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Periodontitis results in loss of periodontal attachment. This case report focuses on diagnosing a special case of periodontitis that required extreme care and maintenance. The peculiarities of this case are that based on 1999 American Academy of Periodontology classification this is a case of generalized aggressive periodontitis, but as per the recent 2017 classification, this is a case of periodontitis - generalized, Stage IV, Grade B, progressive and with no risk factors. Although this case is ideal for surgical management using regenerative techniques, it has been limited to mechanical therapy and laser due to patient-related economical factors. Within the limitations, this case has been successfully managed by dental laser and strategic implants. Despite all the limitations, 1-year follow-up shows periodontal stability and bone regeneration as evidenced through series of panoramic radiographs (OPG).

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PURPOSE: To retrospectively analyze the success of implant-assisted removable partial dentures (IARPDs) according to three types of strategic positions in distal extension areas of Kennedy Class I and II arches. MATERIALS AND METHODS: The data included 102 arches in 95 patients with Kennedy Class I/II arches treated with IARPDs with implants in three strategic positions: Type 1a, assisted by P-1a implants on the anterior area adjacent to the abutment tooth; Type 1b, assisted by P-1b implants on the anterior area apart from the abutment tooth with or without P-1a; Type 2, assisted by P-2a implants on the posterior area adjacent to the natural tooth or P-2b implants on the posterior area apart from the abutment tooth to modify from Kennedy Class I /II to Class III. The success was defined as the IARPDs without abutment tooth-related, denture-related, and implant-related complications. Kaplan-Meier curves and the multivariable Cox regression model were used to analyze the success of IARPDs and implants. RESULTS: The overall success rate of IARPD treatment was 66.7%; 77.8% in Type 1a, 60.0% in Type 1b, and 68.0% in Type 2. There was no significant effect of treatment type on success rate of IARPDs. However, there was significant differences at the level of implant supporting IARPDs: 83.3% in Type 1a implants, 62.6% in Type 1b implants, and 73.2% in Type 2 implants. The implants of IARPD's adjacent to the natural tooth abutments (P-1a and P-2a) had higher success rates than those away from the natural tooth abutments. CONCLUSIONS: Within the limitations of this study, there was no significant difference in the prosthodontic complications of IARPDs depending on the treatment type. However, the success of implants of IARPD is associated with the strategic position. Strategic implant abutments adjacent to the natural tooth had higher success rates than those away from the natural teeth abutments.

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Inserting a dental implant in a strategic position under a removable partial denture (RPD) can upgrade the RPD design by changing a mainly tissue-supported RPD to an implant-tissue-supported RPD or an implant-tooth-tissue-supported RPD with better retention, support, and stability. CASE PRESENTATION: The patient (female, 77-year-old) was unsatisfied with her maxillary and mandibular clasp-retained removable dentures (RDs). Medical, social, and systemic health evaluations revealed that the patient was healthy. Dental history, intraoral and extraoral examinations, functional screening, and esthetic analyses revealed that the patient had a reduced vertical dimension, resulting in pseudo-class III malocclusion and angular cheilitis. Strategic implants were used to improve the retention, support, and stability of the new RDs. The maxillary canine 23 (World Dental Federation notation) and maxillary premolar 24 were used to retain the maxillary conical crown attachments. Three strategic mini-implants were inserted in the positions of teeth 12, 13, and 14 to support and retain the maxillary RPD. Two locators above the standard implants (33 and 43) were used to support and retain the mandibular overdenture. An improvement in the oral health-related quality of life and patient satisfaction with respect to the maxillary and mandibular RDs was observed immediately after using the new RDs. This improvement did not diminish after a year. CONCLUSION: Herein, using strategic implants to support the maxillary RPD and two standard implants under the mandibular overdenture improved the oral health-related quality of life and patient satisfaction with respect to the maxillary and mandibular prostheses in terms of the retention, stability, support, eating ability, speaking ability, appearance, and cleanability.

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OBJECTIVES: The present pilot study analyzed two abutment types (a retentive ball and a non-retentive dome) in implant-assisted removable partial dentures (IARPDs) on 6 mm short implants with respect to clinical, radiological, and patient-reported outcomes (PROs), during the first year. MATERIALS AND METHODS: Two implants were placed bilaterally in mandibular molar sites, converting existing free-end removable partial dentures (RPDs) to IARPDs. Twelve subjects were randomized to initially receive either the dome (Group A, n = 6) or the ball abutment (Group B, n = 6). After eight weeks, the abutments were exchanged. After another 8 weeks, the participants were given the choice of one of the abutments. Mean values and standard deviations (SD) were calculated, and random-effect linear regression analyses were applied to analyze marginal bone level alterations and PROs (α < .05). RESULTS: Twelve participants were included in the study; however, one dropout occurred. Patient ratings increased significantly in both study groups. The majority of the participants (82%) ultimately chose the ball abutment. The implant survival rate was 100%, and the success rate was 90.9% twelve months after implant placement (mean peri-implant bone-loss: -1.2; SD: 0.6 mm) without a statistically significant difference between the study groups, in terms of clinical- and radiological outcomes. CONCLUSION: Placing 6 mm short implants at mandibular molar sites of RPD wearers seems to be a viable treatment option, based on this investigation with a short-term follow-up. Although only minor differences between the two abutments were observed, patients seem to prefer the ball over the dome abutment.

