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Implant Articles
The Replacement of Small-Diameter Teeth in the Esthetic Zone Using Narrow-Diameter Implants

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

Author(s): David Garber, DMD;Maurice Salama, DMD;Henry Salama, DMD
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Guided Bone Regeneration of a Seibert Class III Bone Defect With Bioactive Calcium Phosphosilicate Bone Graft: Human Histology and Clinical Report Premium Member Content

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.

Author(s): Filipe Lopes, DDS, DMD;Maurice Salama, DMD
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Three-Dimensional (3D) Facially Driven Workflow for Anterior Ridge Defect Evaluation: A Treatment Concept Premium Member Content

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.

Author(s): Maurice Salama, DMD;Christian Coachman, DDS, CDT;Hian Parize, Newton Sesma, Lauren Bohner
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Effects of Osseodensification on Immediate Implant Placement: Retrospective Analysis of 211 Implants Premium Member Content

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

Author(s): Márcio de Carvalho Formiga, Kinga Grzech-Lesniak, Vittorio Moraschini, Jamil Awad Shibli, and Rodrigo Neiva
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Bone Grafting Articles
Clinical and Esthetic Outcomes of the Surgical Veneer Grafting Protocol in the Anterior Maxilla Premium Member Content

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 implant placement and provisionalization in an anterior extraction socket.

Author(s): Maurice Salama, DMD;Richard Martin, DDS;Henry Salama, DMD;Andrea Mastrorosa Agnini, DDS;Alessandro Agnini, DMD
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Fibrinogen-Induced Regeneration Sealing Technique (F.I.R.S.T.). An Improvement and Modification of Traditional GBR: A Report of Two Cases

Fibrinogen-Induced Regeneration Sealing Technique (F.I.R.S.T.). An Improvement and Modification of Traditional GBR: A Report of Two Cases
Guided bone regeneration is a technique widely known, clinicians know very well indications and limitations of this technique. One of the principles to achieve bone augmentation and formation resides in the stability of the blood clot forming under a barrier membrane. The technique proposed in this article has the goal of providing stabilization to the bone graft by adding fibrin sealant (FS) to the bone graft and also using the fibrin sealant to attach a bone membrane (cortical lamina) to the recipient site. This simple modification of the technique of guided bone regeneration is presented in two successful cases.

Author(s): Vincenzo Foti, MD, DDS;Roberto Rossi, DDS
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Recombinant Human Platelet– Derived Growth Factor: A Systematic Review of Clinical Findings in Oral Regenerative Procedures

Recombinant Human Platelet– Derived Growth Factor: A Systematic Review of Clinical Findings in Oral Regenerative Procedures
The use of recombinant human plateletderived growth factor–BB (rhPDGF) has received Food and Drug Administration approval for the treatment of periodontal and orthopedic bone defects and dermal wound healing. Many studies have investigated its regenerative potential in a variety of other oral clinical indications. The aim of this systematic review was to assess the efficacy, safety, and clinical benefit of recombinant human plateletderived growth factor (rhPDGF) use for alveolar bone and/or soft tissue regeneration. Based on the clinical evidence, rhPDGF is safe and provides clinical benefits when used in combination with bone allografts, xenograft, or β-TCP for the treatment of intrabony and furcation periodontal defects and gingival recession or when used with allografts or xenograft for GBR and ARP.

Author(s): L. Tavelli, A. Ravidà, S. Barootchi, L. Chambrone, W.V. Giannobile
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Modified IVAN Technique: Long-Term Follow-Up of 20 Cases Over 2 to 11 Years

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.

Author(s): Snježana Pohl, MD, DMD;Gregori M. Kurtzman, DDS
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Sinus Lift Articles
Survival of Implants after Indirect Maxillary Sinus Elevation Procedure: A Two Years Longitudinal Study

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.

Author(s): Lanka Mahesh, BDS, MBA;Ashutosh Agarwal; Jose C Guirado; Praful Bali; Nitika Poonia
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Sinus Floor Elevation Via the Maxillary Premolar Extraction Socket With Immediate Implant Placement: A Case Series

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

Author(s): Monish Bhola, DDS, MSD;Shilpa Kolhatkar; Tamika N. Thompson-Sloan
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Alternative Applications of Guided Surgery: Precise Outlining of the Lateral Window in Antral Sinus Bone Grafting

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

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

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

Author(s): Lanka Mahesh, BDS, MBA;Dr. Manesh Lahori; Dr. Sagrika Shukla; Dr. Prerna Kaushik
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Soft Tissue Articles
The Root Submergence Technique at Single Tooth Sites to Short-Span Edentulous Sites: A Step-By-Step Partial Extraction Therapy Protocol

The Root Submergence Technique at Single Tooth Sites to Short-Span Edentulous Sites: A Step-By-Step Partial Extraction Therapy Protocol
Submerging roots for ridge preservation was the earliest partial extraction therapy and has been described since the 1970s. Despite the approximately 47 animal and human studies published since, an updated and contemporary step-by-step protocol has not yet been provided. This technique report describes in detail how to manage submerged roots at single tooth sites and at short-span edentulous areas.

Author(s): Jonathan Du Toit, BChD, Dip Oral Surg, Dipl Implantol, MSc, MChD (OMP), FCD(SA) OMP, PhD;Maurice Salama, DMD;Howard Gluckman, BDS, MChD, PhD;Katalin Nagy, DDS, PhD
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Fibrinogen-Induced Regeneration Sealing Technique (F.I.R.S.T.). An Improvement and Modification of Traditional GBR: A Report of Two Cases

Fibrinogen-Induced Regeneration Sealing Technique (F.I.R.S.T.). An Improvement and Modification of Traditional GBR: A Report of Two Cases
Guided bone regeneration is a technique widely known, clinicians know very well indications and limitations of this technique. One of the principles to achieve bone augmentation and formation resides in the stability of the blood clot forming under a barrier membrane. The technique proposed in this article has the goal of providing stabilization to the bone graft by adding fibrin sealant (FS) to the bone graft and also using the fibrin sealant to attach a bone membrane (cortical lamina) to the recipient site. This simple modification of the technique of guided bone regeneration is presented in two successful cases.

