Emergence Profile Research Articles

Partial Extraction Therapy for Implant Placement: A Newer Approach in Implantology Practice.

One of the most popular treatment modalities in routine implantology practice is extraction followed by immediate or delayed implant insertion. Teeth removal alone is insufficient, particularly in the maxillary anterior region of the jaw. Patients may experience several issues after tooth extractions. Due to trauma and the loss of periodontal ligaments, post-extraction alveolar ridge resorption cannot be prevented. Atraumatic extraction, socket preservation, grafting, and implant placement immediately after the extraction are some of the procedures that are carried outto minimize or prevent the resorption ofalveolarbone. Osseointegration is essential for keeping the clinical effectiveness of dental implants. If the supporting tissues at an implant site resorb and are worsened by risk factors for recession, there may be considerable esthetic and functional failure. Implant placement at the retained root structure preserves the buccal bone resulting in an excellent emergence profile. Resorption in the posterior alveolar ridge may result in a decrease in attached keratinized tissue and a decrease in vestibular depth. This might have a negative impact on the stability of the implant and leads to peri-implantitis resulting in the failure of the implant. Without papilla loss or arch collapse, partial extraction therapy has resulted in effective esthetic outcomes. The socket shield technique is a minimally invasive surgical procedure that helps to maintain both soft and hard tissues by preserving a small section of the root. It lessens the necessity for surgeries on bone and mucogingival grafts, cutting the length of the overall recovery process and reducing the treatment time.When soft and hard tissue grafts are used to fill the socket before applying pressure with pontics, it is known as the pontic shield procedure. However, there is no published study that explains partial extraction therapy in a straightforward and clear manner that can guide a practitioner in determining a shield design with a proven track record of success. This review article focuses on the partial extraction procedure which is very helpful for preserving soft and hard tissues in cases involving immediate implant insertion post-extraction. It has long-term therapeutic success with implant and pontic therapy. This review article will also be helpful for clinicians to understand shield design in different case scenarios and help to learn step-wise procedures carried out in partial extraction therapy.

Editorial: Prosthetically Driven or Periodontally Maintainable? We Need Both.

Emil Capetta, DMD/Howard Drew, DMD/Joel Pascuzzi, DMD/Andrew Sullivan, DDS: We were educated in the age of periodontal prostheses, when periodontics and prosthetics were integrated and dependent upon each other. The authors of this editorial would often travel to hear the masters, including Abrams, Amsterdam, Cohen, Kramer, Nevins, Skurow, Weisgold, and others. We were taught restorations had to be hygienic. Rules about contour, emergence profile, embrasures, attached gingiva, tooth positioning, adequate support, and balanced occlusion, to name a few, were emphasized and mandated. In the era of periodontal prostheses, we were nervous about long teeth, small gingival overhangs on restorations, and inadequate embrasures. In the 1980s, we embraced implants, but Brånemark again emphasized “high water” cases that allowed access for oral hygiene, debridement, and maintenance. Years later, as a reaction to the concept of placing implants “where the bone is,” we embraced the concept of prosthetically driven implant placement. Adopting this concept has not solved all of our problems, and improvements in guided bone regeneration (GBR) and prosthetic abutments are not always the complete solution. Presently, many treatment plans are based on the prosthesis that is currently preferred or can be marketed profitably. It is not uncommon to see periodontally maintainable teeth extracted, or 5 to 8 mm of vertical bone removed, to make room for prosthetic materials. That removed bone could prove to be critical if, in time, peri-implantitis strikes the patient. We often see prostheses inserted with inadequate access for patients or clinicians to debride the area, or hybrid prostheses with significant buccal/facial cantilevers that are not maintainable. Due to patient esthetic demands, we often place a fixed appliance when it should be removeable. Staging cases with natural teeth and/or transitional implants may add additional time and cost to the case, but there are benefits: Very often, bone can be preserved, hygiene assessed, GBR sites kept from loading forces, soft tissue managed, vertical dimension maintained or adjusted, and better implant positioning achieved. Years ago, when an implant-supported hybrid prosthesis was placed, it was common to remove it during maintenance visits to access the implants for debridement, and we often saw significant amounts of plaque and calculus on the intaglio surfaces. The implants were debrided, the prosthesis was cleaned, and many times the screws were removed and changed. Why have peri-implantitis rates skyrocketed? The literature lists multiple possible explanations, including plaque-retentive surfaces, active periodontal disease on remaining teeth, occlusion, inadequate zones of attached keratinized gingiva, and poorly positioned implants, among others. At what point do we embrace restorations, which are both prosthetically driven and periodontally maintainable? Restorations should be esthetic but must be cleansable by both the patient and the clinician. We need to remember the masters, and an appliance placed in a sound periodontal environment needs to be our primary goal. Why have peri-implantitis rates skyrocketed? The literature lists multiple possible explanations, including plaque-retentive surfaces, active periodontal disease on remaining teeth, occlusion, inadequate zones of attached keratinized gingiva, and poorly positioned implants, among others. At what point do we embrace restorations, which are both prosthetically driven and periodontally maintainable? Restorations should be esthetic but must be cleansable by both the patient and the clinician. We need to remember the masters, and an appliance placed in a sound periodontal environment needs to be our primary goal. Emil Capetta, DMD Howard Drew, DMD Joel Pascuzzi, DMD Andrew Sullivan, DDS Newark, New Jersey, USA

