International Journal of Periodontics & Restorative Dentistry, 04/2019

The goal of this case series report is to demonstrate the predictability of providing immediate restorations with an implant specifically designed to achieve high primary stability, and to report on 12-month survival outcomes. Twenty-nine implants were placed in eight patients with various tooth-replacement needs, from single teeth to partially edentulous spans to fully edentulous mandibles. A new tapered-implant system (The Marc Nevins, Little Implant) was utilized that incorporates a self-tapping thread design with a thread pitch and thread lead to improve primary stability at insertion. All implants were placed with a minimum insertion torque of 45 Ncm. Four immediate implants and two early placements at extraction sites were included in the cohort. Twenty-seven implants were clinically successful at 1 year. Two implants in a healed ridge were found to have failed at 6 weeks postoperative in one patient wearing an ill-fitting removable partial denture. The radiographic crestal marginal bone levels were recorded in millimeters from the top of the implant platform to the first bone-to-implant contact. The mean crestal marginal bone level change was -0.57 ± 0.82 mm. This case series report demonstrates the ability of an implant designed for high primary stability to achieve successful integration in the presence of an immediate restoration for various clinical presentations, including single-tooth, multi-unit, and edentulous cases.

An effective treatment regime for peri-implantitis (P-I) should include disinfection and regeneration of peri-implant tissues. Twenty consecutive patients exhibiting 23 P-I implants with 84 deep (≥ 6 mm) defects were treated using an Er:YAG laser for implant surface decontamination, removal of defect granulomatous tissues, and grafting therapy for bony defect resolution. Probing pocket defects (PPD) ≥ 6 mm (deep probing depths) before surgery were reduced on average to approximately 3.5 mm at 12 months. Probing depths 6 mm (shallow probing depths) remained stable (mean PPD 3.2 mm at 12 months). Radiographs indicated PPD reductions were achieved along with peri-implant defect fill.

This multicenter study retrospectively evaluated implant survival and bone growth in atrophic ridges that were augmented with titanium mesh and 100% mineralized solvent-dehydrated bone allografts (MSDBA). A secondary objective of this study was to evaluate differences in outcomes by diagnostic model type. Titanium mesh was shaped on a diagnostic wax-up of the patient's jaw: Twenty-three patients (Group 1) had wax-ups on dental stone models, and 16 patients (Group 2) had wax-ups on models fabricated with three-dimensional (3D) printing technology. Clinical and histologic data were analyzed. The average bone gain ranged from 5.94 to 6.91 mm horizontally and 5.76 to 6.99 mm vertically and was not significantly different between the two model groups (P > .05). Implant survival was 100% after 18 to 48 months. Although model type had no significant influence on outcomes, 3D-printed models allowed for faster surgery and served as visual aids for patient education.

Free connective tissue grafts, barrier membranes, pedicle flaps, soft tissue allografts, and xenografts have been described for root coverage and augmenting the zone of attached gingiva. The present report evaluated a modified tunnel surgical procedure for root coverage of mandibular anterior teeth where a connective tissue graft was combined with a tunnel and double papilla flap. Fourteen patients with 18 consecutive Miller Class I or II gingival recession defects in the anterior mandible were treated with a connective tissue graft combined with a tunnel and double papilla flap procedure. The following parameters were recorded at baseline and every 6 months postsurgery for up to 19 months: probing depth (PD), vertical recession dimension (RD), keratinized tissue width (KT), and recession width (RW). Statistical analysis consisted of descriptive statistics, analysis of variance with repeated measures, and t test. Statistical analysis proved significant differences between pre- and postoperative values. Mean percentage of root coverage was 83.28% (standard deviation: 22.897), while complete root coverage was obtained in 55% of sites. Baseline values differed between Class I and II recession defects. Clinical attachment level gain, KT gain, and amount of root coverage were statistically significantly larger in Class II defects, while the degree of residual recession and percentage of root coverage were similar in both recession classes. A statistically significant interaction between recession class, independent variable, and pre- and postoperative vertical recession defects (dependent variables) was recorded (P = .004). Within the limitations of the sample size, the reported procedure showed predictable root coverage with color match combined with an increased zone of keratinized tissue.

The aim of this report is to present a case with a 10-year follow-up of a single anterior tooth dental implant replacement with a xenogenous bone graft in a patient with a large bone defect associated with a cleft lip and palate. At 10 years postloading, the implant was healthy and wellintegrated. Although the implant restoration appeared slightly intruded due to growth and development at that time, the patient was happy with the esthetic result and refused corrections of the uneven occlusal plane.

