International Journal of Periodontics & Restorative Dentistry, 05/2007

The lateral window sinus elevation procedure has become a routine and highly successful preprosthetic procedure that is used to increase bone volume in the posterior maxilla for the placement of dental implants. Many surgical techniques have been proposed that provide access to the maxillary sinus through the lateral wall to allow for elevation of the sinus membrane. Among these are the multiple variations of the hinge and complete osteotomy techniques, which make use of rotary cutting instruments for the antrostomy. The most common intraoperative complication with these surgical approaches is perforation of the schneiderian membrane, with perforation rates of 14% to 56% reported in the literature. In most instances, perforation occurs either while using rotary instruments to make the window or when using hand instruments to gain initial access to begin the elevation of the membrane from the sinus walls. This article presents an alternative approach that uses a piezoelectric instrument for the sinus elevation procedure. Although new to the United States, this approach has been used successfully in Europe for many years. The membrane perforation rate in this series of 100 consecutive cases using the piezoelectric technique has been reduced from the average reported rate of 30% with rotary instrumentation to 7%. Furthermore, all perforations with the piezoelectric technique occurred during the hand instrumentation phase and not with the piezoelectric inserts.

Human studies have demonstrated the safety and effectiveness of highly purified recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in combination with osteoconductive matrices for the treatment of moderate to severe periodontal intrabony defects. These study results, together with binding and release characteristics for rhPDGF-BB with different matrices, provide clear evidence that demineralized freeze-dried bone allograft and ß-tricalcium phosphate (ß-TCP) each can be combined with rhPDGF-BB to promote significant improvements in clinical, radiographic, and histologic parameters. The purpose of the current case series was to determine the clinical and radiographic regenerative potential of rhPDGF-BB-enhanced mineralized freeze-dried bone allograft (FDBA) for the treatment of severe periodontal intrabony defects. Clinical reentry and radiographs at up to 11 months showed complete bone fill in these challenging cases, indicating that rhPDGF combined with FDBA provides excellent clinical results.

Autogenous grafting of gingival or bone tissue is often indicated to obtain optimal esthetics and function in periodontal and implant therapy. In the present study, 32 maxillary teeth were extracted, and the postextraction defects were treated with 32 autogenous cylindric free gingival-bone grafts retrieved with trephine burs from intraoral donor sites. Free gingival-bone grafts were also used to obtain root coverage and papilla reconstruction in three patients who required esthetic enhancement. Twelve to 16 weeks after the graft procedure, biopsies were retrieved and processed for histologic evaluation to verify integration of the grafts. The implants placed in the treated sites healed without complications and were functionally loaded after healing. The clinical and histologic results of this study suggest that the free gingival-bone graft technique may favor hard and soft tissue reconstruction of the sites treated, with esthetic and functional advantages.

The purpose of this study was to evaluate the results of treatment of buccal mandibular Class II furcation defects with a combination of autologous bone grafts and enamel matrix derivative over a 24-month period. Eleven individuals with chronic periodontitis were selected and contributed one furcation defect each. Statistically significant improvements in mean vertical probing attachment level and horizontal probing attachment level were obtained at the 2-year evaluation. Complete clinical closure was achieved in four sites, which exhibited favorable defect morphology for this regenerative procedure. All other residual defects were reduced to Class I.

The present study reports on the results of the use of a screw-retained narrowdiameter implant (NDI) system as an option for implant placement in areas of limited bone volume. This retrospective report followed 48 NDIs in 27 patients for 1 to 5 years postloading. No implant failures were reported, yielding a 100% survival rate. The screw-retained attribute of this system allows retrievability of the restorations, which may require replacement because of porcelain fracture, chipping, or a desire to change color. The three diameters available-1.8 mm, 2.2 mm, and 2.4 mm-allow flexibility for a variety of narrow edentulous spaces. These NDIs present a cost-effective alternative for restoring limited spaces with implant restorations, without the bone augmentation or orthodontic procedures required for conventional fixed restorations. The NDI system is approved by the U.S. Food and Drug Administration for long-term use.

Recent advances in periodontal plastic surgery have encouraged reassessment of the envelope technique and its modified version, the tunnel technique, for root coverage. This article describes alterations in the technique-sensitive tunnel approach, which include an undermining split flap preparation of the buccal tissues with newly developed instruments to minimize trauma and ensure a better blood supply for the connective tissue graft. The use of a microsurgical concept, including microsurgical blades and suture material, improves wound healing and establishes a better esthetic result. Because these modifications simplify the tunnel approach, the spectrum of indications for the tunnel technique may be expanded and a broader application achieved.

There have been few case reports of cystic lesions occurring after gingival grafting. There are three reports of this type of sequela after connective tissue grafting, but this is the first known case of a cystlike lesion developing secondarily to a free gingival graft procedure. The bulky tissue, which had developed under the previously grafted area, was properly excised under local anesthesia. The small specimen removed was sent for histologic analysis. A new gingival graft was performed immediately after the lesion enucleation, as the cystic lesion had dislocated the earlier graft. The surgical wound healed uneventfully, and no recurrence was seen 18 months later. The microscopic sections showed a cystic cavity lined with an orthokeratinized, hyperplastic, stratified squamous epithelium covered with fibrous connective tissue. The development of a cystlike lesion following a free gingival graft is, to date, an unpublished event. The fact that most cystic lesions appear in the mandibular lateral incisor-canine-first premolar area deserves further consideration.

The aim of this study was to investigate the effect of a combination of enamel matrix derivative (EMD) and bovine-derived xenograft (BDX). Intrabony defects were created in dogs and treated with BDX plus EMD, with BDX alone, or with neither (control group). Control group defects were characterized by a long junctional epithelium and little bone formation. The BDX+EMD sites showed a statistically significant increase (P .05) in new bone and cementum formation compared with the BDX-only sites. These findings suggest that the use of BDX with EMD is effective in enhancing new bone and cementum formation and that this combination is effective in the treatment of intrabony defects.

This article describes a staged approach to provide a fixed restoration to patients with a hopeless dentition without a removable provisional phase. The rehabilitation protocol, which includes initial conservative periodontal care, starts with strategic extraction of some of the remaining teeth. The aim of the first step is to permit implant placement and to strategically keep residual teeth as abutments for a provisional fixed denture during the implant healing period. After the implants have osseointegrated, abutment connection is performed, residual teeth are extracted and, simultaneously, a second group of implants is placed. A second fixed provisional restoration is delivered to the patient. After the second group of implants has healed, the patient is ready to undergo normal prosthetic treatment. Advantages of the technique include no removable provisional prosthesis, soft tissue management, preserved function and enhanced esthetics during treatment, and prosthetically driven implant placement. The main drawbacks are extended treatment time, adjustments of the provisional restorations, and no less than two surgical steps.