Simple dental implant treatment for rehabilitating posterior mandibular teeth

Dental implant became the solution to conventional dentures and bridges these days. Both single crown implants and implant-supported fixed partial dentures came as the options for restoring partially missing teeth. Fixed implant supported restorations could be screwed, cemented, or both through cemented prosthesis with palatal or lingual fastening screws. Understanding the advantages and disadvantages of each system are important. This case report will show step by step of implant placement using bone level implant fixture and screw and cement retained zirconia restoration. Transgingival healing was achieved by using healing abutment through one step surgery. Good emergence profile acquired from the use of healing abutment will give good aesthetic outcome. Digital workflow was included in this treatment to replace impression process with digital scanning of implant. The fabricaton of the restoration used in this case also using CAD/CAM technology. Zirconia ceramic has proven to have strength and good aesthetic results in dentistry. Cementation of the restoration became one of the important steps in this case report, therefore determining the appropriate cement for zirconia would affect long-term outcome of the restoration. Patient were required to maintain oral hygiene before and after the implant placement. The aim of this case report is to show simple way in restoring missing teeth in posterior region of mandible by using dental implant.

Association between Peri-Implant Soft Tissue Health and Different Prosthetic Emergence Angles in Esthetic Areas: Digital Evaluation after 3 Years' Function.

The aim of the present retrospective study was to assess peri-implant soft tissue health for implants restored with different prosthetic emergence profile angles. Patients were treated with implants supporting fixed dentures and were followed for 3 years. Buccal emergence angle (EA) measured at 3 years of follow-up visits (t1) were calculated for two different groups: Group 1 (153 implants) for restorations with angle between implant axis and prosthetic emergence angle from ≥30°, and Group 2 (67 implants) for those with angle ≤30°, respectively. Image J software was used for the measurements. Moreover, peri-implant soft tissue parameters such as pocket probing depth (PPD), plaque index (PI) and gingival index (GI) were assessed, respectively. A total of 57 patients were included in the analysis and a total of 220 implants were examined. Mean (±SD) EA in Groups 1 and 2 was 46.4 ± 12.2 and 24.5 ± 4.7 degrees, respectively. After 3 years of follow-up, a PPD difference of 0.062 mm (CI95% -0.041 mm; 0.164 mm) was calculated between the two groups and was not statistically significant (p = 0.238). Similar results were found for PI (OR = 0.78, CI95% 0.31; 1.98, p = 0.599). Furthermore, GI scores of 2 and 3 were found for nine implants (5.9%) in Group 1, and for five implants in Group 2 (7.5%). A non-significant difference (p = 0.76) was found. Peri-implant soft-tissue health does not seem to be influenced by EA itself, when a proper emergence profile is provided for implant-supported reconstructions in anterior areas.

