Copy-paste concept: Full digital approach in the management of gingival emergence profiles
Obtaining a perfect integration of a prosthetic rehabilitation on natural teeth and implants in the esthetic zone requires a deep knowledge of the biological processes and a clear understanding of the characteristics of the restorative materials. Once the soft tissue profile has been created with the placement of a temporary prosthesis, the ability to accurately transfer information about the tissue profile and the contour of the restoration for the fabrication of the definitive crowns can be challenging.

The Socket Shield Technique with Promixal Extensions for Single-Rooted Teeth
The conventional socket shield (SS) design extends from the mesiolabial to the distolabial line angle. C-shaped SS, L-shaped SS, and proximal SS designs have proximal extensions that help to maintain the hard and soft tissue in the interproximal areas. This is beneficial for implant sites adjacent to an existing implant or an edentulous space. The most common complication of the socket sheild technique (SST) is internal shield exposure. Due to anatomical features such as a scalloped ridge shape and an oval socket shape of some teeth, the risk of complications such as internal shield exposure, inadvertent SS displacement, and fracture of the SS during implant insertion is greater in proximal shield areas. The present article describes guidelines for case selection for proximal shield extensions, along with SS preparation and the selection of implant and prosthetic components.

Root Submergence Technique, A Case Series with Follow-Up up to Seven Years
In the era of aesthetic dentistry, the goal is not only to provide a function to our patients but also to preserve the hard and soft tissue anatomy, to have a pleasing prosthesis. Obtaining natural aesthetics is simpler in single implant cases, however, in multiple implant prosthesis achieving natural dentition becomes a challenge. The root submergence technique (RST) is one such procedure that provides maximum preservation of the surrounding alveolar bone and soft tissue. This case series discusses the effect of a root submergence technique on preserving the periodontal tissue at the pontic site of fixed dental prostheses in the maxillary arch. The results of this clinical case series indicate that a root submergence technique can be successfully applied in the pontic site development with fixed dental prostheses, especially in the maxillary anterior aesthetic zone.

Teeth First: A novel surgical treatment concept for the edentulous, acquired Class III, severely atrophied maxilla
Extreme atrophy of the edentulous maxilla still represents a challenge as far as prosthetic rehabilitation with implant-supported fixed (screw-type) prostheses is concerned. This is due not only to insufficient bone volume for implant placement but also to unfavorable three-dimensional inter-maxillary relationships that is caused by the pattern of bone resorption in the maxilla. In the scientific literature, there are few clinical studies describing the use of the Le Fort I osteotomy, as a 1 or 2 stage procedure, for the reconstruction of a three dimensionally severely atrophied maxilla, prior to implant placement.

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.

Guided Bone Regeneration of a Seibert Class III Bone Defect With Bioactive Calcium Phosphosilicate Bone Graft: Human Histology and Clinical Report
This clinical case aimed to achieve two main objectives. The first was to determine if the use of only calcium phosphosilicate bone graft as a regeneration material (with no autologous bone added) on a severe vertical and horizontal mandibular defect would allow enough bone to be obtained to enable the placement of dental implants. The second objective was to determine histologic characteristics of the regenerated site after a healing period of 10 months.

Three-Dimensional (3D) Facially Driven Workflow for Anterior Ridge Defect Evaluation: A Treatment Concept
The esthetic rehabilitation of anterior ridge defects and achieving patient satisfaction have become major clinical challenges for dentists and technicians.

Effects of Osseodensification on Immediate Implant Placement: Retrospective Analysis of 211 Implants
Osseo densification is a new method of bone instrumentation for dental implant placement that preserves bulk bone and increases primary implant stability, and may accelerate the implant rehabilitation treatment period and provide higher success and survival rates than conventional methods. The aim of this retrospective study was to evaluate and discuss results obtained on immediate implant placement with immediate and delayed loading protocols under Osseodensification bone instrumentation

Three-Dimensional (3D) Facially Driven Workflow for Anterior Ridge Defect Evaluation: A Treatment Concept
The esthetic rehabilitation of anterior ridge defects and achieving patient satisfaction have become major clinical challenges for dentists and technicians. Poor diagnosis and treatment planning are frequently associated with multiple surgical procedures that fail to meet patient expectations.

