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Six block grafts harvested from the mandibular symphysis were used to augment partially atrophied ridges. Three maxillary defects and three mandibular defects were treated in five patients. Autologous bone grafts from the chin were stabilized in the recipient sites with resorbable pins and no membranes were used over the grafts. Healing proceeded without complications. At 3 to 4 months the external cortical surface of the grafts progressively resorbed and the profiles of the pins protruded from underneath the buccal tissue that covered the augmented areas. However, the pins never perforated the tissue and they were resorbed macroscopically within 4 to 6 months. At 6 months the areas treated showed successful ridge augmentation and when exposed for stage 2 surgery, remnants of the pin holes on the external surface of the repaired defects were detected. Radiographic evaluation of the block grafts was performed at 3 and 6 months and histologic specimens were obtained at 6 months; the specimens demonstrated incomplete pin resorption and encapsulation. A severe foreign-body reaction was detected in one case. The presence of an acellular bone matrix in certain sections and a normal bone pattern with a cellular component in others was a consistant finding. ITI endosseous Implants were placed with excellent primary stability in all treated cases.

Fixed provisional prostheses are fabricated to maintain, improve, and/or change oral function and esthetics for varying periods. It is important to know when to provide a provisional prostheses and how to make one so that it will meet the needs of the patient. This article describes a modification of the design of a cast metal reinforced processed acrylic resin provisional restoration for extensive, long-term reconstruction with implants, because some of the treatments rendered to patients require temporization for up to 2 years. This design has been used by the authors since 1991, and has resulted in fewer problems of fracture of the provisional restorations. In addition, removable partial dentures are rarely needed, even when large spans exist between remaining abutments in serial extractions. This procedure also permits performing guided bone regeneration for deficient ridges without the problem of transmucosal loading, while still maintaining the patient's esthetics and function after surgery.

This case report describes the use of a single implant as an abutment for a removable cast partial denture. The patient had only anterior teeth remaining in the mandible. One single-stage implant was placed to be used as an abutment for a cast removable partial denture. The periapical X-ray taken 14 months after initial loading showed no bone loss. Clinically, there was no crown loosening, no pocket depth, nor any implant loosening at 14 months. A long-term multicenter study is advocated to evaluate a greater number of patients over a 3- to 5-year time period to evaluate the success fo implant-supported crowns when they are used as partial denture abutments.

In 1991, the Dental Implant Clinical Research Group comprising 30 Department of Veterans Affairs medical centers and two dental schools initiated a long-term clinical study to investigate the clinical performance of implants within the Spectra-System (Core-Vent Corporation, Las Vegas, NV). This article focuses on a portion of the study database related to incision type, implant success rates, and response of crestal bone up to the time of surgical uncovering. The crestal incision was used for 1,705 implants (381 patients) and the remote incision for 593 implants (141 patients). No statistically significant difference (P = .092 chi-square statistic) was found in implant integration or the response of crestal bone.

Independent external monitoring committees are an important part of scientific clinical trials. They monitor patient safety, study progress, investigators' performance, and accurate interpretation/reporting of the study data. Data trends observed by a study monitoring committee detected a change in the pattern of patient screening by investigators after an increased awareness that tobacco use could directly compromise the osseointegration of root-form dental implants. This increased awareness is believed to have altered the number of active smokers accepted into a multicenter prospective dental implant study. Recent data analyses indicate that the success ratios were improved by alterations in this discretionary inclusion-exclusion criterion.

Immediate loading of threaded implants with a fixed provisional restoration at stage 1 surgery was evaluated in 10 consecutive patients. The patients selected had to be completely edentulous and have adequate bone for a minimum of 10-mm-long implants. A minimum of 10 implants were placed in each patient's arch. A minimum of five implants were submerged initially for medicolegal reasons and allowed to heal without loading. The remaining implants were loaded the day of stage 1 surgery. Once the provisional restoration was relined, it was cemented or screw retained. A total of 107 implants were placed in these 10 patients; 6 had them placed in the mandible, and 4 in the maxilla. Six patients were treated with Nobel Biocare implants, one with ITI Bonefit implants, two with Astra Tech TiOblast implants, and one with a 31 implant. Sixty-seven of 69 implants that were loaded integrated, and 37 of 38 submerged implants integrated. All 10 patients have been restored with a definitive prosthesis, and all had a fixed provisional prosthesis from stage 1 surgery. The results of this study indicate that immediate loading of multiple implants rigidly splinted around a completely edentulous arch can be a viable treatment modality.

