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Implant Articles
A Decade of the Socket-Shield Technique: A Step-by-Step Partial Extraction Therapy Protocol

A Decade of the Socket-Shield Technique: A Step-by-Step Partial Extraction Therapy Protocol
Ten years have passed since Hürzeler and coworkers first introduced the socket-shield technique. Much has developed and evolved with regard to partial extraction therapy, a collective concept of utilizing the patient’s own tooth root to preserve the periodontium and peri-implant tissue. The specifications, steps, instrumentation, and procedures discussed in this article are the result of extensive experience in refining the socket-shield technique as we know it today. A repeatable, predictable protocol is requisite to providing tooth replacement in esthetic dentistry. Moreover, a standardized protocol provides a better framework for clinicians to report data relating to the technique with procedural consistency. This article aims to illustrate a reproducible, step-by-step protocol for the socket- shield technique at immediate implant placement and provisionalization for single-rooted teeth.

Author(s): Howard Gluckman, BDS, MChD;Jonathan Du Toit, BChD, Dip Oral Surg, Dipl Implantol, MSc;Maurice Salama, DMD;Katalin Nagy, DDS, DSc, PhD;Michel Dard, DDS, MS, PhD
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Modified IVAN Technique: Long-Term Follow-Up of 20 Cases Over 2 to 11 Years

Modified IVAN Technique: Long-Term Follow-Up of 20 Cases Over 2 to 11 Years
When natural teeth fail, frequently there is a loss of hard and soft tissue. This may complicate subsequent dental implant placement by creating insufficient bone to house the implant. This also occurs when the tooth has been missing for an extended period, especially in the premaxilla, where the bone is less dense and often lacks sufficient volume of facial bone. Site reconstruction to accommodate implant placement often requires both hard and soft tissue augmentation. The modified interpositional vascularized augmentation neogenesis (mIVAN) technique achieves the desired treatment goals in both delayed and immediate placement scenarios. The technique will be discussed as well as the long-term follow-up on 20 cases.

Author(s): Snježana Pohl, MD, DMD;Gregori M. Kurtzman, DDS
View Article>>
The Modified IVAN Technique: Hard and Soft Tissue Augmentation at Extraction for Delayed Implant Placement

The Modified IVAN Technique: Hard and Soft Tissue Augmentation at Extraction for Delayed Implant Placement
Failure of a natural tooth may not permit placement of an implant at the time of extraction due to insufficiency in available bone to house the implant. Reconstruction of the extraction socket frequently involves both hard and soft tissue augmentation to provide a site that can house the implant and ridge contours that mimic the adjacent natural anatomy. This situation becomes more problematic in the maxillary anterior due to the anatomy and the lower density of the bone of the premaxilla. The solution is the interpositional vascularized augmentation neogenesis (IVAN), which consists of hard tissue grafts, various barrier membranes, and closure with the pediculated connective tissue graft (PCTG). The modified IVAN (mIVAN) technique achieves the necessary goals and may be used in both delayed and immediate placement situations.

Author(s): Snježana Pohl, MD, DMD;Gregori M. Kurtzman, DDS
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Maintenance of Alveolar Ridge Dimensions Utilizing an Extracted Tooth Dentin Particulate Autograft and Platelet-Rich Fibrin: A Retrospective Radiographic Cone-Beam Computed Tomography Study

Maintenance of Alveolar Ridge Dimensions Utilizing an Extracted Tooth Dentin Particulate Autograft and Platelet-Rich Fibrin: A Retrospective Radiographic Cone-Beam Computed Tomography Study
This study utilized radiographic comparative analysis in order to evaluate dimensional ridge changes four months after tooth extraction and immediate grafting with mineralized dentin particulate autograft and chopped platelet-rich fibrin. Fifty-eight extraction sockets with up to 2mm of missing buccal bone in the coronal aspect compared to the lingual bone were included. Graft material was covered with either a platelet-rich fibrin membrane or collagen sponge with no effort to achieve primary closure.

Author(s): Snježana Pohl, MD, DMD;Itzhak Binderman; Jelena Tomac
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Bone Grafting Articles
Recombinant Human Platelet– Derived Growth Factor: A Systematic Review of Clinical Findings in Oral Regenerative Procedures

Recombinant Human Platelet– Derived Growth Factor: A Systematic Review of Clinical Findings in Oral Regenerative Procedures
The use of recombinant human plateletderived growth factor–BB (rhPDGF) has received Food and Drug Administration approval for the treatment of periodontal and orthopedic bone defects and dermal wound healing. Many studies have investigated its regenerative potential in a variety of other oral clinical indications. The aim of this systematic review was to assess the efficacy, safety, and clinical benefit of recombinant human plateletderived growth factor (rhPDGF) use for alveolar bone and/or soft tissue regeneration. Based on the clinical evidence, rhPDGF is safe and provides clinical benefits when used in combination with bone allografts, xenograft, or β-TCP for the treatment of intrabony and furcation periodontal defects and gingival recession or when used with allografts or xenograft for GBR and ARP.

