Horizontal root fractures in posterior teeth: a case series

Abstract – This case series describes observations of 12 patients who developed horizontal root fractures in non‐endodontically treated teeth. Using clinical and radiographic examination, horizontal fractures were observed in eight maxillary first molars, one maxillary second molar, one mandibular first premolar and four mandibular second premolars. A total of 12 teeth had clinically intact crowns and 2 had carious. Eight fractures of maxillary molars occurred in the palatal roots, while one fracture was observed in the distobuccal root. Eleven patients experienced pain from the affected teeth during mastication. Within the limits of this case series, it was concluded that these fractures were related to; root morphology, damaging masticatory habits and excessive occlusal forces.     

Immediately loaded short implants: analysis of a case series of 133 implants.

OBJECTIVE: To perform a retrospective study on the success of immediately loaded short implants (ie, length < 10 mm). METHOD AND MATERIALS: From January 1995 to October 2004, 133 short implants were inserted and immediately loaded. Multiple implant systems were used, with a mean follow-up of about 4 years. Only 3 of the 133 implants were lost (ie, a survival rate of 97.7%), and no statistically significant differences were found among the studied variables; no or reduced marginal bone loss was considered as an indicator of the success rate when evaluating the effects of several factors with the use of a general linear model. RESULTS: By using the survival rate, no differences were detected among the studied variables. On the contrary, the analysis of the success rate by means of a general linear model showed that wider (diameter > 3.75 mm) and longer (length = 10 mm) implants were related to a lower delta insertion abutment junction (or marginal bone loss) and thus a better outcome. CONCLUSION: Immediately loaded short implants had a high survival rate and success rate similar to those reported in previous studies of 2-stage procedures. Immediate loading of short implants can be considered a reliable technique, although a higher marginal bone loss was to be expected when narrow (diameter < or = 3.75 mm) and shorter (length < 10 mm) implants were used.     

Bleaching teeth treated endodontically: long-term evaluation of a case series

The chromatic stability of nonvital discolored teeth, subjected to the combined intracoronal bleaching technique and to endodontic treatment, was evaluated at a distance of 16 yr (1989-2005). The series comprised 50 patients (age range 7-30 yr) selected from among those attending the Dental Clinic at "Federico II" University, Naples, between 1987 and 1989. After 16 yr, only 35 cases could be evaluated: in 22 of these cases (62.9%) the color had remained stable and was similar to that of adjacent teeth, indicating a successful outcome of the combined bleaching technique. There were 13 cases (37.1%) classified as failures because of marked color relapse. Radiology showed none of the cases re-examined to have undergone internal or external root resorption. These results confirm the validity of the combined intracoronal bleaching technique in terms of efficacy, rapid esthetic result, and safety.     

Immediate placement of bone level Sraumann implants: a case series

Endosseous dental implants have revolutionized the methods clinicians use to treat edentulous and partially edentulous patients. Traditional implant protocol specifies a healing period of several months after tooth extraction, as well as an unloaded healing period prior to restoration. Over the last decade, numerous studies have documented successful immediate placement of endosseous dental implants in fresh extraction sites and have found positive results with early functional loading. The purpose of this article is to present a clinical treatment protocol for the immediate placement and early loading of dental implants and to report the clinical and radiographic outcomes of the SLActive surface Straumann Bone Level implant placed in either maxillary or mandibular fresh extraction sockets.     

Dental implants in patients with Ehlers-Danlos syndrome: a case series study

Ehlers-Danlos syndrome (EDS) encompasses six types of hereditary connective tissue disorders, with skin hyperextensibility, joint hypermobility, and connective tissue fragility as the main findings. Oral health is also affected, sometimes including periodontitis and tooth loss. This is the first report on dental implant treatment for patients with hypermobility or classic EDS. Five female patients aged 19 to 68 years who tolerated treatment under local anesthesia and did not require bone augmentation were enrolled in the study and received 16 implants. They were observed for 2 to 12 years. No implants were lost, bone loss was minimal, and all patients were pleased with the treatment outcomes.     

