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Purpose Biomechanical behavior of tooth-implant-supported prostheses (TISPs) with external and internal implants was compared. Materials and methods Two 3-D models of TISP were designed by varying the implant: external (Model EH) and internal hexagons (Model IH). After loading, von Mises stresses were obtained in implants, abutments, and screws. Principal maximum (σmax) and minimum (σmin) stresses were analyzed in periodontal ligament (PL), alveolar bone, and periimplant bone. Results Model IH showed lower stress peaks in axial loading in the implant and in the screw but higher in abutment. In oblique loading, Model IH had lower stresses in the implant, but higher in the abutment and in the screw. In the σmax analysis for axial and oblique loads, stress peaks in Model IH were lower in PL, alveolar bone, and periimplant bone. In the σmin analysis for axial load, stress peaks in Model IH were lower in PL, but higher in alveolar bone and in periimplant bone. In oblique load, Model IH showed lower stress peaks in PL and alveolar bone, but higher stress peaks in periimplant bone. Conclusions TISPs with IH implants do present lower risk of biomechanical failure.

Background: Posterior maxillary tooth loss may complicate the implant treatment due to the alterations in alveolar anatomy and maxillary sinus pneumatization. This study aimed to comprehensively examine the anatomical structure of this region from cone-beam computed tomography (CBCT) images. Materials and Methods: The posterior maxilla regions with single tooth loss were analyzed by dividing the variables into 3 subgroups from images of 597 patients chosen from 1160 CBCTs. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height (ABH) and width (RW), posterior superior alveolar artery (PSAA), and adjacent roots were evaluated. Results: The majority of the patients demonstrated 0 to 5 mm membrane thickness. Irregular SM thickening was lower for female patients. While females showed higher number of narrow sinus, males had higher RW than females. Sinus augmentation classification showed negative correlation with ABH, root-tip sinus floor and edentulous site classification. Posterior septa height was correlated with number of septa and ABH. PSAA diameter and location were also correlated between each other. Conclusion: The present results define formation of a sinus space with 11 mm coronal and 16 mm apical width after single tooth loss. A flat or semispherical thickening around 4 mm is usual in most cases with 51% possibility of anterior septum existence. A ridge anatomy, around 7.5 mm ABH and 7.2 to 9 .3 RW from coronal to apical, complements this anatomy. Further studies are needed to clarify the reasons behind the SM and crestal anatomy variations between genders.

Purpose To evaluate survival rate and bone response around immediate loaded Morse taper implants installed in fresh sockets on the anterior area of the maxilla. Material and methods The sample comprised 16 patients in whom 16 single implants were installed. All the teeth were extracted in a flapless surgery. Radiographic and tomographic evaluations were performed immediately after surgery (T1) and after 12 months (T2). The variables studied were height of the buccal wall (HBW), buccal wall width (BW) at 3 levels, and proximal bone height at 2 different areas: the alveolar crest level (CLH) and at the point where bone tissue meets the implant surface (BIS). Results Statistically significant differences were observed. The buccal plate showed bone loss in height (HBW = -0.50 ± 0.42 mm) and in width (BW-1 = -0.71 ± 0.48 mm; BW-2 = -0.48 ± 0.34 mm; BW-3 = -0.48 ± 0.34 mm). In the proximal areas, there was also bone loss in height (CLH-M = -0.85 ± 0.89 mm; BIS-M = -0.91 ± 0.70 mm; CLH-D = -0.64 ± 0.57 mm; and BIS-D = -0.68 ± 0.62 mm). Conclusion There was 100% survival rate after a 12-month period, but bone loss was observed in all evaluated areas.

This study was conducted to investigate one-piece narrow-diameter implants installed in maxillary lateral and mandibular incisor sites using immediate nonfunctional loading.In this 10-year clinical trial study, 42 narrow-diameter (3.0-mm) one-piece implants for 35 patients were inserted. Clinical and radiographic measurements were recorded in 10 years and analyzed statistically using t test.A total of 26 patients (20 females and 6 males) with 30 implants were available for the 10-year follow-up. The 10-year implant survival rate was 100%. A statistically significant mean marginal bone loss was observed between 12 months and 10 years (0.18 ± 0.29 mm). The mean pocket depth increase was statistically significant (0.68 ± 0.83 mm). No bleeding on probing was observed around 90% of the implants. Full-mouth plaque index was registered at 20% of the implants.The results obtained in this analysis suggest that modest marginal bone loss was observed around the implants. One-piece narrow-diameter implants (Maximus 3.0; BioHorizons) can predictably restore missing maxillary lateral incisors and mandibular incisors in cases of careful patient selection.

INTRODUCTION The purpose of this retrospective analysis of clinical data was to evaluate the predictability of replacing failing single teeth with immediately placed implants loaded via a transitional (provisional) restoration. MATERIALS AND METHODS Implants were placed immediately at the time of extraction of failing single teeth that met predetermined inclusion criteria. A detailed protocol was followed to enable immediate loading of the implant with the use of prefabricated abutments in combination with transitional restorations. RESULTS A total of 375 immediate implants had been placed in 274 patients and loaded immediately. With the certainty of 95%, an estimated overall mean survival rate better than 97.6% was observed after a mean observation period of 36 months. The maximum observation period was 142 months. Four implants had been lost in function. CONCLUSION Immediate loading of immediately placed implants is a possible treatment option that might be predictably and successfully achieved. Implants of adequate primary stability coupled with a range of prefabricated abutments permit function to be achieved using transitional restorations. The preliminary results of this clinical case series are very promising.

