More Editor's Picks


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 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.

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.

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.

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.”

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

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.

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

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

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

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

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

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

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.

How a perfect, implant-retained anterior bridge can cause facial pain

Dr. Lee N. Sheldon discusses a problem your patients may experience called an interference with the cranial rhythm. But if you don’t know the symptoms, you’ll dismiss their concerns. We were never taught about it in dental school, and it isn't often recognized in traditional dentistry or medicine. The whole issue begins with the “perfect” implant case.

A unique method of debriding a full-arch, maxillary prosthesis supported by dental implants

The role of endosseous dental implants in restorative dentistry has evolved dramatically since original treatment concepts of the early 1970s. Dr. Kavit N. Shah, a prosthodontist in London, shares with colleagues a way to rotate patients’ prostheses on a two- to three-year basis so that they can be thoroughly and effectively debrided, disinfected, and refurbished where required, effectively offering a cost-effective and time-efficient solution through the use of a “spare” prosthesis.

10 steps to perform an oral cancer screening

Squamous cell carcinoma of the oral cavity and throat account for about 45,000 cases each year in the United States, resulting in approximately 8,000 deaths per year. Studies show that successful treatment is highly dependent upon diagnosis and treatment of this disease in its early stages. Although there have been advances in surgical, chemotherapy, and radiation treatment, five-year survival rates of patients with moderate to advanced cases of oral cancer are less than 60%. Patients who do survive typically have trouble chewing, speaking, eating, and smiling after treatment thus it is extremely important to diagnose OC before it becomes advanced, since treatment for early cancer is not as severe. Editorial Director Dr. Scott Froum offers steps to use as you screen patients in your office.

Increasing dental case acceptance through the use of salivary diagnostics

A tremendous amount of literature supports the correlations between gingivitis and/or periodontitis and systemic health. Reports and research continue to find correlations between inflammation of the oral cavity and other inflammatory disease processes, especially cardiovascular disease and diabetes. Educating patients about these links and encouraging oral health awareness has always been a challenge. Dr. Michael Scialabba talks about how salivary testing along with personalized custom periodontal therapy can be a tool to help patients improve not only their oral health but also their overall health.

Understanding and managing peri-implant bone loss

Although a high survival rate of implants has been documented in numerous long-term studies, peri-implant bone loss presents a problem that can compromise—or even result in the loss of—a successful dental implant restoration. Dr. Stuart J. Froum offers an in-depth look at how the dental professional can diagnose and prevent bone loss, and maintain a successful implant restoration.

For the love of everything holy, don't use permanent cement for implants

Whether you prefer screw-retention or cement retention, I think we can all agree that the ability to retrieve the restoration is very important. If there is a fracture of restorative material, such as porcelain or acrylic, then it’s nice to be able to remove the thing and have the lab fix it. I would also urge you to consider how certain contours of the prosthesis can hinder hygienic access, so periodically removing some restorations can significantly aid peri-implant maintenance procedures. But when it comes down to the bitter end, let’s all make a pact together: no more permanent cement for implant restorations.