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Implant Articles
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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Bone Grafting Articles
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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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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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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Manejo Integral de Maloclusion Clase III en Adulto, con Requerimientos Periodontales y Protesicos; Reporte de un caso clinico

Manejo Integral de Maloclusion Clase III en Adulto, con Requerimientos Periodontales y Protesicos; Reporte de un caso clinico
En nuestra clinica observamos un aumento de pacientes adultos con problemas esqueletales, compromiso periodontal y necesidades protesicas. Debemos recurrir a la interconsulta con el periodoncista, protesista y cirujano maxilofacial, para la correccion del caso, prestando especial atencion al componente dentario, esqueletal y los tejidos blandos faciales del paciente. La cirugia ortognatica, que generalmente la realizamos luego de una preparacion ortodoncica, permite corregir discrepancias en el adulto y restaurar la funcion y estetica en los tres planos del espacio. Realizada la correccion oclusal, procedemos a sustituir dientes ausentes, mediante implantes y protesis fijas. El Periodoncista, mantiene un control constante de la salud de los tejidos de soporte, durante todas las fases de la terapia multidisciplinaria.

Author(s): Miguel Hirschhaut, DDS;Jorge Ravelo, DDS
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Sinus Lift Articles
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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Alternative Applications of Guided Surgery: Precise Outlining of the Lateral Window in Antral Sinus Bone Grafting

Alternative Applications of Guided Surgery: Precise Outlining of the Lateral Window in Antral Sinus Bone Grafting
Computed tomography (CT) and the application of CT-based guided implant surgery allow clinicians to provide enhanced precision and accuracy in implant surgery. Because of the difficulty in transferring a patient’s often complex anatomic sinus configurations, as viewed on a preoperative CT scan, into precise osteotomy cuts at antral bone graft surgery, a prototype cutting guide was developed. The surgical guide was developed through the use of CT imaging and the stereolithographic process to precisely position the lateral window, facilitating schneiderian membrane elevation. This report demonstrates the step-by-step method to perform precise guided sinus window preparation using computer software and a stereolithographically generated surgical guide.

Author(s): George A. Mandelaris, DDS, MS;Alan L. Rosenfeld, DDS, FACD
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Indirect Sinus Lift with CPS Putty

Indirect Sinus Lift with CPS Putty
In situations where lack of bone volume is related to an enlarged maxillary sinus, elevation of the sinus floor has been advocated for implant placement.

Author(s): Lanka Mahesh, BDS, MBA;Dr. Manesh Lahori; Dr. Sagrika Shukla; Dr. Prerna Kaushik
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Schneiderian Membrane Perforation Rate During Sinus Elevation Using Piezosurgery - Clinical Results of 100 Consecutive Cases

Schneiderian Membrane Perforation Rate During Sinus Elevation Using Piezosurgery - Clinical Results of 100 Consecutive Cases
This article presents an alternative approach that uses a piezoelectric instrument for the sinus elevation procedure.

Author(s): Steven S. Wallace, DDS;Ziv Mazor, DMD;Dennis P. Tarnow, DDS;Stuart J. Froum, DDS; Sang-Choon Cho, DDS
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Soft Tissue Articles
Antimicrobial Effect of a Single Dose of Amoxicillin on the Oral Microbiota

Antimicrobial Effect of a Single Dose of Amoxicillin on the Oral Microbiota
Amoxicillin is commonly used in oral surgery for antimicrobial prophylaxis against surgical-site infection and bacteremia because of its effect on oral streptococci. The aim of this study was to determine whether amoxicillin reaches the break-point concentrations in saliva and has any effect on the salivary microbiota, colonizing bacteria on mucosal membranes and on the gingival crevice after a single dose of amoxicillin. A single dose given as prophylaxis to prevent a surgical-site infection results in a significant reducing effect on the oral streptococcal microflora in the gingival crevice and may have an impact on bacteria spreading into tissues and the bacteria of streptococci.

Author(s): Cecilia Larsson Wexell, DDS, PhD; Henrik Ryberg, PhD; Wivi-Anne Sjöberg Andersson, DDS; Susanne Blomqvist, BSc; Pieter Colin, PhD; Jan Van Bocxlaer, PhD; Gunnar Dahlén, DDS PhD
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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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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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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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Periodontic Surgery Articles
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
View Article>>
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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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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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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Other Surgical Articles
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
View Article>>
Mucosal Coronally Positioned Flap for the Management of Excessive Gingival Display in the Presence of Hypermobility of the Upper Lip and Vertical Maxillary Excess: A Case Report

Mucosal Coronally Positioned Flap for the Management of Excessive Gingival Display in the Presence of Hypermobility of the Upper Lip and Vertical Maxillary Excess: A Case Report
Excessive gingival display is a frequent finding that can occur because of various intraoral or extraoral etiologies. This report describes the use of a mucosal coronally positioned flap for the management of a gummy smile associated with vertical maxillary excess and hypermobility of the upper lip. For patients desiring a less invasive alternative to orthognathic surgery, the mucosal coronally positioned flap is a viable alternative. We demonstrate short-term successful use of this technique for the management of excessive gingival display in the presence of slight vertical maxillary excess and hypermobility of the upper lip. Long-term follow-up studies are needed to determine stability of the results.

Author(s): Monish Bhola, DDS, MSD;Nomahn Humayun; Shilpa Kolhatkar; Jason Souiyas
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Cirurgia ortognática: uma alternativa possível e viável para o tratamento de problemas odontológicos interdisciplinares.

Cirurgia ortognática: uma alternativa possível e viável para o tratamento de problemas odontológicos interdisciplinares.
Cirurgia ortognática: uma alternativa possível e viável para o tratamento de problemas odontológicos interdisciplinares. Além de curar diversos sintomas dos problemas funcionais que incomodam os pacientes no seu dia-a-dia, proporciona ainda a elevação da autoestima e da autoconfiança, pois os resultados estéticos são surpreendentes

Author(s): Rogério Zambonato Freitas, DDS, MS
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Periodontal Accelerated Osteogenic Orthodontics - A Description of the Surgical Technique

Periodontal Accelerated Osteogenic Orthodontics - A Description of the Surgical Technique
The purpose of this article is to describe the clinical surgical procedures that comprise the PAOO procedure.

Author(s): Kevin George Murphy, DDS, MS;M. Thomas Wilcko, DMD; William M. Wilcko, DMD, MS; Donald J. Ferguson, DMD, MSD
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