A histologic assay of the grafting material associated with the sinus elevation procedure would provide insight into the quality and quantity of vital bone at the implant-bone interface. This case report documented for the first time the sequential healing process of a sinus graft in the same patient at 4, 8, 12, and 20 months. Histology of trephine-obtained core samples showed that in a sinus grafted with a mixture of xenograft (80%) and autograft (20%), 12 to 20 months was required for remodeling to vital bone. The study also demonstrated that a significant amount of vital, mature bone was generated by this procedure. Quantification of the resulting bone and comparison with other grafting techniques should be the next phase of continuing research efforts.

A new technique, the modified coronally positioned flap procedure, is described for treatment of Class 2 and Class 3 molar furcation defects in conjunction with barrier membranes. This technique is designed to minimize barrier exposure during the healing phase and to cover and protect the newly formed granulation tissue following barrier removal. Examples are presented and discussed, and modifications for varying situations are described. The modified coronally positioned flap technique is applicable for use with nonresorbable and resorbable membranes.

Single-tooth replacement in contemporary dentistry is often accomplished with an osseointegrated implant-supported restoration. To accomplish this in an esthetically acceptable manner requires a thorough course of treatment, including diagnosis, treatment planning, surgery and restorative and preventive care. This article discusses surgical considerations that are applicable before implant placement, as well as at the time of stage I and II surgery. Furthermore, the interrelationship between the tissues and the restoration is addressed. Preservation of the result by preventive-care protocol is shown to be essential.

A retrospective analysis was done comparing the success rate of osseointegration at stage 2 of implants placed under "sterile" versus "clean" conditions. "Sterile" surgery took place in an operating room setting with strict sterile protocol. "Clean" surgery took place in a clinic setting with the critical factor that nothing touched the surface of the implant until it contacted the prepared bone site. A total of 273 implants in 61 cases were placed under sterile conditions with a fixture success rate of 98.9% and a case success rate of 95.1%; 113 implants were placed under clean conditions in 31 cases with a fixture and case success rate of 98.2% and 93.5%, respectively as judged clinically at stage 2. The difference in the success rates was not statistically significant. The results of this analysis indicate that implant surgery can be performed under both "sterile" and "clean" conditions to achieve the same high rate of clinical osseointegration.

Dental implants are becoming more commonly used in periodontal offices. The literature related to implants this past year was filled with important material that will change the way we diagnose and formulate treatment plans. This review covers the key points that must be understood to maximize success with dental implants.

A retrospective analysis compared the success rate of osseointegration of Nobelpharma implants at stage 2 surgery. The implants had been placed using either a mucobuccal fold incision or a crestal incision. A total of 386 implants was placed in 92 patients; 265 implants were placed in 60 patients using a mucobuccal fold incision, with a success rate of 98.8%, and 121 implants were placed in 32 patients using a crestal incision, with a success rate of 98.3%. Implants can be placed using either a mucobuccal fold incision or a crestal incision to achieve predictable success.

This study was designed to determine whether the distance from the base of the contact area to the crest of bone could be correlated with the presence or absence of the interproximal papilla in humans. A total of 288 sites in 30 patients were examined. If a space was visible apical to the contact point, then the papilla was deemed missing; if tissue filled the embrasure space, the papilla was considered to be present. The results showed that when the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was 6 mm, the papilla was present 56% of the time, and when the distance was 7 mm or more, the papilla was present 27% of the time or less.

Surgical procedures for the prosthodontic patient have advanced greatly over the last decade. Both the aesthetics and function of the final restoration can be greatly enhanced by various surgical procedures. Some are very predictable, and others are still in the developmental stages. This review is divided into three basic categories: aesthetic root coverage; crown lengthening; and ridge augmentation procedures.

A modification of Abram's roll technique is described. A "trap-door" approach is used to reflect and preserve the epithelium that overlies the connective tissue pedicle; the epithelial pedicle is used to cover the donor site. Two case reports illustrate the technique.

The current classifications of teeth with furcation involvements refer mainly to the horizontal component of bone loss. This article presents a subclassification that measures the probeable vertical depth from the roof of the furca apically. The subclasses being proposed are: A, B and C. "A" indicates a probeable vertical depth of 1-3 mm, "B" 4-6 mm and "C" 7 or more mm of probeable depth from the roof of the furca apically. Furcations would thus be classified as IA, IB, IC, IIA, IIB, IIC and IIIA, IIIB, IIIC.

A semilunar coronally positioned flap is described. The technique involves a semilunar incision made parallel to the free gingival margin of the facial tissue, and coronally positioning this tissue over the denuded root. This technique has the advantage over other coronally positioned flaps, in that no sutures are required, there is no tension on the flap, there is no shortening of the vestibule, and the existing papillae are not interfered with.