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Patients with failing implants or teeth may require multiple procedures to correct their problems. The purpose of this article was to describe an algorithmic approach for clinicians to use to simplify the restoration of the patient.The topics for this article were used to search for references using PubMed. Topics included the effect of thickening thin gingiva to promote stable soft tissue margins, the use of different bone graft materials for sockets and for ridge augmentation, and methods to use digital technology for efficient planning. Other sources were book chapters, which had an extensive reference section including multiple case series and clinical trial results. Based on the search results, references were chosen that would verify the techniques suggested to be used for these problems. For this narrative, diagnostic information is described using virtual digital methods rather than analog methods to develop the final prosthetic plan, which guides the surgical procedures. The surgical phases are described in detail.The gingiva needs to be healthy and thick to support a hard tissue graft. The timing of procedures begins with assessment of the quality of the soft tissue and the loss of both soft and hard tissues. The operative procedures should be based on the final prosthetic plan, created digitally, to provide information that is required to properly position soft and hard tissue grafts and the implants.This organized, algorithmic approach can be used for many situations that clinicians are seeing in their daily practice due to complications that can occur.

After tooth extraction in the posterior maxilla, bone resorption often limits implant placement unless additional grafting procedures are performed. However, it is difficult to predict the amount of bone that will remain after extraction based on current evidence. The purpose of this study was to develop a method for predicting the postextraction alveolar bone height in the posterior maxilla.The authors conducted a retrospective cohort study that included all patients who were treated for the extraction and replacement of a maxillary first molar with a dental implant from 2008 to 2019. Potential predictor variables included thirteen pre-extraction radiographic measurements obtained via cone-beam computed tomography. The outcome variable was having more than 6 mm of bone height from the alveolar crest to the sinus floor after extraction. Decision tree analyses were used to search for the best predictors of this outcome using random forest analysis with a maximum of 3 randomly chosen covariates in each candidate tree.A total of 63 patients were included in the study; 55.6% were women, and the mean age was 57.6 ± 14.5 years. In this study population, having a bone height from the furcation to the maxillary sinus floor of6.7 mm had a 7.1% chance of having6 mm of bone height postoperatively, whereas those patients with ≥6.7 mm at the same position preoperatively had a 61.9% chance of having6 mm of bone height postoperatively (P .001).This study suggests that patients with6.7 mm of bone from the furcation to the sinus are at increased risk of having insufficient bone to support a dental implant without additional grafting at the maxillary first molar position. When treating these patients, the surgeon should consider performing a procedure at the time of extraction to increase bone height or explain additional bone grafting is expected for ideal implant placement.

Surgeons placing implants use navigation for implant placement accuracy. The importance of this review is to document the sources of error that are involved with navigation so surgeons can recognize factors to decrease error. The objective is to provide surgeons with a reference to optimize navigation.Pubmed.gov was the information source. Years reviewed included 2010 to 2022. The inclusion criteria included only articles in peer-reviewed journals. In vitro results were included only if they involved testing of variables microgap, cone beam computerized tomography (CBCT) accuracy evaluation, or accuracy of printed models. Variables were searched and evaluated. Data collected included the objectives and outcomes of the study including statistical significance. The conclusions made by the authors were confirmed by evaluating the data analysis, and then these conclusions were listed in each error-related topic.The search used terms which included guided implant surgery complications (n = 4,029), accuracy of CBCT scanners (n = 319), accuracy of implant navigation (n = 983), and the error between drills and static guides (n = 3). From this search, 70 articles were collated that satisfied the inclusion criteria. There are multiple sources of error that are less than 1 mm, including but not limited to errors associated with the scanner and method for scanning, errors associated with merging scanned files with the CBCT scan, errors using different guide stent fabrication methods, errors associated with intraoperative techniques, the learning curve, and planning error. If small errors are not taken into consideration, implant placement errors can exceed 1-2 mm of platform location and angulation errors in excess of 8°.The surgeon needs to take into consideration controllable factors that will result in the avoidance of implant malposition and thus be able to effectively utilize navigation for accurate implant placement.