This report presents a histologic assessment of guided bone regeneration for dehiscence defects treated with bovine bone mineral or a combination of autogenous and synthetic bone. The samples were obtained from an autopsy specimen donated by a patient, which is a rare opportunity to evaluate longterm results of guided bone regeneration and osseointegration. The values for bone-to-implant contact were similar in both sites. The augmentation with bovine bone mineral demonstrated bone reconstruction after 1 year, whereas the augmentation with autogenous and synthetic bone failed to maintain the augmented volume, eventually leading to mucosal recession after 5.5 years.

This article describes the combined use of the immediate dentoalveolar restoration (IDR) technique and the osseodensification implant site preparation method to improve immediate implant primary stability in periodontally compromised extraction sites. Positioning of soft and hard tissues was evaluated in two clinical cases in which the IDR technique and the osseodensification implant site preparation method were used to replace teeth at sites with severe alveolar bone loss. The results were analyzed by clinical assessment, photography, radiography, and computed tomography scans. Based on this preliminary study, the use of osseodensification can enhance the results achieved using the IDR technique due to improved primary implant stability, as measured by higher insertion torque.

The purpose of this study was to assess the healing of periodontal intrabony defects treated using enamel matrix derivative (EMD) after at least 5 years of followup. Six patients with seven intrabony defects were included in the study. Treatment with EMD yielded a mean clinical attachment level gain of 4.3 ± 2.4 mm, a mean probing depth reduction of 4.7 ± 2.1 mm, and a mean gingival recession increase of 0.7 ± 1.8 mm. Reentry measurements showed a complete resolution of the intrabony defect in five cases, while in two cases a residual intrabony component was recorded. The present study indicates that treatment using EMD provided good clinical outcomes maintained in most cases over a period of at least 5 years.

This retrospective study investigated the changes in the maxillary sinus floor and alveolar crest following extraction of maxillary molars. Pre- and postextraction cone beam computed tomography scans of 23 patients were analyzed. Paired-sample t tests compared pre- and postextraction measurements, and independent-sample t tests were utilized for intergroup comparisons. Pearson correlation was used to assess the association between the measured variables and the outcome measures. The mean alveolar bone height reduction was 3.42 ± 2.40 mm and the alveolar crest loss was 3.07 ± 2.53 mm. The maxillary sinus floor position shifted coronally by a mean of 0.47 ± 0.32 mm. Approximately 88% of postextraction changes in alveolar bone height were due to alveolar crest changes, compared to 12% due to changes in the sinus floor position. The results of this study challenge the commonly held concept of extensive postextraction maxillary sinus floor alterations leading to sinus pneumatization.

The aim of the present randomized study was to radiographically evaluate the early marginal bone remodeling (EMBR) around one-stage implants with a collar surface that is laser-microtextured (LM), placed with the mirograp/ interface at different levels relative to the bone crest, and to clinically evaluate the influence of keratinized tissue thickness (KTT) on outcomes. Thirty partially edentulous patients were selected to each receive at least two one-stage implants with LM collars placed at different depth levels in the mandible and maxilla: one implant placed at an equicrestal level (E group) and one implant placed at a supracrestal level (SP group). Rank-based analysis of variance test was used for statistical comparison between groups. Before loading, the E and SP groups showed a mean marginal bone loss of 0.03 ± 0.04 mm and 0.02 ± 0.03 mm, respectively, without a statistically significant difference (P > .05) between the groups. Moreover, no statistically significant correlation between EMBR and the amount of KTT was found (P > .05). Within the limitations of the present study, it can be concluded that neither the vertical position of the microgap/interface of one-stage implants with an LM surface nor the thickness of keratinized tissue around the implant site influences the amount of EMBR.

Healing of extraction sockets may sometimes result in formation of fibrous tissue instead of bone, even after 4 months, an occurrence that may hinder implant placement. The aim of this preliminary observational study was to histologically evaluate quality and amount of bone regeneration after treating nonhealing sockets with a bovine-derived xenograft enriched with porcine collagen (Bio-Oss Collagen, Geistlich) without barrier membranes. Biopsy specimens were collected during implant placement, 4 months after grafting. A total of 10 cases were treated and evaluated. In all cases, correct implant placement was possible and no implant failure occurred up to 6 months after loading. The histologic analysis demonstrated new bone formation in all specimens. The percentage of newly formed bone was 29.1% (SD 20.71%; range 5% to 48%). Xenograft particles in direct contact with newly formed bone were visible, and mature lamellar bone was observed in 8 cases.

