A Periodontal Expert

台灣牙周補綴醫學會 2010 春季學術活動

2010-02-13T02:43:00.001+08:00

台灣牙周補綴醫學會 2010 春季學術活動

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A reflection from the Live surgey

2008-01-22T20:12:00.000+08:00

@ A combined dental implantation & ridge spitting + bone grafting from Srcaper (May23, 06') [Bone Scraping with Bone Collec]
* post suture (10 days after surgery) * 2nd surgery on 25,26 sites and additional bone grafting on 24 site(post-implantation 6 months):

@ Cortical bone collector in this case is reusable 50 times; after that, changes the blade to bone scraped. Some detail see another blog of mine: http://implantproducts.blogspot.com/2006/05/cortical-bone-collector.html

* Final restoration:(Jan17,2007)
** Post restoration 1 year:

** Taking a Certificate from Prof. Isaksson (big guy): I learded the specific ridge splitting and bone grafting from Halstam university program. This csae presentation is my deep-heart thanks to them and some kinds of refection after the course.

Subantral Membrane Elevation with Balloon technique

2007-01-16T12:00:00.000+08:00

Balloon Subantral Membrane Elevator ( SME )

The advantages of Subantral Membrane Elevator, or SME:

Decreases Surgical Time
Reduces Risk of Membrane Tears
Mini Balloon Inflates to 3.1mm (Micro Mini Inflates to 1.9mm)
Can be used in small osteotomies
Single Use, Supplied Sterile
Supplied with 5cc Luer Lok® Syringe

@ Clinical Appilcation for SME with balloon technique:(by Dr. Perio Apr06')

*** 7mm bone height under sinus membrane >> localized elvation to insert 4.8X12mm dental implant.

@Detail s lideshow description of Balloon Subantral Membrane Elevator

...PostSx 1 wk

** 2nd surgery and final restoration: See next blog!

Final restoration after the Balloon technique

2007-01-16T07:38:00.000+08:00

* 2nd Surgery and Final restoration (apical films)

Simplified Mini-Incision (SMI) at Dental implant Surgery

2006-10-12T15:39:00.000+08:00

Simplified Mini-incision for Dental Implant Surgery:(Designed by Dr. Perio)

Fit to Stage 1- and 2- surgery
Incision & Suture: a/Slight semilunar crest incision; b/two short vertical incisions (stoped at mucoginigival junction); c/Mini- middle releaving incision; d/apically positioned flap; e/one sling suture to fix flap; f/two fixing simple loop sutures.
Advantages for this thechnique: a/Simple procedure; b/faster tissue healing and c/ post-surgery more comfortable.

A case using SMI technique: (postSx 1wk)

@ Final healing:

Blog capacity is full ---Move to second part

2006-06-30T10:19:00.000+08:00

** Notice !!!
Home move to Demtal Implant Professional !

See You .....

Localized Management of Sinus Floor (LMSF)

2006-06-01T09:21:00.000+08:00

Localized management of sinus floor (LMSF) achieves implant placement and sinus lifting simultaneously. LMSF is a further application of the principles of the edentulous ridge expansion (ERE) technique. It comprises the dissection of a partial-thickness flap, the buccal expansion of the residual alveolar bone, and the fracture and elevation of the sinus floor with simultaneous implant placement. The selected patients, who showed no signs of sinus pathology, exhibited insufficient vertical alveolar bone dimensions for the placement of dental implants with the traditional technique. The minimal residual alveolar bone height was between 5 and 7 mm. Based on the criteria established by Albrektsson and his coworkers in 1986, the success rate of the 499 implants placed with the LMSF was 97.5%.(Code by Dr.Buschi et al;1998.Three hundred three patients were treated with 499 implants placed using the LMSF between April 1988 and December 1993)
#Clinical Report by Dr. Perio:

@LMSF with Wide Implant + Bone Grafting: (Dec10,05)

PostSx 1wk>>><<PostSx 4 months---

@Final restoration (May30,06')-post implantation 6 months later

#15GBR + #16LMSF (Dec05')

@Post Sx 5 months (May06')

Dental Implant Fracture: a complication of treatment with dental implants

2006-05-30T23:48:00.000+08:00

Dental implants are a functional and esthetic solution to partial and total edentulism. The initial success rate of this treatment modality is 90-95%. But, that treatment modality is not free of complications. One of the rare complications yet, with severe clinical results is fracture of dental implants. The current literature review (Biomaterials. 2002 Jun;23(12):2459-65)presents the various causative factors that may lead to implant fracture. Implant failures may be sorted into groups by the timing of their appearance, or by the origin of failure. Fractures belong to the group of late complications, caused by a biomechanical overload. Overload may be caused by inappropriate seat of the superstructure, in-line arrangement of the implants, leverage, heavy occlusal forces (bruxing, clenching), location of the implant and the size of the implant or metal fatigue. Good clinical examinations and correct treatment plans may reduce the risk of implant fracture.
*A Case Report for Fractured Implant Removal: >>Trephine to remove the fractured implant

*New larger implant with bone graft into the old implant site>>

>>>one & 2.5 months later>>>

@Final Restoration:( after 6 months later from reimplantation!)

Periodontal Treatment Options for Receding Gumlines

2006-05-27T19:57:00.000+08:00

Erosion of the gums at the gumline is relatively common. It is seen as a result of chronic inflammation associated with chronic gum disease. I t is also fairly common in young adults with aggressive toothbrushing habits. Generally, teeth will develop gum recession when a root is prominent in the bone compared to other teeth. Patients who grind their teeth also stress the sockets in which the teeth reside. When this stress is delivered to sockets with thin bone, loss of bone and gum may occur. The resulting gum recession can lead to thermal sensitivity to the tooth and may be unsightly. Dentists are concerned about recession when the amount of gum tissue deteriorates. Research has shown that when the amount of attached gum tissue diminishes below one millimeter, these teeth are more vulnerable to developing further recession. When these teeth are treated with gum grafts, the recession will stabilize and help to prevent the further loss of tooth support.Soft Tissue Grafts are procedures that rebuild the protective gum tissue around the tooth or teeth.

The procedure usually follows the following protocol:
1) Local anesthetic is given.
2) The tissue below the receded gum is dissected away exposing underlying tissues.
3) Gum tissue is procured from the roof of the mouth. This is usually a 1-2mm paper-thin graft that can easily be positioned around the problem tooth. The roof of the mouth is essentially an eternal reservoir of gum tissue. The donor site will be slightly tender but usually heal quickly and return to normal after a few days.
4) The graft tissue is then sewed to place over the exposed underlying tissues. Sutures are enough to secure the graft and allow for proper healing. The graft will turn first white and then often red as the graft bonds to the surrounding tissue. Ultimately, grafts will range from normal colored to slightly.
New variations of grafting have emerged over the past several years. Tissue bank skin graft material is available for those patients who would prefer not to use the roof of the mouth as a donor site. These grafts tend to have more shrinkage but will provide more natural color matching to the surrounding gums. Root coverage is now a very predictable option for teeth with receding gum lines. Subepithelial Connective Tissue Grafts borrow internal tissue from the roof of the mouth. This tissue is positioned under a flap of gum in the area of recession. The combined nutrition from the gum under and over the graft keeps the graft alive over the previously exposed root surface. The result is both an increase in the amount of protective gum tissue as well as improved esthetics. These grafts also provide the best color match with the surrounding gums.

Case report: A lower anterior area generalized gingival recessions/fenestration with roots exposure during orthodontic treatment__The Subepithelial connective tissue graft to improve the thickness of overlying gingival tissue and roots coverage __Referred from other general practitioner for some malpractice during the orthodontic therapy

Live surgery Case 3~5

2006-05-19T17:26:00.000+08:00

Live surgery case3:
Very narrow ridge over right mandibular -
Open type Ti mesh + Autogenous bone graft (Harvesting from Safe scaper)

@Live surgery case4: Lt' Maxillary sinus lift + Intra-antral bone grafting + Dental implantation

@Live surgery case5: Failing implant removal + Ridge augmentation / Sinus augmentation under Ti mesh

*** The Use of Ramus Grafts for Ridge Augmentation- Clinical Article-(Dental Implantology Update: June 1998)
@ Photo with professor Isaksson and Dr. Becktor

@ Ramus onlay graft harvesting procedures: Video (Please don't publish in public): http://www.youtube.com/watch?v=Xk8rstO-tME

A wonderful course in a lovly city

2006-05-18T17:30:00.000+08:00

Clinical Training Course -
Advanced implant Surgery with Forcus on Minor Bone Grafting Procedures

May 18-19, 2006
Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden

Astra Tech AB

Participants:
Dr. Ramon Gomez Meda (Spain)
Dr. Alberto Trigas Damian (Spain)
Dr. Lennart Mollersten (Sweden)
Dr. Sven-Ake Nilsson (Sweden)
Dr. Stefan Ohlsson (Sweden)
Dr. Chi-Chou Huang (Taiwan)
Dr. Yin-Pin Wang (Taiwan)

Faculty:
Sten Isaksson DDS MD PhD (Head of the maxillofacial Unit Oral & Maxillofacial Surgeon)
Jonas Becktor DDS

Two Live Surgery on First Day
#case 1
#case 2

Out town 1 week to attend advanced implant surgery course in Sweden

2006-05-15T17:12:00.000+08:00

Advanced Implant Surgery with Focus on Minor Bone Grafting Procedures

On two different occasions: May 18–19 and September 14–15, 2006 Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden. For the clinician with experience in conventional implant surgery and an interest in advanced surgical techniques.Various pre-implant surgical techniques suitable for general dentistry will be discussed and performed. The course includes local bone grafting such as sinus lifting and onlay grafting as well as distraction osteogenesis and fixture installation in grafted bone. Lectures, patient demonstrations and live surgery with opportunities for the participants to assist will illustrate the different procedures.

Lecturers:Sten Isaksson, DDS, MD, PhD, Clinical Director,Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden

Jonas Becktor, DDS, Consultant, Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden

Course ContentLectures
• Indications and limitations for local bone graftingtechniques suitable for general dentistry
• Distraction Osteogenesis (DOG)
• Treatment planning and discussions of participants’ own cases
• Postoperative treatment– Follow-up– Complications
• Various bone grafting techniques suitablefor local and general anesthetics
• Research and studies on implants and bone graftLive Surgery*
• Titanium mesh and bone graft• Bilateral sinus inlay bone graft
• Onlay bone graft for single tooth implant• Implant surgery in grafted bone

Duration: 2 days
Participants: Min 7, max 8
Course fee: SEK 11,300 ex. VAT.
Included in the fee: Course material, diploma, coffee,lunches and one dinner.
Language: English

@Welcome to my Astra nordic tour Blog: http://astratour.blogspot.com/
@ Join a special group for Astra dental implant:
http://health.groups.yahoo.com/group/astraimplant/join

Click to join astraimplant

How to predict the percentage of root coverage ?

2006-05-13T15:20:00.000+08:00

@ A case (#43) of severe gum recession and root exposure after orthodontic treatment:

Severe root prominence
Root outer the alveolar house
Miller's classification : Class III
Root exposure with wide and deep type

For severe gum recession + loss of some interproximal bone + wide and deep root exposure>>> 100% root coverage is not possible!

....70~80 % root coverage will be predictale goal.

....Cervical operative restoration may be needed to cover exposed root surface.

A Dentist taking the implant surgery and restoration

2006-05-12T10:24:00.000+08:00

A handsome dentist (famous at his hometown) suffering an anterial tooth missing and flipper discomfort!
He decided to have a fixed restoration after dental impant and bone augmentation.
For his thin and bone concavity over the implant site, the bone augmentation and dental implantation should be together.
When a healing abutment into the implant at 2nd surgery, the implant position was far palatally. Lab technician (顏氏技工所) helped him to correct implant position by custom made angle abutment from bone crestal level.
Final result is OK. and he restores his shining smile again !

@Detail procedures see the following pictures:

Maxillary Sinus Septa

2006-05-08T21:09:00.000+08:00

Journal of Periodontology
2006, Vol. 77, No. 5, Pages 903-908
(doi:10.1902/jop.2006.050247)

Maxillary Sinus Septa: Prevalence, Height, Location, and Morphology. A Reformatted Computed Tomography Scan Analysis

Min-Jung Kim

Background: The sinus lift technique may be difficult to perform if an aberrant sinus anatomy is encountered during surgical exposure, such as when a septum is present on the sinus floor. The objective of this study was to determine the prevalence, size, location, and morphology of maxillary sinus septa in the atrophic/edentulous and non-atrophic/dentate maxillary segments.
Methods: The sample population consisted of 100 patients (41 women and 59 men, with a mean age of 50 years, ranging between 19 and 87 years) for whom treatment was being planned for implant-supported restorations. Reformatted computerized tomograms (CT) from 200 sinuses were analyzed using imaging software.
Results: The prevalence of one or more septa per sinus was found to be 26.5% (53/200), 31.76% (27/85), and 22.61% (26/115) in the overall study population and the atrophic/edentulous and the non-atrophic/dentate maxillary segments, respectively. In the analysis of the anatomic location of the septa within the sinus, it was revealed that 15 (25.4%) were located in the anterior region, 30 (50.8%) in the middle region, and 14 (23.7%) in the posterior region. The measured heights of the septa varied among the different areas. The mean heights of the septa were 1.63 ± 2.44, 3.55 ± 2.58, and 5.46 ± 3.09 mm in the lateral, middle, and medial areas, respectively.
Conclusions: It can be inferred that there is a wide anatomical variation in the prevalence, size, location, and morphology of maxillary sinus septa, irrespective of the degree of atrophy. Therefore, to prevent the likelihood of complications arising during sinus augmentation procedures, a thorough and extensive understanding of the anatomic structures inherent to the maxillary sinus is indispensable.