Our recent study indicated that patients with osteoporosis had an increased risk for early and late implant failure perhaps due to a large cancellous space. Therefore, the purpose of the article is to explore the relationship between the amount of cancellous space in an implant site and implant failure.The authors conducted a retrospective cohort study on patients who received dental implants in the posterior mandible at the senior author's practice from January 1, 2008 to October 1, 2019. The primary outcome variable was time to implant failure. The primary predictor variable was the amount of cancellous bone between the buccal and lingual cortices (cancellous space). Other study variables included demographic variables, medical history variables, and implant site measurements. Statistical analysis was performed using descriptive statistics, chi-squared tests, single variable and multiple Cox proportional hazard analyses.The study cohort (n = 220) was composed of 62.3% women and the average age was 58.2 years. The median follow-up time was 3.5 years (range: 1-12). Five-year survival rates for patients with a cancellous space of4 mm was 100%, with a cancellous space of 4-6 mm was 95.3%, with a cancellous space of 6-8 mm was 88.2%, and with a cancellous space of8 mm was 64.1%. In the final multivariate Cox proportional hazard model adjusting for age, gender, smoking status, site and buccal cortex width, cancellous space remained significantly associated with time to implant failure (aHR 1.7 per millimeter change [1.4 - 2.2], P .0001).The width of the cancellous space and subsequent gap between implant and cortical bone should be considered when placing implants into the mandibular molar sites. When the patient presents for an implant in the mandibular molar region, if the cancellous space is large, the patient should be informed of the risk.

Alveolar ridge augmentation is often required before implant placement. The purpose of the present study was to determine whether maxillary and mandibular ridge augmentation with a high-temperature xenograft remains stable over time.A retrospective case series was performed of subjects who had undergone maxillary anterior or posterior ridge augmentation with a high-temperature xenograft (HTX). The primary predictor variable was the HTX. The primary outcome variable was the ridge width, measured T0 (before augmentation), T1 (immediately after augmentation), T2 (4 to 6 months after augmentation), and T3 (4 years after augmentation). The secondary outcome variable was implant success. Analysis of variance and linear regression analysis were used to determine significance. A P value .05 was considered statistically significant.A total of 31 patients (age, 52.4 ± 18 years; 61.3% women) were identified who had undergone ridge width augmentation performed using HTX. Of these, 23 had cone-beam computed tomography scans available 4 to 10 years after augmentation had been performed. At the anterior maxilla, the initial ridge augmentation (T1) was 4.7 ± 1.3 mm, which had decreased to 3.7 ± 1.0 mm within 6 months of augmentation (T2) and to 3.3 ± 1.1 mm after an average of 7 years (T3) of follow-up (P .05). At the posterior mandible, the initial ridge augmentation was 5.4 ± 0.9 mm, which had decreased to 4.1 ± 0.7 mm within 6 months of augmentation and to 3.5 ± 1.0 mm at an average of 7 years of follow-up. A total of 61 implants had been placed in these 23 patients, 3 (4.9%) of which had failed to integrate.The use of HTX does result in long-term stability for ridge augmentation.

Long-term success with a dental implant restoration relies on a stable connection between the abutment and the implant. The purpose of this article is to review current knowledge of the abutment interface, identify problems that develop due to wear and mismatch of parts, and use a problem list to propose a solution. The objective was to provide a concise overview that clinicians can then use to choose a system that addresses the problems of the abutment implant interface.Manufacturing methods will result in surface variations across the surface of the abutment and implant. Microgaps change in dimension upon function due to wear. Bacterial leakage can lead secondary to functional wear, and the microgap will get larger. The increase in the microgap with function has been clinically verified. Micromotion will result in larger areas of surface gap in both flat and conical connections, with gaps larger than the size of bacteria.For an ideal abutment, an implant system must have high tolerances for manufacturing with minimal gap formation along the abutment to implant surface; a connection that is resistant to micromotion; screws that have minimal deformation during loading; and a microgap less than 1 micron which is maintained during implant function.

The purpose of this study was to confirm that after simultaneous implant placement and vertical bone augmentation in the posterior maxilla, the immediate postoperative bone height is maintained after 2 to 3 years of follow-up.Consecutive patients treated with implant placement in the posterior maxilla were evaluated. Cone-beam scans were taken preoperatively; immediately after implant placement; and for the sinus-grafted cases, 2 to 3 years after surgery. Crestal bone heights were measured. Patients were grouped according to the use of sinus augmentation or no sinus augmentation at the time of implant placement.The increase in bone height was significant in the graft group when we compared immediate and 3-year follow-up measurements (P .00001). In the graft group, there were no significant differences in bone height when we compared the immediate and 3-year follow-up periods (P = .31).Simultaneous sinus floor elevation with grafting at implant placement results in stable bone levels after 2 to 3 years' follow-up.

