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Implant Articles
Surgical Veneer Grafting - Compensation for Natural Labial Plate Remodeling After Immediate Implant Placement

Surgical Veneer Grafting - Compensation for Natural Labial Plate Remodeling After Immediate Implant Placement
Contemporary implant therapy aims to provide highly esthetic and predictable treatment outcomes while decreasing treatment duration and complexity. The clinician must therefore be cognizant of circumstances with a predisposition toward esthetic outcomes and treatment plan accordingly. Preservation of the surrounding hard and soft tissues associated with an immediate postextraction socket implant to replace a nonrestorable tooth in the esthetic zone is one of the greatest challenges facing the dental team. A case report of a hopeless maxillary left central incisor in a patient with a thin periodontal phenotype illustrates this new surgical and prosthetic approach. Clinical, radiological, and esthetic parameters were recorded to evaluate primary treatment outcomes.

Author(s): Alessandro Agnini, DMD;Maurice Salama, DMD;Henry Salama, DMD;David Garber, DMD;Andrea Mastrorosa Agnini, DDS
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Reconstruction of a Single-Tooth Traumatic Defect in the Anterior Maxilla Using the Khoury Bone Plate Graft

Reconstruction of a Single-Tooth Traumatic Defect in the Anterior Maxilla Using the Khoury Bone Plate Graft
Trauma to teeth and the dentoalveolar process may result in a ridge defect that precludes straightforward implant therapy of the patient. Typically bone and soft tissue augmentation of the area would first be needed to adequately prepare the tissues for the implant and its restoration..Grafting of the site is substantially more difficult in cases where the ridge also lacks adequate height, and techniques to recreate a bony envelope to apply guided bone regeneration may be required. Moreover, defects in the anterior aesthetic zone that require both bone and soft tissue grafting and a restoration that harmonizes the adjacent pink and white aesthetics may be an even more significant challenge to the restorative team. Hereafter a case of trauma to an anterior maxillary tooth that saw destruction of the ridge is presented, with the defect reconstructed to accommodate a functional and aesthetically pleasing implant supported restoration.

Author(s): Howard Gluckman, BDS, MChD;Jonathan Du Toit, BChD
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The Pontic-Shield: Partial Extraction Therapy for Implant Dentistry

The Pontic-Shield: Partial Extraction Therapy for Implant Dentistry
Augmentive ridge preservation techniques aim to manage the postextraction ridge. The partial extraction of teeth may better preserve the ridge form by maintaining the bundle bone-periodontal tissues and preserve the ridge beneath dentures or fixed prostheses. The socket-shield technique entails preparing a tooth root section simultaneous to immediate implant placement and has demonstrated histologic and clinical results contributory to esthetic implant treatment. A retrospective 10-patient case series treating 14 partial extraction sites demonstrates how a modification of the socket-shield technique can successfully develop pontic sites and preserve the ridge.

Author(s): Howard Gluckman, BDS, MChD;Maurice Salama, DMD;Jonathan Du Toit, BChD, Dipl Implantol, Dipl Oral Surg, MSc Dent
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Immediate Implant Placement into Extraction Sockets with Labial Plate Dehiscence Defects: A Clinical Case Series

Immediate Implant Placement into Extraction Sockets with Labial Plate Dehiscence Defects: A Clinical Case Series
To measure the buccal plate reconstruction of extraction sockets with labial plate dehiscence defects using a bone allograft in combination with an absorbable collagen membrane and a custom-healing abutment at the time of tooth removal. Implants placed into sockets with labial plate dehiscence defects demonstrated radiographic reformation of the labial plate dehiscence defect at 6 to 9 months post-treatment. The net gain in labial plate on CBCT in L1 and L2 was 3.0 mm, where 0 mm existed at pre-treatment. The minimum amount of labial plate thickness of 2.0 mm was achieved in all treated sites, evaluated radiographically at 6-9 months post-operatively, in a single procedure, without flap elevation and maintaining the gingival architecture and satisfactory esthetics.

Author(s): Stephen J. Chu, DMD, MSD, CDT;Dennis P. Tarnow, DDS;Guido O. Sarnachiaro, DDS; Evangelina Sarnachiaro, DDS; Sergio Luis Gotta, DDS
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The Socket-Shield Technique: First Histological, Clinical, and Volumetrical Observations after Separation of the Buccal Tooth Segment – A Pilot Study

The Socket-Shield Technique: First Histological, Clinical, and Volumetrical Observations after Separation of the Buccal Tooth Segment – A Pilot Study
The “socket-shield technique” has shown its potential in preserving buccal tissues. However, front teeth often have to be extracted due to vertical fractures in buccolingual direction. It has not yet been investigated if the socket-shield technique can only be used with intact roots or also works with a modified shield design referring to vertical fracture lines. The aim of this study was to assess histologically, clinically, and volumetrically the effect of separating the remaining buccal root segment in two pieces before immediate implant placement.

Author(s): Markus B. Hürzeler, DMD, PhD;Daniel Bäumer, DDS; Otto Zuhr, DDS; Stephan Rebele, DDS; David Schneider, DDS, PhD; Peter Schupbach, PhD
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Flapless Postextraction Socket Implant Placement, Part 2. The Effects of Bone Grafting and Provisional Restoration on Peri-implant Soft Tissue Height & Thickness - A Retrospective Study

Flapless Postextraction Socket Implant Placement, Part 2. The Effects of Bone Grafting and Provisional Restoration on Peri-implant Soft Tissue Height & Thickness - A Retrospective Study
This article presents the results of evaluating the changes in peri-implant soft tissue dimensions associated with immediate implant placement into anterior post-extraction sockets for four treatment groups: no BGPR(bone graft, no provisional restoration), PR (no bone graft, provisional restoration), BG (bone graft, no provisional restoration), and BGPR (bone graft, provisional restoration). The vertical distance of the peri-implant soft tissue was greater for grafted sites than for non-grafted ones. The facial soft tissue thickness at the gingival third was greater for grafted than for non-grafted sites and for sites with provisional restorations compared to sites without them, respectively. The net gain in soft tissue height and thickness was about 1mm. The increases in vertical and horizontal dimensions for grafted sites were between 0.5 and 1.0mm, as compared to sites with no bone graft and no provisional restoration.

Author(s): Stephen J. Chu, DMD, MSD, CDT;Maurice Salama, DMD;David Garber, DMD;Henry Salama, DMD;Guido O. Sarnachiaro, DDS; Evangelina Sarnachiaro, DDS; Sergio Luis Gotta, DDS; Hanae Saito, DDS, MS
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Crestal Bone Stability around Implants with Horizontally Matching Connection after Soft Tissue Thickening: A Prospective Clinical Trial

Crestal Bone Stability around Implants with Horizontally Matching Connection after Soft Tissue Thickening: A Prospective Clinical Trial
It has been shown that thin mucosal tissues may be an important factor in crestal bone loss etiology. Thus, it is possible that mucosal tissue thickening with allogenic membrane might reduce crestal bone loss. Purpose: The purpose of this study was to evaluate how implants with traditional connection maintain crestal bone level after soft tissue thickening with allogenic membrane. After 1-year follow-up, implants in group A had 1.65 1 0.08-mm bone loss mesially and 1.81 1 0.06 mm distally. Group B had 0.31 1 0.05 mm mesially and 0.34 1 0.05 mm distally. C group implants experienced bone loss of 0.44 1 0.06 mm mesially and 0.47 1 0.07 mm distally. Differences between A and B, and A and C were significant both mesially and distally, whereas differences between B and C were not significant mesially and distally

Author(s): Tomas Linkevicius, DDS, Dip Pros, PhD;Algirdas Puisys, DDS; Laura Linkeviciene, DDS, PhD; Vytaute Peciuliene, DDS, PhD; Markus Schlee, DDS
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Developing Optimal Peri-Implant Papillae within the Esthetic Zone: Guided Soft Tissue Augmentation

Developing Optimal Peri-Implant Papillae within the Esthetic Zone: Guided Soft Tissue Augmentation
Osseointegrated dental implants have enjoyed long-term success in the rehabilitation of totally edentulous patients. Every aspect of traditional treatment planning protocols continues to be re-evaluated and updated to better incorporate the benefits of osseointegration into clinical practice. This is particularly evident as dentistry has committed to fully integrating this approach into the more varied and demanding environment of the partially edentulous patient. Along with the many benefits of added predictability and enhanced options, the ever-evolving role of osseointegrated implants in the treatment pf the partially edentulous jaw has also created new challenged. Unlike the fully edentulous individual who maintains the implant-restorative interface beyond the lip perimeter, many partially edentulous patients undergo the transition within the esthetic zone.

Author(s): Henry Salama, DMD;Maurice Salama, DMD;David Garber, DMD;Pinhas Adar, MDT, CDT
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Effectiveness of a Super-Pulsed CO2 Laser For Removal of Biofilm From Three Different Types of Implant Surfaces: An In Vitro Study

Effectiveness of a Super-Pulsed CO2 Laser For Removal of Biofilm From Three Different Types of Implant Surfaces: An In Vitro Study
As dental implants become a routine part of dental practice, so too will the prevalence of peri-implant diseases. Inherent to the treatment of peri-implant disease is the removal of microbial biofilms from the implant surface. Currently, there is no standardized protocol for application of any treatment modality directed at implant surface decontamination. In this in vitro study, we report on the effectiveness of a super-pulsed CO2 laser, delivering an average fluence of 6.3 to 113 J/cm2, to remove biofilm from three different types of implant surface topographies. Biofilms ranged in thickness from 5 to 15 μm. An average fluence of 19 J/cm2 was sufficient to achieve 100% ablation of the biofilm on hydrophilic sandblasted and acidetched surface specimens (SA). However, to achieve 100% ablation of biofilm on HA and highly crystalline, phosphate enriched titanium oxide (PTO) surfaced implants required an average fluence of 38 J/cm2.

Author(s): Peter Vitruk, PhD;Charles M. Cobb, DDS, MS, PhD
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Finding Z: A Mathematical Method For Predicting Tissue Position After Implant Abutment-Restoration Placement

Finding Z: A Mathematical Method For Predicting Tissue Position After Implant Abutment-Restoration Placement
A visible abutment-restorative interface is a problematic consequence, especially in the esthetic zone. This article presents formulas to predict the vertical tissue position around the abutment-restoration, which can be used both as a guide to the clinical situation and as an aid to computer-aided design and computer-aided manufacturing design.

Author(s): Dean C. Vafiadis, DDS;Gary Goldstein, DDS; John Kim, BA
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Subclassification and Clinical Management of Extraction Sockets with Labial Dentoalveolar Dehiscence Defects

Subclassification and Clinical Management of Extraction Sockets with Labial Dentoalveolar Dehiscence Defects
Immediate implant therapy involving implants placed into intact Type 1 extraction sockets has become a consistent clinical technique. The classification of Type 2 extraction sockets, where the mucosal tissues are present but there is a midfacial osseous dehiscence defect, has been described according to the extent of the buccal bone plate absence. The literature has offered different techniques in the treatment of Type 2 sockets; however, the extent of the defect has never been defined or delineated.

Author(s): Stephen J. Chu, DMD, MSD, CDT;Dennis P. Tarnow, DDS;Guido O. Sarnachiaro, DDS; Mark N. Hochman, DDS
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Advanced Esthetic Management of Dental Implants: Surgical and Restorative Considerations to Improve Outcomes

Advanced Esthetic Management of Dental Implants: Surgical and Restorative Considerations to Improve Outcomes
This article demonstrates the importance of proper surgical and prosthetic principles in achieving esthetic implant results.Successful dental implant therapy in the maxillary anterior dentition requires meticulous attention to surgical and prosthodontic measures. Proper diagnosis, extraction technique, implant selection, and placement significantly impact outcomes. Respect of hard and soft tissue physiology following tooth loss and implant placement requires specific steps be taken. Management tissue contours properly, via regenerative therapy, results in successful framing of the restoration. Provisionalization and definitive restorative therapy also impacts the level of esthetic success.The contours of the temporary abutment and crown develop soft tissue contours for the final restoration. Overcontouring can lead to soft tissue recession and mucosal asymmetry. Design of the definitive crown(s) is crucial for long-term maintenance of esthetically acceptable results.

Author(s): Sergio Rubinstein, DDS;Barry P. Levin, DMD; Louis F. Rose, DDS, MD
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The Socket-Shield Technique to Support the Buccofacial Tissues at Immediate Implant Placement

The Socket-Shield Technique to Support the Buccofacial Tissues at Immediate Implant Placement
Tooth loss and subsequent ridge collapse continue to burden restorative implant treatment. Careful management of the post-extraction tissues is needed to preserve the alveolar ridge. In-lieu of surgical augmentation to correct a ridge defect, the socket-shield technique offers a promising solution. As the root submergence technique retains the periodontal attachment and maintains the alveolar ridge for pontic site development, this case report demonstrates the hypothesis that retention of a prepared tooth root section as a socket-shield prevents the recession of tissues buccofacial to an immediately placed implant. The socket-shield technique is a highly promising addition to clinical implant dentistry and this case report is among the first to demonstrate the procedure in clinical practice with a 1-year follow up.

Author(s): Howard Gluckman, BDS, MChD;Maurice Salama, DMD;Jonathan Du Toit, BChD
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Long Term Follow-Up of Dental Implants Placed in Autologous Onlay Bone Graft

Long Term Follow-Up of Dental Implants Placed in Autologous Onlay Bone Graft
The aim of this study was to evaluate the efficacy of autologous intraoral onlay bone grafting (OBG) in correlation with long-term survival rates of dental implants placed in the augmented bone. A retrospective study was conducted on 214 patients who received a total of 633 dental implants placed in 224 autologous intraoral block OBG augmentations, combined with Bio-Oss – mixed with platelet-rich plasma (PRP) and covered by platelet-poor plasma (PPP) – as scaffold, with a follow-up time up to 137 months. We suggest that augmentation of severely atrophied jaw bone through the placement of horizontal and/or vertical intraoral OBGs in combination with Bio-Oss saturated with PRP and covered by PPP should be considered a reliable, safe, and very effective surgical technique for obtaining high bone graft survival rate and high long-term implant survival rate.