First Laser Gum Disease Procedure to gain FDA Clearance

2006-05-03T20:19:00.000+08:00

First Laser Gum Disease Procedure to gain FDA Clearance - “Laser Assisted New Attachment Procedure or Laser-ANAP®”

The US Food and Drug Administration cleared Laser-ANAP? ("Laser Assisted New Attachment Procedure") with a unique and specific claim for, "cementum-mediated new periodontal ligament attachment to the root surface in the absence of long junctional epithelium."
FDA clearance for Laser-ANAP?using the PerioLase?MVP-7?variable pulsed Nd:YAG dental laser follows three years of research at Louisiana State University, School of Dentistry, New Orleans, by principal investigator, Professor Raymond A. Yukna, DMD, MS, and coordinator of post-graduate periodontics at LSU. Professor Yukna led a controlled, blinded, clinical and human histology study that evidenced new root surface coating (cementum) and new connective tissue (periodontal ligament) formation (collagen) on on tooth roots by stimulating existing stem cells to grow following the use of the PerioLase?MVP-7?& Laser-ANAP?protocol.
"These results are very positive, very consistent, and very encouraging related to the treatment of deep gum pockets," said Yukna. "Dentists have been looking for ways to regenerate some of the tissues lost to gum infections and Laser-ANAP?is an exciting and revolutionary treatment protocol showing microscopically that we can form a new root coating (cementum) and new connective tissue attachment (collagen). Our consistent results (all LANAP treated teeth showed a positive result) suggest that the best possible type of healing can be obtained using the specific Laser-ANAP?protocol. This presents a wonderful alternative to traditional surgery."

@ Laser-assisted new attachment procedure inprivate practice by David M. Harris, PhD
-Article in PDF

***AAP-Commissioned ReviewLasers in Periodontics: A Review of the Literature Charles M. Cobb*
Conclusions: Based on this review of the literature, there is a great need to develop an evidence-based approach to the use of lasers forthe treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current evidence does suggest that use of the Nd:YAGor Er:YAG wavelengths for treatment of chronic periodont it is may be equivalent to scaling and root planing (SRP) withrespect to reduction in probing depth and subgingival bacterial populations.However, if gain in clinical attachment level is considered the gold standard for non-surgical periodontal therapy, then the evidence supporting laser-mediated periodontal treatment over traditional therapy is minimal at best. Lastly, there is limited evidence suggesting that lasers used in an adjunctive capacity to SRP may provide some additional benefit. J Periodontol 2006;77:545-564.

Dental Implant Overload

2006-04-29T09:36:00.000+08:00

Dental Implant Overload
@information from the atlantadentalimplants.com
Nobody likes to be overworked. Dental implant dentists say that a dental implant is overloaded when the dental implant has too much work to do. It is always best to have one dental implant replace one missing tooth. However, dental implant patients do not always want to pay for the best treatment available and dental implant dentists try hard to please their patients. Yes, a dental implant patient can get by with less than one dental implant per missing tooth, but this is not ideal and leads to overworking the dental implants harder than the original natural teeth! In the long run, the money saved may not be worth it. In matters of health, it is always best to choose the best road, not the cheapest.
Dental implants can also be overloaded by poorly designing the dental work on top of the dental implants or by poorly placing the dental implants. Both of these problems can often be avoided with excellent dental implant treatment planning before the dental implants are ever placed. Dental implants should ideally be placed so that a dental implant patient's biting forces are directed straight downward onto the dental implant. This can not always be achieved especially when a dental implant patient has lost a great deal of bone.

@Evaluation of load transfer characteristics of five different implants in compactbone at different load levels by finite element analysis. (PDF!)

@ A case with another implant rescure and bone augmentatrion after dental implant overloading. (Surgery by Dr. Perio)

Paroxysmal positional vertigo as a complication of osteotome sinus floor elevation

2006-04-28T11:35:00.000+08:00

Eur Arch Otorhinolaryngol. 2005 Aug;262(8):631-3. Epub 2005 Feb 27.

Paroxysmal positional vertigo as a complication of osteotome sinus floor elevation.
Di Girolamo M, Napolitano B, Arullani CA, Bruno E, Di Girolamo S.
School of Dentistry, University of Rome Tor Vergata, Rome, Italy.

Paroxysmal positional vertigo (PPV) is a high prevalence, vestibular end organ disorder due to the detachment of the utricular otoconia floating in the posterior or lateral semicircular canal. Even though in the majority of cases the etiology of PPV is unknown, it may follow viral infection, vascular disorders and head trauma after different surgical procedures. The aim of this study was to investigate the correlation between PPV and the surgical trauma induced by the vibratory and percussive forces on the upper maxilla during the osteotome sinus floor elevation procedure. We performed a complete otoneurological examination on 146 patients affected by atrophic ridges before and after upper maxilla surgery. Four patients showed a PPV of the posterior semicircular canal controlateral to the implanted side 1 or 2 days after the surgical procedure, which promptly was solved with the Epley re-positioning maneuver. We hypothesize that the surgical trauma, and specifically the pressure exerted by the osteotomes, determines the detachment of the otoliths from the utricular macula while the patient head position, hyper-extended and tilted opposite to the side where the surgeon is working, favors the entry of these free-floating particles in the posterior semicircular canal of the implanted side. Although this disease is rather frequent in the normal population and it is a benign, self-limiting peripheral disorder, it should be considered by the oral surgeon as a possible complication of pre-prosthetic upper maxilla surgery, and the patient should be informed before undergoing surgery.

@ Clinical suggestions for preventing BPPV: (Dr. Perio had the BPPV after ridge expansion with Osteotome technique twice!) @ Dignosis and Therapy for BPPV: Epley maneuver
***Supplemental material on the site CD: Animation of Epley Maneuver.
Note that this maneuver is done faster in the animation than in the clinic. Usually one allows 30 seconds between positions

Multiple dental fractures following tongue barbell placement

2006-04-26T16:20:00.000+08:00

** a picture download from frickr
Multiple dental fractures following tongue barbell placement: a case report

The number of adolescents and young adults undergoing intra-oral piercing, is increasing worldwide. There have been several case reports documenting oral and systemic complications of this practice. These include damage to the dentition, gingivae, infection, speech impediments and nerve damage. The case presented here draws attention to the possibility of multiple tooth fracture as a result of trauma incurred from a barbell inserted into the tongue.

## Worldwide warning for Tongue Piercing:
@A complication of tongue piercing. A case reportand review of the literature (PDF)
@Investigating tongue piercing (BDJ)
@Tongue piercing: Case report and review of currentp r a c t i c e (ADA in Australia)
@Tongue Piercing andAssociated ToothFracture (cda-adc.CA)
@Oral piercing and oral trauma in a New Zealand sample

Stimutainous dental implantation with other techniques

2006-04-25T10:01:00.000+08:00

Presurgery - Long-term apical lesion with persistant sinus teact

Atrumatic extraction and socket curettage

Immediate dental implantation

GBR for periimplant bony defect with BioOss bone graft + Ti mesh + Teruplug

Immediate provionalization

Post Sx 2 wks

台灣牙醫植體醫學會暨南台灣口腔植體醫學會２００６年年會

2006-04-23T23:25:00.000+08:00

台灣牙醫植體醫學會暨南台灣口腔植體醫學會２００６年年會

將於高雄金典酒店舉辦
時間：2006 4/22~23(六,日)，
地點：高雄金典酒店４１樓
主辦：台灣牙醫植體醫學會
承辦：南台灣口腔植體醫學會
協辦：中華民國口腔植體醫學會
　　　台北市牙科植體醫學會 @ Dr. Perio present a post at academy meeting (Apr22~23,06)

"Sandwich" bone augmentation technique

2006-04-21T23:47:00.000+08:00

Int J Periodontics Restorative Dent. 2004 Jun;24(3):232-45.

"Sandwich" bone augmentation technique: rationale and report of pilot cases.
Wang HL, Misch C, Neiva RF.

The aim of this article is to present a new technique for augmentation of deficient alveolar ridges and/or correction of osseous defects around dental implants. Current knowledge regarding bone augmentation for treatment of osseous defects prior to and in combination with dental implant placement is critically appraised. The "sandwich" bone augmentation technique is demonstrated step by step. Five pilot cases with implant dehiscence defects averaging 10.5 mm were treated with the technique. At 6 months, the sites were uncovered, and complete defect fill was noted in all cases. Results from this pilot case study indicated that the sandwich bone augmentation technique appears to enhance the outcomes of bone augmentation by using the positive properties of each applied material (autograft, DFDBA, hydroxyapatite, and collagen membrane). Future clinical trials for comparison of this approach with other bone augmentation techniques and histologic evaluation of the outcomes are needed to validate these findings.

Mucogingival pouch flap for sandwich bone augmentation: technique and rationale.

2006-04-21T15:58:00.000+08:00

Implant Dent. 2005 Dec;14(4):349-54
Park SH, Wang HL

This article introduces a novel flap design, mucogingival pouch flap (MPF), to enhance the clinical outcome of sandwich bone augmentation. MPF uses a pouch flap reflection via mucogingival junction extension incisions to provide an improved graft retention, minimized membrane exposure, preserved papilla dimension, and soft tissue camouflage for improved esthetics.There are 4 implant-associated buccal dehiscence defects in 3 patients treated with sandwich bone augmentation technique in conjunction with MPF. All cases yielded an adequate new bone thickness of 1.5-3.5 mm as well as a height of 84% to 100% at 6 months. Rationales, indications, contraindications, advantages, and disadvantages for MPF designs are further discussed.

Immediate provisionalization after dental implantation

2006-04-20T21:09:00.000+08:00

@ Single tooth immediate provisional restoration of dental implants: technique and early results.
J Oral Maxillofac Surg. 2004 Sep;62(9):1131-8
Block M, Finger I, Castellon P, Lirettle D

PURPOSE: Patients desire efficient restoration of missing teeth. Immediate provisionalization of implants at the time of placement can provide the patient with a tooth-like restoration. Our hypothesis is that preoperative fabrication of the implant abutment and provisional restoration can provide successful immediate provisionalization of implants, if specific diagnostic criteria are used for patient selection.
PATIENTS AND METHODS: This hypothesis is evaluated by prospectively following 74 implants thus treated for 6 months to 2 years. A technique is presented to illustrate a simple and reliable method to provisionally restore a single tooth restoration. The method involves preoperative placement of an implant analog into a model, preparation of the abutment on the model, and fabrication of a provisional crown out of occlusion. At the time of surgery, the implant is placed according to the prescription of the restorative dentist, the surgeon places the abutment and provisional crown, and the final restoration is fabricated after the implant integrates.
RESULTS: Seventy of 74 (94.6%) restorations have been successful with up to 2-year follow-up, which is similar to single tooth implants treated using a 2-stage protocol.
CONCLUSIONS: Single tooth immediate provisionalization implants are effective techniques when specific diagnostic criteria are used.

@Single-tooth replacement in the aesthetic zone with immediate provisionalization: fourteen consecutive case reports.

Immediate dental implantation + Bio-Col socket augmentation

2006-04-19T19:32:00.000+08:00

Immediate Implantation in Fresh Extraction Sockets. A Controlled Clinical and Histological Study in Man

Dr. Michele Paolantonio et al.
Journal of Periodontology
2001, Vol. 72, No. 11, Pages 1560-1571

Background: Early implantation may preserve the alveolar anatomy, and the placement of a fixture in a fresh extraction socket helps to maintain the bony crest. Although a number of clinical studies exist, no histological reports show the outcome of implantation in fresh extraction sockets without the use of membranes in humans compared to implants placed in mature bone.

Methods: Forty-eight healthy patients, receiving at least 4 fixtures in each of 2 symmetrical quadrants, underwent placement of 1 experimental fixture placed in a fresh extraction socket (TI) and 1 contralateral fixture in mature bone (CI). TI were placed after atraumatical tooth extraction, with a surgical site at the apex of the socket and a tight contact between the fixture and the socket's walls, but without the use of filling materials or membranes. The flap was coronally repositioned to obtain primary wound closure. Immediately after surgical intervention, a standardized periapical radiograph was taken. Second-stage surgery was done after 6 months. Six months after the second surgery, a second standardized periapical radiograph was taken and clinical parameters (bleeding and plaque index) recorded. Marginal bone loss (MBL) from the time of implant placement to the time of fixture removal was calculated by comparing periapical radiographs. TI and CI were then removed by a hollow drill to obtain histological specimens. Non-demineralized sections were stained by acid fuchsin and toluidine blue, and by von Kossa to evaluate the degree of bone mineralization. The percentage of direct implant-bone contact (DBC) was calculated by a computerized microscopic digitizer.

Results: No significant differences in the clinical and radiographic parameters were observed between the 2 experimental categories. There was no statistically significant difference between TI and CI for DBC either in the maxilla or in the mandible. No connective or fibrous tissues were present around TI or CI. Bone resorption was not present in any of the histological sections.

Conclusions: The present study shows that when a screw-type dental implant is placed without the use of barrier membranes or other regenerative materials into a fresh extraction socket with a bone-to-implant gap of 2 mm or less, the clinical outcome and degree of osteointegration does not differ from implants placed in healed, mature bone. J Periodontol 2001;72:1560-1571

@ Clinical procedure for Immediate dental implantation after premolar tooth extraction + Socket augmentation with BioOss bone graft /Collage plug Bio-Col technique

Have the " biological width " around the dental implants?

2006-04-19T08:20:00.000+08:00

*An osseointegrated implant restoration may closely resemble a natural tooth.However, the absence of a periodontal ligament and connective tissue attachment via cementum, results in fundamental differences in the adaptation of the implant to occlusal forces, and the structure of the gingival cuff. @ The Outlines from Keynote speech by Dr. Berglundh on EAO05'
Topic:
What determines the biological width at implants?
Integrated esthetics – a biological and biomechanical approach

• Definition of “Biological width”
• Clinical soft tissue dimensions
• True soft tissue dimensions
• Soft tissue integration to different materials

Dimensions and relations of the dentoginigval junction in humans (1)
Sample:
Human autopsy specimens (Orban's and Kronfei's collections) exhibiting varying degree of periodontal tissue breakdown
Examination:
Histometric assessment of
Epithelial attachment
Connective tissue attachment

Dimensions and relations of the dentoginigval junction in humans (2)
Normal
Moderate breakdown
Advanced breakdown

Dimensions and relations of the dentoginigval junction in humans (3)
Results;
Epithelial attachment varied:
1.4 mm (normal)
0.8 mm (moderate breakdown)
0.7 mm (advanced breakdown)
CT attachment was stable:
1.1 mm
And did not vary with degree of bone loss

Dimensions and relations of the dentoginigval junction in humans (4)
Conclusion:
The biological width of soft tissue attachment is about 2.5 mm and includes 1.5 mm epithelium and 1 mm connective tissue.

