Through a special affiliation arrangement with the institute, second year postgraduate periodontology students at Maurice H. Kornberg School of Dentistry at Temple University attend and participate on a tuition-free basis in six three-day advanced surgical oral implantology courses given at the Misch Institute. In tandem, Misch had been appointed as Clinical Professor and Director of Oral Implantology in the Department of Periodontology at the dental school.[5] Jon Suzuki, past director of the periodontal program at Temple Dental School, and Thomas Rams, chairman of the same program, are both on surgical faculty at the institute.[6]
Ridge (socket) preservation. (a) Root tip was left on tooth #8. (b) Periotome (Hu-Friedy, Chicago, Ill) was used to loosen (via periodontal ligament space) the remaining root in the socket. (c) The tooth was atraumatically extracted, preserving the labial bony plate. (d) Socket occlusal view showed signs of angiogenesis. (e) Demineralized freeze-dried human bone allograft (Puros, Centerpulse, Carlsbad, Calif) was placed on the bottom two thirds of the socket. (f) Colla-plug (Centerpulse, Carlsbad, Calif) was cut and placed on the top one third of the socket. (g) Socket was compressed with all the materials underneath. (h) Cross mattress suture with 4-0 Vicryl suture (Ethicon, Inc, Somerville, NJ). (i) Two weeks postoperative showed uneventful healing
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This technique involves 1) atraumatic tooth extraction without a periodontal flap followed by socket curettage, 2) socket grafting with demineralized freeze-dried bone allograft (DFDBA), and 3) placement of a free gingival palatal graft over the extraction socket. The dimensions of the socket are measured after tooth extraction using a periodontal probe and transferred to a harvest site in the palatal tissue at least 3 mm apical to the free gingival margin of the premolars or molars. An additional 1 mm is added to the diameter of the free gingival graft to increase keratinized tissue at the extraction site and expand the existing tissues to minimize shrinkage during the healing phase. The graft is harvested and the thickness adjusted to match the thickness of the existing tissues at the extraction site. The graft is immobilized with interrupted sutures and left to heal for 6 months before implant surgery. This technique results in preservation of existing papillary, crestal, and buccal bony support while maintaining ideal tissue contours during healing.87
Bone augmentation to enhance soft tissue profile. (a) Tooth #9 has root fracture. (b) Occlusal view of the healing socket. (c) Initial incision. Two vertical, diverging, releasing incisions were done. (d) Full thickness periosteal reflection indicated inadequate bone width for proper implant placement. (e) Implant drill sequence (2 mm twist drill). (f) Implant (3.75 13 mm) placement (Nobel BioCare, Yorba Linda, Calif). (g) Decortication was performed using one-half round bur on the side of the implant to promote regional acceleratory phenomenon (RAP). (h) Demineralized freeze-dried bone allograft was placed. (i) Collagen membrane (BioMend Regular, Centerpulse, Carlsbad, Calif) was placed to cover the bone graft area and extended to the lingual. (j) Sutured with passive tension. A modified vertical mattress suture was placed on the center of defect to ensure proper wound coverage. (k) Two weeks postoperatively showed uneventful healing. (l) Four months healing after ovate pontic site development by temporary crown. (m) New bone formation was noted on the buccal side. (n) Healing abutment was placed. (o) Sutured around healing to allow soft tissue maturation. (p) Two weeks after healing. (q) Final radiography. (r) Final restoration
This technique is used to augment a future implant site through allowing the body to manufacture gingival tissue around a tooth scheduled for extraction; it has been reported to reduce the need for additional grafting procedures at implant placement.94,95 This technique involves reduction of the condemned tooth below the level of the free gingival margin followed by 2 to 3 weeks of soft tissue healing. The gingival tissues proliferate, covering the remaining tooth root with keratinized gingiva, after which a flap can be elevated, the remaining root extracted, and an implant immediately placed. Some distinct advantages of this technique include complete primary coverage of the implant at stage 1 surgery, reduced treatment time, and cost to the patient, when compared with other socket preservation techniques. Drawbacks include the possibility of damaging the crestal bone during extraction and the presence of fenestration or dehiscence defects, which would necessitate further grafting procedures.
This technique was developed to correct deficient interproximal papillae contours between multiple implants at stage 2 surgery and is primarily an esthetically driven procedure. The procedure involves elevating a full thickness mucoperiosteal flap at the palatal or lingual extent of the implant cover screws. Vertical releasing incisions are used to aid in flap elevation, and the incisions are made so as to exclude the papillary tissue of adjacent natural teeth. Semilunar, beveled incisions are then created in the buccal flap extending toward each abutment, beginning with the distal aspect of the most mesially located implant. The pedicles are secured between the abutments using tension-free suturing and are allowed to heal for 4 to 6 weeks before final restoration.
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There are two main advantages to orthodontic space closure to treat the missing anterior tooth situation:25,26 (1) minimal additional procedures (recontouring the natural tooth) were required after orthodontics, (2) the overall treatment fee was less. The disadvantages of the lateral or canine space closed with orthodontics include: (1) loss of the canine tooth in the canine position resulting in mandibular excersions guided on the first maxillary premolar; (2) the canine eminence was not formed, causing a depressed labial lip position lateral to the nose; (3) It was difficult to the contour cuspid facio-palatally and mesiodistally to appear as a lateral incisor;27 (4) the free gingival margin of the canine was higher than the contralateral lateral incisor; (5) patient compliance was necessary during orthodontic procedures, (6) the midline was usually shifted to the missing tooth side. Anchorage to advance the canine and all posterior teeth forward was often insufficient. 2ff7e9595c
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