Edentulous Sites Research Articles

Screw-type device diameter and orthodontic loading influence adjacent bone remodeling.

To evaluate the effect of diameter and orthodontic loading of a screw-type implantable device on bone remodeling. Screw-shaped devices of four distinct diameters, 1.6, 2, 3, and 3.75 mm, were placed into edentulous sites in five skeletally mature beagle dogs (n = 14/dog) following premolar extraction. Using a split-mouth design, devices on one side were loaded using calibrated 2N coil springs. Epifluorescent bone labels were administered intravenous prior to sacrifice. Bone-implant sections (∼ 70 μm) were evaluated to quantify bone formation rate (BFR), and other histomorphometric variables were assessed in the implant supporting bone. The mean BFR ranged from 10.93 percent per year to 38.91 percent per year. BFR in the bone adjacent to the device was lower for the loaded 1.6-mm screws when compared with the nonloaded 1.6-mm screws (P < .01) and the loaded 2.0-, 3.0-, and 3.75-mm diameter screws (P < .01). No significant differences in BFR were noted, regardless of loading condition, between the 2.0-, 3.0-, and 3.75-mm diameter screws. We detected a dramatic reduction in bone remodeling. Although orthodontic loading of 2N did not alter bone remodeling associated with screws with a 2.0-mm diameter or larger, it did decrease bone remodeling adjacent to a loaded 1.6-mm screw. The long-term effect of this diminished remodeling should be further investigated.

Update of Surgical Techniques for Maxillary Sinus Augmentation: A Systematic Literature Review.

A wide range of surgical techniques are available for maxillary sinus augmentation. This review aimed to determine which techniques have achieved the highest success rates and so offer the greatest predictability. A systematic literature review was performed using the PubMed, MEDLINE, and Scopus databases, identifying clinical trials that assessed different surgical techniques for maxillary sinus augmentation, and registered the success rates of subsequent implant placement. A total of 40 articles described clinical studies involving different maxillary sinus augmentation procedures with follow-up periods of at least 6 months after dental implant placement. Implant success rates varied between 94% and 100% during the follow-up periods. A wide variety of clinical techniques are available for maxillary sinus augmentation; the choice of the technique will depend chiefly on the characteristics of the edentulous site, which will permit or prevent the placement of the implant at the moment of sinus augmentation surgery.

Upper full arch rehabilitation with sinus by-pass with tilted implants via tapered-threaded expanders in low density bone: a clinical trial.

In the present paper the use of tapered-screw bone expanders (TSBEs) is proposed, in combination with the placement of tilted implants, in close proximity to the anterior sinus wall, solving the problem of the reduced height of the alveolar bone in the sub-antral area. The Authors present a case series of full-arch rehabilitations performed with this procedure named: Tilted Implant Expansion Osteotomy (TIEO). 12 patients (5 males and 7 females, average age 58.5 ± 8.1 years) with totally or partially edentulous maxilla were enrolled in this study. For each patient 4 implants were placed, the anterior implants in the area of lateral incisors or canines while, the posterior implants, immediately in front of the maxillary sinus, with an inclined position. Adopting the aforesaid procedure, 48 cylindrical two-piece implants were placed, 24 of which were placed in tilted position, in order to by-pass the maxillary sinus. After a healing period of 6 months, the second stage surgery was performed. The cases were finalized by means of a hybrid metal-acrylic prosthesis. The post finalization follow-up was at 12 months. Survival rate was 100% since none fixtures were lost. At the one-year follow up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. TIEO is a promising surgical procedure for full-arch rehabilitation of maxillary edentulous sites and represents a therapeutic alternative to sinus lift techniques.

The influence of initial alveolar ridge defect morphology on the outcome of implants in augmented atrophic posterior mandible: an exploratory retrospective study.