Author(s): L. Tavelli, A. Ravidà, S. Barootchi, L. Chambrone, W.V. Giannobile
View Article>>
Modified IVAN Technique: Long-Term Follow-Up of 20 Cases Over 2 to 11 Years

Modified IVAN Technique: Long-Term Follow-Up of 20 Cases Over 2 to 11 Years
When natural teeth fail, frequently there is a loss of hard and soft tissue. This may complicate subsequent dental implant placement by creating insufficient bone to house the implant. This also occurs when the tooth has been missing for an extended period, especially in the premaxilla, where the bone is less dense and often lacks sufficient volume of facial bone. Site reconstruction to accommodate implant placement often requires both hard and soft tissue augmentation. The modified interpositional vascularized augmentation neogenesis (mIVAN) technique achieves the desired treatment goals in both delayed and immediate placement scenarios. The technique will be discussed as well as the long-term follow-up on 20 cases.

Author(s): Snježana Pohl, MD, DMD;Gregori M. Kurtzman, DDS
View Article>>
The Modified IVAN Technique: Hard and Soft Tissue Augmentation at Extraction for Delayed Implant Placement

The Modified IVAN Technique: Hard and Soft Tissue Augmentation at Extraction for Delayed Implant Placement
Failure of a natural tooth may not permit placement of an implant at the time of extraction due to insufficiency in available bone to house the implant. Reconstruction of the extraction socket frequently involves both hard and soft tissue augmentation to provide a site that can house the implant and ridge contours that mimic the adjacent natural anatomy. This situation becomes more problematic in the maxillary anterior due to the anatomy and the lower density of the bone of the premaxilla. The solution is the interpositional vascularized augmentation neogenesis (IVAN), which consists of hard tissue grafts, various barrier membranes, and closure with the pediculated connective tissue graft (PCTG). The modified IVAN (mIVAN) technique achieves the necessary goals and may be used in both delayed and immediate placement situations.

Author(s): Snježana Pohl, MD, DMD;Gregori M. Kurtzman, DDS
View Article>>
Maintenance of Alveolar Ridge Dimensions Utilizing an Extracted Tooth Dentin Particulate Autograft and Platelet-Rich Fibrin: A Retrospective Radiographic Cone-Beam Computed Tomography Study

Maintenance of Alveolar Ridge Dimensions Utilizing an Extracted Tooth Dentin Particulate Autograft and Platelet-Rich Fibrin: A Retrospective Radiographic Cone-Beam Computed Tomography Study
This study utilized radiographic comparative analysis in order to evaluate dimensional ridge changes four months after tooth extraction and immediate grafting with mineralized dentin particulate autograft and chopped platelet-rich fibrin. Fifty-eight extraction sockets with up to 2mm of missing buccal bone in the coronal aspect compared to the lingual bone were included. Graft material was covered with either a platelet-rich fibrin membrane or collagen sponge with no effort to achieve primary closure.

Author(s): Snježana Pohl, MD, DMD;Itzhak Binderman; Jelena Tomac
View Article>>
Sinus Lift Articles
Survival of Implants after Indirect Maxillary Sinus Elevation Procedure: A Two Years Longitudinal Study

Survival of Implants after Indirect Maxillary Sinus Elevation Procedure: A Two Years Longitudinal Study
The aim of the study was to evaluate the survival rate of two diverse implant systems with different implant surfaces with the same geometrical design. In the present study, we achieved clinical success with both kinds of implant surfaces however Bioetched implant surface showed promising results comparable to Tiunite surface of Nobel BioCare Implants. In the future, more case-controlled studies with longer follow-up are needed to validate the results of the present findings.

