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Immediate one-stage postextraction implant: a human clinical and histologic case report.

The placement of an implant immediately after tooth extraction may have the following advantages: reduction in morbidity, treatment time, and treatment costs; preservation of the residual ridge width and height; optimal esthetic result; and easier definition of implant position. The aim of the present study was the presentation of a human clinical and histologic report involving a nonsubmerged implant placed in a mandibular postextraction site and removed because of persistent pain. At low-power magnification, it was possible to see that newly formed bone with wide osteocyte lacunae was present around the implant. A 1.5-mm sulcular epithelium was visible on one side of the implant, with a 0.5-mm epithelial attachment. The thickness of the supracrestal connective tissue was 3.2 mm. This connective tissue was dense, had few cells, was well vascularized, and showed no evidence of an inflammatory infiltrate. Under polarized light, it was possible to observe that the connective fibers were arranged perpendicular to the implant surface and that these fibers became parallel near the implant. These results show that human immediate postextraction implants can have a high percentage of bone-implant contact.

Alveolar Process↗

Healing of dehiscence defects at delayed-immediate implant sites primarily closed by a rotated palatal flap following extraction.

In 21 patients, 28 maxillary teeth were extracted because of periapical or periodontal infection, root fracture, or untreatable caries. A rotated palatal flap procedure was used to achieve primary soft tissue closure over extraction sites. At 5 to 7 weeks postextraction, 28 implants were placed. Buccal dehiscence-type defects were treated with guided bone regeneration procedures using bovine bone mineral and resorbable collagen membranes. Mean defect area at the time of implant placement (23.7 mm2, SD 11.49) was significantly reduced at uncovering (0.7 mm2, SD 0.99). The mean percentage of defect reduction (clinical bone fill) was 97% (SD 4.26). Implants placed in compromised sites shortly postextraction according to the presented 2-stage protocol gave good short-term clinical results.

Adult↗

Clinical coverage of dehiscence defects in immediate implant procedures: three surgical modalities to achieve primary soft tissue closure.

In 61 patients, 61 consecutive implants were placed immediately after extraction of one anterior or premolar maxillary tooth. One of 3 surgical approaches based on rotated full (RPF) or rotated split (RSPF) palatal flaps, with and without the use of barrier membranes to enable primary soft tissue closure, was applied. A bovine bone mineral graft was used in all cases. At the time of implant placement, the distance between the most apicobuccal alveolar crestal bone and the coronal aspect of the implant body was measured; this was measured again at second-stage surgery. All implants appeared clinically stable. The buccal crestal bone gain was statistically significant for all groups (RPF = 2 mm, RSPF = 1.6 mm, RSPF with membrane = 3.7 mm) (P < .001). Analysis of covariance showed a significant covariant for preoperative measurements; however, this was not significant between groups.

Alveolar Process↗

Ridge preservation of dentition with severe periodontitis.

Severe loss of alveolar bone height and width can occur following the removal of teeth with advanced periodontitis. This compromise of the alveolar bone can limit the options available for achieving an acceptable dental restoration. Two case reports are presented of alveolar ridge augmentation after tooth removal and before implant placement using bone grafting and a biodegradable membrane. The resultant alveolar ridges in both patients were adequate for the placement of dental implants.

Adult↗

Immediate loading of single-tooth implants: immediate versus non-immediate implantation. A clinical report.

The hypothesis of the present study was that immediate loading of implant-supported restorations replacing single missing teeth could be a successful procedure. The present study compared the clinical success of immediately loaded single-tooth implants placed in fresh extraction sites to that of immediately loaded single-tooth implants placed in healed sites. From the years 1997 to 1998, 26 patients, ranging in age from 18 to 70 years, presented for the placement of 28 immediately loaded implants intended to support single-tooth ceramometal restorations. Nineteen implants were placed into fresh extraction sites, and 9 implants were placed into healed sites. Temporary prefabricated acrylic resin crowns were prepared and adjusted. At the time of traditional second-stage surgery (3 to 6 months after implantation), the implants were restored with single-tooth ceramometal prostheses. The survival rates were 82.4% and 100% for immediate and non-immediate implants, respectively. Follow-up ranged from 6 to 24 months from the day of implant placement, with a mean of 13 months for the immediate implants and 16.4 months for the non-immediate implants. Radiographic marginal bone loss after 3 to 6 months did not extend beyond the abutment-implant junction. Within the limits of the present investigation, immediate loading of single-tooth implants placed in healed sites is a possible treatment alternative. Immediate loading of single-tooth implants placed in fresh extraction sites carried a risk of failure approximating 20% in this patient population.

