The Journal of Implant & Advanced Clinical Dentistry

CZRAM for Implant Site Development

Thursday, September 27th, 2018

6. Custom Zirconia Ridge Augmentation Matrix (CZRAM) for Implant Site Development: A Report of Two Cases

This is a report of two cases describing the use of custom zirconia ridge augmentation matrices (CZRAM) to effectively augment deficient alveolar ridges prior to dental implant placement. 3D computer-aided design (CAD) of customized zirconia rigid space maintenance devices was carried out using a baseline cone beam CT (CBCT) scan of the deficient ridges, and the devices were milled from partially-sintered zirconia blocks using a five-axis dental mill.

16. Repair of Dental Implant Induced Inferior Alveolar Nerve Injuries with Dehydrated Human Amnion-Chorion Membranes: A Case Series

Dental implant treatment has become a common treatment modality for the replacement of missing teeth. As the number of implants placed annually continues to increase, so too has the incidence of iatrogenic nerve damage secondary to implant placement. Over the past decade, a handful of conservative protocols have been proposed for the treatment of neural maladies following the placement of dental implants with varying degrees of success. Recent advances in biologic growth factor technology have introduced products that may serve as adjuncts in the treatment of neural injury.

30. Full Mouth Rehabilitation with Immediate Implants and Fixed Prosthetics: A Surgeons’ Prospect and Critical Review

Dental implants have become the preferable choice of restoring the missing teeth for the patient, which made the dental professionals look for the best implant systems, advanced research, and techniques for constant improve in the quality of patients life. Dental implants can be placed immediately after the extraction – “Immediate implants” or can be placed after complete healing of the extraction site – Delayed Implants. This article is about the author’s experience with full mouth immediate implants and explained the critical factors that influenced the outcome.

36. Extra-Short Implants for Rehabilitation of Atrophic Ridges: A Retrospective Study with up to 5 Years of Follow-Up

The bone augmentation techniques suggested by literature including onlay bone grafts, guided bone regeneration (GBR), maxillary sinus elevation and distraction osteogenesis (DO) have been proved effective in regaining bone volume. However these approach techniques can present multiple complications and morbidity after surgery, with prolonged treatment duration and extra costs. Short implants could be a simpler, cheaper and faster alternative than augmentation procedures, if they can be shown to result in similar success rates. Recently the use of extra-short implants (6 mm) has been reported with good outcomes 5-8 and promising results have been published in comparison with alveolar bone augmentation techniques.

48. Leveraging the Dental Hygienist to Promote the Periodontal Practice

Periodontal referral is declining, and a dental office must market itself to alert potential patients to its existence. Offering a free cleaning to new patients is a marketing tool that pays long-term dividends in return visits for dental hygiene or periodontal surgery. The number of active dental hygiene patients is a measure of the practice’s financial health, as this service accounts for 40-60% of the office’s income.

Fibrous Dysplasia

Thursday, August 2nd, 2018

6. Fibrous Dysplasia of the Mandible: A Case Report

Fibrous dysplasia is a skeletal developmental disorder of the bone forming mesenchyme that manifests as a defect in osteoblastic differentiation and maturation. It is a lesion of unknown etiology, uncertain pathogenesis, and diverse histopathology. Fibrous dysplasia represents about 2.5% of all bone tumours and over 7% of all benign tumours. The aim of this article is to present a rare case report of monostotic fibrous dysplasia of posterior mandible in a forty seven year old asymptomatic Indian female and its interdisciplinary management.

12. Florid Cemento-Osseous Dysplasia of the Jaws: Report of a Rare Case

Florid Cemento-Osseous Dysplasia (FCOD) is a rare “fibro-osseous” lesion that characteristically affects the jaw bones in middle aged individuals. The condition is usually asymptomatic and needs no treatment. The diagnosis of FCOD is made typically on the basis of clinical and radiological features and biopsy is generally not recommended due to the risk of post operative secondary infection. This article reports a rare case of FCOD affecting the maxilla and mandible as an incidental finding in a sixty three year old asymptomatic Indian female patient.

20. Analysis of the Mechanical Behavior of Components of Osseointegrated Implants Submitted to Maximum Compression

Adell et al. presented a longitudinal clinical study of the protocols proposed by Brånemark, where the clinical behavior of osseointegrated implants was evaluated over 15 years. In this study, the authors confirmed the predictability and high success rate of this new modality of treatment, as well as analyzed its complications and failures

26. Developing a Long-Term Relationship with Patients: The Role of the Dental Hygienist

Dental insurance policies typically include two free cleanings per year, a service performed by dental hygienists; these professionals, therefore, bring new patients to the dental practice. Since most patients desire and can probably afford a teethcleaning session, they are likely to schedule one ( The patients’ self-driven motivation is a valuable opportunity for an office to invest in a strong dental hygiene program, and proper planning and staffing will make such a program an investment yielding high returns.


