Nabil Khzam

Systematic Review of Soft Tissue Alterations and Esthetic Outcomes Following Immediate Implant Placement and Restoration of Single Implants in the Anterior Maxilla

BACKGROUND The aim of this review is to assess the outcome of single-tooth immediate implant placement and restoration (IPR) in the maxillary anterior region, with a particular emphasis on soft tissue and esthetic outcomes. METHODS An electronic search in Medline, EBSCOhost, and Ovid (PubMed) was performed to identify studies that reported on soft tissue outcomes following immediate placement and restoration of implants in the maxillary esthetic region with a mean follow-up of ≥1 year. RESULTS Nineteen studies on single implants inserted immediately into fresh extraction sockets and provisionally restored in the maxillary esthetic region were included. Soft tissue changes were found to be acceptable, with most studies reporting mean gingival recession of 0.27 ± 0.38 mm and mean papillary height loss of 0.23 ± 0.27 mm after follow-up of ≥1 year. Advanced buccal recession (>1 mm) occurred in 11% of cases. Long-term follow-up studies (>2 years) reported that the interdental papillae, in particular, showed a tendency to rebound over time. The few studies that reported on patient-centered outcomes showed a high level of patient satisfaction with the outcomes of IPR treatment. CONCLUSIONS The IPR protocol resulted in generally acceptable soft tissue and esthetic outcomes, with suboptimal results reported in ≈11% of low-risk cases. Factors such as preoperative tissue biotype or use of a flap or connective tissue graft did not significantly influence soft tissue and esthetic outcomes. Long-term prospective controlled clinical trials are necessary to identify factors that may influence the esthetic outcomes associated with IPR.

Immediate placement and restoration of dental implants in the esthetic region: clinical case series.

AIM The objective of this study was to assess the hard and soft tissue changes following immediate placement and provisional restoration of single-tooth implants in the aesthetic zone. METHODS Thirteen patients with immediately placed and restored implants were included in this study. All participating patients underwent the same treatment strategy that involved removal of the failed tooth, flapless surgery, immediate implant placement, and connection of a screw-retained provisional restoration. Three months following implant placement, the temporary crowns were replaced by the definitive restorations. Implant survival rates, and hard and soft tissue changes were measured using periapical X-rays and photographs. The range of the observation period was between 12 and 37 months with a mean period of 23.2 ± 7.6 months. RESULTS At the time of follow-up, all implants were present with no complications. Radiographic evaluation revealed a mean mesial bone gain of 1.20 ± 1.01 mm and a mean distal bone gain of 0.80 ± 1.14 mm, which reached statistical significance. The mean mid-buccal recession was 0.20 ± 0.78 mm, whereas the mesial and distal papillae height loss was 0.50 ± 1.26 mm and 0.30 ± 0.82 mm, respectively. The changes in the soft tissues did not reach statistical significance. CONCLUSION Notwithstanding the limitation of a small sample size, this study shows that immediate implant placement and provisional restoration in the maxillary aesthetic zone can result in favorable treatment outcomes with regards to soft and hard tissues changes over a follow-up period of 23.2 ± 7.6 months. CLINICAL SIGNIFICANCE Most clinical trials investigating immediate implant placement and immediate restoration in the maxillary anterior zone have focused on implant survival and implant success, with particular emphasis on radiographically assessed hard tissues changes. However, this study assesses the soft tissue changes associated with this procedure, which is an important area of study given the esthetic demands of implant therapy in the maxillary anterior region.

Immediate implant placement and restoration in the anterior maxilla: Tissue dimensional changes after 2-5 year follow up.