Clinical soft tissue dimensions

Implant supported single tooth replacements compared to contra-lateral natural teeth.
Probing >>Chang et al 1999
Dimensions of peri-implant mucosa at evaluation of maxillary anterior single implant in man.
Bone sounding>>Kan 2003

The height of the mucosa at single implants and teeth
Implant Teeth
facial aspect
Probing: 3 mm 2 mm
Sounding: 4 mm 3 mm
proximal aspects
Probing: 4 mm 3 mm
Sounding: 5-6 mm 4 mm

The biological width: 2.5 mm (Gargiulo et al 1961)
PPD under estimates
Sounding over estimates
“Biological width” is not synonymous with Probing Pocket Depth or with Sounding

True soft tissue dimensions

The soft tissue barrier at implant and teeth (Berglundh et al 1991)

PM/GM~aJE= 2.14 / 2.05 mm
aJE~B= 1.66 / 1.12 mm
The mucosal at implants is comprised of a 2 mm long barrier epithelium and a 1-1.5 mm zone of “connective tissue integration”.
The “connective tissue integration” zone is characterized by absence of blood vessels and a large number of fibroblasts interposed between thin collagen fibers.

Dimensions of the periimplant mucosa (B & L 1996)
3 beagles dogs
3 months:
Flap adaptation and suturing
Test OE=2 mm
Control OE=4 mm
6 months:
Test
PM~aJE 2.0
aJE~B 1.3
Control
PM~aJE 2.1
aJE~B 1.8
A minimum width of the periimplant mucosa is required and bone resorption may take place to allow a proper mucosal attachment to form.

Morphogenesis of the mucosal attachment at implants (Berglundh et al 2006)
The soft tissue dimension – the biological width – at implant was established after 6 wks following Sx

How to preserve the marginal bone and avoid soft tissue recession ?
Respect the biological wwidth

Soft tissue integration to different abutment materials (Wennstom 2006)
Abutment shift (1 month after implant surgery)
Control abutment: Ti (c.p. Ti)
Test abutment: Direct (c.p. Ti)
Conclusions
The soft tissue dimensions were similar at implant abutment made of c.p. Titantium, ZrO2, based Ceramic and Au/Pt alloy
The connective tissue interface at Au/Pt alloy abutment contained lower amount of collagen and larger portions of leukocytes than that at abutment made of Ti and ZrO2

@ A review article of "teeth and implant" on BJD
@The effect of subcrestal placement of the polished surface of implants on marginal soft and hard tissues-a retrospective clinical study
*** On Line Internet Course: Biological Width by Dr. S. Robert Davidoff
@ Abstracts of Biological Width for Dental Implants
$$$ The biological aspects of the soft tissue – Titanium implant interface (PDF)

Retrograde peri-implantitis treatment

2006-04-17T22:10:00.000+08:00

The term retrograde peri-implantitis has just recently been introduced through several case reports. It is defined as a clinically symptomatic peri-apical lesion (diagnosed as a radiolucency) that develops shortly after implant insertion while the coronal portion of the implant achieves a normal bone to implant interface (for a review, see Quirynen et al. 2003). A retrograde peri-implantitis is often accompanied by symptoms of pain, tenderness, swelling, and/or the presence of a fistulous tract . It should be distinguished from a clinically asymptomatic, peri-apical radiolucency, which is usually caused by placing implants that are shorter than the drilled cavity or by a heat-induced aseptic bone necrosis. Retrograde peri-implantitis can result from bacterial contamination during insertion, premature loading leading to bone micro-fractures, or the presence of a pre-existing inflammation (bacteria, inflammatory cells, and/or remaining cells from a cyst, granuloma). A peri-apical lesion from a nearby devitalized tooth, on the other hand, can encroach upon the implant and contaminate it (e.g. reactivation of a dormant peri-apical lesion or removal of the peri-apical endodontic seal). The treatment of periapical peri-implantitis is still empiric. The longitudinal study, together with the outcome in some case reports, seem to indicate that the removal of all granulation tissue is sufficient to arrest the progression of the bone destruction. The removal of the apical part of the implant does not seem mandatory.

Clinically stable after 9.5 years!>>

Can Dental Implants Connect with Natural Teeth?

2006-04-14T14:41:00.000+08:00

The literature in the peer-reviewed journals seems divided on the question of connecting dental implants to natural teeth in fixed partial dentures. The problem encountered is the submersion of natural teeth producing a gap between the fixed partial denture crown margin and the prepared tooth. Some literature supports the position that dental implants and natural teeth should not be connected. Some literature supports the position that dental implants and natural teeth can be connected with rigid attachments (solid metal framework, solder joint) but not with non-rigid attachments (precision attachments).
>>>Rigid attachment with T-block>>

@Osseonews discussion for implant to natural tooth connecting

Implant to Natural Tooth Splinting
Doctors who use this philosophy will sometimes connect an implant to a natural tooth. The advantage of this is that by connecting implants to natural teeth, fewer implants are needed to complete the case. This can dramatically reduce the cost of treatment while allowing the patient to have permanent teeth. The disadvantage of this type of treatment is that should a problem arise with either the implant or natural tooth the problem has to be handled differently because the implants and natural teeth are connected. Furthermore, there are limited data regarding the effects of splinting implants to natural teeth. In this regard, it has been reported that intrusion of splinted teeth and pronounced vertical bone loss around implant abutments are potential sequelae;however, the majority of patients, , in one study suffered no adverse effects. Other reports have indicated that connecting implants to teeth in a fixed prosthesis has a good prognosis. A 5-year prospective study designed to compare bridges supported only by implants with bridges supported by both implants and natural teeth within the same patient, noted no higher risk of implant or prosthetic failure for tooth-implant fixed bridges as comparedwith implant-supported bridges.

@Post Implant-Tooth connection 6 years >>>>>

OsseoNews discussion about Implant - Tooth connection

>>> Somebody did the case with implant connecting natural tooth, let the canine intrusion.<<<

>>>Orthodontic extrusion/Crown lengthening procesure of #33 + Additional implant of #34>>>

Dental implants placement in conjunction with osteotome sinus floor elevation

2006-04-14T08:36:00.000+08:00

Dental implants placement in conjunction with osteotome sinus floor elevation: a 12-year life-table analysis from a prospective study on 588 ITI®implants

Authors: Ferrigno, Nicola1; Laureti, Mauro1; Fanali, Stefano1
Source: Clinical Oral Implants Research, Volume 17, Number 2, April 2006, pp. 194-205(12)
Publisher:Blackwell Publishing

The purpose of this prospective study was to evaluate the clinical success of placing ITI dental implants in the posterior maxilla using the osteotome technique. Material and methods:
All implants were placed following a one-stage protocol (elevating the sinus floor and placing the implant at the same time). Five hundred and eighty-eight implants were placed in 323 consecutive patients with a residual vertical height of bone under the sinus ranging from 6 to 9 mm. The mean observation follow-up period was 59.7 months (with a range of 12–144 months). This prospective study not only calculated the 12-year cumulative survival and success rates for 588 implants by life-table analysis but also the cumulative success rates for implant subgroups divided per implant length and the percentage of sinus membrane perforation were evaluated. Results:
The 12-year cumulative survival and success rates were 94.8% and 90.8%, respectively. The analysis of implant subgroups showed slightly more favourable cumulative success rates for 12 mm long implants (93.4%) compared with 10 and 8 mm long implants (90.5% and 88.9%, respectively). During the study period, only 13 perforations of the Schneiderian membrane were detected with a perforation rate of 2.2% (13 perforations/601 treated sites). Ten perforations out of 13 were caused during the first half of the study period and of these, seven were detected during the first 3 years of this prospective study.
Conclusion:
Based on the results and within the limits of the present study, it can be concluded that ITI implant placement in conjunction with osteotome sinus floor elevation represents a safe modality of treating the posterior maxilla in areas with reduced bone height subjacent to the sinus as survival and success rates were maintained above 90% for a mean observation period of ≈60 months. Shorter implants (8mm implants) did not significantly fail more than longer ones (10 and 12 mm implants): the differences were small compared with the number of events; hence, no statistical conclusion could be drawn. But, from the clinical point of view, the predictable use of short implants in conjunction with osteotome sinus floor elevation may reduce the indication for complex invasive procedures like sinus lift and bone grafting procedures .

A tooth can tell a long story

2006-04-04T22:47:00.000+08:00

1. GTR after endodontic failure with DFDBA + Gore-Tex nonresorbable membrane
2. Root fracture after crown insertion (7 years)

3. Immediate dental implantation after root extraction

4. Final restoration

How to prevent the nerve impinge during dental implantation?

2006-04-01T18:00:00.000+08:00

@Download from the Doe report
The inferior dental nerve is at risk of damage during removal of lower third molars, during apicectomy of lower premolar and molar teeth, the placement of intraoral implants and soft tissue surgery around the mental foramen, especially in the elderly where the mental nerve may lie at or close to the alveolar crest.
Intraoral implants, particularly mandibular endosseous implants are emerging as yet another cause of litigation resulting from iatrogenic nerve damage. Preoperative planning and imaging together with the careless siting of endosseous implants may damage the inferior alveolar nerve either within the mandibular canal or after its exit from the mental foramen. The prevalence of altered inferior alveolar nerve sensation following the placement of mandibular endosseous implants has been reported to be as high as 36% of which 23% of cases were transient and 13% of cases were persistent at 6 months or more post implant placement. Although uncommon, transient lingual nerve paraesthesia has also been reported where mandibular endosseous implants have perforated the lingual cortical plate. Inferior alveolar nerve repositioning to facilitate the placement of endosseous implants posterior to the mental foramen is associated with a very high incidence of temporary inferior alveolar nerve damage. In one series inferior alveolar neurosensory dysfunction was present in 70% of patients at 1 week before falling to 20% at 6months and 0% at 1 year postoperatively. However, the technique enables the placement of more and longer implants resulting in increased prosthesis strength and stability and has a lower permanent dysaesthesia rate than when a non-transposed nerve has been accidentally damaged by drilling or implant placement. If such a technique is to be used it is vital that the patient is fully informed about the possibilityof temporary and permanent inferior alveolar nerve paraesthesia.

#1. The surgeon should always be cognizant of the location of the mental foramen. The mental foramen lies on the same vertical line defined by the pupil, infraorbital foramen and the second bicuspid tooth.

@Morphometric Analysis of Implant-Related Anatomy in Caucasian Skulls
Journal of Periodontology
2004, Vol. 75, No. 8, Pages 1061-1067

Rodrigo F. Neiva et al.

The most common location of the MF (mental foramen) in relation to teeth was found to be below the apices of mandibular premolars. The mean MF-H was 3.47 ± 0.71 mm and the mean MF-W was 3.59 ± 0.8 mm. The mean distance from the MF to other anatomical landmarks were: MF-CEJ = 15.52 ± 2.37 mm, MF to the most apical portion of the lower cortex of the mandible = 12.0 ± 1.67 mm, MF to the midline = 27.61 ± 2.29 mm, and MF-MF = 55.23 ± 5.34 mm.

^^^88% cases .. anterior loop of mental bundle >4.13mm

#2. @Evaluation of the tracings for implants in panoramic radiographs before dental implaantation

***A Website special for Oral Nerve Injury

http://www.sciential.net/cgi-bin/dcforum/dcboard.cgi?az=post&forum=DCForumID9&om=113&omm=0

Listen!!! @A completely terrified statement of inferior alveolar nerve injury following a dental implant from a patient

@Commends from OsseoNews for a case about special pain after dental implant impinged the nerve

Localized ridge augmentation using titanium mesh

2006-03-31T21:27:00.000+08:00

A configured titanium mesh (CTM) is served as a mechanical and biologic device for restoring a vertically defected/resorbed alveolar ridge.

Vertical ridge augmentation using xenogenic material supported by a configured titanium mesh: clinicohistopathologic and histochemical study
Artzi Z, Dayan D, Alpern Y, Nemcovsky CE.
Int J Oral Maxillofac Implants, Vol. 18, No.3, pp:440-446,2003.

MATERIALS AND METHODS: The study comprised 10 severely resorbed sites in 10 patients. Pre- and post-operative ridge measurements were taken with reference to the neighboring teeth and supporting screw head base of the CTM. Bio-Oss® served as the augmentation filler material. The metal mesh was removed after 9 months. Subsequently, root-form, screw-type implants were placed. During the implant placement phase, cylindric bone samples were retrieved from the augmented area for histopathologic and histochemical examination.
RESULTS: Upon soft tissue reflection and before augmentation, defect height, as recorded by a periodontal probe along the main threads exposed on the support screw, was between 5 and 8 mm (average 6.4 mm; SD +/- 1.17). At 9 months after augmentation, during the implant placement phase, the defect height was between 0 and 2 mm (average 1.2 mm; SD +/- 0.63). Differences were statistically significant (P < .001). Bone height gain was between 4 and 6 mm (average 5.2 mm, SD +/- 0.79), which gave an average bone fill of 81.2% (SD +/- 7.98). Polarizing microscopic examination of sections stained with Picrosirius red showed a gradual increase in new lamellar bone from coronal to apical cuts, reaching the highest area percentage in the deep apical zone. DISCUSSION: At 9 months postaugmentation using the CTM surgical technique, the quality and quantity of the newly established hard tissue appeared to be different in the coronal versus apical areas of the restored alveolar ridge.
CONCLUSION: Although at 9 months postoperatively, the augmented alveolar ridge had different bone content, clinicohistochemical results demonstrated that this surgical technique could be a successful.

