Shilpa Kolhatkar

Immediate Implant Placement: Clinical Decisions, Advantages, and Disadvantages

Implant placement in fresh extraction sockets in conjunction with appropriate guided bone regeneration is well documented. The decision to extract teeth and replace them with immediate implants is determined by many factors, which ultimately affect the total treatment plan. The goal of this article is to review some of the important clinical considerations when selecting patients for immediate implant placement, and to discuss the advantages and disadvantages of this mode of therapy.

Mucosal Coronally Positioned Flap for the Management of Excessive Gingival Display in the Presence of Hypermobility of the Upper Lip and Vertical Maxillary Excess: A Case Report

BACKGROUND Excessive gingival display is a frequent finding that can occur because of various intraoral or extraoral etiologies. This report describes the use of a mucosal coronally positioned flap for the management of a gummy smile associated with vertical maxillary excess and hypermobility of the upper lip. METHODS A 24-year-old female presented for consultation regarding a gummy smile. At full smile the average gingival display ranged from 2 to 4 mm. A clinical examination revealed hypermobility of the upper lip and absence of generalized altered passive eruption. A cephalometric analysis pointed to the presence of vertical maxillary excess. The surgical procedure consisted of an elliptical mucosal excision followed by coronal advancement of the flap. This procedure aimed to limit the activity of the elevator muscles and reestablish the depth of the vestibule. RESULTS Rapid surgical healing with minimal postoperative sequelae was observed. The patient reported significant reduction of gingival display at 1 week, which was maintained at the 1-year postoperative visit. Reduction in the amount of gingival display at the 1-year follow-up visit was stable. CONCLUSIONS For patients desiring a less invasive alternative to orthognathic surgery, the mucosal coronally positioned flap is a viable alternative. We demonstrate short-term successful use of this technique for the management of excessive gingival display in the presence of slight vertical maxillary excess and hypermobility of the upper lip. Long-term follow-up studies are needed to determine stability of the results.

Immediate Dental Implant Placement in HIV-Positive Patients Receiving Highly Active Antiretroviral Therapy: A Report of Two Cases and a Review of the Literature of Implants Placed in HIV-Positive Individuals

BACKGROUND There are numerous reports of oral surgical procedures in patients undergoing highly active antiretroviral therapy. In the general population, the success of immediate implant placement for replacing teeth is well documented. The number of human immunodeficiency virus (HIV)-positive patients seeking comprehensive dental care, including implant therapy, continues to increase. Aside from a solitary case report published 12 years ago, there is very limited evidence describing immediate implant placement in the HIV-positive population. The two cases described herein demonstrate successful immediate implant placement in this population. METHODS Two white male patients aged 48 and 55 were scheduled to undergo extraction of a mandibular premolar. Both patients were HIV-positive, receiving highly active antiretroviral therapy, and were closely monitored by their physicians. On the day of the surgical procedure, atraumatic extractions were completed, osteotomies prepared in the ideal orientation, and implants placed. The bone-to-implant gap was >1.5 mm in Case 2, which required particulate bone graft placement. Case 1 did not need additional bone grafting. In Case 1, the healing abutment was placed at the time of implant placement, whereas a second-stage surgical procedure was performed for Case 2. RESULTS Patients were seen at 2 and 4 weeks for postoperative assessment. No adverse postoperative sequelae were observed, and both implants integrated and were successfully restored. CONCLUSIONS Immediate implant placement in HIV-positive patients is a viable and successful treatment option. To our knowledge, only one other similar report exists. It is hoped that this case report adds to the body of evidence supporting immediate implant placement in the HIV-positive population.

Sinus Floor Elevation Via the Maxillary Premolar Extraction Socket With Immediate Implant Placement: A Case Series

BACKGROUND When immediate implant placement is considered for teeth with close proximity to the sinus floor, apical extension of the osteotomy is significantly limited, and often a staged approach is used. Implant placement into fresh extraction sockets and sinus floor manipulation using bone-added osteotome sinus floor elevation with implant placement are techniques most often used independently or sequentially. Very few reports have described the combined use of immediate implant placement in fresh sockets and the bone-added osteotome sinus floor elevation technique. METHODS We present five cases in which a maxillary premolar was extracted and an implant placed into the extraction site with simultaneous abfracture of the sinus floor using osteotomes. All teeth were extracted atraumatically, and sockets carefully debrided and checked for integrity of the walls. After ideal osteotomy preparation, particulate bone graft was placed in the osteotomy and appropriately sized osteotomes were used for sinus floor elevation. After sufficient elevation, implant placement was completed and particulate bone was packed in the bone-implant gap when indicated. RESULTS All implants were restored after a minimum healing period of 6 months. At the time of final restoration, bone was seen surrounding the implants from the apical portion to the most coronal thread. All five implants healed without complications and were in function for periods ranging from 6 to 12 months. CONCLUSIONS Immediate implant placement with simultaneous osteotome sinus floor elevation is an advantageous combination of two successfully used techniques. This combined approach can significantly reduce the treatment time for implant therapy in teeth with close sinus proximity and provide the operator with the ability to place implants of desired length.