Odontogenic Keratocyst Marsupialization and Decompression

Wednesday, June 13th, 2018

6. Odontogenic Keratocyst Treatment with Marsupialization and Decompression: A Case Series

Odontogenic cysts such as the odontogenic keratocyst are benign lesions that have the potential for aggressive infiltrative behavior and undesirable comorbidities. Treatment of these lesions with conservative techniques such as marsupialization and decompression have proven and lasting benefits. The following series presents two cases in which conservative treatment of odontogenic keratocysts resulted in lesion elimination, spontaneous bone fill, and stability lasting at least 5 years.

12. 3-D Printing of a Customized Bone Scaffold using Beta- Tricalcium-Phosphate, Alginate, and Cellulose Nanofibers: A Novel Test

Three-dimensional bio printing of tissues and biological structures has been proposed to enable precise manufacture of various biomaterials with complex 3D architectures, while being compatible with multiple cell sources and being customizable to patient-specific needs. The construct developed presented with mechanical stiffness that can be transported to an intra-oral bone defect and secured to the recipient site.

16. The Role of Antimicrobials in the Success Rate of Dental Implants

Single tooth replacement implants were placed following two-staged implant placement protocol under aseptic conditions. In the test group, 430 patients were randomly prescribed with an antibiotic, whereas in the control group 430 patients were randomly prescribed with a non-steroidal anti-inflammatory drug after implant procedure. Patients were scheduled for a regular check-up every 6 months. At the end of three years, 8 implants were lost from test group and 11 implants from the control group.

24. Periodontal Perspectives of Autologous Blood Preparations

Periodontitis is an infectious disease of the dental attachment apparatus. Untreated periodontitis leads to bone loss and attachment loss. Though several periodontal treatments are available, only some of them are regarded as true regeneration. Regeneration is reconstitution of both hard and soft tissues in both structure and function. Various modalities such as bone grafts and substitutes, guided tissue regeneration (GTR) membranes and polypeptide growth factors (PGFs) are used for periodontal regeneration. Platelet concentrates are the richest source for polypeptide growth factors. This review highlights various platelet concentrates, and their clinical applications in the treatment of periodontal diseases.


Rebuilding Buccal Plate Deficiency During Immediate Implant Placement

Wednesday, May 2nd, 2018

6. A New Technique for Rebuilding the Buccal Plate during Placement of Immediate Dental Implants in an Extraction Site with Buccal Defects

The final decision when placing a dental implant in an extraction site must be done looking at the integrity of the socket walls. When the buccal plate is partially or totally lost, the primary treatment goal is to preserve the socket until it matures for good implant stability and good esthetic results. What this technique proposes is to allow an immediate implant placement without the problems, esthetic and functional issues of the future final restoration.

16. The Bernotti V-Y Flap: An Alternative to Manage Soft Tissue Esthetic Issues with Implants

Mucosal issues such as inflammation, swelling, fistulas, lack of sufficient keratinized tissue, deficient buccal contour volume, recession and thin biotype became treatment challenges with implant and natural tooth restorations, especially when less than ideal 3D position implant placement has resulted. Management of the soft tissue with an inadequate flap incision may complicate surgical results instead of improving the clinical situation, leading to apical mucosal recession and the resulting aesthetic complications that may ensue. The “Bernotti V-Y Flap” eliminates the complications reported with other approaches to correct these clinical issues.

28. Soft Tissue Augmentation to Increase Width of Keratinized Tissue Around Dental Implants Using Tissue Fixation Screws: A Novel Technique for Graft Tissue Stabilization

Presence of adequate width of attached gingiva for longevity of implants has long been debated upon. The implant-mucosa interface differs from the interface between the mucosa and natural teeth, and these differences are important to the understanding of the susceptibility of implants to infection. Few studies have examined the relationship between the width of keratinized mucosa and the health of peri-implant tissues. The results of these studies are contradictory.