Clinicians commonly consider atrophic site topography as an important determinant in deciding the augmentation technique to utilize, as well as forecasting the likelihood of success. The purpose of this retrospective study was to examine the influence of initial atrophic posterior mandible morphology on the outcome of implants placed following augmentation. A total of 52 patients contributed 71 edentulous sites, and 185 implants were placed with mean follow-up of 37.97months. The initial defect morphology was classified according to ABC classification (Journal of Oral Implantology, 37, 2013a and 361). Ridge augmentation was performed by "cortical autogenous tenting" (CAT) followed by either simultaneous or delayed implant placement after 4-6months of healing. The European Academy of Osseointegration success criteria were used to evaluate implant outcomes. The overall survival and success rates of dental implants were 98.91% and 80%, respectively. Cumulative success and survival rates in CAT group were 95% and 100% after 2years of follow-up. The highest marginal bone loss (MBL) was observed (1.26mm±0.99) around implants placed in augmented edentulous sites with initially narrow and flat alveolar crest (defect class CII). Conversely, least MBL (0.48mm±0.78) was detected around implants placed into edentulous sites with two sloped boney walls (defect class AII). Differences between MBL observed around implants placed into initial defect class C, initial defect type and class A (I, II), as well as class BII, were statistically significant (P<0.05). Among all implants, 148 were considered as successful, 26 exhibited satisfactory survival, nine with compromised survival, and two implants failed. The present data confirmed the effect of initial ridge morphology on the outcome of implants placed into augmented bone. Specifically, class A and class B atrophic ridge defects, with one and two vertical boney walls, respectively, may be considered as more favorable recipient sites than class C defects with flat morphology. This conclusion is based on least MBL around implants placed into initial defect class A and class B augmented sites, and higher MBL in implants placed into class C recipient sites. A randomized controlled trial is warranted to examine these exploratory observations.

Distal extension mandibular removable partial denture with implant support

This case report describes the fabrication of a distal extension removable partial denture (RPD) of a 65-year-old man with implant support. Loss of fibroelasticity of the peripheral tissues and reduced mandibular vestibular sulcular depth due to a previous surgical resection and radiotherapy at the right side were the main clinical factors that created difficulty for denture retention and stability. The fabrication of a mandibular RPD supported by anterior teeth and two bilaterally placed implants in the molar area to convert from Kennedy Class 1 design to Kennedy Class 3 implant-bounded RPD is reported. Retention and stability of the denture were improved with implant support on the distal extension site of the RPD. The common clinical problems about distally extended RPDs are lack of retention and stability due to the movement around the rotational axis. Dental implant placement to the distal edentulous site minimizes the potential dislodgement of the RPD is popular. Implant-supported RPD can be suggested as an advantageous and cost-effective treatment option for the partially edentulous patients.

A Double-Blind Randomized Trial Comparing Implants with Laser-Microtextured and Machined Collar Surfaces: Microbiologic and Clinical Results.

The purpose of this study was to compare the clinical outcome of and determine the differences in periodonto-pathogenic microbiota around two types of implant collar surfaces: laser-microtextured (test) vs machined (control). Seventeen patients (11 periodontally healthy, and 6 periodontally compromised) were selected to receive the two different implants, placed randomly, in two edentulous sites. Six months following the surgical placement of the dental implants, subgingival plaque samples were collected using paper points from the peri-implant sulcus and from the sulcus of an adjacent tooth. The presence of five putative periodontal pathogens, namely, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, and Tannerella forsythensis, was assessed using real-time polymerized chain reaction (RT-PCR). Peri-implant parameters and intraoral radiographs were recorded up to 1 year after abutment connection. In the main population, and in the periodontally compromised subgroup, the total number of periodontal pathogens around test implant sites was lower than control implant sites and adjacent tooth sites, with a statistically significant difference (P < .05). In periodontally healthy patients, the mean probing pocket depth for the test implant was 1.31 ± 0.51 mm, compared with 2.66 ± 0.83 mm for the control implant, while in periodontally compromised patients, it was 1.61 ± 0.58 mm for the test implant, compared with a mean value of 2.84 ± 1.0 mm for the control implant. Implants with a laser-microtextured collar surface are not more vulnerable to pathogenic microflora colonization than implants with a machined collar surface. In both of the subgroups of patients (periodontally healthy and periodontally compromised), implants with a laser-microtextured collar surface have a better clinical outcome at 1 year of loading, compared with implants with a machined collar surface.