Objectives: To investigate the survival rate of short ( 0.05). Conclusions: Survival rate of short implants restored with single-unit, nonsplinted restorations over an average period of 37 months was favorable and comparable with longer implants.

Purpose: This study evaluated the mechanism of an abutment fracture by means of a case-based finite element (FE) stress analysis. Materials and Methods: A patient presented with a complaint of fracture of an implant-retained single posterior restoration that had been in place for 6 years. The retrieved restoration was examined on the original working cast and subjected to microscopic observation for fracture surface analysis. A case-based FE analysis was conducted to detect the location and magnitude of stress concentration in the implant structures. Results: The fracture occurred at the concave neck of the abutment, with an evidence of fatigue fracture on the titanium surface. Ratchet marks were shown at the distal lingual edge, indicating that the crack proceeded from distolingual to mesial direction. The highest maximum tensile stress at the distolingual concave neck of the abutment was shown when the load was directed on the internal and external surfaces of the mesial buccal cusp. Conclusions: It is suggested that an offset loading because of the cantilever structure caused a high tensile stress on the distolingual edge, resulting in the fatigue fracture of the abutment.

Purpose The aim of this study was to evaluate the effects of static magnetic fields (SMFs) on the implants immediately placed in fresh extraction sockets. Materials and methods Twenty patients who were in need of 20 fixed implant-supported single crowns in the anterior maxilla were included. After tooth extraction, screw-type implants were placed immediately into fresh extraction sockets and were randomly covered with either magnetic abutment (test group) or conventional healing abutment (control group). Radio frequency analysis (RFA) was conducted at implant placement and after 1, 2, and 3 months. Marginal bone level changes were recorded 1, 2, and 3 months postoperatively. Results The RFA measurements showed a significant higher stability for implants in test group than that of control group after 1 month (P = 0.04). At month 2, less crestal bone loss was found in the test group (P = 0.03). However, at month 3, there was no significant difference between the groups for both parameters (P > 0.05). Conclusion SMFs caused more noticeable increase in implant stability and less bone loss during the initial weeks of healing.

Periimplantitis is the most frequent cause of late implant failure; however, little is known about the long-term success of periimplantitis treatment and the effectiveness of various therapeutic interventions.A total of 142 patients were referred to the Academy for Oral Implantology in Vienna for the treatment of recurrent periimplantitis around single-tooth implants. Of them, 72 patients (51%) were treated by laser decontamination, 47 patients (33%) by implantoplasty surgery, and 23 patients (16%) by a combination of both approaches.Overall success of periimplantitis therapy was 89% after 9 years of follow-up, and it did not differ significantly between female and male patients (P = 0.426). The number of implant failures that could not be prevented by periimplantitis treatment was 6 after laser decontamination (8%), 6 after implantoplasty surgery (13%), and 4 after a combination of both therapies (17%). Implant loss occurred after 4.9 ± 1.9 years of therapy, on average. No significant difference between the 3 treatment groups could be observed (P = 0.393).The present results suggest that success rates of periimplantitis therapy with either laser decontamination or surgical implantoplasty are high. These success rates do not appear to be associated with patient gender or treatment strategy.

The anatomical remodeling technique (ART) was proposed to place postextraction implants with the aid of specific osteotomes. This study is a clinical and radiographic evaluation with 10-year follow-up of anterior postextraction single implants placed with the ART and immediately restored.Thirty-five patients, with a hopeless tooth in the anterior maxilla, were included in the study and 35 implants were inserted according to the ART. Clinical and radiographic evaluations were performed at baseline (T0), after 6 (T1) and 14 months (T2), 4 years after surgery (T3) and every other year up to the 10-year follow-up (T4, T5, and T6). Implant success, survival, and failure rates were evaluated according to the International Congress of Oral Implantologists Pisa Consensus Conference criteria.Twenty-nine patients and 29 implants were available for the 10-year data analysis. After 10 years, the accumulated mean marginal bone loss was 2.69 ± 0.42 mm. The cumulative survival rate of the implants was 100%.Immediately loaded postextractive implants, placed according to the ART, have been proved to be a predictable method to rehabilitate single tooth in the anterior maxilla.

Introduction A case series was used to evaluate the efficacy and predictability of a ceramic matrix in a putty-like collagen carrier in immediate extraction sockets. Methods A single failing tooth was atraumatically extracted from each of 10 subjects. The sockets were debrided and grafted with ceramic matrix in a putty-like collagen carrier (15% hydroxyapatite, 85% β-tricalcium phosphate complex). A bovine pericardium membrane was draped over the graft site and a tension-free primary closure was obtained. After 6 months of healing, a trephine biopsy was taken from the center of each graft and a dental implant was placed. Two subjects were withdrawn from the study and were considered treatment failures. One of them moved to another state and the second exhibited delayed healing that required debridement of the grafting material from the socket. Results After 6 months follow-up, there was a mean reduction of ridge width of 1.667 mm and mean reduction of ridge height of 0.483 mm after graft healing and integration. Over a 24-month follow-up, mean new bone fill was 40.25% and implant osseointegration was 100%. Conclusion Ceramic matrix in a putty-like collagen carrier maintained ridge dimensions and, despite ongoing bone turnover, produced adequate mineralized tissue that enabled implant placement at 6 months.

