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Objectives: In periodontology, it is widely recognized that evidence characterizing the incidence and effect of treatment complications is lacking. The objective of this study was to assess the influence of operator-, procedure-, patient-, and site-associated factors on intraoperative and postoperative complication occurrence., Material and Methods: A single investigator reviewed records of patients treated by eight periodontics residents from July 2018 through June 2022. For each procedure, the investigator recorded each intraoperative and postoperative complication or indicated that no complication had occurred. These outcomes were analyzed against a panel of explanatory covariates. In addition, the severity of each postoperative complication was assessed using a standardized grading system., Results: A total of 1135 procedures were included in the analysis. Intraoperative and postoperative complications were identified in 2.8% and 15.2% of procedures, respectively. The most common intraoperative complications were Schneiderian membrane perforation (1.3%) and gingival flap perforation/tear (1%), and the most common postoperative complications were dentin hypersensitivity (2.6%), excessive pain (2.5%), and infection (2.2%). Subepithelial connective tissue graft (odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.6, 6.1; p < .001), guided bone regeneration (OR: 3.0, 95% CI: 1.4, 6.5; p = .004), and guided bone regeneration with implant placement (OR: 3.1, 95% CI: 1.3, 7.6; p = .011) were associated with higher odds of postoperative complication, whereas lateral sinus elevation (OR: 102.5, 95% CI: 12.3, 852.9; p < .001), transalveolar sinus elevation (OR: 22.4, 95% CI: 2.2, 224.5; p = .008), open flap debridement (OR: 36.4, 95% CI: 3.0, 440.7; p = .005), and surgically facilitated orthodontic therapy (OR: 20.5, 95% CI: 1.2, 358.4; p = .039) were associated with higher odds of intraoperative complication occurrence., Conclusions: Consistent with previous reports, procedure type appears to be the predominant factor driving complication occurrence. As analyses of treatment complications increase, individualized risk-benefit assessments will become progressively meaningful for patients., (© 2024 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Focused Clinical Question: What factors identify the optimal bone augmentation techniques for managing slight, moderate, and severe horizontal alveolar ridge deficiency (ARD) at dental implant sites?, Summary: Horizontal ARD is a concern at a high proportion of sites receiving dental implants, and clinicians have developed a variety of surgical procedures to address such defects. In a particular case, selection of the optimal treatment may depend predominantly on defect severity, location (anterior versus posterior), and configuration (contained versus noncontained). This report provides a framework for selecting an augmentation method when presented with a slight, moderate, or severe horizontal ARD at a site requiring dental implant placement., Conclusion: Multiple treatment options are available for planned implant sites exhibiting horizontal ARD; severe posterior and slight anterior defects intuitively call for different approaches. Although rigid guidelines for selecting the optimal augmentation method do not exist, some techniques are poorly suited for esthetically demanding sites. A framework considering defect severity, location, and configuration may help guide clinical decisions on this topic., (Published 2023. This article is a U.S. Government work and is in the public domain in the USA.)

Focused Clinical Question: Under what circumstances may a clinician consider dental implant placement at a site exhibiting a focal high or mixed density (HMD) osseous lesion radiologically?, Summary: Some conditions and pathologic entities exhibiting high and mixed density radiological appearance pose low risk for dental implant failure or complications following implant surgery. However, other lesions represent contraindications to implant placement, and implant surgery at such sites can result in severe morbidity., Conclusion: Potential implant sites exhibiting focal HMD osseous lesions/conditions present varying levels of risk. In most cases, optimal management will include advanced imaging of the site, multidisciplinary consultations, and detailed informed consent to assure full understanding of procedural risks, benefits, and complications. Currently, clinical recommendations rely on case reports, opinion, and usual practice (level 3 evidence). The strength of each recommendation provided in this report is categorized as level C., (Published 2022. This article is a U.S. Government work and is in the public domain in the USA.)

