Mithridade Davarpanah

Unconventional implant treatment: I. Implant placement in contact with ankylosed root fragments. A series of five case reports

OBJECTIVE Implant treatment presumes that implants are placed in bone, without any contact with root. At ankylosed teeth, complete root removal is often invasive; subsequently, the sites require additional augmentation procedures to complete the treatment. The aim of this paper is to report on a series of five cases that have been treated with an approach that avoided extractive invasive surgery and bone damage. MATERIAL AND METHODS The procedure consisted of preparing the osteotomy site by drilling through the root. At the end of the drilling sequence, the root fragments that were not removed were deliberately left at the osteotomy site. Their mobility was checked with a dental pick and when stable an implant was placed in contact with them. The sites were required to be asymptomatic and inflammation free. Ankylosed teeth were replaced with 13-15-mm-long Osseotite implants, four in the anterior maxilla and one in the anterior mandible. RESULTS All implants healed uneventfully; they have been now loaded for a period of 12-42 months. On peri-apical radiographs, appearance of the bone-implant interface was similar to osseointegrated implants. The remaining root fragments were visible, in contact with the implants; no specific pathological sign could be detected. A limited resorption of dentine was found at one site after 4 years. CONCLUSION This series of cases suggests that implants placed in contact with ankylosed root fragments might not interfere with implant integration or harm occlusal function, at least in the mid-term. More cases are warranted before this procedure might be considered as a reliable clinical option when, at ankylosed teeth, one wishes to avoid an invasive extraction surgery.

Unconventional Implant Placement Part III: Implant Placement Encroaching upon Residual Roots – A Report of Six Cases

BACKGROUND When a residual root is found in the way of a planned implant placement, invasive surgery is usually performed in order to remove it. Consequently, implant therapy is rendered more complex and lengthy. PURPOSE We present 6 cases treated according to an unconventional protocol in which invasive surgery was avoided by allowing the implants to encroach upon the residual roots in order to permit a prosthetically driven surgery. MATERIALS AND METHODS Six patients were treated with 7 implants placed through a residual root (4 in the mandible and 3 in the maxilla). The residual roots had to be clinically and radiographically asymptomatic and covered by bone or healthy gingiva. The radiographic follow-up ranged from 20 months to 9 years. RESULTS Healing was uneventful. Implants were clinically stable, and radiographic examination did not show any unusual feature at the root-implant interface. CONCLUSION Several types of new implant-tissue interfaces were created in addition to the classical implant-bone interface, but this did not seem to jeopardize implant integration. Reports of more cases with a longer follow-up are needed before this protocol can be endorsed for routine application. Nonetheless, if confirmed as acceptable, this protocol might open intriguing possibilities; it might also lead to revision of one of the leading concepts in dental implantology.Background When a residual root is found in the way of a planned implant placement, invasive surgery is usually performed in order to remove it. Consequently, implant therapy is rendered more complex and lengthy. Purpose We present 6 cases treated according to an unconventional protocol in which invasive surgery was avoided by allowing the implants to encroach upon the residual roots in order to permit a prosthetically driven surgery. Materials and Methods Six patients were treated with 7 implants placed through a residual root (4 in the mandible and 3 in the maxilla). The residual roots had to be clinically and radiographically asymptomatic and covered by bone or healthy gingiva. The radiographic follow-up ranged from 20 months to 9 years. Results Healing was uneventful. Implants were clinically stable, and radiographic examination did not show any unusual feature at the root-implant interface. Conclusion Several types of new implant-tissue interfaces were created in addition to the classical implant-bone interface, but this did not seem to jeopardize implant integration. Reports of more cases with a longer follow-up are needed before this protocol can be endorsed for routine application. Nonetheless, if confirmed as acceptable, this protocol might open intriguing possibilities; it might also lead to revision of one of the leading concepts in dental implantology.