BACKGROUND Immediate implant placement followed by an immediate restoration has proven to be a viable technique in the anterior maxillary region. PURPOSE This prospective study evaluated the mid-long term (2-5 years) tissue changes around immediately placed and restored implants in the anterior maxilla using flapless surgery and simultaneous hard tissue augmentation. MATERIALS AND METHODS Thirty AstraTech implants were immediately placed in 30 patients, followed by the delivery of an immediate provisional restoration on the same day. All participating 30 patients underwent the same treatment strategy that involved flapless removal of a failing maxillary anterior tooth, immediate implant placement, simultaneous augmentation with a deproteinized particulate xenograft, followed by the connection of a screw-retained provisional restoration. Radiographs and photographs were used to measure hard and soft tissue changes. Aesthetic evaluation was performed using the Pink Esthetic Score (PES). RESULTS All implants remained osseointegrated during the follow up period of 2-5 years (mean 47 ± 15 months). Twelve of the thirty patients completed the 5 year follow up. Radiographic evaluation revealed average gains in bone levels of 0.18 and 0.34 mm mesially and distally, respectively. Soft tissue evaluation showed a mean tissue loss of 0.05 ± 0.64 mm and 0.16 ± 0.63 mm at the mesial and distal papillae, respectively, while mid-facial mucosal recession was 0.29 ± 0.74 mm. A significant improvement in the Pink Esthetic Scores was seen at the final follow-up (mean PES 11.50), as compared to the baseline (mean PES 10.27) (P = .001). CONCLUSIONS In addition to a favorable implant success rate and peri-implant bony response, the soft tissue levels and overall aesthetics around single immediately placed and restored implants can also be maintained in the mid-long term.

A New Multi-Ingredient Recipe for the Treatment of Localized Advanced Periodontal Disease following the Surgical Removal of Impacted Wisdom Teeth

Periodontal disease is a chronic inflammation of the tooth supporting structures. It leads to bone and attachment loss which is irreversible. Extraction of horizontally impacted lower third molar (L3M) teeth may result in localized periodontal pockets at the distal aspect of the adjacent lower second molars (L2M). We present a case of a 21-year-old male who suffered from a swelling and pain around his lower right second molar following surgical removal of a mesioangular impacted lower right third molar. We showed that oral hygiene measures, surgical access, mixture of autogenous and synthetic bone graft, and guided tissue regeneration (GTR) were enough to control the problem.

Hydrogen Peroxide Tooth Whitening Agent Alters the Protein Content of Enamel

Tooth whitening is a relatively quick, inexpensive and conservative treatment options for managing discoloured teeth and can be applied easily by dentists and patients. Bleaching agents at various concentrations have been marketed for dental office and home application. The aim of this study was to assess the effects of 30% hydrogen peroxide on the protein content of enamel. The effect of bleaching for 30 minutes with 30% hydrogen peroxide on the protein content of sound enamel was also investigated. Protein was extracted from the enamel by precipitation with trichoracetic acid after dissolution of the inorganic phase and the amount of protein was quantified using the Lowry and the Bradford protein assays. From 0.01g of sound enamel, the mean amount of protein detected using the Lowry, and the Bradford assays were50.56µg ± 0.06, and 3.08µg ± 0.01 respectively. After surface treatment of the enamel with 30% hydrogen peroxide, the mean protein values using same protein assays were 9.2 µg ± 0.04, and 1.2 µg ± 0.004 respectively. These results indicate that bleaching treatment with 30% hydrogen peroxide resulted in a significant reduction in protein content. The contribution of the protein modified or extracted from mature, sound enamel by bleaching with 30% hydrogen peroxide to the mechanical properties of enamel should be further investigated.

Gingival Enlargement Induced by Felodipine Resolves with a Conventional Periodontal Treatment and Drug Modification

We present a case of a 47-year-old male who suffered from GE around his lower anterior teeth as soon as he started treatment with Felodipine 400 mg. We show that oral hygiene measures, antibiotics, and conventional periodontal treatment (scaling and root planing SRP) were all not sufficient to resolve the drug induced GE, which will persist and/or recur provided that systemic effect of the offending medication is still present. The condition immediately resolved after switching to a different medication. The mechanism of GE is complex and not fully understood yet. It is mainly due to overexpression of a number of growth factors due to high concentrations of calcium ions (Ca2+). This affects fibroblasts proliferation and DNA synthesis and leads to a heavy chronic inflammatory cell infiltrate. Our case was managed according to the suggested protocols in previous case studies. The unique features in our case were the immediate onset of the adverse effect after starting the medication and the absence of any underlying medical condition apart from high blood pressure. Improving the oral hygiene together with SRP and cessation of the medication resolves drug induced GE.