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bone graft, bone grafting, bone augmentation

A new minimally invasive bone grafting technique: SMART

The subperiosteal minimally invasive esthetic ridge augmentation technique called SMART—developed as an alternative to traditional guided bone regeneration procedures—has the potential to profoundly impact the future of bone augmentation. Ernesto A. Lee, DMD, explains more about the clinical features of this new bone grafting technique.

ridge augmentation, soft tissue grafting, dental implants, bone grafting

Deciding between pink porcelain versus ridge augmentation in the esthetic zone

Although dental implants are a predictable treatment modality for the replacement of failed or lost teeth, the challenge continues to be achieving desirable esthetic outcomes in the maxillary anterior region that are acceptable to both patient and clinician. Two cases from Peter Mann, DDS, FICOI, FAGD, highlight two different approaches to reconstructing tissue defects during dental implant therapy, and considerations as to why that specific modality was selected.

A novel approach for the treatment of desquamative gingivitis

Periodontal conditions vary in their level of pain and severity, but desquamative gingivitis (DG) is one of those delicate gingival conditions that can be extremely painful for sufferers and may limit their ability to eat and perform basic oral hygiene care. Robin D. Henderson, DMD, MS, explains a technique he uses in his practice that involves Perio Trays custom-fabricated tray delivery system to deliver multiple medications precisely to the affected tissues. The process helps effectively manage both the periodontal and autoimmune symptoms of DG, while empowering patients to have a part in co-managing their disease.

tongue, pathologies, dental examination, oral pathology

5 pathologies most likely to affect the tongue: Importance of proper examination and diagnosis

Although the dental technology that can identify oral pathology has greatly improved in the past decade, dental professionals should still understand the importance of conducting visual exams and be able to accurately diagnose disease when present. Perio-Implant Advisory Editorial Director Scott Froum, DDS, offers dental health professionals an aid to examining the tongue, recognizing characteristics of a normal disease-free tongue, and identifying the top five pathologies most likely to affect the tongue that could represent larger systemic issues.

osteonecrosis of the jaw, MRONJ, oral surgery, osteoporosis

Medication-related osteonecrosis of the jaw: Lowering the risk of MRONJ using new drug alternatives

By now, we have all faced the clinical decision about whether to proceed with elective oral surgery for the postmenopausal female patient who has begun bisphosphonate (BP) therapy. The potential for medication-related osteonecrosis of the jaw (MRONJ) that may occur after oral surgery persists for years after BPs have been administered, due to the fact that they have been found in bone 10 years after even a single administration. Michael DiPace, DDS, offers a general review of three alternative drugs used to treat osteoporosis that have little or no known association with MRONJ.

flossing, oral hygiene, dental hygiene, interproximal cleaners

Lies, damned lies, and statistics: The truth behind the importance of flossing

Last week the Associated Press released an investigative report citing “weak evidence” behind the importance of flossing. This week Scott Froum, DDS, editorial director of Perio-Implant Advisory, gives the history behind this investigative report, examines what the term “weak evidence” means in the larger scheme of things, and offers dental professionals talking points when patients ask about the importance of flossing.

dental implants, dental restorations, peri-implantitis, dental crowns

Prosthetic screw loosening: An innovative technique to manage a common complication with dental implants

When abutment screw loosening occurs with a cement-retained crown, the clinician is faced with a difficult challenge, often requiring the dentist to send the crown to the lab to be “uncemented” from the abutment. The patient is left without a crown for several days until it comes back from the lab separated from the abutment. Daniel D. Gober, DDS, and Markus L. Weitz, DDS, illustrate a technique to reseat a cement-retained crown-abutment unit that loosened from the implant by converting a cement-retained crown into a screw-retained crown at the very same appointment.

oral-systemic, periodontal disease, salivary diagnostic testing, salivary diagnostics

Oral-systemic links and tests we never thought about

Oral-systemic interconnections—typically understood to mean the impact of periodontal disease and periodontal pathogens on a variety of systemic diseases and conditions—have been studied intensely for generations. The consensus is that they are now accepted in both the dental and medical professions, although the strength of the various relationships is still being investigated. An equally impactful oral-systemic link that has quietly proceeded largely unnoticed by many dental professionals is the use of saliva to detect the presence of an incredible number of diseases and conditions by evaluation of biomarkers of disease. Richard H. Nagelberg, DDS, discusses the advancements in salivary diagnostic testing and explains how the effects of this technology on health care and the dental profession in particular will be profound.

bone graft, socket debridement, mechanical debridement, postextraction treatment - Scott Froum, DDS

Postextraction treatment: Did your bone graft fail, or did you fail your bone graft?