The surgeon needs to have an inexpensive, available, nontoxic, and practical disinfectant that is effective in sanitizing against the COVID-19 (Coronavirus Disease 2019) virus. The purpose of this article was to review the evidence for using hypochlorous acid in the office setting on a daily basis. The method used to assemble recommendations was a review of the literature including evidence for this solution when used in different locations and industries other than the oral-maxillofacial clinic facility. The results indicate that this material can be used with a high predictability for disinfecting against the COVID-19 (Coronavirus Disease 2019) virus.

Purpose Recognition of patient-specific risk factors should reduce implant failure. The purpose of this study was to identify risk factors associated with implant failure and to determine if these factors differ over time after implant placement. Methods The investigators implemented a retrospective case-controlled study and enrolled a sample composed of patients who had 1 or more implants removed from December 1, 2007 to February 29, 2020. Risk factors were grouped into demographic, medical history, and treatment-related variables. The primary outcome variable was whether the patient's implant failed, with control patients including those without implant failure. The duration was recorded for follow-up from the time of implant placement to the last visit or implant removal. Backward variable selection was used to predict whether an implant failed within 1 year, 1 to 4 years, or after 4 years in 3 multivariable logistic regressions. Results Of 224 patients in this cohort, 82 experienced an implant failure. The mean age was 58.6 ± 15.3 years, and 53.1% were females. Patients with osteoporosis had an increased risk of failure in each period. Alcohol use, smoking, depression, and penicillin allergy were all associated with an increased probability of failure within 1 or more of the periods considered. Conclusions This study has identified multiple discrete risk factors for implant failure and has demonstrated that these factors are associated with implant failure at different periods after placement.

This technical note addresses a method to increase the height of the posterior maxilla using a crestal window approach. This approach decreases the need for use of the lateral window approach and provides clinicians with an alternative with less morbidity. An island of crestal bone is mobilized superiorly and the site is grafted, resulting in 4 to 10 mm of vertical bone augmentation in a thin crest. A small case series is presented with implants integrated into these grafts.

The present article on the history of dental implants spans beyond the past 100 years of the American Association of Oral and Maxillofacial Surgeons. It was not until the materials and methods became less traumatic to the bone that implants could become firmly attached to the surrounding bone. This phenomenon is now used to replace single and multiple teeth and restore the patient to function and well-being. Many of the methods used to increase denture function are still used with modifications to augment the environment for an implant. These technological changes have allowed patients to be treated efficiently, with the same need for a good treatment plan and physical evaluation by the clinician.

One clinical problem when augmenting a narrow or vertically deficient ridge is maintenance of the graft position during the immediate healing phase and preservation of the augmentation over time. The use of Tisseel (Baxter, Deerfield, IL), a fibrin sealant product, to stabilize particulate grafts, has been reported, and we have reviewed its use. Fibrinogen is converted to fibrin and forms a fibular network that binds the particulate graft. A protease inhibitor is included, which prevents lysis of the coagulum for at least 2 weeks and allows for fibrous ingrowth and graft stabilization. We have reviewed the reported data and included 2 case reports to demonstrate the use of Tisseel.

The replacement of one tooth using one implant involves a set of unique criteria for long-term success. Successful therapy should be based on long-term function and health of the adjacent tissues. Sections of this article examine these critical criteria that when working together can result in successful long-term tooth replacement.

The use of the crestal approach to augment vertical height of the posterior maxilla for dental implant placement is reviewed in this article. The review of the literature documents the success of using a procedure that has minimal complications associated with it when performed correctly. An algorithmic approach is presented to guide surgeons on using the crestal osteotome approach for posterior maxillary augmentation.

Purpose Clinicians might decide to use a xenograft to reconstruct an osseous defect. Xenografts are processed differently depending on the manufacturer. The purpose of this article is to review the processing methods and clinical ramifications of these processing methods on the behavior of xenografts. Materials and Methods Differences in surface morphology of xenografts based on processing, xenografts used for sinus augmentation, onlay grafting using particulate xenografts, and available clinical trials are reviewed. Results When used for grafting the extraction socket or preserving or reconstructing the ridge contour, xenografts can result in different resorption rates over time. Conclusion Based on the available information gleaned from the literature, clinical recommendations are included for specific clinical applications.

