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Historically, diagnosing peri-implantitis is done based on whether the disease is present, evaluated using the arbitrary thresholds of probing depths and bone loss. Using this approach as a tool to ascertain meaningful information regarding prevalence and treatment is limited. Efforts have been made to improve upon this, but to date, only one of these classifications has provided a simple method to communicate disease severity based on the amount of bone loss. A modified version of this simplified classification is proposed here, including information regarding the implant position, as emerging information suggests that this is a crucial factor in the etiology and prognosis of peri-implantitis. This enhancement to the classification better serves both researchers and clinicians in their discussion about peri-implantitis and helps to determine and recommend the most effective methods of management.

This retrospective study evaluated 335 hybrid implants placed in edentulous ridges; 167 were placed with an immediate implant protocol (IIP) and 168 were placed with a delayed implant protocol. Radiographic bone level changes were measured 1 to 23 years after loading. The average bone loss between implant placement and second-stage loading was 0.16 mm in the delayed group and 0.12 mm in the IIP group. Average bone loss from implant loading to the final radiograph was 0.26 mm in the IIP group and 0.13 mm in the delayed group. There was statistically significantly more bone loss in the IIP group, in patients taking amoxicillin (vs those taking azithromycin), in sites with splinted implants (vs nonsplinted implants), and in smokers (vs nonsmokers). However, even when statistically significant, bone loss would be considered clinically insignificant by most clinicians over the 1- to 23-year follow-up.

Long-term survival of dental implants in both fully and partially edentulous patients has been proven successful, as reported in the literature. However, maintenance of soft-tissue quality and volume is often difficult due to the multiple surgeries involved in implant placement and the physiological resorption of bone after tooth extraction. Soft-tissue augmentation is frequently necessary to improve soft-tissue contour and can be done simultaneously with implant or abutment placement or following the final insertion of the implant-supported prostheses. The purpose of this case report is to demonstrate a surgical procedure used to augment a peri-implant buccal soft-tissue defect using interdental palatal tissue from a pocket reduction procedure in combination with a distal wedge graft from the tuberosity as connective tissue utilizing a tunneling approach in the esthetic area. The implant restorations in the reported case were delivered 1 year prior to the soft-tissue reconstruction.

Inferior alveolar nerve (IAN) damage following implant placement is a severe complication that can compromise a patient's quality of life. Previous studies have suggested that a safety zone of 2 mm, if maintained, might avoid this problem. This retrospective study evaluates implants placed in closer proximity to the IAN without resulting in any postoperative neurologic complications and suggests a new concept of safety distance. A total of 60 consecutive patients receiving 101 mandibular implants < 2 mm from the IAN were included in this study. All enrolled patients had a CBCT scan done for radiologic assessment before implant placement and following final restoration. Measurements were obtained through cross-sectional views using Simplant software. In patients without neurologic disturbances, a mean distance of +0.75 mm was seen from the closest portion of the implant to the nerve bundle. In cases where a direct transection and/or compression of the nerve was not observed, the patients did not experience neurosensory disturbances.

Dental implant treatment has been proven to be a successful therapy to rehabilitate single, partial, and fully edentulous sites. Evidence shows that the use of implant-supported restorations is predictable and can deliver long-term success. However, discontinuation of implant systems can be challenging for prosthesis maintenance. In this case report, a 70-year-old female patient presented to the implant department at New York University College of Dentistry with a press-fit implant with a one-piece cementable abutment that was placed more than 30 years prior. The patient's chief complaint was that the crown kept falling off. Upon evaluation, it was found that the implant was well-integrated in bone with no signs of infection. Explantation and replacement of the well-integrated implant was not considered the best option. An alternative approach was to address the retention of the abutment. The purpose of this case report is to demonstrate an intraoral technique for fabricating a custom cement-retained crown over a non-retentive one-piece press-fit implant.

Implant-supported restorations have proven to be a predictable option for replacing missing teeth. In cases of inadequate bone quantity, the bone volume can be increased by bone augmentation procedures. Several factors can affect bone regeneration, including the morphology of the defect at the implant site. A defect surrounded by bony walls (an intraosseous defect) is known to yield a highly successful regeneration. The purpose of this retrospective case series study was to present a new step-by-step surgical procedure known as the Custom Alveolar Ridge-Splitting (CARS) technique for maxillary anterior ridge augmentation. This technique creates an intraosseous defect while splitting and augmenting an atrophic ridge. Sixteen consecutive cases were treated with the CARS procedure. All implants were restored and followed for 12 to 24 months after loading, and all cases were effectively treated with successful implant placement. According to this retrospective study, the CARS procedure is simple, successful, and predictable and may be used as a surgical option for horizontal alveolar ridge augmentation in the anterior maxilla.