Impact of implant-abutment connection on osteoimmunological and microbiological parameters in short implants: a randomized controlled clinical trial.

The study aimed to determine the levels of soluble receptor activator of nuclear factor-кB ligand (sRANKL) and osteoprotegerin (OPG) as well as their relative calculated ratio in peri-implant crevicular fluid (PICF) obtained around two different types of implant-abutment connection on short implants following a 12-month monitoring period. Moreover, the levels of a number of oral bacterial species were investigated in the corresponding submucosal biofilm samples. Thirty short implants were randomly placed in posterior maxillary edentulous sites using a split-mouth design in 15 periodontally healthy subjects. Tapered interference fit (TIF) and taper-integrated screwed-in (TIS) types of implant-abutment connections were selected for investigation. PICF and submucosal biofilm samples were collected 1month after surgery and repeated 12months after prosthetic loading. Clinical parameters, including probing depth, dichotomous presence of bleeding on probing, and plaque index, were recorded and digital periapical radiographs were taken at each time point. sRANKL and OPG levels in PICF were analyzed using an enzyme-linked immunosorbent assay. Total bacterial levels, as well as levels of Fusobacterium nucleatum, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia, and Streptococcus oralis, were analyzed in the corresponding submucosal biofilm samples using quantitative real-time polymerase chain reaction. The total amount of sRANKL in TIF implants was 2.64-fold lower than that in TIS implants at baseline (P<0.001), whereas similar levels were found after 12months (P>0.05). Accordingly, OPG and RANKL/OPG ratio were similar between the groups at each time point (P>0.05). Microbiological results were similar in both groups at each time point (P>0.05). The results of this longitudinal study suggested that sRANKL and OPG in PICF, as well as microbiological parameters in submucosal biofilms, were similar between TIF and TIS implants, after a 12-month monitoring period, despite early differences in the former. Therefore, the type of implant-abutment connection does not appear to influence longitudinally the levels of osteoimmunological and microbiological markers in the peri-implant tissues of short implants.

Alveolar bone density and its clinical implication in the placement of dental implants and orthodontic mini-implants.

Objectives:To assess the bone density in maxilla and mandible in dentate and edentulous patients in Saudi population.Methods:This study involved a retrospective analysis of cone beam CT images of 100 patients (50 male and 50 female) who have come to College of Dentistry, University of Dammam, Dammam, Kingdom of Saudi Arabia between January 2014 and 2015. Using the bone density option in the Simplant software, the Hounsfield unit (HU) was calculated at the edentulous sites. While for dentate sites, a region of interest was selected coronally at 3-5 mm to the root apex using I-CAT vision software. The densities of the buccal bone and cancellous bone were measured at interradicular areas of a specific teeth.Results:The highest bone density at the edentulous sites was at the mandibular anterior region (776.5 ± 65.7 HU), followed by the mandibular posterior region (502.2 ± 224.2 HU). Regarding the dentate sites, the highest bone density was at the buccal cortical plate of the lower incisor teeth (937.56 ± 176.92 HU) and the lowest bone density was at the cancellous bone around the posterior maxillary teeth (247.12 ± 46.75 HU).Conclusion:The alveolar bone density at dentate and edentulous sites in our population is generally lower than the norm reference density of other populations, which dictates the need for quantitative assessment of bone density before implants and mini-implants placement.

Bone Adaptation Induced by Non-Passively Fitting Implant Superstructures: A Randomized Clinical Trial.