Author(s): Devorah Schwartz-Arad, DMD, PhD;Ronen Ofec, DMD, MSc; Galit Eliyahu, PhD; Angela Ruban, PhD; Nir Sterer, DMD, PhD
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The Management of Recession Midfacial to Immediately Placed Implants in the Aesthetic Zone

The Management of Recession Midfacial to Immediately Placed Implants in the Aesthetic Zone
Immediate placement and loading protocols are the most technique sensitive and at the highest risk of complication, especially in the aesthetic zone. The peri-implant tissues undergo a resorption pattern that may see exposure of parts supporting the restoration, otherwise intended to be submerged, with extreme aesthetic compromise or even complete failure of treatment. The literature is not definitive in terms of any one treatment modality to recover such a complication. Grafting the exposure by a guided bone regeneration technique and an adjunct soft tissue augmentation could well restore an unaesthetic recession exposure. Recovery of midfacial recession by soft tissue augmentation alone may be successful, as is presented hereafter.

Author(s): Howard Gluckman, BDS, MChD;Jonathan Du Toit
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Ridge Preservation with Modified “Socket-Shield” Technique: A Methodological Case Series

Ridge Preservation with Modified “Socket-Shield” Technique: A Methodological Case Series
After tooth extraction, the alveolar bone undergoes a remodeling process, which leads to horizontal and vertical bone loss. These resorption processes complicate dental rehabilitation, particularly in connection with implants. Various methods of guided bone regeneration (GBR) have been described to retain the original dimension of the bone after extraction. Most procedures use filler materials and membranes to support the buccal plate and soft tissue, to stabilize the coagulum and to prevent epithelial ingrowth.

Author(s): Markus Glocker, Dr. Med. dent ; Thomas Attin; Patrick R. Schmidlin
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Effect of Different Cementation Techniques on Retained Excess Cement and Uniaxial Retention of the Implant-Supported Prosthesis

Effect of Different Cementation Techniques on Retained Excess Cement and Uniaxial Retention of the Implant-Supported Prosthesis
The aim of the study was to identify the different techniques of cementation (half filling, practice abutment, and venting) that will reduce the amount of retained cement and the effect of these techniques on retention of implant supported prostheses. The venting and practice abutment techniques are suitable methods of reducing retained excess cement with optimal retention values.

Author(s): Zubeda Begum, MDS; Radhika Sonika, BDS; Chheda Pratik, BDS
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Guided Bone Regeneration Using a Titanium Membrane at Implant Placement: A Case Report and Literature Discussion

Guided Bone Regeneration Using a Titanium Membrane at Implant Placement: A Case Report and Literature Discussion
Reconstruction of the oral supporting tissues lost by disease or trauma is essential to tooth replacement with dental implant therapy. This treatment requires evidence based augmentative procedures combined with up-to-date and current techniques. Guided bone regeneration (GBR) aims to initialize this process of alveolar ridge reconstruction by utilizing biologically active and supportive materials best coupled to the body’s healing processes. The use of nonresorbable, titanium membranes can achieve GBR by ensuring graft stability and space maintenance so as to ensure optimal neovascularization. Hereafter is a case report of a ridge defect reconstructed at implant placement, with the rationale and current, evidence-based literature discussed.

Author(s): Howard Gluckman, BDS, MChD;Jonathan Du Toit
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Post-Traumatic Treatment of Maxillary Incisors by Immediate Dentoalveolar Restoration with Long-Term Follow-Up

Post-Traumatic Treatment of Maxillary Incisors by Immediate Dentoalveolar Restoration with Long-Term Follow-Up
Replacing both missing maxillary interior teeth is particularly challenging, especially in compromised sockets. The case report describes the management of an 18-year-old female patient, who suffered avulsion of both maxillary central incisors at 7 years of age. The multidisciplinary implant technique, called Immediate Dentoalveolar Restoration (IDR), included extraction of the injured teeth and a single procedure for immediate implant placement and restoration of the compromised sockets after root fracture and peri-apical lesion development were detected during orthodontic treatment. Successful esthetic and functional outcomes and reestablishment of the alveolar process after bone reconstruction were observed during the 3-year follow-up period. The predictable esthetic outcomes and soft and hard tissue stability that can be achieved following IDR are demonstrated.

Author(s): José Carlos Martins da Rosa, DDS, MS;Ariadene Cristina Pertile de Oliveira Rosa, DDS, MSc; Carlos Eduardo Francishone, DDS, MSc, PhD; Mauricio de Almeida Cardoso, DDS, MSc, PhD; Ana Carolina Alonso, DDS; Leopoldino Capelozza Filho, DDS, MSc, PhD
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10 Tips About Aesthetic Implantology That Will Help You in Your Daily Practice

10 Tips About Aesthetic Implantology That Will Help You in Your Daily Practice
For these reasons there are some golden rules that every implantologist should manage in order to achieve predictable results on the aesthetic zone and in this article there will be described ten rules that everyone should consider:

Author(s): Dr. Francisco Teixera Barbosa
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Guidelines for the Diagnosis and Treatment of Peri-Implant Disease

Guidelines for the Diagnosis and Treatment of Peri-Implant Disease
Although some risk factors of peri-implant disease are well defined, the lack of efficient and predictable approaches to treat peri-implantitis has created difficulty in the management of those complications. The aim of this review was the evaluate the reliability of the diagnosis methods and to provide a set of guidelines to treat peri-implant disease. A search of PubMed and a hand search of articles related to peri-implant diseases were conducted up to August 2013. A summary of the current methods for the diagnosis of peri-implantitis, its potential risk factors, and a flow chart to guide the clinical management of these conditions are presented.

Author(s): Miguel Padial-Molina, DDS, PhD; Fernando Suarez, DDS; Hector F. Rios, DDS, PhD; Pablo Galindo-Moreno, DDS, PhD; Hom-Lay Wong, DDS, MSD, PhD
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Biologic Width Adjacent to Loaded Implant with Machined and Rough Collars in the Dog

Biologic Width Adjacent to Loaded Implant with Machined and Rough Collars in the Dog
Dental implant surface technology has evolved from a relatively smooth machined implant surface for osseointegration to more roughened osteoconductive surfaces. Recent studies suggest that peri-implant soft tissue inflammation with progressive bone loss (ie peri-implantitis) is becoming a prevalent condition. One possibility that could explain sucha a finding is that more bacterial plaque forms on the roughened implant and abutment surfaces, which may result in the peri-implant inflammation if the soft tissues. This study compared 36 tissue-level implants with a machined transmucosal collar to 36 implants with a relatively roughened transmucosal surface in the dog. The results demonstrated that the connective tissue contact was similar between the two implant types but that the junctional epithelium and biologic width dimensions were greater around the implants with the machined collars...

Author(s): David L. Cochran, DDS, PhD; Marcel Obrecht, SDIS; Klaus Weber, PhD, MDV, MS; Michel Dard, DDS, PhD; Dieter Bosshardt, PhD; Frank L. Higginbottom, DDS; Thomas G. Wilson Jr., DDS; Archie A. Jones, DDS
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The Management of Immediate Implant Placement to Optimize Aesthetic Outcome in the Anterior Maxilla

The Management of Immediate Implant Placement to Optimize Aesthetic Outcome in the Anterior Maxilla
Following tooth extraction the implant surgeon may select between various implant placement timing and loading protocols. Ideally these are to be determined prior to extraction, be it immediate, early, or late placement. Immediate implant placement even in the aesthetic zone is a literature supported treatment modality with success comparable to alternative placement protocols. Meticulous restorative treatment planning of a tooth destined for extraction is essential. Selecting the appropriate implant and techniques may preserve and ensure natural aesthetics. Utilizing the patient’s own tooth crown can better provisionalize the implant with a ‘walk out as you walk in’ result.

Author(s): Howard Gluckman, BDS, MChD;Jonathan Du Toit
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Immediate Placement of Dental Implants in the Esthetic Zone: A Systematic Review and Pooled Analysis

Immediate Placement of Dental Implants in the Esthetic Zone: A Systematic Review and Pooled Analysis
Research interest on immediate placement of dental implants has shifted from implant survival toward optimal preservation of soft and hard tissues. The aim of this study is to systematically assess the condition of implant survival, peri-implant hard and soft tissue changes, esthetic outcome, and patient satisfaction of immediately placed single- tooth implants in the esthetic zone. A pooled analysis was performed to identify factors associated with survival and peri-implant tissue changes after immediate implant placement. Immediate placement with immediate provisionalization of dental implants in the esthetic zone results in excellent short-term treatment outcome in terms of implant survival and minimal change of peri-implant soft and hard tissue dimensions.

Author(s): Kirsten W. Slagter; Laurens den Hartog; Nicolaas A. Bakker; Arjan Vissink; Henny J.A. Meijer; Gerry M. Raghoebar
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Diameter Selection of Implants Placed in Extraction Sockets: A New Approach

Diameter Selection of Implants Placed in Extraction Sockets: A New Approach
Implant placement in extraction sockets is considered a daunting challenge due to offering risks of bone remodeling and consequent gingival alterations. Objective: This study aims at proposing a protocol for selecting the diameter of upper anterior osseointegrated implants placed in extraction sockets. This protocol was based on the bucco-palatal dimension of the socket and allows a 3-mm gap to form between the implant and the outer surface of the buccal bone wall. Such gap must be filled with biomaterial or autograft so as to increase the predictability of long-term results.

Author(s): José Carlos Martins da Rosa, DDS, MS;Ariádene Cristina Pértile de Oliveira Rosa; Carlos Eduardo Fra ncischone; Bruno Salles Sotto-Maior
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Sinus Floor Elevation Via the Maxillary Premolar Extraction Socket With Immediate Implant Placement: A Case Series

Sinus Floor Elevation Via the Maxillary Premolar Extraction Socket With Immediate Implant Placement: A Case Series
When immediate implant placement is considered for teeth with close proximity to the sinus floor, apical extension of the osteotomy is significantly limited, and often a staged approach is used. Implant placement into fresh extraction sockets and sinus floor manipulation using bone-added osteotome sinus floor elevation with implant placement are techniques most often used independently or sequentially. In this care report, immediate implant placement with simultaneous osteotome sinus floor elevation is an advantageous combination of two successfully used techniques. This combined approach can significantly reduce the treatment time for implant therapy in teeth with close sinus proximity and provide the operator with the ability to place implants of desired length.

Author(s): Monish Bhola, DDS, MSD;Shilpa Kolhatkar; Tamika N. Thompson-Sloan
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Soft Tissue Stability with Immediate Implants and Concave Abutments

Soft Tissue Stability with Immediate Implants and Concave Abutments
The aim on the present retrospective study was to observe the dimensional alterations of the peri-implant tissues after immediate implants and single tooth restorations with concave abutments performed on 28 patients, with a mean follow-up time on 20.4 months.

Author(s): Marco Redemagni, MD, DDS; Sergio Cremonesi, DDS; Guiliano Garlini, DDS; Carlo Maiorana, MD, DDS
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Buccal Plate Regeneration with Immediate Postextraction Implant Placement and Restoration: Case Reports

Buccal Plate Regeneration with Immediate Postextraction Implant Placement and Restoration: Case Reports
In these reports, buccal bone plate regeneration was obtained through a flapless approach and immediate postextraction implant placement with a cancellous bone and collagen graft in the buccal gap.

Author(s): Alberto Maria Albiero, MD; Renato Benato, MD, DMD; Marco Degidi, MD, DDS
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Flapless Postextraction Socket Implant Placement in the Esthetic Zone: Part 1. The Effect of Bone Grafting and/or Provisional Restoration on Facial-Palatal Ridge Dimensional Change

Flapless Postextraction Socket Implant Placement in the Esthetic Zone: Part 1. The Effect of Bone Grafting and/or Provisional Restoration on Facial-Palatal Ridge Dimensional Change
The dental literature has reportted vertical soft tissue changes that can occur with immediate implant placement, bone grafting, and provisional restoration ranging from a gain or loss of 1.0mm. However, little is known of the effects of facial-palatal collapse of the ridge due to these clinical procedures. Based upon treatment modalities rendered, an ensuing contour change can occur with significant negative esthetic consequences. The results of a retrospective clinical cohort study evaluating the change in horizontal ridge dimension associated with implant placement in anterior postextraction sockets are presented for four treatment groups. Therefore, it is recommended to place a bone graft and contoured healing abutment or provisional restoration at the time of flapless postextraction socket implant placement.

Author(s): Dennis P. Tarnow, DDS;Stephen J. Chu, DMD, MSD, CDT;Maurice Salama, DMD;Christian F.J. Stappert, DDS, MS, PhD, Priv-Doz;Henry Salama, DMD;David Garber, DMD;Guido O. Sarnachiaro, DDS; Evangelina Sarnachiaro, DDS; Sergio Luis Gotta, DDS; Hanae Saito, DDS, MS
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A Novel Strategy for Bone Integration and Regeneration: Case Studies

A Novel Strategy for Bone Integration and Regeneration: Case Studies
Ultraviolet light treatment of dental implants immediately prior to placement, or photofunctionalization, is a novel clinical tool with the potential to improve implant therapy. Photofunctionalization improves the surface properties of titanium surfaces by removing hydrocarbons, regenerating hydrophilicity, and optimizing electrostatic properties. We photofunctionalizated dental implants and titanium mesh (Ti mesh) in two complex clinical cases requiring simultaneous guided bone regeneration, sinus elevation, immediate implant placement into the extraction socket, and esthetic consideration

Author(s): Akiyoshi Funato, D.D.S.;Ryohei Tonotsuka, DDS; Hitochi Murabe, DDS; Makoto Hirota, DDS, PhD; Takahiro Ogawa, DDS, PhD
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Complex Case Rehabilitation in Light of New Technologies

Complex Case Rehabilitation in Light of New Technologies
This case report describes a step-by-step full arch restoration (upper and lower), rehabilitated utilizing new technologies in dentistry. CAD/CAM technology has changed not only the technician's working process, but also the clinician's, offering new benefits to clinical workflow.For example the possibility of using zirconia and its characteristics as a restorative material. The clinician's and technician's professional backgrounds and relationships are critical to achieving optimal aesthetic and functional results; while prosthetic success depends upon an in-depth knowledge of the materials and their properties and on carefully performed clinical procedures, which are still of utmost importance to obtain satisfactory results.