Although the term "halitosis" was first coined in 1874, people have become increasingly aware of this problem more recently during the COVID-19 pandemic due to extensive wearing of protective masks. In fact, following dental caries and periodontal disease, halitosis is the third most prevalent reason for patients going to the dentist. Due to multifactorial etiology, the diagnosis of halitosis requires a rigorous health/dental/social history, a clinical examination, and measurements. The treatment ranges from the use of dentifrices, mouthwashes, tongue scraping, and masking products, and more recently includes photodynamic therapy, probiotics, and ozone. The purpose of this narrative review was to examine the published literature concerning halitosis over the past 30 years and discuss the diagnosis, etiology, and treatment of the disease.

The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020. SARS CoV-2, the virus that causes COVID-19, has shown the ability to become aerosolized with a potential airborne route of transmission. Dentists and dental hygienists are listed as two of the occupations in a nonhospital setting with the greatest risk of contracting the SARS-CoV-2 virus, as routine dental procedures involve aerosol generation. In a statement on interim guidance, WHO recommended that all routine dental procedures be delayed until COVID-19 transmission rates decrease from community transmission to cluster cases and until the risk of transmission in a dental office can be studied and evaluated. This prospective study involves 2,810 patients treated over a 6-month period (March 15 to September 15, 2020) in three different dental offices by two dentists and three hygienists during and shortly after the height of the pandemic in New York. By utilizing screening questionnaires, performing enhanced infection control, and having appropriate personal protective equipment, these dental offices were able to record no transmission of COVID-19 to the dental healthcare workers or patients during the study. In addition, 69% of the patients treated in these dental offices were recorded as having one or more high-risk comorbidities related to COVID-19 severity.

Peri-implantitis is a biologic complication that can affect the survival of a dental implant. Most surgical and nonsurgical treatments have been relatively ineffective even when using targeted antimicrobial approaches. A growing number of reports are documenting the presence of titanium granules and/or cement in the soft tissues surrounding peri-implantitis-affected dental implants. Two case reports are presented demonstrating how the Nd:YAG or a carbon dioxide (CO2) laser used following regenerative surgeries changed failures into successes as measured by radiographic bone fill and improved clinical parameters. These cases suggest that successful peri-implantitis treatment may need to incorporate decontamination of the soft tissues in addition to the implant's surface. Further studies are warranted to determine if each of these lasers would be successful over a larger patient cohort.

Because of their documented long-term success rates, dental implants have become a predictable treatment option to replace hopeless or missing teeth. However, full-arc transition from a hopeless dentition to a prosthesis supported by dental implants remains a challenge. One treatment option for this process is the use of transitional implants, an approach that allows for the transitioning of full-arch reconstructions from teeth to implant-supported prostheses without immediate loading the permanent implants or the need for provisional removable partial dentures. This article, which presents a long-term clinical case report, describes the steps and sequence of therapy involved in transitioning from a hopeless dentition to a maxillary full-arch implant-supported fixed prosthetic rehabilitation with the use of transitional implants, avoiding removable provisional prostheses. An assessment of the 20-year follow-up, dental implant survival rates, and marginal bone loss is also presented.

Different techniques have been introduced when replacement with an implant is planned after tooth extraction. The conventional approach consists of waiting 3 to 4 months before implant placement. However, many other options are available for implant placement, including immediate implant placement (IIP), IIP and immediate provisionalization (IIPIP), and early implant placement (EIP). When the ridge is deficient, guided bone regeneration (GBR) with simultaneous implant placement is often performed. However, this procedure has potential for postoperative complications and patient discomfort, as well as an extended treatment time. The recent introduction of the Customized Alveolar Ridge-Splitting (CARS) technique can help avoid many of these problems and treat atrophic ridges that will require two or three GBR surgeries. The purpose of this case report is to demonstrate the step-by-step surgical and restorative procedures for the CARS technique and present histologic data of the new bone generated utilizing this technique.

Keratinized mucosa around implants is considered essential for maintaining peri-implant health. Clinicians may find it necessary to augment keratinized tissue after implant loading when complications arise. Immobilizing the graft can be challenging when there is a complete absence of attached gingiva or when the vestibule is shallow creating an opportunity for muscle forces to move the graft. To overcome these limitations, various stents have been created aimed at improving the stability of soft-tissue grafts around implants; however, many of these stents have drawbacks. This case report presents a novel approach for improving free gingival graft immobility and success around implants that utilizes a completed implant restoration.