A Titanium Mesh is stabilized by screwing it onto one of the implants. Bone graft material is deposited under the Mesh and around the implants. The Mesh is then formed into the desired ridge shape and the gum tissue pulled over the entire site and sutured together. The Mesh will protect the graft from chewing forces while still allowing blood flow through the opening areas. Because the graft site will remain below the gum tissue during the initial growth period, it will also be protected from bacteria. The Mesh will remain under the gum tissue TEMPORARILY for approximately six weeks to a six months period while bone grows into the space under the Mesh.

Free Article>>>Three-Dimensional Bone Reconstruction in thePosterior Mandible Using DFDBA in a BiologicCarrier Matrix and Titanium Mesh

@@Clinical Application by Dr Perio

@Titanium Membranes in Prevention of Alveolar Collapse After Tooth Extraction. Implant Dentistry. 15(1):53-61, 2006. Pinho et al.

Background and Purpose: The resorption of alveolar bone following tooth extraction results in a narrowing and shortening of the residual ridge, which leads to esthetic and restorative problems, and reduces the bone volume available for implant therapy. The aim of this study was to evaluate the prevention of alveolar collapse after tooth extraction, using titanium membrane (Frios Boneshield; DENTSPLY Friadent, Mannheim, Germany), associated (or not) with autologous bone graft.
Materials and Methods: A total of 10 nonsmoking healthy subjects, ranging from 35 to 60 years old, were selected for this study. Each patient had a minimum of 2 uni-radicular periodontally hopeless teeth, which were scheduled for extraction. After the procedure, 2 titanium pins were fixed on the vestibular bone surfaces that were used as references for the initial measures (depth, width, and height) of the socket. Of the sockets,1 was randomly chosen to be filled with autologous bone graft (test) removed from superior maxillary tuber, and the other one did not receive the graft (control). A titanium membrane was adapted and fixed, covering the sockets, which remained for at least 10 weeks. After a 6-month healing, the final measures were performed.
Results: There was exposure of the membrane in 5 of the 10 treated subjects. Average bone filling (+/-standard deviation) among the 10 subjects was 8.80 +/- 2.93 mm (range 4-13) in the control group and 8.40 +/- 3.35 mm (range 4-13) in the test group. Average bone loss in width in both group was 1.40 +/- 1.97 mm (range -4-1) in the control group and 1.40 +/- 0.98 mm (range -4-0) in the test group. There was no significant statistical difference between groups considering the evaluated standards.
Conclusion: The use of titanium membrane, alone or in association with autogenous bone, favored the prevention of alveolar ridge after tooth extraction. This membrane seems to be a possible and safe alternative to other nonresorbable membranes when the prevention of alveolar ridge resorption is the objective.

@ Question from Dr. Perio

Is it necessary to put a resorbable membrane over the Titanium mesh + bone grafting for GBR before dental implantation? Comments...

Ridge spitting / expansion for dental implantation

2006-03-30T15:26:00.000+08:00

Ridge spitting / expansion for dental implantation:
tooth#14 extraction + tooth#13 ridge splitting and immediate dental implantation (Surgery by Dr. Perio)

>>>post Sx 10 days

@An article about ERE:
Clinical application of maxillary endossenous implant with edentulous ridge expansion technique

Huang Y, Ou Y, Song G.
Guangdong Provincial Stomatological Hospital, Guangzhou 510280, China

OBJECTIVE: To evaluate the application and the effect of edentulous ridge expansion(ERE) technique in maxillary endossenous implant placement. METHODS: 49 patients with maxillary alveolar ridge atrophy received edentulous ridge expansion using condenser. In order to be similar to natural root, dental implants were selected and placed to tooth missed sites according to the requirements of aesthetics, function and dimension. RESULTS: 49 patients with atrophied alveolar ridge received 86 implants. The labio-lingual width augmented from 3.3 to 5.4 mm and the alveolar ridge height from 2 to 7 mm 6 months after operation. The implants osseintergrated tightly with alveolar bone and second-step prosthesis was performed 6 months after implant placement. CONCLUSION: The edentulous ridge expansion technique can meet the requirements of aesthetics and function and is applicable to endossenous implant placement in maxilla. The method is simple and valuable to clinical application

Bio-Col Socket Preservation Technique

2006-03-24T18:53:00.000+08:00

SOCKET GRAFT is indicated when the clinician wants to preserve the maximum amount of bone after tooth extraction. SOCKET GRAFT is designed to retain the alveolar ridge and speed bone fill into the socket. However, SOCKET GRAFT will not rebuild any part of the ridge lost prior to placement of SOCKET GRAFT. If the clinician knows prior to extraction that a significant amount of alveolar ridge is missing and more ridge is needed for implant placement or for esthetics then a ridge augmentation procedure is indicated with the use of hard bone graft material and the placement of a barrier to retain the graft.
Ridge Preservation for Optimum Aesthetics and Function. The primary goal of any ridge preservation technique should be to preserve both the hard and soft tissues, especially the interdental papillae, in such a way as to optimize aesthetics and function. The Bio-Col Socket Preservation Technique with an understanding of these goals and biological considerations, the "Bio-Col" socket preservation technique was developed. The surgical protocol ensures the preservation of both hard and soft tissues at the time of tooth extraction, and it virtually eliminates the bone resorption that would normally follow tooth removal.

1. Top View: Bleeding Extraction Socket with No Defect. Tooth is extracted atraumatically without flap reflection. Note intact bony walls of extraction socket and preservation of surrounding gingival anatomy.
2. Top View: Grafted Extraction Socket in Preparation for Conventional Prosthesis. Socket with intact bony walls is grafted up to alveolar crest with Bio-Oss® natural bone mineral. CollaPlug®* absorbable dressing is placed over the Bio-Oss® graft and sutured in place with a horizontal matress suture.
3. Buccal View in Transparency: Bio-Col Technique for Conventional Prosthesis. Socket with intact bony walls is grafted up to alveolar crest with Bio-Oss® graft material. CollaPlug® absorbable dressing is placed over the Bio-Oss® graft and maintained with suture. A removable or fixed provisional restoration with an ovate pontic extending 3 mm to 4 mm subgingivally is placed, compressing the CollaPlug® and supporting the surrounding soft tissue.
4. Top View: Bio-Col Technique With Immediate Implant Placement. Immediate implant placed into intact bony socket. Bio-Oss® bone mineral grafted between implant and bony socket walls. Implant fixture and Bio-Oss® graft covered with CollaPlug® absorbable collagen dressing. Horizontal mattress suture placed to maintain position of collagen wound dressing.
5. Buccal view in Transparency: Bio-Col Technique With Immediate Implant Placement. Procedure same as step 4 with the following addition: Tooth borne provisional restoration with a modified ovate pontic to avoid pressure over cover screw. Ovate pontic extends subgingivally to support surrounding soft tissues.
6. Top View: Compromised Extraction Socket With Buccal Wall Defect. After extraction, socket presents with a large buccal wall bone defect. Note the partial soft-tissue collapse into the defect area.
7. Top View: Grafted Compromised Extraction Socket in Preparation for Delayed Implant Placement or Conventional Prosthesis. After tooth removal, Bio-Gide® resorbable collagen membrane placed in prepared subperiosteal pocket, covering bony socket wall defect. Bio-Oss® bone mineral placed into the socket and defect area. Note that Bio-Oss® slightly expands the adjacent Bio-Gide® membrane and overlying soft tissues. CollaPlug® absorbable dressing is placed over the Bio-Oss® graft and maintained with suture.
8. Buccal View in Transparency: Grafted Compromised Socket in Preparation for Delayed Implant Placement or Conventional Prosthesis. Note Bio-Gide® membrane covering buccal wall socket defect. Procedure same as step 7 with the following addition: Provisional restoration with ovate pontic extending 3 mm to 4 mm subgingivally against CollaPlug® dressing, supporting surrounding soft tissues.

Clinical Case Report by Perio(Nov.05'):

Apical /clinical checkup 3 months later<<

@Flapless approach for dental implantation after Bio-col ridge augmentation: (Surgery by Dr. Perio )

#Apicl check-up after dental inplantation (Mar06')

>>> 3 months later !

@ Socket Augmentation: Rationale and Technique by Dr. Wang

@Free Article of Bio-Col ridge preservation technique

Immediate dental implantation + Provisionalization

2006-03-22T09:19:00.000+08:00

Immediate Load Implant Criteria

To do an immediate load implant, certain criteria have to be met. There has to be adequate bone, a large enough implant needs to be placed, and the implant once placed has to be able to resist at least 40 ncm of force.The temporary crown has to be adjusted so that no forces are placed on it during function. Meeting these criteria allows the bone to grow around the implant (osseointegration). After a period of nine weeks a permanent crown can placed.The following picture sequence demonstrates an ideal situation for an immediate load implant or what I call a Vanity Crown because the patient refused to go out in public with a missing tooth. A template was made of the tooth prior to removing the fractured root so as to facilitate fabrication of a temporary crown. An important factor in this procedure is to carefully remove the tooth without removing any bone in the process [Atrumatic extraction- detail see another blog a + b].

Clinical procedures: (78 y/o male pt' , AMI twice - Surgery/Restorative procedures by Dr. Perio)

Preparation of Implant Socket
Socket Drilling
Precision Implant Placement
Abutment insertion
Temporary Crown
X ray confirm

@For a complete step-by-step guide, download the Restorative Guide PDF.

Immediate Restoration Technique (Download from Zimmer Dental Co;.)
In a case with a failing tooth, perform an atraumatic extraction. Prepare surgical site according to the drilling sequence. Place the implant and select the appropriate abutment. Prepare extraorally and seat on implant with hex tool. Fabricate provisional prosthesis chairside and check occlusion to confirm no occlusal contacts are present. Cement in place using temporary cement. After the healing period, record full-arch impression and fabricate final restoration.
Immediate Provisional Restoration Presurgical (248k) Last updated: July 1, 2002

Immediate Provisional Restoration (328k) Last updated: July 1, 2002

Interdental Papilla Recontruction

2006-03-12T20:42:00.000+08:00

Loss of the interproximal papilla may create phonetic problems or predispose to interproximal food entrapment and is esthetically displeasing. An interproximal contact point and an adequate level of bone support are essential for maintenance of a healthy papilla that completely fills the interproximal space. If certain vertical or horizontal interproximal dimensions are exceeded, the papilla may be either partially or totally lost. For example, with excessive horizontal spacing,a diastema can develop and the papilla will be lost; vertically,the likelihood that the papilla will fill the interproximalspace decreases as the alveolar crest to contact point distance increases beyond 5 mm. Surgical therapy to reconstruct the papilla is a promising area of development that is surgically challenging due to the small size of the interproximal site and the lack of blood supply. Regeneration of lost papilla height with periodic curettage has been reported in cases of necrotizing ulcerative gingivitis. Orthodontic therapy to establish or lengthen a contact is useful incertain situations. Surgical techniques that have been utilized to reconstruct a lost papilla include a modification of the roll technique; soft tissue grafting, sometimes accompanied by a semilunar coronally positioned flap; or a combination of hard tissue and soft tissue grafting. Adapted from J perio: Informational Paper Oral Reconstructive and Corrective Considerationsin Periodontal Therapy*
@Key Articles:
1.http://www.quintpub.com/userhome/prd/prd_24_1_Carnio_3.pdf
2.http://www.quintpub.com/userhome/prd/prd_24_3_Pini_Prato_5.pdf

***"Surgical reconstruction of interdental papilla using interposed subepithelial CT graft" clinical procedures : (Surgery by Dr. Perio)

Staged approach with Localized ridge augmenation + Dental implantation

2006-03-10T19:22:00.000+08:00

Dental implants are established alternatives for replacing missing teeth. Tooth loss for different reasons may leads to alveolar resorption. Shortage of bone can prevent proper positioning of dental implants according to prosthetic needs and treatment planning, unless the volume of hard and soft tissues is increased before implantation. In the esthetic area it is essential not only to achieve well anchored implants but also sufficient soft and hard tissue in order to obtain natural looking result. This case report (detail see down ppt.) will present the treatment modalities to augment the soft and hard tissues in order to obtain proper insertion of implants according to prosthetic needs and patient satisfaction.

Related articles:
1. Alveolar distraction osteogenesis vs. vertical guided bone regeneration
2. Absorbable versus nonabsorbable membranes
Key Article:
Optimizing Esthetics for Implant Restorations

Periowave : A New Treatment for Periodontal Disease

2006-03-08T08:35:00.000+08:00

Ondine´s proprietary treatment, Periowave uses a novel non-antibiotic approach for treating the underlying infection responsible for periodontal disease. After routine scaling, the dentist will apply the compound directly into the periodontal pockets and around the gum line of affected teeth. The compound quickly penetrates the plaque preferentially binding to multiple structural components in bacteria, including their toxic secretions. Laser light is then applied directly to the affected sites using a fibre optic probe. A powerful free-radical reaction destroys the targeted bacteria and the associated toxins such as collagenase. More.....

Immediate implants after extraction

2006-03-03T20:02:00.000+08:00

One of the advantages of immediate implantation is that post-extraction alveolar process resorption is reduced , thus affording improved functional and esthetic results .
Another advantage is represented by a shortening in treatment time, since with immediate placement it is not necessary to wait 6-9months for healing and bone neoformation of the socket bed to takeplace. Patient acceptance of this advantage is good , and psychological stress is avoided by suppressing the need for repeat surgery for implantation .
Preservation of the vestibular cortical component allows precise implant placement, improves the prosthetic emergence profile, and more over preserves the morphology of the peri-implant soft tissues- thereby affording improved esthetic-prostheticperformance.