The purpose of this study was to evaluate the efficacy of the alveolar ridge preservation technique using collagen sponge and xenograft after extraction.Twenty patients were divided into the control group and the experimental group, which contained about 10 patients each. The control group patients were planned 3-unit bridge without performing implant and without special treatments for the extraction socket, and prosthetic treatments were performed after 3 months. In the experimental group, using collagen sponge and xenogeneic bone graft, alveolar ridge preservation was performed simultaneously with tooth extraction; implants were placed after 3 months. Clinical and histological evaluations and statistical analysis were performed.The resorption rate of the width of alveolar bone 3 mm below the alveolar ridge of the control group was shown to be 20.74% and of the experimental group was an average of 14.26%, approximately a difference of 6% was observed, and it was statistically significant. New bone formation in the vicinity of bone graft materials was achieved well, and inflammation findings were not observed.The results indicated that in the ridge preservation using collagen sponge and xenograft, xenograft prevents the horizontal resorption of the alveolar ridge, and the upper collagen sponge blocks the infiltration of soft tissues to the lower area, and thus it has the advantage of the enhancement of bone fill.

Background: Immediate implant placement after tooth extraction is a predictable solution in various clinical situations. The purpose of this study was to evaluate the predictability of a treatment, including the placement of implants, using a modified insertion technique at the time of maxillary molar extraction. Materials: Sixty-eight patients with a total of 68 teeth scheduled for tooth extraction and immediate implant placement into fresh sockets were included in the study. Implants were positioned just after teeth removal and, in case of necessity, a regenerative therapy was performed at the same time. After a 3-month period of healing, implants were restored with single crown fixed prostheses. Results: All implants restored with single crowns were monitored for 36 months; only, 3 implants failed with a cumulative survival rate of 97.96%. Conclusion: The combination of atraumatic extraction of maxillary molars, sufficient residual inter-radicular bone, and the use of appropriate regenerative material at the time of implant insertion, represents a predictable long-term treatment.

Numerous studies demonstrate successful immediate loading of dental implants. The purpose of this study was to evaluate the long-term survival of single-tooth implants immediately placed in fresh extraction sites at the anterior maxilla with immediate infraocclusion-provisional restorations and nonfunctional immediately loading.A total of 24 implants were placed in 16 patients. The fixed provisional restorations were connected to a prefabricated plastic abutment. Occlusal contacts were avoided. Follow-up starting at implantation day ranged from 24 to 72 months with a mean of 40.7 months.One implant failed 1 month after placement due to the unscrewing of a temporary abutment that resulted in implant overload. Overall implant survival rate resulted in 95.8%. The mean marginal bone loss increased by 0.9 +/- 1.1 mm. starting from implant placement.Within the limits of this study, the data indicate that nonfunctional immediate loading of single-tooth implants placed in fresh extraction sites in the anterior maxilla can result in successful implant integration and stable peri-implant conditions up to 6 years.

There is much evidence in the literature to support the success and predictability of guided bone regeneration. Multiple techniques have been introduced using various types of membranes and bone grafting materials. The clinician is now faced with having to select the most predictable guided bone regeneration technique put forth within this extensive literature. Within this context and in addition to its demonstrated success, the "sandwich" bone augmentation technique creates an environment that mimics native bone and promotes regeneration. Its concept is based on a sound biologic rationale while providing flexibility in the selection of biomaterials. This article discusses the principles, the complications, and a step-by-step protocol of sandwich bone augmentation.

STATEMENT OF PROBLEM Despite careful attention to waxing, investing, and casting, marginal discrepancies are inevitable. Vertical and horizontal discrepancies can result in crestal bone resorption, peri-implantitis, and loss of osseointegration. PURPOSE The aim of this study was to evaluate marginal gap and overhang in 3 casting techniques for implant framework fabrication. MATERIALS AND METHODS A total of 24 frameworks, 8 each with the Burn-out Cap (ITI; Straumann) (group BC), with Impression Cap (ITI; Straumann) (group IC), and with conventional wax-up technique (group WX) were fabricated. All specimens were waxed on the analog abutments and cast with Type IV gold alloy. All castings were fixed on the analog abutments with cyanoacrylate and embedded in acrylic resin. Specimens were sectioned and prepared for scanning electron microscope evaluation. Frameworks were analyzed for vertical and horizontal discrepancies with x200 magnification (scanning electron microscopy). Data were analyzed statistically by multivariate analysis and the post hoc tests (alpha = 0.05). RESULTS The vertical discrepancy measurements for the 3 groups showed mean values of 53.74 +/- 11.0 mum, 63.6 +/- 13.2 mum, and 50.1 +/- 17.3 mum, respectively. The interfacial gap differences were not statistically significant in all groups (P > 0.05). Waxing the frameworks with impression caps significantly increased the horizontal discrepancy at the interfaces (P < 0.001). CONCLUSIONS Within the limitations of this experiment, it was demonstrated that the vertical discrepancy of the frameworks made with the 3 techniques were comparable in lack of accuracy with each other. Although conventional waxing produced the least horizontal discrepancy, the difference with burn-out cap group was not statistically different.