Intraoral periapical (PA) radiography is commonly used for measuring the remaining crestal bone height when implants are treatment planned in the maxillary posterior region. A major drawback of conventional radiographs is that a 3-dimensional (3D) entity is compressed and superimposed on itself into a 2-dimensional (2D) image, which is often distorted. Conversely, 3D information can be extracted from computerized tomography. The purpose of this article is to evaluate and discuss limitations of intraoral PA radiography for the measurement of posterior maxillary alveolar bone height and describe the use of information obtained by means of 3D computerized tomography to help plan implant placement.Clinical data in this study was obtained from the Implant Database (ID) at New York University College of Dentistry (NYUCD). The data set was extracted as de-identified information from the routine treatment of patients at the Ashman Department of Periodontology and Implant Dentistry at NYUCD. The ID is certified by the Office of Quality Assurance at NYUCD. This study is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) requirements. Thirty-five sites were compared with both PA and cone-beam computed tomography (CBCT) images of the posterior region, including the anatomical relationship of the maxillary crest to the sinus floor. The values recorded from the CBCT were used as the standard to which PA was subtracted from.Linear differences were consistently seen in which the remaining maxillary posterior crestal bone height appeared larger or smaller on the PA radiographs when compared to the measurements made of the same area on the CBCT images.CBCT imaging is a valuable adjunct in radio-anatomical and radio-diagnostic observations in the posterior maxillary region. Furthermore, in this study CBCT measurements were shown to be more accurate in assessing the remaining crestal ridge height apical to the sinus membrane when compared to PA radiographs. More research is necessary to verify these findings.

The posterior maxilla has traditionally presented a challenge for successful placement of dental implants due to a combination of poor bone quality, ridge atrophy, and pneumatization of the sinus floor following tooth extraction. However, with the successful and predictable surgical outcomes reported in the literature, more clinicians and patients are choosing an implant-supported restoration in the edentulous posterior maxilla. Consequently, sinus elevation and augmentation have gained more popularity. Extensive research has been conducted on types of bone graft materials and implants, less-invasive techniques to perform sinus augmentation, and timing for implant placement for sinus grafting. Despite the predictability of the techniques and biomaterials employed in sinus grafting procedures, intra- and postoperative complications are common. Much of the current literature discusses the local risk factors related to sinus augmentation, with few studies focusing on the patient-related risk factors. The purpose of this review is to identify, evaluate, and discuss the possible management of patient-related risk factors to allow for more predictable maxillary sinus floor augmentation outcomes.

Purpose The purpose of this prospective randomized clinical trial was to test the hypothesis that narrow-diameter titanium-zirconium (Ti-Zr) alloy implants with a chemically modified hydrophilic surface are not inferior in regard to crestal bone level change compared with standard-diameter implants with the same implant surface and material (control). Materials and methods This multicenter study included 50 patients in need of a single tooth replacement in the anterior (canine to canine) or premolar region of the mandible or maxilla. Patients were included if the site could accommodate a 4.1-mm-diameter implant. Implants were temporarily restored at 3 to 4 weeks after placement. Definitive restorations were delivered 4 to 6 months after placement. Patients returned 1 year after implant loading for clinical measurements and radiographic examination. The primary outcome was mean crestal bone level changes measured between implant loading and 12 months postloading. Secondary outcomes included implant success, survival, gingival recession, and patient satisfaction. Results Fifty patients were enrolled; 47 completed the study. Twenty-three patients were in the narrow-diameter implant group (test), and 24 patients were in the standard-diameter implant group (control). The success and survival rates at 12 months postloading were 100% for both groups. The change in the mean crestal bone level from implant loading to 12 months postloading around narrow-diameter implants was -0.27 ± 0.34 mm. For the standard-diameter implants, the change was significantly higher at -0.48 ± 0.67 mm (P = .02). No significant difference was found in gingival recession and patient satisfaction. Conclusion The results of this prospective randomized clinical trial suggest noninferiority of the narrow- vs standard-diameter Ti-Zr implant. In addition, bone remodeling was less pronounced for the narrow-diameter implants.

A link between periodontitis and cardiovascular disease has been reported in the literature. For this systematic review, the keywords "cardiovascular disease" (CVD) were combined with "periodontitis" and "peri-implantitis" and were used to search for literature published on MEDLINE and PubMed between 1990 and 2020. Hand searching was also performed. A total of 206 articles were identified, 51 of which were reviewed. A link between periodontal disease and CVD can be explained by both the infection and inflammatory pathways. Interventional studies on the treatment of periodontal disease related to CVD have shown conflicting results. Therefore, based on published studies, CVD should presently be considered a comorbidity of periodontitis (with an association but no direct cause and effect documented). The association of CVD with peri-implantitis has too few studies to draw any conclusions. More studies are necessary before any conclusions can be made between CVD and periodontitis and CVD and peri-implantitis regarding possible links and the extent of association.

