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Background: Current evidence acknowledges guided bone regeneration (GBR) as a predictable therapeutic modality in the augmentation of a deficient alveolar ridge. Such deficiencies often reveal inadequate bone volume to support implant placement in a position amenable to prosthetic reconstruction. Additionally, an evolving body of literature demonstrates that membrane fixation may lead to improved clinical bone gain through positively influencing blood clot formation, stability, and the eventual osteogenic potential of the defect. Alternative benefits to membrane fixation, such as reduced graft displacement and reduction in wound micromotion, have also been cited as mechanisms for an increased regenerative response., Methods and Results: The aim of this report was to present a case, including diagnosis, treatment, and follow-up for the reconstruction of a horizontal ridge deficiency. The patient's deficiency in ridge volume was found to be a developmental sequelae of lateral incisor agenesis, resulting in an underdeveloped midfacial region of the alveolar process subjacent to sites #7 and #10. The fixation protocol outlined in this report demonstrated adequate horizontal ridge augmentation to facilitate future prosthetic reconstruction with the use of implants., Conclusions: Numerous protocols have been established in an attempt to achieve effective barrier membrane stabilization for bone augmentation procedures. However, some techniques are poorly suited for the anatomically challenging region of the anterior maxilla. A case report describing the utilization of the anterior nasal spine for anchorage of a membrane-stabilizing suture may present a novel, safe, and effective technique for stabilizing the intended region of augmentation, as well as preventing graft migration beyond the membrane-maxilla interface. Key points Regarding guided bone regeneration (GBR) procedures, micromotion of the membrane or of the underlying particulate graft may negatively influence the volume of the augmented site. The ability to adequately stabilize the graft-membrane interface is recognized as a necessary prerequisite to predictably achieve optimal surgical outcomes. To the authors' knowledge, there is no clinical or scientific evidence regarding the use of the anterior nasal spine for membrane anchorage in maxillary GBR procedures, and thus a novel approach to membrane stabilization is introduced., (Published 2024. This article is a U.S. Government work and is in the public domain in the USA.)

Background: The physiologic bone remodeling accompanying tooth extraction is a phenomenon well described in the dental literature. Extraction sockets severely compromised by local infection, trauma, iatrogenesis, or other factors may exhibit enhanced reduction in alveolar dimensions during healing. The purpose of this report is to present an alveolar ridge preservation (ARP) protocol specifically intended for use at severely compromised sites., Methods: Seven patients presented to the Department of Periodontics, Army Postgraduate Dental School, Fort Gordon, Georgia, requiring extraction of teeth with partial or near-complete loss of the facial/buccal cortex. At each site, a cross-linked bovine collagen membrane was used to prevent collapse of the facial/buccal soft tissue and maintain space, a freeze-dried bone allograft was applied in the socket, and a dense polytetrafluoroethylene membrane covered the occlusal aspect., Results: All sites healed uneventfully and resulted in favorable alveolar ridge dimensions for implant placement., Conclusion: Few authors have proposed specific ARP methods for managing severely deficient extraction sockets. The predominant recommendation has been staged reconstruction of the site applying hard and soft tissue augmentation. Observations reported herein suggest that staged reconstruction is avoidable at some extraction sockets exhibiting severe alveolar compromise. Controlled clinical investigation of this protocol appears warranted., Key Points: Few authors have proposed alveolar ridge preservation (ARP) methods specifically intended for use at severely compromised extraction sockets. The prevailing recommendation at such sites is a staged protocol involving tooth extraction with delayed hard and soft tissue augmentation. The presented bilaminar ARP technique may eliminate the need for staged reconstruction at some severely compromised extraction sockets., (Published 2023. This article is a U.S. Government work and is in the public domain in the USA.)

Background: Delivery of a high-quality provisional restoration at a maxillary anterior immediate implant site enhances patient-centered outcomes and promotes development of favorable hard and soft tissue architecture. The purpose of this report is to present a protocol relying upon compatible guided surgery and laboratory systems for fabrication of a custom provisional crown prior to immediate implant surgery in the esthetic zone., Methods and Results: A female patient, aged 33 years, presented to the Army Postgraduate Dental School, Fort Gordon, Georgia, with an unfavorable prognosis for tooth #9. The patient elected extraction with immediate implant placement. Prior to the surgery, we utilized a cone-beam computed tomography volume, stone models, implant planning software, and an implant indexing system to fabricate a custom provisional crown. Following extraction of tooth #9 and immediate implant placement, the provisional crown exhibited excellent fit and finish, requiring virtually no chairside adjustment. We noted minimal change in baseline mucosal contours throughout the healing phase., Conclusion: The clinical/restorative protocol described in this report assured accurate three-dimensional implant positioning and permitted indirect fabrication of a high-quality custom provisional crown in advance of surgery. The laboratory workflow-which dental technicians/auxiliaries can master-has the potential to shorten surgery, enhance treatment outcomes, and increase patient satisfaction., Key Points: Why is this case new information? This report provides a stepwise workflow guiding indirect fabrication of a custom provisional crown prior to immediate implant placement. What are the keys to successful management of this case? The described technique requires compatible laboratory and guided surgery systems to assure that the restoration accounts for the three-dimensional position and timing of the implant. What are the primary limitations to success in this case? Dental technicians/auxiliaries can master this protocol and independently produce high-quality provisional implant restorations under supervision, potentially enhancing practice efficiency. However, practitioners should provide adequate staff training to optimize reliability and quality., (Published 2022. This article is a U.S. Government work and is in the public domain in the USA.)