Osseointegrated dental implants in private practice: a long-term case series study

BACKGROUND: Osseointegrated dental implants have become a routinely recommended procedure in the clinical practice of dentistry and periodontics. Due to their predictability, they have changed the way many cases are treatment planned. The purpose of this paper is to report the results of a prospective study of factors affecting the successes and failures of a large group of dental implants and compare them to published literature. METHODS: A total of 1,003 consecutively placed pure titanium dental implants placed from August 1987 to January 2002 and followed to October 2003 are reported. All implants were placed in one private practice by the same surgeon. RESULTS: Success rates statistically were influenced only by the age of the implant, although when the raw data are examined, some trends are seen. Success was unaffected by patient age, gender, surface roughness of implant, site of placement, smoking, bone type, arch, screw versus press-fit, diameter, length, manufacturer, reason for tooth loss, site bony augmentation and timing, placement timing, one-versus two-stage placement, or torque testing of implants; 75% of failures occurred before restoration. CONCLUSIONS: Osseointegrated dental implants are a highly predictable procedure with proper case selection. Failure rates vary for a number of factors reviewed, although only the age of the implant was statistically important in predicting failure. Male smokers, maxillary first molars, and type 4 bone had increased failure rates. Threaded, surface-roughened implants had the highest success rates.     

Intentional replantation of periodontally involved hopeless teeth: a case series study

To explore the clinical effect, the healing modes, and the potential influence factors of intentional replantation for periodontally hopeless teeth in comb     

Management of periodontitis associated with endodontically involved teeth: a case series

The pulp and the periodontal attachment are the two components that enable a tooth to function in the oral cavity. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. The function of the tooth is severely compromised when either one of these is involved in the disease process. Treatment of disease conditions involving both of these structures can be challenging and frequently requires combining both endodontic and periodontal treatment procedures. This article presents cases of periodontitis associated with endodontic lesions managed by both endodontic and periodontal therapy.     

Microsurgical endodontic retreatment of post restored posterior teeth: a case series

Post-treatment apical periodontitis may persist due to biological factors as outlined by Nair or when treatment procedures have been ineffective in eliminating the intraradicular infection. This case series reports on the management of five posterior teeth restored with posts where microsurgical techniques were employed utilising the operating microscope, ultrasonics, micro-instrumentation and mineral trioxide aggregate as a root-end filling material. Healing was evident at 12-month review appointments. Microsurgical techniques have significantly improved the outcomes for healing of periapical lesions when compared to traditional approaches to endodontic surgery. Success rates have been shown to be comparable with conventional orthograde treatment.     

Replacement of adjacent missing anterior teeth with scalloped implants: a case report.

As the biological width is established around neighboring implants, there is a flattening of the interimplant bone and a change in the position of the soft tissue. As a result, a normal progression of papilla from natural teeth through the adjacent implant area is lost. This presentation describes various techniques and strategies to improve the aesthetic outcome of anterior implant restorations, together with the use of a scalloped implant designed to sustain the interdental bony peaks, and in doing so, maintain the interimplant papillae.     

Maintenance therapy for teeth and implants

Maintenance care is mandatory for the long‐term success of periodontal and implant treatment. As it is frequently necessary to treat recurrent or persisting disease, maintenance therapy goes beyond a true prophylaxis. During this lifelong therapy, both the patient and the dental team need to be working closely together. It is imperative to combine efforts to have the build‐up of biofilm under control during maintenance and to reduce, as much as possible, the influence that risk factors may play in plaque accumulation as well as in the tissue inflammatory response. Guidelines to evaluate periodontal tissue response are described, and a maintenance protocol is outlined. The management of residual pockets is stressed, and a variety of treatment approaches are considered and evaluated. How to evaluate peri‐implant tissues during maintenance is discussed, as is the protocol of the cumulative interceptive supportive therapy.     

