Blog Posts

Esthetic Crown Lengthening - Achieving Excellent Results

1/20/2016

Esthetic Crown Lengthening is an excellent treatment for patients with a "gummy" smile or short/worn teeth. Below are a few recent articles with great treatment planning and results:

Click Here: Esthetic Crown Lengthening - Innovative Proportion Gauges

Click Here: Esthetic Crown Lengthening - Evaluation of Biologic Width Healing

Click Here: Esthetic Crown Lengthening - Wax-up and Stent

Click Here: Gingivectomy Vs. Ostectomy

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Minimally Invasive Gingival Rejuvenation

11/12/2015

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Here are two recent articles regarding minimally invasive gingival rejuvenation:

Click Here: Minimally Invasive Soft Tissue Grafting

Click Here: Tunneling Gingiva to Enhance Veneers

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11 Point Inspection of Dental Implants

10/18/2015

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Listed below are important areas to inspect when evaluating dental implants:
1. Materials / Type of Implant and Restoration
2. Mobility
3. Plaque / Calculus
4. Probing / Bone levels
5. Bleeding / Suppuration
6. Recession / Attachment
7. Color of Gingiva and Restoration
8. Occlusion / Wear
9. Contact points / Contours
10. Cement
11. Radiographic evaluation

Listed below are important risk factors for peri-implant inflammation:
1. Previous periodontal or peri-implant disease
2. Plaque control / inability to clean
3. Residual cement
4. Smoking
5. Genetics
6. Uncontrolled diabetes
7. Occlusal overload

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New teeth in one day: Immediate Implant Placement and Provisionalization Surgery in the Aesthetic Zone

9/24/2015

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This surgery involves extraction of one or more teeth, immediate implant placement, and attachment of temporary crown(s) and bridge(s) in just one surgery!

This treatment is preferred by patients for the following reasons:
1) Immediate Aesthetic results.
2) A fixed result.
3) Optimum patient comfort during the healing period.
4) Minimum amount of pain.
5) Minimum number of appointments.
6) Minimum amount of healing time required until final restoration.
7) Prevents collapse of hard and soft tissues.
8) Prevents recession due to due to minimum number of surgeries.
9) In some cases, existing crown or tooth can be attached for optimum aesthetics.
10) In most cases, does not require waiting for lab work. The surgery can be started immediately.

For predictable, excellent results, the specialist must be an expert in performing the following surgical procedures:
1) Atraumatic extractions.
2) Extraction of infected teeth or damaged teeth.
3) Socket degranulation and repair.
4) Immediate implant positioning.
5) Implant stabilization in minimal quality and volume of bone.
6) Hard tissue grafting including buccal plate repair when needed.
7) Soft tissue grafting.
8) Immediate abutment and crown provisionalization.

Technologies and diagnostics that aid the specialist include:
1) Digital radiography and 3D imaging.
2) Implant radiographic stents.
3) Implant surgical guides.
4) Study models and wax-ups.
5) Color-matched acrylic temporary shells.

Listed here are excellent examples of this surgery and a consensus statement regarding this treatment:

Click here for article:
Immediate Implant Placement and Provisionalization: The new standard for predictable esthetics in single-tooth implants

Click here for article:
The management of immediate implant placement to optimize aesthetic outcome in the anterior maxilla

Click here for article:
Consensus Statements and Recommended Clinical Procedures Regarding Optimizing Esthetic Outcomes in Implant Dentistry

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Locator Implant Overdentures using 2-4 implants!

9/14/2015

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The articles listed below are excellent for planning an overdenture case:

Click here for article: Implant Retained Overdenture: Diagnosis to Delivery

Click here for article: Implant Overdentures: A new Standard of Care for Edentulous Patients - Current Concepts and Techniques

Click here for article: Guidelines for implant overdenture treatment with standard or narrow diameter implants: A clinical rationale

Click here for article: The use of narrow-diameter implants to support mandibular overdentures: A prospective clinical study

Click here for article: Unsplinted Implants Retaining Maxillary Overdentures with Partial Palatal Coverage: Report of 5 Consecutive Cases

Please feel free to comment about your experiences with locator implant overdentures.

