With immediate implant placement and provisionalization (IIP) in the esthetic zone, measures to counter hard and soft tissue loss are frequently necessary. To reduce the morbidity associated with bone and connective tissue procurement,... more
With immediate implant placement and provisionalization (IIP) in the esthetic zone, measures to counter hard and soft tissue loss are frequently necessary. To reduce the morbidity associated with bone and connective tissue procurement, various exogenous materials are utilized. The "Dermal Apron Technique" presented in this article demonstrates the use of a composite bone particulate (allograft/xenograft) plus a dermal allograft, adapted around screw-retained temporary crowns and secured within a subperiosteal pouch. The purpose is to augment the thickness of peri-implant mucosa for the purpose of preserving ridge dimensions and preventing mucosal recession. Controlled studies are required to further support its use. Soft tissue health and harmony are critical for successful implant therapy in the esthetic regions of the dentition. Often, autogenous soft tissue grafts are used to augment peri-implant soft tissues. The Dermal Apron Technique is a method, that in specific sit...
Research Interests: Dentistry, Dental Implants, Medicine, Humans, Female, and 5 moreAged, Adult, Implant, Soft Tissue, and Dental Esthetics
Background: A retrospective comparative radiographic and clinical studywas performed to evaluate primary stability, bone volume, and esthetic outcomes of tapered (T) implants (control group) versus inverted body-shift (INV) implants (test... more
Background: A retrospective comparative radiographic and clinical studywas performed to evaluate primary stability, bone volume, and esthetic outcomes of tapered (T) implants (control group) versus inverted body-shift (INV) implants (test group). Methods: A total of 42 platform-switched implants, 21 T and 21 INV, were used to replace nonrestorable teeth in maxillary central incisor post-extraction sockets. Implant primary stability and insertion torque values in addition to radiographic differences in labial plate dimension, tooth-to-implant distance, and marginal bone levels were correlated with clinical outcomes using the pink esthetic score (PES). Results: Statistically significant differences (P ≤ .05) were found between groups, with T implants having not only lower primary stability at immediate implant placement than INV implants but also less circumferential bone volume at recall. Consequently, lower PESs were seen in the T implant group that equated to an increased frequency of midfacial recession, tissue discoloration, and papilla loss. Conclusions: INV implants, which feature a unique macro hybrid design, may offer advantages over T implants in maxillary anterior post-extraction sockets with regard to achieving both higher primary stability and superior esthetic outcomes.
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Over time, patients treated in developmental stages of implantology may need additional treatment,as teeth adjacent to implants may fail and require replacement themselves with new implants. Blending newer implant rehabilitations into a... more
Over time, patients treated in developmental stages of implantology may need additional treatment,as teeth adjacent to implants may fail and require replacement themselves with new implants. Blending newer implant rehabilitations into a dentition with existing implant-supported restorations can be challenging. The use of implants with a subcrestal angle correction (SAC) enables predictable screw-retained anchorage of temporary and definitive restorations. An SAC implant often can be placed into the palatal bone of an extraction socket, along the incisal angle of the crown, allowing screw retention of the prosthesis. This case report demonstrates the use of both straight and SAC implants combined with hard- and soft-tissue augmentation and serial provisionalization to replace hopeless teeth adjacent to pre-existing implants and improve esthetics in the anterior maxilla.
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Enduring a period of edentulism between extraction and final restoration is difficult for patients- especially when it concerns the esthetic zone. The approach described demonstrates key points of consideration when replacing a maxillary... more
Enduring a period of edentulism between extraction and final restoration is difficult for patients- especially when it concerns the esthetic zone. The approach described demonstrates key points of consideration when replacing a maxillary anterior tooth with a dental implant using immediate implant placement, hard- and soft-tissue augmentation, and provisionalization. The authors stress adherence to patient selection and prosthetic design guidelines, and recommend the use of a digital impression technique, rather than traditional, rubber-based impressions.
