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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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

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.

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

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

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.

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.

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.

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.

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.

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.

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).

Prosthetic Gingival Reconstruction in a Fixed Partial Restoration - Part 1: Introduction to Artificial Gingiva as an Alternative Therapy
Prosthetic gingival restoration of a Class III defect environment.

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.

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.

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

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

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.

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…

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

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

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

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

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.”

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.

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…

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…

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.

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.

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.

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.

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.

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…

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…

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…

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.

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.

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…

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.

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

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.

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…

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

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.…

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.…

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…

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…

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...

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…

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…

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…

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…

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,…

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…

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…

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.

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

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.

Healing of Osseotite Implants

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…

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.

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…

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

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.

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…

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…

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…

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…

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…

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…

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.

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,…

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…

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…

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,…

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.

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…

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…

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.

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…

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…

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?

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,…

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…

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.

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,…

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.

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…