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Recent Surgery Articles
The Socket Shield Technique with Promixal Extensions for Single-Rooted Teeth

The Socket Shield Technique with Promixal Extensions for Single-Rooted Teeth
The conventional socket shield (SS) design extends from the mesiolabial to the distolabial line angle. C-shaped SS, L-shaped SS, and proximal SS designs have proximal extensions that help to maintain the hard and soft tissue in the interproximal areas. This is beneficial for implant sites adjacent to an existing implant or an edentulous space. The most common complication of the socket sheild technique (SST) is internal shield exposure. Due to anatomical features such as a scalloped ridge shape and an oval socket shape of some teeth, the risk of complications such as internal shield exposure, inadvertent SS displacement, and fracture of the SS during implant insertion is greater in proximal shield areas. The present article describes guidelines for case selection for proximal shield extensions, along with SS preparation and the selection of implant and prosthetic components.

Author(s): Snježana Pohl, MD, DMD;Maurice Salama, DMD;Udatta Kher, BDS, MDS
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Root Submergence Technique, A Case Series with Follow-Up up to Seven Years

Root Submergence Technique, A Case Series with Follow-Up up to Seven Years
In the era of aesthetic dentistry, the goal is not only to provide a function to our patients but also to preserve the hard and soft tissue anatomy, to have a pleasing prosthesis. Obtaining natural aesthetics is simpler in single implant cases, however, in multiple implant prosthesis achieving natural dentition becomes a challenge. The root submergence technique (RST) is one such procedure that provides maximum preservation of the surrounding alveolar bone and soft tissue. This case series discusses the effect of a root submergence technique on preserving the periodontal tissue at the pontic site of fixed dental prostheses in the maxillary arch. The results of this clinical case series indicate that a root submergence technique can be successfully applied in the pontic site development with fixed dental prostheses, especially in the maxillary anterior aesthetic zone.

Author(s): Lanka Mahesh, BDS, MBA
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Human Histologic Analysis of Implant Osseointegration in a Healed Site Grafted with Nondemineralized Autologous Tooth-Derived Graft Material

Human Histologic Analysis of Implant Osseointegration in a Healed Site Grafted with Nondemineralized Autologous Tooth-Derived Graft Material
Human autologous tooth-derived grafts (ATDGs) were recently introduced as a source of bone substitute biomaterial. Using dentin autografts in humans was first reported in 2003. In that first report, demineralized dentin matrix granules were used as a bone substitute biomaterial for sinus augmentation. Since then, a variety of TDGs have been introduced clinically, including block or particulate forms of tooth structures with various levels of mineralization, as shown in Fig 1. In the present article, “TDG” is used as an all-encompassing term to better capture the variability of tooth-derived grafts that can contain the total root structure, dentin only, dentin and cementum, or even enamel.

Author(s): Snježana Pohl, MD, DMD
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Recent Restorative Articles
Three-Dimensional (3D) Facially Driven Workflow for Anterior Ridge Defect Evaluation: A Treatment Concept

Three-Dimensional (3D) Facially Driven Workflow for Anterior Ridge Defect Evaluation: A Treatment Concept
The esthetic rehabilitation of anterior ridge defects and achieving patient satisfaction have become major clinical challenges for dentists and technicians. Poor diagnosis and treatment planning are frequently associated with multiple surgical procedures that fail to meet patient expectations. The loss of hard and soft tissues in anterior ridges results in an esthetically compromised zone that affects the rehabilitation prognosis. The presence of interdental papilla and papillary configuration play a decisive role in patient satisfaction.

Author(s): Maurice Salama, DMD;Christian Coachman, DDS, CDT
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When Esthetic Becomes Challenging

When Esthetic Becomes Challenging
This case report shows the successful change of a young lady smile, by following standard dental esthetic guide lines. With careful, detailed examination and diagnosis, we could reach our goal toward providing a high esthetic smile change.

Author(s): Ahmed M. Shamiyah - BDS, MSc, FIDc
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Treating Two Adjacent Missing Teeth in the Esthetic Zone - Part 1: The Pink Hybrid Restoration & the Unilateral Versus Bilateral Defect Concept

Treating Two Adjacent Missing Teeth in the Esthetic Zone - Part 1: The Pink Hybrid Restoration & the Unilateral Versus Bilateral Defect Concept
This article, the first of a planned three-part series, outlines a new surgical & prosthetic approach for treating cases involving two missing adjacent teeth in the esthetic zone. These type of cases, particularly when combined with a three-dimensional ridge deficiency, represent one of esthetic dentistry's most challenging dilemmas. A Clear understanding of the unilateral and bilateral defect concept is necessary to properly evaluate each particular case, understand surgical limitations, perform a better risk assessment, establish an esthetic prognosis, develop the best clinical-laboratory strategy, and adjust patients' expectations. While not recommended for every case, represents a useful, economical, and predictable alternative that decreases the umber and complexity of interventions.

Author(s): Christian Coachman, DDS, CDT;Maurice Salama, DMD;Eric Van Dooren, DDS; Eduardo Mahn, DDS, DMD, PhD
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Recent General Articles
Antimicrobial Effect of a Single Dose of Amoxicillin on the Oral Microbiota

Antimicrobial Effect of a Single Dose of Amoxicillin on the Oral Microbiota
Amoxicillin is commonly used in oral surgery for antimicrobial prophylaxis against surgical-site infection and bacteremia because of its effect on oral streptococci. The aim of this study was to determine whether amoxicillin reaches the break-point concentrations in saliva and has any effect on the salivary microbiota, colonizing bacteria on mucosal membranes and on the gingival crevice after a single dose of amoxicillin. A single dose given as prophylaxis to prevent a surgical-site infection results in a significant reducing effect on the oral streptococcal microflora in the gingival crevice and may have an impact on bacteria spreading into tissues and the bacteria of streptococci.