Unconventional implant placement. V: Implant placement through impacted teeth; results from 10 cases with an 8- to 1-year follow-up ☆

The aim of this paper is to document additional cases to an unconventional protocol published in 2009. In 9 patients, sites rendered edentulous by the presence of an impacted maxillary canine were treated with 12 implants placed through the impacted canines. In another patient, 3 implants were inserted in the mandible to rehabilitate a failing bridge. Implants were placed encroaching upon either the root or the crown. No postoperative pain was reported. Healing was uneventful in all but one patient; the latter underwent soft tissue infection 2 weeks after implant placement and was successfully treated. All implants were restored; no implant failed during the 1- to 8-year follow-up. Before implementing this protocol on a routine basis, more implants and a longer follow-up are required. However, it opens intriguing treatment possibilities. It also suggests that there is still room for shifting a well-anchored paradigm in dental implantology.

Unconventional Implant Placement Part III: Implant Placement Encroaching upon Residual Roots - A Report of Six Cases: Implant Placement Encroaching upon Residual Roots

BACKGROUND When a residual root is found in the way of a planned implant placement, invasive surgery is usually performed in order to remove it. Consequently, implant therapy is rendered more complex and lengthy. PURPOSE We present 6 cases treated according to an unconventional protocol in which invasive surgery was avoided by allowing the implants to encroach upon the residual roots in order to permit a prosthetically driven surgery. MATERIALS AND METHODS Six patients were treated with 7 implants placed through a residual root (4 in the mandible and 3 in the maxilla). The residual roots had to be clinically and radiographically asymptomatic and covered by bone or healthy gingiva. The radiographic follow-up ranged from 20 months to 9 years. RESULTS Healing was uneventful. Implants were clinically stable, and radiographic examination did not show any unusual feature at the root-implant interface. CONCLUSION Several types of new implant-tissue interfaces were created in addition to the classical implant-bone interface, but this did not seem to jeopardize implant integration. Reports of more cases with a longer follow-up are needed before this protocol can be endorsed for routine application. Nonetheless, if confirmed as acceptable, this protocol might open intriguing possibilities; it might also lead to revision of one of the leading concepts in dental implantology.Background When a residual root is found in the way of a planned implant placement, invasive surgery is usually performed in order to remove it. Consequently, implant therapy is rendered more complex and lengthy. Purpose We present 6 cases treated according to an unconventional protocol in which invasive surgery was avoided by allowing the implants to encroach upon the residual roots in order to permit a prosthetically driven surgery. Materials and Methods Six patients were treated with 7 implants placed through a residual root (4 in the mandible and 3 in the maxilla). The residual roots had to be clinically and radiographically asymptomatic and covered by bone or healthy gingiva. The radiographic follow-up ranged from 20 months to 9 years. Results Healing was uneventful. Implants were clinically stable, and radiographic examination did not show any unusual feature at the root-implant interface. Conclusion Several types of new implant-tissue interfaces were created in addition to the classical implant-bone interface, but this did not seem to jeopardize implant integration. Reports of more cases with a longer follow-up are needed before this protocol can be endorsed for routine application. Nonetheless, if confirmed as acceptable, this protocol might open intriguing possibilities; it might also lead to revision of one of the leading concepts in dental implantology.

Technique to Obtain a Predictable Aesthetic Result through Appropriate Placement of the Prosthesis/Soft Tissue Junction in the Edentulous Patient with a Gingival Smile

BACKGROUND Treating the edentulous patient with a gingival smile requires securing the prosthesis/soft tissue junction (PSTJ) under the upper lip. PURPOSE To present a simple method that helps achieve a predictable aesthetic result when alveoplasty of the anterior maxilla is needed to place implants apical to the presurgical position of the alveolar ridge. MATERIALS AND METHODS The maximum smile line of the patient is recorded and carved on a thin silicone bite impression as a soft tissue landmark. During the three-dimensional radiographic examination, the patient wears the silicone guide loaded with radiopaque markers. The NobelClinician® software is then used to bring the hard and soft tissue landmarks together in a single reading. Using the software, a line is drawn 5 mm apical to the smile line; it dictates the position of the crestal ridge to be reached following the alveoplasty. Subsequently, the simulated implant position and the simulated residual bone height following alveoplasty can be simultaneously evaluated on each transverse section. RESULTS An alveoplasty of the anterior maxilla was performed as simulated on the software, and implants were placed accordingly. The PSTJ was always under the upper lip, even during maximum smile events. The aesthetic result was, therefore, fully satisfactory. CONCLUSION This simple method permits the placement of the PSTJ under the upper lip with a predictable outcome; it ensures a reliable aesthetic result for the edentulous patient with a gingival smile.