Author(s): Alessandro Agnini, DMD;Andrea Mastrorosa Agnini, DDS;Luca Dondi, DT;Matteo Dondi, DT
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Two Immediate Temporization Methods Exemplified: Flap vs. Punch Technique in Implant Surgery

Two Immediate Temporization Methods Exemplified: Flap vs. Punch Technique in Implant Surgery
Protocols and techniques for immediate tooth replacement in the esthetic zone have become more popular and predictable within the past decade. Two different clinical scenarios are presented where immediate temporization of implants placed into healed or augmented ridges is exemplified. The benefits of augmentation prior to implant placement and temporization are that flap elevation is not required; therefore, the blood supply to the labial plate is not compromised, thereby eliminating potential midfacial recession. In addition, the soft tissue subgingival shape of the temporary crown can be non-surgically sculpted at the time of implant placement since the patient is already anesthetized.

Author(s): Stephen J. Chu, DMD, MSD, CDT;Dennis P. Tarnow, DDS
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Esthetic Rehabilitation of the Periodontally Compromised Dentition - A Novel Interdisciplinary Approach Using Orthodontic Extrusion and Dental Implants

Esthetic Rehabilitation of the Periodontally Compromised Dentition - A Novel Interdisciplinary Approach Using Orthodontic Extrusion and Dental Implants
Rehabilitation of esthetics in advanced periodontal cases presents a major challenge in dentistry today. Patients with advanced disease affecting teeth in the esthetic zone, where significant asymmetrical bone loss and tissue recession are present, constitute a challenging treatment-planning dilemma when choosing the optimum therapeutic option for long-term maintenance. This article reviews a novel interdisciplinary approach for vertical augmentation of bone and soft tissues by means of orthodontic extrusion of severely periodontally compromised teeth, facilitating the restoration of esthetics with improved bone and soft tissue volume around immediate implants.

Author(s): Tidu Mankoo, BDS
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RevitaliZe Patient Solutions: preliminary results from a single cohort prospective study using Screw-Vent TSVT implants

RevitaliZe Patient Solutions: preliminary results from a single cohort prospective study using Screw-Vent TSVT implants
The aim of this paper was to report preliminary results from a cohort of subjects treated with the RevitaliZe Patient Solutions approach. Clinical and radiographic results of axial and tilted implants up to fourteen months of loading are presented. Seven patients were followed up for an average of 11,88 months (range 8-16 months). Five subjects received implant treatment in both arches, resulting in 12 restorations. A total of 48 fixtures were placed and no failure was reported during the follow-up period, leading to 100% implant and prosthetic survival rates. Radiographic analysis after 6 months of loading was conducted for all prostheses. No significant difference in marginal bone loss was found between tilted and axial implants in both jaws. The present preliminary data suggests that immediate loading with RevitaliZe Patient Solutions could be considered a predictable and cost- and timeeffective approach for the treatment of total edentulism.

Author(s): Alessandro Agnini, DMD;Maurice Salama, DMD;Andrea Mastrorosa Agnini, DDS;Henry Salama, DMD;Christian F.J. Stappert, DDS, MS, PhD, Priv-Doz;Davide Romeo, DDS, PhD
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Immediate Rehabilitation of the Extremely Atrophic Mandible with Fixed Full-Prosthesis Supported by Four Implants

Immediate Rehabilitation of the Extremely Atrophic Mandible with Fixed Full-Prosthesis Supported by Four Implants
The purpose of this article is to prospectively assess the outcome of immediate rehabilitation of extremely atrophic mandibles by a full-arch fixed bridge anchored to four implants. All patients were followed for a minimum of 1 year (range 20–48 months, mean 30.1 months). No failures were recorded to date. The 1-year implant survival rate and prosthesis success rate were 100%.Marginal bone loss around axial and tilted implants was similar at 12-month evaluation, being, respectively, 0.6 1 0.3 (standard deviation) mm and 0.7 1 0.4 mm. High patient’s level of satisfaction was recorded for function, phonetics, and aesthetics.

Author(s): Enrico Agliardi, MD, DDS;Davide Romeo, DDS, PhD;Roberto Weinstein, MD, DDS; Massimo D. Fabbro, BSc, PhD; Luca Francetti, MD, DDS
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Success Rate, Healing Time, and Implant Stability of Photofunctionalized Dental Implants

Success Rate, Healing Time, and Implant Stability of Photofunctionalized Dental Implants
This is the first study to report the clinical outcomes of photofunctionalized dental implants. This retrospective study analyzed 95 consecutive patients who received 222 untreated implants and 70 patients who received 168 photofunctionalized implants over a follow-up period of 2.5 years. Photofunctionalization was performed by treating implants with UV light for 15 minutes using a photo device immediately before placement. Within the limits of this retrospective study, despite the more frequent use of shorter and smaller-diameter implants, the use of photofunctionalization allowed for a faster loading protocol without compromising the success rate.

Author(s): Akiyoshi Funato, D.D.S.;Masahiro Yamada; Takahiro Ogawa
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A Technique for Making Impressions of Deeply Placed Implants

A Technique for Making Impressions of Deeply Placed Implants
Precise fit between dental implants and the superstructure is important for the long term success of implants and implant-supported prostheses. One factor which may influence the accuracy of the definitive prosthesis is the stability of the impression coping in polymerized impression material. In some circumstances, an implant must be placed well below the gingival margin, meaning that most of the impression coping will also be situated subgingivally with no contact with the impression material. This can result in reduced stability of the impression coping, allowing it to rotate when fastening the implant analog. This article describes a simple technique that involves the use of a roll of composite resin, tray adhesive, and a small amount of occlusal registration material applied around a transfer coping in a direct implant impression.

Author(s): Tomas Linkevicius, DDS, Dip Pros, PhD;Olga Svediene, DDS; Egle Vindasiute, DDS;Laura Linkeviciene, DDS, PhD; Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Management of Retrograde Peri-Implantitis by Apical Resection and Guided Bone Regeneration in Adjacent Maxillary Implants

Management of Retrograde Peri-Implantitis by Apical Resection and Guided Bone Regeneration in Adjacent Maxillary Implants
Retrograde peri-implantitis (RPI) is defined as a clinically symptomatic periapical lesion that develops shortly after implant insertion while the coronal portion of the implant sustains a normal bone-to-implant interface. A 61-year-old male was screened and evaluated for three maxillary anterior implants placed 10 years previously. Evaluation included a thorough periodontal and dental exam, radiographs, and cone-beam computed tomography. Probing depths around all implants ranged from 2 to 4 mm with no bleeding on probing/mobility. The apices of implants #8 and #9 exhibited radiolucencies, and a draining fistula was associated with implant #8. Treatment consisted of sectioning and removal of the affected portion of the implants and collection of a specimen for histopathologic examination. Resection of the apical portion of implants is a viable treatment modality in the management of RPI.

Author(s): Monish Bhola, DDS, MSD;Tamika N. Thompson-Sloan; Shilpa Kolhatkar
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Soft Tissue Enhancement After Implant Placement

Soft Tissue Enhancement After Implant Placement
Soft tissue management is one of the key factors for successful implant restoration. Esthetics can be strongly influenced by the conditions of the peri-implant tissue. Substantial knowledge of tissue anatomy and biology is a fundamental prerequisite for surgical success. The present chapter introduces different techniques to improve the appearance of the soft tissue after implant placement. Cases of repositioned flaps, FGGs, and CTGs are presented along with biological considerations. It was our intention to present various indications and options to the clinician to achieve an increased amount of peri-implant KG or connective tissue thickness.

Author(s): Christian F.J. Stappert, DDS, MS, PhD, Priv-Doz;Davide Romeo, DDS, PhD
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Significance of Crown Shape in the Replacement of a Central Incisor with a Single Implant-Supported Crown

Significance of Crown Shape in the Replacement of a Central Incisor with a Single Implant-Supported Crown
When utilizing a single implant-supported crown to replace a central incisor, understanding the final shape of the implant restoration is an important factor to help achieve a successful esthetic outcome. In today's dentistry, tooth shape is a critical factor when dental implant prosthesis are considered in the esthetic zone. The goal of this study was to objectively analyze the significance of natural crown shape when replacing a central incisor with a single implant-supported crown. Data analysis revealed that is there is a "black triangle", a diastema, or presence of dental or gingival asymmetry, an additional restoration on the adjacent central incisor is often required in order to fulfill esthetic goals. The additional restoration is highly recommended in situations with a triangular crown shape, while it is suggested in cases of square/tapered and square tooth shapes in the presence of a dental diastema.

Author(s): Luca Gobbato, DDS, MS;Gianluca Paniz, DDS, MS, FACP;Fabio Mazzocco, DDS; Andrea Chlerico, DDS; Teppel Tsukyama, DDS; Paul A. Levi Jr. DMD; Arnold S. Welsgold, DDS
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Clinical Outcome of Submerged vs. Non-Submerged Implants Placed in Fresh Extraction Sockets

Clinical Outcome of Submerged vs. Non-Submerged Implants Placed in Fresh Extraction Sockets
The aim of this study was to compare the clinical outcome of submerged vs. nonsubmerged tapered implants placed into fresh extraction sockets. The results showed statistically significant differences between the two groups in the mean value of keratinized tissue (KT) height after surgery that was significantly reduced for submerged implants when compared with transmucosal implants. Similar outcomes were found for submerged and non-submerged implants placed in fresh extraction sockets with a horizontal peri-implant defect smaller than 2mm, except for a reduction of KT in the submerged group. Either with a submerged or a nonsubmerged procedure, 1mm of mean soft tissue recession is seen after 1 year when compared with the pre-extraction situation.

Author(s): Luca Cordaro; Ferruccio Torsello; Mario Roccuzzo
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Maintaining Interimplant Crestal Bone Height Via a Combined Platform-Switched, Laser-Lok Implant/Abutment System: A Proof-of-Principle Canine Study

Maintaining Interimplant Crestal Bone Height Via a Combined Platform-Switched, Laser-Lok Implant/Abutment System: A Proof-of-Principle Canine Study
Interimplant papillae are critical for achieving esthetic implant-supported restorations in the maxillary esthetic zone. Stable papillary anatomy, however, depends upon a stable volume underlying crestal bone for support. Multiple studies have documented a critical interimplant distance of 3mm under which crestal bone resorption occurs. This preclinical proof-of-principle canine study examines a novel implant-abutment system design, combining platform switching with precisely configured laser-ablated abutment and implant microgrooves to maintain interimplant crestal bone at interimplant distances of 2 and 4 mm. Results of this initial preclinical study suggest that it is possible through precise implant/abutment design modifications to place adjacent implants at distance of 2 to 4 mm without inducing subpapillary crestal bone loss.

Author(s): Myron Nevins, DDS;Marc Nevins, DMD, MMSc; Luca Gobbato, DDS, MS; Hyo-Jung Lee, DDS, PhD; Chin-Wei Wang, DDS; David M. Kim, DDS, DMSc
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Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis

Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis
The purpose of this study was to determine the relationship between patients with a history of periodontitis and development of cement-related peri-implant disease. Seventy-seven patients with 129 implants for this retrospective analysis were selected from completed implant cases that were scheduled for regular maintenance or had experienced mechanical or biological complications between years 2006 and 2011 in private practice. Implants with extracoronal residual cement and implants without cement remnants were analyzed.

Author(s): Tomas Linkevicius, DDS, Dip Pros, PhD;Algirdas Puisys; Egle Vindasiute; Laura Linkeviciene; Peteris Apse
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The Dual-Zone Therapeutic Concept of Managing Immediate Implant Placement and Provisional Restoration in Anterior Extraction Sockets

The Dual-Zone Therapeutic Concept of Managing Immediate Implant Placement and Provisional Restoration in Anterior Extraction Sockets
Improvements in implant designs have helped advance successful immediate anterior implant placement into fresh extraction sockets. Clinical techniques described in this case enable practitioners to achieve predictable esthetic success using a method that limits the amount of buccal contour change of the extraction site ridge and potentially enhances the thickness of the peri-implant soft tissues coronal to the implant-abutment interface. This approach involves atraumatic tooth removal without flap elevation, and placing a bone graft into the residual gap around an immediate fresh-socket anterior implant with a screw-retained provisional restoration acting as a prosthetic socket seal device.

Author(s): Stephen J. Chu, DMD, MSD, CDT;Maurice Salama, DMD;Henry Salama, DMD;David Garber, DMD;Dennis P. Tarnow, DDS;Hanae Saito, DDS, MS
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Clinical Investigation on Axial versus Tilted Implants for Immediate Fixed Rehabilitation of Edentulous Arches: Preliminary Results of a Single Cohort Study

Clinical Investigation on Axial versus Tilted Implants for Immediate Fixed Rehabilitation of Edentulous Arches: Preliminary Results of a Single Cohort Study
The aims of this study were to evaluate the clinical outcomes and patients’ satisfaction with immediately loaded full-arch fixed prostheses supported solely by axial or by a combination of axial and tilted implants in both jaws and to compare the outcome of tilted versus axial fixtures in the same patients up to 5 years. The null hypothesis was that no difference in survival rate and marginal bone level change would exist between axial and tilted implants and no difference in prosthetic survival between rehabilitation's supported only by axial implants or by a combination of axial and tilted implants.

Author(s): Alessandro Agnini, DMD;Andrea Mastrorosa Agnini, DDS;Davide Romeo, DDS, PhD;Christian F.J. Stappert, DDS, MS, PhD, Priv-Doz;Manuele Chiesi, DDS; Leon Pariente, DDS
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Immediate Dentoalveolar Restoration - A New Technique for Compromised Extraction Sites

Immediate Dentoalveolar Restoration - A New Technique for Compromised Extraction Sites
Immediate loading of implant in damaged fresh extraction socket with gingival architecture involvement, using bone sliver graft from maxillary tuberosity: a clinical case. <br> Immediate loading of implants in undamaged sockets following tooth extraction is very well established in the literature. In cases of tooth loss with socket structure loss, the esthetic risk increases, thus contraindicating immediate loading, such that the bone graft procedure needs to be prior to implant insertion. This paper describes an immediate loading procedure in a damaged fresh socket in the region of an upper central incisor that presented unevenness of gingival contour.