Passive fit of implant-supported restorations is difficult to achieve. The aim of this randomized clinical trial was to test the null hypotheses that a reduction in misfit strain does not occur over time, regardless of the initial strain level, and that changes in prosthesis-induced bone strain do not differ between restorations with two different levels of fit. Twenty edentulous sites were restored with screw-retained fixed restorations on two implants either cast in one piece (misfit) or assembled by an intraoral bonding procedure (fit). The restorations had a bar-shaped pontic onto which a strain-gauged metal plate could be fixed. Repeated strain gauge measurements on patient-specific in vitro resin models and on the implants intraorally were performed every 4 weeks for a period of 6 months. Statistical analysis was based on Kruskal-Wallis tests, t tests, Welch two-sample t test (α = .05), and linear regression analysis. No reduction in misfit strain could be observed in vitro, indicating that alterations in prosthetic fit had not occurred in any restoration (Kruskal-Wallis; P > .05). Initial strain levels varied widely and differed significantly between fit and misfit restorations (t test; P = .0032). Regrouping the restorations with respect to a threshold strain level of 100 μm/m resulted in 10 fit and 9 misfit restorations; 1 restoration had to be excluded from analysis due to a malfunctioning strain gauge. Seven fit restorations and five misfit restorations showed strain reduction in vivo based on linear regression, while percentage strain reduction did not differ between groups (Welch two-sample t test; P = .8186). Within the limitations of this randomized clinical trial characterized by an observation period of 6 months and only healthy subjects being enrolled, bone adaptation around statically and dynamically loaded implants occurred, causing a decrease in misfit strain evoked by non-passively fitting prostheses. For maintaining osseointegration of dental implants, passivity of fit of multiunit restorations seems not to be as critical as previously thought.

Anatomical presentation of edentulous sites in the posterior maxillary in cone beam computed tomography

This study aimed to analyze the bone anatomy of edentulous sites in the posterior maxillary by cone beam computed tomography (CBCT). A total of 100 CBCT radiographs from patients with missing maxillary posterior teeth were obtained, resulting in a sample size of 217 edentulous sites. The width and height of edentulous were assessed by three-dimensional reconstruction. In addition, the angle A and morphology of the maxillary sinus walls were evaluated. The mean bone height was 9.53 mm, and the percentage of sites than 10 mm was 62.67% (136/217). The mean bone width was 9.30 mm, and the percentage of sites more than 6 mm was 91.71% (199/217). The bone height decreased from premolar to molar areas, but the opposite trend was observed in bone width. Regarding the morphology of the sinus floor, 64.52% exhibited an oblique configuration. In angle A, the group of less than 30° was 10.14%, 30°-60° was 42.40%, and greater than 60° was 47.47%. A high percentage of edentulous sites in the posterior maxillary requires sinus floor elevation to allow the placement of dental implants. Thus, the use of CBCT scans is recommended to evaluate the anatomical structure of the maxillary sinus for reasonable implant planning.

Long-term outcomes of osteotome sinus floor elevation without bone grafts: a clinical retrospective study of4-9years.

To evaluate the long-term clinical and radiographic outcomes of dental implant placed using osteotome sinus floor elevation (OSFE) without bone grafts, and to analyze the potential influence factors of implant survival and endo-sinus bone remodeling. A retrospective study design was adopted. The clinical and radiographic data of 96 implants in 80 patients were collected after 4-9 (mean 5.40) years follow-up. Implant failures, peri-implant marginal bone loss (MBL), and endo-sinus bone remodeling on the radiographs were evaluated. A life-table analysis was used to assess the implant survival. Statistical models were established to investigate the potential influence factors of implant survival and endo-sinus bone gain (ESBG). In total, nine implants in seven patients failed, giving the 9-year cumulative survival rates of 90.6% and 91.3% for implant-based analysis and patient-based analysis, respectively. The mean MBL between implant installation and the 4- and 9-year follow-up visit was 0.46±0.88 and 0.50±1.69mm, respectively. The average ESBG on radiographs was 2.95±1.25 and 2.16±1.13mm at the 4- and 9-year follow-up. The final ESBG was found to be positively correlated to implant protrusion length after surgery without any other factors related. The implant survival rate was significantly lower in severe atrophic site (residual bone height <5mm). Osteotome sinus floor elevation without bone grafts is a predictable treatment modality in the long run. But it should be used with caution when the initial bone height of the edentulous site is lower than 5mm. The final endo-sinus bone height was found to be positively correlated to implant protrusion length measured on radiographs immediately after implant installation.

