissue with appropriate thickness, symmetry with adjacent teeth, well-shaped interdental and interimplant papillae, and high patient satisfaction, making this approach a valuable addition to the surgical armamentarium. Future clinical studies are needed to evaluate the performance of this novel approach.