This report discusses the expanded use of narrow-diameter implants (< 3.0-mm diameter) for permanent use and presents multiple clinical uses for supporting permanent restorations. The increased applications of narrow-diameter implants have expanded the options of treatment available to clinicians based on the patients' needs, desires, and limitations. The advantages, disadvantages, indications, and limitations are presented for the use of these narrow-diameter implants for permanent-case scenarios. These implants can serve as a treatment option in cases where standard-diameter implants cannot be placed due to limitations in volume or size of a planned implant site or due to financially or medically compromised patients.

Dental impressions are used to produce a replica of an oral structure for use as a permanent record or in the production of a dental restoration or prosthesis. Accurate impression-taking is an essential procedure in implant dentistry. Traditionally, clinicians have used two different implant impression techniques: transfer and pick-up. The pick-up impression technique is considered to be the more accurate of the two because with this technique the impression copings are maintained within the impression upon removal from the mouth, thus eliminating the potential for error that may occur when manually placing the copings in the impression as in the transfer technique. This design has become increasingly popular and useful for multi-unit impressions. The purpose of this article is to review various pick-up impression copings and propose a new impression coping design for accurate, easy impression-taking without discrepancies.

The purpose of impression-taking is to attain the accurate transfer of intraoral information for extraoral use. It is a crucial step in performing a successful dental implant restorative procedure. To accurately replicate the implant position for adaptation of an abutment that will completely engage with the implant, a pick-up impression is taken with an impression coping. Several factors can affect seating of the impression coping, including soft-tissue interference, the size of the impression coping, angulation, proximity or contact with adjacent teeth, damage to the coping, misfit caused by use of other manufacturers' parts, and differences between seating in an external- versus internal-connection implant. This article presents use of a novel verification guide that is intended to ensure complete seating of the impression coping with the implant.

This in vitro pilot study was performed to determine whether a treatment algorithm including mechanical debridement, followed by air powder abrasion with glycine, followed by citric acid conditioning with vigorous flushing of the surface with sterile water after each step, is capable of decontaminating an infected implant surface. A total of 14 dental implants that were deemed hopeless due to advanced peri-implantitis were extracted. Of these, 6 implants served as tests and had their exposed surfaces treated with the decontamination protocol, 6 served as untreated controls, and 2 were mechanically treated only, followed by rubbing the surface with sterile saline. All implants were placed in culture with human osteoprogenitor cells for 72 hours, and evaluation was performed using scanning electron microscopy. The 6 test implants all demonstrated attachment and proliferation of the normal human osteoprogenitor cells on their prior exposed and decontaminated surfaces. All of the untreated control and the mechanically debrided, sterile water-treated implants failed to demonstrate this same success. The results suggest that this protocol can decontaminate an implant surface affected by peri-implantitis. Further studies are warranted to determine if this technique would demonstrate similar success over a greater number of implants and whether this outcome may occur in humans.

To evaluate the changes in marginal bone levels (MBL) and soft tissue dimension around platform-switched implants with the implant-abutment junction (IAJ) placed at the crest or 1.5-2 mm subcrestally.In all, 96 platform-switched implants were placed in either the posterior maxilla or mandible in 48 partially edentulous patients in a split-mouth study. All implants were provisionally restored after 4-5 months and definitively after 6 months (T6). Radiographic assessment of MBL was assessed at implant placement (T0), T6, 12 months (T12), and 18 months (T18) after placement. Mid-buccal soft tissue and papilla measurements were performed at T6, T12, and T18.In all, 43 patients with 86 implants completed the study. The T18 examination showed an implant survival rate of 100% in both groups. Analysis showed that MBL varied as a function of IAJ location, which indicated more coronal bone levels with subcrestal (2.39 ± 0.08 mm) than with epicrestal placements (0.88 ± 0.08 mm) (p .05). Greater average marginal bone loss was found in the subcrestal group (0.40 ± 0.07 mm) compared to the epicrestal group (0.13 ± 0.08 mm) although no statistically significant difference was found at T18 (p .05). Levels of mid-buccal soft tissue had no significant changes over time, regardless of group (p .05). There was a significant difference in increase in papilla between T6 and T12 and T18 (p = .005 and .001), but not between T12 and T18 (p = .61). These papilla levels and changes were similar between groups (p .05).The MBL changes around platform-switched implants with same geometry were not affected by the epicrestal or subcrestal location of the IAJ. Furthermore, the location of the IAJ did not affect the implant survival and soft tissue dimensions. However, no bone loss was located apical to the IAJ when the implants were placed subcrestally.

Maintenance or reconstruction of interproximal papilla for a successful dental implant restoration can be challenging. To date, the results from various surgical and prosthetic techniques to maintain or regenerate papilla adjacent to dental implants have been unpredictable. To maintain the quality of the soft tissue around an implant, the blood supply must be preserved and formation of scar tissue must be minimized during surgery. Therefore, incision design is vital to producing an esthetic and successful dental implant restoration. In this study, specific incision designs and soft tissue management techniques were used to preserve or create interproximal papilla around single or adjacent implants.