This case report presents an analysis of the clinical, radiographic, and histological features of a peri-implant lesion around an implant placed immediately after extraction of a tooth with a periapical lesion. A 52-year-old man received an immediate implant (3.75 x 11.5 mm2) placed in the anterior region of the maxilla. Three years after implant placement, the patient presented with swelling in the anterior portion of the maxilla. Radiographic examination showed a well-circumscribed radiolucency around the implant. The implant and the lesion were removed and fixed in 10% buffered formalin and processed. Histological analysis showed 3 types of epithelium: respiratory, cuboidal, and non-keratinized stratified squamous. In the cyst wall peripheral nerves, arteries, veins, and chronic inflammation were present. The diagnosis was nasopalatine duct cyst. We concluded that the nasopalatine duct cyst can develop in association with dental implants. Clinically, the lesion is similar to the classical nasopalatine duct cyst. Histological analysis should be mandatory in all cases of peri-implant lesions and in all dental periapical lesions before immediate implant placement.

PURPOSE Benign paroxysmal positional vertigo (BPPV) is a possible and well-documented complication after the osteotome internal sinus lift technique. But we report a case of unexpected BPPV complication after direct sinus lift by lateral approach for implant placement that was not reported till date. METHODS A 30-year-old woman had undergone direct sinus lift procedure by lateral window technique to replace her missing right molar with dental implant. The patient suffered with intense vertigo with nausea, vomiting, and aggravated when she changed the position of her head towards right immediately after procedure and was diagnosed with BPPV after the referral. CONCLUSION We assume that prolonged hyperextended head position of iatrogenic origin can be the reason, in this case, for BPPV after direct lateral sinus lift procedure. There is also a possibility that the temporal relationship with the surgical area and surgical action by rotating tools during window preparation are also contributing factors.

Functional bite impression (FBI) has been described as a definitive impression made under occlusal force after functional generated path (FGP) recording. This study compared the accuracy of occlusal contact of implant-fixed prostheses using the FBI technique and the conventional impression technique.Twelve subjects, each missing a single premolar or molar, were selected for this study. The conditions of the occlusal contacts were identified by the modified transillumination method. The occlusal contact condition was determined by comparing the rate of change in the occlusal contact area of the implant-fixed prostheses and both adjacent teeth before and after occlusal adjustment.The rate of change in the occlusal contact area using the FBI technique was 96%, and the rate using the conventional technique was 54%. The occlusal contact of implant prostheses using the FBI technique revealed better accuracy than that of the conventional technique.Regarding the FBI technique, a precise and functional prosthesis could be produced by completing the maxillomandibular registration, impression, and FGP at the same time.

This case series describes single implant rehabilitation in the maxillary first molar sites. It aims to show the surgical approaches carried out versus the residual bone height (RBH) and to evaluate implant success rate and bone anchorage height after 1 year.Placement of 10-mm-long tapered bone level implants was carried out according to the RBH: when RBH ≥10 mm, standard implant placement; when 6 mmRBH10 mm, osteotome sinus floor elevation procedure (OSFE) without graft; and, when RBH ≤6 mm, OSFE with graft.Fourteen patients received 15 implants in a mean RBH of 5.0 ± 2.4 mm (range, 2.0-11.0 mm). One implant was placed with a standard placement technique, 4 using OSFE without graft, and 10 using OSFE with graft. The 1-year success rate was 100%, and mean bone anchorage height reached at least 9.5 mm.Almost all cases of maxillary single implant rehabilitation might be performed by using OSFE. In the extremely atrophic maxilla, simultaneous grafting ensures implant embedding in bone.

The soft tissue profile created around a conventional healing abutment may be inadequate to accommodate an anatomically shaped abutment that is larger than a standard machined abutment. This causes difficulties in its insertion and subsequent impression-making and provisional restoration fabrication. This article presents a simple technique to overcome these problems.

The purpose of this pilot study is to propose a technique, the split-finger approach, to preserve/promote papillae formation.Twenty-one patients with 39 implants consecutively placed in the maxillary anterior region were evaluated at 6 months to 1 year after prosthodontic restoration. The implants evaluated included 16 single-tooth implants, 1 2-unit implant prosthesis, 2 4-unit tooth implants, 1 6-unit prostheses, and 1 7-unit restoration. The papillae were recorded as 0 = no papillae; 1 =or =50% of the gingival embrasure height; 2 =50% but100% of embrasure height; 3 = 100% closure of the proximal space; and 4 = overgrowth of the interproximal tissue.Data from this pilot study showed no class 0, class 1, or class 4 interproximal papillae after the final restoration. The 16 single-tooth restorations and 32 papillae had an average mesial papilla score of 3 and an average of 2.82 for the distal interproximal space. The average papilla score of the other implant papillae sites were 2.7 at 6 months to 1 year. A lower papilla score was noted in interimplant papillae.The proposed split-finger technique could serve as a clinically useful alternate procedure to promote/augment papillae formation around dental implants.

To solve some of the problems inherent in bone regeneration, various types of graft materials, matrix, putty, and gel delivery systems have been developed. These deliver demineralized bone matrix (DBM) to a graft site and maintain it in an appropriate position to achieve favorable results. This prospective study reviewed 10 cases of extraction immediate grafting with a putty-DBM delivery system. Five patients were male and 5 female. At intervals ranging from 4 to 21 months postextraction grafting, bone cores were harvested at the time of surgical insertion of Replace endosteal two-stage implants. All patients were restored with single-tooth self-standing prostheses. Bone quality and quantity in each of the bone cores were evaluated. All 10 cases were completed with favorable outcomes.

