The alveolar ridge split and expansion (ARSE) technique is a predictable approach for horizontal ridge augmentation in atrophic edentulous sites. The objectives of the present study were to assess the impact of piezoelec...The alveolar ridge split and expansion (ARSE) technique is a predictable approach for horizontal ridge augmentation in atrophic edentulous sites. The objectives of the present study were to assess the impact of piezoelectric surgery and screw expanders on tissue and implant health, and also to comparatively evaluate the efficacy of piezoelectric surgery and screw expanders in edentulous ridge expansion compared to the conventional drilling technique. Thirty-six single or multiple edentulous sites were recruited into 3 groups based on ridge width measurements, that is, 12 sites/group. In group 1 (control), implants were placed with a conventional drilling technique. In contrast, in groups 2 and 3 (test groups), ARSE was performed with implants placed simultaneously, and follow-up was conducted at the first week, second week, fourth week, third month, and sixth month postoperatively. Ridge width was measured before and after ridge expansion at 2 mm and 6 mm from the crest. Implant stability quotient (ISQ), insertion torque (IT), TNF-α inflammatory marker, pain, and soft tissue parameters, including redness and swelling, were also recorded. Wilcoxon signed rank test, Mann-Whitney U test, repeated measure ANOVA test, 1-way ANOVA test, Kruskal-Wallis test, and independent t test were used. P value was set at ≤ .05. Results show that intragroup comparison of ridge width before and after expansion at 2 mm and 6 mm from the crest was statistically significant (P < .05) in both group 2 and group 3. The change in ridge width was nonsignificant (P > .05) between group 2 and group 3 after intergroup comparison. Intragroup comparisons of ISQ were statistically significant (P < .05) in all 3 groups. Intergroup comparisons of ISQ and insertion torque values show no significant differences (P > .05). The observations of the present study demonstrate that the ARSE technique, using PES and screw expanders, may be an efficient approach for providing predictable ridge augmentation along with simultaneous implant placement in moderate to severe ridge deficiency sites. However, proper case selection, along with the use of appropriate techniques, achieves predictable results even in moderate to severe ridge width deficiency sites. Further studies are needed to determine the long-term success of this technique.
Socket preservation (SP) with bone grafting is often used to maintain alveolar ridge dimensions following tooth extraction. However, healing in compromised patients, such as tobacco smokers and patients with type 2 diabe...Socket preservation (SP) with bone grafting is often used to maintain alveolar ridge dimensions following tooth extraction. However, healing in compromised patients, such as tobacco smokers and patients with type 2 diabetes mellitus (DM), is compromised. Oxygen-releasing hydrogels have emerged as potential adjuncts to enhance osseous healing by improving angiogenesis and osteogenesis. This case report presents 6-month follow-up clinical results of SP using an oxygen-releasing hydrogel dressing in a male smoker with type 2 DM. A 51-year-old male habitual cigarette smoker with a history of type-2 DM presented for the replacement of a grossly carious left maxillary second premolar. Following atraumatic extraction, the socket was irrigated with an oxygen-enriched solution and treated with a topical oxygen-releasing gel before bone grafting with a corticocancellous allograft mixed with the gel. The site was sutured with resorbable sutures, and the healing process was monitored at 2 weeks and 6 months. Clinical and radiographic evaluations were conducted to assess bone regeneration before implant placement. Healing was uneventful, and at the 6-month follow-up, a bone-level dental implant was successfully placed with adequate primary stability. The application of a topical oxygen-rich gel during SP appears to facilitate osseous healing; however, further power-adjusted, long-term randomized controlled trials and histologic investigations are needed to confirm this relationship.
The success of implant therapy is influenced by multiple factors that impact the bone-implant, implant-abutment, and abutment-prosthesis connections. The distribution of stress in the bone is a key determinant of whether...The success of implant therapy is influenced by multiple factors that impact the bone-implant, implant-abutment, and abutment-prosthesis connections. The distribution of stress in the bone is a key determinant of whether dental implants succeed or fail. This study aimed to investigate the impact of bone density on the fatigue of abutment screws. This laboratory-based experimental study utilized a 3-dimensional bone model with 2 distinct densities, a Dentis OneQ implant, an inclined cyclic force of 100 N applied at a 30-degree angle, and positioned 4 mm above the implant platform. The analysis was conducted using the 3-dimensional finite element method in Abaqus software. The implant and abutment were of standard size, and stress measurements were taken at 5 locations on the abutment screw: Point A (beneath the screw head), Point B (middle of the screw neck), Point C (first thread), Point D (middle of the threads), and Point E (last thread), over time. The data underwent statistical analysis using Wilcoxon and Kruskal-Wallis tests. An increase (P < .001) in the mean von Mises stress was observed in low-density bone. The forces acting on the implant system were greater in dense bone, leading to increased deformation of the abutment screw and consequently a reduced fatigue life of the screw. Given that the total force applied to the implant system remains the same in both loose and dense bone, the greater transmission of force from the abutment to loose bone lessens the force impact within the implant-abutment system and the abutment screw.
