Advances in Esthetic, Immediate Tooth Replacement Therapy Aimed at Improving Clinical Outcomes.

The criteria for successful tooth replacement in the esthetic zone is comprehensive and often complex. Merely achieving osseointegration is no longer the bar for which clinicians strive to reach in this endeavor. Achieving and maintaining hard- and soft-tissue stability as well as physiologic, scalloped soft-tissue architecture to frame cosmetic restorations is the ultimate goal of esthetic, immediate tooth replacement therapy (EITRT).

A comparative analysis of dual-axis implants placed into maxillary anterior extraction sockets versus virtual planning with uniaxial implants: A simulated cone beam computed tomography study of implant length and diameter.

Objective: The biaxial nature of the anterior maxilla poses a surgical and restorative challenge in implant dentistry. The present study sought to investigate the apical socket perforation rate (ASPR) from a simulated uniaxial implant placement and to determine the effect of implant length and diameter on ASPR when a uniaxial implant was placed compared with the orientation of the pre-existing dual-axis implant.

Material And Method: Cone beam computed tomography (CBCT) scans from the database of three private practices were searched for patients who received dual-axis implants within the esthetic zone in immediate tooth replacement therapy.

Changes in Peri-Implant Soft Tissue Thickness with Bone Grafting and Dermis Allograft. Part III: A Case Series Using a Novel, Hybrid Implant Design with a Subcrestal Angle Correction.

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.

Outcomes of a 1-Year Prospective Single-Arm Cohort Study Using a Novel Macro-Hybrid Implant Design in Extraction Sockets: Part 1.

A novel macro-hybrid implant design was introduced to afford high apical primary stability and more coronal space to preserve the circumferential extraction socket architecture. This study presents 1-year data from a prospective single-arm cohort study. The data was distilled based on the following criteria: (1) single-tooth immediate tooth replacement therapy (ITRT) in the maxillary anterior and premolar regions in intact (Type 1) extraction sockets that were (2) treated with the dual-zone grafting technique.

What Are the Three Most Essential Elements to Implants in the Esthetic Zone?

There are many essential elements to achieving long-lasting esthetic and physiologic outcomes in implant dentistry in the esthetic zone. Here are three specialists take on the three most essential elements to implants in the esthetic zone.

Long-Term Esthetic Complications Associated With Anterior Implant-Supported Restorations.

Having demonstrated high average survival rates, osseointegrated endosseous dental implants are considered a predictable solution for the replacement of missing teeth. Most studies and case reports have concentrated on the success and/or failure of dental implant-supported restorations in the posterior regions of the mouth, while fewer reports have investigated the performance of such treatments in the esthetic segment. Today, it is recognized that in addition to implant survival, other parameters of implant dentistry are considerations when evaluating success or failure in the esthetic zone.

A Novel Implant Design for Immediate Extraction Sites: Determining Primary Stability.

Achieving primary stability is a critical challenge presented by immediate implant therapy. Surgeons often utilize wider, tapered implants for this purpose, or they use longer implants to achieve primary stability. Both strategies are associated with negative ramifications.

Rehabilitation of an Esthetic Compromise in a Patient Previously Treated With Maxillary Anterior Implants.

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.

Use of a Novel Implant with an Inverted Body-Shift and Prosthetic Angle Correction Design for Immediate Tooth Replacement in the Esthetic Zone: A Clinical Case Series.

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.

The Importance of Interdisciplinary Treatment in an Esthetically Challenging Case.

A single missing tooth is a common occurrence among young patients and impacts esthetics and long-term oral health in terms of compromised bone, gum tissue, and, if warranted, an implant and final prosthesis. In this case report, after years of poorly executed orthodontic therapy, the patient's dental growth complicated the development of an esthetically pleasing smile. An interdisciplinary approach was utilized comprising periodontal surgery, a second course of orthodontics, and prosthodontics to provide comprehensive patient care that included evaluation of occlusion and esthetics.

Immediate Tooth Replacement Therapy in Postextraction Sockets: A Comparative Prospective Study on the Effect of Variable Platform-Switched Subcrestal Angle Correction Implants.

Immediate tooth replacement therapy (ITRT), ie, immediate implant placement and provisional restoration in postextraction sockets, has been shown to achieve favorable outcomes in reference to soft tissue stability and esthetics. However, avoiding socket perforation with uniaxial implants in the anterior maxilla can be challenging due to the inherent anatomy. Dual or co-axis subcrestal angle correction (SAC) implants have been developed to change the restorative angle of the clinical crown restoration subcrestally at the implant-abutment interface to enhance the incidence of screw-retained definitive restorations.