Purpose: Our purpose was to assess the frequency and impact of various site development procedures provided before, during, and after implant placement in an advanced dental education program., Methods: We evaluated all implant cases completed by two residents in each of three consecutive periodontics residency classes. Dependent variables included implant failure, complication occurrence, presence of radiographic bone loss, and need for tissue augmentation. We analyzed these outcomes against a panel of explanatory covariates., Results: Our study sample involved 370 site development procedures at 290 implant sites in 160 patients. Three factors exhibited statistically significant associations with need for tissue augmentation: alveolar ridge preservation (ARP) (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.13, 0.57), immediate implant placement (IIP) (OR 0.21; 95% CI 0.10, 0.47), and implant submergence (OR 8.3; 95% CI 4.5, 15.3). Four factors predicted treatment complications: ARP (OR 6.1; 95% CI 1.3, 29.1), IIP (OR 6.1; 95% CI 1.06, 35.3), implant submergence (OR 5.3; 95% CI 1.1, 24.9), and mandibular arch (OR 31.3; 95% CI 1.9, 500). Anterior sites (OR 2.7; 95% CI 1.3, 5.8) were more likely to receive IIP., Conclusions: In the evaluated sample, implant placement at a site exhibiting a favorable volume of native bone was rare. Seventy-eight percent of sites received hard tissue grafting during the treatment phase. The use of ARP or IIP at tooth extraction reduced subsequent tissue augmentation requirements. Education and training in ARP and other site development procedures may enhance the clinical practice and treatment outcomes of implant surgeons., (Published 2022. This article is a U.S. Government work and is in the public domain in the USA.)

Background: Prior studies have defined minimum mesiodistal space (MS) and faciolingual alveolar width (FAW) requirements for dental implant sites, and failure to observe these constraints may adversely impact peri-implant health and esthetics. However, to the authors' knowledge, no previous reports have established frequencies at which anterior tooth positions present favorable MS and FAW for implant accommodation., Methods: A single examiner analyzed 205 cone-beam computed tomographic images, recording MS and FAW available for implant placement at anterior tooth positions. The examiner compared measurements with standardized implant diameters to assess anticipated implant-to-tooth distances and peri-implant bone thicknesses., Results: In the esthetic zone, lateral incisor sites most frequently failed to present favorable MS. At maxillary lateral incisor positions, 22% (left) and 27% (right) of sites offered less than 2 millimeters between the proposed implant platform and the adjacent teeth. In mandibular incisor positions, implant-to-tooth distance was less than 2 mm at 79% through 97% of sites and less than 1.5 mm at 35% through 76% of sites. Over one-half of maxillary incisor sites and 78% through 95% of mandibular incisor sites exhibited FAW of less than 4 mm beyond implant diameter., Conclusions: In the population evaluated, mandibular incisor positions frequently presented unfavorable MS to accommodate conventional narrow-diameter implants. In addition, considerable proportions of mandibular incisor and maxillary lateral incisor sites may be at risk of developing unfavorable peri-implant bone thickness when conventional narrow-diameter implants are used., Practical Implications: Practitioners should consider small-diameter implants and nonimplant tooth replacement methods for many patients missing single mandibular incisors or maxillary lateral incisors., (Copyright © 2019 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Introduction: Whether or not laser use provides any meaningful benefit at immediate implant and ridge preservation sites remains an open question in periodontics. However, various lasers have been used in conjunction with tooth extraction and immediate implant placement. Evidence supporting adjunctive laser irradiation at immediate implant and ridge preservation sites is mostly limited to preclinical studies and a small number of case reports., Case Series: Adjunctive neodymium‒doped: yttrium, aluminum, garnet (Nd:YAG) laser irradiation was used at six immediate implant sites and five ridge preservation sites. Three immediate implants were in maxillary incisor positions and three were in premolar positions, two maxillary and one mandibular. All cases exhibited favorable healing and satisfactory clinical outcomes., Conclusions: Nd:YAG laser energy application with 650-µs pulse duration consistently supported rapid clot formation and graft containment at immediate implant and ridge preservation sites. Histologic analyses and controlled clinical trials comparing ridge preservation and immediate implant procedures with and without laser use are needed. Because cellular responses and clinical outcomes may be exquisitely sensitive to irradiation parameters, studies should report materials and methods in detail., (© 2019 American Academy of Periodontology.)

Introduction: The epithelialized palatal graft (EPG), introduced in 1963, has persisted as the gold standard for gingival augmentation, and in the present era, mucosal augmentation around dental implants has become an important concern. A limited body of evidence suggests peri-implant mucosal augmentation may favorably impact bone and mucosal stability and peri-implant health under some circumstances. Although more contemporary procedures for peri-implant mucosal augmentation are often preferred based on convenience and esthetic considerations, EPG augmentation at dental implant sites is distinguishable from methods which do not deepen the vestibule and eliminate unfavorable superficial soft tissue. Implant sites augmented with EPG are qualitatively distinct from sites augmented using other methods., Case Series: Seven generally healthy patients received EPG augmentation before dental implant placement, at implant placement, before implant uncovering, or after implant uncovering. In each case, the patient exhibited a favorable zone of attached peri-implant mucosa following treatment., Conclusions: Reliable mucosal augmentation with EPG is achievable at multiple phases in the course of dental implant therapy. EPG augmentation offers distinct clinical advantages and may be preferable to other mucosal augmentation strategies at some dental implant sites., (© 2019 American Academy of Periodontology.)