34. The Waya Technique: A Novel Approach Using a Palatal Flap of Apical Repositioning for Primary Tension-Free Closure in Maxillary Bone Augmentation

The success of the processes of horizontal bone augmentation requires that the procedure has a tension-free closure. The greatest challenge in these regenerative techniques is to establish a flap design that covers an increased dimension after the bone graft had been applied to the defect; for this objective there are frequently using alternatives, but they cause loss of vestibular depth and keratinized mucosa, that cause functional and aesthetic discomfort.


Platelet Rich Fibrin Augmentation

Wednesday, February 28th, 2018

6. Bone Augmentation with Platelet Rich Fibrin, Particulate Bone and Cortical Plates

Complex bone defects could be challenging and treatment planning confusing with multiple alternatives available for treatment. The aim of this study is to evaluate clinically the result of bone augmentation mixing platelet rich fibrin with particulate bone and cortical plates. Clinical success was achieved with this bone augmentation technique for different bone defects. 6 months after grafting, vascularity and integration were clinically observed.

16. Simplified Ridge and Extraction Socket Augmentation using Sohn’s Poncho Technique

Bone augmentation is essential before placing a dental implant in an atrophic edentulous ridge. Guided bone regeneration techniques have recently incorporated autologous fibrin membranes with concentrated growth factors to enhance healing. This article presents Sohn’s Poncho Technique which is a method to utilize the healing capacity of CGF or PRF autologous membranes in an open wound when performing localized guided bone regeneration techniques.

38. Amnio Cord in the Treatment of Gingival Recession: A Report of Two Cases

Treatment of gingival recession has been one of the core areas of practice in periodontics for either increasing the zone of keratinized tissue to root coverage. Through the years, the treatment ranged from the use of gingival flaps, autografts, xenografts and acellular dermal allografts. The benefits of the procedures aim towards improving esthetics and eliminating exposed dentin hypersensitivity. The Amnio cord is the structure that encircles the blood vessels in the umbilical cord and been used in tissue engineering in the medical field. The healing of the surgical area was uneventful and resulted in a visible increase in the keratinized gingival tissue.

44. The Use of Steroeolithography in Dental Implant Placement: A Case Report

While smile analysis and design has been routinely used by cosmetic dentists, prosthodontists, and orthodontists to help plan and execute treatment, they are not typically utilized by dental implant surgeons. Because of this, a breakdown in communications between the lab, surgeon, and restorative dentist can sometimes lead to less than optimal final results for full arch immediately loaded dental implant cases. The DIAsmile™ smile analysis and design protocol provides a systematic and standardized manner in which the smile of a patient can be analyzed pre-surgically and an aesthetic restoration planned.


Palatal Torus Removal and Stereolithographic Modeling

Wednesday, January 24th, 2018

6. Torus Palatinus: A Brief Review of the Literature and Case Report of Removal

The Torus Palatinus is a specific type of exophytic bony protuberance that can have profound effects on certain patients. While typically slow growing and asymptomatic in most patients, Torus Palatinus can lead to chronic pain and frustration for patients with prosthetic devices such as complete dentures. The following article provides a brief review of the literature regarding Torus Palatinus and a Case Report in which this type of bony growth was removed to facilitate better maxillary complete denture comfort for a long suffering patient.

12. Comparison of the Linear Dimensional Accuracy and Detail Representation in Stereolithographic Models of a Human Mandible: An In-Vitro Pilot Study

The accuracy of stereolithographic models produced by commercial biomedical laboratories using cone beam computed tomography (CBCT) data has not been investigated. The purpose of this study was to determine the accuracy of stereolithographic models of a human mandible produced by three commercial biomedical laboratories using data acquired from cone-beam technology. All three laboratories models exhibited significant differences when the measurement were at the reference notches, only thirteen out of 30 sites had no significant differences when height of contour were used for measurements.

28. Ridge Splitting Crest Technique and Simultaneous Implant Placement in a Patient with Severe Maxillary Ridge Atrophy and Palatal Torus: A Case Report

Severe maxillary atrophy frequently limits dental implant placement. In the presence of a protruding palatal torus, such a situation may further condition the final prosthetic reconstruction. The width of the average preoperative alveolar ridge measured in the CBCT was 2.8 mm and increased to 5.2 mm 5 years after surgery. This technique allows the volume to be increased horizontally and the simultaneous placement of the implants, being highly predictable, safe and comfortable for the patient…

36. The DIAsmile™ Smile Analysis and Design Protocol for Full Arch Immediately Loaded Implant Dentistry

While smile analysis and design has been routinely used by cosmetic dentists, prosthodontists, and orthodontists to help plan and execute treatment, they are not typically utilized by dental implant surgeons. Because of this, a breakdown in communications between the lab, surgeon, and restorative dentist can sometimes lead to less than optimal final results for full arch immediately loaded dental implant cases. The DIAsmile™ smile analysis and design protocol provides a systematic and standardized manner in which the smile of a patient can be analyzed pre-surgically and an aesthetic restoration planned.