>>> Provisional prostheses insertion

waiting final prostheses.>>>

Final restoration<<

Dr Buser's Commends for Immediate Implantation after Tooth Extraction:
(+Advantage /- Disadvantage)
+ Shorter treatment time
+ No bone resorption prior to implant placement
- Implant bed preparation is more difficult
- Bone augmentation procedure is needed
- Primary soft tissue closure is difficult to obtain
- Problematic in infected sites

*The articles of "Immediate Implantation in Fresh Extraction Sockets "

Immediate Loading Protocols ( Dr. Balshi on OsseoNews Blog's Interview ) Part I~IV

2006-02-28T12:26:00.000+08:00

Dr. Thomas Balshi and Dr. Glenn Wolfinger have established The Institute for Facial Esthetics in Fort Washington, Pennsylvania. They are Diplomates of the American Board of Prosthodontics and also place all their implants. They have developed surgical and prosthetic protocols for the Teeth-in-an-Hour and Teeth-in-a-Day paradigms. Their web site is: http://dentalimplants-usa.com/. Dr. Balshi has taken time out of his busy schedule to grant an interview to Osseonews.com.
Interview conducted by Gary J. Kaplowitz, DDS, MA, MEd, ABGD
Comment on this interview by visiting the OsseoNews Blog

OsseoNews (ON): Could you present an overview of the immediate loading protocols that you and Dr. Wolfinger have developed and are utilizing at the Institute of Facial Esthetics.
Dr. Balshi: There are several basic concepts that distinguish our protocols from the traditional approach to implant placement and restoration. In the first place, we utilize an immediate loading approach where we place the implants and subject them to loading on the day of surgery. This is our standard operating procedure in contradiction to the traditional placement followed by a waiting period where the implant fixture is undisturbed and undergoes osseointegration. We have been collecting data over two decades and have firmly established that our protocol produces a very high rate of success over the long term.
ON: Could you explain how you have encorporated computer software into your protocols.
Dr. Balshi: We make a CT scan of the patient to generate a three dimensional virtual replication of the bone, soft tissue and alignment of teeth. We feed this data into our software program to generate a surgical guide, which selects the most advantageous implant sites and angulations. The surgical guide will have three guide pins, which will securely stabilize the guide stent during the drilling and placement of the implants. The stent will first be used as a guide to drill a hole for each of the guide pins. The guide pins will then be inserted through the stent and into the bone. The advantage of this technique is that the drilling and placement of the implants is very precise and accurate. The implants end up exactly where you want them, at the desired angulation and the desired occlusogingival height.
ON: How do you generate the prosthesis?
Dr. Balshi: The prosthesis is generated by the software program based on the data from bone, soft tissue and alignment of teeth. We do a CT scan of the patient at the proper vertical dimension of occlusion in centric relation position.
ON: What if the patient is already wearing removable partial dentures or complete dentures?
Dr. Balshi: We scan the patient wearing the removable dentures. We do a second scan of the removable dentures alone. All of this information that we collect enables our software program to generate a fixed-detachable partial or complete denture that will fit the abutments torqued into the implant fixtures.
ON: The permanent abutments then are also torqued down at the time of implant placement?
Dr. Balshi: The permanent abutments are torqued down permanently at the time of implant placement. They are not removed after they have been torqued down. The final form and orientation of the abutments is established at the time of implant placement.
ON: The CT scan and software program provide accurate enough data to produce a prosthesis that precisely fits the abutments?
Dr. Balshi: The prosthesis fits the abutments with great precision. The prosthesis is then inserted with screw retention.

Log back onto osseonews.com next week for Part II of our interview with Dr. Balshi.
Comment on this interview by visiting the OsseoNews Blog Case present by Perio: Immediate loading with provisional restoration after Molar implant insertion@

Dr. Thomas Balshi on Immediate Loading Protocols :Part II>>>
Determining Primary Stability :Part III of IV

Staged Approach with Ridge preservation / augmentation + Esthetic dental implantation

2006-02-22T10:49:00.000+08:00

How can a ridge be preserved when the tooth it contains an advanced periodontal disease?

Nemcovsky CE, Serfaty V. Alveolar Ridge Preservation Following Extraction of Maxillary Anterior Teeth. Report on 23 Consecutive Cases. J. Periodontol. 1996; 67(4):390-395.

Commentary: There is no doubt that post-extraction bone loss is a serious problem for periodontally involved teeth. However, the use of hydroxyapatite to augment ridges and repair periodontal defects has been received with mixed reviews in the periodontal community. Some clinicians swear by it and others refuse to use it. One of the major criticisms has been its motility and migrative tendencies when not placed properly. The authors in this case report suggest that the deeper flap secures the HA in place to reduce migration. According to these investigators, packing the alveolus with HA may indeed preserve alveolar bone; but the limitation of not being able to place implants in sites treated so, make it an irreversible process. Clinicians need to consider where a patient is going to be long term and other author have suggested the use of guided tissue regeneration as ridge maintenance procedure. Hence, it is critical to understand where a patient wants to go with treatment. If finances are a concern, they may not always be. The practitioner must then consider which service is really best for the long-term prognosis of the patient. A maintained ridge is great but not if it requires a future corrective procedure for patients who may have other options available to them in the future. Nonetheless, this preservation option may be well suited to many patients.

**A clinical case of long-term root resorption, ridge preservation with GBR technique and esthetic dental implantation and restoration later! --- Surgery and Prosthetic reconstruction by Dr. Perio

* R't piture is pre-extraction ; L't picture is final restoration (total 1 year!)

#Apical Xray checkup: (pre-extraction;post-augmentation;implantation & final restoration!)

@ Ti Mesh application in GBR: More....
@ Implant esthetic with all-ceramic crown-Cercon: More...

The Mini-Screw as an Orthodontic Anchoring

2006-02-17T09:56:00.000+08:00

The use of osseointegrated implants and mini implants has become a valid alternative to those methods normally employed to manage anchorage in modern orthodontics. Most clinical procedures aimed at providing adequate anchorage require patient co-operation, some degree of discomfort as well as prolonged chair time for the orthodontist. Over the last few years though, a great deal of experience has been gained regarding the use of Mini Implants to obtain bone anchorage and this particular therapeutic optionhas proved to be extremely reliable and stable. In recent times, osseointegrated dental implants have been used for orthodontic anchorage; these however have turned out to present the Orthodontist with some disadvantages:the difficulty of choosing the right implant positioning in individual patients, the necessity of waiting for osseointegration to occur before any force can succesfully be applied, an extremely invasive removal procedure and, last but not least,excessive costs involved. The Mini Screw Implants we use are made of surgical grade stainless steel, therefore they do not require osseointegration to be able to perform. They allow immediate loading and it is extremely easy to remove them. We do however recommend that the Orthodontist allows approximately 2weeks for the soft tissues to heal before any forces areapplied. Mini Implants of reduced diameter are available for insertion in any desired point, including inter-radicular spaces. The main indications for the use of Mini Implants are: 1 – Intra-arch extrusion in the anterior sections; 2 – Intra-arch intrusion in the posterior sections; 3 – Surgical disinclusions; 4 – Orthodontic anchorage after extractions; 5 – Orthodontic anchorage to support distalization

Free PDF Articles about orthodontic mini screw:

1.A Radiographic Evaluation of the Availability of Bone for Placement of Miniscrews

2.Lever-arm and Mini-implant System for Anterior Torque Control during Retraction in Lingual Orthodontic Treatment

3.Group Distal Movement of Teeth Using Microscrew Implant Anchorage

4.Maxillary Molar Intrusion with Fixed Appliances and Mini-implant Anchorage Studied in Three Dimensions

5.Intrusion of the Overerupted Upper Left First and Second Molars by Mini-implants with Partial-Fixed Orthodontic Appliances: A Case Report

@Discussion from Osseonews blog

Atraumatic Extraction with Periotome before Dental Implantation

2006-02-14T09:48:00.000+08:00

Eliminate the fibrous attachment thru cutting rather than tearing! The NEW Osseous Technologies of America (OTA) Periotomes offer a completely new approach to Atraumatic exodontia.

For Atraumatic Extractions!
Minimizes Damage to Alveolar Bone
Thick and Thin Flat Blad and Angled Blade
For Root Tips and For Wedding Interproximal Spaces
One-Piece Construction Allows Apical Tapping with a Mallet

A tooth removal that does not comprimise the extraction site is the ideal
precondition for a predictable immediate implant placement and a successful nonloaded temporization. Various forms (especally with the Periotome =3 changeable inserts)of atraumatic tooth removal are used, depending on the specific clinical case.

Dr. Becker's Methods for Atraumatic Extraction(Taiwan's Lecture,2005):

Sever PDL with blade
Hu fridy Molt CM2 curette
Thin pointed diamond bur
Forceps rotating
Be Patient

**Ridge Dimension Changes after tooth extraction

Araujo and Lindhe' studies series (2003~2005)

"Platform Switch" To Preserve Crestal Bone-A new concept in Dental Impant

2006-02-03T13:20:00.000+08:00

Implant neck (crest module) :The highest bone stresses have been reported to be concentrated in the cortical bone in the region of the implant neck as demonstrated in Finite Element Analysis (FEA) of loaded implants with or without superstructure. This is consistent with findings from experimentsand clinical studies that demonstrated that bone loss begins around the implant neck. It has been suggested that the implant neck should be smooth/ polished, supporting the belief that the crest module should not be designed for load bearing. However, significant loss of crestal bone has been reported for implants with 3 mm long smooth polished necks. Following the placement of an endosseous implant,there is an initial bone modeling/ remodeling during healingand the establishment of a biological seal around the neck of the implant. This bone modeling for biologic seal is acombination of a 1.0-1.5 mm junctional epithelium and a 1.5-2.0 mm connective tissue region that is established superior to the alveolar crest. Evidence from in vivo studies supports the observation of establishment of a biologic seal. Hammerle et al did not observe crestal bone to be maintained above the junction of the Titanium Plasma-sprayed Surface (TPS) and machined neck with ITI implant system,and they concluded that polished implant collars do not integrate, as Buser et al demonstrated in his mini-pigmodel. Similarly, bone modeling occurs to the level where the porous surface begins, with the Endopore implants. Disuse atrophy, due to sub-normal mechanical stimulation, has been speculated to be an etiologic factor for this marginal bone resorption. It appears that when the implant heads have been placed at the crest of the alveolar bone cortical bone will change in the process of establishing a biologic width, and that this modeling/ remodeling behavior typically occurs to the level where the screw threads start and/ or the roughened surface topography begins. Implant design should therefore take into consideration the bone remodeling in establishingthe biological width. The use of a roughened crest module that is level with the crest of the bone may providea positive stress stimulus to the bone and decrease bone loss in this area, while the smooth part of the crestal module, above the level of crestal bone, should provide an area for connective and epithelial tissue contact. (Adapted from a review article from U Michigan Dr. Wang)

The concept was found accidentally !

The Only Way To Provide For Your Patients Is To Adapt.

With the increasing demands for implant therapy, the Provide™ Restorative System offers both surgical and restorative clinicians more options and greater flexibilityto meet these demands and better serve patients. Provide Abutments give implant surgeons four collar height options for unmatched surgical flexibility. In addition, because the implant is placed at bone level and not transgingivally, the final crown margin is not pre-determined at the time of surgery and there is no need to prepare the implant if or when the tissue recedes.

Certain™QuickSeat™Connection
Snap-Fit Impression Components
Superior Surgical And Restorative Flexibility

Surgical Flexibility
1.No Need To Determine Final Crown MarginAt The Time Of Surgery
2.Multiple Collar Heights (1, 2, 3 and 4mm)
3. No Need To Prepare Implant Due To Tissue Recession
4.Use In A One- Or Two-Stage Surgical Protocol
5.Opportunity To Platform Switch To Preserve Crestal Bone
6.Ability To Change Abutment At A Later Date

The Prevailing Biologic Width Hypothesis:

>>>Another system for "Paltform Switch" concept: Astra
The system is based on three core features: Conical Seal Design™ abutment connection, the original MicroThread™ implant neck and the unique OsseoSpeed™ surface

Sky-Implant-System

2006-01-22T22:14:00.000+08:00

An implant system which fulfills all essential requirements on modern dental implantology in a perfect way. Treatment time and costs can be reducedconsiderably thanks to the simple system concept and the maximum reliability. The Sky-Implant system was developed by practitioners and has been used by experienced implantologists and beginners for two years. More than 15,000 Sky implants have been successfully integrated since 2002. The advantages of the Sky-Implant system at a glance -Optimization of the primary stability-One abutment diameter for all implant diameters-Reduction of the implant accessories-Torx as inner connection-Simpler preparation of the implant bed with the SIS drill set-Funnel-shaped depression at the inner connection-Rounded implant apex-Transfer axis = transfer abutment-Gingiva former = bar segment -Titanium grade 4 kv (cold formed)-Modular system
Product Survey (pdf)
Presentation of the system (pdf)
article: The implant as a tap (pdf)
article: The special benefits of the SKY-Implant system from the prosthetic view (pdf)
article: Immediate loading of implants (pdf)
article: immediate implantation and immediate loading (pdf)

**Sinus Implant Stabilizer (designed by Dr. Manfred Lang; a special lecture in Taiwan)

Using the SIS-Sinus Implant Stabilizer one step sinus lift is possible. The implants are stabilized by the SIS and drifting into the sinus is prevented. Additionally the SIS can be fixed with Mondeal microscrews of the ARC System

(A sinus dental implant assembly stabilizer comprising (a) an elongated implant having an internal recess at one end, (b) an insert removably fitting into said recess, and having a head projecting laterally beyond said recess, (c) a washer capable of being removably held in fixed position by said implant and insert, and (d) a nut having an opening to fit over said implant of a size and internal configuration so as to be held in position on said implant, said nut holding said nut securely when said implant is being inserted into said nut.)
ARCS System: The Mondeal Alveolar Crest Reconstruction System; ARCS has been designed and developed to meet with the requirements of modern dental implantology.