Author(s): José Carlos Martins da Rosa, DDS, MS
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Restoring Facial Aesthetics and Function with Implant Overdentures

Restoring Facial Aesthetics and Function with Implant Overdentures
Implant supported overdentures are fast becoming the choice of treatment for edentulous patients as they provide various advantages over the conventional dentures; most importantly they are a reliable and simple solution to denture retention and stability problems. This article discusses aesthetics and function provided with implant borne Overdentures in Maxillary and Mandibular arches.

Author(s): Lanka Mahesh, BDS, MBA;Gregori M. Kurtzman, DDS; Lee H. Silverstein, DDS, MS, Vishal Gupta, BDS
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Retrospective Evaluation of Crestal Bone Changes Around Implants With Reduced Abutment Diameter Placed Non-Submerged and at Subcrestal Positions: The Effect of Bone Grafting at Implant Placement

Retrospective Evaluation of Crestal Bone Changes Around Implants With Reduced Abutment Diameter Placed Non-Submerged and at Subcrestal Positions: The Effect of Bone Grafting at Implant Placement
One method to measure the success of dental implant treatment is to evaluate marginal peri-implant bone-level changes and stability over time. The location of the fixture–abutment interface (FAI) can be of major importance when the goal is to construct esthetic restorations. In these situations the FAI is often placed in a more apical position to create an ideal emergence profile for the prosthetic construction. However, several animal studies have reported that placement of the FAI in a subcrestal position may result in peri-implant marginal bone loss. The aim of the present study is to evaluate the effect of bone grafting of the defect between the bone crest and the coronal aspect of the implant for implants with reduced abutment diameters placed non-submerged and in subcrestal positions.

Author(s): Alan Fetner, DMD;Theofilos Koutouzis, DDS; Michael Fetner, DMD; Tord Lundgren, DDS
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Crestal Bone Changes Around Implants With Reduced Abutment Diameter Placed Non-Submerged and at Subcrestal Positions: A 1-Year Radiographic Evaluation

Crestal Bone Changes Around Implants With Reduced Abutment Diameter Placed Non-Submerged and at Subcrestal Positions: A 1-Year Radiographic Evaluation
There is limited information about two-part implants placed in subcrestal positions. The present study reported a minimal loss of mineralized hard tissue around dental implants placed non-submerged and at subcrestal positions. In addition, these implants had hard tissue healing that extended onto the implant shoulders on most of the observed implants.

Author(s): Alan Fetner, DMD;Ryan Donovan; Theofilos Koutouzis; Tord Lundgren
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Advantages of the Root Submergence Technique for Pontic Site Development in Esthetic Implant Therapy

Advantages of the Root Submergence Technique for Pontic Site Development in Esthetic Implant Therapy
This article suggests a strategy to provide a more predictable protocol for esthetic implant treatment for multiple- tooth defects using the root submergence technique (RST). The RST maintains the natural attachment apparatus of the tooth in the pontic site, which in turn allows for complete preservation of the alveolar bone frame and assists in the creation of an esthetic result in adjacent multipletooth- replacement cases.

Author(s): Maurice Salama, DMD;Henry Salama, DMD;Akiyoshi Funato, D.D.S.;Tomohiro Ishikawa, DDS;David Garber, DMD
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Pilot Clinical and Histologic Evaluations of a Two-Piece Zirconia Implant

Pilot Clinical and Histologic Evaluations of a Two-Piece Zirconia Implant
An investigation was conducted to evaluate the clinical and histologic results of bone and soft tissue healing around a two-piece zirconia dental implant in a human model.

Author(s): Myron Nevins, DDS;Marcelo Camelo, DDS; Marc L. Nevins, DMD, MMSc; Peter Schupbach, PhD; David M. Kim, DDS, DMSc
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Immediate Implant Placement with GBR Using Alloplast

Immediate Implant Placement with GBR Using Alloplast
Presented here is a case report wherein guided bone regeneration was done simultaneously at the time of immediate implant placement to achieve a desirable outcome.

Author(s): Lanka Mahesh, BDS, MBA;Dr. Sagrika Shukla; Dr. Prashant Nanda; Dr. Manoj Eapen
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Biologic Interfaces in Esthetic Dentistry - Part II: The Peri-implant/Restorative Interface

Biologic Interfaces in Esthetic Dentistry - Part II: The Peri-implant/Restorative Interface
The design of the implant–abutment interface is important because it is one of the primary determinants of prosthetic stability.

Author(s): Arndt Happe, Dr med dent, DDS; Gerd Körner, Dr med dent
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Anterior Extraction &amp; Implant Placement in a Severely Deficient Site

Anterior Extraction & Implant Placement in a Severely Deficient Site
Extraction and implant placement is a functionally predictable therapeutic modality. Esthetic predictability, however, can sometimes prove elusive. This is especially true for the implant replacement of severely compromised anterior teeth with hard and soft tissue deficiencies within the esthetic zone.

Author(s): Sergio Rubinstein, DDS;Maurice Salama, DMD;Henry Salama, DMD;David Garber, DMD;Mark B. Jacob, DDS
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Computer-aided Design/Computer-aided Manufacturing Applications Using CT and Cone Beam CT Scanning Technology

Computer-aided Design/Computer-aided Manufacturing Applications Using CT and Cone Beam CT Scanning Technology
The advent of 3-D reconstruction using CT or cone beam CT (CBCT) empowers clinicians with tools to simulate implant placement, bone grafts, or orthognathic surgical procedures in a true and accurate virtual environment.

Author(s): Scott D. Ganz, DMD
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Techniques for the Use of CT Imaging for the Fabrication of Surgical Guides

Techniques for the Use of CT Imaging for the Fabrication of Surgical Guides
Often, difficulties related to poor surgical or prosthetic outcomes can be directly linked to the diagnostic and treatment-planning phase.

Author(s): Scott D. Ganz, DMD
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Screw Spreading: Technical Considerations and Case Report

Screw Spreading: Technical Considerations and Case Report
The spreading system is an alternative technique to the Summers osteotome. A specific screw instrument, the "spreader", achieved a controlled and standardized dilation of the bone horizontally.

Author(s): Renato Sussumu Nishioka, DDS, PhD, MSc; Alberto Noriyuki Kojima, DDS, PhD, MSc
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Immediate Occlusal Loading (IOL) of Dental Implants: Predictable Results Through DIEM Guidelines

Immediate Occlusal Loading (IOL) of Dental Implants: Predictable Results Through DIEM Guidelines
In recent years, the immediate loading of dental implants has become more accepted as a standard protocol for the treatment of the fully edentulous mandible. The pioneers in implant dentistry often tried this technique but only achieved mixed success. One of the main reasons for the failure of these early attempts was the lack of understanding of the biological and mechanical principles that we now know are necessary for clinical success.

Author(s): Craig M Misch, DDS, MDS;Tiziano Testori, MD, DDS, FICD;Dennis P. Tarnow, DDS;Richard J. Lazzara, DMD, MScD, Alan Meltzer, DDS, MScD, Stephan Porter, DDS, MDS, MS, Robert del Castillo, DMD, Ronnie J. Goene, DDS
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Save the Natural Tooth or Place an Implant? Three Periodontal Decisional Criteria to Perform a Correct Therapy

Save the Natural Tooth or Place an Implant? Three Periodontal Decisional Criteria to Perform a Correct Therapy
To perform advanced periodontal therapy to save a natural tooth or to extract it and place an implant-which is best?

Author(s): Giano Ricci, MD, DDS, MScD; Andrea Ricci, DDS; Caterina Ricci, DDS
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Dental Cone Beam Computed Tomography Analyses of Postoperative Labial Bone Thickness in Maxillary Anterior Implants - Comparing Immediate and Delayed Implant Placement

Dental Cone Beam Computed Tomography Analyses of Postoperative Labial Bone Thickness in Maxillary Anterior Implants - Comparing Immediate and Delayed Implant Placement
This study aimed to evaluate the influence of labial alveolar bone thickness and the corresponding vertical bone loss on postoperative gingival recessions around anterior maxillary dental implants.

Author(s): Yasukazu Miyamoto, DDS;Tadakazu Obama, DDS
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Bio-Oss Collagen in the Buccal Gap at Immediate Implants - A 6-Month Study in the Dog

Bio-Oss Collagen in the Buccal Gap at Immediate Implants - A 6-Month Study in the Dog
Following tooth extraction and immediate implant installation, the edentulous site of the alveolar process undergoes substantial bone modeling and the ridge dimensions are reduced. Five beagle dogs about 1 year old were used. The 4th premolar in both quadrants of the mandible were selected and used as experimental sites.The outline of the marginal hard tissue of the control sites was markedly different from that of the grafted sites.

Author(s): Dr. Mauricio G. Araújo; Dr. Elena Linder; Dr. Jan Lindhe
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Microbiology of Peri Implant Infections

Microbiology of Peri Implant Infections
It is important to understand the microbiological aspects of peri-implant disease in order to proffer appropriate treatment.

Author(s): Lanka Mahesh, BDS, MBA;Gregori M. Kurtzman, DDS; Tv Narayan, BDS, MDS; Dr. Sagrika Shukla
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A comparative study of bone densitometry during osseointegration: Piezoelectric surgery versus rotary protocols

A comparative study of bone densitometry during osseointegration: Piezoelectric surgery versus rotary protocols
The aim of this study was to compare the radiographic differences, through evaluation of peri-implant bone density, between implant insertion using traditional surgical technique and piezoelectric technique.

Author(s): Luca Di Alberti, DDS, PhD; Federica Donnini, RDH; Claudio Di Alberti, DDS; Michele Camerino, DDS
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Maximizing Aesthetics in the Deficient Alveolar Ridge

Maximizing Aesthetics in the Deficient Alveolar Ridge
This article will present a predictable method for replacing the lost bone prior to implant placement through the ramus block graft technique.

Author(s): Steven L. Rasner, DMD, MAGD
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Peri-Implant Tissue Response Following Connective Tissue and Bone Grafting in Conjunction with Immediate Single-Tooth Replacement in the Esthetic Zone

Peri-Implant Tissue Response Following Connective Tissue and Bone Grafting in Conjunction with Immediate Single-Tooth Replacement in the Esthetic Zone
The case series evaluated the peri-implant tissue response following extraction and immediate placement and restoration of an implant in conjunction with subepithelial connective tissue graft (SCTG) and bone grafting in the esthetic zone.

Author(s): Hirotaka Tsuda, DDS; Kitichai Rungcharassaeng, DDS, MS; Joseph Y. K. Kan, DDS, MS; Phillip Roe, DDS, MS; Jaime L. Lozada, DDS; Grenith Zimmerman, PhD
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Three-Dimensional Bone and Soft Tissue Requirements for Optimizing Esthetic Results in Compromised Cases with Multiple Implants

Three-Dimensional Bone and Soft Tissue Requirements for Optimizing Esthetic Results in Compromised Cases with Multiple Implants
In this article, the concepts behind achieving esthetic and functional implant restorations and the necessary three-dimensional peri-implant hard and soft tissue management required to realize these goals are discussed.

Author(s): David Garber, DMD;Maurice Salama, DMD;Henry Salama, DMD;Akiyoshi Funato, D.D.S.;Tomohiro Ishikawa, DDS;Hajime Kitajima, DDS; Hidetada Moroi, DMD
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The Efficacy of Full-Arch Immediately Restored Implant-Supported Reconstructions in Extraction and Healed Sites - A 36-Month Retrospective Evaluation

The Efficacy of Full-Arch Immediately Restored Implant-Supported Reconstructions in Extraction and Healed Sites - A 36-Month Retrospective Evaluation
Implants placed and restored immediately in a cross-arch mode, whether in extraction sites or in healed alveoli, can be clinically successful and maintainable.

Author(s): Zvi Artzi, DMD; Jerry Kohen, DMD; Guy Carmeli, DMD; Benny Karmon, DMD; Ariel Lor, DMD; Zeev Ormianer, DMD
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The Reverse Pathway - Parameters for the Integration of Function and Aesthetics with Implants

The Reverse Pathway - Parameters for the Integration of Function and Aesthetics with Implants
Restorative driven implant based decision making by the surgeon will lead to the correct augmentation and implant selection for the specific needs of the patient. This "reverse pathway" approach is the protocol featured in this article to achieve excellent results and avoid complications.

Author(s): Sergio Rubinstein, DDS;David Garber, DMD;Henry Salama, DMD;Maurice Salama, DMD
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Sinus Augmentation for Single-Tooth Replacement in the Posterior Maxilla: A 3-Year Follow-up Clinical Report

Sinus Augmentation for Single-Tooth Replacement in the Posterior Maxilla: A 3-Year Follow-up Clinical Report
A technique for single-tooth sinus lift and simultaneous implant placement in the posterior maxilla is presented. Ten hydroxyapatite-coated cylindric implants, 13 to 15 mm in length, were placed together with a composite bone graft of demineralized freeze-dried bone allograft and autogenous bone in 10 adults. Surgical technique and anatomic considerations are discussed. Follow-up of 3 years showed successful function and no cervical bone loss in all patients.

Author(s): Ziv Mazor, DMD;Michael Peleg, DMD;Michael Peleg, DMD; Martin Gross, BDS, LDS, MSc
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Smoking and Complications of Endosseous Dental Implants

Smoking and Complications of Endosseous Dental Implants
Titanium endosseous implants have been increasingly used in various edentulous situations for well over a decade. Cigarette smoking has long been suspected as adversely affecting wound healing. Arteriolar vasoconstriction and decreased blood flow are seen in response to smoking. In the oral cavity,an increase in plaque accumulation,a higher incidence of gin-givitis and periodontitis,a higher rate of tooth loss,and an increased resorption of the alveolar ridge have been found among smokers.