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This prospective study evaluates immediately placed and immediately provisionalized implants in the esthetic zone. All implants were TiO2-blasted, fluoride-modified, grade 4 titanium, with a coronal microthread design. Bone grafting and... more
This prospective study evaluates immediately placed and immediately provisionalized implants in the esthetic zone. All implants were TiO2-blasted, fluoride-modified, grade 4 titanium, with a coronal microthread design. Bone grafting and guided bone regeneration (GBR) was performed at all sites, and screw-retained temporary restorations were delivered on the day of surgery. All of the provisional crown(s) were out of occlusal function and remained in place for at least 8 weeks prior to initiation of definitive restorative therapy. Bone maintenance (BM) was considered successful if radiographs demonstrated proximal bone levels even or coronal to the implant platform. Of the 29 implants placed, 25 (86 percent) achieved bone maintenance at least 12 months post-loading with the final restorations. This study was considered successful, with 100 percent implant survival after at least 1 year loading of the final restoration, and 100 percent of patients were satisfied with the esthetics of their implant treatment.
Research Interests: Dentistry, Titanium, Medicine, Prospective studies, Humans, and 15 moreFemale, Pubmed, Male, Patient Satisfaction, Aged, Middle Aged, Adult, Implant, Dental Prosthesis Design, Crowns, Dental Esthetics, Abutments and Dental Implants, Cone Beam Computed Tomography, Bone Transplantation, and Alveolar bone loss
A clinical case series of three patients is presented using a novel implant design to not only address primary stability but also to prevent damage to the labial bone plate and improve the interdental space for papillae preservation with... more
A clinical case series of three patients is presented using a novel implant design to not only address primary stability but also to prevent damage to the labial bone plate and improve the interdental space for papillae preservation with immediate tooth replacement therapy. This unique implant design features an apicocoronal inverted body-shift in diameter (wide to narrow), shape (tapered to cylindrical), thread depth (deep to shallow), and thread pattern (V-shaped to square) to achieve uncompromised primary stability and esthetics, particularly in extraction sockets, in a singular body form. In addition, the implant possesses a prosthetic angle correction within the implant body to facilitate screw-retention of the restoration and avoid the risk of apical socket perforation.
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The anatomic proximity of the maxillary sinus to the apices of molar and premolar teeth is a significant factor when considering implant therapy to replace maxillary posterior teeth. An emerging field within tissue engineering is the... more
The anatomic proximity of the maxillary sinus to the apices of molar and premolar teeth is a significant factor when considering implant therapy to replace maxillary posterior teeth. An emerging field within tissue engineering is the application of xenografts capable of stimulating de novo bone regeneration. This article presents a technique using a crestal approach to sinus grafting utilizing a novel bone graft material composed of porcine, ribose cross-linked collagen seeded with a nanocrystalline hydroxyapatite mineral. This highly cohesive biomaterial is able to minimize graft migration, which is particularly important in case of undetected Schneiderian membrane perforations. The material also has been demonstrated in animal studies to be capable of osteoconduction, resulting in increased bone volume in ridge augmentation procedures.
Research Interests: Dentistry, Medicine, Pubmed, Biomaterial, Implant, and 4 morePremolar, Maxillary Sinus, Bone Grafting, and Molar
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Enduring a period of edentulism between extraction and final restoration is difficult for patients- especially when it concerns the esthetic zone. The approach described demonstrates key points of consideration when replacing a maxillary... more
Enduring a period of edentulism between extraction and final restoration is difficult for patients- especially when it concerns the esthetic zone. The approach described demonstrates key points of consideration when replacing a maxillary anterior tooth with a dental implant using immediate implant placement, hard- and soft-tissue augmentation, and provisionalization. The authors stress adherence to patient selection and prosthetic design guidelines, and recommend the use of a digital impression technique, rather than traditional, rubber-based impressions.
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Whether it's a single tooth or multiple teeth, tooth loss has esthetic, functional, and health implications. Replacing multiple teeth can be especially complicated due to the loss of surrounding structures, often making it necessary... more
Whether it's a single tooth or multiple teeth, tooth loss has esthetic, functional, and health implications. Replacing multiple teeth can be especially complicated due to the loss of surrounding structures, often making it necessary to use additional procedures--eg, bone grafting--to solve the problems that arise. Fortunately, modern techniques and materials in dentistry enable clinicians to replace and mimic lost teeth in a realistic, healthy, and functional way like no other field in medicine. This report discusses two cases that involve multiple subspecialties working synergistically to accomplish ideal tooth replacement and emphasizes the importance of proper diagnosis, treatment planning, and execution of surgical and restorative therapy to achieve optimal results.