The aim of the study was to comparatively evaluate periodontally accelerated osteogenic orthodontics (PAOO) and conventional fixed orthodontic mechanotherapy in the management of bimaxillary dentoalveolar protrusion in adults. The selected patients were grouped into two groups: Group I: PAOO procedure followed by orthodontic fixed mechanotherapy; Group II: orthodontic fixed mechanotherapy alone. The total treatment time, the quantum of root resorption, and the periodontal status of Group I and Group II were compared. Group I had a shorter treatment time and stable overall periodontal health, both of which were statistically significantly different compared to Group II. Within the limitations of this study, significant statistical differences were found in the clinical and radiographic parameters among the patients treated with PAOO along with conventional fixed orthodontic therapy as compared to the patients treated with orthodontic therapy alone.

Treatment of gingival recessions associated with noncarious cervical lesions (NCCL) can be a challenging clinical situation for clinicians. Both periodontal and restorative treatment can be necessary for this kind of defect. By using both digitally precise computer-aided design/computer-assisted manufacture (CAD/CAM) procedures and natural inlay (NI) material for restoration of defects before the coronally advanced flap (CAF) surgery, attachment of soft tissues on the root surface can be achieved successfully. Seven nonsmoking patients with NCCL associated with gingival recessions in the maxillary esthetic zone were treated with NI restoration before CAF surgery. All of the included patients needed at least one tooth extraction, and extracted teeth were used for NI restoration for the CAD/CAM milling procedure. After application of the restorative material onto NCCL defects, CAF surgery was performed for root coverage. The primary outcome was increased mean root coverage percentage and clinical attachment gain after a 6-month follow-up period. Successfully restored NCCL defects were covered with CAF, and 91.67% mean root coverage was achieved with a 1.98-mm attachment gain. Additionally, 71.42% of the root surfaces covered completely. Application of NI restoration materials with CAD/CAM techniques can be a promising procedure for the restoration of NCCL defects before periodontal surgery. This method can achieve a better clinical attachment after root surface coverage.

This case report describes alveolar ridge augmentation around a hopeless maxillary canine with severe buccal gingival recession and periodontitis using orthodontic extrusion and a 90-degree buccal root torque in preparation for implant placement. After the orthodontic therapy, the palatal surface of the canine root reached the top of the alveolar bone, parallel to the occlusal plane, with newly formed bone and keratinized mucosa. An implant was successfully placed without combined bone augmentation. This technique may be a useful, minimally invasive approach for implant site development where hopeless teeth with severe buccal recession remain in the esthetic areas.

The objective of this study was to compare patient-related outcomes of conventional protocols with computer-assisted implant planning and templateguided implant placement (CAIPP) protocols. Partially edentulous patients (N = 73) were assigned to either surgical planning based on two-dimensional radiographs and freehand implant placement (control; n = 26) or using threedimensional computer-tomography data and implant placement using a toothsupported surgical guide (test groups T1 [n = 24] and T2 [n = 23]). The two test groups differed from each other in digital data acquisition, software functionality, and the guide-manufacturing process. All surgeries were performed as openflap procedures. Patient-related outcome measures were evaluated using questionnaires. Statistical tests were performed to investigate differences between treatment groups. Before treatment, 53% of patients in the control group and 83% of patients in the test groups (T1: 88%, T2: 78%) were satisfied with their group allocation. In the control group, 37% of patients favored CAIPP technology, while only 11% in the test groups would have preferred a conventional procedure. After treatment, 50% of patients in the control and 86% in the test groups (T1: 76%, T2: 94%) were satisfied with their allocation. Twenty-one percent of controlgroup patients favored the CAIPP treatment, while 6% of the test-group patients would have preferred a conventional treatment. The quality-of-life parameters during and after surgery did not show significant differences between groups. More postoperative discomfort was reported after longer and more-complex surgeries including guided bone regeneration and surgeries with two surgical sites. Generally, patients preferred computer-based technologies. No differences in the intra- or postoperative discomfort were observed compared to control protocols. More-extensive surgical procedures negatively affected the intraand postoperative quality of life, irrespective of the treatment group allocation.