Customised abutment for achieving the predictable emergence profile for immediate implant in molar site

The alveolar bone undergoes a remodelling process after tooth extraction, which leads to horizontal and vertical bone loss. These resorption processes complicate dental rehabilitation, particularly in connection with implants. Clinical studies have suggested that retaining roots of hopeless teeth may avoid tissue alterations after tooth extraction. The aim is to seal the surgical site following the outline of extraction socket and to develop an ideal prosthetic emergence profile, modelled on the anatomy of the existing tooth. In present case report a non restorable mandibular molar was treated with socket sealing protocol followed by immediate implant placement. Using sequential osteotomy drills implant site was prepared and roots were dissected in buccolingual direction along the long axis. Roots were extracted using elevators and implant of desired size was placed. A Customized sealing socket abutment (SSA) was prepared to support the coronal emergence profile of the tooth. This technique is a minimally invasive that can preserve the hard and the soft tissue contour of the ridge.

Soft tissue phenotype modification impacts on peri-implant stability: a comparative cohort study.

Soft tissue phenotype modification (STPM) could be performed to maintain peri-implant health. Therefore, the aim of the study was to analyze tissue alteration around implants following soft tissue phenotype modification during implant uncovering surgery. Patients who had STPM (either pouch roll or modified roll technique) during implant second-stage surgery with at least 12-month follow-up were included. Clinical and radiographic parameters including mucosal tissue thickness (MTT), recession (REC), keratinized mucosa width (KMW), probing pocket depth (PPD), marginal bone loss (MBL), emergence profile, and emergence angle were extracted from 2-week, 2-month, and 12-month visits after second-stage surgery. Twenty-eight patients with 33 implants that fulfilled the inclusion criteria were included. After soft tissue phenotype modification, at 2weeks, REC was negatively correlated to mean MTT at mid-buccal site (r = - 0.41, p = 0.018) and borderline correlated at mid-lingual site (r = - 0.343, p = 0.051). Stable KMW was maintained from 2weeks to 12months with minimal shrinkage rate (3 ~ 14%). MBL change was limited (0.24 ~ 0.47mm) after STPM. All implants had shallow PPD (≤ 3mm) with the absence of bleeding on probing. Emergence angle at the mesial side, however, was significantly correlated to surgical techniques, which indicated pouch roll technique would have 6.96 degrees more than modified roll technique (p = 0.024). Soft tissue phenotype modification, either pouch roll or modified roll technique, during uncovering surgery resulted in favorable clinical outcomes. Thin mucosal tissue thickness and pouch roll technique are the factors related to more recession at 2weeks. Pouch roll technique could influence the restorative design by having a wide emergence angle at the mesial side. Modified and pouch roll techniques during uncovering surgery were viable methods to yield favorable peri-implant health, while the preciseness of pouch roll technique was required to avoid mucosal recession and inadequate restorative design.

A digital workflow for pair matching of maxillary anterior teeth using a 3D segmentation technique for esthetic implant restorations

We investigated a state-of-the-art algorithm for 3D reconstruction with a pair-matching technique, which enabled the fabrication of individualized implant restorations in the esthetic zone. This method compared 3D mirror images of crowns and emergence profiles between symmetric tooth pairs in the anterior maxilla using digital slicewise DICOM segmentation and the superimposition of STL data. With the outline extraction of each segment provided by 100 patients, the Hausdorff distance (HD) between two point sets was calculated to identify the similarity of the sets. By using HD thresholds as a pair matching criterion, the true positive rates of crowns were 100, 98, and 98%, while the false negative rates were 0, 2, and 2% for central incisors, lateral incisors, and canines, respectively, indicating high pair matching accuracy (> 99%) and sensitivity (> 98%). The true positive rates of emergence profiles were 99, 100, and 98%, while the false negative rates were 1, 0, and 2% for central incisors, lateral incisors, and canines, respectively, indicating high pair matching accuracy (> 99%) and sensitivity (> 98%). Therefore, digitally flipped contours of crown and emergence profiles can be successfully transferred for implant reconstruction in the maxillary anterior region to optimize esthetics and function.