The purpose of the present report is to contrast and compare 2 methods of dental implant placement. One method uses computed tomography data for computer-aided design and computer-aided manufacturing to generate static guides for implant placement. The second method is a dynamic navigation system that uses a stereo vision computer triangulation setup to guide implant placement. A review of the published data was performed to provide evidence-based material to compare each method. Finally, the indications for each type of method are discussed.

The clinician is often asked to remove a tooth and place an implant into the site. The implant must be placed with appropriate stability to allow for integration to occur, which requires bone presence. Bone is also necessary to allow for ideal implant positioning within the alveolus for functional and esthetic concerns. The purpose of this article is to discuss the changes in socket dimensions over time and how to promote space maintenance, with an algorithm for treatment based on evidence.

When a maxillary molar tooth needs to be removed, the treatment plan often includes subsequent dental implant placement. However, there may be less than 5 mm of bone available in the central fossa region of the proposed implant site. This report describes a technique to use a precise osteotomy within the maxillary molar socket to mobilize a segment of bone and superiorly raise it to provide increased alveolar bone height using grafting. This technique eliminates the need for lateral window surgery.

The narrow ridge in the anterior maxilla often requires horizontal augmentation for ideal implant placement. This article reviews the historical use of a closed, tunnel approach to augment deficient alveolar ridges and describes its application for augmentation of the narrow ridge in the anterior maxilla. The use of a tunnel approach through a vertical incision in the unattached mucosa provides access to the ridge while maintaining crestal attachments without displacement of the crestal attached gingiva. This approach is atraumatic and provides excellent access for placement of graft material for ridge augmentation.

The purpose of this technique note is to describe an improvement of a previously published method to augment the thin posterior mandibular ridge. The technique uses a subperiosteal tunnel to place a collagen membrane within the tunnel to maintain the shape of the augmentation. After the collagen membrane has been placed, a sintered xenograft is packed as an onlay graft, with implant placement 6 to 9 months later.

Patients often present with the need for replacement and reconstruction of teeth in the anterior maxilla. This chapter describes a sequence of preoperative, intraoperative, and postoperative methods to treat many of these patients in an organized and evidence-based set of methods.

Purpose The purpose of this prospective study was to measure and compare the accuracy and precision of dynamic navigation with freehand (FH) implant fixture placement. The authors hypothesized that the evaluated dynamic navigation system would have high accuracy and precision and would be superior to FH methods. Materials and Methods The authors designed and implemented a prospective cohort study and enrolled patients who had implants placed from December 2014 through December 2016. The predictor variable was implant placement technique comparing fully guided (FG) and partially guided (PG) dynamic navigation with FH placement. The outcome variables were accuracy measured as deviation from the virtual plan, and precision was represented as the standard deviation of the measurements. Analysis of variance (ANOVA) was used to compare measurements. Virtual implant placement was compared with post-implant placement using mesh analysis. Deviations from the virtual plan were recorded for each implant for each surgeon. FH implant placement was evaluated by comparing a virtual plan with postoperative scans for patients who did not have the navigation system used for their implant placement. One-way ANOVA was performed to determine within-group and between-groups differences to determine whether there were meaningful differences among surgeons and methods (FG, PG, and FH) of placement. Results Prospective data from 478 patients involving 714 implants were evaluated. There were no demographic differences among surgeons. The sample size differed by the number of implants placed by each surgeon. Within each method group, the only difference among surgeons was angular deviation. All surgeons' data were combined. For FG navigation, the mean angular deviation was 2.97 ± 2.09°, the mean global platform position deviation was 1.16 ± 0.59 mm, and the mean global apical position deviation was 1.29 ± 0.65 mm. For PG navigation, the mean angular deviation was 3.43 ± 2.33°, the mean global platform position deviation was 1.31 ± 0.68 mm, and the mean global apical position deviation was 1.52 ± 0.78 mm. For FH placement, the mean angular deviation was 6.50 ± 4.21°, the mean global platform position deviation was 1.78 ± 0.77 mm, and the mean global apical position deviation was 2.27 ± 1.02 mm. Differences in measurements comparing FG and PG navigation with FH indicated significantly less deviation from the virtual plan (P

Clinical success of an endosseous implant to replace a single tooth is not only defined by its survival. Esthetic parameters have become integral aspects in defining success and failure. All-ceramic abutments have started to play a major role in achieving an esthetically successful result. The material itself, however, is not the exclusive determinant for esthetic success. It is the appropriate design and proper handling of the material and the abutment that enables the clinician to achieve esthetic outcomes that were not possible with traditional metal alloys. This article explores the rationale for using zirconia for prosthetic implant components, explains specific material properties, and discusses strategies and guidelines for the design and successful clinical implementation of CAD/CAM-fabricated zirconia implant abutments.