Vol. 2 No. 2 Pos. 42

Development and properties of resorbable implant stabilizer concerning sinus lift operation
Author(s): Alfred Johannes Patyk1*, Alberto Nadalini2, Oliver Duesmann3, Hans-Albert Merten41Dept. of Prosthetic Dentistry I3Dept. Orthodontics4Dept. of Oral and Maxillofacial Surgery, University Goettingen2Dentist, Trento, Italia

Abstract: To obtain a sufficient primary stability of implants in the lateral maxillary area, a bone thickness of minimum 4 mm is necessary, but often additional osteoplastic operations are required. Regarding this, several sinus lift techniques are known. In this case, the use of an implant stabilizer made of resorbable synthetic material reduces the operation invasivity. For this purpose, a polylactate implant stabilizer with appropiate shape and function has been developed. The following material’s characteristics, such as the material’s hydrolysis, the reduction of the molecular weight and the mechanical retention on the implant have been analysed in vitro. Hydrolysis has been performed following ISO/TC 150 SC 1 standard, and its effects have been documented by SEM images and illustrated with degradation curves. The mechanical properties are defined by the stabilizer’s traction forces in the direction of the implant shaft. Before hydrolysis, the median traction force is 118 [N], one month after, it is reduced to 94 [N] and three months after hydrolysis, the complete absence of any retention force is achieved. The stabilizer has been inserted in the subperiostal tissue of a Goettingen mini pig‘s frontal bone. Four months later, the material has been removed. The presented histological preparation shows the osteo-inductive properties of the stabilizer.

@ASIS-The Autologous Sinus Implant Stabilizer
In cases of sinus lifts with an extremely low height of residual local bone the primary stability of the implants is achieved through a cortico-cancellous bone block graft (ASIS) from the mandibular angle instead of a manufactured splint (SIS ®). This produces both vertical and/or lateral augmentation of atrophied alveolar process at the same time

Astra® Dental Implant System

2006-01-22T17:13:00.000+08:00

The Astra Tech implant system is developed with a biological and biomechanical approach. It is a well-documented simple and reliable system of minimum components and maximum flexibility:

1.One system for all indications
2.Developed for both one-stage and two-stage surgery
3.Designed for immediate or early loading
The system is based on three core features: Conical Seal Design™ abutment connection, the original MicroThread™ implant neck and the unique OsseoSpeed™ surface.

PostImplant 1 mo>>>>
@Final restoration :

OsseoSpeed™ is a well-documented, fluoride-modified fixture surface that speeds up the bone healing process. The result is more bone in less time. Despite the proven success of our highly effective TiOblast™ surface, we started to ask ourselves if rough really is enough? What if we could develop a surface that actually speeds up the bone healing process? The result is OsseoSpeed – an innovative, biologically-based bone trigger, perfect for all your dental implant patients.
MicroThread™–a dynamic mechanical coupling
A thorough understanding of bone physiology is vital to optimal implant design. Bone tissue is designed to carry loads. To retain bone, dental implants must be designed to mechanically stimulate the surrounding bone. What’s more, the most critical part of the implant-bone interface is located at the marginal cortical bone where the peak stresses arise. This is why the neck of the fixture is designed with MicroThread™ – very minute threads that offer optimal load distribution and lower stress values.
Conical Seal Design™ –strong and stable fit
The tight and precise-fitting implant-abutment relation of the Conical Seal Design™ makes abutment connection a quick and simple procedure. The abutment is self-guiding and the installation procedure is non-traumatic, eliminating the risk of damage to the bone. Compared to a flat-to-flat design that creates high stress concentration at the bone margin, the Conical Seal Design transfers the load deeper down in the bone–reducing peak stresses. The Conical Seal Design also seals off the interior of the fixture from the surrounding tissues. It minimizes micro-movements and micro-leakage. This simplifies maintenance and ensures reliability in all clinical situations.

@@Immediate Dental Implantation with 4.5ST

** Direct Abutment Impression>>

Wide-Diameter Dental Implant

2006-01-19T23:30:00.000+08:00

Wide Diameter (WD) Dental Implants:Used on 5.0, 5.5 and 6.0mm implants.WD implant implements a balanced design approach to achieve the best overall performance in compressive occlusal forces, off-axis occlusal forces, and torsional forces applied during implant placement. The WD external hex provides 79% more surface area than the standard hex size for unparalleled strength in implant seating. It is designed to reduce deformation or stripping of the hex during implant placement.The WD implant connection offers surgical and restorative advantages including increased prosthetic stability and provides more surface area for torsional strength.Corresponding WD prosthetic components offer the advantage of a larger table for increased prosthetic stability, as well as a larger abutment screw to virtually eliminate screw fracture and resist loosening. 2.5mm abutment screw provides 65% more strength over the standard 2.0mm screw for additional resistance to off-axis loads and improved torque retention. 1mm tall hex provides 43% more height over the standard hex for additional prosthetic stability, which is particularly important for single tooth applications. The WD implant enables bilateral cortical bone engagement in wide ranges, especially in posterior regions.

>>> 2 years later!

>>>above photo:A Flapless Appraoch with Lifecore® 4.8 WDS (photoright by Dr. Perio)
@ Another case:

Hints>>Implant size: Selecting the proper implant size in relation to the size of the missing tooth is a valid rule. In other words, the more the similarity between the diameter of the implant and the diameter of the missing tooth at the bony crest, the greater the esthetic outcome.

Int J Periodontics Restorative Dent. 2001 Apr;21(2):149-59.
Wide-diameter implants: new concepts.
Davarpanah M, Martinez H, Kebir M, Etienne D, Tecucianu JF.
Department of Periodontology, Pitie Salpetriere Hospital, Paris, France.

At the end of the 1980s, it was suggested that wide-diameter implants be used to better the prognosis in cases in which the condition of the supporting bone is unfavorable. Technical improvements associated with different shapes and materials used for implants have led to an evolution of our concepts of surgical and prosthetic treatments. The aim of these new suggestions is to optimize the functional and esthetic result while respecting the fundamental principles of osseointegration. Up to the present time, very few studies have been published on wide-diameter implants. However, the short- and medium-term results that have been reported have been very satisfactory.

Current Topics in Dentistry
What are the clinical limitations of wide-diameter (4 mm or greater) root-form endosseous implants?

Compend Contin Educ Dent. 1997 Jul;18(7):687-92, 694; quiz 696.
Biomechanical advantages of wide-diameter implants.
Jarvis WC.

In implant cases in which bone quantity and interdental space are sufficient, wide-diameter implants may be preferable to standard-size implants in restoring the partially edentulous patient. Although wide-diameter implants are often considered for their esthetic possibilities, they can also offer important biomechanical advantages, particularly in reducing the magnitude of stress delivered to various parts of the implant and in improving stability. In this article, standard 3.7-mm- and wide 4.7-mm-diameter implants are compared and discussed.

A Successful Strategy for the Efficient, Consistent and Profitable Restoration of Dental Implants

2006-01-17T09:59:00.000+08:00

Free online CE course from Dentaltown

This electronically delivered self-instructional program is free-of-charge and qualifies for 2 AGD PACE CE credits (Course Code: 692) and 1 ADA CERP CE credit. This program will be available until 11/10/2007.

Synopsis:This course will allow the restorative dentist to systematically plan for, sequence and treat patients with dental implants. Multiple sequencing protocols will be discussed that will allow both the patient and the doctor to save time and effort and yet still obtain a clinically superior result. Techniques and technology will be introduced that will allow the restorative dentist to develop a protocol for dental implant restoration that will allow him/her to restore any dental implant that comes in their office, the same way, every time.

Description of Speaker:Dr. Mark W. Adams is a recognized authority on prosthodontics and practice management as applied to the restorative practice. His dynamic teaching style makes him a favorite of audiences everywhere he goes. He is the Co-developer of Zimmer Dental successful Peer Practicum and Continuum Implant Training Programs, a former Faculty Alumni Speaker with the Pride Institute and a former Clinical Assistant Professor in Graduate Prosthodontics at the University of Michigan. Dr. Adams is a 1985 Graduate of the University of Michigan Graduate Prosthodontics Program and maintains a private practice, limited to Implant, Esthetic and Reconstructive Dentistry in Flint and Clarkston, Michigan. He is President of ddsSolutions, a dental services company dedicated to helping dentists build the practices of their dreams.

Educational Objectives:Upon completion of this course, participants should be able to achieve the following:
1. Present a system of effective, predictable and profitable dental implant restoration.
2. Describe the use of new technology and techniques in order to obtain outstanding clinical results.
3. Develop a rationale for reasonable dental implant fees.
4. Introduce protocols for implant restoration for a multitude of clinical situations (Traditional Protocol, Accelerated Protocol, Immediate Protocol)
5. Become comfortable restoring any implant that comes into your office, irregardless of the manufacturer, the same way, every time.

>>Another Free online course: Simplified Single Tooth Implants for General Dentists

Educational Objectives:Upon completion of this course, participants should be able to achieve the following:
1. Understand the role of the general dentist in implant placement
2. Evaluate whether or not incorporating implants into his/her practice is appropriate
3. Be familiar with a flapless surgical procedure
4. Estimate the cost of getting started with placing implants
5. Know where to go for additional training

Buser Periosteal Elevator

2006-01-14T21:03:00.000+08:00

Spear and paddle-shaped ends are ideal for delicate tissue retraction. The spear-shaped end is used to initiate the flap by reflection of the papilla in a sulcular incision. The small, paddle-shaped end is used to continue the flap reflection apically.

Mini Dental Implants - Treatment Alternative

2006-01-14T12:34:00.000+08:00

Denture Stabilization - Mini-Implants

A lucky few feel comfortable when they wear their dentures. Every other denture wearer is left to contend with slippage, wobbling, discomfort and in many cases, pain.This is because without teeth, the underlying bone deteriorates and the denture no longer fits. The lips are working so hard to keep the denture in place, a natural smile doesn't come naturally at all.A technological break-through now available with some dental practices is denture stabilization also known as Single Day Implants. The procedure stabilizes the existing lower denture by anchoring it into place using mini dental implants or MDIs.The entire proceedure can be completed in a matter of hours... with results that can be quite stunning. Patients can hardly believe the improvement in their abilities to eat, speak, laugh and smile. (Download from Dental Health Directory Library )

What Are Mini Dental Implants?

The MDI System consists of a miniature titanium implant that acts like the root of your tooth and a retaining fixture that is incorporated into the base of your denture, The head of the implant is shaped like a ball and the retaining fixture acts like a socket that contains a rubber O-ring. The O-ring snaps over the ball when the denture is seated and holds the denture at a predetermined leve of force. When seated, the denture gently rests on the gum tissue. The implant fixtures allow for micro-mobility while withstanding natural lifting forces. Late in l997, Dr. Sendax collaborated about his mini implant theory and design concepts with a colleague, Dr. Ronald A. Bulard. Dr. Bulard had previously formed a dental implant company, IMTEC Corporation, which was at the time manufacturing and marketing standard sized dental implants, abutments, and other dental products. Convinced they were on to something special, the two implantologists spent countless hours studying and refining Dr. Sendax's original creative design, resulting in a more efficient top and collar to the mini dental implants. Combining this now re-designed mini implant with Dr. Sendax's original insertion protocol resulted in a successful breakthrough. Under Dr. Bulard's direction, IMTEC Corporation began the rather complex and expensive design and manufacturing procedures which ultimately resulted in what is now offered to the dental community under the brand name IMTEC Sendax M D I (mini dental implant). The innovative system and procedure was thereafter formally introduced to the United States dental community at an implant conference in Orlando, Florida in April, l999. It was an instant success and now represents one of the fastest growing segments of the dental product industry. (Download from IMTEC Co.)

@ Clinical Application on Lower Anterior Region: (Surgery by Dr.Perio)

@ Clinical and radiographic evaluation of small-diameter (3.3-mm) implants followed for 1–7 years: a longitudinal study

First Recombinant Growth Factor Approved by FDA for Use in Periodontal Applications

2006-01-11T12:38:00.000+08:00

Source: Osteohealth Company, www.osteohealth.com

Osteohealth Company announced that GEM 21S® (Growth-factor Enhanced Matrix) has been approved by the U.S. Food and Drug Administration (FDA). GEM 21S® is a fully synthetic regeneration system for the treatment of periodontal bone defects and associated gingival recession. GEM 21S® is composed of the tissue growth factor, recombinant human Platelet-Derived Growth Factor (rhPDGF-BB), and a synthetic bone matrix, Beta-tricalcium phosphate (ß-TCP). It is the first totally synthetic product combining a purified recombinant growth factor with a synthetic bone matrix to be approved by the FDA for human application. The combination of the two components of GEM 21S ® are key to the overall effectiveness of the product. The rhPDGF-BB provides the biological stimulus for tissue repair by stimulating the proliferation and in-growth of osteoblasts, cells responsible for the formation of bone, while the ß-TCP provides the framework or scaffold for new bone growth to occur. In recognition of the unique treatment modality provided by GEM 21S®, the FDA has established it as a first-in-class product in its treatment category.

GEM 21S® Clinical Trial Results
FDA approval of GEM 21S® was based on results from a pivotal 180 patient double-blind, randomized, controlled multicenter, pivotal clinical trial involving subjects who required surgical intervention to treat periodontal bone defects. Patients were studied for six months following implantation of the product.
The study assessed both clinical attachment and bone regeneration, which was determined radiographically. The results of the study demonstrated that treatment with GEM 21S® (Growth-factor Enhanced Matrix) led to statistically significant benefits in bone growth and accelerated tissue attachment level gain compared to the control group that received the ß-TCP plus buffer, without the addition of the growth factor. Additionally, the study revealed no evidence of either local or systemic adverse effects resulting directly from placement of GEM 21S®.

ITI Dental Implant System - One system fit all

2006-01-10T16:03:00.000+08:00

One system – three implant lines.
The Straumann Dental Implant System offers the user a clear number of implant lines for the successful treatment of all surgical indications in oral implantology.
Depending on the oral situation and selected surgical procedure, the following three implant lines of the Straumann Dental Implant System are available:
The Standard Implant:The pioneer in one-stage or transgingival healing and the proven classic from Straumann, mainly indicated for the posterior region.
The Standard Plus Implant:The flexible solution for trans-, semi- or subgingival implant placement in the esthetic region.
The Tapered Effect Implant:The specialist for immediate and early implantation in extraction alveoli.
All three implant types are fully compatible with the prosthetic systems of the Straumann Dental Implant System and offer the restorative doctor the greatest possible freedom of choice.
Three prosthetic diameters are available:
Narrow Neck:Implants with the 3.5 mm Narrow Neck (NN) restorative platform (Standard Plus Implant with a built-in octa abutment with external connection, for single-tooth restorations).
Regular Neck:Implants with the 4.8 mm Regular Neck (RN), restorative platform.
Wide Neck:Implants with the 6.5 mm Wide Neck (WN), restorative platform.