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The technology of the Strategic Implant® has expanded the indications for tooth and bone removal. This case report shows what kind of results are possible and how much the appearance of a patient can be changed within a few days if both teeth and bone are removed. The treatment option explained here could be considered by patients with a gummy smile. This treatment conflicts with the traditional thinking of dentists, who are educated to keep and maintain teeth. This can be compared to other fields of esthetic surgery where the patient's right to self-determination in medical decision-making has been established for a considerable period of time and is more frequent than in dentistry.

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INTRODUCTION: Rehabilitation with dental implants of total or partial edentulousness in the maxilla encounters a number of difficulties due to the anatomical distinctions and the topography of this region. The maxilla is rigidly attached to the other skull bones, and therefore, its structure is functionally adapted to transmit loads through three main buttresses. Outside these supporting zones, the bone structure is poorly mineralized, or its volume is limited to the thin bone layer. In strategic implantology, a number of defined clinically-proven surgical methods have been proposed to utilize these maxillary load transmitting buttresses. This study was aimed to evaluate its safety with respect to maxillary sinus complications as a result of anchoring Strategic Implants® in the cortical boundaries of the sinus and/or passing through it, to reach the pterygoid plate of the sphenoidal bone. MATERIALS AND METHODS: This prospective cohort study was carried on 217 cortico-basal implants penetrating through the cortical walls of the maxillary sinus (Simpladent GmbH, Gommiswald, Switzerland), placed between September 2013 and December 2014 in a total of 70 patients (131 maxillary sinuses). Two hundred and four implants were anchored in the cortical bone of the sinus protruding into the sinus up to 3 mm, and 13 were placed trans-sinuously. RESULTS: None of the implants failed during the observation period, with only one instance of adverse reaction in the maxillary sinus to the polished corticobasal implants. DISCUSSION: Anchoring polished corticobasal implants in the wall of the maxillary sinus as well as in the pterygoid plate of the sphenoid bone is a safe and effective procedure that per se (if executed properly) does not cause any adverse reaction of the maxillary sinus.

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Dental implant treatment and immediate loading protocol in the front maxillae provides severe esthetical difficulties, for example in cases where the transition zone of the patients' teeth and the gums is visible during habitual movements of the upper lip or when the patient presents excessive gingival display. In this case report, it is shown in detail how to overcome the esthetic problems in a straightforward manner in such clinical situations. The article also discusses in which financial environments treatments on teeth are endlessly continued and under which conditions patients manage to get (and prefer) an early switch to implant borne teeth.

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BACKGROUND: Immediate functional loading of one-piece dental implants has become an accepted treatment modality for fixed restorations in fully edentulous mandibles and maxillae. Nevertheless, studies regarding immediate loading procedures in extraction sites in both the jaws, as well as in segment reconstructions and single-tooth replacements, are limited. PURPOSE: The purpose of this study was to evaluate the presently used protocol for immediate functional loading (within maximum 3 days) of one-piece implants which are placed according to the following methods as published by the IF. MATERIALS AND METHODS: This prospective cohort study included totally 87 consecutively treated patients who receive 1169 immediately loaded one-piece Strategic Implant®, supporting fixed complete-arch maxillary or mandibular metal-ceramic bridges or segment reconstructions in both the jaws. All implants were placed by one treatment provider, who delivered also the prosthetics and controlled all cases himself over the years. Data were extracted by an experienced dentist from the patient records and from panoramic X-rays. A number of patients were interviewed at the end of the observation period. Although a total of 5100 implants were placed and observed for 12 - 57 months totally (with 105 implants out of these, having failed), this article reports the detailed results only for 1169 implants which have been followed for at least 48 months. RESULTS: Immediate functional loading of using multiple, cortically anchored basal screw implants as a support for fixed full-arch and segment prosthesis in the upper and lower jaw demonstrated a high cumulative implant survival rate after an observation period of up to 57 months. Neither hypertension nor diabetes and neither smoking nor bending of the implant's neck had an influence on the success of the implants observed in this study. Within the limits of this study (5100 Strategic Implants were observed over a period of up to 57 months), "peri-implantitis" was not observed at all. CONCLUSION: The treatment concept developed for the technology of the Strategic Implant® is safe and effective and it avoids bone augmentations and "peri-implantitis".