Neurofibromatosis Type 1 Rehabilitation with Dental Implants

Monday, December 4th, 2017

6. Dental Rehabilitation of a Patient with Neurofibromatosis Type 1

Neurofibromatosis not only manifests in several physical issue but may also affect the oral cavity. Rehabilitation of the dentition will likely involve several dental specialty disciplines in coordination with medical colleagues. This case report demonstrates the coordination of treatment of a neurofibromatosis type I (NF1) patient to correct her dental issues along with efforts to improve her facial deformity.

14. Prosthetic Implant Management of Extraction Site Following Removal of Anterior Tooth

The Extraction Defect Sounding (EDS) classification has importance in helping the clinician in establishing an appropriate plan for surgical implant treatment. This classification sometimes comes up short and no detailed recommendation of the provisional stage is described before and after surgical treatment in the esthetic zone. The purpose of this paper is to describe all possible provisional techniques available to restore a single tooth in the anterior esthetic zone and to give recommendations to the preferable techniques during site development and implant placement according to the EDS classification.

28. A Novel Technique to Optimize Screw-Retained Implant Restorations

This paper discusses the challenges of fabricating screw-retained implant supported restorations in clinical situations. Due to either non-ideal anatomy, or inadequate surgical alignment, screw holes for restorative retention often emerge out of restorations in poor position. As clinicians are faced with mounting evidence of peri-implantitis associated with cement restorations, screw-retained restorations are becoming more prevalent in clinical situations. There is an increasing need for technologies to assist in optimizing restorations where implant placement is non-ideal. The new angulated screw channel technology has provided a workable solution to satisfy the clinical requirements for excellence while employing screw-retained restorations.


Hybrid Dental Implants

Saturday, November 4th, 2017

6. Hybrid Dental Implants as an Alternative to Conventional Dental Implants, Eliminating the Need for Associated Ridge Augmentation Procedures

Bone augmentation procedures are demanding concerning surgical skills and biostability of materials. As such, the revolution of advancements and search for alternative procedures for the replacement of missing teeth has evolved to avoid obvious problems and complications of bone augmentation procedures. The hybrid dental implants utilized in these cases provide proof of principle that this is a viable alternative to traditional dental implants when bone augmentation would be normally required.

12. Gingival Revitalization by Inverted Gingival Pouch (IGP) Technique

The reconstruction of bone and soft tissue in implant therapy for periodontally compromised patients is challenging. Based on our previous findings of periodontal surgery, a 10-year follow-up multicenter case series study was carried out in the United States, China and Taiwan. In the current article, we introduce a novel periodontal surgical procedure for Gingival Revitalization using the Inverted Gingival Pouch (IGP) Technique. The Inverted Gingival Pouch Technique might be potentially useful in achieving the goals of periodontal infection control, soft tissue regeneration, including increased width and thickness of keratinized tissue, bone augmentation, improved aesthetics, clinical safety, and efficiency.

26. The Comparison of Implant Stability Between Two Dental Implant Surfaces using Resonance Frequency Analysis: A Pilot Study

Although the chemically modified implant topography proves its positive rapid bone formation effect, the comparative studies on implant stability changes between the standard and modified surfaces are limited. Methods: Thirty patients were selected randomly into two groups: Straumann SLA and Straumann SLActive (Straumann Institute AG, Waldenburg, Switzerland). CBCT was
used to determine the quantity and quality of bone. RFA measurement was performed on day 0 and 2; week 1, 2, 3, 4 and 8. The relationship between ISQ values, implant surface or bone quality were analyzed statistically.

38. Decontamination of Titanium Surfaces with Air Polishing and Glycine Powder

The efficacy of removing bacteria from smooth-surface titanium using an air-polishing device with glycine powder abrasive was evaluated. For smooth surface titanium, air polishing with glycine powder and water, glycine powder alone, water alone, or tetracycline and water significantly reduced the amount of Streptococcus oralis, Streptococcus mutans, Aggregatibacter actinomycetemcomitans, and Tannerella forsythia.