Author(s): Lanka Mahesh, BDS, MBA;Ashutosh Agarwal; Jose C Guirado; Praful Bali; Nitika Poonia
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Sinus Floor Elevation Via the Maxillary Premolar Extraction Socket With Immediate Implant Placement: A Case Series

Sinus Floor Elevation Via the Maxillary Premolar Extraction Socket With Immediate Implant Placement: A Case Series
When immediate implant placement is considered for teeth with close proximity to the sinus floor, apical extension of the osteotomy is significantly limited, and often a staged approach is used. Implant placement into fresh extraction sockets and sinus floor manipulation using bone-added osteotome sinus floor elevation with implant placement are techniques most often used independently or sequentially. In this care report, immediate implant placement with simultaneous osteotome sinus floor elevation is an advantageous combination of two successfully used techniques. This combined approach can significantly reduce the treatment time for implant therapy in teeth with close sinus proximity and provide the operator with the ability to place implants of desired length.

Author(s): Monish Bhola, DDS, MSD;Shilpa Kolhatkar; Tamika N. Thompson-Sloan
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Alternative Applications of Guided Surgery: Precise Outlining of the Lateral Window in Antral Sinus Bone Grafting

Alternative Applications of Guided Surgery: Precise Outlining of the Lateral Window in Antral Sinus Bone Grafting
Computed tomography (CT) and the application of CT-based guided implant surgery allow clinicians to provide enhanced precision and accuracy in implant surgery. Because of the difficulty in transferring a patient’s often complex anatomic sinus configurations, as viewed on a preoperative CT scan, into precise osteotomy cuts at antral bone graft surgery, a prototype cutting guide was developed. The surgical guide was developed through the use of CT imaging and the stereolithographic process to precisely position the lateral window, facilitating schneiderian membrane elevation. This report demonstrates the step-by-step method to perform precise guided sinus window preparation using computer software and a stereolithographically generated surgical guide.

Author(s): George A. Mandelaris, DDS, MS;Alan L. Rosenfeld, DDS, FACD
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Indirect Sinus Lift with CPS Putty

Indirect Sinus Lift with CPS Putty
In situations where lack of bone volume is related to an enlarged maxillary sinus, elevation of the sinus floor has been advocated for implant placement.

Author(s): Lanka Mahesh, BDS, MBA;Dr. Manesh Lahori; Dr. Sagrika Shukla; Dr. Prerna Kaushik
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Soft Tissue Articles
Buccal Sliding Palatal Pedicle Flap Technique for Wound Closure After Ridge Augmentation

Buccal Sliding Palatal Pedicle Flap Technique for Wound Closure After Ridge Augmentation
One standard approach for wound closure after ridge augmentation is coronal flap advancement. Coronal flap advancement results in displacement of the mucogingival junction and reduction of the vestibulum. In the maxilla, a buccal sliding palatal flap can be applied for primary wound closure after ridge augmentation. The dissected part of the palatal connective tissue is left exposed, thus eliminating or reducing the amount of the coronal flap advancement respectively and increasing the amount of keratinized gingiva. In combination with guided soft tissue augmentation, this flap design enables a three-dimensional peri-implant soft tissue augmentation.

Author(s): Snježana Pohl, MD, DMD;Maurice Salama, DMD;Pantelis Petrakakis, DDS, DPH
View Article>>
A Decade of the Socket-Shield Technique: A Step-by-Step Partial Extraction Therapy Protocol

A Decade of the Socket-Shield Technique: A Step-by-Step Partial Extraction Therapy Protocol
Ten years have passed since Hürzeler and coworkers first introduced the socket-shield technique. Much has developed and evolved with regard to partial extraction therapy, a collective concept of utilizing the patient’s own tooth root to preserve the periodontium and peri-implant tissue. The specifications, steps, instrumentation, and procedures discussed in this article are the result of extensive experience in refining the socket-shield technique as we know it today. A repeatable, predictable protocol is requisite to providing tooth replacement in esthetic dentistry. Moreover, a standardized protocol provides a better framework for clinicians to report data relating to the technique with procedural consistency. This article aims to illustrate a reproducible, step-by-step protocol for the socket- shield technique at immediate implant placement and provisionalization for single-rooted teeth.

Author(s): Howard Gluckman, BDS, MChD;Jonathan Du Toit, BChD, Dip Oral Surg, Dipl Implantol, MSc;Maurice Salama, DMD;Katalin Nagy, DDS, DSc, PhD;Michel Dard, DDS, MS, PhD
View Article>>
Recombinant Human Platelet– Derived Growth Factor: A Systematic Review of Clinical Findings in Oral Regenerative Procedures

Recombinant Human Platelet– Derived Growth Factor: A Systematic Review of Clinical Findings in Oral Regenerative Procedures
The use of recombinant human plateletderived growth factor–BB (rhPDGF) has received Food and Drug Administration approval for the treatment of periodontal and orthopedic bone defects and dermal wound healing. Many studies have investigated its regenerative potential in a variety of other oral clinical indications. The aim of this systematic review was to assess the efficacy, safety, and clinical benefit of recombinant human plateletderived growth factor (rhPDGF) use for alveolar bone and/or soft tissue regeneration. Based on the clinical evidence, rhPDGF is safe and provides clinical benefits when used in combination with bone allografts, xenograft, or β-TCP for the treatment of intrabony and furcation periodontal defects and gingival recession or when used with allografts or xenograft for GBR and ARP.