Background: Crestal bone thickness is a critical determinant of peri-implant tissue stability. This retrospective observational study sought to quantify the buccal bone thickness achieved adjacent to virtual dental implants following guided bone regeneration (GBR) surgery and evaluate the influence of patient- and procedure-related variables on buccal bone thickness., Methods: Cone-beam computed tomography (CBCT) images acquired from patients who had undergone GBR surgery between July 1, 2012, and November 7, 2016, were used for this analysis. In all cases, the GBR procedure involved a dense polytetrafluoroethylene (dPTFE) barrier membrane and a mineralized cortical particulate freeze-dried bone allograft (FDBA). Eighty-four virtual dental implants were placed at planned locations using CBCT images from 84 patients, and the adjacent buccal bone thickness was measured at each site. The effects of sex, age, estimated baseline ridge width, number of missing teeth in site, site type (tooth-bounded versus terminal position in arch), dental arch (mandibular or maxillary), arch location (anterior or posterior), smoking status, titanium reinforcement in the membrane, membrane fixation, and tenting screw use were assessed., Results: The mean post-GBR buccal bone thickness adjacent to virtual dental implants was 2.24 ± 1.01 mm. Fifty-nine of 84 virtual implants (70%) exhibited buccal bone thickness > 1.9 mm. GBR sites using membrane fixation produced significantly greater virtual implant buccal bone thickness than those without membrane fixation (2.31 ± 0.96 versus 1.15 ± 1.25 mm, P = 0.012). Virtual implant buccal bone thickness also exhibited moderate correlation with estimated initial ridge width (r = 0.43, P < 0.0001). The alveolar ridge at 81 virtual implant sites (96%) was classified as good or satisfactory, meaning dental implants were actually placed at these sites, with or without additional grafting at implant placement., Conclusions: Observations in this study suggest GBR procedures using dPTFE membranes and FDBA result in favorable ridge dimensions for dental implant placement in most cases. However, additional augmentation at implant surgery may be necessary at ≈ 30% of sites, if buccal bone thickness > 1.9 mm is intended., (© Published 2018. This article is a U.S. Government work and is in the public domain in the USA.)

Focused Clinical Question: How should clinicians manage dental extraction sockets when immediate implant placement is contraindicated, and alveolar ridge preservation is expected to result in inadequate bone volume for implant placement?, Summary: Three fundamental options for extraction socket management form a hierarchical continuum in sites where dental implant placement is planned: place an immediate implant, perform ridge preservation, or perform ridge augmentation. The available volume and quality of bone and keratinized mucosa are the primary considerations driving the decision, and each tier in the continuum encompasses a variety of techniques with attendant advantages and disadvantages., Conclusions: Some immediate implant protocols require no mucoperiosteal flap and possibly produce the most favorable clinical and patient-centered outcomes compared with other extraction socket management approaches. Conversely, guided bone regeneration at dental extraction sites can result in substantial gains in alveolar ridge dimensions, although this treatment may adversely influence mucosal architecture and carry increased risk of postoperative morbidity. When favorable bone and mucosa are present at a dental extraction site, immediate implant placement may be the treatment of choice, barring unusual circumstances. Ridge preservation, typically associated with minimal postoperative morbidity, is a rational second choice when acceptable ridge dimensions are anticipated after healing., (© 2018 American Academy of Periodontology.)

Pyogenic granuloma is a benign nodular lesion occurring most commonly on the gingiva of females during periods of elevated sex hormones such as puberty and pregnancy. Possible molecular mechanisms responsible for the appearance of pyogenic granuloma in this demographic have been suggested. Increased incidence of pyogenic granuloma in post menopausal women on hormone replacement therapy has not been reported. A 49-year-old woman with preexisting titanium implant placement in the left posterior mandible presented with complaint of food impaction and slight discomfort associated with the implant. Clinical examination revealed slight soft tissue erythema and edema, but no foreign body could be identified. Subsequently, a nodular gingival lesion associated with the implant developed and was treated by conservative surgical excision. Histologic characteristics of the lesion were consistent with pyogenic granuloma. The patient was informed of the diagnosis. No evidence of recurrence could be identified after 6 months. Like peripubertal and pregnant women, postmenopausal women treated with hormone replacement therapy may be at increased risk for pyogenic granuloma. Observational studies designed to establish an association between hormone replacement therapy and pyogenic granuloma have not been conducted. Dentists should be aware of putative pathophysiologic mechanisms for pyogenic granuloma formation and the possibility that hormone replacement may trigger these mechanisms.

