Monthly Updates January 2026

Immediate Implant Placement in Hopeless Teeth: A Risk-Based Decision Algorithm

This lecture delivered a clear, practical framework to decide whether a compromised tooth qualifies for safe immediate implant placement or requires strategic staged reconstruction to prevent tissue collapse prior to implant placement or a conventional 3 unit bridge.

Focusing on critical diagnostic thresholds (buccal plate, biotype, socket type, apical pathology, bone-marginal soft tissue relationship), you’ll master a repeatable risk-stratification tool that predicts esthetic and functional outcomes with confidence.

Walk away knowing exactly when “immediate” is truly low-risk — and when staged regeneration is mandatory to preserve hard and soft tissue integrity.

Diagnosis & treatment options to improve a cracked tooth ’lifespan‘

Cracked teeth represent a very challenging condition in restorative dentistry, as untreated cracks may compromise pulpal vitality and can ultimately lead to tooth loss. This lecture presents an evidence-based treatment protocol and a novel, clinically oriented classification system specifically designed for vital teeth with structural cracks.

Beginning with the aetiopathogenesis, contemporary diagnostic strategies are critically examined. Building on this foundation a structured decision-making is presented, integrating material selection and the appropriate level of therapeutic invasiveness required to achieve biologically sound and predictably stable outcomes.

A series of clinical cases illustrates the practical implementation of the proposed classification and highlights its value in enhancing prognostic accuracy and optimizing clinical management.

The non-vital tooth and options to increase its lifespan

Root canal treated teeth present specific biomechanical and optical challenges. During the lecture several aspects were discussed for both posterior and anterior teeth:

- Factors increasing risk of fracture

- Remaining tooth structure and restorative options

- Cusp coverage and "ferrule" designs

- Adhesive versus retentive restorations

- Controversy on the use of posts and/or fiber-reinforced composites

- Preparation designs according to each clinical scenario

- Specific challenges in anterior and posterior teeth

- Most recent evidence from in vitro and in vivo studies

Choosing the Right Treatment Plan to Meet the Patient’s Expectations

effective communication among the interdisciplinary team involved in a complex rehabilitation case is often the key to success. This case builds on this idea and shares our philosophy and workflow as a true interdisciplinary team in which we all aim to deliver the best treatment option that successfully meets the patient’s expectations.

As doctors, we all take pride in our ability to design an appropriate treatment plan for our patients, but we often face the challenge of aligning this with the patient’s expectations and identifying the right course of action to deliver on that. In order to arrive at a proper diagnosis and make appropriate clinical decisions, we need to look beyond the smile and consider the entire face of the patient. When talking about facially driven full-mouth rehabilitation, we must pay special attention to establishing the nature of the concern—whether it is purely dental, skeletal, or both—to select the appropriate treatment and achieve the best functional and esthetic results for our patients. Where skeletal issues are concerned, simply trying to improve one aspect will almost certainly result in failure.

for more details of the above case: Quintessence of Dental Technology 2024 | Volume 46

Replacement of an hopeless lower incisor for structurally reasons

This case is related to the replacement of an hopeless lower incisor for structurally reasons, with of course, a reduced surgical and prosthetic space, which is one of the most challenging clinical situations when we have to replace a single tooth. In addition, the phenotype in this area is definitively thin as usual and every surgical approach concern should be not only conservative but should have an overcorrection purpose both for hard and soft tissues.

treatment plan:

1. periodontal phase, to reduce the plaque-induced inflammation, with the splinting of tooth 31 following coronoplasty, to eliminate the contacts in MI and so to decrease the pain: this phase was performed on the day of her first visit.
2. Extraction of tooth 31,immediate implant placement, and temporization of this implant as well, if the surgical context is favorable, I mean: preservation of the buccal plate after extraction, and a good primary stability.
3. Final implant restoration.
4. A periodontal and implant supportive treatment.

The CBCT cuts show the thinness of the buccal plate and the surgical planning using a 3 mm implant diameter as the best tool for both surgical and prosthetic aspects. After an atraumatic «flapless » extraction, the integrity and level of the buccal wall is checked, using a periodontal probe: this point is crucial for the ideal 3D implant positioning.  The small diameter implants placed with a good primary stability; a soft tissue graft is harvested form the tuberosity and placed on the buccal aspect: note that a small part of the CTG remains exposed in order to increase the quantity of KT.