Surgical crown lengthening in a population with human immunodeficiency virus: a retrospective analysis).

BACKGROUND Individuals with human immunodeficiency virus (HIV) have an increased risk of developing health problems, including some that are life threatening. Today, dental treatment for the population with a positive HIV diagnosis (HIV+) is comprehensive. There are limited reports on the outcomes of intraoral surgical therapy in patients with HIV, such as crown lengthening surgery (CLS) with osseous recontouring. This report investigates the outcome of CLS procedures performed at an urban dental school in a population of individuals with HIV. Specifically, this retrospective clinical analysis evaluates the healing response after CLS. METHODS Paper and electronic records were examined from the year 2000 to the present. Twenty-one individuals with HIV and immunosuppression, ranging from insignificant to severe, underwent CLS. Pertinent details, including laboratory values, medications, smoking history/status, and postoperative outcomes, were recorded. One such surgery is described in detail with radiographs, photographs, and a videoclip. RESULTS Of the 21 patients with HIV examined after CLS, none had postoperative complications, such as delayed healing, infection, or prolonged bleeding. Variations in viral load (<48 to 40,000 copies/mL), CD4 cell count (126 to 1,260 cells/mm(3)), smoking (6 of 21 patients), platelets (130,000 to 369,000 cells/mm(3)), and neutrophils (1.1 to 4.5 × 103 /mm(3)) did not impact surgical healing. In addition, variations in medication regimens (highly active anti-retroviral therapy [18]; on protease inhibitors [1]; no medications [2]) did not have an impact. CONCLUSIONS The results of this retrospective analysis show the absence of postoperative complications after CLS in this population with HIV. Additional investigation into this area will help health care practitioners increase the range of surgical services provided to this group of patients.

Root Coverage in an HIV-Positive Individual: Combined Use of a Lateral Sliding Flap and Resin-Modified Glass Ionomer for the Management of an Isolated Severe Recession Defect

BACKGROUND Gingival recession is a frequent clinical finding in the general population. Exposed root surfaces are more likely to develop root sensitivity and root caries and pose esthetic concerns for the patient. Most root coverage procedures have been described on non-restored root surfaces. Limited data are available that describe root coverage procedures on restored root surfaces. To our knowledge, this is the first case report in which a severe recession defect and its associated carious lesion were managed using the combination of a lateral sliding flap and a resin-modified glass ionomer restoration in an HIV-positive individual. METHODS A 53-year-old male patient with a 25-year history of HIV infection presented for comprehensive care. The facial surface of tooth #22 had a fractured composite restoration, recurrent decay, and a Miller Class III recession defect. The lesion was restored with resin-modified glass ionomer and root coverage was obtained by a lateral sliding flap mobilized from the adjacent edentulous ridge. After 8 weeks, surgical access was used to correct a previously undetected void in the restoration. RESULTS Uneventful healing was observed at the 1-, 4-, 8-, 10-, 12-, and 24-week postoperative visits. Root coverage of 5 mm along with a 2-mm band of keratinized tissue was obtained at 24 weeks. The gingiva displayed no signs of inflammation and was tightly adapted to the root surface with minimal probing depths circumferentially. CONCLUSION Successful root coverage was obtained on a resin-modified glass ionomer-restored surface in an HIV-positive individual.

Immediate implants for aesthetic success: New guidelines

Immediate implant placement in extraction sockets is well-documented. There is adequate long-term evidence that immediate implants have survival rates similar to delayed placement. Additionally, immediate implants also help preserve the crestal bone and minimize soft tissue changes in the aesthetic zone. The decision to extract teeth and replace them with implants is determined by many factors. While implant insertion at the time of tooth extraction is desirable for a number of reasons, extraction socket morphology, soft tissue biotype, presence of infection, health of the bone and soft tissue, and other factors help determine if the site is ideal for immediate implant placement or not. This article will review some key and new guidelines for immediate implant placement in the aesthetic zone for long-term success and stability.