[show abstract][hide abstract] ABSTRACT: Achieving an esthetic outcome in tooth replacement and implant treatment requires a proper tooth shape and stable surrounding soft tissue profiles. Bone augmentation is considered vital to support the esthetic soft tissue profile around definitive restorations. To prevent recession of the peri-implant soft tissue in cases with multiple implants, buccal bone augmentation of more than 2 mm from the implant platform is necessary to overcome the normal pattern of bone remodeling. Drawing an imaginary horizontal line spanning the space between the remaining healthy interproximal bone peaks is the most reliable vertical augmentation target to create esthetic papillae around an implant prosthesis. Provided that the adjacent bone peaks are at an ideal height and the bone is augmented vertically up to this line, the accepted general guideline of 2 to 3 mm of interproximal vertical bone augmentation from ideally placed implant platforms will invariably also be achieved. In addition, placing pontics in strategic positions to avoid consecutively placed implants has been suggested to facilitate vertical bone height preservation after bone augmentation. Even with esthetically successful results, there have been very few long-term studies on compromised cases with multiple implants. This will become more and more critical over time and must be remedied.
The International journal of periodontics & restorative dentistry 10/2010; 30(5):503-11. · 1.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: This second article in a three-part series on the use of artificial gingiva in fixed partial restorations focuses on diagnosis and treatment planning. Often, traditional treatment of complicated situations can result in a definitive restoration that is less than esthetic. With appropriate planning that incorporates thorough clinical examinations, three-dimensional imaging, diagnostic wax-ups, and consideration of patient expectations, a modified approach to ridge augmentation, implant placement, and prosthetic reconstruction can lead to an ideal restoration that incorporates artificial gingiva.
The International journal of periodontics & restorative dentistry 12/2009; 29(6):573-81. · 1.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: The Class III defect environment entails a vertical and horizontal deficiency in the edentulous ridge. Often, bone and soft tissue surgical procedures fall short of achieving a natural esthetic result. Alternative surgical and restorative protocols for these types of prosthetic gingival restorations are presented in this three-part series, which highlights the diagnostic and treatment aspects as well as the lab and maintenance challenges. A complete philosophical approach involves both a biologic understanding of the limitations of the hard and soft tissue healing process as well as that of multiple adjacent implants in the esthetic zone. These limitations may often necessitate the use of gingiva-colored "pink" restorative materials and essential preemptive planning via three-dimensional computer-aided design/computer-assisted manufacture to achieve the desired esthetic outcome. The present report outlines a rationale for consideration of artificial gingiva when planning dental prostheses. Prosthetic gingiva can overcome the limitations of grafting and should be a consideration in the initial treatment plan. (Int J Periodontics Restorative Dent 2009;29:471-477.).
The International journal of periodontics & restorative dentistry 10/2009; 29(5):471-7. · 1.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Ultrasonic bone surgery was recently introduced as an osteotomic technique; however, documentation is scarce. This article reports on the application of ultrasonic bone surgery for 53 bone-augmentation procedures in the posterior maxilla in 34 patients over 5 years. The initial residual bone height under the sinus varied between 1 and 9 mm (mean: 3.7 mm). Distribution according to residual bone height classes was 7.7% for Class B, 39.3% for Class C, and 53.0% for Class D. The procedures included bony window opening of the sinus, cortical and cancellous bone harvesting, and activation of the sinus wall. During the sinus approach, 2 of 53 membranes (3.8%) were perforated and covered with a membrane made of platelet-poor plasma. Bone grafting was carried out with autologous bone at 22 implant sites (18.8%), with a mixture of autologous bone and anorganic bovine bone mineral (Bio-Oss) at 29 sites (24.8%), and with Bio-Oss alone at 66 sites (56.4%). The perforated membranes healed uneventfully. At second-stage surgery, four implants failed. The survival rate of the 117 placed implants was 96.6%. No implant failed after loading. Performing the sinus grafting procedure with ultrasonic bone surgery limited the occurrence of membrane perforation; by changing the tips, all surgical steps were performed safely and comfortably.
The International journal of periodontics & restorative dentistry 07/2008; 28(3):221-9. · 1.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: A single-tooth implant in the esthetic region has good potential for success, but it is still challenging to restore multiple-tooth defects with implant-supported prostheses that resemble the natural dentition. This article suggests a strategy to provide a more predictable protocol for esthetic implant treatment for multiple-tooth defects using the root submergence technique (RST). By maintaining the natural tooth root with the RST a much greater amount of surrounding tissue may be preserved than with the commonly used socket preservation technique, which almost always leads to crestal bone resorption and thus reduction of the height of the interdental papillae and width of the edentulous ridge. RST instead maintains the natural attachment apparatus of the tooth in the pontic site, which in turn allows for complete preservation of the alveolar bone frame and assists in the creation of an esthetic result in adjacent multiple-tooth-replacement cases. In situations with periodontal bone loss, orthodontic extrusion is required to create the underlying bone support for the papilla that is necessary to guarantee predictability.
The International journal of periodontics & restorative dentistry 01/2008; 27(6):521-7. · 1.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Many articles address the predictability of immediate implant placement into extraction sockets; however, there are only a few reports that mention the indications and limitations of this technique. The aim of this article is to re-examine specific indications for immediate implant placement and to clarify the timing or "fourth dimension" relative to extraction and implant placement. The expanded concept of four-dimensional implant treatment planning involves the new axis of time, which must be considered along with the traditional spatial or three-dimensional management of implant positioning.
The International journal of periodontics & restorative dentistry 09/2007; 27(4):313-23. · 1.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: As patient demand increases for more natural restorations in the esthetic zone, clinicians must have the highest level of skill and knowledge to maintain or reform the interdental papilla between teeth, between implants and teeth, and between adjacent implants. To date, there are no reports that have measured the distance from the contact point to the bony crest between implants. One reason for this may be the fact that, with two adjacent implants, the contact point of the crown can be established at any distance from the gingival margin according to the restorative dentist's specifications. Therefore, in this study, the height of the soft tissue to the crest of bone was measured between two adjacent implants independent of the location of the contact point. The purpose of this study was to determine the range and average height of tissue between two adjacent implants.
A total of 136 interimplant papillary heights were examined in 33 patients by eight different examiners in five private dental offices. After administration of appropriate local anesthesia, a standardized periodontal probe was placed vertically from the height of the papilla to the crest of bone. The measurements were rounded off to the nearest millimeter.
The mean height of papillary tissue between two adjacent implants was 3.4 mm, with a range of 1 mm to 7 mm.
Clinicians should proceed with great caution when placing two implants adjacent to each other in the esthetic zone. In most cases, only 2, 3, or 4 mm of soft tissue height (average 3.4 mm) can be expected to form over the interimplant crest of bone. These results showed that modification of treatment plans may be necessary when esthetics are critical for success.
Journal of Periodontology 01/2004; 74(12):1785-8. · 2.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: Part 1 of the present series presented a rationale for including prosthetic gingiva in the planning of a fixed restoration to ensure an esthetic result for patients with severe horizontal and vertical ridge deficiencies. The second part focused on the diagnostic and treatment planning aspects of the use of artificial gingiva. This third and final installment in the series focuses on the laboratory and clinical procedures involved in fabricating a prosthesis with artificial gingiva and provides information on proper maintenance of these restorations.
The International journal of periodontics & restorative dentistry 30(1):19-29. · 1.08 Impact Factor