A dental implant system breaks Crown/Root Ratio- Endopore (Innova)

2006-01-07T16:23:00.000+08:00

The Endopore implant system is a new dental implant system that is distinctly different from other implant systems presently available. Its unique design allows for ease of placement, use of shorter implants, three-dimensional ingrowth of bone (and thus greater resistance to torque), and a faster healing period. Its truncated-conical design allows for better distribution of stress and more leeway for error when it is placed adjacent to vital structures or in narrow regions of bone. The prosthetic components have been deliberately designed to be simple and cost-effective, yet provide all the variety that is required to restore any clinical situation. For an overdenture, the unique abutment and prosthetic technique allows for a cost-effective method of providing stability to an existing or newly-fabricated full denture. For fixed prosthetics, the prosthetic components have been designed to allow the use of straight-forward crown and bridge techniques, with a minimal number of additional laboratory parts or costs required to restore the case. Furthermore, a full arch can be restored with a screw-retained
fixed / retrievable restoration, using the new UMA abutments. The surgical and prosthetic techniques required by the Endopore system are simple and inexpensive, and could be managed by a general dentist with a good knowledge of sterile surgical technique. Multicentre trials by private practitioners in Canada and the United States indicate that implant treatment by a general practitioner using the Endopore system can be predictably and reliably successful.

@ Clinical approach on atrophic max. ridge using Endopore dental implant system. (by Dr.Perio)

*** Free Online CE couse on Dentaltown

Topic: Dental Implant Options in Atrophic Jaws

@ Cr/Rt=1 is myth? or reality? My specific case (by Dr.Perio)for more than 5 years followup with sever poor cr/rt ratio = 2.1 >>>

Forced Orthodontic Eruption (FOE) before Dental Implantation

2005-12-30T23:41:00.000+08:00

The treatment of esthetic areas with dental implants represents a new challenge for the clinician. Placementof a single-unit implant is indicated for fractured or periodontally compromised teeth. In 1993, a modification ofthe forced eruption technique, called “orthodontic extrusive remodelling,” was proposed as a way to augment both soft- and hard-tissue profiles at potential implant sites. This case report describes augmentation of the coronal softand hard tissues around the teeth with severe periodontal destruction , which was achieved by forced orthodontic extrusion before implant placement. This technique may be used to improve primary anchorage of a dental implant, fill the alveolar socket with bone, preserve interdental bone height and increase the amount of attached gingiva.
An approach to soft- and hard-tissue augmentation is forced orthodontic eruption (FOE). As first described by Heithersay and Ingber, this technique is based on osteophysiologic and orthodontic principles. It has been usedf requently because of its demonstrated advantages, including correction of isolated infrabony defects, repositioning ofthe gingival margin and clinical lengthening of thecrown.
Clinical Case Report by Perio: (FOE by Dr. Tsai)

@Buccal and coronal bone augmentation using forced eruption and buccal root torque( Int J Periodontics Restorative Dent. 2003 Dec;23(6):585-91.)

*Multidisciplinary Treatment Approach for Enhancement of Implant Esthetics(Dr. Wang 2004)

Ceramic Implant Abutment - zirconium dioxide (zirconia, ZrO2)

2005-12-20T08:38:00.000+08:00

Cercon® The quest for a biocompatible and esthetic metal free restoration, capable of multiple unit bridges and promising reliability has been the focus of research and development activity in dental materials for the last decade. The Cercon system takes advantage of the excellent strength, reliability and biocompatibility of ceramic zirconia (zirconium oxide, ZrO2), along with the accuracy, control and advance materials capability of an innovative computer aided machining (CAM) process. Cercon also allows dental professionals to bring the wealth of their clinical and lab experience to bear, to design and create esthetic metal-free restorations best suited to their patients’ need.

A case presentation with Cercon® abutment and Cercon® all-ceramic crown:(photoright by Perio)

Flapless dental implantation

2005-12-18T23:48:00.000+08:00

For esthetic outcome! Flapless approach to dental implantation is highly recommended.ATRAUMATIC EXTRACTION BY Periotome first.
Then Inserted implant into the prepared bone site.
It will keep the soft and hard tissue as much as possible. Home>>>

Dr. Buser's Opinions for Flapless appraoch of dental implantation:

Anterior Implant Esthetics

2005-12-17T16:37:00.000+08:00

The first decision to make is whether the failing tooth is needed for implant site development. The failing tooth may be useful in situations where significant bone loss is associated with the failing tooth but not with adjacent teeth. If one extracts the tooth, the bone level may be more apical relative to the adjacent teeth. This creates a difficult situation for impression taking and implant-supportive maintenance. As plaque accumulates at the implant interface, the inflammation may adversely affect the periodontal status of adjacent teeth. The ideal treatment is to delay the extraction so the failing tooth can be orthodontically extruded. As this is done over the course of six months, the bone and periodontal attachment surrounding the failing tooth will be coronally positioned to match adjacent bone levels. This provides more ideal bone height and allows the restorative implant platform to be placed at the desired height of 3 to 4 mm subgingivally. This section will focus on situations where the failing tooth needs to be extracted and define key determinants for preserving hard and soft tissue for an optimal implant-supported prosthesis.
There are several factors to consider when planning an implant restoration of failed dentition in the esthetic zone. Most often, the esthetic zone involves the maxillary anterior dentition. Although the single-tooth implant-supported restoration appears simple to perform, it is the most challenging in the esthetic zone. One of the initial assessments is determining if the tooth in question is a candidate for immediate implant replacement or a ridge preservation procedure.
The following checklist of nine issues will be discussed.
* Assessment of patient expectations;
* Assessment of gingival display;
* Gingival thickness;
* Papilla presence or absence;
* Morphology of adjacent teeth (crown-to-root ratio);
* Size and shape of contact areas of adjacent teeth;
* Available bone height;
* Available bone width; and
* Studies appropriate for final decision making.

Clinical Considerations for Increasing the Esthetic for Anterior Single-tooth Implant Restorations
1. Bone volume-quality and contour
2. Proximity of anatomical structures
3. Gingival morphology-facial and interproximal
4. Periodontal prognosis of adjacent teeth
5. Mesiodistal width of edentulous space
6. Interocclusal space
7. Implant size and site
8. Custom provisional prosthesis and abutment
9. Oral hygiene, etc.

Hydraulic Sinus Condensing (HSC) for Implant Placement

2005-12-12T12:26:00.000+08:00

The More Predictable and Less Invasive 21st Century Sinus Augmentation Technique

Background of Hydraulic Sinus Condensing (HSC)Technique

Developed by Leon Chen, D.M.D., M.S., Hydraulic Sinus Condensing, is today’s premier technique for sinus augmentation. Dr. Chen has demonstrated this technique to sold-out crowds at the annual meeting of the American Academy of Periodontology, the European Federation of Periodontology, and other academy meetings.

To read an interview about Hydraulic Sinus Condensing, please click here.

An 8-year retrospective study: 1,100 patients receiving 1,557 implants using the minimally invasive hydraulic sinus condensing technique. Chen L, Cha J.
J Periodontol. 2005 Mar;76(3):482-91

Clinical procedure:

New Technique by Dr. Smiler?? :
Balloon Subantral Membrane Elevator ( SME )
The advantages of Subantral Membrane Elevator, or SME:
Decreases Surgical Time
Reduces Risk of Membrane Tears
Mini Balloon Inflates to 3.1mm
(Micro Mini Inflates to 1.9mm)
Single Use, Supplied Sterile
Supplied with 5cc Luer Lok® Syringe
Can be used in small osteotomies

*Effects of sealing the perforated sinus membrane with a resorbable collagen membrane: a pilot study in humans.

J Oral Implantol. 2003;29(5):235-41

Proussaefs P, Lozada J, Kim J.

Graduate Program in Implant Dentistry, Loma Linda University, Loma Linda, CA 92350, USA.

The effects of repairing the perforated sinus membrane with collagen membrane are unknown. The purpose of this pilot study was to clinically, histologically, and histomorphometrically evaluate the results of repairing the perforated sinus membrane with resorbable collagen membrane. A split-mouth design was followed in the current study. Five subjects requiring bilateral sinus grafting were included in the study, where one site was accidentally perforated during sinus augmentation procedures and the other site was not perforated. The perforated sites were repaired with a resorbable collagen membrane. Dental implants were placed at a second stage and biopsies were harvested from both sinuses. New bone formation was measured for all sites. Implant survival was recorded at second-stage surgery. Nonperforated sites demonstrated significantly more bone formation (34.40%) than perforated sites (12.80%) (P = .016). Implant survival at second-stage surgery was significantly inferior in perforated sites (54.5%) when compared with nonperforated sites (100%) (P = .0146). The study demonstrated that perforation and repair of the Schneiderian membrane can compromise new bone formation and implant survival rate.

Tension-Free Suture for Dental Implantation or Bone Augmentation

2005-12-05T22:09:00.000+08:00

To obtain tension free primary closure, the buccal full thickness flap periosteum was scored using horizontal releasing incisions and spreading by Metzenbaum scissors or Scaple after insertion into the tissue. The flap was approximated using Gortex® (Gore, Flagstaff, AZ) sutures or monofilament suture. These sutures prevent wicking of bacteria into the graft as well as maintain tensile strength. One cannot overly emphasize the importance of establishing and maintaining primary closure following bone-grafting procedures. The sutures were removed two weeks postoperative. The patient agreed to refrain from wearing a prosthesis over this area thus facilitating undisturbed healing.
Clinical Technique of Tension-free Sutures by Perio:
<< post Sx 1 wk ..............postSx 2 wks>> >>PostSx 1.5mo
Join Discussion@

Edentulous Ridge Expansion (E.R.E.)

2005-12-03T10:26:00.000+08:00

Developed by Scipioni, Bruschi and Calesini, 1986.
*Not MEMBRANE-guided & not much involved with BONE GRAFTs.
*Permit the dental implants insertion with ideal dimensions.
*Experimental results from the animal studies confirmed the bone augmentation.

The advantages of the ERE
1. Greater bone density
2. Possible in patients with maxillary sinusitis
3. Shorter healing time
4. Lower material costs
5. Faster prosthetic restoration

Requirements for bone splitting technique
@ A minimum ridge width of 2-3 mm to guarantee spongiose bone within lamellar splitting region;
@ A minimum bone height of 10 mm; splitting process should ＜ 70% of the total bone height.
@ Bone Quality : D3~4 Clinical Procedure by Dr. Perio(Nov30,05):

Ridge Splitting Technique in Lower Anterior Region: (Surgery by Dr. Perio)
@Piezoelectric Ridge Expansion technique
@Piezosurgery
http://www.flexident.ch/upload/flexident/files/bro_piezosurgery_eng_13_10_04.pdf

Surgical extrusion technique for clinical crown lengthening

2005-11-27T22:12:00.000+08:00

Int J Periodontics Restorative Dent. 2004 Oct;24(5):412-21.

Surgical extrusion technique for clinical crown lengthening: report of three cases.
Kim CS, Choi SH, Chai JK, Kim CK, Cho KS.
Department of Periodontology, Research Institute for Periodontal Regeneration, Oral Science Research Center, College of Dentistry, Yonsei University, Seodaemun-Gu, Seoul, Korea.

Although a number of techniques have been proposed for clinical crown lengthening procedures, all have some limitation in terms of function and esthetics. This report presents the clinical and radiographic results of a surgical extrusion technique for clinical crown lengthening. Atraumatic surgical extrusion using a specially designed instrument (Periotome) was performed in three cases in which it was expected that extensive resective osseous surgery would have to be used for crown lengthening. Full-thickness mucoperiosteal flaps were raised both labially and palatally. The tooth was carefully luxated and extruded to the desired position without damaging the marginal bone area or root apex. No rigid splint was applied. Clinical examinations performed for more than 1 year after surgery revealed probing depths < or =" 3">@ Clinical procedure for CLP with surgical extrusion

@ Orthodontic Extrusion for CLP (PDF from U. Ohio)

The Vector™ System: an Ultrasonic Device for Periodontal Treatment

2005-11-26T15:50:00.000+08:00

Several years ago the Vector system was introduced to the European market for ultrasonic periodontal treatment. The manufacturer claimed that the system removed root cementum and periodontal soft tissues less aggressively than hand instruments. Furthermore, the treatment with the Vector system was claimed to be less painful than treatment with conventional systems, as vibrations applied horizontally to the root surface were avoided by a specific oscillation pattern. In addition, by changing the different insert tips of the handpiece, it is possible to use the device not only for periodontal treatment but also in restorative dentistry (i.e. minimal invasive preparation). Several studies assessed the properties of the device, and evaluated its possible benefits especially for periodontal debridement and supportive periodontal care.

*Efficiency of subgingival calculus removal with the Vector™-system
*Treatment of peri-implantitis by the Vector® system: A pilot study

News from Durr's Company:
Dürr Vector System
- Periodontal Treatment Breakthrough
More than 60% of all adults in the industrial world suffer from Periodontitis. With the Dürr Vector System you gain control of this disease. The Dürr Vector removes biofilm, plaque, calculus, endotoxins and eliminates the causal bacteria quickly and reliably. With Vector you work ergonomically and with a sensitive touch right into the last corner, even in pockets more than 5, 9 or 11 mm deep.
Many dentists tend to view the use of sonic and ultrasonic equipment sceptically, especially when working in subgingival areas. There is too great a danger that instruments, whatever their shape, that are oscillating or swaying in an undifferentiated manner, do more harm than good in the pocket. This is not the case with Vector.
Vector converts the ultrasonic dynamics of 25,000 Hz in such a way that you as a dentist can work in a completely relaxed and non-traumatic manner. Quickly and effectively.
The actively oscillating ring of the Vector functions in a similar way to a hula-hoop. If it is pressed into the horizontal position it moves with exactly 90° deflection vertically.
It is a question of allowing the instruments to oscillate exactly linearly, parallel to the surface of the tooth, without circling, swaying or knocking. With the Vector method you can do practically nothing wrong.

