Maurice Salama

Flapless postextraction socket implant placement in the esthetic zone: part 1. The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change-a retrospective cohort study.

A number of human comparison studies and case series have demonstrated the effectiveness of using a platform-switched implant-to-abutment connection to prevent peri-implant bone loss and subsequent soft tissue loss. To compare the bone around platform-switched and nonplatform-switched connections, adjacent pairs of both connection types were placed in a one-stage surgical procedure on each side of the mandibles of three monkeys (Macaca fascicularis). Eight weeks after abutment connection, histomorphometric analysis showed that both vertical and horizontal alveolar bone resorption had occurred around the nonplatform-switched implants, whereas bone was maintained vertically and new bone formed horizontally around the platform-switched implants.The dental literature has reported vertical soft tissue changes that can occur with immediate implant placement, bone grafting, and provisional restoration ranging from a gain or loss of 1.0 mm. However, little is known of the effects of facial-palatal collapse of the ridge due to these clinical procedures. Based upon treatment modalities rendered, an ensuing contour change can occur with significant negative esthetic consequences. The results of a retrospective clinical cohort study evaluating the change in horizontal ridge dimension associated with implant placement in anterior postextraction sockets are presented for four treatment groups: (1) group no BGPR = no bone graft and no provisional restoration; (2) group PR = no bone graft, provisional restoration; (3) group BG = bone graft, no provisional restoration; and (4) group BGPR = bone graft, provisional restoration. Bone grafting at the time of implant placement into the gap in combination with a contoured healing abutment or a provisional restoration resulted in the smallest amount of ridge contour change. Therefore, it is recommended to place a bone graft and contoured healing abutment or provisional restoration at the time of flapless postextraction socket implant placement.

Flapless Postextraction Socket Implant Placement, Part 2: The Effects of Bone Grafting and Provisional Restoration on Peri-implant Soft Tissue Height and Thickness- A Retrospective Study.

This article presents the results of evaluating the changes in peri-implant soft tissue dimensions associated with immediate implant placement into anterior postextraction sockets for four treatment groups: no BGPR (no bone graft, no provisional restoration), PR (no bone graft, provisional restoration), BG (bone graft, no provisional restoration), and BGPR (bone graft, provisional restoration). The vertical distance of the peri-implant soft tissue was greater for grafted sites than for nongrafted ones (2.72 mm vs 2.29 mm, P < .06). The facial soft tissue thickness at the gingival third also was greater for grafted than for nongrafted sites (2.90 mm vs 2.28 mm, P < .008) and for sites with provisional restorations compared to sites without them (2.81 mm vs 2.37 mm, P < .06), respectively. The net gain in soft tissue height and thickness was about 1 mm. The increases in vertical and horizontal dimensions for grafted sites were between 0.5 and 1.0 mm, as compared to sites with no bone graft and no provisional restoration.

Partial Extraction Therapies (PET) Part 2: Procedures and Technical Aspects

Part 1 of this series introduced the partial extraction therapies as a group of techniques for ridge preservation at immediate implant placement and beneath pontic sites. The concept proposes a paradigm shift away from extract and augment toward partly retaining the tooth root to preserve the ridge and prevent buccopalatal collapse. The revolutionary socket-shield technique was introduced in 2010; however, there has been no follow-up literature to guide the clinician in terms of procedural steps. While root submergence is well established, the socket-shield and pontic shield are still in their clinical infancy and require long-term clinical data before they can be proposed as routine in everyday implant dentistry. Yet without sound knowledge on how to carry out the partial extraction therapies, a global dental community cannot participate in their application or contribute to the growing knowledge base. In this, the second part of the series, the procedures for root submergence, socket-shield, and pontic shield are addressed, step by step, supplemented with applicable guidelines as the first such publication guiding the clinician to apply these root- and ridge-preservation techniques. Technical aspects and complication management are also addressed.

Human Histologic Evidence of New Bone Formation and Osseointegration Between Root Dentin (Unplanned Socket-Shield) and Dental Implant: Case Report

The socket-shield technique described 7 years ago has since grown in its reporting in the literature as a valid method of ridge preservation at immediate implant placement. To date, large clinical cohorts with up-to-4-year follow-up have been reported. Additionally, evidence of tissue histology at the dental implant and socket-shield has been demonstrated in the animal model. However, human histologic evidence has not yet been available, and the clinicians uncertainty regarding the tissues that may form between the socket-shield and dental implant may remain unanswered until now. This case report presents the first human histologic evidence that bone may entirely fill the space between root dentin and an osseointegrated implant surface.

The socket-shield technique at molar sites: A proof-of-principle technique report

The socket-shield technique for avoiding postextraction tissue alteration was first described in 2010. The technique was developed for hopeless teeth in anterior esthetic sites but has not yet been described for molar sites. Managing postextractive ridge changes in the posterior region by prevention or regeneration remains a challenge. The socket shield aims to offset these ridge changes wherever possible, preserving the patients residual tissues at immediate implants. This technique report describes the molar socket-shield step by step.

Flapless Postextraction Socket Implant Placement, Part 3: The Effects of Bone Grafting and Provisional Restoration on Soft Tissue Color Change—A Retrospective Pilot Study

This article presents the results of a soft tissue color study on flapless immediate implant therapy from a sample of 23 patients who received either a provisional restoration alone or with bone grafting. The gingival color in clinical photographs was measured for the implant and for the contralateral tooth site at 2.0 and 5.0 mm below the free gingival margin using Photoshop software (Lightroom CC, Adobe). The average color difference (ΔE) values for the two groups were 2.6 and 2.4 at 2.0 mm and 1.9 and 2.5 at 5.0 mm from the free gingival margin, respectively. Approximately 80% of the sites were below the visibly perceptible threshold (ΔE = 3.1 ± 1.5) and not detectable by the human eye. The use of provisional restorations has shown positive outcomes on the stability of peri-implant soft tissue thickness and lower ΔE values. Further research is required to assess esthetic outcomes inclusive of color change relative to the clinical treatment rendered.

The “Scalloped Guide”: A Proof-of-Concept Technique for a Digitally Streamlined, Pink-Free Full-Arch Implant Protocol

Inadequate restorative space can result in mechanical, biologic, and esthetic complications with full-arch fixed implant-supported prosthetics. As such, clinicians often reduce bone to create clearance. The aim of this paper was to present a protocol using stacking computer-aided design/computer-assisted manufacturing (CAD/CAM) guides to minimize and accurately obtain the desired bone reduction, immediately place prosthetically guided implants, and load a provisional that replicates predetermined tissue contour. This protocol can help clinicians minimize bone reduction and place the implants in an ideal position that allows them to emerge from the soft tissue interface with a natural, pink-free zirconia fixed dental prostheses.