Root submergence technique as a partial extraction therapy to preserve the alveolar ridge tissues: A systematic review and appraisal of the literature
The loss of alveolar ridge volume as a result of tooth extraction has been noted in the literature since the 1960s.1-3 The full extent of why this happens is still not entirely understood,4 with a widely accepted explanation for the loss relating to factors that include trauma the extraction socket as a wound sees upregulation of inflammatory processes, resultant activation of osteoclastic activity, resorption of the extraction socket, and an eventual healing that typically results in loss of tissue volume and architecture.5 Second, bundle boned removal of the tooth results in periodontal ligament (PDL) fibers being severed, loss of Sharpey fibers that insert into bundle bone, and a subsequent loss of the mineralized bone layer that lines the alveolus.4-6 At the buccal or facial aspect, the bone plate may consist entirely of bundle bone.

Molar Septum Expansion with Osseodensification for Immediate Implant Placement, Retrospective Multicenter Study with Up-to-5-Year Follow-Up, Introducing a New Molar Socket Classification
The ideal positioning of immediate implants in molar extraction sockets often requires the osteotomy to be in the interradicular septum, which can be challenging in some cases, with traditional site preparation techniques. Patients who had undergone molar tooth extraction and immediate implant placement at five different centers, and followed up between August 2015 and September 2020, were evaluated. Inclusion criteria were use of the osseodensification technique for implant site preparation. The primary outcome was septum width measurement pre-instrumentation and osteotomy diameter post expansion. Clinical outcomes, such as implant insertion torque (ISQ) and implant survival rate, were also collected. A total of 131 patients, who received 145 immediate implants, were included. T

Immediate loading of a socket shield (partial extraction therapy) post-extraction implant with the final CAD/CAM crown The ONE protocol for one-day natural aesthetics and preventing buccal collapse
Immediate implant placement is a well-recognised and successful treatment option after tooth extraction.1,2 Success rates for both immediate and delayed implant techniques are comparable; however, the literature reports that one can expect buccal collapse of the original buccal volume and midfacial recession of at least 1mm after immediate implant placement, possibly worse in thin gingival biotypes.3

Clinical and Esthetic Outcomes of the Surgical Veneer Grafting Protocol in the Anterior Maxilla
A multicenter cohort clinical investigation evaluated the change in horizontal ridge dimension associated with immediate placement and provisionalization in anterior extraction sockets. Following the surgical veneer grafting (SVG) protocol, a combination of a bone and connective tissue graft (CTG) was performed in 37 patients to compensate for the natural hard and soft tissue remodeling to achieve a sustainable and predictable esthetic outcome in patients with a thing gingival phenotype. The patients were followed for an average of 39 months (range of 10 to 58 months). At the four-year recall, 61% of the fixtures were evaluated. All 37 implants were successfully integrated, demonstrating stable and healthy peri-implant soft tissues as documented by standard clinical parameters. The results showed an average volume gain of 0.68 mm in the tissue zone, compared to the initial situation.

A Decade of the Socket-Shield Technique: A Step-by-Step Partial Extraction Therapy Protocol
Ten years have passed since Hürzeler and coworkers first introduced the socket-shield technique. Much has developed and evolved with regard to partial extraction therapy, a collective concept of utilizing the patient’s own tooth root to preserve the periodontium and peri-implant tissue. The specifications, steps, instrumentation, and procedures discussed in this article are the result of extensive experience in refining the socket-shield technique as we know it today. A repeatable, predictable protocol is requisite to providing tooth replacement in esthetic dentistry. Moreover, a standardized protocol provides a better framework for clinicians to report data relating to the technique with procedural consistency. This article aims to illustrate a reproducible, step-by-step protocol for the socket- shield technique at immediate implant placement and provisionalization for single-rooted teeth.

Modified IVAN Technique: Long-Term Follow-Up of 20 Cases Over 2 to 11 Years
When natural teeth fail, frequently there is a loss of hard and soft tissue. This may complicate subsequent dental implant placement by creating insufficient bone to house the implant. This also occurs when the tooth has been missing for an extended period, especially in the premaxilla, where the bone is less dense and often lacks sufficient volume of facial bone. Site reconstruction to accommodate implant placement often requires both hard and soft tissue augmentation. The modified interpositional vascularized augmentation neogenesis (mIVAN) technique achieves the desired treatment goals in both delayed and immediate placement scenarios. The technique will be discussed as well as the long-term follow-up on 20 cases.

The Modified IVAN Technique: Hard and Soft Tissue Augmentation at Extraction for Delayed Implant Placement
Failure of a natural tooth may not permit placement of an implant at the time of extraction due to insufficiency in available bone to house the implant. Reconstruction of the extraction socket frequently involves both hard and soft tissue augmentation to provide a site that can house the implant and ridge contours that mimic the adjacent natural anatomy. This situation becomes more problematic in the maxillary anterior due to the anatomy and the lower density of the bone of the premaxilla. The solution is the interpositional vascularized augmentation neogenesis (IVAN), which consists of hard tissue grafts, various barrier membranes, and closure with the pediculated connective tissue graft (PCTG). The modified IVAN (mIVAN) technique achieves the necessary goals and may be used in both delayed and immediate placement situations.

