A decision-making tree for evaluating an esthetically compromised single dental implant

Threshold for Implant Removal in Peri-implantitis Defects. Is There Any?

This article aims to comprehensively address and discuss the thresholds for implant removal in cases of severe peri-implantitis. Electronic databases were searched comprehensively, electronically, and manually. Studies focusing on criteria for explantation of dental implants were included and reviewed comprehensively. Based on the latest evidence, explanation thresholds were proposed. Moreover, the included studies were evaluated and summarized. Current guidelines for implant removal are primarily based on expert opinions rather than actual data. Standardized data encompassing the extent of peri-implant bone loss for assessing treatment outcomes after surgical intervention for peri-implantitis is scarce. Nevertheless, newly available data confirms a poor prognosis for implants with more than 50% bone loss. This supports the recommendation for implant removal in cases of more than 50% bone loss due to peri-implantitis. Implant mobility resulting from the total loss of osseointegration necessitates the removal of the implant. While probing depth provides information about disease severity, it should not be used as the sole diagnostic tool. In the decision-making process for treatment or explantation, factors such as the number of affected implants, the implant's position within the bony housing, intraosseous defect morphology, type of implant restoration, and patient characteristics should be considered. The removal of severely compromised dental implants with peri-implantitis and bone loss exceeding 50% is supported. Moreover, factors related to the restoration, the implant itself, and the patient must be considered when deciding whether to remove or salvage a compromised implant. Clear clinical guidelines for explanting dental implants in cases of severe peri-implantitis need to be included. This poses significant challenges to clinicians when determining whether to explant or treat dental implants compromised by substantial bone loss.

Prediction of pink esthetic score using deep learning: A proof of concept

OBJECTIVES

This study aimed to develop a deep learning (DL) model for the predictive esthetic evaluation of single-implant treatments in the esthetic zone.

METHODS

A total of 226 samples, each comprising three intraoral photographs and 12 clinical features, were collected for proof of concept. Labels were determined by a prosthodontic specialist using the pink esthetic score (PES). A DL model was developed to predict PES based on input images and clinical data. The performance was assessed and compared with that of two other models.

RESULTS

The DL model achieved an average mean absolute error (MAE) of 1.3597, average root mean squared error (MSE) of 1.8324, a Pearson correlation of 0.6326, and accuracies of 65.93 % and 85.84 % for differences between predicted and ground truth values no larger than 1 and 2, respectively. An ablation study demonstrated that incorporating all input features yielded the best performance, with the proposed model outperforming comparison models.

CONCLUSIONS

DL demonstrates potential for providing acceptable preoperative PES predictions for single implant-supported prostheses in the esthetic zone. Ongoing efforts to collect additional samples and clinical features aim to further enhance the model's performance.

CLINICAL SIGNIFICANCE

The DL model supports dentists in predicting esthetic outcomes and making informed treatment decisions before implant placement. It offers a valuable reference for inexperienced and general dentists to identify esthetic risk factors, thereby improving implant treatment outcomes.

An esthetic solution for restoring a labially inclined implant by using an additively manufactured plug-assisted retained zirconia veneer: A dental technique

The facial opening of the screw access channel can lead to esthetic compromises in screw-retained restorations, while the use of cement-retained complete crowns may result in residual cement in the proximal areas, and traditional veneers without proximal coverage often lack adequate retention. To address these issues, a plug-assisted retained veneer was developed. First, the 3-dimensional position of an implant was obtained, and a custom abutment was designed to mimic the contour of a veneer preparation. Subsequently, the abutment was fabricated and positioned on the printed cast. After the acquisition of the scan data, a veneer with a plug was designed and produced. A reference scan was then obtained. Finally, the veneer with the plug was delivered, where a digital protocol was used to verify a good fit. This plug functions as a macro retention form while simultaneously seals the screw access opening, enhancing retention and the esthetic outcomes without compromising the fit.

Soft Tissue Management in Implant Dentistry: A Comprehensive Review

The success of dental implant therapy relies on achieving optimal osseointegration while maintaining the esthetics and function of the surrounding soft tissues. Soft tissue management plays a crucial role in ensuring long-term implant stability, preventing complications, and enhancing esthetic outcomes. The peri-implant mucosa differs structurally and functionally from the gingiva surrounding natural teeth, necessitating specific augmentation strategies to compensate for tissue deficiencies. Factors such as biotype, mucogingival conditions, wound healing dynamics, ridge deficiencies, general patient health, genetics, and oral habits such as smoking influence treatment outcomes. Various soft tissue augmentation techniques, including pedicle grafts, free connective tissue grafts, pouch grafts, and onlay grafts, have been employed to enhance peri-implant soft tissue volume and contour. These procedures improve keratinized mucosa width, reduce mid-buccal recession, and contribute to superior pink esthetic scores. While immediate and delayed soft tissue augmentation protocols exist, the optimal timing remains debated. Clinical evidence suggests that augmenting soft tissue in conjunction with implant placement improves long-term esthetic outcomes and minimizes peri-implant bone loss. The present review highlights the significance of soft tissue augmentation in implant dentistry, emphasizing its role in improving peri-implant health, function, and patient satisfaction in esthetically demanding cases.

Timing implant provisionalization: Decision-making and systematic workflow

OBJECTIVE

Provisionalization is an important step to achieve esthetic results in implant cases, and many different techniques for provisional restoration fabrication have been described. However, depending on the clinical scenario, the provisionalization strategy will require different approaches and timing. The clinician should modify the provisional restorations efficiently to reduce the number of disconnections from the implant, as repeated disconnections may have biological consequences. This article aims to schematize different scenarios requiring implant provisionalization and propose strategies to help the clinician condition the peri-implant tissues, respecting perio-prosthodontic fundamentals for soft tissue, biological, and esthetic stability.

CLINICAL CONSIDERATIONS

The clinical outcomes of modern implant therapy aim to achieve results that emulate natural dentition. Different scenarios may require adjunct therapy, including hard- and soft-tissue grafting, which complicates treatment. The provisionalization strategy will vary depending on the initial condition of the tissues, the need for reconstructive procedures, and the timing of implant placement. Selecting the right strategy based on the case type is necessary to reduce treatment time and complications associated with inadequate prosthetic handling of the soft tissues.

CLINICAL SIGNIFICANCE

Proper emergence profile conditioning through provisional restorations will allow for biologically sound and esthetically pleasing outcomes in implant restorations.