Introduction: Existing evidence supports superior treatment outcomes in guided bone regeneration (GBR) procedures employing membrane fixation. The purpose of this report is to present a specific flap design and suturing method for stabilizing GBR barrier membranes., Case Presentation: Two generally healthy patients received GBR using native collagen membranes stabilized with absorbable sutures. In both cases, we fixed barrier membranes apically using "triangle" sutures. Sling sutures (Case 1) or triangle sutures (Case 2) secured the crestal and palatal aspects of the membranes. No postoperative complications occurred, and both sites exhibited favorable alveolar ridge volume for implant placement., Conclusions: The described triangle suture technique reliably stabilized GBR barrier membranes without the need for fixation hardware. Compared with suturing methods that limit graft volume and apply pressure over the grafted area, the triangle suture may offer clinical advantages., (© 2022 American Academy of Periodontology.)

Introduction: Schneiderian membrane perforation (SMP), which is usually readily manageable, is the most common intraoperative complication of sinus elevation surgery. Some evidence suggests that SMP is associated with increased risk for postoperative complications, including maxillary sinusitis. Antral wall discontinuity (AWD) is an acquired condition that may increase SMP likelihood and lead to larger, less-manageable perforations., Case Presentation: A generally healthy patient receiving sinus elevation surgery exhibited an AWD in the palatine process of the maxilla. The osseous defect was isolated intraoperatively, and the Schneiderian membrane was sharply dissected from the palatal connective tissue. Favorable augmentation of the maxillary sinus was noted on cone-beam computed tomography (CBCT) assessment at postoperative month 34., Conclusions: AWD (fusion of the Schneiderian membrane with the periosteum of the maxilla) is a condition identifiable on preoperative CBCT images, which may increase the incidence and severity of SMP during sinus elevation procedures. Careful assessment for integrity of antral osseous walls before surgery is essential. Presence of AWD may obligate modifications to the surgical plan, or in some cases, contraindicate sinus elevation surgery., (© 2020 American Academy of Periodontology.)

Introduction: Introduction of a surgical insult in conjunction with orthodontic therapy has been shown to accelerate treatment in minor tooth movement and comprehensive orthodontic cases by induction of the regional acceleratory phenomenon (RAP). When applying this concept to a molar tipped into an adjacent edentulous site, a dental implant can be planned to anchor the movement., Case Presentation: A generally and periodontally healthy 25-year-old patient presented missing tooth #19, with tooth #18 mesially tipped into the first molar crown space. A dental implant was placed in the #19 position. Following osseointegration, the implant anchored orthodontic movement of the adjacent tooth, which was initiated in conjunction with third molar extraction., Conclusion: Favorable biomechanics for molar uprighting can be achieved using an osseointegrated implant and a customized orthodontic device. The presented technique facilitates implant site development without delaying placement of the fixture and simplifies fabrication of a harmonious and anatomic implant-supported restoration. Induction of the RAP may hasten treatment completion., (Published 2020. This article is a U.S. Government work and is in the public domain in the USA.)

Introduction: Continuous and interrupted sling sutures (ISSs) are used around teeth in contemporary periodontics. However, conventional ISSs depend upon favorable tooth morphology for stability through the early healing period. The purpose of this report is to present a variation of the classic ISS that does not rely on favorable tooth morphology., Case Series: Tissue-supported sling sutures (TSSs) were used for six patients undergoing root coverage, gingival augmentation, or pontic site development (guided bone regeneration) procedures., Conclusions: Although techniques such as vertical mattress suturing may support greater coronal flap advancement, the TSS technique does maintain coronal flap position while minimizing trauma to papillae. TSS stability is independent of tooth morphology and may offer clinicians flexibility in achieving reliable closure over hard and soft tissue implants. Like mattress sutures, TSSs reduce tension at the crestal incision line in tissue grafting procedures., (Published 2019. This article is a U.S. Government work and is in the public domain in the USA.)

