Implant and Regenerative Therapy in Dentistry: A Guide to Decision Making

Abstract

FigureImplant and Regenerative Therapy in Dentistry: A Guide to Decision Making. Paul A. Fugazzotto. 405 pp., illustrated, Wiley-Blackwell; 2009. ISBN 978-0-8138-2962-3. Chapter 1 begins with a review of the periodontal literature with regard to the long-term predictability and results of periodontal therapy. This important information provides the implant clinician with a scientific basis for either removing a tooth and replacing it with an implant or maintaining the tooth with more conventional peridontal therapy. It also reviews systemic and local factors as well as the cost of treatments, and how they should enter into the treatment planning equation. Chapter 2 is dedicated to guided-bone regeneration. With the aid of diagrams and photographs, the important steps of flap design and primary closure are very well explained. The topics of membrane selection and bone graft selection are discussed briefly without favoring any particular brand or product. The multiple clinical cases presented complete the chapter and demonstrate a range of clinical situations. Chapters 4 and 5 review patient evaluation and treatment planning, with chapter 5 dedicated solely to the esthetic region. They provide a cursory lecture on local soft and hard tissue evaluation and considerations. Augmentation of the posterior maxilla is very well covered in chapter 6. This chapter provides an in-depth and thorough discussion of the sinus augmentation technique and the bone grafts and membranes used. The chapter includes multiple references in regard to the information presented. Clinical examples are well documented and provide useful clinical examples. Many clinicians consider the use of shorter implants in their practice, and chapter 7 is dedicated entirely to this treatment modality. The chapter reviews the rationale of shorter implants and reviews several clinical studies to develop a useful decision guide for their use. Chapter 8 discusses the extraction of maxillary multirooted teeth and the treatment options available at the time of extraction. Diagrams along with treatment planning exercise photographs take the reader through a step-by-step analysis of the treatment options. The role of periodontal therapy for mandibular molars is reviewed in chapter 9. Resective and regenerative procedures for the treatment of furcation invasions around mandibular molars are explored and the literature is also reviewed for the long-term success of these treatment modalities. The remainder of the chapter focuses on implant placement into extracted molar sites. The technique and decision-making process for immediate implant placement into fresh extraction sites is demonstrated. Finally, algorithms help guide the reader through the decision-making process when faced with a mandibular molar with a furcation defect. Chapters 10 and 11 guide the reader through the decision-making process when faced with an extraction in the esthetic zone. The chapters provide good instructions and decision-making guide for treatment options in this clinically challenging area of the mouth. The topics of tooth extraction, socket preservation, and implant placement are well covered, and the clinical photographs provide good clinical examples. This book provides “real world” clinical knowledge to the implant dentist. Of unique and particular value is the review of the periodontal therapies and literature that provide an evidence-based rationale for the treatment decisions made. As such, it is not just a book on techniques but rather as the title implies a guide to decision making. The cases are well documented, and the treatment planning exercises at the end of the chapters provide the reader with real cases that demonstrate the principles just discussed. In summary, this is a well-written and informative book that will be of value to any implant clinician. Avi Schetritt, DMD Board-Certified Periodontist, Private Practice Miami, FL The book, edited by Dr. Paul A. Fugazzotto, is a well-written and structured text. Authors have condensed their years of experience into a simple decision-making guide that can assist practitioners when dealing with implant and regenerative therapy in dentistry. This book provides many well-documented clinical cases to support the approaches of many different contributors in making this decision guide. A brief summary of how this book is structured follows: Chapter 1 discusses the treatment algorithms of when to perform tooth retention procedure and when to extract the tooth and replace with a dental implant. Authors used several cases to illustrate the issues/factors related to this important decision. For example, the factors authors addressed include treatment options, cost analysis, and finally a flow chart to guide readers to make this important decision. It is also important to note that much of the decision making is based on the author's years of clinical experience. Chapter 2 discusses guided-bone regeneration (GBR), which is one of the areas for which the author is known. Discussed are the diagnostic requirements for selecting proper cases and technique considerations in GBR. These include, but are not limited to, soft tissue management, suturing material and techniques, the rationale of using decortication or platelet-related growth factor (PRGF), membrane selection for each clinical scenario, and the need for membrane fixation during GBR. Twelve clinical cases are analyzed. This section was well written. One of the unique items in this chapter is another treatment planning exercise. A clinical situation with different treatment modalities is given. The author then pointed out the advantages and disadvantages associated with this specific treatment modality. This will help many clinicians to have a better understanding of why they should choose certain treatment options versus others. Another unique feature of this chapter is a table that addresses 4 generations of how we define the success of GBR for 4 different clinical scenarios (buccolingual ridge augmentation, implant dehiscences and fenestrations, extraction socket reconstruction, and apico-occlusal ridge augmentations). Chapter 3 provides a rationale for the use of