Complications and treatment errors in implant positioning in the aesthetic zone: Diagnosis and possible solutions.

Incorrect implant positioning can lead to functional and aesthetic compromise. Implant positioning errors can occur in three dimensions: mesiodistal, corono-apical, and orofacial. Treatment solutions to manage adverse outcomes through positioning errors require an understanding of the underlying conditions and of those factors that may have led to the error being committed in the first place. These types of complications usually occur because of human factors. If errors do occur with adverse aesthetic outcomes, they are difficult and sometimes impossible to correct. Connective tissue grafts to reverse recession defects are only feasible in defined situations. The option to remove and replace the implant may be the only recourse, provided the removal process does not further compromise the site. Error in judgment by the clinician

Non-invasive assessment of peri-implant mucosal thickness: A cross-sectional study.

BACKGROUND This study aimed to evaluate the reliability and reproducibility of different non-invasive methods for the assessment of peri-implant mucosal thickness. METHODS Subjects with two adjacent dental implants in the central maxillary region were included in this study. Three different methods to assess facial mucosal thickness (FMT) were compared: digital file superimposition using Digital Imaging and Communication in Medicine (DICOM) and stereolithography (STL) files of the arch of interest (DICOM-STL), DICOM files alone, and non-ionizing ultrasound (US). Inter-rater reliability agreements between different assessment methods were analyzed using inter-class correlation coefficients (ICCs). RESULTS A total of 50 subjects with 100 bone-level implants constituted the study population. Assessment of FMT using STL and DICOM files demonstrated excellent inter-rater reliability agreement. Mean ICC values of 0.97 and 0.95 were observed in the DICOM-STL and DICOM groups, respectively. Comparison between the DICOM-STL and US revealed good agreement, with an ICC of 0.82 (95% CI: 0.74 to 0.88) and a mean difference of -0.13 ± 0.50 mm (-1.13 to 0.86). Comparison between DICOM files alone versus US showed good agreement, with an ICC of 0.81 (95% CI: 0.73 to 0.89) and a mean difference of -0.23 ± 0.46 mm (-1.12 to 0.67). Comparison between DICOM-STL and DICOM files revealed excellent agreement, with an ICC of 0.94 (95% CI: 0.91 to 0.96) and a mean difference of 0.1 ± 0.29 mm (LOA -0.47 to 0.46). CONCLUSIONS Quantification of peri-implant mucosal thickness via analysis of DICOM-STL files, DICOM files, or US assessment are comparably reliable and reproducible methods

Peri-implant soft tissue conditioning with provisional restorations in the esthetic zone: the dynamic compression technique

An optimal esthetic implant restoration is a combination of a visually pleasing prosthesis and surrounding peri-implant soft tissue architecture. This article introduces a clinical method, the dynamic compression technique, of conditioning soft tissues around bone-level implants with provisional restorations in the esthetic zone. The technique has several goals: to establish an adequate emergence profile; to recreate a balanced mucosa course and level in harmony with the gingiva of the adjacent teeth, including papilla height/width, localization of the mucosal zenith and the tissue profile's triangular shape; as well as to establish an accurate proximal contact area with the adjacent tooth/implant crown

The Management of Peri-implant Mucosa Deficiencies in Esthetic Sites: Case Report of a Combined Surgical-Prosthetic Approach.

In cases of single missing teeth, implant rehabilitation is generally the preferred treatment option. However, obtaining pleasing esthetic results in the anterior maxillary region and maintaining or rebuilding peri-implant papillae remain challenging tasks. The loss of papillae may cause not just functional but also phonetic and esthetic problems. There is scarce information on the reliability of surgical approaches concerning the peri-implant papilla. The purpose of this case report is to present a modified prosthetic-surgical technique to enhance the convex facial contour of the peri-implant mucosa and volume and height of papillary tissue in an esthetically highly demanding patient

Implant placement post extraction in esthetic single tooth sites: when immediate, when early, when late?

