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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.

Have infection, will travel: Paving the path to dental implant failure

Why did this dental implant fail? You did everything right during your implant treatment. You properly diagnosed and treatment planned the patient’s implant therapy. The implant was surgically placed in a prosthetically driven orientation. You (or the restorative dentist) placed the abutment and crown on the implant with the correct contours, perfect fit, and (if not screw retained) without excess cement. The patient adhered to the follow-up appointments and had good oral hygiene. Follow-up visits showed good bone levels around the implant . . . and then one day there was implant infection and loss of integration. In his clinical tip, Perio-Implant Advisory’s Editorial Director Scott Froum, DDS, talks about one huge oversight that—if detected early and treated properly—is highly preventable and can change the entire outcome of your case.

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.

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.

'If I choose the dental implant option, how long do you guarantee it?'

This question can be a tough balancing act for the dentist being that you do not want to give patients false expectations, but at the same time, you do not want to have your patients forgo treatment they need or go to another dental office. Perio-Implant Advisory’s Editorial Director Dr. Scott Froum posed this question to 100 different dentists of varying years in practice, in various locations throughout the United States, of those who place dental implants. Here is a sample of responses from some of the leaders in the dental implant industry.

It's 10 p.m.; do you know where your patient's hemostasis is?

If you are a dentist who performs surgical treatment, such as extractions and/or implant therapy, a dreaded phone call can be from your emergency service regarding a patient you treated earlier in the day who now has uncontrollable bleeding. This is of greater concern if the patient has a medical history that warrants anticoagulation medication and the physician did not let your patient go off medication prior to surgery. Dr. Scott Froum, editorial director of Perio-Implant Advisory, introduces the feature article on hemostasis that will help you answer pertinent questions prior to surgery.

Establishing hemostasis post-extraction

Dr. Gregg Jacob, an oral and maxillofacial surgeon in New York, says, “One of the most common clinical scenarios that I am faced with in daily dental practice is the management of patients who have alterations to their coagulation.” Here, he shares his insight and valuable advice on how to handle patients who present with various medical issues and who have risks to consider.

This month's clinical tip from the editor: After a tooth extraction, are you guilty of chucking the tissue?

There are many etiologies behind the development of a radiolucent lesion at the apex of a tooth root. What clinicians are most familiar with are lesions of endodontic origin. But what happens when that lesion is of nonendodontic origin? What happens when the clinician proceeds with business as usual and performs an apicoectomy or extraction with subsequent implant placement because of a perceived root canal failure down the line? Perio-Implant Advisory Editorial Director Scott Froum, DDS, and Dr. Naomi Ramer, chief of oral pathology at Mt. Sinai Hospital, offer advice on how to handle these situations.

This month's clinical tip from the editor: 'The implant you put in my mouth is now bleeding; what should I do?'

A dreaded phone call that every dental office involved in dental implant therapy may encounter is when a patient calls and says, “Hey Doc, the implant you put in my mouth a few days (or months or years) ago started to bleed.” Most often patients will claim that the problem started “out of the blue” and they tried rinsing their mouths with various medicaments all to no avail. Perio-Implant Advisory Editorial Director Scott Froum, DDS, shares his advice and gives the top five reasons why implant restorations can bleed in his clinical tip of the month.

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.

Perio-Implant Advisory JOMI Clinical Pearls: Analyzing techniques for maxillary implant placement success

JOMI Clinical Pearls is a regular column in Perio-Implant Advisory that discusses articles from The International Journal of Oral and Maxillofacial Implants (JOMI)—the official journal of the Academy of Osseointegrationas reviewed by a member of the Academy’s Young Clinicians Committee. Here, Dr. José Antonio Garcia M. discusses implants with different abutment interfaces to replace anterior, maxillary single teeth; the effect of barrier membranes on the outcomes of maxillary sinus floor augmentation; and the effects of implant morphology on rotational stability during immediate implant placement in the esthetic zone.

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.

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.

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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