Author(s): Vincenzo Foti, MD, DDS;Roberto Rossi, DDS
View Article>>
Buccal Sliding Palatal Pedicle Flap Technique for Wound Closure After Ridge Augmentation

Buccal Sliding Palatal Pedicle Flap Technique for Wound Closure After Ridge Augmentation
One standard approach for wound closure after ridge augmentation is coronal flap advancement. Coronal flap advancement results in displacement of the mucogingival junction and reduction of the vestibulum. In the maxilla, a buccal sliding palatal flap can be applied for primary wound closure after ridge augmentation. The dissected part of the palatal connective tissue is left exposed, thus eliminating or reducing the amount of the coronal flap advancement respectively and increasing the amount of keratinized gingiva. In combination with guided soft tissue augmentation, this flap design enables a three-dimensional peri-implant soft tissue augmentation.

Author(s): Snježana Pohl, MD, DMD;Maurice Salama, DMD;Pantelis Petrakakis, DDS, DPH
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A Decade of the Socket-Shield Technique: A Step-by-Step Partial Extraction Therapy Protocol

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.

Author(s): Howard Gluckman, BDS, MChD, PhD;Jonathan Du Toit, BChD, Dip Oral Surg, Dipl Implantol, MSc, MChD (OMP), FCD(SA) OMP, PhD;Maurice Salama, DMD;Katalin Nagy, DDS, DSc, PhD;Michel Dard, DDS, MS, PhD
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Periodontic Surgery Articles
The Root Submergence Technique at Single Tooth Sites to Short-Span Edentulous Sites: A Step-By-Step Partial Extraction Therapy Protocol

The Root Submergence Technique at Single Tooth Sites to Short-Span Edentulous Sites: A Step-By-Step Partial Extraction Therapy Protocol
Submerging roots for ridge preservation was the earliest partial extraction therapy and has been described since the 1970s. Despite the approximately 47 animal and human studies published since, an updated and contemporary step-by-step protocol has not yet been provided. This technique report describes in detail how to manage submerged roots at single tooth sites and at short-span edentulous areas.

Author(s): Jonathan Du Toit, BChD, Dip Oral Surg, Dipl Implantol, MSc, MChD (OMP), FCD(SA) OMP, PhD;Maurice Salama, DMD;Howard Gluckman, BDS, MChD, PhD;Katalin Nagy, DDS, PhD
View Article>>
Buccal Sliding Palatal Pedicle Flap Technique for Wound Closure After Ridge Augmentation

Buccal Sliding Palatal Pedicle Flap Technique for Wound Closure After Ridge Augmentation
One standard approach for wound closure after ridge augmentation is coronal flap advancement. Coronal flap advancement results in displacement of the mucogingival junction and reduction of the vestibulum. In the maxilla, a buccal sliding palatal flap can be applied for primary wound closure after ridge augmentation. The dissected part of the palatal connective tissue is left exposed, thus eliminating or reducing the amount of the coronal flap advancement respectively and increasing the amount of keratinized gingiva. In combination with guided soft tissue augmentation, this flap design enables a three-dimensional peri-implant soft tissue augmentation.

Author(s): Snježana Pohl, MD, DMD;Maurice Salama, DMD;Pantelis Petrakakis, DDS, DPH
View Article>>
A Decade of the Socket-Shield Technique: A Step-by-Step Partial Extraction Therapy Protocol

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.

Author(s): Howard Gluckman, BDS, MChD, PhD;Jonathan Du Toit, BChD, Dip Oral Surg, Dipl Implantol, MSc, MChD (OMP), FCD(SA) OMP, PhD;Maurice Salama, DMD;Katalin Nagy, DDS, DSc, PhD;Michel Dard, DDS, MS, PhD
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The Pontic-Shield: Partial Extraction Therapy for Implant Dentistry

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

Author(s): Howard Gluckman, BDS, MChD, PhD;Maurice Salama, DMD;Jonathan Du Toit, BChD, Dipl Implantol, Dipl Oral Surg, MSc Dent
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Other Surgical Articles
Socket Shield Technique - Implantology Today

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.

Author(s): Udatta Kher, BDS, MDS;Ali Tunkiwala, MDS
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The “Scalloped Guide”: A Proof-of-Concept Technique for a Digitally Streamlined, Pink-Free Full-Arch Implant Protocol

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.

Author(s): Maurice Salama, DMD;Prof. Dr. Alessandro Pozzi;Wendy AuClair-Clark, DDS, MS;Marko Tadros, DMD;Lars Hansson, CDT, FICOI;Pinhas Adar, MDT, CDT
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The Socket-Shield Technique: First Histological, Clinical, and Volumetrical Observations after Separation of the Buccal Tooth Segment – A Pilot Study

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

Author(s): Markus B. Hürzeler, DMD, PhD;Daniel Bäumer, DDS; Otto Zuhr, DDS; Stephan Rebele, DDS; David Schneider, DDS, PhD; Peter Schupbach, PhD
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Mucosal Coronally Positioned Flap for the Management of Excessive Gingival Display in the Presence of Hypermobility of the Upper Lip and Vertical Maxillary Excess: A Case Report

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

Author(s): Monish Bhola, DDS, MSD;Nomahn Humayun; Shilpa Kolhatkar; Jason Souiyas
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