Anterior implant restorations with a convex emergence profile increase the frequency of recession: 12-month results of a randomized controlled clinical trial.

To test whether the emergence profile (CONVEX or CONCAVE) of implant-supported crowns influences the mucosal margin stability up to 12 months after insertion of the final restoration. Forty-seven patients with a single implant in the anterior region were randomly allocated to one of three groups: (1) CONVEX (n= 15), implant provisional and an implant-supported crown both with a convex profile; (2) CONCAVE (n= 16), implant provisional and an implant-supported crown both with a concave profile; (3) CONTROL (n= 16), no provisional (healing abutment only) and an implant-supported crown. All patients were recalled at baseline, 6, and 12 months. The stability of mucosal margin along with clinical, aesthetic, and profilometric outcomes as well as time and costs were evaluated. To predict the presence of recession, multivariable logistic regressions were performed and linear models using generalized estimation equations were conducted for the different outcomes. Forty-four patients were available at 12 months post-loading. The frequency of mucosal recession amounted to 64.3% in group CONVEX, 14.3% in group CONCAVE, and 31.4% in group CONTROL. Regression models revealed that a CONVEX profile was significantly associated with the presence of recessions (odds ratio: 12.6, 95% confidence interval: 1.82-88.48, p= .01) compared with the CONCAVE profile. Pink aesthetic scores amounted to 5.9 in group CONVEX, 6.2 in group CONCAVE, and 5.4 in group CONTROL, with no significant differences between the groups (p= .735). Groups CONVEX and CONCAVE increased the appointments and costs compared with the CONTROL group. The use of implant-supported provisionals with a CONCAVE emergence profile results in a greater stability of the mucosal margin compared with a CONVEX profile up to 12 months of loading. This is accompanied, however, by increased time and costs compared with the absence of a provisional and may not necessarily enhance the aesthetic outcomes. German Clinical Trials Register; DRKS00009420.

Esthetic Integration Area concept to improve the emergence profile of fixed restorations: A dental technique

A technique for obtaining the esthetic integration and optimal emergence profile of tooth-supported and implant-supported restorations is described. Using a computer-aided design software program, data captured with an intraoral scanner were used to establish the anatomic landmarks for determining the maximum buccal volume to which a restoration can be extended. This technique could be applicable to different types of fixed-dental prostheses treatments. Advantages of this technique include the establishment of periodontal-prosthetic criteria and the improvement of clinical and laboratory communication since the same guidelines for evaluating restorative space in the buccolingual direction of tooth preparations are used to avoid overcontoured restorations.

Depth of mucosal tunnel in peri-implant health during 12-month follow-up in patients with controlled periodontitis.

The association between thickness of peri-implant mucosa, known as mucosal tunnel (MT) and related clinical parameters in bone-level implants has not been investigated. Posterior implants, in patients with controlled periodontitis, were evaluated at different time intervals: during uncovering surgery (T0 ), 2-month after uncovering surgery (T2M ) and 12-month after placement (T12M ). Clinical parameters including vertical soft tissue height (VSTH), MT, tooth-implant discrepancy of bone level (DBL), pocket depth (PD), peri-implant marginal bone loss (MBL), emergence profile and emergence angle (EA) were collected, and the correlation were assessed at different time points. Forty-two patients with 60 implants were recruited, and 81.7% of the patients were Stage III-IV, Grade B-C generalized periodontitis. MT presented no significant difference in PD, VSTH, and MBL. Periodontitis Grade C and absence of bone regeneration were significant predictors for deep MT (>3mm), and 5.850 less EA at mesial side of implants (p=0.02).The regression of analysis implied the increase of DBL 1mm would cause 0.26mm deeper MT, 1.7 times higher risk of having deep MT (p=0.041; OR=1.731; 95% CI:1.02-2.93) and 2.1 times higher risk of having circumferential PD>4mm (p=0.019; OR=2.1; 95% CI:1.13-3.92). In bone-level implants, a correlation between MT and clinical parameters at 12-month follow-up was not found. However, history of periodontitis Grade C, absence of bone regeneration and tooth-implant discrepancy of bone level might define the depth of MT. Additionally, the depth of MT played a critical role in determining restorative design.