Patients who are about to undergo dental treatment, especially surgery, will often inquire as to the success rate of the procedure to be performed. When we look at the etiology of poor bone fill or bone-graft integration postextraction, many factors can influence the outcome, including medical history, medications, social factors, etc. Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, says there are also iatrogenic factors, including sterility of the procedure, surgical technique, and—one of the most important and often-overlooked factors—complete debridement of the postextraction socket.

antidepressants - nutraceuticals - oral-systemic health - dental implants - periodontal health

Antidepressant medications and nutraceuticals: Effects on the success of dental implants

Kevin Oberlander, RPh, says, “As a pharmacist working closely with the dental profession, I read with great interest the recent pilot study conducted by the University of Buffalo that brings to light fresh concerns over the adverse effects in dental implant patients taking antidepressants.” In this article, he discusses research concerning the value of supplementing with nutraceuticals—specifically Vitamin D and magnesium—for patients with dental implants who are taking medications that cause deficiencies affecting bone health.

malpositioned dental implants, Steven Pigliacelli, CDT, MDT - dental implant prosthetics

Correcting malpositioned dental implants: Where do we go from here?

An unfortunate occurrence in dental implant prosthetics is malpositioned implant placement. Steven Pigliacelli, CDT, MDT, offers insight into the various restorative options available as well as their drawbacks. He says, “The team concept of oral surgeon, restoring dentist, and lab technicians is most crucial at the planning stages rather than the final restoration stage. By using scans and implant placement software, we can preplan the final restoration and carry out our plan with no late surprises to the patient or restoring doctor as far as lab fees or final esthetics.”

surgical guides for ridge augmentation, dental implant restoration, Peter Mann, DDS, FICOI, FAGD

A cost-effective method of creating a dental implant surgical guide for ridge augmentation

Peter Mann, DDS, FICOI, FAGD, says, “Building the ideal ridge form via hard- and soft-tissue ridge augmentation makes ideal implant placement possible. However, creating surgical guides for ridge augmentation—even though it is just as important as implant surgical guides—is not usual practice.” Study his step-by-step technique that describes a cost-effective, easy-to-manufacture surgical guide for ridge augmentation that you can easily implement into your practice.

A patient’s perspective on the importance of tooth-sparing periodontal treatment by Martin Heilweil, PhD

A patient's perspective on the importance of tooth-sparing periodontal treatment

Martin Heilweil, PhD, faced severe bone loss and periodontal treatment consisting of extraction, bone grafts, sinus lifts, implants, and crowns. He didn’t like the idea of losing his teeth. He didn’t like his dentist. It was time to do something about this. It was time to shop for a new dentist. After some research, he decided he wanted to give the “saving the teeth” option a try. Here is his story.

dental scalers Dreamstime.com periodontal treatment

Call to the dental profession: Saving the art of scaling and root planing in periodontal treatment

Dr. Victor M. Sternberg sets forth the value of scaling and root planing for the maintenance of periodontal patients. As such, he references studies that speak of its value for periodontal treatment and explains how he believes the procedures of scaling and root planing have become abandoned in the institutions of graduate schools, dental schools, dental hygiene schools, dental practices, the dental industry, and patients themselves. As he says, “At one time, the giants of periodontology walked the halls of American dental schools.” He offers four frank suggestions to remedy these problems as he sees them.