Purpose: Preoperative identification of the intraosseous posterior superior alveolar artery (PSAA) is critical when planning sinus surgery. This study was conducted to determine the distance between the cementoenamel junction and the PSAA, as well as to identify factors influencing the detection of the PSAA on cone-beam computed tomography (CBCT). Materials and Methods: In total, 254 CBCT scans of maxillary sinuses, acquired with 2 different scanners, were examined to identify the PSAA. The distance from the cementoenamel junction (CEJ) to the PSAA was recorded at each maxillary posterior tooth position. Binomial logistic regression and multiple linear regression were employed to evaluate the effects of scanner type, CBCT parameters, sex, and age on PSAA detection and CEJ-PSAA distance, respectively. P-values less than 0.05 were considered to indicate statistical significance. Results: The mean CEJ-PSAA distances at the second molar, first molar, second premolar, and first premolar positions were 17.0±4.0 mm, 21.8±4.1 mm, 19.5±4.7 mm, and 19.9±4.9 mm for scanner 1, respectively, and 17.3±3.5 mm, 16.9±4.3 mm, 18.5±4.1 mm, and 18.4±4.3 mm for scanner 2. No independent variable significantly influenced PSAA detection. However, tooth position (b= -0.67, P<0.05) and scanner type (b= -1.3, P<0.05) were significant predictors of CEJ-PSAA distance. Conclusion: CBCT-based estimates of CEJ-PSAA distance were comparable to those obtained in previous studies involving cadavers, CT, and CBCT. The type of CBCT scanner may slightly influence this measurement. No independent variable significantly impacted PSAA detection. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: In generally healthy patients receiving third molar, periodontal, or dental implant surgery, do postoperative oral corticosteroids effectively limit pain and swelling compared with placebo or alternative medications? [ABSTRACT FROM AUTHOR]

Introduction: Guided bone regeneration (GBR) is the most commonly utilized procedure for augmenting deficient alveolar ridges in support of dental implant placement. In a GBR procedure, barrier membrane dimensions, bone graft volume, and surgical complexity may influence the risk of postsurgical morbidity. Case presentation: A 25-year-old female in good general health received GBR at two mandibular first molar sites exhibiting horizontal ridge deficiency. High-density polytetrafluoroethylene membranes were intentionally limited in size, and small-volume freeze-dried bone allografts were applied only where clinically beneficial for implant site development. Treatment resulted in clinically favorable ridge augmentation with no appreciable swelling and minimal postoperative discomfort. Conclusion: At dental implant sites exhibiting modest alveolar ridge deficiency, limiting GBR barrier membrane dimensions and bone graft volumes may enhance patient-centered outcomes while accomplishing clinical goals. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to illustrate the efficacy of a novel imaging analysis technology to capture horizontal and vertical dimensional changes following horizontal alveolar ridge augmentation (HRA). Methods: Cone-beam computed tomography (CBCT) volumes from 65 HRA sites in 57 patients were available for evaluation, employing a three-dimensional analysis software to overlay preoperative and post-augmentation CBCT volumes. Horizontal and vertical alveolar ridge dimensional (HRD/VRD) changes were recorded considering a panel of patient-, site-, and procedure-related explanatory variables. Results: VRD changes ranged from -2.9 to 3.0 mm, more than half anterior sites losing alveolar ridge height. Mean HRD increase at the 3- and 5-mm levels apical to the alveolar crest amounted to 2.3±1.6 and 2.4±1.3 mm, respectively, membrane fixation and non-resorbable membrane use associated with significantly greater gains. Conclusions: To date, studies reporting dimensional changes following HRA predominantly rely on serial in situ orofacial caliper recordings omitting vertical alterations. The protocol employed in this study allows simultaneous HRD and VRD evaluations and assures baseline and post-augmentation recordings are made at the same alveolar ridge position. Compared with in situ recording, CBCT overlay analysis may achieve a more complete characterization of dimensional changes following HRA. [ABSTRACT FROM AUTHOR]

A considerable percentage of dental implant patients experience biofilm-mediated peri-implant disease following transmucosal abutment application. Bacterial adhesion is an early step in biofilm development. Our purpose was to assess adhesion of specific bacterial species to titanium over short exposure periods. Eight bacterial species were selected for this analysis: Streptococcus oralis, Streptococcus mitis, Gemella haemolysans, Streptococcus gordonii, Streptococcus sanguinis, Neisseria flavescens, Streptococcus salivarius, and Pseudomonas aeruginosa. We cultured each species with appropriate media and exposed titanium foil discs to the bacteria for 60, 15, 5, 1, or 0.25 minutes. Optical density at 600-nm wavelength (OD600) was assessed for the baseline inoculum and each species/exposure combination. The proportion of bacteria adherent to titanium was determined for each experimental condition. Striking titanium adhesion was noted for all evaluated species even when exposure time was limited to 15 seconds. Strategies to limit bacterial adhesion at dental implant surfaces may offer potential for improved treatment outcomes and preservation of peri-implant health. [ABSTRACT FROM AUTHOR]