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Successful dental implant therapy in the maxillary anterior dentition requires meticulous attention to surgical and prosthodontic measures. Proper diagnosis, extraction technique, implant selection, and placement significantly impact... more
Successful dental implant therapy in the maxillary anterior dentition requires meticulous attention to surgical and prosthodontic measures. Proper diagnosis, extraction technique, implant selection, and placement significantly impact outcomes. Respect of hard and soft tissue physiology following tooth loss and implant placement requires specific steps be taken. Management tissue contours properly, via regenerative therapy, results in successful framing of the restoration. Provisionalization and definitive restorative therapy also impacts the level of esthetic success. The contours of the temporary abutment and crown develop soft tissue contours for the final restoration. Overcontouring can lead to soft tissue recession and mucosal asymmetry. Design of the definitive crown(s) is crucial for long-term maintenance of esthetically acceptable results. Visualizing the outcome of treatment prior to its inception, following specific surgical and restorative guidelines, increases the likelih...
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This prospective study evaluates immediately placed and immediately provisionalized implants in the esthetic zone. All implants were TiO2-blasted, fluoride-modified, grade 4 titanium, with a coronal microthread design. Bone grafting and... more
This prospective study evaluates immediately placed and immediately provisionalized implants in the esthetic zone. All implants were TiO2-blasted, fluoride-modified, grade 4 titanium, with a coronal microthread design. Bone grafting and guided bone regeneration (GBR) was performed at all sites, and screw-retained temporary restorations were delivered on the day of surgery. All of the provisional crown(s) were out of occlusal function and remained in place for at least 8 weeks prior to initiation of definitive restorative therapy. Bone maintenance (BM) was considered successful if radiographs demonstrated proximal bone levels even or coronal to the implant platform. Of the 29 implants placed, 25 (86 percent) achieved bone maintenance at least 12 months post-loading with the final restorations. This study was considered successful, with 100 percent implant survival after at least 1 year loading of the final restoration, and 100 percent of patients were satisfied with the esthetics of ...
Research Interests: Dentistry, Titanium, Medicine, Prospective studies, Humans, and 15 moreFemale, Male, Patient Satisfaction, Aged, Middle Aged, Adult, Implant, Dental Prosthesis Design, Tooth Extraction, Crowns, Dental Esthetics, Abutments and Dental Implants, Cone Beam Computed Tomography, Bone Transplantation, and Alveolar bone loss
This comparative case series presents 16 consecutively placed and temporized immediate implants in the maxillary esthetic zone. The implants have a novel, inverted body-shift design, intended to achieve high levels of primary stability... more
This comparative case series presents 16 consecutively placed and temporized immediate implants in the maxillary esthetic zone. The implants have a novel, inverted body-shift design, intended to achieve high levels of primary stability via the tapered apical portion. The coronal narrow cylinder provides greater space between the implant platform and facial socket wall and adjacent teeth/ implants, allowing a greater opportunity for augmentation. The restorative platform also features a subcrestal angle correction, which facilitates screw retention. The wider, facial platform-shift thus creates more room for augmentation via dual-zone bone grafting and the application of a dermal allograft, which yields greater soft tissue thickness after initial healing. This case series aimed to evaluate soft tissue thickness and compare the results to two previously published cohorts where implant design served as the only variable between groups. Int
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This study followed 30 consecutively placed implants in the esthetic zone, inserted at the time of tooth extraction, and immediately temporized and augmented with bone grafting and resorbable guided bone regeneration. Implant survival,... more
This study followed 30 consecutively placed implants in the esthetic zone, inserted at the time of tooth extraction, and immediately temporized and augmented with bone grafting and resorbable guided bone regeneration. Implant survival, adverse events, and esthetic outcomes were evaluated. In this study, the esthetic zone is defined as the dentition spanning maxillary or mandibular first bicuspids. All implants osseointegrated and were ready for definitive restorative therapy by 12 weeks. No adverse events, such as infection, persistent inflammation, or abutment screw loosening, occurred. Radiographic bone levels were documented. This study also emphasizes clinical technique and rationale.