Author(s): Cecilia Larsson Wexell, DDS, PhD; Henrik Ryberg, PhD; Wivi-Anne Sjöberg Andersson, DDS; Susanne Blomqvist, BSc; Pieter Colin, PhD; Jan Van Bocxlaer, PhD; Gunnar Dahlén, DDS PhD
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Effectiveness of a Super-Pulsed CO2 Laser For Removal of Biofilm From Three Different Types of Implant Surfaces: An In Vitro Study

Effectiveness of a Super-Pulsed CO2 Laser For Removal of Biofilm From Three Different Types of Implant Surfaces: An In Vitro Study
As dental implants become a routine part of dental practice, so too will the prevalence of peri-implant diseases. Inherent to the treatment of peri-implant disease is the removal of microbial biofilms from the implant surface. Currently, there is no standardized protocol for application of any treatment modality directed at implant surface decontamination. In this in vitro study, we report on the effectiveness of a super-pulsed CO2 laser, delivering an average fluence of 6.3 to 113 J/cm2, to remove biofilm from three different types of implant surface topographies. Biofilms ranged in thickness from 5 to 15 μm. An average fluence of 19 J/cm2 was sufficient to achieve 100% ablation of the biofilm on hydrophilic sandblasted and acidetched surface specimens (SA). However, to achieve 100% ablation of biofilm on HA and highly crystalline, phosphate enriched titanium oxide (PTO) surfaced implants required an average fluence of 38 J/cm2.

Author(s): Peter Vitruk, PhD;Charles M. Cobb, DDS, MS, PhD
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Oral Soft Tissue Laser Ablative and Coagulative Efficiencies Spectra

Oral Soft Tissue Laser Ablative and Coagulative Efficiencies Spectra
The key to the success of soft tissue lasers is their ability to cut and coagulate the soft tissue at the same time. Present work is aimed to derive the wavelength-dependent differences in photo-thermal ablation and coagulation efficiencies for oral soft tissue pulsed dental Near-IR Diode, Mid-IR Erbium and IR CO2 lasers. Even though the soft tissue photothermal ablation has been extensively studied, there remains a discrepancy between (a) the widely proliferated notion about efficient Near-IR 800-1,100 nm laser ablation of the oral soft tissue, and (b) studies reporting the inefficient soft tissue Near-IR absorption/ablation. Indeed, the notions about “the key to the usefulness of the Nd:YAG is that this wavelength is highly absorbed in oral soft tissue”, and “all currently available dental laser instruments and their emission wavelengths have indications for use for incising, excising... oral soft tissue surgery”, contradict an observation illustrated here...

Author(s): Peter Vitruk, PhD
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Recent Orthodontics Articles
Decision Making for Soft and Hard Tissue Augmentation in Surgically Facilitated Orthodontics

Decision Making for Soft and Hard Tissue Augmentation in Surgically Facilitated Orthodontics
The purpose of this article is to present a decision-making algorithm for soft and hard tissue augmentation in surgically facilitated orthodontics (SFOT). In cases where there is adequate hard and soft tissue envelope, selective corticotomies may be adequate. In cases, where the existing hard and soft tissue anatomy is inadequate, hard and soft tissue augmentation is recommended. Also, hard and soft tissue augmentation is recommended to avoid teeth extractions during orthodontics.

Author(s): Thanos Ntounis, DDS, MS;Lillie M. Pitman
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Manejo Integral de Maloclusion Clase III en Adulto, con Requerimientos Periodontales y Protesicos; Reporte de un caso clinico

Manejo Integral de Maloclusion Clase III en Adulto, con Requerimientos Periodontales y Protesicos; Reporte de un caso clinico
En nuestra clinica observamos un aumento de pacientes adultos con problemas esqueletales, compromiso periodontal y necesidades protesicas. Debemos recurrir a la interconsulta con el periodoncista, protesista y cirujano maxilofacial, para la correccion del caso, prestando especial atencion al componente dentario, esqueletal y los tejidos blandos faciales del paciente. La cirugia ortognatica, que generalmente la realizamos luego de una preparacion ortodoncica, permite corregir discrepancias en el adulto y restaurar la funcion y estetica en los tres planos del espacio. Realizada la correccion oclusal, procedemos a sustituir dientes ausentes, mediante implantes y protesis fijas. El Periodoncista, mantiene un control constante de la salud de los tejidos de soporte, durante todas las fases de la terapia multidisciplinaria.

Author(s): Miguel Hirschhaut, DDS;Jorge Ravelo, DDS
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Sequencing of Periodontal Procedures and Orthodontic Treatment

Sequencing of Periodontal Procedures and Orthodontic Treatment
Severe cases of periodontal disease often require periodontal surgery and realignment of teeth. Surgical techniques have been developed that attempt to minimize post-surgical gingival recession and compromise the interdental papillae. A case report is presented in which reversal and correction of a deteriorating maxillary frontal dentition were effectively achieved through combined use of periodontal and orthodontic principles. The treatment plan included the control of periodontal inflammation, restoration of lost attachment apparatus, realignment of anterior dentition, stabilization of occlusion, and minor periodontal plastic surgery. The anticipated loss of a maxillary lateral incisor was avoided. Restoration of a pleasant smile with nicely aligned teeth and esthetic gingival contours was achieved. The correct sequencing of the procedures involved was considered a key factor for the long-term esthetic outcome.

Author(s): Cobi J Landsberg, DMD;Ofer Sarne, DMD
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