The accuracy of linear measurements of maxillary and mandibular edentulous sites in cone-beam computed tomography images with different fields of view and voxel sizes under simulated clinical conditions.

PurposeThe objective of this study was to investigate the effect of varying resolutions of cone-beam computed tomography images on the accuracy of linear measurements of edentulous areas in human cadaver heads. Intact cadaver heads were used to simulate a clinical situation.Materials and MethodsFiduciary markers were placed in the edentulous areas of 4 intact embalmed cadaver heads. The heads were scanned with two different CBCT units using a large field of view (13 cm×16 cm) and small field of view (5 cm×8 cm) at varying voxel sizes (0.3 mm, 0.2 mm, and 0.16 mm). The ground truth was established with digital caliper measurements. The imaging measurements were then compared with caliper measurements to determine accuracy.ResultsThe Wilcoxon signed rank test revealed no statistically significant difference between the medians of the physical measurements obtained with calipers and the medians of the CBCT measurements. A comparison of accuracy among the different imaging protocols revealed no significant differences as determined by the Friedman test. The intraclass correlation coefficient was 0.961, indicating excellent reproducibility. Inter-observer variability was determined graphically with a Bland-Altman plot and by calculating the intraclass correlation coefficient. The Bland-Altman plot indicated very good reproducibility for smaller measurements but larger discrepancies with larger measurements. ConclusionThe CBCT-based linear measurements in the edentulous sites using different voxel sizes and FOVs are accurate compared with the direct caliper measurements of these sites. Higher resolution CBCT images with smaller voxel size did not result in greater accuracy of the linear measurements.

Treatment of an Erratic Extraction Socket for Implant Therapy in a Patient with Chronic Periodontitis.

As implant therapy becomes more commonplace in daily practice, preservation and preparation of edentulous sites are key. Many times, however, implant therapy may not be considered at the time of tooth extraction and additional measures are not taken to conserve the edentulous site. While the healing process in extraction sockets has been well investigated and bone fill can be expected, there are cases where even when clinicians perform thorough debridement of the sockets, connective tissue infiltration into the socket can occur. This phenomenon, known as “erratic healing,” may be associated with factors that lead to peri-implant disease and should be appropriately managed and treated prior to surgical implant placement. This case report describes the successful management of an erratic healing extraction socket in a 62-year-old Caucasian male patient with chronic periodontitis and the outcomes of an evidence-based treatment protocol performed prior to implant therapy. Careful preoperative analysis and cone beam computed tomography imaging can help detect signs of impaired healing in future implant sites and prevent surgical complications.

Management of gingival recession in mandibular molar using lateral pedicle flap technique

Gingival recession is a common mucogingival deformity, and various treatment options are available. Patients with exposed root surfaces can possibly develop root sensitivity, root caries, and pose a major esthetic problem. Among various procedures, laterally positioned pedicle graft (LPG) is a widely used technique to cover gingival recession defects. The main advantages of the LPG are that it is relatively easy, not time-consuming, produces excellent esthetic results, and no second surgical site is involved for donor harvesting. This case report presents a case of Class III gingival recession in relation to molar adjacent to an edentulous site that was successfully treated with lateral pedicle technique.

Mini-Implants, Mega Solutions: A Case Series.

Dental implants have evolved as a standard of care for replacement of missing teeth. Though this treatment modality promises a high level of patient satisfaction and success, it cannot be performed in all cases. Apart from medically compromised patients, implant use is also restricted whenever there is limited available bone volume at the edentulous site. An example includes the mandibular incisor, the maxillary lateral incisor region, and other sites with reduced interdental spacing and atrophic edentulous maxillary and mandibular ridges. Bone volume at some of these sites can be increased by suitable augmentation procedure for placement of a regular diameter implant (3.75 to 4.2 mm). But many a times such procedure cannot be undertaken either due to financial constraint, risk of subjecting the patient to additional surgical procedure, added time factor, or guarded prognosis of the grafted site. In such cases, mini-implants can be used. In this case series, mini-implants (2.5 to 3 mm) were used to replace teeth in all mouth quadrants and to retain a mandibular overdenture in a compromised case. The implants served well at all the sites with minimal bone loss and a high level of patient satisfaction.Mini-implants hold the potential to serve as an alternate to regular diameter implants in certain situations. Preferably they should be used in multiples to retain fixed dental prostheses and might serve as an efficient, low-cost solution for retaining overdentures in selected cases.