The goal of this article is to provide clinicians with a list of technical problems that can occur throughout the process of using computed tomography (CT) for guided surgery. Complications can occur because of inaccurate planning, radiographic stent error, intrinsic errors during scanning, software planning, rapid prototyping the guide stent, and transferring information for the prosthetics. If the clinician recognizes these sources of inaccuracy, efforts can be made to minimize the error and optimize patient treatment. Computed tomography (CT) can be used to image a patient with or without radiographic stents to plan implant reconstructive surgery. These 3-dimensional images in DICOM format are entered into a computer, after which planning software is used to virtually plan implant placement and restorations, create rapid prototype surgical guide stents, and subsequently fabricate provisional or final restorations before implant placement surgery. As this process is used, the indications for using parts of or all of the process are defined as complications occur and are collated. It is the purpose of this article to discuss the complications with CT-guided surgery and to define the limitations associated with this treatment process. Based on this discussion, recommendations will be made to guide clinicians choosing to use CT imaging and guided surgery. Situations that contribute to the accuracy or inaccuracy of the CT planning or CT-guided surgery process begin with diagnostics, radiographic stent fabrication, scanning error, planning error, and the surgical and prosthetic technical aspects of orchestrating the process in the patient. 1 The following sections include specific examples of complications that occur at each stage of the process. Literature is reviewed, and the experiences of the authors are combined to discuss multiple scenarios. The clinician must account for the cumulative error that may be involved in all of the steps leading up to surgery (Table 1).

Purpose The purpose of this report was to review the published data on orthodontic extrusion and make recommendations for its use according to the evidence presented, including the technique for use by clinicians. Materials and Methods A MEDLINE search was performed to identify reports in referenced journals in English. These studies were collated and reviewed for clinical and animal data on orthodontic extrusion. In addition, the experiences of our team using orthodontic extrusion was added to the evidence used to make the recommendations. Results From this background information, orthodontic tooth extrusion is able to move the soft tissues when the sulcular attachment apparatus is intact. Bone formation as the tooth is extruded is dependent on the vector of the movement of the tooth. The rate of tooth extrusion is effected by the bone–tooth attachment. Conclusions When used as we have described, extrusion can effectively move the facial gingival margin to allow for esthetic restoration of implants placed in the extruded tooth position.

Purpose The hypothesis for this prospective evaluation is that resorbable plates are equal to the performance of titanium 2-mm plates, regarding healing of the fracture with bone union and restoration of function. To prove this hypothesis, specific end points will be compared with literature norms for titanium 2-mm miniplate rigid fixation. The primary end point variable for this analysis is the union of the fracture and return to normal function. Secondary end point variables included the incidence of complications such as infection, malunion with malocclusion, soft tissue dehiscence, the need for revision surgery, specific technical challenges, operative time, and the learning curve for the surgeon. Patients and Methods This prospective study consisted of a sequential enrollment of 50 fractures that met the inclusion criteria of having a fracture of the mandibular body, symphysis, angle, or ramus, and required an open reduction and internal fixation for stabilization and repair. The resorbable plates and screws used consisted of an amorphous injection molded copolymer of L-lactide/D-lactide/trimethylene carbonate (Inion CPS system, Tampere, Finland). Data were collated and compared with literature norms for titanium plates and also compared with nonrigid fixation data from a prospective study performed on a similar population in the same institution. Results Clinical and radiographic evaluation indicated union of all fractures at the eighth follow-up visit. Three sites (6%) noted to have clinical signs of infection were treated immediately upon presentation, with fracture union by 8 weeks. There was no need for revision surgery in this series of patients; 12 screw heads fractured during screw placement and were immediately replaced without significant fracture sequelae. Conclusion Based on this limited series of patients, the hypothesis formulated for this study was validated.

Bone morphogenic proteins (BMP) are members of the family of transforming growth factors. Fifteen different BMP have been identified, all with varying degrees of cellular activity, including cartilage- or bone-inductive properties. Two recombinant proteins are available: recombinant human bone morphogenetic protein (rhBMP)-2 and rhBMP-7. These products have been investigated as alternatives to autogenous bone grafts in a variety of clinical situations, including spinal fusions, fracture repair, treatment of bone defects, and reconstruction of maxillofacial conditions. Reconstruction in the maxillofacial region includes alveolar ridge augmentation, mandibular reconstruction, and maxillary sinus augmentation.

