Orthodontic micro implants play an integral role in providing anchorage for orthodontic tooth movement. The success of implant depends on the device, dentist, and patient. This article gives an overview of the possible complications and management of implants used in orthodontics.

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Background: During treatment planning for dental implant placement, there is a need for assessment of alveolar bone. Bone evaluation limited to the use of panoramic and or periapical radiographs may be insufficient, as it provides only two-dimensional information about the implant sites. Computed tomography (CT) provides three-dimensional information. The measurement of alveolar ridge dimensions can be accomplished using ridge-mapping technique. This technique involves penetrating the buccal and lingual mucosa down to the alveolar bone (following the administration of local anesthetic) with calipers and measures the bucco-lingual width of the underlying bone. Purpose: The aim of the study is to compare the techniques, i.e. ridge mapping, direct surgical exposure, and CT scan, which are used to measure the alveolar ridge bone width, and determine their accuracy in the clinical application. Materials and Methods: The study was conducted on 20 patients who reported to the Out-patient Department (OPD) of Prosthodontics and Crown and Bridge, PGIDS, Rohtak (Haryana) for replacement of edentulous span with dental implant. Width of alveolar ridge was studied by three techniques, i.e. CT scan procedure, ridge mapping, and direct surgical exposure at two points (3 mm from the crest of ridge and 6 mm from the crest of ridge), and then taking measurements of surgical exposure as the control group, the measurements obtained from the other two techniques were compared and then accuracy of these methods was assessed. The mean, standard deviation, standard error of mean, and degree of freedom were calculated and subjected to statistical analysis using Student's unpaired " t" test. Results: Results suggested that there is no significant difference in the measurements obtained by direct surgical exposure technique, ridge-mapping technique, and CT technique. Conclusion: Use of ridge-mapping technique along with panoramic and intraoral radiograph is adequate in cases where the pattern of resorption appears more regular and where mucosa is of more even thickness. It is suggested to use CT scan technique in situations where the alveolar ridges are resorbed, there is presence of maxillary anterior ridge concavities, vestibular depth is inadequate, and ridge mapping is not feasible.

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Gingival discrepancies are reported to be the most common complications surrounding implant replacements of single teeth. Recently, preservation of soft tissue and gingival aesthetics has been gaining immense importance due to the high aesthetic expectations of the patient. Maintenance of interproximal soft tissue and the need for aesthetics are being increasingly recognized as important criteria for the success of implants. Optimum aesthetics is achieved by the creation of a suitable gingival architecture using customized healing abutments. In addition, a customized impression post should be made for the accurate transfer of gingival cuff morphology to the cast. This case report explains a systematic approach in achieving optimum aesthetics in implant restorations.

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Implant prosthodontics is a vast and varied field. The most crucial stage in the replacement of a missing tooth using an implant supported prosthesis is the occlusal loading of the fixture. The longevity and the success of the restoration are primarily determined by the direction and amount forces in occlusion. The quality of bone, type of implant, type of prosthesis and patient factors all play important roles in the selection of an occlusal scheme. Each patient must be treated with an individualistic approach. The guidelines for the choice of restoration or type of occlusal scheme must be customized to allow for longevity of the restoration in harmony with the health of the surrounding dentoalveolar structures. This review article encapsulates the different factors to be considered while planning implant restorations and establishing occlusal and prosthetic schemes to protect and preserve the associated oral structures.

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Immediate implants are positioned in the course of surgical extraction of the tooth to be replaced. The percentage success of such procedures varies among authors from 92.7-98.0%. The main indication of immediate implantation is the replacement of teeth with pathologies not amenable to treatment. Its advantages with respect to delayed implantation include reduced postextraction alveolar bone resorption, a shortening of rehabilitation treatment time, and avoidance of a second surgical intervention. The inconveniences in turn comprise a general requirement for membrane-guided bone regeneration techniques, with the associated risk of exposure and infection, and the need for mucogingival grafts to seal the socket space and/or cover the membranes. The surgical requirements for immediate implantation include extraction with the least trauma possible, preservation of the extraction socket walls and thorough alveolar curettage to eliminate all pathological material. Primary stability is an essential requirement, and is achieved with an implant exceeding the alveolar apex by 3-5 mm, or by placing an implant of greater diameter than the remnant alveolus. Esthetic emergence in the anterior zone is achieved by 1-3 mm subcrest implantation. Regarding guided regeneration of alveolar bone, the literature lacks consensus on the use of membranes and type of filler material required. While primary wound closure is desirable, some authors do not consider it to be of great relevance.