Adolescent↗

Postmortem tooth loss in human identification processes.

Teeth provide essential data for human identification. However, they are frequently lost during the process of skeletonization or under manipulation during exhumation. Because of the high frequency of postmortem tooth loss, this phenomenon was examined in three different samples, in an attempt to simulate the actual circumstances experienced in the forensic processes of identification of human remains. The method employed aimed to describe and quantify dental spaces, distinguishing between loss after death or before by extraction. The results showed a high prevalence of postmortem tooth loss: 41.37% in sample A, 56.83% in sample B and 3.96% in sample C. These losses were most frequent in the maxillary incisor group in all three samples analysed. These data underline the need for redoubled care in recovery, transportation and storage of crania, so that teeth are not lost, which could seriously compromise the identification process.

Forensic Dentistry↗

Prosthetic concerns about atrophic alveolar ridges.

Recently, research has provided much insight into the problem of residual ridge resorption. It has become clear that ridge maintenance and preservation dramatically improves the quality of restorative dentistry provided, in addition to lessening the complexity of the treatment plan for the dentist. This article discusses the concerns, difficulties, and prosthetic challenges that must be addressed when restoring a patient with residual ridge resorption to acceptable function and esthetics. While patients can expect to lose a significant portion of their residual ridge as a result of normal physiologic activity, frequently resorption is the result of tooth extraction. The importance of postextraction grafting with calcium phosphates and the complexity of the prosthodontic rehabilitation needed to restore residual ridge resorption patients is also reviewed.

Alveolar Process↗

Ridge preservation utilizing an alloplast prior to implant placement--clinical and histological case reports.

A calcified copolymer alloplast (Bioplant HTR, Bioplant Inc., South Norwalk, CT) was utilized to fill osseous defects in five patients. Hard tissue cores were obtained from the grafted sites and prepared for biopsy. In one patient, the lining of a soft tissue flap was biopsied 8 months postgrafting. Histological evaluation of the specimens revealed that the copolymer particles placed adjacent to the bony defect walls served as an osteoconductive material in which vital remodeling bone and marrow formed and fused to the surface of the particles. This process of bone deposition and remodeling was present 11 years following grafting.

Adult↗

Immediate placement and provisionalization of maxillary anterior single implants: a surgical and prosthodontic rationale.

Maintaining the existing gingival architecture of a failing maxillary anterior tooth is essential in achieving an optimal aesthetic result. Immediate implant placement has been advocated to minimize tissue loss following extraction. The incorporation of a customized temporary abutment and immediate fixed provisionalization facilitates maintenance of the gingival architecture for optimal aesthetics and eliminates the need for a removable provisional prosthesis during the healing phase. This article describes the surgical and prosthodontic approach of this procedure as well as its clinical rationale.

Acrylic Resins↗

Efficacy of porous bovine bone mineral in various types of osseous deficiencies: clinical observations and literature review.

Recent developments in osseous regenerative techniques have increased the demand for bone-substitute grafting materials. Porous deproteinized bovine bone mineral (PBBM), a biocompatible xenograft, has been used in different osseous deficiencies prior to or in conjunction with the placement of titanium implants. The different PBBM applications in fresh extraction sites, anatomic defects, and subantral floor elevation techniques are described. The use of an occlusive barrier membrane to regenerate bone via guided tissue regeneration principles was determined for each patient by clinical parameters. PBBM was well amalgamated and incorporated with the augmented hard tissue, but the transition between preexisting bone and the newly regenerated bone-like tissue was distinguishable by clinical examination even after 12 months. Grafted material was also identified using follow-up radiographs. In the presented cases, PBBM showed clinically satisfactory results as a biocompatible filler in bone augmentation procedures.

Adult↗

Immediate functional loading of immediate implants in edentulous arches: two-year results.

The purpose of this study was to evaluate the clinical success of immediate functional loading of immediate implants in edentulous arches. Five maxillary and five mandibular jaws were treated, and a total of 91 implants were placed; 66 of these implants were placed immediately after tooth extraction, and 25 were placed in healed sites. No bone substitutes or barrier membranes were used. Within 24 hours, fixed temporary restorations were inserted in all cases. During the entire 6-month healing time, all fixed temporary restorations were in normal function, after which the final fixed implant-supported restorations were inserted. After 24 months, the overall success rate of the implants was 92.31% (87.50% for the maxillary implants and 97.26% for the mandibular implants). The bone level measured mesially and distally was in 93.40% of all cases between the implant shoulder and the first thread. The present study shows that the immediate functional loading of immediate implants without the use of any bone substitutes or barrier membranes for fixed complete-arch reconstructions can be successful over a 2-year period.

Adult↗