Cover Image, volume 34, Issue 5

The cover image is based on the Clinical Article A digital workflow for accurately and rapidly creating an immediate provisional restoration with natural emergence profile using extracted tooth by Jiakang Zhu et al., https://doi.org/10.1111/jerd.12836.image

Implant-abutment emergence angle and profile in relation to peri-implantitis: A systematic review.

StatementThe aim of this systematic review is to analyze literature regarding the relationship between the implant‐abutment emergence angle (EA) and implant emergence profile (EP) and the prevalence of peri‐implantitis.MethodsPubMed and the Cochrane Library were searched for studies from initiation up to April 2022. Studies describing the EA and EP in association with peri‐implantitis were considered eligible for this review and selected for inclusion in this review if implant groups with wide and narrow EA and different EP types were described.ResultsSearches in PubMed and the Cochrane Library led to 1116 unique titles and the inclusion of three studies. These concerned 168–349 implants. Two studies presented the mean prevalence of peri‐implantitis which was 16.7% and 24.8% at the implant level. Both studies showed a significant relationship between peri‐implantitis in bone‐level implant groups with an EA above 30° compared to implants with an EA below 30°. A third study presented marginal bone loss which tended to be smaller when the EA was around 20°–40°. In one of the three included studies, the prevalence of peri‐implantitis was significantly higher if implants had a convex EP compared to a concave or straight EP. Another study showed a significantly higher prevalence of peri‐implantitis in implants with a convex EP compared to other EP types, if combined with an EA above 30°.ConclusionsThree eligible studies were found. Reported associations should therefore be considered with caution. Synthesis suggests an association between a larger EA (>30°) and a higher prevalence of peri‐implantitis or marginal bone loss compared to a smaller EA (<30°). A convex EP may also be associated with a higher prevalence of peri‐implantitis. However, causality remains a question.

Intravenous Caffeine Infusion Accelerates Emergence from Total Intravenous Anesthesia: A Randomized, Double-blind, Placebo-controlled Study

Background: Emerging from general anesthesia remains a passive process. Recent studies show the importance of dopaminergic pathways in sleep–wake cycles. The effect of caffeine in increasing the level of consciousness and cognitive function has been well documented. The purpose of the current study was to evaluate the effect of intravenous caffeine, a dopamine receptor stimulant, on accelerating recovery from Total Intravenous Anesthesia (TIVA) with propofol. &#x0D; Methods: Fifty patients, aged between 20 to 50 years old scheduled for elective laparoscopic cholecystectomy, were enrolled in this double-blind clinical trial, and forty-eight were analyzed. The study group, consisting of 24 patients, received 500 mg IV caffeine infusion 15 minutes before the end of the surgery. The control group, comprising 24 patients, received an equal volume of saline infusion. Emergence profile was evaluated and compared in two groups. The depth of anesthesia was determined by Bispectral Index (BIS) monitoring.&#x0D; Results: Our research demonstrated that in the study group, the time intervals for increasing BIS values from 60 to 80, endotracheal extubation, eye-opening on verbal command, and achieving an Aldrete’s discharge score ≥ 8 were significantly less than the control group. Short Orientation Memory Concentration Score (SOMCT) was lower in the control group as well. Incidence of nausea, vomiting and, shivering had no significant difference between the two groups.&#x0D; Conclusion: Since emergence from general anesthesia is a passive process, caffeine may be used as a measure for active reverse of general anesthesia at clinical practice.