This retrospective study aimed to evaluate the up to 10-year survival rate of tapered internal dental implants featuring an 11° Morse taper and internal hex connection with sandblasted and acid-etched (SA) surfaces and t...This retrospective study aimed to evaluate the up to 10-year survival rate of tapered internal dental implants featuring an 11° Morse taper and internal hex connection with sandblasted and acid-etched (SA) surfaces and to determine whether patient-related or procedural variables significantly influence implant longevity. A total of 2474 tapered internal implants featuring an 11° Morse taper and internal hex connection with SA surfaces (Osstem TS III SA) were placed in 1298 patients at Seoul National University Dental Hospital in Korea between 2013 and 2019. Inclusion criteria required at least 5 years of follow-up postprosthesis placement. Variables such as sex, age, diabetes mellitus, smoking status, implant location, diameter, length, surgical protocol, timing, bone augmentation, and prosthesis type were analyzed. Kaplan-Meier survival analysis and Cox proportional hazards modeling were performed using SPSS 29.0. The overall implant survival rate was 98.3%. Peri-implantitis was the leading cause of failure. Cox analysis showed that only sex significantly affected implant survival, with male patients exhibiting a higher risk of failure (HR, 0.347; P = .004). No other clinical or procedural variables, including diabetes, smoking, or implant dimensions, showed statistically significant effects. Within the limitations of this single-center retrospective study, tapered internal implants featuring an 11° Morse taper and internal hex connection with SA surfaces demonstrated excellent long-term clinical outcomes. Among the evaluated factors, only sex had a significant influence on implant survival. To better identify risk factors, future multicenter prospective studies with randomized designs are recommended.
This multicenter study investigated patient-reported outcome measures (PROMs) following immediate placement of zirconia dental implants. Fifty-four patients from Austria, Spain, and Germany received 272 implants and comp...This multicenter study investigated patient-reported outcome measures (PROMs) following immediate placement of zirconia dental implants. Fifty-four patients from Austria, Spain, and Germany received 272 implants and completed the PROM questionnaires before implantation (T0) and at the time of definitive prosthetic restoration (T1). Patient experiences were assessed using a visual analog scale (VAS) across the following 5 domains: functional limitations, psychological discomfort, physical pain, physical and social disability, and handicap. The follow-up duration was 8.1 ± 1.5 years, with a 100% implant survival rate. Overall patient satisfaction rate improved from 77.88% at T0 to 94.99% at T1 (P < .0001). Significant correlations were observed between higher VAS scores at T0 and clinical variables, such as implant diameter, number of implants placed, use of augmentation procedures, and loading timing. Qualitative differences between the participating countries were also noted, with Spanish patients reporting the most significant reduction in VAS scores from T0 to T1. This study highlights the importance of integrating PROMs in implant dentistry to address the efficacy-effectiveness gap and support a value-based care model. The results demonstrated high long-term patient satisfaction and acceptance of immediately placed zirconia implants in diverse clinical settings.
Implant placement is often combined with contour augmentation surgery, involving flap elevation and material placement extending to the ridges of adjacent teeth. This study evaluated horizontal ridge dimensional changes...Implant placement is often combined with contour augmentation surgery, involving flap elevation and material placement extending to the ridges of adjacent teeth. This study evaluated horizontal ridge dimensional changes and the stability of the implant site and adjacent teeth in the esthetic zone following early implant placement with contour augmentation. Twenty-one patients received maxillary incisor single implant placement with contour augmentation. Alginate impressions were taken before tooth extraction (T0) and at 1-year follow-up (T1), and stone casts were scanned using a desktop 3D scanner to generate stereolithography files. Horizontal ridge dimensions were measured at 0, 1, 3, and 5 mm below the mucosal margin at the groups of implant site (I), mesial tooth (MI), distal tooth (DI), and contralateral canine (C). Results indicated significant differences in ridge dimensions between T0 and T1 at the 3- and 5-mm levels in group MI (P < .05). No significant differences were observed among the 4 groups at any level. Early implant placement with contour augmentation appeared to maintain the facial-palatal ridge dimension close to pre-extraction width, suggesting acceptable hard and soft tissue stability in the esthetic zone after 1 year with no consistent adverse effects on ridges of adjacent teeth.
