Faculty Bibliography

An innovative macro hybrid implant design is aimed at enhancing labial plate dimension and tooth-implant distance while achieving consistent esthetic outcomes. This unique "body-shift" concept in diameter and shape combines a tapered apical portion with a cylindrical coronal portion in a singular implant body design. The overall configuration of the implant is inverted and "convergent" in form toward the implant-abutment interface where bone is thinnest. Conversely, the tapered apical portion is wider where the bone is greatest in volume and vascularity. By reducing the coronal portion of the implant with the inverted body-shift design, a coronal circumferential chamber is created, thereby allowing larger amounts of graft material to be placed labially and interdentally to create a net increased bone dimension. Use of the implant is demonstrated in a case report.

PURPOSE/OBJECTIVE:To determine the layperson's esthetic preference to the visual display (presence) or lack thereof (absence) of the interdental papillae during minimum smiling or the low smile line patient type. MATERIALS AND METHODS/METHODS:Two hundred lay-people were shown three-paired smile images indicative of a low gingival smile line patient type in which the vermillion border of the maxillary lip covered the mid-facial gingiva of the anterior teeth. The three images differed only with respect to [1] presence of interdental papillae, [2] absence of the interdental papilla ("black triangle"), or [3] absence of the interdental papillae (replaced with a long restorative contact area). The three images were paired in multiple groupings; group-1 consisted of a comparison of the presence of interdental papillae vs the lack of the interdental papillae "black triangle," group-2 compared the long restorative contact compared to the presence of the interdental papillae and Group-3 compared the long restorative contact replacing a missing papilla to the absence of the interdental papillae "black triangle." The comparisons were designed to determine the subjective preference of lay individuals between these groupings. RESULTS:Ninety-eight percent of lay-people demonstrated a preference to the presence of the interdental papillae in the smile (image 1) when compared to its absence ("black triangle"; image 2) with a low smile line. Seventy percent preferred the visual display of the interdental papillae, that is, pink tissues (image 1), compared to the absence of the interdental papillae replaced with a long contact area (image 3), that is, white restorative materials, when viewing a low gingival smile line. And when comparing the absence of the interdental papillae "black triangle" to a long contact area, 92% of lay-people preferred a long contact area vs the absence of the interdental papillae with a "black triangle" with a low smile line. CONCLUSIONS:The visual display [presence] of the interdental papillae, that is, pink tissues, is notably preferred to the absence of the interdental papillae when replaced by either a "black triangle" or long contact area in the commonly known low smile line. This emphasizes the need to assess the Interdental Smile Line (ie, visual display of interdental papillae during smiling) in all patients and the importance to preserve and/or re-establishment of the interdental papillae, that is, pink tissues, even in patients with a low smile line.

A preclinical pilot study was performed to evaluate the safety, efficacy, primary stability, and wound healing of a hybrid dental implant with a unique macrogeometry design in which the coronal section is narrower and cylinder-shaped followed by a wider, tapered apical portion, each comprising approximately one half the length of the implant. Eighteen hybrid macrogeometry-designed dental implants were placed bilaterally into three foxhounds in the mandibular third and fourth premolar and first molar (P3, P4, and M1, respectively) extraction sockets of different dimensions immediately following full periosteal flap elevation and removal of teeth without socket grafting. Bone plate thickness, implant position and depth, gap distance, and insertion torque values were measured following implant installation. Surgical sites were healed uneventfully for 3 months, and then samples of soft and hard tissues surrounding the implants were retrieved to perform light microscopic and histomorphometric analyses. All 18 implants were stable and osseointegrated both clinically and radiographically. The analyses revealed that the amount of hard tissue alteration and bone fill that occurred during the healing period was significantly influenced by the thickness of the bone plate, the size of the horizontal buccal gap, and the implant diameter, position, and depth within the extraction socket. The P3 and P4 hybrid implants placed approximately 1.0 mm subcrestal from the interproximal height of bone with less gap distance (≤ 1.0 mm) exhibited minor to modest (1.5 to 2.0 mm) crestal bone remodeling relative to the implant platform. Conversely, M1 implants positioned with greater depth (≥ 2.0 mm) and gap distance (≥ 2.0 mm) that were evaluated in a buccal-lingual dimension exhibited minimal crestal change with first bone-to-implant contact within 1.0 mm (range: 0.00 to 0.89 mm) of the machined-collar surface. The thicker lingual bone plate on all M1 implants was relatively maintained and unaffected. The apical half of the implant provided high initial stability (range: 65 to 100 Ncm). The mean percentage of bone-to-implant contact was 56.34% (range: 40.15% to 72.04%). This preclinical study provided clinical and histologic evidence to support the safety and efficacy of a new hybrid macrogeometry implant design that achieved excellent primary and secondary stability in immediate extraction sockets without grafting.

The peri-implant soft tissue seal consists of a connective tissue cuff and a junctional epithelium that is different from the arrangement of periodontium around a natural tooth. However, the peri-implant soft tissue complex lacks Sharpey's fibers, thus offering less resistance to clinical probing and biofilm penetration compared to the natural dentition. Therefore, the proper restorative emergence profile design is essential to facilitate favorable esthetic outcomes and maintain peri-implant health. The aim of this article is to review the currently available evidence related to the design of subgingival (critical and subcritical) and supragingival contours of the implant restorative emergence profile (IREP) as well as provide a flowchart for decision-making in clinical practice. Theoretically, the subgingival contours of the crown/abutment complex should mimic the morphology of the root and the cervical third of the anatomic crown as much and as often as possible. However, this is highly dependent upon the three-dimensional spatial position of the implant relative to the hard and soft tissue complex, in addition to the location of the definitive restoration. Frequently, a convex critical contour is required on the facial aspect of a palatally or incisally positioned implant to support an adequate gingival-margin architecture. Conversely, if the implant is placed too far facially, then a flat or concave contour is recommended. In instances where soft tissue support is not needed, the subcritical area may be undercontoured to increase the thickness, height, and stability of the soft tissue cuff.