Implant placement in post-extraction sites of single teeth in the esthetic zone has been a topic of great interest in the field of implant dentistry since 1990. Triggered by the development of guided bone regeneration, the concept of immediate implant placement became quite popular in the 1990s. In the past 12 years, however, the dental community has begun to focus increasingly on the esthetic outcomes of post-extraction implant placement and several studies indicated a significant risk for the development of mucosal recessions with immediate implants. Parallel with this, significant progress has been made in the understanding of tissue biology in terms of hard and soft tissue alterations post extraction, based on preclinical, clinical and radiological studies. This knowledge has helped better to understand the etiology of these esthetic complications with immediate implant placement. The present review first analyzes the various phases of the development of therapeutic strategies over the years for post-extraction implant placement in single tooth sites in the esthetic zone. It presents the current knowledge concerning the terminology with immediate, early and late implant placement, the risk factors for the development of esthetic complications, and the selection criteria for the various treatment options. In the second part, clinical recommendations are given, since a clinician active in this field of implant therapy can use all treatment options depending on the preoperative analysis including a 3D cone beam computed tomography. The selection criteria for all four treatment options are presented and documented with typical case reports to illustrate the current treatment approaches applied in daily practice

Early implant placement following single-tooth extraction in the esthetic zone: biologic rationale and surgical procedures

Early implant placement is one treatment option for implant therapy following single-tooth extraction in the anterior maxilla. The surgical technique presented here is characterized by tooth extraction without flap elevation, a 4- to 8-week soft tissue healing period, implant placement in a correct three-dimensional position, simultaneous contour augmentation on the facial aspect with guided bone regeneration using a bioabsorbable collagen membrane combined with autogenous bone chips and a low-substitution bone filler, and tension-free primary wound closure. The surgical step-by-step procedure is presented with a case report. In addition, the biologic rationale is discussed

Early loading of non-submerged titanium implants with a sandblasted and acid-etched surface: 5-Year results of a prospective study in partially edentulous patients

Objectives: The aim of this prospective cohort study was to evaluate the success rate of titanium screw-type implants with the sandblasted and acid-etched (SLA) surface loaded early, after 6 weeks of healing. Material and methods: A total of 104 implants were inserted into posterior sites of 51 partially edentulous patients exhibiting bone densities of class I-III. After a healing period of 6 weeks, all implants were functionally loaded with cemented crowns or fixed partial dentures. The patients were recalled at 3, 12, 24, 36, 48 and 60 months for clinical and radiographic examination. Results: One implant failed to integrate during healing, and three implants were lost to follow-up and were considered drop-outs. The remaining 100 implants showed favorable clinical and radiographic findings at the 5-year examination. The peri-implant soft tissues were stable over time; the mean probing depths and mean attachment levels did not change during the follow-up period. None of the radiographs exhibited signs of continuous peri-implant radiolucency, which confirmed ankylotic stability for all 100 implants. The measurement of the bone crest levels (DIB values) indicated stability as well. Based on strict success criteria, all 100 implants were considered successfully integrated, resulting in a 5-year success rate of 99%. Conclusion: This prospective study using an early loading protocol with 6 weeks of healing demonstrated that titanium implants with the SLA surface can achieve and maintain successful tissue integration with high predictability for at least 5 years of follow-up in selected patients and sites. Copyright © Blackwell Munksgaard 2005.Link_to_subscribed_fulltex

Early loading of nonsubmerged titanium implants with a sandblasted and acid-etched (SLA) surface: 3-Year results of a prospective study in partially edentulous patients

Purpose: The aim of this study was to evaluate the success rate of ITI implants with the SLA surface that were loaded after 6 weeks of healing. Materials and Methods: In this prospective cohort study, a total of 104 implants were placed in posterior sites of 51 partially edentulous patients exhibiting bone densities of Class 1, 2, or 3. After a healing period of 6 weeks, all implants were functionally loaded with cemented crowns or fixed partial dentures. The patients were recalled at 3, 12, 24, and 36 months for clinical and radiographic examination. Results: One implant failed to integrate during healing, and 1 implant was lost to follow-up and considered a dropout. The remaining 102 implants showed favorable clinical and radiographic findings and were considered successfully integrated at the 3-year examination. This resulted in a 3-year success rate of 99.03%. Discussion: The peri-implant soft tissues were stable over time, as evidenced by no changes in the mean probing depths and the mean attachment levels during the follow-up period. None of the radiographs exhibited signs of continuous peri-implant radiolucency, which confirmed ankylotic stability of all 102 implants. The radiographic evaluation of the bone level at the implant indicated stability of the bone crest levels. Conclusion: The results of this prospective study demonstrated that early loading of ITI implants with the SLA surface after an unloaded healing period of 6 weeks provided successful tissue integration with high predictability, and that successful tissue integration was well maintained up to 3 years of follow-up in this study population.Link_to_subscribed_fulltex