Tapered Versus Inverted Body-Shift Implants Placed Into Anterior Post-extraction Sockets: A Retrospective Comparative Study.

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).

Simultaneous Crestal Sinus Elevation and Implant Placement Using a Ribose Cross- Linked, Collagen Bone Graft Material: Case Series of 28 Consecutive Patients.

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.

Changes in Peri-implant Soft Tissue Thickness with Bone Grafting and Dermis Allograft. Part II: A Comparative Retrospective Case Series Using a Subcrestal Angle Correction Implant Design.

Immediate tooth replacement therapy (ITRT) in the maxillary anterior sextant is an increasingly frequent treatment option sought by patients and performed by clinicians worldwide. Achieving long-term results that are predictable, stable, esthetic, and healthy is the ultimate goal. This trend also lends itself to minimally invasive surgery as well as defining the procedure to a singular surgical intervention.

A Paradigm Change in Macro Implant Concept: Inverted Body-Shift Design for Extraction Sockets in the Esthetic Zone.

An innovative macro hybrid implant design is aimed at enhancing labial plate dimension and tooth-implant distance while achieving consistent esthetic outcomes. This unique "body-shift" concept in diameter and shape combines a tapered apical portion with a cylindrical coronal portion in a singular implant body design. The overall configuration of the implant is inverted and "convergent" in form toward the implant-abutment interface where bone is thinnest.

Prosthetic and Surgical Management of Atypical Space When Teeth Are Missing.

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.

Changes in Peri-implant Soft Tissue Thickness with Bone Grafting and Dermis Allograft: A Case Series of 15 Consecutive Patients.

Immediate implant placement and provisional restoration has become a popular and well-supported method of tooth replacement in the maxillary anterior dentition. Aside from achieving osseointegration, esthetic demands have grown with better understanding of the behavior of hard and soft tissues following this mode to therapy. Stability of gingival contours, texture of the surrounding tissues, and blending of prosthetic components with the natural dentition are critical for successful outcomes to be maintained long-term.

Framing the Restorative Result: How Tissue Augmentation and Preservation Maximizes Implant Therapy Outcomes.

The role of hard- and soft-tissue augmentation as it pertains to dental implant therapy is often underestimated. If this restorative aspect is neglected during the natural healing process and subsequent remodeling following extraction(s), the long-term outcome of treatment can be catastrophic. Three of the most common opportunities for surgeons to enhance outcomes with regenerative therapy are: reconstruction of edentulous segments of the alveolus, management of extraction sockets, and immediate implant placements.

Ridge Augmentation Simultaneous With Immediate Implant Placement: The Subperiosteal Tunneling Technique.

The efficacy of immediate implant placement has made it an appealing treatment modality in dentistry. Over the past several decades various surgical techniques to minimize the ridge collapse and other adverse changes that occur after tooth extraction have been advocated. This case series proposes a method of soft-tissue augmentation when multiple implants are being immediately placed.

Use of a Sugar Cross-Linked Collagen Membrane Offers Cell Exclusion and Ossification.

Resorbable barrier membranes are advantageous for use in guided bone regeneration for treatment of peri-implant defects, eliminating the need for surgical re-entry. Ribose, a natural sugar-based material that has been used to cross-link collagen, is able to be utilized in high concentrations to extend barrier function for long periods without eliciting inflammation or foreign body reactions in situ. A unique finding with a ribose cross-linked collagen membrane is the in situ ossification of the material upon re-entry.

Redesigning Existing Provisional Restorations While Maintaining Established Transmucosal Anatomy in a Multi-Implant System/Natural Tooth, Full-Arch Case.

Redesigning existing provisional restorations when a combination of two different implant systems and natural teeth exist in the same arch can be challenging. Problems such as acrylic locking into undercuts and loss of spatial landmarks both subgingivally and supragingivally are common concerns for the practitioner. Two techniques, presented herein, offer treatment options to retain the previously developed transmucosal anatomies of implant-level provisional abutments while allowing for redesign of the clinical crown component of the same long-term provisional restorations.

The Correlation Between Immediate Implant Insertion Torque and Implant Stability Quotient.

Different parameters can be measured during dental implant insertion to determine the primary stability of the implant. The purpose of this retrospective study was to investigate whether a correlation exists between immediate implant insertion torque value (ITV) and implant stability quotient (ISQ) in nonmolar sites. A total of 59 implants in 52 patients were placed into extraction sockets.

The Dermal Apron Technique for Immediate Implant Socket Management: A Novel Technique.

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 teamwork approach to esthetic tooth replacement with immediate implant placement and immediate temporization.

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.