Developmental absence of one or more teeth referred to as hypodontia is frequently encountered in dental practice, whereas severe hypodontia is a rare developmental dental anomaly. A case of severe hypodontia is presented. It was successfully treated with osseointegrated implants.

Diabetes mellitus is no longer considered to be a contraindication for implant-supported prostheses, provided that the patient's blood sugar is under control, and that there is motivation for oral hygiene procedures. This paper presents the experiences of treating diabetic patients using implants with good success rates.

Purpose The aim was to evaluate the reproducibility of a radiographic technique using a new customized film holder in the follow-up of screwed single-tooth implants. Materials and methods Ten implants placed in the mandible (n = 6) and maxilla (n = 4) of 8 patients were submitted to radiographic assessments. Radiographs were taken using a customized film holder adapted to implant abutment after 4 (T0) and 8 (T1) months of implant placement. Quantitative evaluations were performed through horizontal and vertical measurements to analyze radiographic standardization. Results No differences were detected after comparison of implant and abutment diameter measurements between radiographs after 4 and 8 months. No significant variations were detected in vertical measurements (implant and abutment length) between radiographs obtained in T0 and T1. Conclusions The use of customized film holder adapted to the implant abutment seems to contribute to the standardization of radiographs at different times of screwed single-tooth implants.

Patients demand the esthetic replacement of missing teeth in an economic and expedient manner. When teeth are extracted, or have been missing for some time, the resorption process often limits the opportunity to replace those missing teeth with dental implants. The technique presented allows the restoration of missing teeth while maintaining the hard and soft tissues. It also prevents the patient from having to wear a removable appliance during the healing phase, and this maximizes the patient's comfort and esthetics. The new method described here has been used in 55 patients with a success rate of over 98%.

A procedure using osteotomes and bioactive glass as an alloplastic bone graft material is discussed, and three clinical cases are reviewed. Bioactive glass of a narrow size range (300-355 microns) has been shown to be osteoconductive and allows for good integration and regeneration of surrounding bony tissue. We have found this technique to be a predictable method of preparing and placing longer implants in the region of the maxillary premolar region without the need for additional donor site morbidity.

The effects of implant shape and size on the stress distribution around high-strength silicon nitride implants under vertical and oblique forces were determined using a three-dimensional finite element analysis. Finite element models were designed using as a basis the serial sections of the mandible. Using Auto-CAD software, the model simulated the placement of implants in the molar region of the left mandible. Results of the analyses demonstrated that mainly the implant root shape and the directions of bite forces influence the stress distributions in the supporting bone around each implant. Implant size is a lesser factor. The serrated implants presented a larger surface area to the bone than either the cylindrical or tapered implants, which resulted in lower compressive stress around the serrated implants. With increasing implant diameter and length, compressive stress decreased. The mean compressive stress distribution on the serrated implants was more flat (platykurtic) than on either the cylindrical or tapered implants. Results of studies on two load directions (vertical and oblique) showed that, in either case, the compressive stress in the cortical bone around the neck of the implant was higher than in the cancellous bone along the length of the implant. The most extreme principal compressive stress was found with oblique force. This study provides the first information on the relationship between shape of the silicon nitride implant and stress on the supporting bone.

This case report describes the use of a single implant as an abutment for a removable cast partial denture. The patient had only anterior teeth remaining in the mandible. One single-stage implant was placed to be used as an abutment for a cast removable partial denture. The periapical X-ray taken 14 months after initial loading showed no bone loss. Clinically, there was no crown loosening, no pocket depth, nor any implant loosening at 14 months. A long-term multicenter study is advocated to evaluate a greater number of patients over a 3- to 5-year time period to evaluate the success fo implant-supported crowns when they are used as partial denture abutments.

Most endosseous implant systems are placed using a two-stage surgical procedure. The surgical stages are separated by a period of 4 to 6 months to allow osseointegration. At Stage-I surgery, the implant is fixed in bone and submerged under mucosa, while at Stage-II surgery, the implant is exposed and the transmucosal abutment is connected to the implant. The one-stage nonsubmerged surgical procedure with immediate transmucosal extension using traditional two-stage implant systems is being used to treat partial and complete edentulism. This is a case report of 10 patients treated with endosseous implants in the maxillary anterior region with immediate provisionalization using a one-stage surgical procedure. The investigators found that all patients experienced minimal discomfort from complications after the one-stage surgery and immediate placement of the provisional restoration. No signs of inflammation or mobility were observed during the first 6 months. The partially edentulous anterior maxilla can be restored to an esthetic form in a single clinic visit.

Various treatment options have been advocated to restore short span edentulous spaces. For a single edentulous space, some clinicians have advocated the use of a unilateral removable partial denture because this design has certain advantages for the patient, and it does not require the preparation of adjacent teeth for the fabrication of a fixed partial denture. However, potentially serious consequences associated with this design type have been reported. The unilateral partial denture can become dislodged, swallowed, or aspirated, which can result in hospitalization, perforation of the gastrointestinal tract, possibly followed by surgical intervention to retrieve the prosthesis. Although an implant-supported single tooth replacement has been widely accepted and documented as a predictable treatment alternative, few clinical cases present have been presented in which potential severe iatrogenic damage can be so easily avoided. A treatment alternative that avoids potential hazards inherent in the design of a unilateral partial denture has been presented in this article.