Purpose The purposes of this article were to review the literature for treatment of teeth with external resorption secondary to avulsive injuries and to illustrate treatment of patients with teeth following different clinical scenarios to develop a predictable course of therapy. Materials and Methods Cases that demonstrate treatment of teeth with external resorption following injury during the growing period, external resorption treated with a delayed approach after tooth extraction, immediate grafting of the extraction site to repair labial bone loss, and immediate implant placement with provisionalization are shown. Conclusion Based on a review of the literature, the decision to place dental implants to replace teeth with external resorption can be timed depending on the location and type of the resorption, with excellent esthetic results.

Purpose Patients desire efficient restoration of missing teeth. Immediate provisionalization of implants at the time of placement can provide the patient with a tooth-like restoration. Our hypothesis is that preoperative fabrication of the implant abutment and provisional restoration can provide successful immediate provisionalization of implants, if specific diagnostic criteria are used for patient selection. Patients and methods This hypothesis is evaluated by prospectively following 74 implants thus treated for 6 months to 2 years. A technique is presented to illustrate a simple and reliable method to provisionally restore a single tooth restoration. The method involves preoperative placement of an implant analog into a model, preparation of the abutment on the model, and fabrication of a provisional crown out of occlusion. At the time of surgery, the implant is placed according to the prescription of the restorative dentist, the surgeon places the abutment and provisional crown, and the final restoration is fabricated after the implant integrates. Results Seventy of 74 (94.6%) restorations have been successful with up to 2-year follow-up, which is similar to single tooth implants treated using a 2-stage protocol. Conclusions Single tooth immediate provisionalization implants are effective techniques when specific diagnostic criteria are used.

The replacement and restoration of missing single teeth with dental implants are routine procedures. However, because of the relatively short clinical history of this procedure in dentistry, custom-tailored protocols for this procedure do not exist. This article will outline the various surgical and restorative steps involved in the treatment planning, fabrication, and delivery of single-implant restoration, and will critically analyze the existing clinical concepts and provide recommendations based on a contemporary approach. As data for and experience with this procedure increase the same general guidelines for all types of implant restorations may not apply. Emphasis will be placed on differentiating between the various types of single-implant restorations, comparing and contrasting the differences between the different types of single-implant restorations, and revising some of the existing concepts of this treatment modality.

Purpose Edentulous patients desire restoration of their chewing ability as soon as possible after placement of dental implants. The purpose of this article is to provide clinicians with evidence that immediate loading of implants placed into the anterior mandible can predictably provide the patient with early functional rehabilitation. Two methods are presented that illustrate delivery of the final restoration or a provisional implant-borne prosthesis immediately after implant placement. Materials and methods A literature search was performed which produced 14 articles in the English literature that provided sufficient evidence that immediate loading is now not experimental and can be recommended as an acceptable treatment alternative. Results Two practical methods to achieve immediate function are presented in a step-wise manner to illustrate how to deliver this service to the patient. Conclusion Based on our literature review, immediate loading of the edentulous mandible with an implant-borne restoration is an acceptable and predictable method to deliver efficient return of function for the edentulous patient.

The choice to replace a single missing tooth can be based on the primary decision that the restorability of the tooth is in doubt. Many teeth are decimated by incipient or recurrent caries, trauma, endodontic complications, or periodontal disease which requires extraction. It is our objective to familiarize the participant with literature comparing success rates of fixed partial dentures and single-tooth implant restorations and a repertoire of prosthodontic techniques used in replacement of single missing teeth with osseointegrated dental implants. The fixed partial denture (FPD) has been regarded as the standard of care for some time in replacement of single and multiple missing teeth. Many studies surveying long term survival have been compiled and analyzed to arrive at a generalized outcome. Most of these studies arrive at common conclusions. Studies surveying success of single-tooth implant-supported restorations are not comparably abundant nor survey for comparable time as those for FPDs. Although, many of the outcomes are statistical survival estimates such as Kaplan-Meier survival tables, implant restorations in partially dentate patients are a predictable means of tooth replacement. There are certain factors which make FPD more appropriate and conversely factors which make an implant restoration more appropriate. Indications and contraindications for each treatment scenario will also be reviewed based on the literature and clinical experience. It is hoped that the practitioner will be able to appropriately identify those cases in which either an FPD or an implant restoration is the appropriate treatment option.