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This consensus document describes treatment modalities with corticobasal implants in the field of oral and maxillofacial implantology.

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While materials for the restoration of teeth and new (digital) technologies develop fast, the choices of the treatment provider and the patients get wider. Choosing an adequate and long-lasting treatment is a question of "doing the right thing," and only after that, the dentist has to think about the question how to do the work properly. This case report explains and illustrates a case, where an adequate treatment by means of conventional dentistry would not have been possible on one hand, and where treatment with the technology of the Strategic Implant® provided a perfect result within only a few days. Thanks to this technology, patients can be treated with fixed prostheses regardless of the amount of residual bone. Recently, published long-term observations on large amounts of implants have shown that the results are sustainable.

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The technology of the Strategic Implant® facilitates dental implant treatment almost regardless of the available bone. This explains its increasing use to resolve problems with the dentition of the middle-aged patient in a radical manner, simply by extracting the residual dentition and placing implants. While a radical change in the implant treatment paradigm has taken place in some countries, in other countries, dentists try hard to keep their work area free of implants or to deliver them only as a last resort. Liberating patients from the burdens of their own teeth are not advocated by dental universities, as their main field of teaching deals with the repair of teeth and conventional ways of replacing them. This case report shows a standard treatment with Strategic Implants®, discussing the topic from the point of view of practitioners, universities, and other parties involved in decision-making. The authors conclude that the interests of the patients are not respected in many cases because the parties involved have vested interests in other treatment modalities.

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The aim of this article was to present the treatment method applied to a patient who suffered from a multiple fracture of the right maxilla, as a result of an accident that happened to him at an early age. The main consequence of this injury was an inhibited growth of the maxillary bone segment due to the lack of functional stimulus. The treatment consisted of four phases: the removal of all the teeth in the upper right maxilla, the immediate restoration with bicortical implants, the immediate prosthetic rehabilitation, and closing the oroantral communication.

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BACKGROUND: Acceptable short-term survival rates (>90 %) of mini-implants (diameter < 3.0 mm) are only documented for mandibular overdentures. Sound data for mini-implants as strategic abutments for a better retention of partial removable dental prosthesis (PRDP) are not available. METHODS/DESIGN: The purpose of this study is to test the hypothesis that immediately loaded mini-implants show more bone loss and less success than strategic mini-implants with delayed loading. In this four-center (one university hospital, three dental practices in Germany), parallel-group, controlled clinical trial, which is cluster randomized on patient level, a total of 80 partially edentulous patients with unfavourable number and distribution of remaining abutment teeth in at least one jaw will receive supplementary min-implants to stabilize their PRDP. The mini-implant are either immediately loaded after implant placement (test group) or delayed after four months (control group). Follow-up of the patients will be performed for 36 months. The primary outcome is the radiographic bone level changes at implants. The secondary outcome is the implant success as a composite variable. Tertiary outcomes include clinical, subjective (quality of life, satisfaction, chewing ability) and dental or technical complications. DISCUSSION: Strategic implants under an existing PRDP are only documented for standard-diameter implants. Mini-implants could be a minimal invasive and low cost solution for this treatment modality. TRIAL REGISTRATION: The trial is registered at Deutsches Register Klinischer Studien (German register of clinical trials) under DRKS-ID: DRKS00007589 ( www.germanctr.de ) on January 13(th), 2015.

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Partial edentulism has multiple implications in relation to function, esthetics and future rehabilitative treatment. This case report illustrates the management of a patient with extreme consequences of partial edentulism. The main clinical findings were unopposed remaining teeth, overeruption of the remaining teeth, loss of vertical dimension of occlusion, and significant disfigurement of the occlusal plane. Following the diagnostic procedure, a well-coordinated prosthodontic treatment involving liaison with other dental disciplines was indicated. The management involved an innovative combination of fixed and removable prostheses in conjunction with crown lengthening surgery and strategic implant placement. Series of provisional prostheses were applied to facilitate the transition to the final treatment.

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Partial edentulism has multiple implications in relation to function, esthetics and future rehabilitative treatment. This case report illustrates the management of a patient with extreme consequences of partial edentulism. The main clinical findings were unopposed remaining teeth, overeruption of the remaining teeth, loss of vertical dimension of occlusion, and significant disfigurement of the occlusal plane. Following the diagnostic procedure, a well-coordinated prosthodontic treatment involving liaison with other dental disciplines was indicated. The management involved an innovative combination of fixed and removable prostheses in conjunction with crown lengthening surgery and strategic implant placement. Series of provisional prostheses were applied to facilitate the transition to the final treatment.

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