International Journal of Periodontics & Restorative Dentistry, 05/1992

Fixed prosthodontic rehabilitation can be accomplished in partially edentulous patients whose maxillary antrum prohibits successful placement of multiple fixtures. A single posterior fixture is placed in the tuberosity region to support a tissue-integrated prosthesis directly connected to a periodontally sound anterior abutment tooth. The treatment planning considerations and surgical aspects are described, and a case report is used to illustrate the technique.

The objectives in establishing a physiologic occlusion for periodontal-prosthetic patients are: (1) the minimization of lateral forces on the teeth and (2) the direction of forces along the long axis of the roots. Functional precision of occlusion is not an objective for this type of patient; rather, stability, with freedom of movement, is the goal. This paper gives an in-depth discussion of these objectives and provides an additional look at dental implant therapy and occlusion.

Peri-implant soft tissue problems seen during the maintenance phase of implant therapy include an inadequate zone of keratinized tissue, mobility of grafted tissue, mucosal pouching, gingival hyperplasia, gingival fistulas, and gingivitis. Techniques to alleviate or reduce these problems include free soft tissue autografts, apically positioned flaps, reduction of tissue thickness by a flap procedure or gingivectomy, and increased attention to the control of inflammation.

A study was conducted to evaluate the potential of guided tissue regeneration in the treatment of human molar Class II furcation defects using BioBrane temporary wound dressing as a barrier membrane and to compare the results to those with open debridement. Eight patients, with a total of nine pairs of Class II buccal furcation molar defects, were studied. Prior to surgery, soft tissue measurements, attachment levels, and hard tissue measurements were recorded. These measurements were repeated 4 to 6 weeks after membrane removal. The study revealed no significant difference between results of treatment using the BioBrane membrane and those obtained using open debridement alone, except in the measurement of horizontal open probing attachment, in which BioBrane-treated sites had a significant gain of soft tissue.

Over a period of 5 months, 18 patients with one or more cracked teeth were treated. Mandibular first molars and maxillary premolars were the teeth most frequently affected. The least affected teeth were mandibular premolars. Predisposing factors for cracked-tooth syndrome are decreased stability (such as caries or poor cavity design) and overloading of the tooth. Treatment involves initial reinforcement and a circumferential cast restoration.

The etched porcelain laminate veneer is a new conservative treatment that offers a solution to fractured, discolored, and worn anterior teeth. Preparation of enamel should be 0.5 mm to give minimal porcelain thickness and to avoid an overcontoured restoration. At the same time, dentinal exposure is contraindicated, because resin bonds better with enamel than with dentin. One hundred fourteen extracted teeth were measured at the gingival, middle, and incisal thirds. The resulting data reported on labial enamel thickness of anterior teeth may offer guidance in the preparation of laminate veneers.

A modification of Abram's roll technique is described. A rap-door approach is used to reflect and preserve the epithelium that overlies the connective tissue pedicle; the epithelial pedicle is used to cover the donor site. Two case reports illustrate the technique.