The long-term success of an implant depends on the stability of bone support for the implant. Implantology has evolved from the conventional protocols suggested by Branemark to more challenging and predictable approach. The purpose of this article is to present a brief review of literature on the factors that influence the success and survival rates of dental implants and also to review the newer concepts in implantology. There is enough evidence in literature that diagnosis and treatment planning must have a proven scientific basis, if consistency of results is to be achieved. Treatment planning must begin through a visualization of the end result. By paying attention to details, systematically analyzing and recognizing inadequacies in each factor predictable implant success can be achieved,

Anchorage has been a worrisome factor since the origin of orthodontics. Many modalities have been suggested in the scientific literature like extraoral anchorage with head gears, Intraoral anchorage with Nance palatal arches and reinforcement of anchorage units with addition of second molars, etc. Yet, the specialty of orthodontics did not find a solution for this problem until the introduction of miniimplants. Orthodontic implants are different from the ones used for prosthetics as there is no osseointegration. Mini-implants provide absolute anchorage and have revolutionized the field of orthodontics. This article reviews the indication, contraindications and their clinical applications in orthodontics.

Introduction: The aim of this study was a retrospective clinical evaluation of the long-term prevalence of peri-implant diseases associated with a modern rough-surface dental implant system. Materials and methods: A total of 237 implants were inserted in 47 patients between 1994 and 2005. Peri-implant parameters (sulcus bleeding, pocket depth and bone loss) were evaluated at a mean of 9.1 years after insertion. Based on these parameters, cases were classified as healthy tissue, peri-implant mucositis and peri-implantitis. One-way analysis of variance was used to compare group parameters. Results: A total of 211 implants (89%) were healthy, 21 implants (9%) showed peri-implant mucositis and 5 (2%) showed peri-implantitis. Risk factors for peri-implant diseases were alcohol (p<0.001) and nicotine abuse (p<0.001) and irradiation (p<0.001). Conclusion: After a mean of 9.1 years, the TiOblast® dental implant showed a marginal rate of peri-implant disease. The calculated risk factors for development of peri-implant diseases are in accordance to previous studies.

Patients wearing conventional dentures often complain about the instability of the prosthesis, particularly the mandibular denture. Denture instability leads to feeling of insecurity, inefficient mastication, and overall dissatisfaction with the prosthesis. Implant-retained dentures have been developed and studied as a method for solving the problem of instability associated with conventional dentures. Ten edentulous patients of age group 60 to 70 years were selected to participate in within subject cross over clinical trial. Complete dentures were fabricated which were later converted to implant retained overdentures. Presurgical dentascan was done with the surgical stent. The bite force measurements taken with conventional dentures and the implant supported dentures after 4 and 16 weeks of prosthetic loading of the implants. Patient's opinions were assessed by means of questionnaires with precoded response categories. The results obtained in study showed that there was statistical increase in the maximum bite force of the conventional dentures from patients without dentures and for implant retained mandibular overdentures in comparison to conventional dentures. The percentage of patients satisfied with their conventional dentures in general was about 20%, and almost all patients were not satisfied with mandibular conventional denture. Compared to 45% patients satisfied with implant retained mandibular overdenture in general whereas almost all the patient's were satisfied with the retention and speech of their implant retained mandibular overdenture dentures.

Background: The most frequent odontogenic cyst is the radicular or periapical cyst. Enucleation is the treatment of choice for radicular cysts that do not interfere with anatomical landmarks. Though large mandibular cysts exhibit spontaneous bone regeneration, the rate of bone in-growth is not adequate for a near-term implant placement. The case presented evaluates bone regeneration of a calcium phosphosilicate putty (NovaBone Dental Putty, NovaBone Products, Alachua, Florida) (NB Putty) when used to restore a large cystic defect in conjunction with platelet rich fibrin (PRF). Materials and methods: The patient, a 55-year-old patient presented with dull pain and tooth mobility in the mandibular right premolar area. Clinical examination of the area revealed attachment loss of 13 mm and 10 mm on the buccal and 11 mm and 10 mm on the lingual side of the right canine and first premolar respectively (Fig. 1). Grade 3 mobility was also recorded for the affected teeth. Preoperative Cone Beam CT (CBCT) revealed a large radiolucency in the apical area of the involved tooth indicative of a periapical cyst. The teeth were extracted and the large defect was restored with NB putty and covered with a PRF membrane that was created from patients serum. The area was evaluated at 3, 5, and 7 months postoperatively. Results: The healing proceeded uneventfully and the ridge width and height remained stabled during the evaluation period. Seven months CBCT showed good bone regeneration in the defect area. The buccal plate was completely regenerated while the crestal plate was still remodeling. The ridge was adequate enough to place a 4.3 mm × 11 mm implant. Conclusion: NB Putty in combination with PRF membrane can be recommended to regenerate cystic defects. However larger, longer term controlled studies are further suggested.

