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Maintaining soft and hard tissues around dental implants after tooth extraction is one of the major challenges in implant dentistry. After tooth extraction, the subsequent loss of bone and soft tissue is inevitable due to the partial resorption of the buccal bone plate. The recently described socket shield technique addresses the problem by maintaining the buccal piece of the tooth in the extraction socket in order to preserve the buccal bone. As with every new technique, specific complications, like infection of the buccal piece of the tooth, can occur. Herein, the authors present a clinical case that developed a complication with the socket shield technique and the consequential surgical management. [ABSTRACT FROM AUTHOR]

In contemporary reconstructive periodontal and implant surgery, attaining uncomplicated wound healing in the early postoperative healing phase is the key to achieving a successful treatment outcome and is of central interest, from the clinical as well as the scientific perspective. The realization of primary wound healing is the central challenge in most cases. Two of the evidence-based factors that affect postoperative wound healing can be influenced by the surgeon: the blood supply to the surgical site and postoperative wound stability. The surgical suture is a key determinant of whether adequate wound stability is achieved in this context without complicating the course of wound healing by exerting unnecessary trauma or excessive tensile strain on the wound edges. Therefore, the inclusion of anchors in the suturing process that make it possible to achieve the best wound stability possible is often an important key to success. This article provides an overview of the principles of successful wound closure that are relevant to postoperative wound healing in order to equip dentists with the tools needed for the correct, indication-specific selection and performance of surgical suturing techniques in daily practice. [ABSTRACT FROM AUTHOR]

Restoring failing anterior teeth with a dental implant is considered a complex treatment even with thorough biologic knowledge of the situation. The goal is to produce a result in which the labial soft tissues and the papillae remain stable over time. Treatment of the fresh extraction socket in the alveolar ridge presents a challenge in everyday clinical practice. Regardless of the subsequent treatment, maintenance of the ridge contour will frequently facilitate all further therapeutic steps. Socket seal surgery and socket preservation in combination with immediate, early, or delayed implant placement can be valuable procedures for single tooth replacement. However, their potential as ridge preservation techniques in these different situations still needs to be demonstrated. The use of these procedures is illustrated in three consecutive cases. [ABSTRACT FROM AUTHOR]

Aim: Comparison of the clinical efficacy (digitally volumetric, aesthetic, patient‐centred outcomes) of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 5 years after gingival recession therapy. Materials and methods: In 18 patients contributing 36 RT1 recessions, study models were collected at baseline and follow‐ups. Optical scans assessed recessions computer‐assisted [recession depth, recession reduction (RECred), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness]. Root coverage aesthetic Score (RES) was used for aesthetic evaluation and visual analogue scales for patient‐centred data collection applied. Results: Sixty months after surgery, 50.0% (TUN+CTG) and 0.0% (CAF+EMD) of sites showed CRC (p = 0.0118), 82.2% (TUN+CTG) and 32.0% (CAF+EMD) achieved RC, respectively (p = 0.0023). CTG achieved significantly better RECred (TUN+CTG: 1.75±0.74 mm; CAF+EMD: 0.50 ± 0.39 mm; p = 0.0009) and aTHK (TUN+CTG: 0.95 ± 0.41 mm; CAF+EMD: 0.26 ± 0.28 mm; p = 0.0013). RES showed superior outcomes (p = 0.0533) for TUN+CTG (6.86 ± 2.31) compared to CAF+EMD (4.63 ± 1.99). The study failed to find significant differences related to patient‐centred outcomes (TUN+CTG: 8.30 ± 2.21; CAF+EMD: 7.50 ± 1.51; p = 0.1136). Conclusions: Five years after treatment, CTG resulted in better clinical and aesthetic outcomes than CAF+EMD. Increased THK was associated with improved outcomes for RECred and RC. [ABSTRACT FROM AUTHOR]

Aim: The aim of this randomized clinical trial was to compare clinical and volumetric outcomes of tunnel technique (TUN) with subepithelial connective tissue graft (CTG) versus coronally advanced flap (CAF) with enamel matrix derivate (EMD) 2 years after gingival recession (GR) treatment. Materials and methods: Twenty‐three patients contributed 45 Miller class I or II GR. At baseline and follow‐up examinations, study models were collected. Their three‐dimensional scans allowed precise computer‐assisted measurement of recession depth (REC), complete root coverage (CRC), percentage of root coverage (RC), pointwise (pTHK) and mean areal (aTHK) marginal soft tissue thickness. Clinical examination delivered probing depths (PPD) and height of keratinized tissue. Results: 24 months after surgery, digitally evaluated CRC was present in 60.0% of the TUN + CTG and 0.0% of the CAF + EMD‐treated sites (p <.0001), meaning a certain relapse of the gingival margin ragarding both approaches. RC amounted to 94.0% (TUN + CTG) and 57.3% (CAF + EMD), respectively (p <.0001). REC reduction (RECred) was significantly higher for TUN + CTG (1.81 ± 0.56 mm) than for CAF + EMD (0.90 ± 0.45 mm) (p <.0001). pTHK and aTHK values were significantly greater in the TUN + CTG group (1.41 ± 0.35 mm and 1.11 ± 0.26 mm) than in the CAF + EMD group (0.78 ± 0.32 mm and 0.60 ± 0.26 mm) (p <.0001). Statistical analysis detected positive correlations between THK and both RC and RECred (p <.001). Conclusions: Two years post‐operatively, CTG showed better clinical and volumetric outcomes than EMD. Increased THK values were associated with improved outcomes regarding RC and RECred. [ABSTRACT FROM AUTHOR]

