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Ectodermal dysplasia (ED) is an inherited disorder characterized by abnormality of ectodermally derived structures. A recurrent oral finding is oligodontia, which in turn leads to a severely hypotrophic alveolar process with typical knife-edge morphology and adverse ridge contours. This unfavorable anatomy can seriously hamper proper implant placement. Fresh-frozen bone (FFB) allografts recently have been pro- posed to augment the residual bone volume for implant placement purposes; however, scientific evidence concerning the use of FFB to treat ED patients is absent. Similarly, data reporting computer-aided template- guided implant placement in medically compromised patients are limited. Thus the purpose of this report is to illustrate the oral rehabilitation of a female patient affected by ED and treated with appositional FFB block grafts and consecutive computer-guided flapless implant placement in a 2-stage procedure. Fixed implant-supported dental prostheses were finally delivered to the patient, which improved her self- esteem and quality of life. During the follow-up recall 1 year after the prosthetic loading, the clinical ex- amination showed healthy peri-implant soft tissues with no signs of bleeding on probing or pathologic probing depths. The panoramic radiograph confirmed the clinical stability of the result. Peri-implant mar- ginal bone levels were radiographically stable with neither pathologic bone loss at the mesial and distal aspects of each implant nor peri-implant radiolucency. Within the limitations of this report, the use of FFB allografts in association with computer-aided flapless implant surgery might be considered a useful technique in patients affected by ED.

An optimal aesthetic implant restoration is a combination of a visually pleasing prosthesis and adequate surrounding peri-implant soft tissue architecture. This study describes a novel workflow for one-step formation of the supra-implant emergence profile. Materials and Methods: Two randomized groups were selected. Ten control group participants received standard healing screws at the surgical stage. Ten individualized healing abutments were Computer aided Design/Computer aided Manufacturing (CAD/CAM)-fabricated out of polyether ether ketone (PEEK) restoration material in a fully digital workflow and seated at the surgical stage in the test group. The modified healing abutment shape was extracted from a virtual library. The standard triangulation language (STL) files of a premolar and a molar were obtained considering the coronal anatomy up to the cement-enamel junction (CEJ). After a healing period ranging from 1 to 3 months depending on the location of the surgical site, namely, mandible or maxilla, a digital impression was taken. The functional implant prosthodontics score (FIPS) and the numerical rating scale (NRS) of pain were recorded and compared. Results: The mean FIPS value for the test group was 9.1 ± 0.9 while the control group mean value was 7.1 ± 0.9. In the test group, pain assessment at crown placement presented a mean value of 0.5 ± 0.7. On the contrary, the control group showed a mean value of 5.5 ± 1.6. Conclusions: Patients in the test group showed higher FIPS values and lower NRS scores during the early phases compared to the control group.

Background:

Methods:

Results:

Conclusion:

Background:

Reconstruction of severely resorbed jaws requires different surgical procedures to restore the correct bone morphology. These procedures often involve the use of bone substitutes or the harvesting of autologous bone from a donor site. Autologous bone is still regarded as the “gold standard” for augmentation procedures because of its osteogenic potential, but this graft has limited availability and the surgical harvesting procedures can cause additional morbidity to the patient. Differently from heterologous bone or alloplatics substitutes, homologous bone has intrinsic osteoinduction properties in addition to osteoconductivity. Despite these benefits, the documented use of homologous block allografts in the treatment of alveolar ridge atrophy is limited in the literature. The purpose of this case report is to evaluate the suitability of deep-frozen allograft for ridge augmentation procedures in severely atrophic maxillae and to analyze the clinical success of dental implants inserted after grafting and prosthetic rehabilitation.

Methods:

A 50-years-old patient in general good health with a total superior edentulism and presenting a severe athrophic maxilla has been subjected, under general anesthesia, to ridge reconstruction with appositional homologous fresh frozen bone (FFB) block grafts pre-contoured onto a stereolithographic model. After 8 months, 6 rough-surface implants were placed and the fixation screws were removed. Implants were left unloaded while a total provisional prosthesis was delivered to the patient. After 6 months a new surgery was scheduled to obtain implant exposure and finally, 5 months later, the definitive overdenture prosthesis was completed.

Results:

A radiological and clinical follow-up evaluation was conducted once a year. After 4 years the patient is still in good condition and no complications were shown.

Conclusion:

The use of homologous FFB grafts present some advantages compared to other biomaterials such as osteoconductive and osteoinductive qualities, reduction of postoperative discomfort for the patient, graft availability and reduction of operating time. The author’s experience support the hypothesis that fresh-frozen bone allografts can be successful as graft material for the treatment of important maxillary ridge defects.