Communication of the exact positioning of the gingival margin is critical to achieving anterior esthetics with implant fixed prosthetics. The time taken to shape and position the gingiva with a provisional restoration can be lost at the impression appointment. Upon removal of the provisional restoration, the gingival complex collapses lossing positioning and hampering the laboratory in fabrication of the final restoration. This article shall review a technique to replicate and communicate the soft tissue positioning and support to the laboratory using custom impression copings, allowing better esthetics with the restoration upon placement.

The use of bisphosphonates (BP) in the treatment of osteopenia and osteoporosis, other than in cancer patients, has been described now for several years. Medical and dental literature in the last decade described the emergence of a new disease, bisphosphonate related osteonecrosis of the jaw (BRONJ), after dental surgical intervention in patients on bisphosphonates. The pathogenesis and complete mechanisms of BRONJ are still unclear, and there is still no all-inclusive understanding of the stages of BRONJ. In this paper, we will describe the treatment of a Lebanese elderly female who had BRONJ after surgical dental treatment. This specific case did not follow the stages set by AAOMS in 2009, and calls for a better understanding of BRONJ and its mechanisms. Better patient education and documentation must be undertaken to decrease the risk of developing BRONJ due to dental procedure.

The placement of dental implants in the anterior maxilla is a challenge for clinicians because of patients’ exacting esthetic demands and difficult pre-existing anatomy. An atrophic alveolar ridge frequently causes functional, esthetic and prosthodontic problems. New approaches to implant therapy are available for patients with insufficient bone volume, like bone grafts, which may be autografts, xenografts, allografts or alloplasts. In maxillofacial reconstruction, the autogenous bone graft is still the “gold standard” for bone augmentation procedures. All ceramic crown emerging from a healthy peri-implant mucosa would fulfil the ultimate goal of a life-like restoration. This article describes a method for harvesting intramembranous monocortical bone from the symphysial region for horizontal alveolar ridge augmentation followed by implant placement in the anterior maxilla. This method provided enough bone volume for insertion of an implant in an optimal position with total bony coverage and esthetics.

Successful implant treatment includes osseointegration as well as prosthetically optimal positions of the implants for esthetics and function. Computer-assisted oral implant surgery offers several advantages over the traditional approach. The purpose of this report was to evaluate a complex case of a 28-year-old female patient who lost all her teeth as a result of a aggressive periodontal disease resulting in severe vertical and horizontal bone loss. The patient underwent a bilateral open sinus lift procedure and after 6 months dental implants were placed in both jaws with the help of computerized tomography (CT)-based software planning and computer-assisted manufacture of a laboratory-based acrylic surgical guide. A total of 13 dental implants were placed in both jaws using a flapless approach followed by immediate loading of the implants and implant-supported full arch fixed dentures. The CT-based software program and surgical stents contributed to the success of this case.

The timing of implant placement after extraction of a tooth requires various factors to be taken into consideration. The decision of when to place an implant should rest with the dentist and be decided on the basis of longetivity, desired clinical outcome and governing clinical situation. The debate between immediate, early or delayed implant placements continues as both procedures offer obvious advantages and disadvantages. This article attempts to put into perspective implant placement protocols post-tooth extraction so that, clinicians may have a risk assessment strategy. Type 1 and 2 implant placement protocols based on the classification agreed upon in the 3rd ITI consensus will be discussed with clinical cases to exemplify both in the anterior zone. In conclusion, the factors favoring immediate placement and those which warrant early delayed placement are itemized.