Importance of soft tissue in interdisciplinary cases: A case study involving orthodontics, periodontics, dental implants by Delia Tuttle, DDS

Importance of soft tissue in interdisciplinary cases: A case study involving orthodontics, periodontics, dental implants

The importance of keratinized soft tissue around both dental implants and natural teeth has been demonstrated in the literature to support effective home care, prevent sensitivity and tissue breakdown, as well as aid in esthetic value. Unfortunately, clinical exams can often overlook the need for soft-tissue enhancement until the patient becomes symptomatic and/or desires esthetic improvement. Soft-tissue augmentation prior to orthodontic treatment, prosthodontic treatment, and implant therapy can be of tremendous benefit to ensure a long-term, successful result. This case study highlights the use of soft-tissue augmentation prior to orthodontic and implant therapy to enhance the zone of keratinized tissue, increase root coverage, and improve esthetics.

Perio-Implant Advisory ‘JOMI Clinical Pearls’: Discussions on zirconia versus titanium implants, peri-implantitis, and dental implant geometry by Joan Pi-Anfruns, DMD

Perio-Implant Advisory JOMI Clinical Pearls: Discussions on zirconia versus titanium implants, peri-implantitis, and dental implant geometry

Dr. Joan Pi-Anfruns authors this JOMI Clinical Pearls column in Perio-Implant Advisory, where he discusses three articles from The International Journal of Oral and Maxillofacial Implants (JOMI)—the official journal of the Academy of Osseointegration (AO)—as reviewed by a member of the Academy’s Young Clinicians Committee (YCC). Topics cover zirconia versus titanium implants, peri-implantitis, and dental implant geometry.

Surgically Facilitated Orthodontic Therapy (SFOT): Maximizing case outcome by Michael E. Curry, DDS, and Richard D. Roblee, DDS, MS

Surgically Facilitated Orthodontic Therapy (SFOT): Maximizing case outcome

Modern science is making disruptive advancements in medicine and dentistry. In dentistry specifically, Surgically Facilitated Orthodontic Therapy (SFOT) is an advanced procedure that pinpoints the underlying problems of insufficient alveolar bone and compromised arch forms to optimally enhance functional and esthetic concerns. A major advantage to patients is that SFOT can significantly decrease the amount of treatment time by more than 50% and then, combined with clear aligner therapy, can increase case acceptance. Michael E. Curry, DDS, and Richard D. Roblee, DDS, MS, present a case in which SFOT was used with a high-tech clear aligner to address hard- and soft-tissue deficiencies and severe maxillary and mandibular arch constriction.

Localized aggressive periodontitis: All-On-4 oral rehabilitation case report by Alphonse Gargiulo, DDS, MS; Rachel Degen, RDH; and Mark Val, CDT

Localized aggressive periodontitis: All-On-4 oral rehabilitation case report

Alphonse Gargiulo, DDS, MS, Rachel Degen, RDH, and Mark Val, CDT, present a case report of a 20-year-old African American female who was diagnosed at puberty with localized aggressive periodontitis, which developed into a generalized form of the disease as the patient entered late adolescence. The authors show how the All-On-4 procedure was used to restore the patient’s confidence and enthusiasm about living her life without dental complications.

Etiology, prevention, and treatment of screw loosening and fracture by Andrew Mackie, BDS, DClinDent, MFGDP, RCS, MRACDS

Etiology, prevention, and treatment of screw loosening and fracture

Prosthodontist Andrew Mackie, BDS, DClinDent, from New Zealand explains the etiology, prevention, and treatment of loose screws and screw fracture of dental implants. He explains often-misunderstood, important concepts such as the physics and technique.

Recession-proof your practice: Increasing patient acceptance of soft-tissue root coverage by Jennifer Hirsch Doobrow, DMD

Recession-proof your practice: Increasing patient acceptance of soft-tissue root coverage

Some 88% of individuals age 65 and older, and approximately 50% of individuals ages 18–64 experience gingival recession at one or more tooth sites. Dr. Jennifer Hirsch Doobrow finds that her patients benefit from a hybrid/combination therapy, whereby a tunneling technique is used in combination with a subepithelial connective tissue graft, enamel matrix derivative, and a coronally advanced flap.

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