Author(s): Devorah Schwartz-Arad, DMD, PhD;Naama Samet, Nachum Samet, and Avi Mamlider
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Immediate Custom Implant Provisionalization: A Prosthetic Technique

Immediate Custom Implant Provisionalization: A Prosthetic Technique
This article outlines a provisionalization technique that can be performed after traditional healing of the implant site. Upon reading this article, the reader should: Realize that this technique is also effective when immediate implant loading is not possible. Become familiar with the benefits of an immediate customized provisional, including duplicating the emergence profile of the extracted tooth.

Author(s): Gerard Lemongello, DMD
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Customized Provisional Abutment and Provisional Restoration for an Immediately-Placed Implant

Customized Provisional Abutment and Provisional Restoration for an Immediately-Placed Implant
This article explores provisionalization immediately following surgical implant placement. Upon reading this article, the reader should: • Understand how the immediate placement of a custom provisional abutmentguides tissue healing. • Recognize how provisionalization can preserve hard and soft tissues and help minimize the duration of treatment.

Author(s): Gerard Lemongello, DMD
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Utilising a restorative approach to correct an adult skeletal class III malocclusion

Utilising a restorative approach to correct an adult skeletal class III malocclusion
Gerard J. Lemongello discusses all the steps taken to correct the malocclusion.

Author(s): Gerard Lemongello, DMD
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Failure Causes,Timing, and Cluster Behavior:An 8-Year Study of Dental Implants

Failure Causes,Timing, and Cluster Behavior:An 8-Year Study of Dental Implants
An implant-supported restoration offers a predictable treatment for tooth replacement. 1–3 Success rates for implants are high. Never the-less,failures that mandate implant removal do occur.This lengthens and complicates the treatment process, 3–7 as well as jeopardize the clinician’s efforts to accomplish satisfactory function and esthetics. For the patient,this usually involves further cost and additional procedures.

Author(s): Devorah Schwartz-Arad, DMD, PhD;Amir Laviv,DMD,and Liran Levin,DMD
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Bone Grafting of Previously Used Symphysial Donor Sites for Onlay of Newly Formed Bone and Reharvesting Potential Symphysis Revisited:Clinical and Histologic Evaluation

Bone Grafting of Previously Used Symphysial Donor Sites for Onlay of Newly Formed Bone and Reharvesting Potential Symphysis Revisited:Clinical and Histologic Evaluation
Placement of an endosseous implant requires sufficient bone volume for complete bone coverage. The use of intraoral block bone grafts from intraoral sources has increased over the years. Possible sources for autogenic bone are the calvarium ,tibia,and the iliac crest(frequently used for major jaw reconstruction).However,these sources are not always recommended because of their morbidity,altered ambulation,and the need for hospitalization,as well as significant resorption associated with corticocancellous block grafts from endochondral donor sites.

Author(s): Devorah Schwartz-Arad, DMD, PhD;Liran Levin
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Radiological Findings of the Post-Sinus Lift Maxillary Sinus: A Computerized Tomography Follow-Up

Radiological Findings of the Post-Sinus Lift Maxillary Sinus: A Computerized Tomography Follow-Up
The purpose of this article is to present radiological findings of a short-term (8 to 10 months) computerized tomography (CT) follow-up study on 1-stage maxillary sinus lift cases.

Author(s): Ziv Mazor, DMD;Michael Peleg, DMD;Gavriel Chaushu, Leon Ardekian and Mati Bakoon
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Cortical Tenting Grafting Technique in the Severely Atrophic Alveolar Ridge for Implant Site Preparation

Cortical Tenting Grafting Technique in the Severely Atrophic Alveolar Ridge for Implant Site Preparation
Tenting of the periosteum and soft tissue matrix using a cortical bone block maintains space and minimizes resorption of the particulate allograft volume. In addition,bridging the cortical blocks with particulate bone avoids unaesthetic ridge defects between cortical block grafts in larger ridge defects. The result was a more uniform and esthetic alveolar ridge, capable of maintaining an implant-supported prosthesis. The technique offers predictable functional and esthetic reconstruction of large volume defects without extensive amounts of autogenous bone. This of- fers a superior functional and esthetic result than with either cortical or particulate grafting alone.

Author(s): Bach Le, DDS, MD, FICD;Jeffrey Burstein, DDS, MD; P. Parish Sedghizadeh, DDS, MS
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Predictability of Simultaneous Implant Placement in the Severely Atrophic Posterior Maxilla: A 9-Year Longitudinal Experience Study of 2,132 Implants Placed into 731 Human Sinus Grafts

Predictability of Simultaneous Implant Placement in the Severely Atrophic Posterior Maxilla: A 9-Year Longitudinal Experience Study of 2,132 Implants Placed into 731 Human Sinus Grafts
Simultaneous implant placement into sinus floor grafts can be a predictable treatment option for patients with at least 1 to 2 mm of vertical residual bone height when careful case planning and meticulous surgical techniques are used.

Author(s): Ziv Mazor, DMD;Michael Peleg, DMD;Arun K. Garg, DMD
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Astra Tech OsseoSpeed 3.0 S Implant

Astra Tech OsseoSpeed 3.0 S Implant
Reduced-diameter implants help manage narrow edentulous spaces.

Author(s): Richard Martin, DDS
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Coloca&#231;&#227;o imediata de implantes na zona anterior

Colocação imediata de implantes na zona anterior
Para uma reabilitação implanto-suportada com um bom resultado estético existem certos requisitos que devem ser respeitados. O Dr. Miguel Stanley e o Dr. João Amaral fazem a sua revisão neste artigo.

Author(s): Miguel Stanley, DDS;Dr. Joao Amaral
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Pr&#243;tese fixa sobre implantes: cimentar ou aparafusar?

Prótese fixa sobre implantes: cimentar ou aparafusar?
Prótese fixa sobre implantes: cimentar ou aparafusar?

Author(s): Miguel Stanley, DDS;Ricardo Vieira Alho
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Reabilita&#231;&#227;o fixa em zona est&#233;tica ap&#243;s extrus&#227;o ortod&#244;ntica de um dente periodontalmente comprometido

Reabilitação fixa em zona estética após extrusão ortodôntica de um dente periodontalmente comprometido
Reabilitação fixa em zona estética após extrusão ortodôntica de um dente periodontalmente comprometido

Author(s): Miguel Stanley, DDS;Ricardo Vieira Alho, Joao Amaral
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Sinus Floor Augmentation With Simultaneous Implant Placement Using Choukroun’s Platelet-Rich Fibrin as the Sole Grafting Material: A Radiologic and Histologic Study at 6 Months

Sinus Floor Augmentation With Simultaneous Implant Placement Using Choukroun’s Platelet-Rich Fibrin as the Sole Grafting Material: A Radiologic and Histologic Study at 6 Months
Sinus augmentation with simultaneous implant placement without bone graft material is a hotly debated technique. This technique could be improved and secured by the use of an autologous leukocyte-and platelet-rich fibrin (PRF) (Choukroun’s technique) concentrate. The objectives of this study were to assess the relevance of PRF clots and membranes as the sole filling material during a lateral sinus lift with immediate implantation using radiologic and histologic analyses in a case series.

Author(s): Ziv Mazor, DMD;Robert A. Horowitz, DDS;Marco Del Corso, Hari S. Prasad, Michael D. Rohrer and David M. Dohan Ehrenfest
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Healing in Smokers Versus Nonsmokers: Survival Rates for Sinus Floor Augmentation with Simultaneous Implant Placement

Healing in Smokers Versus Nonsmokers: Survival Rates for Sinus Floor Augmentation with Simultaneous Implant Placement
Evidence suggests that smoking is detrimental to the survival of dental implants placed in grafted maxillary sinuses. Studies have shown that improving bone quantity and quality, using rough- surfaced implants, and practicing good oral hygiene may improve outcomes. In this prospective study, the long-term survival rates of implants placed simultaneously with sinus grafting in smokers and non- smokers were compared.

Author(s): Ziv Mazor, DMD;Michael Peleg, DMD;Arun K. Garg, DMD
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Defining New Paradigms for Assessment of Implant Receptor Sites

Defining New Paradigms for Assessment of Implant Receptor Sites
This article will demonstrate how computed tomography combined with interactive virtual treatment-planning software applications can empower clinicians with enhanced diagnostic capabilities for implant receptor-site assessment.

Author(s): Scott D. Ganz, DMD
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The Bio-Derm Ridge Plumping Technique for Pontic Site Development

The Bio-Derm Ridge Plumping Technique for Pontic Site Development
Seibert Class III apicocoronal and buccolingual alveolar ridge defects with associated gingival mucosal atrophy and absence of interdental papillae are common in edentulous areas within the anterior esthetic zone of the maxilla. Normal emergence profiles, critical to achieving esthetic restorations, require restoration of normal hard and soft tissue morphology, including re-establishment of adjacent interdental papillae.

Author(s): Nicholas Toscano, DDS, MS;Dan Holtzclaw, DDS, MS
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Introducing Choukroun’s Platelet Rich Fibrin (PRF) to the Reconstructive Surgery Milieu

Introducing Choukroun’s Platelet Rich Fibrin (PRF) to the Reconstructive Surgery Milieu
Platelet-rich fibrin (PRF), developed in France by Choukroun et al (2001), is a second generation platelet concentrate widely used to accelerate soft and hard tissue healing. Its advantages over the better known platelet-rich plasma (PRP) include ease of preparation/application, minimal expense, and lack of biochemical modification (no bovine thrombin or anticoagulant is required). PRF is a strictly autologous fibrin matrix containing a large quantity of platelet and leukocyte cytokines. This article serves as an introduction to the PRF “concept” and its potential clinical applications.

Author(s): Michael Toffler, DDS;Dan Holtzclaw, DDS, MS;Nicholas Toscano, DDS, MS;Marco Del Corso, DDS, DIU ; David Dohan Ehrenfest, DDS, MS, PhD
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Sinus Floor Augmentation With Simultaneous Implant Placement In Severely Atrophic Maxilla

Sinus Floor Augmentation With Simultaneous Implant Placement In Severely Atrophic Maxilla
DENTAL IMPLANT PLACEMENT ASSOCIATED augmentation of the sinus floor in the severely atrophic maxilla can be performed in 1- or 2 surgical stages depending on the height of the residual alveolar bone.

Author(s): Ziv Mazor, DMD;Michael Peleg, DMD;Gravriel Chaushu, Arun K. Garg
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Minimally Invasive Antral Membrane Balloon Elevation – Results of a Multicenter Registry

Minimally Invasive Antral Membrane Balloon Elevation – Results of a Multicenter Registry
The challenge of bone augmentation of this segment has been traditionally addressed by two approaches: lateral maxillary window and the “osteotome technique,” also called bone-added osteotome sinus floor elevation (BAOSFE).

Author(s): Ziv Mazor, DMD;Efraim Kfir, DMD; Moshe Goldstein, DMD; Israel Yerushalmi, DMD; Ronen Rafaelov, DMD; Vered Kfir, DMD; Edo Kaluski, MD, FACC, FESC, FSCAI
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Prosthetic Gingival Reconstruction in a Fixed Partial Restoration - Part 1: Introduction to Artificial Gingiva as an Alternative Therapy

Prosthetic Gingival Reconstruction in a Fixed Partial Restoration - Part 1: Introduction to Artificial Gingiva as an Alternative Therapy
The Class III defect environment entails a vertical and horizontal deficiency in the endentulous ridge. Often, bone and soft tissue surgical procedures fall short of achieving a natural esthetic result. Alternative surgical and restorative protocols for these types of prosthetic gingival restorations are presented in this three-part series, which highlights the diagnostic and treatment aspects as well as the lab and maintenance challenges involved.

Author(s): David Garber, DMD;Maurice Salama, DMD;Henry Salama, DMD;Christian Coachman, DDS, CDT;Marcelo Calamita, DDS, MS, PhD;Guilherme Cabral, DDS, CDT
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The Replacement of Small-Diameter Teeth in the Esthetic Zone Using Narrow-Diameter Implants

The Replacement of Small-Diameter Teeth in the Esthetic Zone Using Narrow-Diameter Implants
The lack of bone available for the surgeon as well as the lack of restorative space available between the adjacent teeth makes tooth replacement with implants challenging for both the restorative dentist and the laboratory technician.

Author(s): David Garber, DMD;Maurice Salama, DMD;Henry Salama, DMD
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Histologic Effect of Pure-Phase Beta-Tricalcium Phosphate on Bone Regeneration in Human Artificial Jawbone Defects

Histologic Effect of Pure-Phase Beta-Tricalcium Phosphate on Bone Regeneration in Human Artificial Jawbone Defects
The effect of the pure-phase beta-tricalcium phosphate (beta-TCP) Cerasorb on bone regeneration was evaluated in hollow titanium cylinders implanted in the posterior jaws of five volunteers.

Author(s): Paolo Trisi, DDS, PhD;Walter Rao, MD, DDS; Alberto Rebaudi, MD, DDS; Peter Fiore, MD, DDS
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Immediate Versus Delayed Functional Loading of Implants in the Posterior Mandible

Immediate Versus Delayed Functional Loading of Implants in the Posterior Mandible
A 2-Year Prospective Clinical Study of 12 Consecutive Cases

Author(s): Georgios E. Romanos, DDS, PhD, Prof. Dr. med. dent.;Georg-Hubertus Nentwig, DMD, Dr Med Dent, PhD
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A Novel Drilling Procedure and Subsequent Bone Autograft Preparation

A Novel Drilling Procedure and Subsequent Bone Autograft Preparation
A Technical Note

Author(s): Eduardo Anitua, MD, DDS, PhD;Carmen Carda, MD, Isabel Andia, PhD
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Bone-to-Implant Apposition with Machined and MTX Microtextured Implant Surfaces in Human Sinus Grafts

Bone-to-Implant Apposition with Machined and MTX Microtextured Implant Surfaces in Human Sinus Grafts
The goal of this study was to histologically document the effect of two different implant surfaces on the percentage of bone-to-implant apposition achieved with implants placed in human sinus grafts.