Biotype Tissue Change at Second Stage Implant Surgery

Thursday, October 5th, 2017

6. Change of Tissue Biotype at Second Stage Implant Surgery: Report of an Alternative Method of Connective Tissue Graft Positioning Concurrent to Membrane Removal

Due to the limited spaces between an implant and neighboring teeth, ideal positioning of the connective tissue grafts at the time of membrane removal may be challenging if the healing abutments are connected at the same intervention. To overcome this difficulty an alternative method of graft positioning and stabilization is described in this case report. Briefly the graft is located by the healing abutment and further secured by a modification of internal mattress suture.

12. Immediate Versus Early Loading of Short Straumann® TE Implants in the Posterior Mandible: 10 Year Results of Randomized Control Clinical Trial

The study aim was to compare clinical results of immediate and early loaded SLActive self-tapping implants. Methods: Fifteen patients with bilateral edentulous posterior mandibular were randomly assigned to treatment either with immediate or early loaded implants. Ninety implants were analyzed. The implant stability quotient was follow in the first year and bone resorption 1, 5 and 10 years after loading.

24. The Choice of Radiographic Imaging for Dental Implant Placement: A Pilot Survey among Indian Dentists

The present era of implant dentistry has seen exponential growth and its success mainly depends upon a proper treatment planning and its execution. Radiographic imaging has a pivotal role in the planning of implant placement and to keep the check on implant survival. Aim – To survey the radiographic prescription trends among the dental practitioners. Within the limitation of the study, it
was observed that the majority of dentists sampled prescribe panoramic radiographs for dental implant assessment based on its availability.

32. Prospective Clinical Evaluation of the Behavior of Single 6mm Length Dental Implants Installed in the Posterior Mandible: 36 Months Follow Up

The purpose was to evaluate the clinical, biological and mechanical behavior of short single osseointegrated implants (6mm) in the posterior mandible over a 36 month period. A total of 58 implants were installed in 51 patients, 18 men and 33 women with an average age of 46.2 years. Average surgical insertion torque of 50Ncm was achieved and a success rate of 100% was observed in 36 months of follow up. Only mechanical complications such as loosening of prosthetic screw, clinically detected by the mobility of the crown, and biological complications, associated with plaque such as mucositis, detected by clinical inspection were observed.

6 Year Multi-Center Study on Osseofuse Dental Implants

Tuesday, August 29th, 2017

6. Osseofuse HexaPlus Dental Implants: A 6-Year Retrospective Follow-Up of Over 250 Implants

Advances in technology have allowed contemporary dental implant systems to achieve success rates that routinely exceed 95% across all brands and models. With such predictable success, clinicians often base their choice for dental implants on certain unique features associated with different systems. While some clinicians focus on costs associated with dental implant systems, others seek ease of use and simplicity. The following retrospective report documents use of more than 250 Osseofuse® HexaPlus™ dental implants by multiple private practicing clinicians and provide a discussion regarding the unique attributes that compelled these clinicians to choose this system over others.

16. Immediate Implant Post-Extraction of Impacted Maxillary Canine: A Clinical Case Report

This clinical report outlines the surgical and restorative steps involved when a patient presented with an impacted maxillary canine. The patient was treated with extraction and immediate implant placement. This was a challenge due to the bone resorption frequently associated with complex tooth extraction that often necessitates bone regeneration in these cases. This report suggests that this treatment for maxillary impacted canines with dental implants is viable with a good outcome both functionally and aesthetically, although more work is needed to strengthen an adequate protocol of this treatment alternative.

22. An Economical Approach to the Establishment of Occlusal Guidances: A Case Report

Whenever treatment is performed on a patient that does not have a concrete foundation of evidence in the literature, one must always consider the ethical considerations before performing irreversible treatment. At all costs, respecting patient autonomy and practicing within a standard of care that is nonmaleficence must always occur. The topic of occlusal rehabilitation and the value of the literature available on the topic are of much discussion in dentistry. After an exhaustive literature search, the same conclusions can be drawn time after time, more research is needed, however many of the research articles analyzed gave recommendations to provide a functional and optimal standard of care when modifying or establishing occlusal scheme in a patient.

30. Prosthetic Implant Management of Extraction Site after the Removal of a Single Anterior Tooth

The EDS classification has its importance in helping the clinician in establishing appropriate plan for surgical implant treatment. This classification came short and no detailed recommendation of the provisional stage was described before and after surgical treatment for the esthetic zone. The purpose of this paper is to describe all possible provisional techniques available to restore a single tooth in the anterior esthetic zone and to give recommendations to the preferable techniques during site development and implant placement according to the EDS classification. It is strongly advisable to have a preplanning session for the preparation of a vacuum heat formed template and ovate pontic(s).


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