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Gingival Perspective: The gingival perspective in restorative dentistry is important in harmonizing esthetics and biological function. In this regard, the gingival biotypes have been stated to be thick or thin. Patients with thin biotype are more prone to recession, inflammation, and compromised soft tissue response. The correct recognition of gingival biotypes is important for the treatment of planning process in restorative and implant dentistry. The purpose of the survey was to evaluate the prevalence of different biotypes in individuals with varying forms of maxillary central incisors. Materials and Methods: A total of 200 subjects visiting the outpatient department in the range of 18-50 years participated in the study. Three clinical parameters were recorded by one examiner. This included the crown width/length ratio of the two central incisors, papillary height and gingival thickness. The measurements were tabulated and evaluated. Results and Conclusion: The thicker biotype was observed to be more prevalent in male population with short, wider forms of maxillary central incisors while the females had thinner biotypes and narrow, long form of maxillary central incisors. Among the different age groups, young group had a thicker biotype (73) compared to older group (40). The mean papillary height was in the range of 4.3-4.7 mm with decreased height in the thicker biotypes.

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Restoration of teeth in the esthetic zone is a great challenge for dental practitioners. Preference to shortened overall treatment period and minimum number of surgical interventions in implant dentistry is desired by patients and clinicians. Immediate implant placement combined with simultaneously guided bone regeneration in post extraction sockets having bony defects has emerged as a predictable method resulting in high implant survival rates and good esthetic outcomes. This article describes a case of immediate implant placement and guided bone regeneration for treatment of severe buccal dehiscence in mandibular anterior region.

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Aims and Objectives: To evaluate the efficacy, clinical acceptability, and patient response to rehabilitation of single edentulous spaces with restorations over screw retained mini dental implants. Materials and Methods: This study consisted of seven patients (four female and three male). Single-stage, 2.4 mm diameter and 10 and 13 mm long, screw form with integrated abutment, self-tapping, threaded, acid-etched and sandblasted, pure titanium mini dental implants were placed in 10 single, narrow, edentulous spaces (<6 mm bucco-lingually) in the anterior region of the jaw (four in the maxilla and three in the mandible). Results: Post-operative evaluation of mini dental implant was done 12 months of implant loading. Following clinical and radiographic parameters were evaluated: Gingival status (Gingival index), probing depth (By William's periodontal probe), stability (periotest), patient compliance, prosthesis loosening and fracture, and marginal bone loss (using Intra-oral periapical radiograph, orthopantomograph) Conclusion: Single-tooth mini-implant restorations demonstrated a rate of success similar to those reported by previous studies for standard single-tooth implant restoration. Therefore, a mini-implant may represent a valid treatment alternative when space problems do not permit the use of standard wide-diameter implants. However, more long-term studies are needed to determine the long term success rate of this self-tapping mini implant design.

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Background: Controversy regarding tooth-implant connection in implant dentistry has emerged due to the differences in the mobility pattern of tooth and implant causing increased stress on the implant leading to implant failure. Purpose: The purpose of this review is to critically analyze the technical complications, the biological impact of tooth-implant connection and the treatment modalities that may be helpful in preventing intrusion. Materials and Methods: A detailed search was carried out in the dental literature available in English language from 1989 to 2012 which included review articles and case reports. The search was carried out in PubMed database, Google search engine, Medline and Science Direct as well as manual search of peer reviewed literature using relevant key words. Results: Literature search revealed studies involving complications and biomechanical interactions of tooth-implant connection and the survival rates of tooth-implant supported fixed prosthesis (TISP). Conclusion: Thus tooth-implant connection has its own advantages, disadvantages, risks and complications, but what justifies its application is the risk-benefit evaluation with a special attention on patient requirements. Thus many longitudinal studies are necessary before this method is declared as the treatment of choice.