PRGF. There is a brief description of the evolution of platelet-rich plasma (PRP) to the current PRGF. Although this is a very controversial topic, the authors have tried their best in presenting their points of why PRGF should be used in dentistry, especially during bone augmentation procedures. Chapter 4 was authored by Will Martin who re-examined patient evaluation and planning considerations. Risk factors for implant therapy and side effects (defect) from tooth loss (eg, soft tissue, hard tissue, crowding, supereruption, anatomical, loss of vertical dimension, and malocclusion) and their related treatment options are considered. Chapter 5 focuses on planning and surgical options for implant-based esthetic treatment in the partially dentate patient. Pretreatment considerations that include esthetic risk analysis, patient concerns, motivation and attitudes, and basic treatment principles in the esthetic zone are reviewed. Chapter 6 discusses augmentation of the posterior maxilla that is aimed at sinus augmentation therapy. Included are techniques (eg, lateral window approach) and materials used (eg, membrane placement and graft material selection). One striking aspect of this chapter is the classification of sinus membrane perforations into 3 classes and the proposed treatments in attempting to correct these perforations. At the end of this chapter, the author made an attempt to rationalize the use of PRGF in conjunction with sinus augmentation procedure. Chapter 7 discusses the use of shorter implants in restoring implant-related prosthesis. The author used results obtained from finite element analysis and some clinical studies to argue that shorter implants have a similar success rate as longer implants. The author provides certain preconditions for the use of shorter implants, most of which should be used at the time of tooth extraction. Chapter 8 discusses decision making following extraction of multirooted maxillary teeth. A variety of treatment options at the time of tooth extraction in the posterior maxillary include the following: socket augmentation, simultaneous implant placement with autogenous bone core graft collected from apical end of extraction socket, and lateral sinus augmentation with or without simultaneous implant insertion. Chapter 9 addresses the decision making at the time of treatment of furcated mandibular molars: roles of resective regenerative and implant therapy. Anatomy challenges such as enamel pearls and cervical enamel projections are discussed. Furcation classification and proposed treatments are also presented. In particular, the writer prefers wider diameter implants in the mandibular molar areas because of the heavy occlusal loading noted in this area. Interestingly, the author showed 99.1% of accumulative success rate with implants function up to 5 years. In Chapter 10, Drs. Philip Melnick and Paulo M. Camargo present their view on alveolar bone preservation following tooth extraction in the esthetic zone. They made their point by targeting the concept of esthetic ridge dimension changes following tooth extraction and the need for ridge preservation. Many aspects such as orthodontic history, periodontal, esthetic, and anatomical assessments are discussed together with the techniques used to perform ridge augmentation. The chapter was well written. However, it would be an improvement had the authors addressed the influence of implant positioning, in particular, buccally placed implants. Chapter 11 addresses immediate implant placement in esthetic single tooth sites. This is an area of recent focus. Both Drs. DePaoli and Fugazzotto have attempted to untangle this complex issue by performing patient examination and workshop, site-specific examination and treatment planning, extraction technique, and assessing the extraction socket. It is interesting to note that the authors propose immediate implant temporization to afford the opportunity to mold soft tissue healing to enhance the final esthetic outcome. A decision tree is included. Chapter 12, authored by Dr. Robert Jaffin, discusses “Immediate loading of the full arch in patients with a failing dentition.” He talks about when immediate implant loading in the failing dentition is indicated. Cases demonstrate his approach and include implant micromotion due to lack of restoration passivity and/or patient compliance. Chapter 13 addressed “the rehabilitation of the edentulous maxillary jaw utilizing dental implant therapy.” This is a very comprehensive chapter written by Dr. Anthony J. Dickinson. Two major options are discussed when considering the use of dental implants for the rehabilitation of the edentulous maxillary jaw: the fixed implant-retained prosthesis and the implant-retained/supported removable prosthesis. The advantages and disadvantages associated with each option are presented. The patient's expectation of treatment, patient risk factors, and operator risk factors, both specific and nonspecific, are discussed. How to properly design these prostheses was also presented. The author concludes, “to ensure a successful outcome, whether providing a fixed or removable implant-supported maxillary prosthesis, all interdisciplinary components of the patient's therapeutic management must be undertaken with the competency of each operator, and the patient's consent to such therapy must be accompanied by realistic expectations of the outcomes of the therapy.” This book provides the clinician with a guide of how to make a decision when faced with different clinical scenarios, especially those associated with implant therapy. It is a very practical book that provides the experiences of many years of many authors. I will encourage clinicians/implantologists to read this book especially when they are dealing with complex clinical situations; because this book not only provides how to make proper clinical decisions but also gives scientific evidence to support clinical decisions. I enjoyed reading this book, and it certainly broadened my horizon of learning in implant therapy. Hom-Lay Wang, PhD, MSD, DDS Professor and Director of Graduate Periodonics Department of Periodontics and Oral Medicine School of Dentistry University of Michigan Ann Arbor, MI

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