Extraction Socket Management Utilizing Platelet Rich Fibrin: A Proof-of-Principle Study of the "Accelerated-Early Implant Placement" Concept.

Dental implants are widely accepted as the golden standard for the rehabilitation of an edentulous site following the extraction of a tooth. The ideal time for implant placement is dependent on the time required for partial or complete tissue healing and the adequacy of socket dimensions. The use of autologous growth factors is a promising new concept that aids clinicians in minimizing treatment time and increasing patient satisfaction. The purpose of this paper is to introduce a protocol for "accelerated-early" implant placement. In this protocol, platelet rich fibrin is employed to accelerate soft and hard tissue healing and to provide a better-healed recipient site for accelerated, early implant placement. Histological analysis revealed that at 6 weeks postextraction, the application of our approach resulted in delicate newly formed bone showing intense osteoblastic activity surrounded by connective tissue as well as areas of mineralized tissue. The present study is a proof-of-principle study of the acceleration of the physiologic postextraction healing sequelae with the use of autologous growth factors. The accelerated-early implant placement concept is a bioengineered protocol that may aid clinicians to achieve increased primary stability, by placing implants in ridges in an advanced stage of bone healing, while offering patients the benefits associated with early implant placement. Controlled studies are warranted to verify the reproducibility of this treatment concept and identify specific indications where the use of the presented technique can lead to significant clinical results.

Bone reactions around dental implants subjected to progressive static load: an experimental study in dogs.

To evaluate histologically and histomorphometrically, the peri-implant bone reaction around implants subjected to controlled progressive orthodontic loading. In three beagle dogs, bilateral edentulous flat alveolar ridges were created in the maxillary area posterior to the canines. After 8weeks of healing, 24 implants (Biomet 3i) were inserted in the edentulous sites. Two experimental groups were created. Progressive loading group: Twelve implants were left to heal for 8weeks uncovered, and abutments were adapted and connected by pairs with Ni-Ti orthodontic springs. A gradual static force of 100, 200 and 300g was applied for a 3-week period each. Thus, a total progressive loading period of 9weeks was exercised. Unloaded control group: Twelve implants were left to heal undisturbed. At the end of the experimental period, all implants of both groups were removed with the surrounding bone. Histologic and histomorphometric analyses were performed, and the following parameters were measured: bone-to-implant contact, bone density 1 and 2mm distant to the implant threads and crestal bone resorption. Median regression models are used for statistical analysis. Implants of the progressive loading group exhibited significantly higher percentage of bone-to-implant contact compared to the unloaded control implants (P=0.018). Bone density 1 and 2mm distant to the threads was found to be the same between the two groups (P=0.734 and P=0.961, respectively). Crestal bone resorption did not differ between loaded and unloaded implants (P=0.813). The application of progressive loading by controlled orthodontic force on osseointegrated implants provoked significant increase in the percentage of bone-to-implant contact of the low-density bone of the dog maxilla.

Electronic assessment of peri-implant mucosal esthetics around three implant-abutment configurations: a randomized clinical trial.