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When a patient presents with congenitally missing teeth, early diagnosis and comprehensive treatment planning are critical to effective restorative management. Interdental space allocation must be identified to accommodate proper clinical... more
When a patient presents with congenitally missing teeth, early diagnosis and comprehensive treatment planning are critical to effective restorative management. Interdental space allocation must be identified to accommodate proper clinical crown proportion(s) through a surgical-prosthetic solution. This article, which presents two case reports describing situations that clinicians may commonly face, demonstrates the management of atypical tooth spacing caused by congenitally missing teeth. The implementation of interdisciplinary therapy resulted in successful outcomes from both functional and esthetic perspectives.
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T he manner in which dental implant therapy is performed in the esthetic zone has evolved significantly over the past two decades. Much of this evolution is related to a more comprehensive understanding of the behavior of hard and soft... more
T he manner in which dental implant therapy is performed in the esthetic zone has evolved significantly over the past two decades. Much of this evolution is related to a more comprehensive understanding of the behavior of hard and soft tissues post-extraction. The concept that implant placement at the time of extraction will maintain alveolar bone dimensions 1 has been refuted in animal and human studies. 2-4 This enhanced knowledge of physiologic modeling and remodeling has led to numerous strategies geared toward preserving 3-dimensional ridge morphology resulting in stability of esthetic outcomes. 5,6 Along with surgical methods of preservation and augmentation, prosthetic treatment plays a significant role in achieving and maintaining soft-tissue harmony. 7,8 Over time, patients treated in the developmental stages of im-plantology may need additional treatment. Teeth adjacent to implants may fail, requiring extraction and replacement with implants. Abstract: Over time, patients treated in developmental stages of implantology may need additional treatment, as teeth adjacent to implants may fail and require replacement themselves with new implants. Blending newer implant rehabilitations into a dentition with existing implant-supported restorations can be challenging. The use of implants with a subcrestal angle correction (SAC) enables predictable screw-retained anchorage of temporary and definitive restorations. An SAC implant often can be placed into the palatal bone of an extraction socket, along the incisal angle of the crown, allowing screw retention of the prosthesis. This case report demonstrates the use of both straight and SAC implants combined with hard-and soft-tissue augmentation and serial provisionalization to replace hopeless teeth adjacent to pre-existing implants and improve esthetics in the anterior maxilla.
Research Interests:
Abstract: Background: A retrospective comparative radiographic and clinical study was performed to evaluate primary stability, bone volume, and esthetic outcomes of tapered (T) implants (control group) versus inverted body-shift (INV)... more
Abstract: Background: A retrospective comparative radiographic and clinical study was performed to evaluate primary stability, bone volume, and esthetic outcomes of tapered (T) implants (control group) versus inverted body-shift (INV) implants (test group). Methods: A total of 42 platform-switched implants, 21 T and 21 INV, were used to replace nonrestorable teeth in maxillary central incisor post- extraction sockets. Implant primary stability and insertion torque values in addition to radiographic differences in labial plate dimension, tooth-to-implant distance, and marginal bone levels were correlated with clinical outcomes using the pink esthetic score (PES). Results: Statistically significant differences (P ≤ .05) were found between groups, with T implants having not only lower primary stability at immediate implant placement than INV implPaRntOs ObuFt—alNsoOleTssFcOirRcuPmUfeBrLeInCtiAalTbIOonNe volume at recall. Consequently, lower PESs were seen in the T implant group that equated to an increased frequency of midfacial recession, tissue discoloration, and papilla loss. Conclusions: INV implants, which feature a unique macro hybrid design, may offer advantages over T implants in maxillary anterior post-extraction sockets with regard to achieving both higher primary stability and superior esthetic outcomes.