Orthodontically Assisted Vertical Augmentation in the Esthetic Zone

Severe periodontal disease leading to tooth loss causes multiple challenges when treatment planning replacement of these teeth with implant‐supported restorations. Provisionalization and transitioning the patient from natural dentition to implant‐supported restorations without use of removable prostheses can be difficult to achieve. A detailed evaluation and comprehensive treatment plan should precede extraction of the affected teeth. Forced eruption as a method of modifying the osseous and gingival topography has been established. This clinical report illustrates the use of nonmaintainable teeth to simultaneously develop the site for future implant placement, as well as support a fixed interim restoration during treatment. Patient was classified as an American College of Prosthodontists Prosthodontic Diagnostic Index (ACP PDI) class IV patient.     

Minimally Invasive Treatment for Papillae Deficiencies in the Esthetic Zone: A Pilot Study

Background: The presence of papillary deficiencies adjacent to dental implants or teeth presents an esthetic concern for the dental team and patients. Purpose: The aim of this pilot project is to evaluate a new method for reducing or eliminating small papillary deficiencies. The use of a commercially available gel was evaluated as a possible method for enhancing deficient papillae. Materials and Methods: Eleven patients, seven females and four males, with an average age of 55.8 years (ranging from 25 to 75 years) with 14 treated sites are included in this pilot study. Patients had a minimum of one papillary deficiency in the esthetic zone. Prior to treatment photographs were either taken at a 1:1 ratio or converted to a 1:1 ratio using a commercially available program. A standardization photographic device was not used. After administration of a local anesthetic, a 23‐gauge needle was used to inject less than 0.2 mL of a commercially available and Food and Drug Administration‐approved gel of hyaluronic acid 2–3 mm apical to the coronal tip of the involved papillae. Patients were seen every three weeks and treatment was repeated up to three times. Patients were followed from 6 to 25 months after initial gel application. A computer program measured changes in pixels between initial and final treatments. A formula was derived to determine percentage change in the negative space between initial and final examinations. Results: Each site was individually evaluated. Three implant sites and one site adjacent to a tooth had 100% improvement between treatment examinations. Seven sites improved from 94 to 97%, three sites improved from 76 to 88%, and one site adjacent to an implant had 57% improvement. Conclusion: Results from this pilot study are encouraging and present evidence that small papillary deficiencies between implants and teeth can be enhanced by injection of a hyaluronic gel. Improvements were maintained for a range of 6 to 25 months.     

Soft Tissue Modeling for the Esthetic Single-Tooth Implant Restoration

Abstract: The ability of the restorative dentist to understand and control the relation of the implant to its associated gingival tissues is extremely important in achieving the maximum esthetic result in the final restoration. The position of the gingival margin following stage-two surgery represents collapse of the gingival tissues until it finds support by the component against which it comes to rest. This component may be a healing abutment, final abutment, or provisional restoration, if placed at the same time of implant exposure. Generally, it will be a healing abutment. There is a complex relation between implant position, gingival management at stage-one and stage-two surgery, the position of the gingival margin over the buccal surface of the implant compared to the adjacent natural teeth, component selection, and lip line esthetics. The therapist who understands these relations will know how to mold the gingival tissue around implants to maximize the esthetic result. This article focuses on these relations and the technique of tissue modeling with subgingival contours to create a restoration with the illusion of reality.     

Periodontal and Other Soft Tissue Considerations in Esthetic Dentistry

Esthetic considerations are playing a greater role in the treatment planning of dental care, especially in the restoration of anterior teeth. Much attention has been paid to both operative and prosthodontic techniques that are available in esthetic restorative dentistry. Less attention has been given to soft tissue esthetics, the shape of the face and position of the lips, and the contours, color, and overall appearance of the gingiva and associated soft tissues. This article reviews a basic approach to soft tissue esthetics, the appearance of the gingiva, the interrelationship of the gingiva, teeth, and restorations, and outlines several common soft tissue problems and their management.     

Sub-Periosteal Dissection with Denture-Guided Epithelial Regeneration: A Novel Method for Peri-Implant Soft Tissue Management in Reconstructed Mandibles

Background

In patients with reconstructed mandibles using free fibula flaps, management of soft tissues around implants supporting dental rehabilitation, is often a clinical problem.

Aim

The aim of this paper is to describe a new technique, namely "Sub-periosteal dissection and denture-guided epithelial regeneration (SD-DGER)", as a method of peri-implant soft tissue management in these patients.

Materials and methods

The technique consists of performing a subperiosteal dissection with creation of buccal and lingual flaps. These flaps form the buccal and lingual vestibule. Implants are placed and an interim denture is immediately loaded onto the implants to guide the regenerated epithelium. A keratinized mucosal layer is formed on the bare fibula bone in six months time.

Results

This technique was successful in producing fixed keratinized epithelial tissue around implants in patients with mandibles reconstructed using the free fibula flap in patients who did not undergo radiotherapy.

Conclusion

The sub-periosteal dissection with denture guided epithelial regeneration is a predictable form of peri-implant soft tissue management in selected patients with reconstructed jaws.