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The success of osseointegrated supported prosthesis is dependent on the establishment of a soft-tissue barrier that is able to shelter the underlying osseous structures and the osseointegration surrounding the implant body. The esthetics of dental implant prosthesis depends on the health and stability of the peri-implant mucosa. The biological seal refers to the soft tissue seal around the dental implants that prevents the ingress of toxins. A thorough understanding of soft-tissue healing and maintenance of dental implants is of paramount importance for the success of an implant. This review article describes the components of the surrounding tissue and the healing process.

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Background: Dental implants that are 2.0 mm in diameter or smaller (mini-implant, small diameter implant) have been advocated as an acceptable alternative to conventional diameter implants (3.0-5.0 mm diameter) for definitive oral restoration. Studies indicate that under normal intra-oral loads, the pattern of force transmitted to supporting crestal bone increases in inverse proportion to the implant diameter. For conventional diameter implants, these stresses were not predicted to exceed physiologic limits. However, none of the available studies investigates implant diameters less than 3.0 mm. Extrapolation of the data suggests that further reduction of implant diameter would induce greater crestal bone stress, possibly beyond physiologic limits. Objectives: A finite element analysis (FEA) study was designed to ascertain if reduction of implant diameter to 1.8 m would, (1) increase cervical bone stress and (2) result in non-physiologic stress in the investing bone. Materials and Methods: A finite element model of a 1.8 mm Χ 12 mm titanium implant was produced through micro computed tomography scanner (Scanco, Switzerland, FEA elements = 144,194. FEA nodes = 162,784). Results: Crestal bone stresses increased as predicted and Von Mises stresses (an average of 300 MPa) exceed the trabecular and cortical bone yield stress of 100 MPa and 33 MPa respectively. Conclusion: The results indicate that, for implants of 1.8 mm diameter, normal occlusal forces can induce stresses that are destructive to investing bone.

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The stability of the connection between different implant parts is important for the overall success of the prosthesis. This is especially true for single-tooth restorations, where a strong interlock between the implant and abutment is necessary. A common problem associated with single-tooth implants has been the loosening of abutment or fracturing of retaining screws. Inadequate torquing force applied to the screw is the most important reason for screw loosening and fracture. Structural inadequacy can also lead to screw fracture. Screw fracture occurs more readily with a loose screw as it is more prone to excessive lateral loads. Screw loosening can be an inconvenience to the patient and the practitioner. It is a fact that screw loosening occurs in single-implant restorations regardless of the implant-abutment connection geometry even if proper antirotational features and torque are provided. The management of a patient who had reported with fracture of an abutment screw is presented in this article.

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Introduction of osseointegrated implants has changed the way partially and completely edentulous patients can be treated. Restorations supported by implants can be either cement retained or screw retained. Cement-retained prostheses have gained preference in many cases, making them the restoration of choice for the treatment of implant patients. One of the drawbacks of cement-retained restorations is the extrusion of excess cement into the peri-implant sulcus with subsequent complications. Both the detection and the subsequent removal of the excess cement are significantly complicated by the depth of the gingival sulcus and by the contours of the abutment and the implant crown. A simple chairside technique to minimize the overflow of cement at the time of cementation by the use of a custom-made abutment replica is described here.

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Teeth being one of the major components of stomatognathic system provide a pleasing smile in addition to its functional aspect of mastication. Loss of tooth/teeth results in loss of structural balance, inefficient oral function, poor esthetics and positional change of remaining natural teeth. In order to overcome the adverse effects of tooth loss, replacement of teeth is necessary. One of the major revolutions in prosthetic dentistry is the advent of implant-supported prosthesis that provides comfort as well as confidence to patient. The present study was carried out to evaluate the topographic changes around implants with the objectives of evaluating the peri-implant clinical parameters of marginal gingival level and radiographic parameters of marginal bone level immediately after implant placement and after loading the implant prosthesis. The topographical evaluation of gingival and marginal bone changes around the peri-implant area in the current study was within the acceptable normal range.