Sinus augmentation is a predictable procedure that is often required when restoring the posterior maxilla with dental implants. Even with high success rates, careful pre-surgical planning is crucial. A 3D model is a valuable aid for the clinician as it allows for pre-operative simulation, which can reduce surgical time, reduce the risk of intra-operative complications and decrease the potential for error. The aim of this case report is to focus on how such a model is useful when undertaking a sinus augmentation procedure with simultaneous implant placement.

This retrospective study reports on the outcome of 19 narrow-diameter implants (NDIs) placed in 14 consecutively treated patients 3 to 14 years postloading. Peri-implant bone remodeling, bone loss, esthetic outcomes, and patient satisfaction with the final restoration were evaluated. No implant failures or prosthetic complications were reported, yielding a 100% survival rate and a 84.2% success rate. All 14 patients reported that they were very satisfied with the esthetic results. The average mesial and distal bone remodeling was 1.99 mm and 1.84 mm, respectively. This represents physiologic bone loss post-implant placement. Only 5 implants presented with bone loss, producing an average mesial and distal bone loss of 0.14 mm and 0.17 mm, respectively. Bone loss was measured on the threads of the implant from the time of restoration to the time of follow-up. The bone loss did not exceed 0.2 mm per year on any implant. These screw-retained NDIs present a cost-effective, esthetically acceptable alternative for restoring limited spaces in the anterior esthetic zone.

To identify determinants of long-term implant survival after sinus augmentation procedure (SAP) using a combination of plasma rich in growth factors (PRGF) and graft material.Patients were included in this retrospective study if they underwent SAP through a lateral wall approach using PRGF in combination with mainly xenograft, and received implants restored for at least 1 year. Sociodemographic, behavioral and implant characteristics (clinical factors, implant details, surgical details, prosthesis details, and complications) were analyzed.Sixty-seven patients received 217 implants in 100 augmented sinuses. The mean follow-up was 7.2 years. Overall, 22 implants failed in 15 patients (90% cumulative implant survival). Multivariable models showed greater implant survival with implants placed with ≥5 mm of residual crestal bone height (RBH) compared with those placed with3 mm of RBH. There was also an improvement in survival comparing implant lengths. In addition, immediate loading of implants significantly increased the risk of implant failure.The use of PRGFs for maxillary sinus grafting may be an effective and safe treatment option for the rehabilitation of atrophic edentulous posterior maxillae. However, randomized clinical trials are needed to confirm these findings.

The 3-dimensional implant position is critical in achieving a successful surgical and prosthetic outcome for an implant-supported restoration. In an edentulous mandibular arch, the lack of neighboring reference points and the nature of the resorptive process make ideal surgical implant placement difficult to achieve. As the edentulous mandibular ridge resorbs lingually and apically, the ideal prosthetic tooth positions often may be located facial to the ridge crest. Achieving proper implant position requires use of a guide that takes into consideration the location of the existing ridge in addition to ideal tooth position. This article describes the use of an adaptable, metal, linked implant position guide that utilizes interimplant spacing of 5 mm, 7 mm, or 9 mm between adjacent tooth positions throughout the arch to aid in keeping adjacent implants parallel and symmetrical to the contralateral side while also respecting the ideal natural tooth dimensions and occlusion. The use of the guide is demonstrated in three cases of mandibular edentulism.

The purpose of this article is to compare the larger (8 × 10-mm single implant and 15 × 20-mm multiple implant) lateral window designs used in the sinus elevation procedure with a newly proposed, less-invasive window design and discuss the advantages and limitations of the new design. The less-invasive window designs differ from the larger window designs in both the size and shape of lateral windows. Following creation of a round-window osteotomy, the quality of the sinus membrane and its ability to be elevated are assessed. The initial window can then be enlarged as a vertical oval window for a single implant or a horizontal oval window for multiple implants. The advantages of these window designs include the preservation of the lateral walls, blood supply to bone grafts, and better containment of the graft material. The limitations of these window designs are decreased visibility, accessibility for correcting a membrane perforation, and access for draining a sinus infection if one occurs. These complications necessitate increasing the size of the window as needed for successful treatment. The proposed less-invasive window design provides distinct advantages for a successful sinus elevation procedure and decreased patient morbidity.

Displacement of a dental implant into the maxillary sinus has become a more frequent occurrence due to a greater number of implant-supported prostheses being placed in the atrophic posterior maxillary area. In addition, dentists are increasingly placing implants into augmented maxillary posterior areas. Reasons for displacement of dental implants into the maxillary sinus may include poor bone quality or quantity, failure of a sinus augmentation procedure, and poor surgical technique. When this complication occurs, the displaced implant in the maxillary sinus should be removed because it could act as a foreign body and cause numerous complications. In this case report, a 56-year-old male patient presented with pain and a loose, cemented prosthesis in the maxillary left posterior area. Radiographic examination showed that an implant with the final abutment supporting the prosthesis in site No. 14 had been displaced into the maxillary sinus. The implant and abutment were successfully retrieved from the sinus using a lateral window technique combined with several diagnostic maneuvers that will be described.

