William Becker

Replacement of maxillary and mandibular molars with single endosseous implant restorations: A retrospective study

This retrospective report presents findings on 22 patients with 24 implants replacing single molars with implant-supported restorations. Patients with known bruxism habits were not considered for single-molar implant replacement. The patients underwent follow-up for an average of 24 months. The cumulative success rate was 95%, which reflects the loss of one 5 x 6 mm wide implant. Eleven implants were placed in edentulous ridges, and 13 were placed in extraction sockets. Most of the implants were placed in type B and C bone quantity and type 2 and 3 bone quality. All implants were restored on abutments with nonrotating gold cylinders. The occlusion for all restorations was developed to minimize centric contacts and lateral interferences. The frequency of gold retaining-screw loosening was obtained for 21 patients. The gold retaining screws loosened in eight implants between one and three times (38%). No incidence of crown or implant fracture occurred. Within the limits of this study, replacement of single-tooth molars by implant-supported restorations was predictable; however, a high incidence of gold screw loosening was seen.

Minimally Invasive Treatment for Papillae Deficiencies in the Esthetic Zone: A Pilot Study

BACKGROUNDnThe presence of papillary deficiencies adjacent to dental implants or teeth presents an esthetic concern for the dental team and patients.nnnPURPOSEnThe aim of this pilot project is to evaluate a new method for reducing or eliminating small papillary deficiencies. The use of a commercially available gel was evaluated as a possible method for enhancing deficient papillae.nnnMATERIALS AND METHODSnEleven patients, seven females and four males, with an average age of 55.8 years (ranging from 25 to 75 years) with 14 treated sites are included in this pilot study. Patients had a minimum of one papillary deficiency in the esthetic zone. Prior to treatment photographs were either taken at a 1:1 ratio or converted to a 1:1 ratio using a commercially available program. A standardization photographic device was not used. After administration of a local anesthetic, a 23-gauge needle was used to inject less than 0.2 mL of a commercially available and Food and Drug Administration-approved gel of hyaluronic acid 2-3 mm apical to the coronal tip of the involved papillae. Patients were seen every three weeks and treatment was repeated up to three times. Patients were followed from 6 to 25 months after initial gel application. A computer program measured changes in pixels between initial and final treatments. A formula was derived to determine percentage change in the negative space between initial and final examinations.nnnRESULTSnEach site was individually evaluated. Three implant sites and one site adjacent to a tooth had 100% improvement between treatment examinations. Seven sites improved from 94 to 97%, three sites improved from 76 to 88%, and one site adjacent to an implant had 57% improvement.nnnCONCLUSIONnResults from this pilot study are encouraging and present evidence that small papillary deficiencies between implants and teeth can be enhanced by injection of a hyaluronic gel. Improvements were maintained for a range of 6 to 25 months.

Prospective Clinical Trial Evaluating a New Implant System for Implant Survival, Implant Stability and Radiographic Bone Changes

BACKGROUNDnThere are a few prospective studies reporting on new implant systems. When a new implant is brought to market, prospective trials should be carried out to determine the predictability of that system.nnnPURPOSEnThis prospective study evaluates implant survival, Resonance Frequency Analysis (RFA), and crestal bone level changes for a new implant system (Neoss System, Bimodal surface, Neoss Ltd, Harrogate, UK).nnnMATERIALS AND METHODSnSeventy-six patients, 38 females (age ranging from 23 to 57 years) and 38 males (ranging in age from 17 to 85 years) received 100 Neoss implants. Patients were consecutively enrolled in the study if they were missing one or more teeth in either arch, or a single tooth was scheduled for removal and immediate implant replacement. Evaluated implants were 4, 4.5, or 5u2003mm wide and were 7, 9, 11, 13, or 15u2003mm long. A one-stage approach was followed. At first stage and prior to healing abutment placement RFA measurements were taken. Measurements were retaken at second stage. Fifty-one implants were placed for restoration of single missing teeth and 49 were for short span implant bridges.nnnRESULTSnThe cumulative survival rate at 1- to 2-year interval was 93%. Average initial RFA measurement for all implants was 72.06, while the average final score was 72.58. These changes were not statistically significant. Changes in RFA scores for maxillary implants were insignificant. Forty-two paired mandibular RFA measurements were evaluated. Initial and final mean mandibular RAF measurements were 73.65 (SD 9.203) and 77.186 (SD 6.177), respectively. These changes were statistically significant (pu2003=u2003.02). Sixty-four paired radiographs were available for evaluation. Between examinations, there was an average -0.6u2003mm of bone loss, which was statistically significant (pu2003=u2003.03). On average, 4.0-mm-wide implants lost 0.1u2003mm of bone when compared with 5-mm-wide implants. These differences were insignificant (pu2003=u2003.86). Bone loss was adjusted for implant length, and tooth position and there were small, but clinically insignificant changes. Five-millimeter-wide implants lose 0.2u2003mm more than 4.0-mm-wide implants (pu2003=u2003.7). Maxillary incisors lose the least amount of bone 0.152 (pu2003=u2003.33).nnnCONCLUSIONSnThe implants tested in this study had initially high RAF readings, indicating good primary stability. RFA readings for implants placed in the mandible improved from baseline and the changes were statistically significant. Marginal bone levels revealed clinically insignificant bone loss from implant installation to second stage. Loss of seven implants with initially high RFA readings is surprising.