Author(s): L. Tavelli, A. Ravidà, S. Barootchi, L. Chambrone, W.V. Giannobile
View Article>>
Modified IVAN Technique: Long-Term Follow-Up of 20 Cases Over 2 to 11 Years

Modified IVAN Technique: Long-Term Follow-Up of 20 Cases Over 2 to 11 Years
When natural teeth fail, frequently there is a loss of hard and soft tissue. This may complicate subsequent dental implant placement by creating insufficient bone to house the implant. This also occurs when the tooth has been missing for an extended period, especially in the premaxilla, where the bone is less dense and often lacks sufficient volume of facial bone. Site reconstruction to accommodate implant placement often requires both hard and soft tissue augmentation. The modified interpositional vascularized augmentation neogenesis (mIVAN) technique achieves the desired treatment goals in both delayed and immediate placement scenarios. The technique will be discussed as well as the long-term follow-up on 20 cases.

Author(s): Snježana Pohl, MD, DMD;Gregori M. Kurtzman, DDS
View Article>>
Periodontic Surgery Articles
Buccal Sliding Palatal Pedicle Flap Technique for Wound Closure After Ridge Augmentation

Buccal Sliding Palatal Pedicle Flap Technique for Wound Closure After Ridge Augmentation
One standard approach for wound closure after ridge augmentation is coronal flap advancement. Coronal flap advancement results in displacement of the mucogingival junction and reduction of the vestibulum. In the maxilla, a buccal sliding palatal flap can be applied for primary wound closure after ridge augmentation. The dissected part of the palatal connective tissue is left exposed, thus eliminating or reducing the amount of the coronal flap advancement respectively and increasing the amount of keratinized gingiva. In combination with guided soft tissue augmentation, this flap design enables a three-dimensional peri-implant soft tissue augmentation.

Author(s): Snježana Pohl, MD, DMD;Maurice Salama, DMD;Pantelis Petrakakis, DDS, DPH
View Article>>
A Decade of the Socket-Shield Technique: A Step-by-Step Partial Extraction Therapy Protocol

A Decade of the Socket-Shield Technique: A Step-by-Step Partial Extraction Therapy Protocol
Ten years have passed since Hürzeler and coworkers first introduced the socket-shield technique. Much has developed and evolved with regard to partial extraction therapy, a collective concept of utilizing the patient’s own tooth root to preserve the periodontium and peri-implant tissue. The specifications, steps, instrumentation, and procedures discussed in this article are the result of extensive experience in refining the socket-shield technique as we know it today. A repeatable, predictable protocol is requisite to providing tooth replacement in esthetic dentistry. Moreover, a standardized protocol provides a better framework for clinicians to report data relating to the technique with procedural consistency. This article aims to illustrate a reproducible, step-by-step protocol for the socket- shield technique at immediate implant placement and provisionalization for single-rooted teeth.

Author(s): Howard Gluckman, BDS, MChD;Jonathan Du Toit, BChD, Dip Oral Surg, Dipl Implantol, MSc;Maurice Salama, DMD;Katalin Nagy, DDS, DSc, PhD;Michel Dard, DDS, MS, PhD
View Article>>
The Pontic-Shield: Partial Extraction Therapy for Implant Dentistry

The Pontic-Shield: Partial Extraction Therapy for Implant Dentistry
Augmentive ridge preservation techniques aim to manage the postextraction ridge. The partial extraction of teeth may better preserve the ridge form by maintaining the bundle bone-periodontal tissues and preserve the ridge beneath dentures or fixed prostheses. The socket-shield technique entails preparing a tooth root section simultaneous to immediate implant placement and has demonstrated histologic and clinical results contributory to esthetic implant treatment. A retrospective 10-patient case series treating 14 partial extraction sites demonstrates how a modification of the socket-shield technique can successfully develop pontic sites and preserve the ridge.