The socket-shieid technique, first published in 2010, has gained worldwide scientific and clinical acceptance. To address possible complications with this innovative approach in esthetic implant dentistry, we provide a comprehensive step-by-step protocol incorporating what we have learnt in the past decade. After initial decoronation of the tooth, the implant bed is prepared through the root of the tooth to be extracted. Following extraction of the palatal root fragments, the shield is prepared according to either a mechanical or biologic 'locking' principle. The mechanical 'locking' comprises a direct contact between the implant and the shield, whereas the biologic approach facilitates ankylosis of the shield, preventing its coronal displacement. The coronal part of the shield is brought into a concave shape, ending up 0.5 mm coronal to the buccal bone. The implant is consequently inserted, and an individualized healing cap fabricated. When performed according to the underlying biologic and mechanical principles, the socket-shieid technique can provide highly esthetic and predictable outcomes. (Int J Esthet Dent 2020;15:288-305) [ABSTRACT FROM AUTHOR]

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Immediate implant placement at multirooted molar sites involves a series of site-specific anatomical challenges, including implant bed preparation in the presence of interradicular bone septa. The aim of this article is to present and discuss a novel approach that gives improved guidance during implant bed preparation for immediate implants at multirooted extraction sites in both the mandible and maxilla. Following decoronation of the concerned teeth, osteotomies were performed directly through the teeth's initially retained root complexes. After completion of the drilling protocol, the remaining root aspects were extracted, and treatment was continued in the usual manner. With the osteotomy drills stabilized and guided by the retained root aspects, this approach allows for precise positioning and angulation of the implant bed preparation, thus enabling ideal implant positioning during immediate implant placement at multirooted extraction sites. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this clinical trial was to evaluate whether the crestal bone height around dental implants could be influenced by the use of a platform-switching protocol. Materials and Methods: All implants placed in the year 2006 in healed bone without any need for ridge augmentation were included in this study. The following groups were created: (1) wide-diameter implants were placed subcrestally and regular-diameter cover screws were connected; (2) regular-diameter implants were placed at the crest and regular-diameter cover screws were connected. Standardized radiographs were obtained after insertion of the definitive prosthesis and after 1 year. Calibrated measurements were conducted initiating from the mesial and distal bone peaks to the implant-abutment junction. The average value of the mean medial and mean distal values was calculated and analyzed with an unpaired twotailed t test. P values < .05 were regarded as statistically significant. Results: In all, 89 dental implants in 36 patients were evaluated. The implants with a platform-switched configuration (n = 75) exhibited statistically significantly less bone loss at time of insertion of the definitive prosthesis (0.30 ± 0.07 mm versus 0.68 ± 0.17 mm; P < .05) and at 1 year (0.39 ± 0.07 mm versus 1.00 ± 0.22 mm, P < .01) when compared to the nonplatform-switched implants (n = 14). Conclusion: Platform-switched implants seem to limit crestal bone remodeling. [ABSTRACT FROM AUTHOR]

The esthetic outcome of implant-supported restorations has become increasingly important, especially for single-tooth implants in the esthetic zone. Because of the morphologic alterations that occur following tooth extraction, augmentation procedures are often necessary before, during, or after implantation to achieve an esthetically pleasing result. This article describes a modified technique for augmenting the soft tissue during stage-two implant surgery. The technique uses a modified roll flap, in combination with a tunneling approach to the adjacent teeth and a coronally positioned palatal sliding flap, to achieve sufficient horizontal dimensions and a scarless and harmonious architecture of the peri-implant soft tissue. [ABSTRACT FROM AUTHOR]

To enable uneventful and accelerated healing processes to occur, common techniques in plastic periodontal and implant surgery focus on stable postoperative flap positions. Flap stability is, in particular, positively influenced by an adequate suturing technique, which therefore represents one important factor with regard to the predictability of successful treatment outcomes. The following article illustrates the use of a modified suturing technique, which aims to improve wound adaptation and soft tissue stabilization after surgical treatment with tunneling flap preparation techniques. Anchored at the incisal contact points of the affected teeth, the suture is crossed through the buccal as well as through the palatal aspect. In this manner, the suture maintains the surgically established coronal displacement of the buccal flap and provides a stable and intimate contact to the underlying tissues. [ABSTRACT FROM AUTHOR]

