Initial stability of the implant is one of the fundamental criteria for obtaining osseointegration. An adequate primary anchorage is often difficult to achieve in low density bone (type IV). Various surgical suggestions were advanced in the 1980s which were aimed at achieving optimal osseous integration in poor quality bone. They offered satisfactory short-term results. Recently, as a result of surgical and technological innovations, new therapeutic proposals have shown very interesting results in their initial studies.
The choice of implant diameter depends on the type of edentulousness, the volume of the residual bone, the amount of space available for the prosthetic reconstruction, the emergence profile, and the type of occlusion. Small‐diameter implants are indicated in specific clinical situations, for example, where there is reduced interradicular bone or a thin alveolar crest, and for the replacement of teeth with small cervical diameter. Before using a small‐diameter implant, the biomechanical risk factors must be carefully analyzed. Preliminary reports of this type of implant show good short‐ and medium‐term results.
CLINICAL SIGNIFICANCE
Specific clinical situations indicate the use of small‐diameter implants: a reduced amount of bone (thin alveolar crest) and where the replacement tooth requires a small cervical diameter. In some cases, the use of small‐diameter implants avoids bone reconstruction.
Twenty patients with large endodontic lesions, which failed to respond to conventional endodontic therapy, were selected for this study. The lesions had a radiographic diameter of at least 10 mm, were removed by periradicular surgery, before retrofilling the apices with either super EBA or dessicated zinc oxide-eugenol. In 10 test sites large e-PTFE membranes (Gortex) were placed to cover the lesions, while at the control sites the lesions were not covered before resuturing. Radio-graphic analysis of the lesions at 3, 6, 9 and 12 months revealed that lesions covered with the membranes healed quicker than the control lesions, and that the quality and quantity of the regenerated bone was superior when membranes were used. Results of the study indicate that guided tissue regeneration (GTR) principles can be effectively applied to the healing of large periapical lesions, especially in through-and-through lesions.
Background: In the Literature, there are several studies demonstrating that infraposition happens also in adult patients.Purpose: To conduct a retrospective evaluation of infraocclusion of implant-retained crowns in the anterior maxilla of adult patients and of the patient awareness and perception of the problem.Material and Methods: From January to June 2017, all adult patients who in the last 5 to 20 years had received in the same clinic implant restorations in the upper anterior maxilla were recalled to assess the presence of crown infraocclusion. Ninety-four patients were recalled. Twenty-six males, 34 females, with 76 implants were included in the study. According to the age, patients were divided into group I (<30 years: 12 males, 14 female) and group II (>30 years: 14 males, 20 females). Digital photographs, taken at the time of final prosthesis delivery (T0) and at time of the study examination (T1) were compared by three blinded previously calibrated examiners. Cast models of the dental arches were taken at T1 and served as a reference for infraocclusion measurements.According to the Literature, cases were included in three categories: infraocclusion <0.5 mm, infraocclusion 0.5-1.0 mm, and infraocclusion >1 mm. An awareness and perception score (APS) was prepared to classify patients in: "unaware patients" (0), "aware but disinterested patients" (1), "aware patients requiring explications" (2), and "aware patients requiring treatment" (3).Results: Infraocclusion was present in 73.3% of all cases, 65.4% among males, 79.4% among females. Infraocclusion was less than 1 mm in 88.2% of males and in 85.1% of females. No significant differences were found for sex (P = .223).No significant differences were found for age: group I: 47.7%, group II: 52.2%, (P = .481).The overall APS was: "unaware patients" = 38.6%, "aware but disinterested patients" = 27.3%, "aware patients requiring explications" = 15.9%, "aware patients requiring treatment" = 18.2%.
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