Introduction: Retained cement following delivery of an implant-supported crown is strongly associated with peri-implant mucositis and peri-implantitis, and screw retention is a strategy for avoiding this problem entirely. In the esthetic zone, screw retention compromises esthetics unless the screw access in the crown is concealed to the palatal of the incisal edge. To avoid positioning the implant platform excessively toward the palate, practitioners can design an angled screw access channel in the crown. Case Presentation: A healthy 22-year-old patient with nonrestorable tooth #9 received extraction and immediate implant placement with immediate provisionalization. The screw access channel for the provisional restoration involved the incisal edge. Rather than placing a custom abutment and cementing the definitive restoration, an angled screw access channel was employed. The implant-supported restoration exhibited favorable esthetics, and the possibility of retained cement was avoided. Conclusion: Up to a point, positioning maxillary anterior implants toward the palate is favorable. When the long axis of the implant is directed between the incisal edge and the cingulum of adjacent teeth, the implantsupported crown can be screw retained without compromising esthetics. In immediate implant situations, such positioning also increases the distance between the implant and the facial alveolar bone and encourages a favorable position of the marginal peri-implant mucosa. However, an excessively palatal platform position compels a restoration with irregular contours, which can frustrate proper oral hygiene and professional maintenance. Angled screw access channels allow screw retention without excessive palatal positioning of the platform, avoiding the possibility of cement-related peri-implant disease. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: For a generally healthy patient with no risk indicators for postoperative infection, what is the most appropriate perioperative antibiotic regimen for sinus elevation surgery in terms of reducing postoperative infection risk and minimizing untoward effects? Clinical Scenario: A 38‐year‐old female patient in good general and periodontal health presents missing tooth #14 (Fig.). She reports no systemic conditions, no history of sinusitis, and no allergies. Medications include acetaminophen and ibuprofen as needed for pain. The patient's dentition is minimally restored, with no active caries. Cone‐beam computed tomography reveals a clear, pneumatized left maxillary sinus and inadequate bone volume to support dental implant placement (Fig.). No septa or pathologic lesions are present, the ostium appears patent, and no thickening of the Schneiderian membrane is appreciable. The patient states that she wants to replace her missing molar without restoring adjacent teeth (Figs. and). Baseline clinical appearance (example sinus elevation case). The patient is a healthy 38‐year‐old female missing tooth #14. Inadequate bone volume is present for dental implant placement due to pneumatization of the left maxillary sinus. Preoperative cone‐beam computed tomography images. 2a Sagittal view. 2b Coronal view. Cone‐beam computed tomography images at postoperative month 6. 3a Sagittal view. 3b Coronal view. Definitive implant‐supported restoration, tooth #14. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Type of Case: A 32‐year‐old female presents missing tooth #5 and requesting replacement with a dental implant. She has an unremarkable medical history. The tooth #5 site is a healed ridge with adequate bone to support an implant without additional augmentation. Clinical Approach #1 (CMR and TMJ): This approach involves routine implant surgery with placement of a healing abutment. Preoperative management includes 2 g amoxicillin 1 hour prior to the procedure and postoperative pain medication. The rationale for use of an antibiotic is to decrease the risk of infection and implant failure and to reduce peri‐implant inflammation during early healing. The desired effect of the antibiotic is to minimize or eliminate the negative effects of bacteria in the wound site and on the implant surface during healing. This clinical approach is recommended to protect the investment of resources and time by the patient and dental team for optimal treatment outcomes. Clinical Approach #2 (AWB, BGC, and KJE): This approach involves routine implant surgery with placement of a healing abutment. Postoperative management includes pain medications without antibiotic use. The rationale for avoidance of antibiotics is to eliminate risk of an adverse drug reaction such as urticaria, anaphylaxis, or gastrointestinal disturbances. Because the evidence justifying antibiotic coverage is considered to be weak, clinicians are advised to consider withholding antibiotic prescriptions for routine implant placement as a means of risk mitigation for the patient and public health in general. [ABSTRACT FROM AUTHOR]

Background Methods and Results Conclusions Key points 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.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.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. 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. 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. [ABSTRACT FROM AUTHOR]