The dome technique: a new surgical technique to enhance soft-tissue margins and emergence profiles around implants placed in the esthetic zone

Tassos Irinakis,1 Salwa Aldahlawi1,2 1Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada; 2Faculty of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia Abstract: Achieving symmetry of the soft-tissue margins between anterior maxillary dental-implant restorations and adjacent teeth is a therapeutic challenge for both the implant surgeon and the restorative dentist. This article describes a modified procedure utilizing autogenous connective-tissue grafts to improve primarily buccal soft-tissue margins and secondarily interproximal tissues around tooth-bound single dental implants. This technique has the advantage of allowing for coronal augmentation of the peri-implant soft tissue while maximizing the blood supply to the area by using tunneling-technique principles. A detailed description of the technique and a case with a stable result over 24 months after crown placement is presented. Keywords: esthetic dental treatment, peri-implant soft tissue, autogenous connective-tissue grafts, dental implants, soft tissue augmentation, tunnel technique&nbsp

The effect of implant placement torque on crestal bone remodeling after 1 year of loading

Salwa Aldahlawi,1 Angela Demeter,2 Tassos Irinakis3 1Department of Basic and Clinical Oral Sciences, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia; 2Private Practice, Calgary, Alberta, Canada; 3Graduate Periodontic Program, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada Purpose: The aim of this study was to evaluate and compare crestal bone levels (CBLs) after 1 year of loading of self-tapping bone condensing implants placed with high insertion torque (IT) compared to those placed with lower IT. Materials and methods: A retrospective chart review of 66 consecutive patients who received at least one self-tapping bone condensing implant and were in function for at least 1 year was conducted. On the basis of intrasurgical notes documenting the implant IT, the patient population was divided into group A (implant IT, >55 Ncm) and group B (IT, <55 Ncm). Radiographs taken immediately after insertion and during annual follow-up appointments were evaluated for detecting crestal bone loss. The relationship between IT and crestal bone loss, bone density, and jaw location were analyzed, and a P-value of 0.05 was considered to be statistically significant. Results: A total of 113 self-tapping bone condensing NobelActiveTM implants were placed. The average follow-up period from the placement of the implant restoration was 12.87 (±4.83) months. Six implants were classified as failures resulting in overall survival rate of 94.6%. Implants in group A had a mean IT of 67.35 ± 4.0 Ncm, whereas implants in the group B had a mean IT of 37.9 ± 12.62 Ncm. Implants in group A had statistically significant crestal bone loss compared to implants in group B (0.95 ± 1.60 and 0.18 ± 0.68 mm, respectively). Group A implants placed in the mandible showed significantly more pronounced crestal bone loss (2.12 ± 1.99 mm) compared to those placed in the maxilla (0.25 ± 0.65 mm; P<0.05); however, this was not the case in group B implants. Conclusion: Implants inserted with high IT (>55 Ncm) showed more peri-implant bone remodeling than implants inserted with a less assertive IT (<55 Ncm). Bone density and jaw location affect IT and CBLs. Keywords: dental implant, nobelactive, insertion torque, torque, crestal bone level, marginal bone leve

Evaluation and comparison of histologic changes and implant survival in extraction sites immediately grafted with two different xenografts: A randomized clinical pilot study

Objectives: The purpose of this prospective, single-center randomized pilot study was to histologically evaluate and compare vital bone development in premolar and molar-extraction sites grafted with two different bovine-derived xenografts. The secondary outcome of interest was implant survival in the grafted sites. Materials and Methods: Adult patients in need of at least two tooth extractions were enrolled. A paired design was used; each patient received at least one of each type of graft at different sites. Each extraction site was randomized to one of two xenograft treatment groups. A resorbable membrane was always placed, and primary intention soft tissue closure was achieved. Four months later, implants were placed and a trephine drill was used to remove bone cores for histologic and histomorphometric analysis. Results: Sixteen patients with 40 extraction sites were enrolled; 20 sites were grafted with one type of xenograft and 20 with another. Mean patient age was 53.5\ua0years, and 65% of patients were male. Evaluation of bone core samples taken from grafted sites showed no significant difference in the mean value of percentage of new bone formation between the different grafted sites (33.4% and 32.4%, p\ua0=.76). Cumulative implant survival was 97.5% at the 24-month follow-up visit. Conclusion: Within the limitations of this pilot study, no statistically significant differences in new bone growth between sites grafted with two different types of xenograft were found. Both graft materials promoted the formation of new bone and provided osseous support for implant placement after socket grafting