Moderately roughened- and roughened-surface implants used as rigid orthodontic anchorage: a case series

Background Osseointegrated implants, especially Brånemark turned‐surface implants, have been shown to function as stable and efficient orthodontic anchors. While it is generally accepted that prostheses can be attached to implants that have been used as anchors, it has not been clarified if the same applies to moderately roughened‐ and roughened‐surface implants. Purpose The purpose of the present study was to assess the differences between moderately roughened‐ and roughened‐surface implants that are used as orthodontic anchors and then bonded with prostheses and those that are bonded with prostheses without serving as orthodontic anchors. Materials and Methods A total of 43 moderately roughened‐ and roughened‐surface implants (ITI titanium plasma spray TPS®] Straumann AG, Waldenburg, Switzerland], ITI sandblasted large‐grit acid‐etched SLA®] Straumann AG], Nobel TiUnite^TM Nobel Biocare AB, Göteborg, Sweden]) were placed in 11 partially edentulous patients, aged 35–61 years (two men and nine women). After an appropriate healing period, orthodontic therapy was performed in 11 patients using 27 implants as orthodontic anchors. After completion of the orthodontic therapy, the prostheses were attached at the same time to both types of implants: the 27 implants that were used as anchors, and 16 implants that were not used as anchors. All 11 patients were followed up regularly. Results: Regardless of use as orthodontic anchorage, all implants maintained osseointegration and continued to function properly. Conclusion: No differences existed in therapeutic results after prosthesis bonding whether or not moderately roughened‐ and roughened‐surface implants were used as orthodontic anchors.     

Periodontal parameters around implants anchoring orthodontic appliances: a series of case reports

BACKGROUND: Implants replacing missing teeth provide advantages over clinical orthodontic treatment as compensation for reaction forces is no longer necessary and the lack of teeth is immediately resolved. METHODS: A total of 38 two-stage implants were inserted (16 in maxilla, 22 in mandible) in 10 partially edentulous patients with orthodontic problems. Osseointegration and marginal bone levels were assessed via intra-oral radiographs taken at the abutment stage and at the completion of the orthodontic treatment and also via probing depth, measurement of recession toward the implant/abutment (I/A) interface, and sulcus bleeding index, recorded after completion of orthodontic treatment. RESULTS: In the maxilla, the cumulative survival rate was 87.1% after 2 years; for the mandible, it remained 100%. Mean amount of bone loss was 1.6 mm for maxilla and 0.8 mm for mandible. No correlation could be found between directions of orthodontic forces and marginal bone loss. Mean percentage of bleeding sites was 38.5% and 25%, respectively, for implants in the maxilla and mandible. Attachment level was 1.2 mm (SD: 1.2) below I/A interface after completion of the orthodonic treatment. CONCLUSION: No significant marginal bone loss was present. Using implants during orthodontics can result in an easier and more predictable treatment.     

Anterior esthetic rehabilitation on teeth and dental implants optimized with Procera technology: a case report

With the latest developments of the Procera® system, all-ceramic crowns have become an attractive solution to provide functional and esthetic rehabilitation on teeth and dental implants. The Procera AllCeram crown and Procera Abutment embrace the concept of computer-assisted design and computer-assisted machining (CAD/CAM) and can be used together for optimal esthetic result. The purpose of this case report was to illustrate the advantages of these new components for complex anterior rehabilitation. Three natural teeth and a Procera Abutment were restored using four Procera AllCeram crowns. Treatment planning and esthetic benefits are discussed.
CLINICAL SIGNIFICANCE
For complex anterior rehabilitations, the Procera system fulfills both functional and esthetic objectives, providing a new way in the field of esthetic and restorative dentistry. Nevertheless, planning and preparation stages are decisive for successful treatment.     

An introductory therapeutic modality for restoring implants and natural teeth using conus crowns: a 5-year case report

The advent of cylindric titanium implants and the prevalence of periodontal disease have necessitated a restoration that facilitates the performance of oral physiotherapy. The use of the conical crown as a metallic covering over natural teeth and implants--with a suprastructure that is retained through a specific degree of convergence without cement or screws--allows access for enhanced oral hygiene practices, while providing for esthetic and functional goals.     