Creation of Emergence Profile in Single Tooth Implant Retained Fixed Prosthesis: Two Case Report

Creation of Emergence Profile in Single Tooth Implant Retained Fixed Prosthesis: Two Case Report

Emergence profile and tissue tropism: optimization for the Coronally Advanced Flap

To analyze gingival tissues modifications following 5-class restoration in patients going to be treated with mucogingival surgery in relation to the new emergence profile after treatment of abrasions of the CEJ. The study included seven female patients aged 22 to 46 years. Fifty teeth were recorded, 47 affected by the vestibular recession (Miller 1) and 3 without recessions. Seventeen had a cervical (class B of the classification by Pini Prato e Coll.) Patients underwent the following protocol: Oral hygiene therapy -Acquisition of alginate and development of plaster cast, filling of the periodontal chart before conservative treatment Class 5 restoration - intraoral photos after conservative treatment, check up after at least 60 days, acquisition of intraoral photos, alginate, and development of plaster cast, and filling of the periodontal chart. The plaster cast was then refined and scanned with a lab scanner to create standard tessellation language (STL) files prior to the conservative therapy (TO) and after at least 60 days (T1) average elapsed time = 132 days (±48). - the 3D matching of the 2 models was carried out by the use of Geomagic Software® - ortho-shaped and parallel (cutter) planes were superimposed - evaluations were obtained using 3D Viewer Visualization Software -The modified emergence profile induced a tissue change in width and height. An increased thickness corresponds to an increase in thickness at the level of the free gingival margin. Over, 5-class restorations with an increased emergence profile were effective in increasing tissue thickness during an average time of observation of 3 months.

Can EPS collaborate with the acquisition of the supra-implant emergence profiles simultaneously to the dental implant's digital transference?

To analyze the Emergence Profile Scanbody (EPS) influence in the acquisition of the supra-implant emergence profile when the dental implant is digitally transferred. Three dental implants were installed in a laboratory model and artificial gingiva was made. This artificial gingiva, with 5 mm of height, reproduced the supra-implant emergence profile designed for maxillary central incisor, maxillary lateral incisor, and maxillary first molar. Using the EPS connected to the dental implants, the laboratory model was scanned five times with TRIOS 3 scanner. Moreover, the reference model, without EPS, was scanned on time. The STL files were analyzed for surface distance and three-dimensional distance through the PolyWorks program. The statistical analysis was performed through the one-way analysis of variance for surface distance and two-way analysis of variance for three-dimensional distance. In addition, the SPSS v23 program was used for statistical calculations, with a 5% significance level. The information about supra-implant emergence profiles design could be captured. On the other hand, there was no statistically significant difference among surface distance values when dental elements are compared. Besides, from the three-dimensional point of view, the measured difference was not significantly affected by the type of tooth. The EPS favored the supra-implant emergence profiles' scanning and the dental implant's digital transference, simultaneously. Therefore, clinical studies are indicated for comparison of results.

Hygienic maintenance of soft tissues in the treatment of minor recessions: a prospective study and three-dimensional analysis.

To assess the hygienic maintenance of the tissues affected by an increase/restoration of the emergence profile, through conservative-periodontal therapy on minor vestibular recessions (Class I Miller) with and without abrasions of the CEJ. Seven recruited subjects aged 22 to 46 years, were analyzed with a total of 50 dental elements. 47 with a vestibular recession -17 with abrasion/recession, 3 only with abrasion. Conservative therapy has been implemented to restore/increase the thickness of the CEJ. The following values have been recorded: N of recessions belonging to the I class Miller/RT1 (Cairo et al); 17 elements with class B+ abrasion. Impressions to record the differences in the emergence profiles before and after conservative therapy. 30 dental elements had type 1 phenotype (thin and festooned), 20 dental elements had type 2 phenotype (intermediate). Clinical protocol: professional oral hygiene session, home hygiene motivation and education, class V fillings, check after 60 days for access to mucogingival surgery. Periodontal probing and Plaque Index were assessed at T0 and T1 (2 months after conservative therapy). The combined restorative-periodontal treatment allows changing of the emergence profile. The reduction of the recession was influenced by different phenotypes. Probing depth decreased significantly between T0 and T1. Plaque Index (PI) decreased statistically significantly (p=0.012). Modification of the emergence profile, obtained through conservative therapy, was easily maintained from the hygienic point of view by the patients. Furthermore, it could provide mechanical protection and support to the gingival margin favoring a reduction of food impaction at the cervical level.