OBJECTIVES To investigate the effect of implant-abutment connection types on reliability and failure modes of anterior single-unit crowns. METHODS Fifty-four implants were divided in 3 groups (n = 18 each): external hexagon (EH), internal hexagon (IH), and Morse taper (MT) connection. Abutments were screwed to the implants, and maxillary central incisor metal crowns were cemented and subjected to step-stress accelerated life testing. RESULTS The beta values derived from use-level probability Weibull calculations for groups IH (2.52), EH (1.67), and MT (0.88) indicated that fatigue influenced the failure only of IH and EH groups. The reliability for a mission of 100,000 cycles at 175 N was 0.99 (0.98-1.00), 0.84 (0.62-0.94) and 0.97 (0.87-0.99) for the EH, IH, and MT, respectively. The characteristic strength was not significantly different between EH (290 N) and IH (251 N) but significantly higher for MT (357 N). For IH and EH groups, failure involved screw fracture, and the MT implants primary failure mode was abutment fracture. CONCLUSIONS Reliability was higher for the EH and MT relative to IH groups, whereas the characteristic strength was significantly higher for implants with MT connection.

PURPOSE The original bony lid technique involves removing window of cortical bone using a microsaw, removing a failing implant through the window, and then replacing the bone into its original position. The purpose of this case series was to present modifications to the bony lid technique to improve outcomes. MATERIALS AND METHODS Ten patients (9 men and 1 woman) aged between 47 and 89 years were treated during a 5-year period with modifications to the bony lid technique. Modifications to the bony lid technique included restricting the size of the bony lid, use of a long shank drill, performing guided bone regeneration, immediate implant placement, and providing rigid fixation. RESULTS No complications occurred in the 10 cases presented in this case series. An immediate implant placement procedure was performed in 3 of the 10 patients treated. Fixation screws and a microplate were used to fix the bony lid in 1 patient. Allogenic bone was used in another case. Additional trephine and thin drills were used in 2 cases in the mandibular molar area. CONCLUSIONS Replacing failing dental implants can be successfully accomplished by removing cortical bone on the buccal aspect of the implant and then replacing this bone after the implant is removed or replaced. Using allogenic bone, fixation screws, microplates, and thin drills can help facilitate the success of this procedure.

PURPOSE To analyze the success and survival rates of the Osstem GSII (Osstem, Busan, Korea) implant in type IV bone. MATERIALS A prospective, multicenter (5 centers) study was conducted by examining the relationship between implant success and survival rates, and several patient and surgical parameters. The implants were placed in 82 patients who visited several nationwide dental hospitals and clinics between 2007 and 2008, followed by clinical and radiographic analyses. RESULTS In type IV bone, the implant success and survival rates were 93.23% and 95.83%, respectively. The maxillary premolar and mandibular anterior tooth areas showed success rates of 100%. The most widely used implant diameter and length was 5.0 and 13 mm, respectively, but the diameter and length had no effect on success rates. However, success rates appeared to decrease with age. CONCLUSIONS The results indicated that the Osstem GSII implant is highly effective in poor-quality type IV bone.

This study compares success rates and hard and periimplant soft tissue responses, between placement and nonplacement of the following five different types of grafts: autogenous bone (A); deproteinized bovine bone mineral (H); demineralized freeze-dried bone allograft (D); A + H; A + D in horizontal gaps between implant surfaces and the buccal bone wall, in immediate placed and immediate nonfunctional loaded implants in maxillary arch.Forty-one patients with a mean age of 42.5 years were enrolled in this retrospective comparative study. Outcome assessments included clinical and radiographic evaluation.Patients were followed up on average for 32 months with a 100% implant survival rate. No significant difference was found between the two groups.Results of this study suggest that immediate placed and immediate restored single implants are valuable therapeutic options in the maxillary arch. The types of grafts placement: A, H, D, A + H, and A + D in horizontal gaps have no additional benefit in promoting better clinical outcomes given that a thick gingival biotype is present.

The aim of this retrospective study is to assess the long-term buccal bone plate changes in cases of single implants in the maxillary aesthetic area placed and restored immediately after extraction.A private practice's database was reviewed to find patients who had a standard computed tomography (CT) scan taken no more than 24 hours after insertion of a single, immediately restored, postextractive implant in the anterior maxilla. After a minimum period of 7 years, a cone beam computed tomography (CBCT) was performed. Buccal bone plate measurements were performed on CT and CBCT Dicom images and in vivo records.Two thousand nine hundred eighty patient records were scanned. Sixteen of them met the primary inclusion criteria. Three CTs were excluded because of poor imaging. Thirteen patients were then eligible to be recalled and 12 of them agreed to a follow-up. One implant failed due to severe periimplantitis. The resulting 11 patients were scanned by CBCT. Vertical mean resorption of 0.5 mm at buccal aspect and an average of 0.9-mm thick buccal bone plate was revealed. In 2 patients (18.18%), the bone peak resorbed under the level of the implant shoulder.The buccal bone plate of single implants placed and restored immediately after tooth extraction in the maxillary aesthetic areas was subjected to a moderate vertical and horizontal reabsorption 7 years after surgery. If a careful selection of the patient and strict clinical protocol are observed, the immediate placement of a single implant in a fresh extraction socket and its immediate restoration do not compromise the preservation of the buccal bone plate.