Purpose To measure the temperature rise and surface damage of titanium dental implants and the surrounding tissue in a pig jaw during 9.3-μm carbon dioxide (CO2) laser irradiation at various durations of time. Materials and methods Thermal analysis tests were performed on 12 implants with the same surface. Twelve implants mounted alone or in pig jaws were laser-irradiated with a 9.3-μm CO2 laser using 3 different power settings. The temperature of the implant body and the proximal tissues was measured with a J-Type Thermocouple after being laser-irradiated with 3 different power setting for 30, 60 seconds, and 2 minutes. Scanning electron microscope (SEM) and digital microscope images were also taken of the all the implants before and after laser irradiation to detect the presence or absence of surface damage. Results Temperature analysis showed that in all cases the implant and the proximal tissue temperatures remained around the start temperatures of the implant and tissues with fluctuations of ±3°C but never reached the upper threshold of 44°C, the temperature at which thermal injury to bone has been reported. Digital and SEM images that were taken of the implants showed an absence of surface damage at the cutting speed of 20% (0.7 W); however, cutting speeds of 30% to 100% (1.0-4.2 W) did yield surface damage. Conclusions Laser irradiation of titanium implant surfaces using a 9.3-μm carbon dioxide laser with an average power of 0.7 W showed no increase in thermal temperature of the implant body and tissue temperatures as well as no evidence of implant surface damage.

The aim of this report is to present a case with a 10-year follow-up of a single anterior tooth dental implant replacement with a xenogenous bone graft in a patient with a large bone defect associated with a cleft lip and palate. At 10 years postloading, the implant was healthy and well-integrated. Although the implant restoration appeared slightly intruded due to growth and development at that time, the patient was happy with the esthetic result and refused corrections of the uneven occlusal plane.

Peri-implant mucositis has been defined as a reversible inflammatory reaction in the soft tissues around a functioning implant with no bone loss. This paper reviews the prevalence, etiology, risk indicators, prevention, and treatment of mucositis. Relying on the literature concerning mucositis, the bacterial etiology is discussed as well as the varying ranges of prevalence, reported to be from 20% to 80% of subjects (13% to 62% of implants) after a minimum of 5 years of implant function. A discussion of the definition of mucositis questions the assumption of it being completely reversible following treatment and challenges the concept of mucositis "transfer" (conversion) to peri-implantitis.

The aim of this case report was to evaluate the histologic and radiographic new bone formation following maxillary sinus reentry surgery without a bone graft. A 61-year-old woman was referred with a failure of a sinus augmentation procedure. A reentry procedure was performed to retreat the sinus complication. The procedure involved removal of the bone graft plus debridement of the sinus. No additional bone graft material was used. A cone beam computed tomography scan was taken 6 months following the reentry procedure. During implant placement surgery, a core biopsy specimen was retrieved, stored, and prepared to obtain thin ground undecalcified sections. The histologic and radiographic analysis showed formation of new bone at the time of implant placement. At 18 months following implant placement, successful evidence of integration was determined by implant stability and radiographs. Space maintained by the previously elevated sinus membrane at the time of sinus reentry was sufficient to induce formation of bone without regrafting. However, more cases involving survival of implants placed in augmented sinuses without the use of bone grafts at the time of reentry are needed to confirm the results of this case report study.

Purpose To present a classification and assess the presence and degree of cortication of the sinus floor utilizing Computerized Tomography (CT) scan images. Materials and Methods One hundred CT scans, of patient who required a sinus augmentation procedure (SAP), were evaluated and classified according to the Type of sinus floor cortication (SFC). Type 1: sinus floor showing similar or higher density than the surrounding cortical areas. Type 2: sinus floor showing less density than the surrounding cortical areas. Type 3: sinus floor showing no cortical bone. Type 4: sinus floor showing the fusion of sinus floor bone and native crestal bone. Results The SFC were present in 31, 41, 18, and 10 cases in Type 1, 2, 3, and 4, respectively. Conclusions This classification based on the level of cortication of the sinus floor is clinically useful as a method of determining if the dental implant can be placed simultaneously or not with the SAP, or can be placed even without a SAP.