A conventional impression is taken immediately after the surgery, and a few hours later, the provisional is screwed in. At 6 days post-op the healing shows a perfect integration even at the exposed soft tissue graft area. At 4-month post-op the soft tissue maturing is very nice, and an analogic impression is used for the final restoration.

The quantity of keratinized tissue at 6 years follow up has been augmented due to the exposed part of the connective tissue graft. The patient can smile again without any limitation.

Interdisciplinary Management of a Complex Aesthetic and Restorative Dilemma

The patient presented to the clinic after losing a veneer (#1.1) during a surfing activity, reporting both aesthetic discomfort and concerns about the integrity of the affected tooth. Clinical evaluation also revealed additional restorative needs involving several posterior and mandibular anterior teeth.

An indirect adhesive restoration was selected for the maxillary central incisor, where a feldspathic CAD/CAM veneer was fabricated to accurately reproduce tooth morphology, optical characteristics, and enamel-like translucency. The restoration was bonded using a full adhesive protocol to ensure optimal retention and seamless integration with the adjacent teeth. Mesial portion of #2.2 was also restored directly.

In the posterior region, direct adhesive restorations were performed on multiple teeth presenting with interproximal Class II lesions and compromised contact points. Composite resin was used to rebuild the proximal walls, re-establish anatomical contact relationships, and restore proper occlusal function.

Direct composite restorations were also carried out on the mandibular incisors to manage wear and minor structural defects. Modern layering techniques allowed precise control over shade, translucency, and texture, ensuring a natural integration with the existing dentition.

The combination of indirect feldspathic veneer rehabilitation and direct adhesive restorations on posterior and anterior teeth enabled a minimally invasive, functional, and highly aesthetic outcome, fully restoring the patient’s smile after the traumatic loss of the original veneer.

Patient: Male, 48 years old.

Chief complaints: Unsatisfactory esthetics, impaired mastication, gingival bleeding, and teeth mobility. The patient expressed fear of losing all teeth. Treatment expectations: Highly motivated and willing to undergo prolonged treatment to preserve the maximum number of natural teeth. Previous consultations: The patient had been advised at other clinics to extract all remaining teeth, place 4–8 implants per jaw and perform full-arch implant-supported prosthetic rehabilitation.

Treatment plan:

1. Reinforcement of the patient’s motivation for oral hygiene
2. Substantial improvement of home-care skills (professional dental prophylaxis
and oral hygiene instruction)
3. Extraction of hopeless teeth
4. Provisional prosthetic rehabilitation
5. Alveolar ridge reconstruction (bone augmentation of alveolar defects)
6. Orthodontic treatment in the mandible
7. Implant placement in adequate prosthetically driven positions
8. Transitional restorations
9. Definitive restorations: veneers on natural teeth and implant-supported crowns

The presented interdisciplinary strategy enabled maximum preservation of the patient’s remaining dentition in both arches while creating the biological and prosthetic prerequisites for a predictable implant-supported rehabilitation. Extensive alveolar defects were successfully reconstructed, providing sufficient hard-tissue volume for prosthetically driven implant placement. In addition, the proposed combined vestibuloplasty technique achieved an adequate zone and thickness of peri-implant keratinized/attached soft tissues, which is considered beneficial for long-term soft-tissue stability, hygiene access, and maintenance of peri-implant health. Importantly, these objectives were accomplished within a condensed clinical timeline, avoiding unnecessary prolongation of an already complex rehabilitation. Finally, the treatment process resulted in a profound improvement in the patient’s health behavior, with sustained motivation and adherence to oral hygiene measures for both teeth and implants, supporting long-term functional and esthetic outcomes

The structurally compromised tooth: Extraction & implant strategies for "irrational to treat" teeth”.

Principles of the guided healing and management of the soft tissues by prosthetic means can be successfully applied in the direct transformation of periodontal tissues into peri-implant tissues by the immediate intra-socket implant restoration in structually of compromised sites. (Tripodakis APD, Immediate  implant placement combined with controlled immediate loading in infected and defective sockets. Part I: Single tooth (N=13), Implantologie 2001; 1:13-25 & Part II: Multiple adjacent teeth (N=20), Implantologie 2002; 3:271-286).