Author(s): Paolo Trisi, DDS, PhD;Carlo Marcato, MD, DDS; Marzio Todisco, DDS
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Progressive Bone Adaptation of Titanium Implants During and After Orthodontic Load in Humans

Progressive Bone Adaptation of Titanium Implants During and After Orthodontic Load in Humans
The aim of the present work was the evaluation of implant stability and periimplant bone reaction by histologic and clinical evaluation after therapeutic orthodontic loads. Forty-one adult patients received titanium implants as an orthodontic anchorage device; 12 patients received a retromolar or palatal implant to obtain tooth movement. Seven implants were removed at the end of the orthodontic therapy, after 2, 4, 6, and 12 months of orthodontic load, and processed for histologic examination. It…

Author(s): Paolo Trisi, DDS, PhD;Alberto Rebaudi, MD, DDS
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Marginal Integrity of Direct and Indirect Castings for Implant Abutments

Marginal Integrity of Direct and Indirect Castings for Implant Abutments
Courtesy of Quintessence Publishing

Author(s): Scott D. Ganz, DMD;Nainesh Desai, BDS, Saul Weiner, DDS
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A Study of the Fate of the Buccal Wall of Extraction Sockets of Teeth with Prominent Roots

A Study of the Fate of the Buccal Wall of Extraction Sockets of Teeth with Prominent Roots
Courtesy of Quintessence Publishing

Author(s): Myron Nevins, DDS;Marcelo Camelo, DDS, Sergio De Paoli, MD, DDS, Bernard Friedland, BchD, MSc, JD, Robert K. Schenk, MD, Prof Dr Med, Stefano Parma-Benfenati, MD, DDS, Massimo Simion, MD, DDS, Carlo Tinti, MD, DDS, Barry Wagenberg, DMD
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Osteoblast Attachment on Titanium Disks After Laser Irradiation

Osteoblast Attachment on Titanium Disks After Laser Irradiation
Courtesy of Quintessence Publishing

Author(s): Georgios E. Romanos, DDS, PhD, Prof. Dr. med. dent.;Roberto Crespi, DDS, Antonio Barone, DDS, Ugo Covani, DDS
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Human Histologic Evidence of Connective Tissue Attachment to a Dental Implant

Human Histologic Evidence of Connective Tissue Attachment to a Dental Implant
Courtesy of Quintessence Publishing

Author(s): Myron Nevins, DDS;Marc L. Nevins, DMD, MMSc, Marcelo Camelo, DDS, Janie Lee Boyesen, DDS, DMSc, David M. Kim, DDS, DMSc
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Implant Placement in the Esthetic Zone: The Use of Autogenous Mandibular Block Grafting &amp; Soft Tissue Augmentation

Implant Placement in the Esthetic Zone: The Use of Autogenous Mandibular Block Grafting & Soft Tissue Augmentation
“Originally published in Inside Dentistry, 2008. Copyright 2008. AEGIS Communications. Reprinted with permission.”

Author(s): David Garber, DMD;Maurice Salama, DMD;Henry Salama, DMD;Guilherme Cabral, DDS, CDT
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Improving Implant Framework

Improving Implant Framework
Passive fit of implant frameworks is related in part to the accuracy of the mastercast. A method of fabricating a verification stent to check the accuracy of the master cast prior to waxing and casting the implant framework is discussed. The methods utilize routinely available materials and do not require any special instrumentation or equipment. The stent can be fabricated either by the laboratory or the dentist.

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Allen Schneider, DDS, Gregori M. Kurtzman, DDS
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Suture Selection for Optimal Flap Closure and Tissue Healing

Suture Selection for Optimal Flap Closure and Tissue Healing
Suture selection is based on a knowledge of the physi cal and biologic characteristics of the suture thread in relationship to the healing process. In addition, accurate apposition of the flap is significant to patient comfort, hemostasis, reduction of the wound to be repaired, and prevention of unnecessary bone destruction. If flaps are not approximated and inadequate hemostasis is present, blood and serum may accumulate under the flap, delaying the healing process by separating the flap from the…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD
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Maintaining Dental Implants

Maintaining Dental Implants
Implant dentistry has become an important treatment regimen in restorative dentistry since outcome predictability became very well-established and recognized for long-term dental implant and restoration success. The increasing number of patients selecting dental implants as a treatment option presents the dental team with the challenge of maintaining these sometimes complex restorations. This article will help the reader to understand the similarity and differences in the periodontal structure…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman, DDS, MAGD, DICOI
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Instrumentation for Modern Day Implant Surgery

Instrumentation for Modern Day Implant Surgery
Public awareness of the aesthetic possibilities through the replacement of missing or nonsalvageable teeth has been elevated with advances in dental implant therapy and related hard and soft tissue regenerative therapies. This has led to an increase in the fabrication of fixed prostheses supported by either natural teeth, dental implants, or removable prostheses anchored by implants rather than conventional tissue- or tooth-supported partial dentures.

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Peter C. Shatz, DDS
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CT-generated Surgical Guides and Flapless Surgery

CT-generated Surgical Guides and Flapless Surgery
Current Issues Forum provides the opportunity for invited individuals with expertise and experience to express their opinions on selected current topics of interest in the field of oral and maxillofacial implants.

Author(s): Maurice Salama, DMD;Dr. Thomas J. Balshi, Stephen F. Balshi, MBE, Dr. Robert Jaffin, Dr. R. Gilbert Triplett, Dr. Stephen Parel
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Computer-Generated Abutment Using A Coded Healing Abutment: A Two-Year Preliminary Report

Computer-Generated Abutment Using A Coded Healing Abutment: A Two-Year Preliminary Report
This article presents a preliminary clinical evaluation following the placement of 107 dental implants covered with computer-coded healing abutments. The healing abutment system evaluated herein provided information to specific computer software that facilitated the delivery of an anatomical definitive abutment. This system also assisted in the development of a titanium abutment whose characteristics mimicked the natural contours of the teeth being replaced. A two-year postoperative evaluation was performed to evaluate occlusion, gingival integrity, contact areas, inflammation, food impaction, porcelain integrity, radiographic condition and overall patient satisfaction. Improved tissue response and resultant aesthetics were observed.

Author(s): Dean C. Vafiadis, DDS
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Dental Implants: Oral Hygeine and Maintenace

Dental Implants: Oral Hygeine and Maintenace
Proper monitoring and maintenance is essential to ensure the longevity of the dental implant and its associated restoration through a combination of appropriate professional care and effective patient oral hygiene. Gregori M Kurtzman and Lee H Silverstein explain the protocols for the dental team.

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman, DDS
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Dental Implants: Oral Hygine &amp; Maintenance

Dental Implants: Oral Hygine & Maintenance
Proper monitoring and maintenance is essential to ensure the longevity of the dental implant and its associated restoration through a combination of appropriate professional care and effective patient oral hygiene. Gregori M Kurtzman and Lee H Silverstein explain the protocols for the dental team.

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman
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Dental Implants: Mastering Esthetics in the Smile Zone

Dental Implants: Mastering Esthetics in the Smile Zone
The key to contemporary restorative dentistry is the fabrication of healthy, maintainable, esthetic, and functional prostheses. The true success of any restoration is reliant on the creation of an “illusion of reality,” regardless of the restorative modality used (eg, porcelain laminate veneers, crowns, and/or implant-supported prostheses). Developments and advances to the restorative armamentarium have significantly improved the clinician’s ability to deliver predictable and reliable treatments. Osseointegration…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kutrzman, DDS, David Kurtzman, DDS, Peter C. Shatz, DDS
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Placing Dental Implants and/or Natural Tooth Restorations in the Esthetic Zone

Placing Dental Implants and/or Natural Tooth Restorations in the Esthetic Zone
A key goal of aesthetic/cosmetic dentistry is the fabrication of maintainable, aesthetic, and functional prostheses that preserve the health of the teeth and soft tissues. Advances in restorative dentistry have significantly improved the clinician’s ability to deliver predictable treatment. When implants are indicated, osseointegration is an added factor that is essential for success. It is universally accepted that implant dentistry is a restorative-driven treatment with a surgical component. Whether…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman, DDS
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Implant Treatment Sequencing

Implant Treatment Sequencing
Periodontal or endodontic related osseous infections of natural teeth may complicate implant treatment. Staging of the surgical aspects of the treatment is important to achieve the desired restorative objectives. Additionally, when cosmetic correction of adjacent natural teeth is required as part of the overall treatment, the final result will be influenced by proper sequencing. Implant surgical placement in immediate extraction sites has been well documented in the literature as a successful treatment…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman, DDS, Marc E. Moskowitz, DDS
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Immediate Rehabilitation of the Completely Edentulous Jaw with a Fixed Prostheses Supported by Implants

Immediate Rehabilitation of the Completely Edentulous Jaw with a Fixed Prostheses Supported by Implants
The aims of this study were to assess the treatment outcome of immediately loaded full-arch screw-retained prostheses with distal extensions supported by both upright and tilted implants for the rehabilitation of edentulous jaws and to compare the outcomes of upright versus tilted implants.

Author(s): Tiziano Testori, MD, DDS, FICD;Matteo Capelli, DDS, Francesco Zuffetti, MD, DDS, Massimo Del Fabbro, PhD
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Influence of a Nanometer-Scale Surface Enhancement on De Novo Bone Formation on Titanium Implants

Influence of a Nanometer-Scale Surface Enhancement on De Novo Bone Formation on Titanium Implants
In this prospective randomized controlled clinical study, small titanium implants were placed in posterior maxillae for the purpose of assessing the rate and extent of new bone development. Nine pairs of site evaluation implants were placed in posterior areas of maxillae and retrieved with trephine drills after 4 or 8 weeks of unloaded healing. The amount of bone in linear contact (%) with the implant surface was used to determine the osteoconductive potential of the implant surface. Implant surfaces…

Author(s): Tiziano Testori, MD, DDS, FICD;Ronnie J. Goene, DDS, Paolo Trisi, DDS, PhD
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Timing, Positioning, &amp; Sequential Staging in Esthetic Implant Therapy

Timing, Positioning, & Sequential Staging in Esthetic Implant Therapy
Many articles address the predictability of immediate implant placement into extraction sockets; however, there are only a few reports that mention the indications and limitations of this technique. The aim of this article is to re-examine specific indications for immediate implant placement and to clarify the timing or “fourth dimension” relative to extraction and implant placement. The expanded concept of four-dimensional implant treatment planning involves the new axis of time, which must be…

Author(s): David Garber, DMD;Maurice Salama, DMD;Henry Salama, DMD;Akiyoshi Funato, D.D.S.;Tomohiro Ishikawa, DDS
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Soft Tissue Recession Around Implants 2

Soft Tissue Recession Around Implants 2
Implant therapy is a predictable method of replacing lost teeth and involves consideration of numerous surgical and restorative criteria. Part I of this article explained the behavior of the hard and soft tissue around the implant and reviewed various parameters that influence tissue remodeling. Part II emphasizes surgical factors (eg, tridimensional implant placement, platelet-rich fibrin, and the use of connective tissue grafts) and restorative factors as means of limiting soft tissue recession around implants.

Author(s): André P. Saadoun, DDS, MS;Bernard Touati, DDS, MS
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Loose Implant Screws-Part 1

Loose Implant Screws-Part 1
Carl Misch’s take on why implant screws loosen

Author(s): Richard Erickson, MS, DDS
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Loose Implant Screws-Part 2

Loose Implant Screws-Part 2
Recent research shows that tightening during try-ins can increase chances of screw loosening

Author(s): Richard Erickson, MS, DDS
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CT-Derived Model-Based Surgery for Immediate Loading of Maxillary Anterior Implants

CT-Derived Model-Based Surgery for Immediate Loading of Maxillary Anterior Implants
A novel approach to predict implant placement utilizing CT-derived model-based surgery was performed for a maxillary-anterior aesthetic immediate extraction/immediate restoration; root proximity and inter-implant positioning was an additional complication. The use of state-of-the-art diagnostic and treatmentplanning tools described in this article has been shown to be effective for both partial and completely edentulous patient presentations. These tools can serve as a foundation for accurate, highly practical, and repeatable CT-scan–derived modelbased presurgical prosthetic planning for the immediate loading of dental implants.

Author(s): Scott D. Ganz, DMD
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Soft Tissue Recession Around Implants

Soft Tissue Recession Around Implants
When treatment with dental implants is indicated, an accurate diagnosis must be made to evaluate the clinical parameters and determine the optimal time for immediate or delayed (ie, early or late) implant placement and loading following tooth extraction. It is also important to identify complications and their implications on the aesthetic outcome.1 This article explains behavior of the hard and soft tissue around the implant, evaluates the timing of implant placement after extraction, and reviews various parameters that influence tissue marginal remodeling.

Author(s): André P. Saadoun, DDS, MS;Bernard Touati, DDS, MS
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The Reality of Anatomy and the Triangle of Bone

The Reality of Anatomy and the Triangle of Bone
“Reality of Anatomy” is a concept developed by the author to describe the anatomical relationship between the tooth, the surrounding alveolar housing, the clinical crown, the root, and other important anatomy. Most textbooks, manufacturers’ literature, journal articles, and meeting presentations describe a relationship of the tooth to bone. These illustrations are acceptable in teaching the concept of crown-to-root ratio and are useful in describing certain procedures related to implant procedures.…

Author(s): Scott D. Ganz, DMD
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Optimizing Anterior Esthetics with Immediate Implant Placement and a Fixed Provisional Restoration

Optimizing Anterior Esthetics with Immediate Implant Placement and a Fixed Provisional Restoration
Implant placement immediately after tooth extraction, followed by an immediate provisional restoration of a single dental implant, provides significant benefits compared with traditional delayed protocols. Patients are not burdened with cumbersome removable interim prostheses, osseous anatomy may be preserved, sulcular form is optimized before definitive restoration, soft tissue has matured before implant integration, fewer surgical interventions are required, and treatment time is accelerated.…

Author(s): George Priest, DMD
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Techniques for the Use of CT Imaging for the Fabrication of Surgical Guides

Techniques for the Use of CT Imaging for the Fabrication of Surgical Guides
Implant dentistry has evolved into one of the most predictable treatment alternatives for partially and completely edentulous patients. The initial excitement about successful osseointegration has allowed clinicians to offer an extended set of treatment alternatives that include single tooth replacement to full mouth reconstruction. Pioneering protocols of the early 1980s relied on a two-stage surgical approach that allowed for the biological aspects of osseointegration to be achieved at the cellular level, insuring long-term success. These procedures often required extended periods of time to complete. Through strategic marketing and word of mouth, demand for implant-related treatment continues to grow and has compelled clinicians to search for new and improved methods to deliver such care within a shorter time period without sacrificing accuracy. As treatment protocols have progressed...