Available soon.
For further information contact
Angela Young - Product Manager
Ivoclar Vivadent Pty Ltd
1-5 Overseas Drive, Noble Park North Vic 3174
Ph: (03) 9795 9599 Email: angela.young@ivoclarvivadent.com.au

Clinical Experience by Perio:
1. More precice to contact root surface,
2. Straight working to the deep pocket,
3. More power to remove the deposit of root,
4. Insert tips too long to approach posterior area,
5. Irrigator liquid too expensive...

Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects

2005-11-16T18:17:00.000+08:00

Emdogain® is the biology-based and scientifically proven solution to promote the predictable regeneration of hard and soft tissues lost due to periodontal disease like intrabony defects, class II mandibular furcation and recession defects. ReliableMore than 40 clinical studies, involving 1500 intrabony periodontal defects in 1200 patients, have demonstrated that Emdogain is effective in stimulating the formation of new periodontal attachment in soft and hard tissue. 60-70% defect fill was measured as a gain of radiographic bone one year following treatment with Emdogain. Simple treatment with Emdogain requires little or no preparation time; no mixing and no specialized products or equipment are necessary. It is convenient and effective to use in areas difficult to treat such as interproximal areas, defects distal to the second molar, defects located under bridgework and wide defects. No second surgery is required.VersatileThe possibility for the use of Emdogain in periodontal defects is expanding.
It is indicated for:
1-,2-,3-wall defects
Recession defects
Class II mandibular furcation defects

Cochrane Review>>>

By mimicking the biological processes of natural tooth development, Emdogain forms an insoluble three dimensional matrix, which allows for the selective colonization of cells. Through cellular interactions, a cascade of events initiates increased cell proliferation, growth factor synthesis and cell differentiation resulting in the formation of necessary hard and soft tissues such as cementum, periodontal ligament and alveolar bone.
1. Attachment – Mesenchymal cells attach to the formed matrix.
2. Proliferation and growth – The cells spread and populate the surface.
3. Cementum formation – The cells start to produce cementum with insertingcollagen fibers.
4. Alveolar bone – Along the treated root surface, and at a certain distance, a condensation of fibrous tissue indicates the region where new alveolar bone is forming.

Post Surgery one wk:

>>>>>PostSx 2wks>>>>>

**Above Clinical Photo present by @Perio^^^
^How to control the bleeding before your application of Emdogain? Dr. Sculean's suggestions from his Taiwan's lecture!

1. Completely remove all infammations (hard/soft tiss);

2. Rinse with normal Saline frequently;

3. Apply Emdogain from apex to crown;

4. Presuture (Mod. Mattress suture);

5. Premixture with bone graft before applied into defects.

>>Suture Technique Review from eMedicine.com>>

Can the Emdogain help to Peri-implantitis ??? (Dr. Sculean et al.)

Modified Papilla Preservation Technique (MPPT)

2005-11-16T12:04:00.000+08:00

The modified papilla preservation technique(1996). A new surgical approach for interproximal regenerative procedures. A modification of the papilla preservation technique has been applied to achieve primary closure of the interproximal tissue over barrier membranes placed coronal to the alveolar crest. Cortellini et al. study:Fifteen patients with deep intrabony interproximal defects were treated. Defects had a probing attachment level loss of 9.9 +/- 3.2 mm and a recession of the gingival margin of 1.7 +/- 1.6 mm. The depth of the intrabony component was 5.5 +/- 2.9 mm; while the suprabony component was 5.9 +/- 2.0 mm. Titanium-reinforced teflon membranes were placed 1.3 +/- 0.7 mm from the cemento-enamel junction, 4.5 +/- 1.6 mm coronal to the interproximal alveolar bone crest. Primary closure over the interproximal portion of the membrane was obtained in 93% of cases. In 73% of the cases complete coverage of the membrane was maintained until its removal at 6 weeks. These data indicate that the modified papilla preservation technique can be successfully applied to obtain primary closure of the interdental space in regenerative procedures with barrier membranes.
J Periodontol. 1995 Apr;66(4):261-6.
Int J Periodontics Restorative Dent. 1996 Dec;16(6):546-59.
Figure Enlarge>>>

Simplified Papillae Preseved Technique(SPPT)

2005-11-14T00:06:00.000+08:00

Figure Enlarge>>>
Microsurgical Approach to Periodontal Regeneration. Initial Evaluation in a Case Cohort
Dr. Pierpaolo Cortellini and Maurizio S. Tonetti

The use of a microsurgical approach was associated with very high ability to obtain and maintain primary closure of the interdental tissues over the barrier membranes. The procedure resulted in clinically important amounts of CAL gains and minimal recessions. J Periodontol 2001;72:559-569.

SPPT procedures: Archives of Oct.>>>

Glass Ionomer filling into severe furcation invlovement of Molar tooth

2005-11-12T22:42:00.000+08:00

Treatment of Class III furcation has historically been less than predictable. Long-term studies have demonstrated poor survival rates of teeth with advanced furcation involvement. Although multiple treatment modalities have been attempted to retain teeth with severe furcation invasion, clinical success has not been predictable. Treatment attempts range from non-surgical therapy, furcation obliteration,surgery to increase access to the furcation, root resections, tunnel procedure, guided tissue regeneration, and a combination of graft materials, membranes, and coronally positioned flaps. Regenerative techniques that have been successful in the treatment of Class II mandibular furcation involvements have been less predictable when performed in Class III situations. In the past restorative materials have been used to obliterate furcation; the goal was to improve plaque control by eliminating the anatomic niches within the furcation where bacteriacan accumulate. Also, in the past polymericreinforced zinc oxide-eugenol (IRM), amalgam,glass ionomer, and resin ionomer restorative materials were utilized to fill Class III furcation invasions.

@Potential advantages of an occlusive barrier such as glass ionomer include:
• Ease of placement
• Does not require a suture for stability
• Elimination of a second stage procedure for retrieval of the membrane since it is permanently bonded
• Long junctional epithelial attachment to the glass ionomer
• Does not require complete coverage by the gingival flap
• Bacteriostatic due to fluoride release
• Lower cost

The use of a glass ionomer to regenerate the attachment apparatus in the treatment of advanced furcation involvement was not the goal of the treatment. There was no intention to regenerate any tissue, hard or soft. The goal of selecting this mode of therapy was simply to retain hopeless molars with advanced furcation defects.

A case report for filling Fuji II LC into Mandibular Cl III molar FI and final procelain to metal crown restoration: Surgery by Dr. Perio
@PostSx 4 months....

Diabetes and periodontal disease: A complex, two-way connection

2005-11-10T22:02:00.000+08:00

Dental visits among dentate adults with diabetes--United States, 1999 and 2004.
MMWR Morb Mortal Wkly Rep. 2005 Nov 25;54(46):1181-3.
Centers for Disease Control and Prevention (CDC).

One of the major complications of diabetes is periodontal disease, a chronic infection of tissues supporting the teeth and a major cause of tooth loss. Adults with diabetes have both a higher prevalence of periodontal disease and more severe forms of the disease, contributing to impaired quality of life and substantial oral functional disability. In addition, periodontal disease has been associated with development of glucose intolerance and poor glycemic control among adults with diabetes. Regular dental visits provide opportunities for prevention, early detection, and treatment of periodontal disease among dentate adults (i.e., those having one or more teeth); moreover, regular dental cleaning improves glycemic control in patients with poorly controlled diabetic conditions. One of the national health objectives for 2010 is to increase the proportion of persons with diabetes who have an annual dental examination to 71% (revised objective 5-15). To estimate the percentage of dentate U.S. adults aged > or =18 years with diabetes who visited a dentist within the preceding 12 months, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys for 1999 and 2004. This report describes the results of that analysis, which indicated that, in 2004, age-adjusted estimates in only seven states exceeded 71% and estimated percentages for four states and District of Columbia (DC) increased significantly from their levels in 1999. The findings underscore the need to increase awareness and support for oral health care among adults with diabetes, including support for national and state diabetes care management programs.

What is the Link Between Diabetes and Periodontal Disease?

Diabetic Control.
Like other complications of diabetes, gum disease is linked to diabetic control. People with poor blood sugar control get gum disease more often and more severely, and they lose more teeth than do persons with good control. In fact, people whose diabetes is well controlled have no more periodontal disease than persons without diabetes. Children with IDDM (insulin-dependent diabetes mellitus) are also at risk for gum problems. Good diabetic control is the best protection against periodontal disease.
Studies show that controlling blood sugar levels lowers the risk of some complications of diabetes, such as eye and heart disease and nerve damage. Scientists believe many complications, including gum disease, can be prevented with good diabetic control.
Blood Vessel Changes.
Thickening of blood vessels is a complication of diabetes that may increase risk for gum disease. Blood vessels deliver oxygen and nourishment to body tissues, including the mouth, and carry away the tissues' waste products. Diabetes causes blood vessels to thicken, which slows the flow of nutrients and the removal of harmful wastes. This can weaken the resistance of gum and bone tissue to infection.
Bacteria.
Many kinds of bacteria (germs) thrive on sugars, including glucose -- the sugar linked to diabetes. When diabetes is poorly controlled, high glucose levels in mouth fluids may help germs grow and set the stage for gum disease.
Smoking.
The harmful effects of smoking, particularly heart disease and cancer, are well known. Studies show that smoking also increases the chances of developing gum disease. In fact, smokers are five times more likely than nonsmokers to have gum disease. For smokers with diabetes, the risk is even greater. If you are a smoker with diabetes, age 45 or older, you are 20 times more likely than a person without these risk factors to get severe gum disease.

> Free Article from JCDC >The Relationship Between Diabetesand Periodontal Disease
http://www.cda-adc.ca/jcda/vol-68/issue-3/161.pdf

Third molars may have a negative impact on periodontal health

2005-11-05T21:26:00.000+08:00

The finding of more severe periodontal conditions associated with visible third molars in these middle-aged and older adults indicates that third molars may continue to have a negative impact on periodontal health well into later life. The relationship between third molars and periodontal disease pathogenesis deserves further study using longitudinal data... More>>>

A consensus development conference on Removal of Third Molars was held at the National Institutes of Health on November 28-3O, 1979. More than 200 practicing dentists and scientists, representing all disciplines within the profession, met in an effort to reach general agreement on when and under what circumstances third molar extraction is advised and to identify areas where further research is needed.
Summary :
The conference participants carefully examined the long-established practice of third molar removal. A number of clinical procedures were endorsed; others were controversial but identified as subjects for additional research. A number of well-defined criteria for the removal of third molars emerged. They are, in part, infection, nonrestorable carious lesions, cysts, tumors, and destruction of adjacent teeth and bone. There is less morbidity associated with removal of these teeth in the young than in the older patient.
The effectiveness of removal of third molars to prevent crowding of lower incisors is not borne out by the studies currently available. Third molar bud removal in youngsters, based on predictive studies, is not currently an acceptable practice in view of available knowledge. Clinical experience suggests that morbidity and serious complications may be reduced if impacted teeth are removed at an early age. The observation is not disputed by available data, but there is enough question about the life-cycle of impacted third molars to suggest the need for well-designed prospective studies of the subject.
Full Report>>>

*Severe infrabony defect caused from impacted 3rd molar >> regeneration surgery with Emdogain + Dynagraft --- Case report by Dr.Perio

How Predictable Are Periodontal Regenerative Surgery?

2005-11-05T19:22:00.001+08:00

Periodontal regeneration has become one of the primary objectives of periodontal therapy.The resulting scientific endeavours have elucidated modes of periodontal wound healing, the growth of periodontal cells and their association with the surrounding matrix, and growth-promoting factors. The periodontal regeneration industry is producing better and more expensive devices, but the criteria for evaluating their success have not progressed to the same extent. Although clinical measurements of attachment level and probing depths, along with radiography, are good methods of evaluating tooth survivaland prognosis, they do not indicate true biological regeneration. In addition, there generation industry may encourage the overuse of allografts and alloplasts which may serve as an impediment to simple wound healing. This review is a critical assessment of the clinical use of various regenerative tools, specifically bone replacements and membranes.The future of the regeneration industry may depend on the merging of various technologies and biological concepts, including the possible use of biological barriers, variousbone and periodontal growth inducers, and artificial matrices that will attract or carry the cells necessary for regeneration.
Oct. Archives>>>

Crown Lengthening Procedure with Modified Distal Wedge Operation

2005-11-05T10:32:00.000+08:00

According to ROBINSON (1966), the periodontal pockets adjacent to distal root surfaces of the second and third molars are aspects of the periodontal therapy of difficult solution and they have been denied frequently for many periodontists. The periodontal pocket on the distal surface of molars can be extremely deep due to the anatomy of this area. When the pocket becomes deeper, that depth is larger than in other areas and the inaccessibility of the area leads to the inability in the mechanical control of bacterial plaque executed by the patient. Regarding to these aspects, he developed the Distal Wedge procedure in order to treat periodontal pockets adjacent to the distal surfaces of the molars. This technique uses internal bevel incisions and it has as objectives: to obtain access to the bone tissue, to preserve attached gingiva, to eliminate periodontal pockets, to reduce the healing period and to minimize the postoperative pain (Robinson RE The distal wedge. Periodontics 1966; 4:256-264).

@Clinical Procedure for Mod. distal wedge:(Surgery by Dr. Perio)

@PostSx 1 wk....

Connective tisue Graft for Root Coverage

2005-11-04T11:57:00.000+08:00

subepithelial connective tissue graft as a donor source for root coverage

The success (complications of CT grafting) of these grafts has been attributed to the double-blood supply at the recipient site from the underlying connective tissue base and the overlying recipient flap.This case has been illustrated to demonstrate the versatility of this procedure for areas of single or multiple root coverage especially in the maxillary arch, coverage of existing crown margins and areas requiring a combination of ridge augmentation and root coverage.

Clinical Tip:

The concept of early implant placement

2005-09-19T21:06:00.000+08:00

Prof Buser's Lecture of EAO 05'

Peri-implantitis

2005-09-12T09:45:00.000+08:00

periimplantitis

Home>>>