| Joseph E. Pechter, DMD Periodontics and Dental Implant Surgery |
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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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 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 
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  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.  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.  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 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.
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 |