Author(s): Howard Gluckman, BDS, MChD;Maurice Salama, DMD;Jonathan Du Toit, BChD, Dipl Implantol, Dipl Oral Surg, MSc Dent
View Article>>
The Socket-Shield Technique to Support the Buccofacial Tissues at Immediate Implant Placement

The Socket-Shield Technique to Support the Buccofacial Tissues at Immediate Implant Placement
Tooth loss and subsequent ridge collapse continue to burden restorative implant treatment. Careful management of the post-extraction tissues is needed to preserve the alveolar ridge. In-lieu of surgical augmentation to correct a ridge defect, the socket-shield technique offers a promising solution. As the root submergence technique retains the periodontal attachment and maintains the alveolar ridge for pontic site development, this case report demonstrates the hypothesis that retention of a prepared tooth root section as a socket-shield prevents the recession of tissues buccofacial to an immediately placed implant. The socket-shield technique is a highly promising addition to clinical implant dentistry and this case report is among the first to demonstrate the procedure in clinical practice with a 1-year follow up.

Author(s): Howard Gluckman, BDS, MChD;Maurice Salama, DMD;Jonathan Du Toit, BChD
View Article>>
Other Surgical Articles
Socket Shield Technique - Implantology Today

Socket Shield Technique - Implantology Today
The socket shield procedure is an effective surgical technique for implant supported restorations. It helps in preserving the labial bone and soft tissue architecture around osseointegrated implants. The procedure provides comparable or better outcomes compared to other conventional alternatives at a lower cost.

Author(s): Udatta Kher, BDS, MDS;Ali Tunkiwala, MDS
View Article>>
The “Scalloped Guide”: A Proof-of-Concept Technique for a Digitally Streamlined, Pink-Free Full-Arch Implant Protocol

The “Scalloped Guide”: A Proof-of-Concept Technique for a Digitally Streamlined, Pink-Free Full-Arch Implant Protocol
Inadequate restorative space can result in mechanical, biologic, and esthetic complications with full-arch fixed implant-supported prosthetics. As such, clinicians often reduce bone to create clearance. The aim of this paper was to present a protocol using stacking computer-aided design/computerassisted manufacturing (CAD/CAM) guides to minimize and accurately obtain the desired bone reduction, immediately place prosthetically guided implants, and load a provisional that replicates predetermined tissue contour. This protocol can help clinicians minimize bone reduction and place the implants in an ideal position that allows them to emerge from the soft tissue interface with a natural, pink-free zirconia fixed dental prostheses.

Author(s): Maurice Salama, DMD;Prof. Dr. Alessandro Pozzi;Wendy AuClair-Clark, DDS, MS;Marko Tadros, DMD;Lars Hansson, CDT, FICOI;Pinhas Adar, MDT, CDT
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The Socket-Shield Technique: First Histological, Clinical, and Volumetrical Observations after Separation of the Buccal Tooth Segment – A Pilot Study

The Socket-Shield Technique: First Histological, Clinical, and Volumetrical Observations after Separation of the Buccal Tooth Segment – A Pilot Study
The “socket-shield technique” has shown its potential in preserving buccal tissues. However, front teeth often have to be extracted due to vertical fractures in buccolingual direction. It has not yet been investigated if the socket-shield technique can only be used with intact roots or also works with a modified shield design referring to vertical fracture lines. The aim of this study was to assess histologically, clinically, and volumetrically the effect of separating the remaining buccal root segment in two pieces before immediate implant placement.

Author(s): Markus B. Hürzeler, DMD, PhD;Daniel Bäumer, DDS; Otto Zuhr, DDS; Stephan Rebele, DDS; David Schneider, DDS, PhD; Peter Schupbach, PhD
View Article>>
Mucosal Coronally Positioned Flap for the Management of Excessive Gingival Display in the Presence of Hypermobility of the Upper Lip and Vertical Maxillary Excess: A Case Report

Mucosal Coronally Positioned Flap for the Management of Excessive Gingival Display in the Presence of Hypermobility of the Upper Lip and Vertical Maxillary Excess: A Case Report
Excessive gingival display is a frequent finding that can occur because of various intraoral or extraoral etiologies. This report describes the use of a mucosal coronally positioned flap for the management of a gummy smile associated with vertical maxillary excess and hypermobility of the upper lip. For patients desiring a less invasive alternative to orthognathic surgery, the mucosal coronally positioned flap is a viable alternative. We demonstrate short-term successful use of this technique for the management of excessive gingival display in the presence of slight vertical maxillary excess and hypermobility of the upper lip. Long-term follow-up studies are needed to determine stability of the results.

Author(s): Monish Bhola, DDS, MSD;Nomahn Humayun; Shilpa Kolhatkar; Jason Souiyas
View Article>>
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