International Journal of Periodontics & Restorative Dentistry, 01/1992

Surgical alternatives in regenerative therapy are presented, along with an explanation of the author's rationale and indications for treatment. These alternatives are lesion, site, and patient dependent. The techniques are described and illustrated in several cases to support the thesis that a multifaceted approach to regeneration is necessary.

The incorporation of prosthetic information into a presurgical implant treatment plan is essential to provide accurate guidelines for fixture placement by the surgeon. Part I of this article presented a modified surgical technique that enables the restorative dentist to construct a prosthesis compatible with the final tooth position. Part II describes a technique in which a computer profile image is used to identify the determinants of the optimal final tooth position and discusses the impact of these determinants on the prosthetic design. Guidelines that could be used to predict the final prosthetic design are also presented.

At surgery, the results of preoperative radiographic evaluation are used in conjunction with surgical stents to determine the ideal site and angulation of implants. However, it would be desirable to be able to plan the optimal implant location before the actual surgical appointment. This paper presents a technique in which barium-coated stents or dentures are used in conjunction with computer-assisted tomography to locate important anatomic landmarks, such as the inferior alveolar nerve, and anomalies of the underlying bone, such as deficiencies in ridge height, preoperatively. This allows more accurate determination of optimal implant placement.

Severe occlusal destruction, whether it results from attrition, abrasion, or erosion, must be met with definitive diagnosis and treatment. This case report illustrates the step-by-step diagnosis and treatment of a patient with severe occlusal wear. Restoration of a functional occlusion and esthetics involved endodontic treatment, reestablishment of the vertical dimension of occlusion, osseous periodontal surgery, and placement of single-tooth cast glass-ceramic crowns.

A modified surgical technique, aimed at the conservation of maxillary anterior esthetics, has been proposed for the treatment of maxillary anterior periodontal pathoses that do not respond to traditional, nonsurgical approaches. The modified resective technique gives selective access to the periodontally diseased root surfaces while allowing the periodontist to avoid facial areas with shallow pockets. This paper describes the technique in detail and discusses its indications, advantages, and disadvantages.