Author(s): Scott D. Ganz, DMD
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Prosthetic Management of Implants with Different Osseous Levels

Prosthetic Management of Implants with Different Osseous Levels
The osseointegrated implant has become a standard treatment with a high degree of predictability for patients missing one or more teeth. It is especially recommended when the patient has a clear medical history and normal bone levels in both width and height in the edentulous areas. In constant search for improvement, clinicians find themselves looking into every element relating to the replacement of a missing tooth or teeth: existing bone structure, surgical technique, implant placement, implant…

Author(s): Sergio Rubinstein, DDS;Alan J. Nidetz, DDS, Leslie B. Heffez, DMD, MS, Fujiki Toshi, RDT, Fujiki Toshi, RDT
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Implant Site Preparation with Motorized Bone Expanders

Implant Site Preparation with Motorized Bone Expanders
The osteotome technique has been utilized for many years as a viable approach to expand atrophic ridges. Despite its effectiveness, the mechanical impact from the surgical mallet is not well tolerated by patients. Additionally, reports in the literature describe postoperative complications that include concussions and benign paroxysmal vertigo. These conditions can be alarming for the patient and clinician, as their effects may persist for several weeks. A new technique for atraumatic ridge expansion…

Author(s): Ernesto A. Lee, DMD
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Facial Development, Continuous Tooth Eruption, and Mesial Drift as Compromising Factors for Implant Placement

Facial Development, Continuous Tooth Eruption, and Mesial Drift as Compromising Factors for Implant Placement
The replacement of teeth lost by children because of trauma can be an important indication for early implant therapy. Osseointegrated dental implants, like ankylosed teeth, alter position as growth-related changes occur within the jawbones (displacement, remodeling, mesial drift). Facial growth of the child and even of the adolescent, as well as the continuous eruption of the adjacent anterior teeth, create significant risk of a less favorable esthetic and/or functional outcome. For patients with…

Author(s): Vincent G. Kokich, Sr., DDS, MSD;Danny G. Op Heij, DDS, Heidi Opdebeeck, MD DDS, Daniel van Steenberghe, MD, DDS, PhD, Urs Belser, DMD, MArc Quirynen, DDS, PhD
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Systematic Review of Survival Rates for Immediately Loaded Dental Implants

Systematic Review of Survival Rates for Immediately Loaded Dental Implants
The primary goal of this paper was to determine the survival rate of immediately loaded (IL) dental implants based on a systematic review of the literature. Secondary goals were to determine the influence of several factors on the implant survival rate, such as the type of reconstruction, implant location, and implant surface characteristics. An electronic search of databases was performed, in addition to a hand search of the most relevant journals. All relevant articles were independently screened…

Author(s): Tiziano Testori, MD, DDS, FICD;Massimo Del Fabbro, BSc, PhD, Luca Francetti, MD, DDS, Silvio Taschieri, MD, DDS, Roberto Weinstein, MD, DDS
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Implant Therapy-Sequence of Surgical &amp; Restorative Phases

Implant Therapy-Sequence of Surgical & Restorative Phases
Failure of the natural dentition due to periodontal- or endodontic-related osseous infections may complicate implant therapy. Sequencing (ie, staging) of the surgical aspects of the treatment is essential to achieve the desired restorative objectives. Additionally, for indications in which the adjacent natural teeth require cosmetic enhancement as part of the overall treatment plan, proper sequencing will influence the definitive results. The following article discusses the surgical and restorative…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman, DDS, Peter C. Shatz, DDS
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Immediate Loading of Osseotitie Implants-After 4 months

Immediate Loading of Osseotitie Implants-After 4 months
A growing number of clinical reports show that early and immediate loading of endosseous implants may lead to predictable osseointegration; however, these studies provide mostly short- to mid-term results based only on clinical mobility and radiographic observation. Other methods are needed to detect the possible presence of a thin fibrous interposition of tissue that could increase in the course of time and lead to clinical mobility. A histologic evaluation was performed on two immediately loaded…

Author(s): Tiziano Testori, MD, DDS, FICD;Serge Szmukler-Moncler, DDS, Luca Francetti, MD DDS, Massimo Del Fabbra, BSc, PhD, Antonio Scarano, DDS, Adriano Piattelli, MD, DDS, Robert L. Weinstein, MD, DDS
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Implant Aesthetic Score for Evaluating the Outcome

Implant Aesthetic Score for Evaluating the Outcome
Implant restorations delivered according to the Brånemark protocol have proven to be highly predictable. To shorten the length of treatment associated with the Brånemark protocol, as well as to preserve soft and hard tissues, newer protocols have focused on reducing or even eliminating the time between tooth extraction and implant placement and between implant placement and prosthetic restoration delivery. The authors present a case in which control of postextraction implant placement, optimal implant…

Author(s): Tiziano Testori, MD, DDS, FICD;Francesca Bianchi, DDS, Massimo Del Fabbro, BSc, PhD, Matteo Capelli, DDS, Francesco Zuffetti, MD, DDS, Ignazio Berlucchi, DDS, Silvio Tashieri, DDS, Luca Francetti, DDS, Roberto Ludovico Weinstein, MD, DDS
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Workshop Guidelines on Immediate Loading in Implant Dentistry

Workshop Guidelines on Immediate Loading in Implant Dentistry
Predictable formation of a direct bone-to implant interface is a treatment goal in implant dentistry. The 2-stage surgical protocol established by Branemark et al to accomplish osseointegration consisted of several prerequisites, including (1) countersinking the implant below the crestal bone, (2) obtaining and maintaining a soft-tissue covering over the implant for 3 to 6 months, and (3) maintaining a minimally loaded implant environment for 3 to 6 months. The primary reasons cited for the submerged,…

Author(s): Henry Salama, DMD;Edward Joseph Mills, DDS;Jack A. Hahn, DDS;Leonard Linkow, DDS, DMSc;Mohamed Sharawy, B.D.S., Ph.D.;Tiziano Testori, MD, DDS, FICD;Craig M Misch, DDS, MDS;Hom-Lay Wang, DDS, MSD, PhD;Carl E. Misch, DDS, MDS, Kenneth W. Judy, DDS, Jack E. Lemons, PhD, Jamie L. Lozada, DDS
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Immediate Occlusal Loading of Osseotite Implants in the Lower Edentulous Jaw

Immediate Occlusal Loading of Osseotite Implants in the Lower Edentulous Jaw
<b>Objective:</b> This paper reports the results of a prospective multicenter clinical study on immediately fully occlusally loaded full-arch screw-retained prostheses with distal extensions (hybrid prostheses) supported by Osseotite implants inserted in edentulous lower jaws. <b>Method and material:</b> Sixty-two patients were enrolled in four clinical centers. Three hundred and twenty-five Osseotite implants were inserted and occlusally loaded according to an immediate loading protocol. The temporary…

Author(s): Tiziano Testori, MD, DDS, FICD;Alan M. Meltzer, DMD, MScD;Massimo Del Farbbro, Francesco Zuffetti, Miguel Troiano, Luca Francetti, Roberto L. Weinstein
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Use of Stereolithographic Models as Diagnostic &amp; Restorative Aids for Predictable Immediate Loading of Implants

Use of Stereolithographic Models as Diagnostic & Restorative Aids for Predictable Immediate Loading of Implants
Implant dentistry has evolved into one of the most predictable treatment alternatives in all of medical science. Advances in the surgical and prosthetic components, implant designs and surface technologies, and imaging techniques have allowed for significant modifications to occur with respect to one- and two-stage surgical protocols, accelerating treatment times to the benefit of patient and clinician. This article presents a technique to improve surgical and restorative accuracy, allowing for predictable placement and immediate loading of implants through use of CT imaging, stereolithographic models, and CT-derived surgical templates.

Author(s): Scott D. Ganz, DMD
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Flapless Immediate Adjacent Implants and Provisionalisation

Flapless Immediate Adjacent Implants and Provisionalisation
Fourth part in a series discussing a biologically driven approach to aesthetics.

Author(s): Tidu Mankoo, DDS
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Vertical Distance from the Crest of Bone to the Height of the Interproximal Papilla Between Adjacent Implants

Vertical Distance from the Crest of Bone to the Height of the Interproximal Papilla Between Adjacent Implants
As patient demand increases for more natural restorations in the esthetic zone, clinicians must have the highest level of skill and knowledge to maintain or reform the interdental papilla between teeth, between implants and teeth, and between adjacent implants. To date, there are no reports that have measured the distance from the contact point to the bony crest between implants. One reason for this may be the fact that, with two adjacent implants, the contact point of the crown can be established at any distance from the gingival margin according to the restorative dentist's specifications. Therefore, in this study, the height of the soft tissue to the crest of bone was measured between two adjacent implants independent of the location of the contact point. The purpose of this study was to determine the range and average height of tissue between two adjacent implants.

Author(s): David Garber, DMD;Maurice Salama, DMD;Henry Salama, DMD;Dennis P. Tarnow, DDS;Dr. Paul Fletcher, Dr. Stuart Froum, Dr. Ann Magner, Dr. Sang-Choon Cho
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Healing of Osseotite Implants

Healing of Osseotite Implants

Author(s): Tiziano Testori, MD, DDS, FICD;Serge Szmukler-Moncler, DDS, PhD, Luca Francetti, MD, DDS
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Preprosthetic Extraoral Verification for Implant-Supported Restorations

Preprosthetic Extraoral Verification for Implant-Supported Restorations
It has been well established that osteointegration of a dental implant is one of the fundamental components for successful implant therapy. A vital portion of this process is ascertainment of the appropriate prosthetic tooth position from which the ideal dental implant position is dictated within the alveolar bone. I It is equally imperative that prosthetically gUided implant positioning be accomplished for predictable attainment of functional, aesthetic, and hygienically maintainable restorative…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman, DDS, MS, Allen Schneider, DDS
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Healing of Osseotite Implants- After 2 months

Healing of Osseotite Implants- After 2 months
A growing number of clinical studies show that early (2 months) and immediate loading protocols may be predictable. However, they are based on clinical stability only. The aim of this case report was to document the osseointegration status of two Osseotite implants after 2 months of healing in soft bone corresponding to type IV and subjected to two distinct mechanical environments. A completely edentulous patient received a total of 11 Osseotite implants in the mandible. Six were immediately loaded…

Author(s): Tiziano Testori, MD, DDS, FICD;Serge Szmukler-Moncler, DDS, PhD, Luca Francetti, MD, DDS, Massimo Del Fabbro, BSc, PhD, Paolo Trisi, DDS, PhD, Roberto L. Weinstein, MD, DDS
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The Use of an Extraoral Verification Template for Dental Implant Supported Prosthesis

The Use of an Extraoral Verification Template for Dental Implant Supported Prosthesis
This article demonstrates the utilization of a preprosthetic extraoral verification template that could be used to ensure the accuracy of the master cast from which the laboratory working model is used as the in vitro foundation for the implant-supported prosthesis framework construction.

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman, DDS, Allen Schneider, DDS, Peter C. Shatz, DDS
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Immediate Total Tooth Replacement

Immediate Total Tooth Replacement
Cutting edge implant procedures are described in detail.

Author(s): David Garber, DMD;Maurice Salama, DMD;Henry Salama, DMD
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CT Scan Technology

CT Scan Technology
Implant dentistry, one of the most predictable treatment alternatives offered to patients who are missing teeth can be enhanced by thorough pre-surgical diagnosis and treatment planning efforts by all members of the implant team. Conventional radiologic techniques including periapical and panoramic radiographs are limited by the two dimensional interpretation of existing hard and soft tissue. The inherent distortion factor can misrepresent bone topography in critical areas associated with vital anatomy or potential implant sites. Advances in diagnostic radiological techniques improved with the introduction of CT scan technology for dental applications. The enhanced diagnostic range of this evolving technology empowers the clinician with necessary tools to avoid potential complications associated with implant dentistry.