Microbiological findings have shown that the previously housed periopathogenic flora associated with the site pathology of the extracted periodontally involved tooth, did not hinder the process of osseointegration. One year post-operatively the intracrvicular flora was found to be less pathogenic, compatible with the attained health of the periimplant tissues.  (Tripodakis AP, Nakou M, Microbiologic evaluation of compromised periodontal sites before and after immediate intrasocket implant placement (N=20) Int. J. Perio Rest Dent 2011;31: e109– e117)

The retrospective evaluation of the distance of the labial hard and soft tissue margins from the implant shoulder in maxillary anterior periodontally compromised sites that were restored by immediate flapless implant restorations, combined with inorganic filler labially, was evaluated in a case series study (N:20) by volumetric analysis 5 years postoperatively, using cone beam computed tomography. Volumetric findings, five years postoperatively have confirmed the presence of the buccal bone (preserved or newly formed) coronally to the implant-transmucosal abutment junction supporting a stable soft tissue free periimplant crest in combination of shallow crevice. In all cases, a labial radiopaque plate component was apparent 5 years postoperatively coronal to the implant shoulder 3.1 ± 0.6 mm, supporting the soft tissue margin, which was extending above this level 5.2 ± 1.1 mm (Tripodakis et al. Five-year volumetric evaluation of periodontally compromised sites, restored by immediate implant restorations (N=24) Int. J. Perio Rest Dent 2016; 36:644-653)

Full Arch Impressions of Biomechanically Compromised Teeth

Full arch impressions are stressful, unpredictable and fraught with difficulty. Although Digital scanning is replacing traditional silicone impressions, there are situations where it cannot match the precision of a silicone impression. Ie:

• Deep subingival due to decay or pre-existing crowns

• On posterior teeth where PFM crowns with precise metal castings are fabricated to fit mechanically resistant preparations with retentive grooves.

This is a refinement/update of an old technique popular in the 1960’s. Refinements have been designed by Mr Salvatore Sgro (Technician, Rome, Italy) and Dr Basil Mizrahi and include :

• use of a specially designed custom tray that allows the resin pick-up copings to be luted to the impression tray for extra rigidity

• Linking of sections of the copings to prevent dislodgement during light body application.

• A verification jig to insure precision of pick-up impression

The technique involved taking multiple individual or small sectional impressions. These impressions are then silver plated for strength and durability. Individual, silver plated, dies are then  made from the multiple impressions. On each die an extremely accurate  Duralay pick-up coping is made. These copings are then reseated intraorally over the teeth and a pick-up impression is made. The main advantage of this technique include is the avoidance of having to capture multiple teeth in a single impression.

Following the presentation a lively debate ensued around the merits of analogue vs digital impressions. Basil defended his presentation saying that severely failing dentitions are beyond  “ minimal invasive dentistry “ and often unsuitable for adhesive dentistry. For these cases he prefers a traditional mechanical crown and bridge approach and for this analogue impressions are superior for the reasons outlined above.

Interdisciplinary Management of a Complex Aesthetic and Restorative Dilemma

Diagnosis: Patient’s concerns, history and background: First seen in 2010. 48 year old female, lives in N Ireland (so has to fly to LHR to see us), referred by colleague who treated her there. NRMH, ASA 1, fit and healthy. History of failed restorations including bridge 13-11 and at presentation 12, 11, 24, 25, 26 have been lost. 2 failed grafts in 12-11 area, initially by referring GDP and then by implant specialist. No financial limitations. Wants single teeth, prefers not have bridgework.
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Prognosis: Periodontally: good; Dental: good (for teeth present and existing implants) with the exception of 13 which is guarded due to post. proximity to root wall. Surgical prognosis: very guarded for 12-11 with high risk of morbidity & complications; good prognosis for 24-26 ; Aesthetics: good
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Treatment options:
-Comprehensive restoration of upper arch & lower posterior teeth with crowns, new fillings etc.
- Additional implant at 24 along with horizontal hard/soft tissue augmentation

Main issues relate to anterior defect management‍

‣ Repeat surgery 21-11?
‣Prosthetic gingivae with new bridge 13-21
‣ Do we keep the tooth 13?
‣ What else can we do?
‣ Can orthodontics help us?
‣ Move 13 into position of 12?

Surgical Extrusion of a Compromised Anterior Tooth

This case report describes the management of a compromised anterior tooth (tooth #23) previously restored with a post-retained crown, which presented with a subgingival fracture. Crown lengthening was initially considered; however, it was contraindicated due to an unfavorable crown-to-root ratio. As an alternative, surgical extrusion was performed to reposition the remaining root structure coronally.
The tooth was stabilized by splinting it to adjacent teeth, allowing for periodontal healing. A definitive crown will be placed upon completion of the healing phase. This approach preserved the tooth and restored function and esthetics without the need for extraction.