Bucco-lingual bone remodeling around implants placed into immediate extraction sockets: a case series

BACKGROUND: Implants placed immediately after tooth extraction have shown high percentages of clinical success. Few studies in the scientific literature have observed the horizontal bone remodeling in the buccal-lingual direction after immediate placement of implants. The aim of this study was to analyze bone healing and coronal bone remodeling around 15 implants placed immediately after tooth removal without the use of guided bone regeneration (GBR) techniques. METHODS: Ten patients received a total of 15 implants placed immediately after removal of 15 single-rooted teeth. All implants were placed within the alveolar confines, limiting, in most cases, small peri-implant bone defects. After implant placement, the distance from the buccal to lingual bone plate was measured. No membranes or filling materials were used. Primary flap closure was performed in all cases. RESULTS: At second-stage surgery, all peri-implant defects were completely filled and the distance from buccal to lingual bone was measured again. The pattern of bone healing around the neck of immediate implants showed an absence of peri-implant defects and a narrowing of bone crest width in a buccal-lingual direction. The mean distance between buccal bone and lingual bone at the time of implant placement was 10.5 mm (+/- 1.52) and, at second-stage surgery, 6.8 mm (+/- 1.33). CONCLUSIONS: The coronal bone remodeling around immediate implants showed a healing pattern with new bone apposition around the neck of the implants and, at the same time, bone resorption with horizontal width reduction of the bone ridge. The small peri-implant bone defects were completely healed without the use of GBR procedures. An absence of complications during the healing period was also observed, probably due to the absence of barrier membranes and grafting materials.     

Guided bone regeneration around single-tooth implants in the esthetic zone: a case series

The objective of this case series was to evaluate the clinical and histologic outcome of guided bone regeneration around simultaneously placed implants in sites with missing buccal bone walls. Eight weeks after tooth extraction, implants were inserted, and the sites were augmented in both the horizontal and vertical dimensions using a mineralized collagen bone substitute and a nonresorbable titanium-reinforced membrane. Six months later, small hard tissue biopsy specimens were harvested from the buccal bone walls at approximately mid-height of the original defect. The histologies revealed ongoing bone formation. Clinically, an adequate amount of hard and soft tissue volume had formed.     

Gaining adequate interdental space with elastic separating rings against implants: a case series

Background: It is clinically challenging to place and restore an implant when the mesio‐distal space is limited or reduced at the occlusal plane and/or the bone level. Placing implants in these cases while ignoring the clinical difficulties and compromising treatment could limit the successful outcome. Treatment options include strategic extractions, sectional orthodontics, and minor orthodontic movements. Purpose: To discuss the clinical problems and difficulties arising from limited edentulous mesio‐distal space interdentally and to present a treatment modality and technique. Materials and Methods: Orthodontic elastic separating rings are used to open interdental space between teeth and implants, exerting forces against implants for regaining the needed space and restoring implants with ease. Results: The advantages of this technique are illustrated by clinical cases. Conclusions: Implants placed in limited interdental edentulous ridges may well assist in regaining lost spaces after loading. Neither an orthodontic background nor special instruments are required for this technique.     

Oral cancer adjacent to dental implants mimicking benign lesions: a case series study

Despite the long‐term survival rates of osseointegrated dental implants, several biological complications are known to affect the peri‐implant tissues, such as peri‐implant mucositis and peri‐implantitis. Occasionally, the clinical features of these more common benign lesions, or others nonrelated to implants, might be similar to oral malignancies, leading to misdiagnosis. The objective of this study was to present a case series of oral cancer located adjacent to dental implants, aimed to identify the reasons for initial misinterpretation of diagnosis. Thirteen patients, 10 females and 3 males, aged 59 to 90, were assessed. Among the differential diagnoses established, a malignant or premalignant lesion was not considered in 10 out of the 13 patients. Peri‐implantitis was the most common preliminary diagnosis, followed by fungal infection, viral infections, and traumatic ulcers. The meantime for the diagnosis of oral cancer was 21.5 months. The clinical presentation of peri‐implant malignancy, such as ulceration, white and red plaques, and exophytic lesions, might mimic benign diseases that are more common in the oral cavity. Suspicious lesions with treatment failure that persist for more than 2 weeks require biopsy and histopathological analysis to establish an early definitive diagnosis to improve the prognosis and quality of life of the patients.