Because the mechanical behavior of the implant-abutment system is critical for the longevity of implant-supported reconstructions, this study evaluated the fatigue reliability of different implant-abutment systems used as single-unit crowns and their failure modes.Sixty-three Ti-6Al-4V implants were divided in 3 groups: Replace Select (RS); IC-IMP Osseotite; and Unitite were restored with their respective abutments. Anatomically correct central incisor metal crowns were cemented and subjected to separate single load to failure tests and step-stress accelerated life testing (n = 18). A master Weibull curve and reliability for a mission of 50,000 cycles at 200 N were calculated. Polarized-light and scanning electron microscopes were used for failure analyses.The load at failure mean values during step-stress accelerated life testing were 348.14 N for RS, 324.07 N for Osseotite, and 321.29 N for the Unitite systems. No differences in reliability levels were detected between systems, and only the RS system mechanical failures were shown to be accelerated by damage accumulation. Failure modes differed between systems.The 3 evaluated systems did not present significantly different reliability; however, failure modes were different.

The periosteum is a necessary component for bone growth, healing, and remodeling. It provides vascularity, osteoblasts, and osteoclasts. It is a regenerative source for stem cells similar to those obtained from bone marrow aspiration. This article describes the inverted periosteal flap technique at an oral bone graft site as a means of enhancing bone regeneration. The technique is recommended when augmenting sites with 3- or 4-wall defects, in conjunction with implant placement or in combination with bone graft surgery.

Bone loss and soft tissue loss are common problems after tooth extraction and that can lead to excessive length of clinical crowns. This problem can be exacerbated by delaying implant placement after tooth extraction. In this case the opposite occurred. After flapless placement of a NobelDirect implant with immediate loading there was not enough vertical space for an esthetic restoration. Surgical crown lengthening was performed to create vertical space to place an esthetically pleasing restoration in harmony with the patient's existing dentition.

Introduction Loss of screw tightness resulting in abutment movement and displacement of the crown or prosthesis may occur from plastic deformation of the screw. This study correlates changes in screw length and diameter with previously reported loss of screw tightness. Materials and methods Samples consisting of a 4 × 10-mm implant (potted in polymethylmethacrylate resin), a standard abutment, and the cemented crown were loaded with a 200-N force for 1 × 10 cycles. Torque audits were performed and the screws retrieved. Measurements were made of the shank length and diameter for 4 groups of implants-BioLok, external connection; Zimmer, internal connection; NobelBiocare, external connection; and AstraTech, internal connection. Results Elongation of the screw shanks were observed for NobelBiocare (77.9 μm) and Zimmer (52.5 μm) systems. This correlated with a loss of tightness of 50% (15 N cm). The BioLok system did not exhibit loss of screw tightness or shank lengthening. The Astra Tech system showed no change in screw shank length, but all the screws loosened multiple times. However, no changes in midshank width were observed for any of the systems. Conclusions For both internal connection and external hexed systems, loss of screw tightness can be correlated with plastic deformation of the screw. This does not seem to be true, however, for a conical interface implant system.

It has previously been demonstrated that immediate full occlusal loading of freestanding anterior implants can be performed using cortical satellite implants, obtaining a success rate similar to conventional protocols. The aim of this report was to present the outcomes after 36 months after initial placement.Twenty patients received 2 single-standing titanium screw implants, which were stabilized during healing time with cortical satellite implants. Immediately after surgery, mandibular overdentures were placed using ball attachments. The satellite implants were removed after 3 months.Implant survival analysis showed a 100% success rate. The following parameters were assessed during the study: Periotest values, -5.89 (minimum: -7.00, maximum: -4.00); radiographic assessment of bone resorption, 0.51 mm (minimum: 0.00 mm, maximum: 1.50 mm); and pocket probing depth, 2.60 mm (minimum: 1.00 mm, maximum: 8.00 mm).The results suggest that immediate loading of freestanding implants stabilized with satellite implants is a successful concept at 3 years observation time.

Purpose : The aim of this retrospective clinical trial was to evaluate the survival rates and the marginal bone levels of immediately placed implants in fresh extraction sockets in a period of 36 months. Patients and methods : One hundred seventeen patients who had received 165 immediately placed implants and followed up for 36 months after loading were included in this retrospective study. Survival rate and mesial and distal marginal bone levels of all implants were determined with the measurements made on periapical radiographs at baseline and recall evaluations. Results : The results of clinical evaluation showed a survival rate of 93.94%. Ten of 165 implants failed: 7 implants in female patients indicating 90.28% survival rate and 3 male patients with 93.4% survival rate. The mean age of patients with implant failure was 60.8 years. No statistically significant differences in marginal bone levels with respect to localization, age, gender, grafting, and implant brands were noted. Grafting did not influence plaque index, gingival index, and periimplant probing depth in a statistically significant way. Conclusions : The results suggest that immediately placed single implants show acceptable survival rates and mesial and distal marginal bone levels in 36-month follow-up period.

