International Journal of Periodontics & Restorative Dentistry, 01/1994

Five cases are presented to document the use of an unusual barrier in the treatment of infrabony defects according to the principles of guided tissue regeneration. A rubber dam was positioned after flap elevation, defect debridement, and root planing to cover the defect and the surrounding bone. The dam was covered with the surgical flap and removed after 5 weeks. The 1-year clinical measurements and reentry procedure demonstrated the efficacay of the rubber dam as a barrier in guided tissue regeneration procedures.

The principle of guided tissue regeneration has demonstrated a level of success in regenerating the periodontal attachment apparatus lost to periodontal disease. Several types of membrane barriers, each one with distinct properties, have been utilized to apply this principle in periodontal wound healing. A series of case reports introduces and discusses the attributes of rubber dam as a barrier membrane for the treatment of multiple periodontal osseous defects. Comparison of preoperative and postoperative clinical measurements as well as reentry procedures are utilized to highlight successful osseous regeneration.

To obtain esthetic results with composite resin restorations, it is necessary to consider the following elements: the structure of composite resin; tint modifiers; opaquers; generic form; and surface texture. This article discusses these elements and presents clinical examples of techniques for achieving esthetic composite resin restorations.

This paper presents a new surgical technique to promote bone formation in localized alveolar ridge defects. The objective was to regenerate sufficient bone volume for implant placement. The technique is dependent on careful defect debridement and the use of absorbable orthopedic pins, which serve as tent poles and prevent the e-PTFE barrier membranes from collapsing into the defects. The three defects treated with this technique were completely resolved with new bone, and implants were successfully placed into augmented ridges. Biopsies from the treated sites revealed new bone formation.

This investigation deals with the proliferation and migration of the progenitor cells during the healing of closed periodontal wounds. Periodontal surgical defects affecting the bone and dentin were created in four mongrel dogs. The defects were treated with topical applications of citric acid, tetracycline, or sterile water with and without the placement of nonresorbable membranes. The dogs were killed at 1, 3, 7, and 21 days after surgery. One hour before they were killed, they were intravenously injected with tritiated thymidine. Tissues were processed and routinely prepared for autoradiographic studies. Labeled cells were counted at the apical, coronal, and central areas of the defects. Results suggested that the citric acid and tetracycline treatments inhibited cellular proliferation at the initial time periods of 1 and 3 days. At 7 and 21 days, differences between citric acid and tetracycline treatments were minimal, and neither showed any advantage over the application of sterile water. The placement of the nonresorbable membrane demonstrated a trend of increased labeling at 21 days for all three treatments.

Part I of this article presented the rationale for the use of the crown-lengthening procedure prior to final prosthetic or restorative treatment. The primary objective of the procedure is the attachment of a periodontal biologic width, free of any invasive restorative dentistry, circumferentially around the tooth. Part II of this article presents a clinical case to demonstrate, step by step, the crown-lengthening procedure. Concurrently the clinical rationale for these steps is also explined.