The aim of this study was to introduce a new surgical technique to regenerate the papilla adjacent to multiple or single implants using a novel instrument and a new incision design. A total of 10 consecutively treated patients with maxillary anterior implant-supported provisional restorations and missing interproximal papillae received a subepithelial connective tissue graft. The recipient site was prepared with a buccal incision apical to the mucogingival junction and to the defective papilla, and a palatal incision, followed by buccolingual tunneling performed with a translingual curette (EBINA). A total of 10 sites were treated and evaluated pre- and postoperatively with the papilla score based on the Jemt classification. The final prosthesis was delivered 3 months after the papilla regeneration surgical procedure. An average improvement in papilla index score from 0.8 to 2.4 was found after an average follow-up period of 16.3 months. This case series demonstrated that interimplant papilla regeneration can be successful over a period of 11 to 30 months postloading. Long-term prospective studies on tissue stability and esthetic outcomes are needed to corroborate the findings in this study.

The aim of this retrospective study was to examine the histories of 100 patients with 170 implants that were consecutively treated and reported in a previous study to identify which patient and implant factors might have affected the outcomes of therapy. Patient factors included history of periodontitis, hypertension, cardiac problems, rheumatoid arthritis, smoking, and penicillin allergy. Implant factors included whether the prosthesis was cemented or screw retained and initial bone loss (≤ 50% or > 50% of implant length). Frequency of maintenance visits (≤ 3 months or > 3 months) were recorded, as was patient age (≤ 60 years or > 60 years). On the patient level, only postoperative maintenance (≤ 3 months) showed a statistically significant effect on radiographic bone gain (RBG) compared to patients with > 3 months maintenance frequency. Nondiabetic patients showed a trend toward soft tissue gain. On an implant level, screw-retained prostheses demonstrated a statistically significant RBG compared to those with cement-retained prostheses. Significant favorable differences were seen in all outcomes when evaluating presurgical bone level loss (> 50% of the implant length). Further studies with larger groups of patients are necessary to substantiate the findings in this report.

Periodontal probing around natural teeth and dental implants remains an efficient and non-invasive method to diagnose loss of attachment, determine presence of diseases, monitor marginal recession, and evaluate positive treatment outcomes. Risks of probing around natural teeth and dental implants include inaccurate measurements, bacteria inoculation, spread of disease, and damage to the implant surface. Improper probing can lead to undiagnosed or overdiagnosed diseases. Some clinicians have questioned the value versus the risk of probing around implants. This article discusses the risks and advantages of probing around teeth and dental implants and suggests methods of probing intended to enable more accurate evaluation of periodontal and peri-implant conditions.

The purpose of the current study was to determine the survival rates and to measure marginal bone changes and peri-implant conditions 8.5 years after placement of one-piece implants with an anodically oxidized surface (AOS). A total of 52 subjects who received a one-piece implant with an AOS using a flapless or flap protocol and completed a previous randomized clinical trial were contacted for a recall visit 8.5 years after implant placement (T8.5). Implant success and survival rates, probing pocket depth (PPD), presence of bleeding on probing (BoP), papilla level, and incidence of complications and peri-implant disease were assessed by a single, blinded examiner. A second blinded examiner evaluated marginal bone level changes. Results for 8.5 years were compared to those at the time of implant placement, implant loading (0.5 year), and 1 and 1.5 years follow-up. The results based on 28 patients who attended the follow-up visit (half had flapless and half a flap protocol) showed a 100% implant survival rate and a 96.4% implant success rate 8.5 years after implant placement using one-piece implants, with no difference in survival and success rates between the flapless and the flap protocol. During the same follow-up period, a significant increase in crestal bone height from 1.5 to 8.5 years was observed. Analysis suggested decreasing mean levels of bone loss with time (P < .001). Moreover, there was 0.8 to 1.0 mm of bone loss through year 1.5, which decreased to 0.3 mm at 8.5 years (P < .05). There was no statistically significant difference in PPD or BoP over time. Similar mean levels of PPD were found in flap and flapless groups (mean [SD] = 2.4 [0.3] and 2.2 [0.4] mm, respectively [P = .18]), as well as similar rates of BoP (22.8% vs 17.9%, respectively). Papilla levels increased during the first year after implant loading. However, there was little additional change between 1.5 and 8.5 years. A total of eight fractured porcelain crowns and three crown loosenings were reported. One-piece implants with an AOS showed high survival rates and stable marginal bone and periimplant soft tissue levels regardless of whether a flapless or flap protocol was used.