Immediate implant placement and provisional restoration has become a popular and well-supported method of tooth replacement in the maxillary anterior dentition. Aside from achieving osseointegration, esthetic demands have grown with better understanding of the behavior of hard and soft tissues following this mode to therapy. Stability of gingival contours, texture of the surrounding tissues, and blending of prosthetic components with the natural dentition are critical for successful outcomes to be maintained long-term. Increasing soft tissue thickness at the time of therapy plays an important role in this regard. A technique combining the proven principles of immediate implant placement and provisional restoration with hard and soft tissue augmentation using nonautogenous materials is demonstrated with comparisons to nongrafted, temporized historical controls.

This article presents the results of a soft tissue color study on flapless immediate implant therapy from a sample of 23 patients who received either a provisional restoration alone or with bone grafting. The gingival color in clinical photographs was measured for the implant and for the contralateral tooth site at 2.0 and 5.0 mm below the free gingival margin using Photoshop software (Lightroom CC, Adobe). The average color difference (ΔE) values for the two groups were 2.6 and 2.4 at 2.0 mm and 1.9 and 2.5 at 5.0 mm from the free gingival margin, respectively. Approximately 80% of the sites were below the visibly perceptible threshold (ΔE = 3.1 ± 1.5) and not detectable by the human eye. The use of provisional restorations has shown positive outcomes on the stability of peri-implant soft tissue thickness and lower ΔE values. Further research is required to assess esthetic outcomes inclusive of color change relative to the clinical treatment rendered.

PURPOSE/OBJECTIVE:To correlate the link between natural teeth located in esthetic regions of the arches before extraction with their definitive dental implant restorations, and to propose a new and contemporary esthetic index based on the natural dentition (EIND) preoperatively. MATERIALS AND METHODS/METHODS:Patients possessing a high smile line with teeth requiring implant replacement therapy in the maxillary anterior region were included. Clinical intraoral photographs and periapical digital radiographs taken before extraction and 10 ± 1.5 months (range: 9 to 12 months) after the delivery of implant-supported permanent restorations were used to make the measurements and evaluations according to the proposed index. Pink esthetic score (PES) parameters were analyzed. Statistical analyses of preimplant and postimplant parameters between tooth sites and implant sites were carried out with a computer software program. RESULTS:The study included 51 patients (35 women, 16 men), with a mean age of 39.6 years, with a total of 83 dental implants placed in the maxillary anterior region. Of these, there were 6 right canines, 22 right lateral incisors, 11 right central incisors, 22 left central incisors, 17 left lateral incisors, and 5 left canines. Of the 83 included implants, 67 were immediately and 16 were delayed placed. Statistical analyses between tooth sites and implant sites showed significant differences in tissue contour (P = .001), texture (P = .001), alveolar deficiency (P = .001), and total PES (P = .007). No statistically significant difference was detected in mesial papilla, distal papilla, tissue margin, tissue biotype, and the amount of keratinized mucosa. Additionally, R2 value presented a higher variance and lower predictable values of peri-implant tissue parameters compared with those of the natural dentition. CONCLUSION/CONCLUSIONS:This study analyzed various periodontal and peri-implant soft and hard tissue parameters, and a new index system, EIND, was proposed. This index could be used to collect the esthetic-related parameters for pre-extraction treatment planning and provide valuable information for esthetic risk assessment.

The efficacy of immediate implant placement has made it an appealing treatment modality in dentistry. Over the past several decades various surgical techniques to minimize the ridge collapse and other adverse changes that occur after tooth extraction have been advocated. This case series proposes a method of soft-tissue augmentation when multiple implants are being immediately placed. The authors describe a subperiosteal tunneling technique that achieves the dual purpose of graft containment/guided bone regeneration and soft-tissue augmentation around maxillary anterior implants.

OBJECTIVE: Porcelain fused to zirconia (PFZ) restorations are widely used in prosthetic dentistry. However, their tendency to delaminate along the P/Z interface remains a practical problem so that assessing and improving the interfacial strength are important design aspects. This work examines the effect of modifying the zirconia veneering surface with an in-house felspathic glass on the interfacial fracture resistance of fused P/Z. METHODS: Three material systems are studied: porcelain fused to zirconia (control) and porcelain fused to glass-graded zirconia with and without the presence of a glass interlayer. The specimens were loaded in a four-point-bend fixture with the porcelain veneer in tension. The evolution of damage is followed with the aid of a video camera. The interfacial fracture energy GC was determined with the aid of a FEA, taking into account the stress shielding effects due to the presence of adjacent channel cracks. RESULTS: Similarly to a previous study on PFZ specimens, the fracture sequence consisted of unstable growth of channel cracks in the veneer followed by stable cracking along the P/Z interface. However, the value of GC for the graded zirconia was approximately 3 times that of the control zirconia, which is due to the good adhesion between porcelain and the glass network structure on the zirconia surface. SIGNIFICANCE: Combined with its improved bonding to resin-based cements, increased resistance to surface damage and good esthetic quality, graded zirconia emerges as a viable material concept for dental restorations.