International Journal of Periodontics & Restorative Dentistry, 01/1999

This paper describes a step-by-step technique for the application of Emdogain, a new enamel matrix derivative (EMD) graft material, per periodontal reconstructive surgery. A case report is presented with a 1-year follow-up. The rationale for use and advantages and disadvantages of EMD are discussed. An additional human histologic case report demonstrates that the formation of new bone, cementum, and periodontal ligament is possible following the use of EMD.

A consecutive group of 55 patients was treated with 63 single-implant restorations. The soft tissue was allowed to heal to either provisional resin crowns (n = 25) that were placed at the time of second-stage surgery, or to healing abutments (n = 38) before final crown insertion. An index that assessed the size of the interproximal mucosa adjacent to the single-implant restorations was used to evaluate the volume of the papillae 2 years after crown insertion. The results indicated that the use of provisional crowns may restore soft tissue contour faster than healing abutments alone, but the papillae adjacent to single-implant restorations presented similar volume in both groups after 2 years in function. Furthermore, the mean marginal bone loss at the implants was 0.9 mm after 1 year, and no differences were observed between the 2 groups. The present data focus on the need for more scientific data to evaluate different clinical procedures for optimizing esthetic results in implant dentistry.

The purpose of the present study was to investigate the scanning electron microscopic texture of enamel and dentin cavity surfaces in extracted human teeth following different etching modalities, specifically combinations of etchants adapted to the tissue composition of the cavity walls. It was concluded that an etching technique that combined the action of 2 different etchants - ethylenediaminetetraacetic acid (EDTA) on dentin and phosphoric acid on enamel - optimized retention structures on each tissue surface of a dental cavity better than either 1 of the 2 etchants that were applied to both types of tissue in the cavity walls.

The closure of surgical wounds in a layer-by-layer fashion, a common principle of plastic surgery, is applied in this article to the field of periodontal surgery with the introduction of a new flap design. The suggested technique is indicated with all periodontal procedures that aim for hard and soft tissue augmentation (guided bone regeneration, mucogingival surgery, or plastic periodontal surgery) where passive, tension-free wound closure is fundamental for wound healing and a successful functional and esthetic outcome. By means of a series of incisions, buccal and lingual flaps are split several times; this results in a double-partial thickness flap and a coronally positioned palatal sliding flap, respectively. Thus, several tissue layers are obtained and the passive advancement of flaps becomes possible for the coverage of augmented areas. Wound closure with microsurgical suture material is accomplished in a multilayer approach, which ensures adaptation and closure of the outer tissue layers without any tension. Two case reports demonstrate the new plastic periodontal approach.

The objective of this study was to assess, using reentry procedures, the capacity of regenerated tissues in implant-associated defects to respond to occlusal loading. Two groups of patients treated with membrane-augmented osseointegrated implants were included in the study. In group A (7 patients), a total of 9 implant-associated defects, including 6 dehiscences and 3 immediate extraction sites, were prospectively followed up 6 months following prosthesis connection. In group B (3 patients), 4 de hiscence defects were retrospectively evaluated 5 years after prosthetic loading. All defects in both groups had an uneventful healing period beyond the 6 months following implant insertion and showed complete fill with bone-like hard tissues at abutment connection surgery. A second surgical reentry was carried out to evaluate the quantitative changes in teh regenerated tissues at the membrane-treated sites; it was carried out 6 months followingprosthesis connection in group A, and 5 years postloa ding in group B. At the second reentry procedure, the mean percentage of defect fill at the dehiscence sites was 82% ± 12.8% in group A and 83% ± 7.3% in group B. In the 3 immediate extraction sites in group A, the most apical bone-implant contact around the implant was consistently located at about 1 mm, relative to the coronal aspect of the implant shoulder, as evidenced both radiographically and during the second reentry. The trends noted in this investigation suggest that tissues regenerated in successfully treated implant-associated defects can be maintained in the short-term and long-term periods following prosthetic loading.

This sutdy evaluated whether differences in design of 3-dimensional pollactic acid barriers (Epi-Guide and Guidor) would influence hard tissue results in the treatment of Grade II furcations in humans. A multicenter study was conducted, using 40 patients with moderate to advanced bilateral chronic adult periodontitis of the mandibular first or second molars. After flap access, debridement, and root preparation, surgical bone level measurements were taken and membranes were placed on a random basis. Surgical reentry occurred at 1 year. Data collected from all 3 investigative centers were pooled and analyzed using an analysis of variance appropriate for a counterbalancing design. Both barrier materails resulted in significant gains of attachment level and defect reduction. The composite reduction in the vertical component of the osseous defects was greater in the sites terated with Epi-Guide as compared to those treated with Guidor; the difference between barriers reached statistical signficiance (P = 0.02)

The placement of osseointegrated implants in extraction sockets is a commonly used and reliable procedure. Many operative protocols have been suggested for use with both submerged and nonsubmerged implants, and some prerequisites have been defined for their successful placement. Dealing exclusively with implants placed in intact extraction sockets, this paper reviews these commonly suggested prerequisites, discusses their clinical relevance, and presents case reports in which clinical success was obtained despite the violation of more than 1 of these factors. Techniques to obtain primary implant stability, procedures to regenerate residual bone defects, the need to submerge implants in the healing phase, and treatment strategy in infected sites are reviewed. Because the simultaneous violation of some prerequisite factors allows postextractive implants to be performed with a single surgical approach, a new classification is proposed based on the number of surgical stages required to replace a failing tooth with an implant-supported restoration.

The primary purpose of this study was to document mean, standard deviation, and range of root trunk dimensions of multirooted tooth types. A total of 412 extracted teeth were e xamined and classified as: maxillary first molars, max illary second molars, maxillary first premolars, mandibular first molars, and mandibular second molars. The distance from the cemento-enamel junction (CEJ) to the root groove and from the CEJ to the root division was measured. Mean CEJ to root groove distances ranged from 1.35 to 1.65 mm for maxillary first molars, from 1.49 to 1.89 mm for maxillary second molars, from 1.71 to 1.73 mm for maxillary first premolars, from 1.16 to 1.22 for mandibular first molars, and from 1.53 to 1.76 mm for mandibular second molars.

This case report describes the use of a subepithelial connective tissue graft to restore the gingival papillae and augment ridge soft tissues adjacent to a dental implant. The patient was referred for periodontic and prosthodontic evaluation after the placement of an implant - with the implant head 6.5 mm below the adjacent cementoenamel junction - in an area of inadequate bone volume with deficient interproximal papillae and ridge soft tissues. The resulting esthetic defect was restored by means of a combined technique that used a subepithelial connective tissue graft and an emergence profile-contoured crown. A 3-year clinical follow-up with complete regeneration of the gingival papillae is described.