Anatomic considerations for dental implants

The shape, quantity, and quality of bone in the mandible and maxilla are significant factors in deciding which implant options are possible. An understanding of the importance of each of these factors is necessary for the successful diagnosis of edentulous and partially edentulous arches and for optimum use of the many devices and concepts being promoted to the profession and the public. This paper will discuss the differences between the bone of the mandible and the maxilla and between the dentulous and edentulous areas and how these affect implant treatment. Reestablishment of bone in deficient areas is also discussed.     

LaminOss immediate-load implants: II. Clinical considerations of osteocompression

The sinusoidal thread design of the LaminOss (Impladent Ltd, Holliswood, NY) osteocompressive immediate-load implant is structured with minimal shear interface to function in horizontal planes and stimulate bone growth by the action of streaming potentials at the implant thread surface area. This implant design, when used with a unique surgical instrumentation technique, allows maximum bone to be molded and compacted circumferentially around the sinusoidal implant threads. The surgical technique of bone lamination around larger implant horizontal planes (or load-bearing areas) creates a stable foundation for placing this implant into immediate function. For the past 10 years this surgical procedure has provided patients with immediate function the day of implant placement. The clinical advantage of immediate implant loading enhances care acceptance and patient satisfaction.     

Tissue considerations for mandibular subperiosteal implants.

The criteria for the preoperative evaluation of the residual alveolar tissue for a potential implant patient have been discussed. To ensure a firm epithelial attachment around the implant post, the residual tissue at the point of oral penetration should be: (1) sufficient in amount or thickness and attached to the periosteum, (2) fibrous, not loose, areolar mucosa, and (3) positioned midway over the stress-bearing area for the implant and overlying prosthesis. If the existing tissue does not meet the above criteria, a free palatal graft can be placed over the point of oral penetration to improve the potential for tissue adaptation around the post.     

Patient selection for endosseous dental implants: oral and systemic considerations

This paper reviews the literature and discusses patient selection for endosseous dental implants and the effect of systemic and local pathology on the success rate of dental implants. Endosseous dental implants may be preferable to conventional dentures in patients with compromised supporting bone or mucosa, xerostomia, allergy to denture materials, severe gag reflex, susceptibility to candidiasis, diseases affecting orofacial motor function or in patients who demand optimal bite force, esthetics, and phonetics. Conventional dentures or fixed partial prostheses may be preferable to endosseous dental implants in growing and epileptic patients and patients at risk of oral carcinoma, anaphylaxis, severe hemorrhage, steroid crisis, endocarditis, osteoradionecrosis, myocardial infarction, or peri-implantitis. A systematic approach to dental implant patient selection is outlined and centralized reporting of dental implant outcomes is recommended.     

Periodontal considerations of implants and implant associated microbiota

The scientific and clinical acceptance of the success of osseointegrated dental implants has been firmly established, but the relationships between clinical observation and periimplant pathogenesis is not well understood. Data and concepts regarding the diagnostic value of traditional periodontal evaluation parameters, such as pocket probing depth, bleeding on probing, attachment loss, gingival and plaque indices, and the amount of attached gingiva are discussed. The microbiologic characterization of plaque associated with various implant systems reveals many similarities and some differences compared to natural teeth. An hypothesis for the "periodontal" etiology of implant failure is proposed. The maintenance of edentulous and partially edentulous patients with implants is discussed.     

Aesthetic crown lengthening: classification, biologic rationale, and treatment planning considerations.

The rationale for crown lengthening procedures has progressively become more aesthetic-driven due to the increasing popularity of smile enhancement therapy. Although the biologic requirements are similar to the functionally oriented exposure of sound tooth structure, aesthetic expectations require an increased emphasis on the appropriate diagnosis of the hard and soft tissue relationships, as well as the definitive restorative parameters to be achieved. The development of a clinically relevant aesthetic blueprint and attendant surgical guide is of paramount importance for the achievement of successful outcomes. LEARNING OBJECTIVES: This article provides a classification system that clinicians can use when treatment planning for aesthetic crown lengthening. Upon reading this article, the reader should have: A clear understanding of the involved biological structures. Didactic instruction on the classification and treatment planning for aesthetic crown lengthening procedures.     

The dentin-root complex: anatomic and biologic considerations in restoring endodontically treated teeth.

The restoration of endodontically treated teeth has been the focus of considerable controversy and empiricism. Time-tested methods have been highly successful in some respects, but failures are still apparent. The inherent causes of failure are rarely evaluated and the limitations of specific restorative systems are seldom identified. Regardless of the system, there should be a thorough understanding of the anatomy and biology of the dentin and root supporting the restoration on the part of the practitioner, because both endodontic and restorative procedures alter the hard tissues.     

Osseointegrated implants for partially edentulous patients. Interim considerations

Osseointegration is a clinical application of a biologically investigated host bone response to the placement of threaded unalloyed titanium implants using a meticulous surgical procedure. Its documented successful use as an analogue for the periodontal ligament in endentulous patients has already profoundly altered the predicament of being edentulous. Its application as a treatment modality for partial edentulism offers exciting challenges for the dentist. This article reviewed preliminary experiences from the University of Toronto's Clinical Osseointegration Unit in this area. Although it is tempting to extrapolate the successful longitudinal clinical applications with edentulous patients to partially edentulous ones, discretion and prudence demand that dentists remember that osseointegration for routine treatment of partially edentulous patients is still in its infancy. Until the results from long-term clinical trials in different centres are published, the dental profession cannot yet subsume the versatility and routine application of this exciting technique.