Author(s): Scott D. Ganz, DMD
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Aesthetic Enhancement of Anterior Dental Implants with the Use of Tapered Osteotomes &amp; Soft Tissue Manipluation

Aesthetic Enhancement of Anterior Dental Implants with the Use of Tapered Osteotomes & Soft Tissue Manipluation
An adequate bone base is usually a prerequisite for functionally and aesthetically optimal reconstruction of the soft tissue architecture around a dental implant. In patients with sufficient bone height but insufficient bone width as a result of tooth loss, a jaw enlargement technique with osteotomes combined with soft tissue manipulation may be utilized to facilitate proper implant placement while concomitantly optimizing the aes thetics of the final implant prosthesis. The learning objective of…

Author(s): Jack A. Hahn, DDS;Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman, DDS, Marc E. Moskowitz, DDS, David Kurtzman, DDS
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Transitional Custom Abutments: Optimizing Esthetics in Implant Supported Restorations

Transitional Custom Abutments: Optimizing Esthetics in Implant Supported Restorations
As the discipline of implant prosthodontics continues to evolve, additional emphasis has been focused on the role of adequate emergence profiles and peri-implant soft tissue contours. Despite the development of anatomically shaped healing abutments, currently advocated techniques exhibit clinical limitations. This article introduces the transitional custom abutment technique as a method of manipulating the supraimplant soft tissue contours so that optimal emergence profiles and increased restorative flexibility…

Author(s): Ernesto A. Lee, DMD
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Aesthetic Enhancement of Anterior Dental Implants with the Use of Tapered Osteotomes and Soft Tissue Manipulation

Aesthetic Enhancement of Anterior Dental Implants with the Use of Tapered Osteotomes and Soft Tissue Manipulation
As osseointegration of endosseous dental implants has become predictable and well-documented, the emphasis in dental- implant treatment has shifted from functional concerns to the achievement of long-term aesthetic results. An adequate alveolar bone base is the prerequisite for functional and aesthetically optimal reconstruction of the soft-tissue architecture. This is true for both fixed partial denture (FPD) pontic sites and dental implant sites. In patients with sufficient bone height but insufficient bone…

Author(s): Jack A. Hahn, DDS;Lee H. Silverstein, DDS, MS, FACD, FICD
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Replacement of a Mutilated Maxillary Incisor With a Single Implant Restoration: A Staged Implant

Replacement of a Mutilated Maxillary Incisor With a Single Implant Restoration: A Staged Implant
Patients are advised to maintain oral health in order to enjoy function and the natural appearance of their dentition for a lifetime. In the event that oral health becomes impaired, clinicians are capable of restoring it through either conservative or sophisticated treatment modalities. This treatment must be based on sound, rationalized clinical evidence and a clear understanding of the biological and physiological processes involved. Dental professionals must also acknowledge their personal limitations…

Author(s): Nitzan Bichacho, DMD;Cobi J. Landsberg, DMD, Rafi Romano, DMD, MSD, Shlomi Silberstein, CDT
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Periodontally Considerations of Dental Implantology

Periodontally Considerations of Dental Implantology
<p>The endosseous dental implant has steadily progressed to become an important modality of restoring incomplete dentitions in either fully or partially edentulous patients. Osseointegrated dental implants have demonstrated relatively high success rates in both the maxillary and the mandibular jaws. The American Academy of Implant Dentistry (AAID), the American Dental Association (ADA), and numerous other professional organizations have endorsed the placement of osseointegrated dental implants as…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Jerry J. Garnick , David Kurtzman, DDS, Peter C. Shatz
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Fifty Years of Interdisciplinary Site Development: Lessons &amp; Guidelines from Periodontal Prosthesis

Fifty Years of Interdisciplinary Site Development: Lessons & Guidelines from Periodontal Prosthesis
Just as "osseointegration" became synonymous with successful restoration of function in the fully edentulous patient during the 1980s, the term "implant site development" has become intricately associated in the 1990s with the techniques used to achieve esthetic results with implants in the partially edentulous patient. This article explores the roots of the concept of site development within the philosophy and principles of periodontal prosthesis. In addition, the myriad of techniques that are…

Author(s): David Garber, DMD;Maurice Salama, DMD;Henry Salama, DMD;Pinhas Adar, MDT, CDT;Edwin S. Rosenberg, DMD
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Prosthodontics, Periodontics &amp; Orthodontics: A Multidisciplinary Approach to Implant Dentistry

Prosthodontics, Periodontics & Orthodontics: A Multidisciplinary Approach to Implant Dentistry
Many aspects of various dental disciplines must be integrated to constitute a sound total approach to implant dentistry. Aside from the surgical elements - encompassing implant placement, position, angulation, and length - the creation of appropriate spaces to accommodate the three-dimensional final prostheses may require use of orthodontic techniques as well. And establishing and maintaining a sound periodontal environment is essential to implant integrity, from the outset of placement to finalization of the prosthetic suprastructure.

Author(s): Henry Salama, DMD
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Restoration Implant Placement &amp; Site Development

Restoration Implant Placement & Site Development
In any restoration or natural tooth, the surrounding soft-tissue profile plays an integral role in the final esthetics of a case. Similarly in implant restorations, it is no longer sufficient to merely attach a prosthetic device to the underlying fixture, but for optimal esthetics it has become essential for the implant site to be reconstituted in a three-dimensional approach. This invariably involves redevelopment or replacement of lost hard tissue and redevelopment of the correct soft-tissue profile,…

Author(s): David Garber, DMD
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Nifedipine-induced Gingival Enlargemenr Around Dental Implants

Nifedipine-induced Gingival Enlargemenr Around Dental Implants
Calcium channel-blocking agents are used extensively for the management of cardiovascular conditions, including angina pectoris, coronary artery spasm, cardiac arrhythmias, and hypertension. Gingival overgrowth around natural teeth has been previously reported in the literature with patients taking calcium channel-blocking agents. This clinical report describes hyperplasia of tissues around titanium dental implants in a patient taking Nifedipine along with the multiphasic approach to treating this…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;J. Paul Koch, DMD, Michael D. Lefkove, DDS, Jerry J. Garnick, DDS, MS, Baldev Singh, BDS, PhD, David E. Steflik, MS, EdD
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Immediate Loading of Bilaterally Splinted Titanium Root-Form Implants in Fixed Prosthodontics

Immediate Loading of Bilaterally Splinted Titanium Root-Form Implants in Fixed Prosthodontics
A load-free healing period has been advocated as a prerequisite to achieving osseointegration. This article reports two cases in which immediate loading of a specially designated additional or "expendable" set of titanium root-form implants was successfully utilized to support provisional fixed restorations in the maxilla and the mandible. This immediate-loading protocol is suggested as a reliable adjunctive therapeutic modality for offering implant patients access to fixed interim restorations…

Author(s): Maurice Salama, DMD;Henry Salama, DMD;Louis F. Rose, MD, Norman J. Betts, DDS, MS
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Implant Prosthodontic Procedures for a Completely Edentulous Patient with a Cleft Palate

Implant Prosthodontic Procedures for a Completely Edentulous Patient with a Cleft Palate
Cleft lip and palate maxillofacial prosthodontics is evolving and re-defining treatment approaches via the use of dental implants. A case report is presented demonstrating the use of the sinus lift procedure originally described by Tatum, the placement of osseointegrated root-form implants, and an implant-supported and -retained maxillofacial prosthesis.

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Michael D. Lefkove, DDS, Bill Matheny, CDT
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Linear Tomography in Conjuction with Pantomography in Implant Assessmnet Sites

Linear Tomography in Conjuction with Pantomography in Implant Assessmnet Sites
Tomography provides a three-dimensional unobstructed and anatomically accurate picture of the region being viewed. Tomography is a radiographic technique in which a "slice" or section of a given internal body structure is imaged in a pre-determined plane. The advantage of utilizing a tomographic evaluation along with a pan tomographic survey is that the clinician may examine the exact position or depth in all three planes of visualization. This radiographic modality can also reveal the quality and…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Roger W. Melkonian, DDS, David Kurtzman, DDS, Jerry J. Garnick, DDS, Michael D. Lefkove, DDS
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The Use of Free Gingival Soft Tissue to Improve Implant/Soft Tissue Interface

The Use of Free Gingival Soft Tissue to Improve Implant/Soft Tissue Interface
Various techniques for the placement of different types of dental implants have evolved to the point where predictable bone-to-implant integration occurs if proper surgical technique is followed. The soft-tissue adaptation to the implant abutment is the first line of defense to prevent the development of peri-implantitis and subsequent bone loss. Given that there is a tenuous protective seal around dental implants, the rationale for soft-tissue augmentation around dental implants to provide an improved,…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Michael D. Lefkove, DDS, Jerry J. Garnick, DDS
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Osseointegrated Titanium Implants for Maxillofacial Protraction in Monkeys

Osseointegrated Titanium Implants for Maxillofacial Protraction in Monkeys
Titanium implants were placed surgically into the maxillary, zygomatic, frontal, and occipital bones of four pigtail monkeys. After a 4-month healing period, the implants were exposed and abutments were placed. Extraoral traction appliances were then attached to the abutments. The cranial implants were used to support the framework of the traction appliance; those in the facial bones were used to attach springs that delivered a protraction force. The application of force varied among animals. In animal…

Author(s): Vincent G. Kokich, Sr., DDS, MSD;Ward M. Smalley, DDS, MSD, Peter A. Shapiro, DDS, MSD, Thomas H. Hohl, DDS, Per-Ingvar Branemark, MD
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Root Fracture During Insertion of Prefabricated Posts

Root Fracture During Insertion of Prefabricated Posts
The consequence of inappropriate post selection and/ or hasty insertion can result in tooth fracture and/or loss. It has been demonstrated that conical or parallel sided post design has a direct effect on root fracture during post insertion. However, during experimentation it became apparent that root size and its relationship to post size had a direct effect on root fracture. This article correlates root size, post size, and fracture rate during insertion of prefabricated posts.

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Allan S. Deutsch, DMD, Barry Lee Musikant, DMD, John Cavallari, MS (EE), James Lepley, DDS, Karen Ohlen, BA, Martin Lesser, PhD
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Socket Preservation to Gain

Socket Preservation to Gain
Tooth loss not only poses difficulty in mastication, it also involves the probable resorption of alveolar bone due to a loss of function and stimulation from the periodontal ligament fibers (PDL). Bone grafting at the time of tooth removal provides bone quantity and quality for future placement of dental implant(s). The challenge during this procedure—referred to as socket preservation—is maintaining the graft in place as well as providing a final working area with sufficient keratinized tissue…

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Peter C. Shatz, DDS
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Determining the Cessation of Vertical Growth of the Craniofacial Structures to Facilitate Placement of Single-Tooth Implants

Determining the Cessation of Vertical Growth of the Craniofacial Structures to Facilitate Placement of Single-Tooth Implants
<b>Introduction:</b> Single-tooth implants are commonly used to replace congenitally missing teeth in adolescent orthodontic patients. However, if implants are placed before cessation of facial growth, they will submerge relative to the adjacent erupting teeth. Therefore, it is important to know when facial growth is complete in postpubertal orthodontic patients. The purposes of this study were to determine and quantify the amount of vertical growth of the facial skeleton and the amount of eruption…

Author(s): Vincent G. Kokich, Sr., DDS, MSD;Piotr Fudalej, Brian Leroux
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Timing of Loading and Effect of Micromotion on Bone

Timing of Loading and Effect of Micromotion on Bone
A significant no-load healing period is the generally accepted prerequisite for osseointegration in dental implantology. The aim of this article was to examine whether this no-load healing period is validated by the experimental literature. In vivo histological data was scrutinized to identify the effect of early loading protocols on the bone-implant interface. Several loading modes were identified. They were categorized into groups according to implant design and the type of prosthetic reconstruction,…

Author(s): Henry Salama, DMD;S. Szmukler-Moncler, Y. Reingewirtz, J. H. Dubruille
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Optimum Esthetics and Rentention with Cast-to Abutments

Optimum Esthetics and Rentention with Cast-to Abutments
Progress and technological evolution is something we should all embrace since such attributes allow us to provide patients with improved care. But when is it appropriate to consider proven materials and techniques outdated and when should one move forward with the promise of better product(s) along with superior outcomes?

Author(s): Sergio Rubinstein, DDS;Alan J. Nidetz, DDs
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A New Implant Design for Crestal Bone Preservation: Initial Observations and Case Report

A New Implant Design for Crestal Bone Preservation: Initial Observations and Case Report
Following the exposure and restoration of two-piece dental implants, some change in the vertical level of the peri-implant crestal bone height has been reported. This change in crestal bone height has not, however, negatively impacted long-term implant success. This article describes how the concept of platform switching is incorporated into a new implant design as a means of reducing or eliminating the occurrence of crestal bone loss. Preliminary observations from clinicians utilizing this new implant design are herein presented.

Author(s): Tiziano Testori, MD, DDS, FICD;Harold Baumgarten, DMD, Roberto Cocchetto, DDS, MD, Alan Meltzer, DMD, MScD, Stephan Porter, DDS, MSD, MS
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Comprehensive Management of Implant Anchorage in the Multidisciplinary Patient

Comprehensive Management of Implant Anchorage in the Multidisciplinary Patient
In recent years, dental implants have become an accepted method of replacing missing teeth. Today millions of implants are placed annually to rehabilitate and reestablish patients’ occlusions. However, in many of these individuals, the teeth may be in less than ideal position to accept the integration of single implants or groups of implants with the remaining teeth. Many of these patients could benefit from orthodontics to reposition malposed teeth to enhance the overall occlusal scheme. However,…

Author(s): Vincent G. Kokich, Sr., DDS, MSD
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Treatment Planning 2000: An Esthetically Oriented Revision of the Original Implant Protocol

Treatment Planning 2000: An Esthetically Oriented Revision of the Original Implant Protocol
The purpose of this article is to outline the blueprint for a comprehensive multidisciplinary treatment philosophy, designed for developing the foundation for optimal esthetics in implant therapy. In addition, the important synergistic relation of the osseous, gingival, and restorative triad in creating the esthetic profile is described. The need to enhance the individual components of this triad is emphasized as the basis for a revised implant protocol actualized for treating the complex partially…

Author(s): David Garber, DMD;Maurice Salama, DMD;Henry Salama, DMD;Pinhas Adar, MDT, CDT;Te-Fu Li, DMD
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Instrumentation for Modern Day Implant Surgery

Instrumentation for Modern Day Implant Surgery
Public awareness of the aesthetic possibilities through the replacement of missing or nonsalvageable teeth has been elevated with advances in dental implant therapy and related hard and soft tissue regenerative therapies. This has led to an increase in the fabrication of fixed prostheses supported by either natural teeth, dental implants, or removable prostheses anchored by implants rather than conventional tissue- or tooth-supported partial dentures.

Author(s): Lee H. Silverstein, DDS, MS, FACD, FICD;Peter C. Shatz, DDS
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Immediate Occlusal Loading the Same Day or Day After Implant Placement

Immediate Occlusal Loading the Same Day or Day After Implant Placement
Immediate loading of endosseous implants is becoming a widespread therapeutic procedure for the rehabilitation of patients with edentulous jaws. The purpose of this prospective clinical trial was to evaluate the long-term success rate of endosseous implants placed in the edentulous lower jaw and loaded on either the same day of surgery or the next day. Nineteen patients were enrolled in the study. Eleven patients, accounting for 64 implants, received their provisional prosthesis the same day of…

Author(s): Tiziano Testori, MD, DDS, FICD;Massimo Del Fabbro, PhD, Fabio Galli, MD, DDS, Luca Fracetti, MD, DDS, Silvio Taschieri, MD, DDS, Roberto Weinstein, MD, DDS
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