A Novel Method for Creating an Optimal Emergence Profile Adjacent to Dental Implants

UNLABELLEDnIn order to establish an optimal esthetic implant result, creation of an optimal emergence profile is necessary. The purpose of this clinical report is to describe a new method for creating an emergence profile starting at the time of immediate implant placement. Clinical steps for creating the emergence profile are described from the time of implant placement to restoration.nnnCLINICAL SIGNIFICANCEnPrefabricated abutments that can be modified and used as healing abutments or for provisional restorations offer clinicians the opportunity to create emergence profiles during the healing phase after immediate implant treatment. This procedure eliminates the need for creation of an arbitrary emergence profile in the dental laboratory and eliminates the need for a surgical procedure prior to impression making.

Resonance frequency analysis: Comparing two clinical instruments

BACKGROUNDnNumerous studies indicate implants placed immediately after extraction or with minimally invasive procedures have excellent long-term success and survival rates. There is general agreement that implants must be stable after implant placement. This study evaluated implant stability changes from the time of implant placement to second stage (prior to restoration). Resonance frequency analysis (RFA) was determined for two commercially available units (Osstell, Osstell USA, Columbia, MD and Penguin, Penguin Integration Diagnostics, Sweden). The unit of measurement was the implant stability quotient (ISQ).nnnMATERIALS AND METHODSnPrior to treatment patients were given medical and dental evaluations. Periapical and panogram radiographs were taken Computerized tomography images were taken for sites where adequate bone volume or quality were uncertain. Thirty patients were enrolled in this study (13 females, 17 males, mean age 73.4 years, (maximum age 90, minimum 47 year total of 38 implants were placed. One implant was lost. Computerized implant planning (Nobel Clinician) Nobel Biocar United States (Nobel Biocare, Yorba Linda, CA) was performed for all patients. Implants were placed utilizing a surgical guide. Using Resonance Frequency anal this study compared two RFA systems for determining implant stability (ISQ; Osstell and Penguin). Measurement pegs were screwed into the implants, and RFA measurements were taken at mesial, distal, lingual, and buccal implant surfaces. Stability measurements were taken at implant placement and at second stage. Clinical data and RFA measurements were recorded on data sheets. The average interval between first and second stages was 144.1 days (range 21.3) RESULTS: Average interval between implant placement and second stage was 141.1 days. One implant was lost prior to second stage. The results are based on 30 patients with 38 implants. At second stage, the RFA measures were slightly higher than first stage with a mean increase of 1.15, SEu2009=u20090.3, P-.067. The Penguin RFA values were marginally higher than Osstell (mean increase 1.10, SEu2009=u20090.64, Pu2009<u2009.08).nnnCONCLUSIONSnRFA values between implant placement and second stage differed slightly between implant placement and second stage (Pu2009<u20090.10). These differences were not clinically or statistically significant. At second stage, Penguin RFA values were slightly higher when compared with the Osstell device (Pu2009<u20090.67). Bone quality appears to be an important factor when determining RFA readings. Type I bone had significantly higher readings when compared with other less dense bone types (Pu2009<u2009.029) Resonance frequency evaluation data were similar for both instruments, indicating their reliability in determining implant stability. Neither instrument predicted implant failure. While subjective, Penguin was less cumbersome to utilize and the window revealing the readings was very easier to read. Further, the pegs are magnetized making insertion easy.