Insufficient crown height space, particularly in the interforaminal region of edentulous ridges with knife-edge morphology, may prevent successful prosthetic rehabilitation. Such conditions require osteoplasty, which might complicate computer-guided implant placement. This clinical report il- lustrates the treatment of a patient with complete edentulism rehabilitated with a mandibular implant-supported fixed dental prosthesis by using a virtually guided approach. Both alveolar ridge reduction and prosthetically driven implant insertions were computer-guided by surgical stents to increase accuracy and predictability. This approach enabled the immediate loading of the implants with an interim prosthesis before the delivery of a definitive screw-retained fixed prosthesis. At the 1-year follow-up visit, clinical and radiographic examination revealed a stable outcome.

Background:

The presence of keratinized tissue around dental implants is more than desirable either from a functional and aesthetic point of view, making soft tissue grafting a common practice in implant rehabilitation. Autogenous soft tissue grafting procedures are usually associated with high morbidity. Aim of this study was to assess the efficacy of a xenogeneic collagen matrix as a substitute for soft tissue grafting around dental implants.

Methods:

15 consecutive patients underwent a vestibuloplasty and grafting, both in the mandible and the maxilla, with a collagen matrix.

Results:

The primary endpoint was to evaluate the resorption of the graft along with the re-epithelization grafted area. The percentage of the resorption was 44,4%, with a mean gain in vestibular height of 3 mm. Secondary endpoints evaluated the clinical appearance, the hemostatic effect and the post-operative pain. All subjects referred minimal pain with no bleeding. No adverse reaction nor infection were noted.

Conclusion:

This study showed that the used collagen matrix can find major interest in those patients who need a greater aesthetic outcome as the matrix has a perfect integration with the surrounding tissues. Furthermore it is strongly recommended for those patients who can bear little pain.

Clinical Significance:

Post-operative morbidity of autologous grafts is the biggest concern of this type of surgery. The possibility to use a soft tissue substitute is a great achievement as morbidity decreases and bigger areas can be treated in a single surgery.
The present study showed the efficacy of a collagen matrix as this kind of substitute.

Peri-implant disease can be objectified in 2 distinct forms: peri-implant mucositis and peri-implantitis. When a peri-mucositis occurs, the inflammatory reaction is confined to the soft tissues surrounding an implant, with no signs of loss of supporting bone. This reversible condition is clinically characterized by the presence of bleeding on probing and/or suppuration, which are usually associated with probing depths >_4 mm. Differently, peri- implantitis has been described as a destructive inflammatory process around an osseointegrated implant that leads to peri- implant pocket formation and progressive loss of supporting bone. For defining a case as peri-implantitis, the presence of bleeding on probing and/or suppuration with or without concomitant deepening of peri-implant pockets must be present, in association with peri-implant marginal bone loss 􏰀2 mm from the expected marginal bone level following remodeling after implant placement. In addition to the soft tissues inflammation, the typical bone defect is crater-like, runs all around the implant, and is strictly demarcated; however, implant mobility is absent due to the osteointegration that is maintained apically to the defect.

As different thresholds for probing depths and radiographic bone loss were applied in the literature to diagnose the peri- implant disease, the true incidence cannot be stated. A recent meta-analyses estimated weighted mean prevalences of peri- implant mucositis and peri-implantitis of 43% and 22%, respectively; however, the prevalence ranged from 19% to 65% and from 1% to 47%, respectively, due to the heteroge- neous use of case definitions. Etiopathologically, a cause and effect relationship between biofilm formation on the implants surface and peri-implant disease has been found; however, even nonmicrobial events including implant fractures and submucosal persistence of luting cement could favor the formation of a pathogenic microbiota with the subsequent bacterial insult. It is therefore generally accepted that the elimination of the biofilm from the implant surface is the prime objective when treating peri-implantitis.

Basically, a nonsurgi- cal treatment could be advisable during early phases to treat peri-mucositis; however, if the progression of the peri-implant lesion or the bone loss could not be arrested, surgical therapy may be considered due to its superiority in the treatment of peri-implantitis. Several decontamination methods, such as air- powder abrasion, saline wash, citric acid application, laser therapy, peroxide treatment, ultrasonic/manual debridement, and application of topical medication have all been investigat- ed, but a definite gold standard could not be identified. Furthermore, different regenerative protocols have been used to reestablish a proper amount of bone circumferentially around an implant following surgical therapy; however, results were heterogeneous.