Purpose: The purpose of this prospective study was to evaluate the clinical outcome of implants immediately placed into fresh extraction sockets for the replacement of endodontically treated teeth with signs of vertical root fracture. Material: Sixteen partially edentulous patients, with 1 tooth scheduled for extraction and showing clinical signs and symptoms and/or radiological evidence of vertical root fracture, were included in the study. Sixteen transmucosal implants were installed immediately after extraction and careful debridement. The gap between the implant surface and the socket walls was filled using synthetic bone grafting cement. Prosthetic phase occurred 3 to 4 months after surgery. Implant success and survival and radiographic bone loss were evaluated after 1 year of function. Patient satisfaction for mastication function, phonetics, and aesthetics was also assessed by means of a questionnaire. Results: No implant failure occurred. The overall implant success and survival was 100% at 1 year. The mean follow-up was 13.5 months. All prostheses were successful. Periimplant bone loss after 1 year averaged 0.48 ± 0.20 mm. All patients reported full satisfaction for mastication function, phonetics, and aesthetics. Conclusions: The use of a synthetic bone grafting cement in combination with immediate implant placement procedure can be considered a safe, effective, and predictable treatment option for the rehabilitation of fresh postextraction sockets.

Purpose The aim of this study was to evaluate the influence of different Young moduli of the ceramic crown on the distribution of tensions in the region of the abutment-crown interface by making use of 2D finite element analysis. Materials Two representative models of a sagittally sectioned maxilla were built through AutoCad program showing an implant in the region of the upper central incisor and were restored by means of IPS e.max Press or Procera AllCeram on zircon abutment. Numerical analysis (Ansys 10.0) was performed under 2 loading conditions (50 N): on the lingual face, at 45 degrees with the implant's long axis (L1) and perpendicular to the incisal edge (L2). The von Mises equivalent stress (σvM) and maximum principal stress (σmax) were obtained. Results It was noticed that, independent of the restoring system, the maximum σvM values were in the incisal region of the cementation interface for both loading conditions. The IPS e.max Press system showed higher σvM on the adhesive interface with higher L1 influence. The same behavior was also observed as regards the σmax variation. Conclusions It was concluded that a restoring system with a lower Young modulus shows higher stress concentration on the abutment-crown interface when cemented on an abutment with a high Young modulus. Thus, IPS e.max Press system provides higher stress concentration in the resin cement layer than Procera AllCeram system, suggesting that the resin cement layer shows lower failure risk when the Procera crown is used.

The maxillary sinus graft procedure is the treatment of choice to increase the vertical bone height in the atrophic posterior maxilla to place dental implants. It is considered as a routine surgical procedure with predictable results. However, complications have been reported with this grafting procedure. With any surgical procedure, complications may arise, and the surgeon must be prepared to effectively manage the complication. In addition to detailed knowledge of the maxillofacial anatomy, recognition of surgical emergencies and its management is critical for the implant surgeon. A case of brisk, prolonged pulsatile hemorrhage during the sinus graft procedure is described, and its intra-operative management with topical Thrombin is presented.

PURPOSE Laboratory processing of implant-supported prostheses may alter the surface of the abutment in contact with the corresponding surface and thus the interface fit. This study assessed changes in the rotational freedom (R) at the interface of 1 implant ceramic abutments before and after preparation and glass infiltration processes. MATERIALS AND METHODS The abutment R was assessed for 20 as-received In-Ceram Ceramic Blanks over synOcta abutments and after both preparation and infiltration procedures. RESULTS Compared with the as-received blanks, there was a statistically significant (P < 0.009) increase of 0.8 minutes in the R after preparation and glass infiltration processes. CONCLUSION The results of this investigation suggest that, if all laboratory steps are observed carefully, changes at the abutment interface of Ceramic Blanks do not occur.

AIMS The primary aim of this study was to evaluate the 1-year crestal bone loss and success rate of an immediately placed single-stage implant placed and restored by novice operators. A secondary aim was to determine the patient's assessment of the appearance of the final restoration. METHODS Fifty-one patients received a tooth extraction and placement of at least 1 immediate implant by a Graduate Periodontics resident. Clinical and radiographic measurements were taken at the surgical, 4-month, and 1-year follow-up visits. After at least 3 months healing, dental students restored the implants with either a crown or an overdenture. Patient satisfaction was assessed using 5 categories: excellent, very good, good, fair, or poor. RESULTS Sixty-two immediate implants were placed. The success rate was 100% at the 12-month visit and was subclassified as grade 3 because of the mean first year bone loss of 1.3 +/- 1.0 mm. Using the 2008 classification of Misch et al, 42 implants were classified as success optimum health, 19 as survival satisfactory health, and 1 as survival compromised health. Radiographic bone loss was stratified by implant platform position relative to the alveolar crest and changed from time 0 to time 12 by -1.0 +/- 1.2 mm for the supracrestal group (n = 25, P < 0.05), -1.5 +/- 0.9 mm for the crestal group (n = 31, P < 0.05), and -1.3 +/- 1.2 mm for the subcrestal group (n = 6, P < 0.05). The supracrestal group had significantly less bone loss than either the crestal or the subcrestal group (P < 0.05). The appearance of the final restoration at 1 year was rated excellent by 82% of patients, very good by 16%, and good by 2%. CONCLUSIONS Immediate implant placement by novice operators using routine dental school procedures was a highly predictable procedure as indicated by the 100% success rate at 12 months. Most patients rated the restoration appearance as excellent.