A custom Root Replica Abutment solution to improve emergence profile and maintain peri-implant tissue in immediate implant placement and restoration

To compare the effect of immediate implant restoration using a prefabricated customized Root Replica Abutment (RRA) v/s a Stock Abutment (SA), for crestal and marginal bone level changes and peri-implant soft tissue changes over a 1-year follow-up. Patients requiring single tooth extraction and immediate implant were planned for guided surgery and immediate loading with a SA or a custom RRA and a restoration. Post extraction, guided, flap-less implant placement was done and the jumping gap was filled with a biomaterial. These were immediately loaded using a SA or a custom RRA, replicating 3mm of the root anatomy from the cementoenamel junction (CEJ) of the tooth. Data from the day of surgery to 12 months was assessed for crestal bone level with CBCT scans and transferred into a medical image processing program (ITK-SNAP 2.4.0). Soft tissue analysis using intra-oral scan (IOS), were obtained and merged using prosthetic software (exoplan®, exocad). Inter-group mean crestal bone volume changes are significantly higher in SA compared to the RRA group. Mean bone Volume-Vpre-op and Vpost-op did not differ significantly. Intra-group mean crestal bone changes at 12-months follow-up did not differ significantly. V post-op is significantly lower compared to V pre-op for both study groups. Labial soft tissue contour at 12 months did not differ significantly between groups. However higher values were observed for the SA group. Marginal gingiva changes at 12 months were higher in the SA group. Custom RRA helps maintain socket volume and provides better support for the peri-implant tissue resulting in the optimal and stable aesthetic final restoration.

Case Report: Combining Molar Interradicular Osteotomy With Immediate Implant Placement: A Three-Year Case-Series Study

Background: Immediate implant placement in the area of multirooted molars includes many anatomical challenges, particularly with osteotomy preparation in the interradicular bone.Methods: In this article, we are reporting ten cases in which implant beds were prepared before root extraction. After coronectomy, pre-extractive interradicular implant bed preparations were performed through the retained root complexes. A dimple in the roof of the furcation was created using a no. 8 round surgical bur. The osteotomies were then completed through the tooth’s initially retained root complex in the regular sequence of drilling. Before implant placement, the remaining root segments were removed. The retained root parts guided the osteotomy drills and allowed for precise positioning and angulation of the implant bed preparation with respect to the emergence profile of the tooth.Results: Data from a 3-year follow-up of the crestal bone showed good bone levels in relation to the implant platform.Conclusion: The technique described permitted accurate implant placement in the prepared osteotomy, thus enabling immediate implant positioning in multirooted extraction sites.

Clinical considerations in the surgical management of peri-implantitis lesions in the esthetic zone.

The treatment of peri-implantitis is commonly associated to soft tissue changes as part of disease resolution. These changes may alter harmony in the esthetic area, and thus may negatively affect patient satisfaction. This technical note presents the key features that may lead to an unsatisfactory esthetic outcome when managing peri-implantitis in the anterior zone. It is essential to consider four pivotal elements in securing therapeutic success through the resolution of inflammation while maintaining esthetics: (1) patient-related factors, including patient willingness to treat and the smile line; (2) implant-related factors that influence implant position; (3) site-related factors related to defect configuration; and (4) prosthetic-related factors referred to the prosthetic emergence profile and the type of prosthesis. A comprehensive examination must be carried out preoperatively to assess the impact of the surgical treatment upon the esthetic outcomes. The clinician must be aware of the key features that condition the esthetic outcome when managing peri-implantitis.