Introduction: Postoperative discomfort is a documented complication of the epithelialized palatal graft (EPG) procedure, and the expectation of an unpleasant patient experience may cause some practitioners to avoid EPG altogether. However, EPG affords distinct advantages in a variety of clinical situations, and the postoperative discomfort associated with the procedure can be minimized., Case Series: Three generally and periodontally healthy patients with gingival recession defects and minimal zones of attached gingiva received mandibular anterior EPG procedures. In all cases, collagen membranes were trimmed to fit the palatal donor sites and sutured in place. Two patients reported minimal donor site discomfort at any time point. One patient with large bilateral donor sites reported moderate palatal discomfort limited to the first postoperative week. All patients reported overall positive treatment experiences., Conclusions: Placement of a resorbable collagen membrane at large EPG harvest sites appears to limit topical irritation of the wound and may substantially improve patient comfort postoperatively. Combining local and systemic measures to minimize patient discomfort may render EPG procedures very tolerable for patients. Controlled clinical trials comparing patient-centered outcomes following EPG harvest with and without collagen membrane placement appear warranted., (© 2019 American Academy of Periodontology.)

Introduction: Sinus graft infection with consequent acute bacterial rhinosinusitis (ABRS) is a complication that can occur during the postoperative period following sinus augmentation surgery. A small group of bacteria appear to predominate in ABRS, and these bacteria are empirically susceptible to tetracycline antibiotics, barring the presence of resistant strains. Historically, clinicians have mixed tetracycline with various biomaterials or hydrated biomaterials in a dilute tetracycline solution in the treatment of periodontal disease and for ridge preservation/augmentation indications., Case Presentation: In the present case, a 39-year-old African-American male with sinus graft infection and signs and symptoms consistent with ABRS was successfully treated by removing the initial graft material, thoroughly debriding and irrigating the antrum, and placing a freeze-dried bone allograft hydrated in an aqueous tetracycline solution., Conclusion: Given the typical bacteria present in ABRS, locally applied tetracycline may be useful prophylactically in sinus elevation surgery or as an adjunct in managing postoperative sinus graft infection., (© 2018 American Academy of Periodontology.)

Introduction: Minimally invasive surgical techniques in periodontics, including methods for ridge augmentation, have been shown to achieve surgical goals while minimizing swelling, decreasing postoperative discomfort, and enhancing soft tissue architecture. The present case illustrates a minimally invasive guided bone regeneration technique for augmentation of a deficient alveolar ridge in the esthetic zone., Case Presentation: A 30-year-old patient received localized ridge augmentation utilizing tunnel access for guided bone regeneration with a dense polytetrafluoroethylene membrane and a freeze-dried bone allograft. The patient experienced minimal postoperative swelling and discomfort, and the procedure resulted in favorable ridge dimensions for implant placement., Conclusions: The tunnel access for guided bone regeneration presented in this case may offer advantages similar to other minimally invasive ridge augmentation techniques. Further controlled clinical study is warranted., (© 2018 American Academy of Periodontology.)

Introduction: A contemporary protocol for managing horizontal alveolar defects adjacent to immediate implants includes placement of a well-designed provisional restoration to contain graft material and seal the socket. However, immediate provisionalization is not always possible or practical., Case Presentation: A 39-year-old male presented with a non-restorable tooth #29, which was extracted. An immediate implant was placed in the tooth #29 position, and a freeze-dried bone allograft was placed in the horizontal defect between the implant platform and osseous walls. A neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was used to create a stable fibrin clot over the graft material. After 31 months, favorable radiographic bone levels and complete papilla fill were noted., Conclusion: The present case illustrates use of an Nd:YAG laser in the management of an immediate implant horizontal defect in lieu of an immediate provisional restoration., (© 2017 American Academy of Periodontology.)

Introduction: Numerous biomaterials are available for augmenting bone around dental implants. In contained extraction sockets, a demineralized freeze-dried bone allograft (DFDBA) appears capable of maintaining dimensional stability of the alveolar ridge as well as mineralized alternatives but may yield a higher percentage of new vital bone. When DFDBA is used in large horizontal gap defects at molar immediate implant sites, graft containment and protection must occur through provisional restoration, an anatomic custom healing abutment, or by other means., Case Series: Two mandibular molar immediate implant sites received DFDBA covered by dense polytetrafluoroethylene membranes., Conclusion: The present report suggests a protocol for maintaining favorable dimensional stability of the alveolar ridge at molar immediate implant sites, while possibly minimizing residual peri-implant biomaterial., (© 2017 American Academy of Periodontology.)