Purpose: This dog study sought to evaluate guided bone regeneration (GBR) in peri-implant defects following implantation of ß-trica/c/um phosphate ( ß-TCP) with and without osteoinductive recombinant human growth/differentiation factor-5 (rhGDF-5). Materials and Methods: In five beagle dogs, all mandibular premolars and the first molar were extracted. After 2 months, six buccolingual critical-size defects were created, and an implant was inserted into the center of each defect. One defect was filled with ß-TCP coated with rhGDF-5 (600 μg/g ß-TCP) and covered with a titanium-reinforced e-PTFE membrane (GDF group). A second defect received the same treatment, but pure uncoated ß-TCP was used (TCP group). A third defect was filled with ß-TCP mixed with autograft and not protected with a membrane (control group). The remaining three defects were filled with other biomaterials. After 2 months, total new bone area, regenerated bone height, and residual amount of ß-TCP were determined histomorphometrically. Results: All implants osseointegrated. One membrane in each group became exposed. Mean new bone area for GDF, TCP, and control sites was 43.9 ± 18.7 mm², 32.3 ± 16.1 mm², and 13.1 ± 4.0 mm², respectively, with a significant difference between GDF and control groups. Mean regenerated bone height was 103.8 ± 29.7%, 75.4 ± 36.6%, and 67.2 ± 19.1% for the GDF, TCP, and control groups, respectively. Mean residual matrix volumes were 25.9 ± 13.6%, 30.0 ± 13.0%, and 13.4 ± 6.5%, respectively. Membrane protection of peri-implant defects filled with ß-TCP resulted in a stronger effect on bone regeneration, although this was not statistically significant. The most pronounced regenerative results were achieved in rhGDF-5/ ß-TCP filled membrane-protected defects. Conclusion: Delivery of rhGDF-5 on ß-TCP might have the potential to enhance the results of GBR in peri-implant defects. [ABSTRACT FROM AUTHOR]

Long-term periodontal stability is one of the major issues of periodontal therapy. Besides a successful active therapy and a meticulous periodontal maintenance phase, the initial risk assessment for each single tooth is of utmost importance. However, the literature contains only limited guidelines and recommendations concerning periodontal risk assessment. In particular, when teeth are to be used as abutments for a new prosthetic reconstruction, long-term periodontal stability should be expected. This clinical report discusses the clinical considerations concerning periodontal risk assessment, and factors that aid in the decision-making process. [ABSTRACT FROM AUTHOR]

Recent advances in periodontal plastic surgery have encouraged reassessment of the envelope technique and its modified version, the tunnel technique, for root coverage. This article describes alterations in the technique-sensitive tunnel approach, which include an undermining split flap preparation of the buccal tissues with newly developed instruments to minimize trauma and ensure a better blood supply for the connective tissue graft. The use of a microsurgical concept, including microsurgical blades and suture material, improves wound healing and establishes a better esthetic result. Because these modifications simplify the tunnel approach, the spectrum of indications for the tunnel technique may be expanded and a broader application achieved. [ABSTRACT FROM AUTHOR]

Several photographs of a case of a dental patient are presented.

The attainment of primary wound closure is one of the major determining factors of success in oral surgery. Especially when dealing with regenerative or augmentative procedures, healing in a submerged environment is crucial to achieving the desired treatment result. In this context, the use of a microsurgical approach and layered suturing techniques is of utmost importance for precise and meticulous wound closure. However, microsurgical wound closure using both mattress sutures and interrupted sutures is very time consuming and may be detrimental to wound healing because of trauma and extended surgical time. The double-sling suture, a modified suture technique that combines two interrupted sutures that have different bite sizes and engage different tissue layers, is able to predictably and efficiently close the surgical site for improved wound healing. This article describes this new technique and presents two case examples. [ABSTRACT FROM AUTHOR]

The esthetic outcome of dental implants in the esthetic zone is a major treatment concern in modern dentistry, especially in singlestep procedures, which unite extraction, implantation, and augmentation into one surgical intervention, and are gaining popularity. Although these procedures offer advantages concerning early soft tissue preservation, they also show a high risk of complications when careful patient selection is neglected. Thus, the aim of this article is to illustrate the complexity and limitations of immediate implant procedures using two case reports. The clinical cases and scientific data show that immediate implant placement must be divided into two different groups: single-tooth implants and multiple adjacent implants. While immediate placement of single-tooth implants often shows predictable and superior esthetic results, the immediate placement of multiple adjacent implants is far less predictable. It is important to establish whether the advantages observed in single-tooth applications are also feasible for multiple adjacent implants. [ABSTRACT FROM AUTHOR]

Replacement of two adjacent teeth in an anterior maxilla with deficient hard and soft tissues appears to be the utmost challenge in implant dentistry in the esthetic zone. In this case report, baseline conditions for implant placement were improved by alveolar distraction to enhance hard and soft tissues around the maxillary central incisors. Three months after the active phase of distraction, the roots of the central incisors were extracted and two screw-type dental implants were immediately placed into the extraction sockets. For immediate provisionalization, acrylic resin crowns were fabricated on UCLA abutments, providing the ideal emergence profile to support the periimplant soft tissue. Six months after implant placement, the prosthetic restoration of the case was finished with ceramic crowns cemented to individually fabricated zirconium oxide abutments. The described treatment strategy appears to have a great potential to restore natural esthetics in cases with major tissue deficiencies in the esthetic zone. [ABSTRACT FROM AUTHOR]