Maintenance of Alveolar Ridge Dimensions Utilizing an Extracted Tooth Dentin Particulate Autograft and Platelet-Rich Fibrin: A Retrospective Radiographic Cone-Beam Computed Tomography Study
This study utilized radiographic comparative analysis in order to evaluate dimensional ridge changes four months after tooth extraction and immediate grafting with mineralized dentin particulate autograft and chopped platelet-rich fibrin. Fifty-eight extraction sockets with up to 2mm of missing buccal bone in the coronal aspect compared to the lingual bone were included. Graft material was covered with either a platelet-rich fibrin membrane or collagen sponge with no effort to achieve primary closure.

Clinical Investigation of an Immediate Load Protocol Using Axial & Tilted Implants to Treat Patients with Failing Dentition or Complete Edentulism
The clinical investigation evaluated a specific surgical/prosthetic protocol for full-arch fixed dental restorations supported by immediate loaded axial & axial tilted implants, as well as the verall prosthetic survival rate. Mid-study results confirmed that immediate loading of axial & tilted implants following the studied protocol provides a viable treatment modality for the rehabilitation of edentulous arches & terminal dentition.

Survival of Implants after Indirect Maxillary Sinus Elevation Procedure: A Two Years Longitudinal Study
The aim of the study was to evaluate the survival rate of two diverse implant systems with different implant surfaces with the same geometrical design. In the present study, we achieved clinical success with both kinds of implant surfaces however Bioetched implant surface showed promising results comparable to Tiunite surface of Nobel BioCare Implants. In the future, more case-controlled studies with longer follow-up are needed to validate the results of the present findings.

Contaminated Implants Raise Global Concern Among Dentists
There is a problem that many implantologists are not aware of: recent analyses of dental implants using scanning electron microscopy indicate that an alarming number of sterile-packaged implants are contaminated. The authors assumed that either foreign particles had found their way into the osseous bed during the implant placement procedure or the implant material itself was contaminated.

Socket Shield Technique - Implantology Today
The socket shield procedure is an effective surgical technique for implant supported restorations. It helps in preserving the labial bone and soft tissue architecture around osseointegrated implants. The procedure provides comparable or better outcomes compared to other conventional alternatives at a lower cost.

Treating Two Adjacent Missing Teeth in the Esthetic Zone - Part 1: The Pink Hybrid Restoration & the Unilateral Versus Bilateral Defect Concept
This article, the first of a planned three-part series, outlines a new surgical & prosthetic approach for treating cases involving two missing adjacent teeth in the esthetic zone. These type of cases, particularly when combined with a three-dimensional ridge deficiency, represent one of esthetic dentistry's most challenging dilemmas. A Clear understanding of the unilateral and bilateral defect concept is necessary to properly evaluate each particular case, understand surgical limitations, perform a better risk assessment, establish an esthetic prognosis, develop the best clinical-laboratory strategy, and adjust patients' expectations. While not recommended for every case, represents a useful, economical, and predictable alternative that decreases the umber and complexity of interventions.

The “Scalloped Guide”: A Proof-of-Concept Technique for a Digitally Streamlined, Pink-Free Full-Arch Implant Protocol
Inadequate restorative space can result in mechanical, biologic, and esthetic complications with full-arch fixed implant-supported prosthetics. As such, clinicians often reduce bone to create clearance. The aim of this paper was to present a protocol using stacking computer-aided design/computerassisted manufacturing (CAD/CAM) guides to minimize and accurately obtain the desired bone reduction, immediately place prosthetically guided implants, and load a provisional that replicates predetermined tissue contour. This protocol can help clinicians minimize bone reduction and place the implants in an ideal position that allows them to emerge from the soft tissue interface with a natural, pink-free zirconia fixed dental prostheses.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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:

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.

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...

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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
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.

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…

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

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

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

A Study of the Fate of the Buccal Wall of Extraction Sockets of Teeth with Prominent Roots
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.”

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…

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.

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…

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.

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.

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

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.

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…

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.…

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...

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 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…

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…

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…

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.

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 & 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…

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…

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…

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…

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…

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…

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.

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,…

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.

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…

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…

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…

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.

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.

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,…

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…