The removal of a tooth initiates a sequence of events including inflammation, epithelialization, and remodeling. Sockets heal by secondary intention, with remodeling continuing to 1 year after the extraction before the site is indistinguishable from adjacent edentulous bone. When a tooth is removed, the empty socket consists of cortical bone known as the lamina dura, torn periodontal ligaments, and a rim of oral epithelium. The socket fills with blood, which clots and seals the socket from the oral environment. The inflammatory stage of healing occurs during the first week. White blood cells enter the site and remove debris and break down remaining bone fragments and other soft tissue remnants. Fibroblasts and capillaries infiltrate the socket. The epithelium migrates down the wall of the socket until it reaches epithelium from the other side or encounters a bed of granulation tissue over which it can migrate. The second week has a large amount of granulation tissue filling the socket. Osteoid deposition begins along the alveolar bone lining the site. These processes continue during the third and fourth weeks, with epithelialization complete by the fourth week and earlier in small sites [1]. Woven bone is formed and fills the extraction site by 8 weeks [2]. Cortical bone continues to be resorbed from the walls of the socket, with new trabecular bone laid down across the socket. As shown by Atwood [3], however, the process of bone remodeling may vary significantly between individuals. The layer of compact bone may fail to regenerate [4], resulting in exposure of the cancellous bone in the alveolar ridge. Further resorption can then occur. Bone loss following tooth extraction may amount to 0.5 mm per year. Bone resorption is affected by overlying pressures

The purpose of this report is to discuss the treatment of a patient with cyclic neutropenia. This patient presented with flared teeth, thin alveolar bone, and mobile teeth. A staged approach was used to remove her teeth, augment the bone, use immediate fixed provisional to determine the type of final prostheses, and ultimately to use cone-shaped overdenture attachments to retain her final prostheses. The result was rehabilitation of the patient with esthetic full-arch fixed-removable dentures with no adverse sequelae in this patient with this systemic disease.

Treatment planning of edentulous patients may reveal a lack of adequate bone in the posterior maxilla for the placement of standard-type endosseous implants. To avoid bone grafting, an alternative method is the use of a zygomaticus implant (Nobel Biocare, Yorba Linda, CA), which is a threaded titanium implant of 3.75 mm in diameter graduating in size to 4.0 mm and available in lengths up to 50 mm. 1 Branemark and others have reported the use of the zygomaticus fixture with follow-up to 10 years in a small number of patients, with larger numbers over 5 years in function. The patient population treated by Branemark includes patients with totally edentulous intact maxillas as well as maxillectomy cases after tumor resection. The reported success rate is in excess of 96%.2-4 The recommended protocol includes the placement of 2 zygomaticus implants, with 1 on each side of the maxilla, in combination with 2 to 4 anteriorly placed standard-length endosseous implants. After 6 months for integration of the zygomaticus fixture to the zygomatic bone, the restoration is completed with the fabrication of a rigid bar connecting the 2 zygomaticus implants to the anterior implants. The final prosthesis is an implant-supported full arch fixed or fixed/removable prosthesis.1 The treatment of patients with nasomaxillary defects can be difficult after tumor ablative surgery. The choice to use vascularized or local flaps usually is not a viable option due to the amount of tissue missing and the fact that many of these patients are treated with radiation therapy. More frequently, these patients are prosthetically reconstructed to enhance their oral function and aesthetics. Very often, patients with nasomaxillary defects have a dual defect. The nasal cavity is confluent with the oral cavity via an anterior maxillary defect. Prosthetic reconstruction relies on segmental methods of intraoral and extraoral anchorage and conjoint anchorage with samarium cobalt magnets. The result is the combination of 2 separate prostheses that may be stable based on the underlying structures. Certain anatomic structures are needed, however, to make these prosthetics stable enough to function effectively. The maxilla should have sufficient anterior posterior length to be effective in providing an anterior stop. Natural teeth can aid in providing this stability. Because the nasal prosthesis derives its support in part from the maxillary prosthesis, anterior stability is paramount to result in a steady and reasonably anchored nasal prosthesis. This case report shows the use of 2 zygomaticus implants, placed horizontally in the orbital rims, combined with 3 nasal bone implants, to support nasal and maxillary prostheses in a patient who had had a radical rhinectomy and partial maxillectomy.