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Great Treatment Plan Using 4-6 Implants!

6/22/2015

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This is an excellent article on how to correctly position 4-6 implants for a full arch case.

Click here for article: Treatment Planning Full Arch Implants

This a great article that shows the latest research in support of the 4 implant system.

Click here for article: Prosthodontic Perspective to All-On-4® Concept for Dental Implants

These are challenging cases with exciting results for patients; additionally, these are great cases for the general dentist and periodontist to work on together. Please feel free to comment about your experiences with this type patient care.

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Screw vs. Cement Retained Implant Restorations - How to Choose?

3/30/2015

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Recent studies have shown that screw-retained implant restorations are more biocompatible than cement-retained restorations. It is therefore recommended that cement-retained restorations be limited to the following situations:

1) When a screw access hole would result in unsupported material (greater resistance to porcelain fracture).
2) When resistance to offset loading is desired (allows forces to be better distributed along the axial inclination of the implant).
3) When a screw access hole would be visible (enhance esthetics).
4) When an intact occlusal surface is desired (occlusal table can be adjusted).
5) To correct implant malposition or angulation.
6) To reduce treatment costs.
7) To simplify the fabrication procedure.
8) When a passive fit is desired (40µm of cement space can compensate for laboratory distortions).
9) When a patient has limited opening.

Choosing Between Screw-Retained and Cement-Retained Implant Crowns
Cemented and Screw-Retained Implant Reconstructions: A Systematic Review of the Survival and Complication Rates
Clinical Performance of Screw-Versus Cement-Retained Fixed Implant-Supported Reconstructions- A Systematic Review
Long-Term Outcome of Cemented Versus Screw Retained Implant-Supported Partial Restorations
Principles of Screw-Retained and Cement-Retained Fixed Implant Prosthesis- A Critical Review

Thanks for reading, and I welcome your feedback.

Best,
Dr. Pechter

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12 Implant Cement Best Practices

3/10/2015

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The following tips were compiled from lessons learned during the annual American Academy of Periodontology meeting and after reading recent articles by Chandur Wadhwani, DDS and Alfonso Pineyro, DDS, both prosthodontists from University of Washington.

Use radiopaque Temp-bond, Temp-bond NE, or zinc phosphate cement (Zn inhibits bacterial growth).
Use a custom abutment and not a stock abutment (this brings the cement line closer to the margin).
Use less cement.
Place a vent hole in the abutment (or instruct your lab do this).
Place gutta percha, cotton, or teflon tape in occlusal access opening (but leave space for excess cement).
Seat crown on an abutment replica to remove excess cement prior to inserting in the mouth.
Do not use Resin modified glass ionomer cement (it is the most commonly used final cement, but it is radiolucent and difficult to remove in a deep sulcus).
Do not use Durelon (it will corrode titanium).
Do not use tissue colored cements.
Understand that most cements were tested to inhibit caries forming bacteria (not periodontal pathogens which are commonly found associated with implant failures and excess cement).
Understand the different biology of attachment of gingival tissues to a tooth versus an implant (there is not a strong intact compartment of tissue fibers to stop peri-implant disease penetration once it starts).
Recommend having your hygienists pay close attention to the gingiva around implant restorations.

Feedback? Questions? Please feel free to post a comment below.

Best Regards,
Joseph Pechter, DMD, Peridontist and Dental Implant Surgeon

References:
Implant Cementation - Clinical Problems and Solutions

The Role of Dental Cements on Implant Success - Part 1

The Role of Dental Cements on Implant Success - Part 2

Technique for Controlling the Cement for an Implant Crown

Techniques to Control or Avoid Cement around Implant-Retained Restorations

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Forward>>

Esthetic Crown Lengthening - Achieving Excellent Results

Minimally Invasive Gingival Rejuvenation

11 Point Inspection of Dental Implants

New teeth in one day: Immediate Implant Placement and Provisionalization Surgery in the Aesthetic Zone

Locator Implant Overdentures using 2-4 implants!

Great Treatment Plan Using 4-6 Implants!

Screw vs. Cement Retained Implant Restorations - How to Choose?

12 Implant Cement Best Practices

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