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Implants have gained tremendous popularity in modern dental practice and their placement in the edentulous region for the prosthetic reconstruction has become routine. Four essential steps in the use of dental implants are careful selection of the patient, correct choice of the implant, proper surgical technique and precise prosthetic replacement. The operator's knowledge and skills have a significant role in each of these steps and each step is as important as others. Neglect in any one can result in iatrogenically induced damage. This article describes some of the commonly occurring iatrogenically induced complications during implant surgery and provides some guidelines to prevent the same.

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Purpose of the Study: Our aim was to check the survival of 10 immediate loaded two-piece Tite fit titanium implants. The objectives of this study were to check the radiological crestal bone level at 0, 3, 6, and 12 months and to check the esthetic outcome at the time of definitive prosthesis placement and during follow-ups. Materials and Methods: Ten Patients with optimum bone volume to accommodate two piece Tite fit titanium implants were selected. Implants were loaded immediately. Radiographical follow up was done for 12 months at 0, 3, 6, 12 months interval. Results: At the end of 6 month of final prosthesis placement, all 10 implants were stable with no clinical mobility and no sign of infection. Crestal bone levels at the end of 12 month were either at first thread or above. Esthetic outcome both patients and operator point of view was satisfactory. Conclusion: Within the limitation of the study, the favorable implant survival rate and stable bone level together with good esthetic and soft tissue outcome suggest that the LifeCare two-piece Titefit implants with immediate loading protocol is a viable and predictable clinical concept.

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Background: The microbiota associated with healthy peri-implant tissues has been studied in many cases. However, gram-negative anaerobic rods may also be found in small numbers and in low proportions around the endosseous dental implants. Objective: The purpose of this study was to investigate colonization of the peri-implant sulcus around two different types of implants by periopathogenic microbiota in a healthy patient. Materials and Methods: A patient with a healthy periodontium was selected. One hydroxy-apatite coated one-stage (AQB) implant was implanted at the site of the missing upper Right maxillary 1 ^st molar; the two units two-stage (PLATON) were implanted at the sites of the missing 1 ^st and 2 ^nd molars in the Left maxillary region. Saliva samples were collected from the peri-implant sulcus using paper points every 3 months for 9 months after implantation and fixation of porcelain crowns. Real-Time Polymerase Reaction (RT-PCR-Invader method) was used to detect periodontal pathogens. Results: Salivary periodontal pathogens were checked prior to implantation and Tannerella forsythia (0.06%) was detected. No periodontal pathogens were observed at 3 months. T. forsythia (0.06%) was detected at 6 months around the AQB implant; it was not detected in the PLATON implant. At 9 months, periopathogens increased in number around both types of implants; there was a major difference in numbers of Fusobacterium nucleatum (10.81%), and T. forsythia (0.057%) around the submerged and non-submerged implant systems. Conclusions: Submerged implants with screw-retained superstructures are more vulnerable to pathogenic microflora colonization than non-submerged implants.

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Background: In open sinus lift procedures, dental implants can be inserted simultaneous with sinus lifting or delayed insertion of dental implants chosen. Delayed implant insertion needs waiting time between 6 months and 9 months, depending on biomaterial which is used. Today, with addition of growth factors to biomaterials like platelet-rich fibrin (PRF) or platelet-rich plasma (PRP), this time is reduced. Materials and Methods: In a retrospective study, the data were collected from dental implant department files. Patients with remaining bone below 5 mm in posterior maxilla were chosen. Group A: Patients with open sinus lift and simultaneous implant insertion. Group B: Patients with open sinus lift surgery and delayed implant insertion. The lengths of inserted dental implants were recorded. Results: Group A: Thirty-six dental fixture implants were inserted. The minimum length of fixtures was 10 mm and the maximum length was 12 mm. The mean length of inserted dental fixtures was 11.3 ± 0.52 mm. In group B: Thirty-eight dental fixture implants were inserted. Minimum length of fixtures was 9 mm and the maximum length was 12 mm. The mean length of inserted dental fixtures was 9.86 ± 0.34 mm. In both groups, the survival rate of implants in 6 month follow up after termination of prosthetic treatment was 100%. There were significant differences in fixture length that were used in two groups. In open sinus lift with simultaneous dental implant insertion, there were longer implants. The mean difference with delayed implant insertion after open sinus lift surgery was 1.44 ± 0.55 mm (P < 0.01).

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