     

腭侧旋转结缔组织瓣在上前牙种植修复中的临床研究

目的:探讨腭侧旋转结缔组织瓣在上颌前牙种植修复中的临床意义。方法:26例上颌前牙种植二期修复时,唇侧软组织有轻度缺损或凹陷,在牙槽嵴顶种植体位置作“H形”切口,形成颊侧带蒂粘骨膜瓣尖端带有腭侧的结缔组织瓣。将腭侧结缔组织旋转折叠,插入颊侧龈瓣内侧。愈合基台挤压龈乳头瓣诱导种植体周围龈乳头成形。2~4周后上部冠修复。6月后测量腭侧旋转结缔组织瓣移植前后唇侧牙龈丰满度等变化。结果:所有种植体均稳固,唇侧龈缘基本对称,手术前后唇侧软组织丰满度差为(1.10±0.45) mm,外形有明显改善,龈乳头顶到牙冠邻面接触点的距离为(2.05±0.76) mm。结论:腭侧旋转结缔组织瓣手术方法简单、易行,针对唇侧软组织缺损较少的部位可以较好地改善上颌前牙美学区种植义齿的软组织凹陷问题。     

Success,Survival Rate,and Soft Tissue Esthetic of Tooth Autotransplantation

IntroductionThe aim of this retrospective study was to assess the success, survival rate, and soft tissue esthetic of autotransplanted teeth.MethodsThis study included patients with at least 1 tooth autotransplanted to the maxilla during childhood or adolescence. The autotransplantation technique included the removal of an immature tooth from a donor site and its placement in the maxilla as a replacement for a missing or extremely compromised tooth. The cases were properly restored to ensure function and esthetic. To be considered successful, the tooth should be asymptomatic at the time of assessment, no pain to palpation and percussion, have no signs of apical periodontitis or a sinus tract, have a periodontal probe ≤3, and have an absence of root resorption and development of at least 70% of the normal root. The esthetic evaluation of the soft tissue was based on the pink esthetic score and graded as very unsatisfactory, unsatisfactory, poor, fair, good, or excellent. Data were statistically analyzed at a significance level of 5%.ResultsThirty-five patients (23 males and 12 females) had 43 anterior teeth replaced, including 42 central incisors and 1 lateral incisor. The follow-up period ranged from 1–25 years. In regard to success and the survival rate, 43 teeth were assessed; 34 cases (79.07%) were considered successful and 9 (20.93%) unsuccessful. Only 1 tooth was lost, and 42 teeth remained functional (survival rate = 97.67%). In regard to the esthetic, 40 teeth could be assessed and were considered as excellent (30%), good (35%), fair (27.5%), and poor (7.5%); there were no reports of unsatisfactory or very unsatisfactory cases.ConclusionsTooth autotransplantation can be considered a valid procedure to replace lost teeth in the maxilla, presenting high survival and success rates. The overall esthetic of the patients was considered as satisfactory.     

Soft Tissue Master Cast for Esthetic Control in Crown and Bridge Procedures

A technique for fabricating a soft-tissue cast for situations when esthetics are very demanding is described in a step-by-step manner. Life-like soft-tissue replication is obtained by means of an impression with the metal castings in situ; the "gingivae" are reproduced using soft pink-colored acrylic.     

Long‐Term Stability of Contour Augmentation in the Esthetic Zone: Histologic and Histomorphometric Evaluation of 12 Human Biopsies 14 to 80 Months After Augmentation

Background: Contour augmentation around early‐placed implants (Type 2 placement) using autogenous bone chips combined with deproteinized bovine bone mineral (DBBM) and a collagen barrier membrane has been documented to predictably provide esthetically satisfactory clinical outcomes. In addition, recent data from cone beam computed tomography studies have shown the augmented volume to be stable long‐term. However, no human histologic data are available to document the tissue reactions to this bone augmentation procedure. Methods: Over an 8‐year period, 12 biopsies were harvested 14 to 80 months after implant placement with simultaneous contour augmentation in 10 patients. The biopsies were subjected to histologic and histomorphometric analysis. Results: The biopsies consisted of 32.0% ± 9.6% DBBM particles and 40.6% ± 14.6% mature bone. 70.3% ± 14.5% of the DBBM particle surfaces were covered with bone. On the remaining surface, multinucleated giant cells with varying intensity of tartrate‐resistant acid phosphatase staining were regularly present. No signs of inflammation were visible, and no tendency toward a decreasing volume fraction of DBBM over time was observed. Conclusions: The present study confirms previous findings that osseointegrated DBBM particles do not tend to undergo substitution over time. This low substitution rate may be the reason behind the clinically and radiographically documented long‐term stability of contour augmentation using a combination of autogenous bone chips, DBBM particles, and a collagen membrane.     

骨引导再生技术在种植体周围牙槽嵴重建中的应用

目的：探讨种植体周围牙槽嵴的重建方式。方法：植A种植体高出牙槽顶骨面，在其周围植入Bio-oss骨粉，以盖嵴式覆以Bio—Gide膜，钛钉固定。分别于术后3、6、8月。通过，临床、X线检查和二期术，观察创面与种植体和周围骨组织结合情况以及牙槽嵴成骨情况。结果：显效34例49枚种植体，无效3例3枚种植体。结论：骨引导再生术可有效重建种植体周围牙槽嵴．     

在美学区域采用多颗相邻种植体即刻种植修复来维持邻间龈乳头——10个复查2～7年的病例报道

相邻多颗上前牙缺失的种植修复，在美学来讲是一个很大的挑战。通常认为．在缺牙区域植入相邻种植体会导致软组织美学效果不佳．尤其是就种植体之间龈乳头来说。基于这一点．通常．在美学区域避免在相邻部位植入种植体。但对于上颌相邻多牙缺失．即刻植入相邻种植体．在维持邻间龈乳头结构方面可能会有一定优势。本文报道了10个病例2～7年的追踪随访结果。本文的结果阐释了病例选择的重要性．强调有必要增加对在不同情况下植入种植体后组织生物反应的理解。显然，拔牙后即刻植入种植体和在已愈合的牙槽骨进行种植．在组织改建方面会有所不同。牙龈生物型、唇侧组织厚度对于唇侧组织外形维护和美学效果的获得也非常重要。要针对不同病例采用适宜的治疗。本文中展示的病例种类很多，都是作者自己私人诊所的患者，结果提示，作者采用的方式可作为在前上颔区域种植修复时一种选择。