During the osteotomy and placement of dental implants, anatomical positions of adjacent natural teeth to a dental implant site may be very close or in actual contact. This can be due to anatomy, the size of the implant s...During the osteotomy and placement of dental implants, anatomical positions of adjacent natural teeth to a dental implant site may be very close or in actual contact. This can be due to anatomy, the size of the implant site, a misguided osteotomy, drifting, or migration of the adjacent tooth. The implant surgeon needs to be aware of the position of adjacent teeth to avoid root damage from the implant drill or the implant itself. The dimension of 1.5-mm space has been discussed, but it is an arbitrary speculative dimension. There is no agreed-upon "safe" proximity to adjacent tooth roots. Theoretically, a large displacement size of an implant may inhibit bone remodeling and cause bone loss if placed close to an adjacent tooth. A small diameter or mini-implant may not significantly affect bone remodeling when placed in close proximity or even in contact with an adjacent tooth root. Many factors dictate "safe" proximity, including the implant diameter, tooth root displacement, periodontal ligament, bone quality, and patient physiologic factors, including diseases and medications. The degree of root contact by an implant or implant drill may be graded by the contact depth. Grade 1 is contact with periodontal ligament, Grade 2 is contact with periodontal ligament and cementum, Grade 3 is contact with periodontal ligament, cementum, and dentin penetration, and Grade 4 is contact with periodontal ligament, cementum, root dentin, and pulpal penetration. This discussion highlights the need for further research on dental implant proximity and contact with adjacent teeth.
The rehabilitation of the atrophic maxilla poses a significant challenge, especially in cases with limited bone height. Nasal floor augmentation has been proposed to improve bone height in the anterior maxilla. However,...The rehabilitation of the atrophic maxilla poses a significant challenge, especially in cases with limited bone height. Nasal floor augmentation has been proposed to improve bone height in the anterior maxilla. However, its effects on nasal function and passage volume have not been thoroughly investigated. The objective of this study was to evaluate the correlation between nasal passage volume changes and patient-reported nasal obstruction after nasal floor augmentation using the Nasal Obstruction Symptom Evaluation (NOSE) scale. This retrospective study included patients undergoing iliac bone grafting and nasal floor augmentation for the rehabilitation of severely atrophic maxilla. Nasal passage volume alterations were measured using cone beam computerized tomography, and nasal function was assessed using the NOSE scale. The correlation between NOSE scores and volume changes was analyzed. A total of 12 patients met the inclusion criteria. The mean bone height increase was 5.70 ± 3.75 mm, and the mean nasal passage volume decrease ratio was 17.73% ± 18.23%. The findings demonstrated a significant correlation between NOSE scores and nasal passage volume alteration (Spearman rank correlation; ρ = .889; 95% CI [0.732, 0.960]; P < .001); however, no significant correlation was found between NOSE scores and bone height alterations (Spearman rank correlation, ρ = -.129; 95% CI [-0.736, 0.457]; P = .689). The results suggest that changes in nasal passage volume may influence patient-reported breathing function more than bone height increase. Whereas a correlation was observed, causality cannot be inferred due to the study's retrospective nature and the limited sample size. Nevertheless, these findings provide preliminary evidence pointing to the potential importance of careful surgical planning to minimize volume reduction during nasal floor augmentation. Further prospective studies with larger and more diverse sample sizes must validate these results and strengthen the conclusions.
The bone shell approach to lateral ridge augmentation has overcome many limitations of the classic block graft and guided bone regeneration approaches. Surgical complexity and expensive dedicated armamentarium may partia...The bone shell approach to lateral ridge augmentation has overcome many limitations of the classic block graft and guided bone regeneration approaches. Surgical complexity and expensive dedicated armamentarium may partially explain why it has not yet become ubiquitously adopted. We propose a screwless simplification of the bone shell approach concerning the posterior mandible lateral defect. Two cases are described to highlight the unique aspects of each case.
