International Journal of Periodontics & Restorative Dentistry, 05/1997

The maintenance of single teeth may often be of crucial importance for the prognosis of the total dentition. In such c ases, as when a single tooth supports a fixed partial denture, a special effort should be made to maintain that tooth. This study reports the treatment of six such terminal cases. The results of a combination of local and systemic antibiotics and the use of guided tissue regeneration with resorbable membranes and grafting material is demonstrated. After defect debridement and root planing, the defects were filled with Biostitie (Coletica), and Paroguide (Coletica) membranes were placed. The results at reentry demonstrated the efficacy of these treatments, and all six treatments were considered successful. The influence of the individual components used in treatment is discussed.

Posterior single-tooth implant resotrations are subjected to an increased risk of bending overload. A high incidence of implant fracture has been reported when using a single standard 3.75-mm-diameter implant to support a molar restoration. The purpose of this article is to demonstrate the clinical feasibility of placing two implants to support a molar restoration and to compare this treatment option to the use of a single standard implant or a wide-diameter implant. Two osseointegrated dental implants used to support a molar restoration in interdental spaces as small as 10 mm is shown to be effective and predictable in 60 restorations over the past 7 years. The use of two implants provides more surface area for osseointegration and spreads the occlusal loading forces out over a wider area, reducing the potential bending forces that would otherwise exist in a single-implant molar restoration.

Guided bone regeneration is a clinical procedure aimed at promoting bone formation at sites where there is severe bone loss. The purpose of this article was to demonstrate reconstruction of deformations of the alveolar process resulting from traumatic injuries to maxillary incisor teeth by guided bone regeneration procedures followed by insertion of dental implants. In both cases, submembranous space-making was stabilized by human demineralized freeze-dried bone. Implant insertion at the sites of bone augmentation resulted in successful restorations. Histologic examination of biopsy samples from the submembranous hard tissue revealed particles of demineralized freeze-dried bone allografts partially surrounded by uninflamed connective tissue and by vital bone adjacent and adhered to the demineralized freeze-dried bone allograft particles.

This study compared the variation in anatomic width of the mucogingival unit following coronally positioned flap or guided tissue regeneration procedures in deep (greater than or equal to 4 mm) buccal maxillary gingival recession defects 12 months postsurgery. Eighteen patients, 10 treated with guided tissue regeneration procedures and eight treated with coronally positioned flap procedures, were retrospectively analyzed. The results demonstrated that both treatments led to consistent recession depth reduction and coronal shift of the mucogingival junction. A significant increase in the amount of keratinized gingiva was observed for the guided tissue regeneration procedure, but a decrease that was not statistically significant was observed for the coronally positioned flap procedure.

The Twin-Stage Procedure was used to measure the amount of disocclusion reproduced on the articulator (in vitro) and in the mouth (in vivo). The results almost coincided, even without measurement of the condylar path. By using this new procedure, quantitiative control of the amount of disocclusion, which was previuosly impossible, has become a reality in daily clinical procedures. The amount of disocclusion occurring on an articulator coincided with the amount of disocclusion intraorally; therefore, the Twin-Stage Porcedure is considered to be highly reliable.

When the clinical crowns of teeth are dimensionally inadequate, esthetically and biologically acceptable restoration of these dental units is difficult. Often an acceptable restoration cannot be accomplished without first surgically increasing the length of the existing clinical crowns; therfore, successful management requires an understanding of both the dental and periodontal parameters of treatment. This report provides further insight into this interdependence by examining the effects of tooth form on the periodontal morphology and surgical treatment, while relating them to requirements for esthetically and biologically acceptable full-coverage dental restorations. This report also explains the role that restoration margin location and emergence profile play in the maintenance of peridontal and dental symbiosis. The effects of violation of the supracrestal gingivae by improper full-coverage restorations is also illustrated.

Amelogenesis imperfecta is a rare dental disease and presents a major challenge to the dentist. With the tremendous advances in the field of esthetic dentistry, espcially in bonding to dentin, it is today possible to restore function and esthetics to an acceptable level. The need for full crown preparation has been decreased to an absolute minimum. A case of amelogenesis imperfecta, complicated by a malocclusion, is presented. A combination of periodontal treatment and resin-bonded porcelain onlays and nobel alloys resulted in a highly successful outcome. The virtual absence of enamel was overcome with the aid of dentin bonding.

The authors have developed a set of four modified sonic scaler inserts with variuosly shaped shafts and diamon-coated budded inserts. The inserts are specially designed for the furcation area since instruments used hitherto have not been successful in completely preventing slow continuous periodontal breakdown in multirooted teeth. To improve understanding of their clinical effectiveness, instrumentation of dentin samples was done with a curette as well as conventional and modified sonic scaler inserts under standardized conditions. The results showed that significantly greater amounts of tooth substance were removed with the diamond-coated airscaler tips than with the conventional tip. The depth of substance removal was comparable to that obtained with hand instruments and increased with application force. Although differences in surface texture were found among the different modes of scaling, it remains to be dtermined whether they are of clinical significance.