Clinical Advantages of Angled Screw Access Channels for Implant-Supported Restorations in the Esthetic Zone.

Introduction: Retained cement following delivery of an implant-supported crown is strongly associated with peri-implant mucositis and peri-implantitis, and screw retention is a strategy for avoiding this problem entirely. In the esthetic zone, screw retention compromises esthetics unless the screw access in the crown is concealed to the palatal of the incisal edge. To avoid positioning the implant platform excessively toward the palate, practitioners can design an angled screw access channel in the crown.

Decisions Before Incisions: Technique Selection for the Distal Wedge Procedure.

Focused Clinical Question: What factors identify the optimal surgical technique when a distal wedge procedure is indicated at a terminal maxillary or mandibular molar site?

Summary: Incision design for the distal wedge procedure is based primarily on the dental arch (maxilla or mandible), the distance from the terminal molar to the hamular notch or ascending ramus, and the dimensions of the attached gingiva.

Conclusions: In most situations, favorable clinical results are achievable irrespective of the chosen distal wedge method, and technique selection is based more on operator preference than evidence. However, anatomic limitations can render distal wedge procedures challenging in some cases, and procedural advantages of specific techniques can simplify treatment.

The Tissue-Supported Sling Suture: Technique and Clinical Applications.

Introduction: Continuous and interrupted sling sutures (ISSs) are used around teeth in contemporary periodontics. However, conventional ISSs depend upon favorable tooth morphology for stability through the early healing period. The purpose of this report is to present a variation of the classic ISS that does not rely on favorable tooth morphology.

The Extraction Socket Management Continuum: A Hierarchical Approach to Dental Implant Site Development.

Focused Clinical Question: How should clinicians manage dental extraction sockets when immediate implant placement is contraindicated, and alveolar ridge preservation is expected to result in inadequate bone volume for implant placement?

Summary: Three fundamental options for extraction socket management form a hierarchical continuum in sites where dental implant placement is planned: place an immediate implant, perform ridge preservation, or perform ridge augmentation. The available volume and quality of bone and keratinized mucosa are the primary considerations driving the decision, and each tier in the continuum encompasses a variety of techniques with attendant advantages and disadvantages.

Conclusions: Some immediate implant protocols require no mucoperiosteal flap and possibly produce the most favorable clinical and patient-centered outcomes compared with other extraction socket management approaches.

Focus on Epithelialized Palatal Grafts. Part 3: Methods to Enhance Patient Comfort at Palatal Donor Sites.

Introduction: Postoperative discomfort is a documented complication of the epithelialized palatal graft (EPG) procedure, and the expectation of an unpleasant patient experience may cause some practitioners to avoid EPG altogether. However, EPG affords distinct advantages in a variety of clinical situations, and the postoperative discomfort associated with the procedure can be minimized.

Case Series: Three generally and periodontally healthy patients with gingival recession defects and minimal zones of attached gingiva received mandibular anterior EPG procedures.