A 64-year-old female patient was referred for the treatment of peri-implantitis around an implant at site 46. Bleeding on probing, excessive probing depth and extensive bone loss (more than 50% of the implant length) wer...A 64-year-old female patient was referred for the treatment of peri-implantitis around an implant at site 46. Bleeding on probing, excessive probing depth and extensive bone loss (more than 50% of the implant length) were evident around the implant. Moreover, the implant site suffered from a lack of keratinized mucosa at the buccal side. The patient received a sequence of cleaning with a titanium brush, decontamination with tetracycline paste, H2O2 and saline, titanium mesh placement, use of xenogenic bone substitute, and eventually, covering the area with a xenogenic collagen matrix. Four years' results showed favorable probing depth, bone gain (more than 80% of the implant length), lack of bleeding on probing, and formation of a keratinized mucosal rim at the buccal side. In the presented case, the mesh technique with xenogenic bone substitute and collagen matrix effectively manages a severe peri-implantitis case.
The canine fossa is an important facial concavity on the labial surface of the maxilla, and it needs to be considered when placing implants in the maxillary canine and premolar region. The present study assessed the cani...The canine fossa is an important facial concavity on the labial surface of the maxilla, and it needs to be considered when placing implants in the maxillary canine and premolar region. The present study assessed the canine fossa and analyzed the depth and distance of its deepest point from the root apex as a guide for immediate implant placement. One hundred cone beam computerized tomography scans taken between January 2017 and December 2021 were analyzed in the sagittal section, evaluating the depth of the canine fossa and its proximity to the root apex. The average depth of the canine fossa was 1.62 ± 0.54 mm, and the distance between the deepest point of the fossa and the root apex was 4.52 ± 1.70 mm. No significant correlation was found between these parameters and gender or age (p > .05). It can be concluded that the canine fossa is near the roots of the canine and first premolar, increasing the risk of fenestration of buccal bone during immediate implant placement.
This study aimed to evaluate the factors contributing to dental implant fracture while focusing on different bone-level (BL) or soft tissue-level (STL) neck designs. This study analyzed 311 patients with 1026 implants tr...This study aimed to evaluate the factors contributing to dental implant fracture while focusing on different bone-level (BL) or soft tissue-level (STL) neck designs. This study analyzed 311 patients with 1026 implants treated between April 2021 and March 2023. The proportions of dental implant sites were 13.6% (140/1026), 31.8% (326/1026), and 54.6% (560/1026) in the anterior teeth, premolars, and molars, respectively. The study investigated the presence or absence of implant fracture due to differences in BL or STL neck designs. The 2 groups were compared using the Pearson chi-square test. These tests used the morphology of the dental implant neck design as the explanatory variable, whereas the presence or absence of implant fractures served as the criterion variable. Statistical significance was set at P < .05. The rate of implant fracture was 3/683 (0.4%) and 0/343 (0%) in the BL and STL groups, respectively (P = .56). By site, the rate was 0/140 (0.0%) in the anterior teeth, 0/326 (0.0%) in the premolars, and 3/560 (0.5%) in the molars (P = .55). No sex difference was observed in the presence of implant fractures (P = .18). However, a significant age difference was observed between the groups with and without fractures (P = .03). All implant fractures occurred in the BL group in this study. Our findings suggest that differences in dental implant neck design are an important factor associated with dental implant fracture.
A technique paper on double-crown systems and a case presentation is presented to describe the short-term outcomes of tooth-implant connections using double-crown systems. A 42-year-old man wearing an upper clasp-retaine...A technique paper on double-crown systems and a case presentation is presented to describe the short-term outcomes of tooth-implant connections using double-crown systems. A 42-year-old man wearing an upper clasp-retained removable partial denture visited the department of prosthodontics at Greifswald University Polyclinic to enhance his chewing efficiency and appearance. The patient underwent a thorough evaluation encompassing medical, social, and systemic health assessments and comprehensive extraoral and intraoral examinations; esthetic analyses; and functional screening. Three prosthodontic treatment options were provided. The patient selected the tooth implant-supported, upper, gold-foil, double crown-retained, removable, partial denture (DCRPD) and lower fixed prostheses with a double-crown, tooth implant-supported bridge. The oral health-related quality of life (OHRQoL) and patient satisfaction were measured before treatment and after inserting the DCRPD and cementing the lower fixed prostheses. The patient reported improved retention, support, stability, chewing efficiency, esthetics, and OHRQoL. Measurements recorded after 1 year indicated that these improvements had been maintained. The outcomes in this case report are consistent with those of several long-term clinical studies and systematic reviews.