Purpose The purpose of this study was to retrospectively evaluate bone stability around implants with anodic oxidized surfaces and correlate this with variables compared in a previous study. Materials and Methods A total of 312 implants with anodic oxidized surfaces were separated from a pool of 1,187 implants placed immediately following tooth extraction. Radiographs made at the time of implant placement were compared to radiographs taken at 2–12 years' follow-up. An independent radiologist used the known distance (mm) between peaks of adjacent threads to calculate actual bone loss measurements. Measurements were evaluated by thread of bone fill on both the mesial and distal of each implant. If

BACKGROUND Oral rehabilitation of edentulous patients with implants that are immediately loaded is a viable treatment alternative today; however, the immediate loading protocol has not been extensively documented in HIV-seropositive patients. METHODS This clinical case report presents a surgical and prosthetic implant-supported immediate loading protocol in an edentulous HIV-seropositive patient (CD4 >200 and T4/T8: 0.99). Eight implants were placed in each jaw, and no ridge augmentation procedures were required. All the implants were connected with abutments, and a temporary fixed restoration was placed immediately after surgery. The final fixed reconstruction was cemented after 10 weeks of loading. RESULTS All implants showed no clinical signs of mobility or infection. Periotest values were evaluated during healing and showed a progressive reduction. Radiological findings showed stable bone levels after an observation period of 4 years. CONCLUSIONS This case report presents an alternative treatment for the oral rehabilitation of an HIV-positive (but disease asymptomatic) edentulous patient. The concept of immediate loading of implants offers advantages when compared with a traditional treatment modality even in immunocompromised patients who are well controlled.

Esteemed colleagues, friends, and distinguished guests. . . First let me thank Don Clem for his help in organizing and moderating this Opening Session. Thanks also to our comoderator, Jennifer Doobrow. As President of the AAP, it is my great pleasure to welcome you all to the 100th Annual Meeting of the American Academy of Periodontology! Thank you for participating in this momentous occasion. There are many I want to thank for organizing this special meeting and helping me during my year as President, beginning with my family, who supported me not only during my presidency, but long before I assumed the office. I am especially thankful to Ellen, my wife, who traveled to every board meeting this year as well as past years and expanded our circle to include those who support us — our spouses and significant others. I want to thank the periodontists who have helped our profession flourish. All week we will be celebrating those early pioneers as well as present-day heroes who continue to advocate for the AAP and periodontics. On the screen are a few of those individuals who are true legends in our specialty. I also welcome the leaders of international periodontal societies and other guests who have traveled far to join us here in San Francisco, making our centennial celebration a global event and a true perio ‘‘melting pot.’’ Greetings to our friends from organized dentistry, including the American Dental Association, Academy of General Dentistry, American College of Prosthodontists, and American Dental Hygienists Association. And last, but not least, I would like to recognize John Forbes, our executive director, and our remarkable AAP staff who work so diligently to keep our organization strong and effective. All year we have been commemorating our past as the foundation for a promising future. Periospectives has illustrated the events that shaped this Academy over the past 100 years, and our Journal of Periodontology has published commentaries on key topics in research and practice from 1914 to today. These publications all remind us of our rich history and the enormous debt we owe to those dedicated clinicians and researchers who created new knowledge and translated it to better patient care. I’ve been a periodontist for over 40 years — more than 10 of them as a trustee and officer. The highs and lows I’ve faced this year as your President have largely mirrored what has occurred in our profession over the last several decades. This year’s long stroll down memory lane has underscored for me that our experience is not unique. The history of humankind is peppered with stark contrast, described most eloquently perhaps by Charles Dickens in the opening lines of A Tale of Two Cities

Background: A myriad of techniques are available for clinicians attempting to regenerate periodontal osseous lesions. In the past decade, the use of biologic agents has been added to periodontal regenerative materials in an attempt to achieve optimal and predictable success. There is a clear need for these agents because graft materials and scaffolding agents vary significantly in their intrinsic inductivity and ability to attract the cells necessary to achieve the histologic endpoint of forming new bone, cementum, and a functionally oriented periodontal ligament. Moreover, biologics have been proven to enhance angiogenesis and facilitate wound closure, which may further optimize results.Summary: The era of biologics has ushered in an opportunity for clinicians to provide their patients with predictable results that acheive not only quantitative clinical results but also qualitative histologic results that demonstrate regeneration of the lost periodontium. Clinicians must weigh the benefits versus the add...

Introduction: Peri-implantitis is an inflammatory disease in the mucosa around an implant that results in bone loss and, if allowed to progress, can result in loss of the implant. This disease has been estimated to have a prevalence varying from 11.3% to 56%. To date, there is little evidence to indicate the most effective method of treatment of peri-implantitis. This report describes a regenerative treatment for restoration of bone and reduction of probing depth (PD) around a peri-implantitis-affected implant.Case Presentation: A 67-year-old male patient presented with advanced peri-implantitis around a mandibular right first molar implant that was placed and restored 3 years before his visit. An examination revealed PD of 7 to 12 mm and bone loss of 7 to 10 mm circumferentially around the implant. Treatment consisted of flap reflection, a six-step surface decontamination, placement of enamel matrix derivative on the implant surface, and fill of the defect with combined allograft/xenografts mixed with pl...