To objectively assess the influence that three different implant-abutment interface designs had on peri-implant mucosal esthetics at 1year post-implant placement via the pink esthetic score (PES). Additionally, to demonstrate the novel employment of a tablet-based digital imaging format to reliably assess and score clinical images as part of a multicenter clinical trial according to PES criteria. Adult subjects (n=141) with healed tooth-bound edentulous sites in the anterior maxilla as well as first premolar region were randomized to receive one of three different implant-abutment interface designs (conical interface=CI; flat-to-flat interface=FI; or platform switch interface=PS). Immediate provisionalization was performed with prefabricated titanium abutments, with definitive custom CAD/CAM zirconia abutments and all-ceramic cement-based crowns being delivered 12-week post-implant placement. Bilateral (anterior sites) or unilateral (premolar sites) digital clinical photographs were made at 1, 3, 6, and 12months post-implant placement. Five calibrated faculty evaluators of different clinical backgrounds scored images during a 4-week timeframe on a standardized, tablet-based, digital imaging format. Six hundred and forty-nine clinical photographs were evaluated resulting in a total of 3245 sum PES values and 22,715 individual PES values. Faculty evaluator intra- and inter-rater reliability was found to be "strong" (ICC=0.84) and "substantial" (ICC=0.64), respectively, demonstrating repeatability of both the PES, evaluator calibration, and standardization of tablet-based scoring. All implant-abutment interface groups demonstrated significant improvements in mean sum PESs up to 1year, with the largest improvement between restoration delivery and 6months. No significant differences were found between groups in mean sum PESs both for individual study visits as well as for changes between study visits. No significant differences in mean sum PESs were found between subjects randomized to three different implant-abutment interfaces. However, significant differences were found as a function of time for all three groups, with the largest improvement in mean sum PESs occurring between definitive abutment and restoration delivery and 6months. Use of electronic, tablet-based digital imaging scoring formats represents a novel and repeatable methodology for scoring PES images in large, multicenter clinical trials.

Bone Replacement Materials and Techniques Used for Achieving Vertical Alveolar Bone Augmentation

Alveolar bone augmentation in vertical dimension remains the holy grail of periodontal tissue engineering. Successful dental implant placement for restoration of edentulous sites depends on the quality and quantity of alveolar bone available in all spatial dimensions. There are several surgical techniques used alone or in combination with natural or synthetic graft materials to achieve vertical alveolar bone augmentation. While continuously improving surgical techniques combined with the use of auto- or allografts provide the most predictable clinical outcomes, their success often depends on the status of recipient tissues. The morbidity associated with donor sites for auto-grafts makes these techniques less appealing to both patients and clinicians. New developments in material sciences offer a range of synthetic replacements for natural grafts to address the shortcoming of a second surgical site and relatively high resorption rates. This narrative review focuses on existing techniques, natural tissues and synthetic biomaterials commonly used to achieve vertical bone height gain in order to successfully restore edentulous ridges with implant-supported prostheses.

Immediate Loading of Microtextured Single-Tooth Implants

Background: The Immediate loading (IL) protocol has gained increased popularity among surgeons in the last decade. Objectives: This study aimed to evaluate the clinical performance of microtextured single-tooth implants using IL protocol six months after loading. Patients and Methods: In this case series, SwissPlus implants (Zimmer Dental Inc, Carlsbad CA, USA) which was straight, self-tapping, 12 mm length and 4.1 mm diameter, were inserted into both jaws and single edentulous sites with clinically and radiologically healed bone by an experienced surgeon. In the test group (with IL protocol), one week after the surgery, the provisional crowns and abutments were loaded, and definitive restorations were delivered three months postoperatively. The factors including pain, mobility, probing depth (PD), bleeding on probing (BOP) and marginal bone loss (MBL) were investigated six months after the IL. The Mc Nemar and Wilcoxon tests were used for nominal variables and the paired ttest was also used for quantitative variables. Results: Twenty-five implants were placed in 23 patients at Dental School, Shahed University, Tehran, Iran. The test group included 15 patients (16 implants) treated with immediately loaded single-tooth implants. The survival rate was 100% in both groups. In test, a significant reduction was measured in PD and pain; moreover, no statistically significant difference was noted between followups with regard to mobility and BOP. The mean PD values six months for test and nine months for control after installation were 2.548 mm and 2.694 mm, respectively. Marginal bone loss was significantly decreased in the test group between the follow-ups. Conclusions: Consequently, this study shows promising results for IL of single implants, and it can be considerable that treatment with microtextured surface implants is a predictable and appropriate method of treatment.