The objective of this study was to compare the accuracy of conventional and computer-assisted implant planning and template-guided placement (CAIPP) protocols. Partially edentulous patients (N = 73) were randomly assigned to either a conventional implant planning and freehand placement protocol (control group, n = 26) or one of two different CAIPP protocols (stereolithographic guide [T1, n = 24] or 3D-printed guide [T2, n = 23]). The virtually planned and final implant positions were compared. Differences between the planned and the obtained implant position were evaluated as horizontal, vertical, and angular measurements. Descriptive statistics were calculated for overall deviation values and their fragmented mesiodistal and bucco-oral vectors at each evaluation plane. To study overall accuracy differences between study groups, analysis of variance (ANOVA) was used with Bonferroni post hoc test (Scheffé method). Possible confounding variables were analyzed using multiple linear regression with respect to treatment group. The mesiodistal or bucco-oral distribution of the positioning errors was evaluated with chi-square test. A multiple linear logistic regression was used to identify confounding variables. Inaccuracy at the level of the occlusal plane of the restoration averaged 0.65 ± 0.26 mm in the control group, 0.59 ± 0.4 mm in T1, and 0.76 ± 0.5 mm in T2. At the implant shoulder level, the inaccuracy amounted to 1.25 ± 0.62 mm, 0.97 ± 0.36 mm, and 0.72 ± 0.31 mm in the control group, T1, and T2, respectively. At the implant apex, mean deviations of 2.32 ± 1.24 mm were recorded in the control group, 0.97 ± 0.57 mm in T1, and 1.08 ± 0.57 mm in T2. Mean discrepancies in vertical direction measured 0.28 ± 1.01 mm (control), 0.2 ± 0.65 mm (T1), and -0.1 mm ± 1.0 mm (T2). Angular deviations of 7.36 ± 3.36 degrees (control), 4.23 ± 2.68 degrees (T1), and 3.13 ± 2.12 degrees (T2) were measured. Statistically significant differences were observed between the conventional and the two CAIPP groups for overall deviations at implant shoulder, apex, and implant angulation. CAIPP protocols seemed to provide a higher accuracy and precision compared to conventional freehand protocols. Still, the amount of inaccuracy using guides demands a safety margin. Moreover, intrasurgical verification during drilling and the implant placement procedure should be performed, including clinical parameters that may not be available from cone beam computed tomography data during the planning phase.

Positive effects of platelet-rich fibrin (PRF) on soft tissue healing are well documented, but its role in hard-tissue healing remains contested. The present case series documents the use of PRF as the sole grafting material in periapical bone defects. PRF was prepared and condensed into the bone defects after debridement. The defects were then covered with a collagen membrane and wound closure was performed. In all three cases presented in this report, excellent bone fill was observed in the periapical defects. The observed benefit may be due to the role of fibrin in initial clot stabilization. The elaboration of various growth factors by the platelets and leukocytes in the PRF clot may also play a role.

This review aims to evaluate the effectiveness of a collagen matrix (CM) utilized in periodontal plastic surgeries around natural teeth and implants. This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Review Manager 5.3 software was used for data analysis. Subgroup analyses were conducted by defect categories and follow-up periods. The GRADE system was applied to classify the quality of evidences. Out of 3,652 articles in the literature, 14 studies were included, totaling 1,260 defects in 565 participants. The meta-analysis showed that CM is superior to coronally advanced flaps (CAF) regarding gains in mean root coverage (MRC) and width of keratinized tissue (KTW). Insufficient evidence demonstrated that CM had higher complete root coverage (CRC). Connective tissue graft (CTG) presented better results in CRC, MRC, and KTW. Greater KTW was also found favoring CTG in implants. In subgroup analysis, moderate evidence showed that, compared to CTGs, CMs present similar results in CRC, MRC, and KTW when treating single gingival recessions. CTGs showed greater efficiency in KTW of multiple gingival recessions and long-term observations. CM presents suitable capabilities as an alternative to soft tissue graft, while CTG still shows better results in most clinical parameters.

After guided bone regeneration (GBR) with different devices, a layer of connective tissue called pseudo-periosteum can be observed above the newly formed bone. The aim of this study is to evaluate the clinical and histologic features and to suggest a classification of this connective tissue after GBR with nonresorbable membranes or titanium (Ti)-mesh plus resorbable membranes. Forty patients with partial edentulism in the posterior mandible were randomized into two groups: 20 patients were treated by means of Ti-reinforced dense polytetrafluoroethylene (d-PTFE) membrane (group A), while the other 20 patients were treated with Timesh and a cross-linked collagen membrane (group B). After 9 months and during re-opening surgery, bone density and pseudo-periosteum type were recorded. Pseudo-periosteum was classified into Type 1 (no tissue or tissue 1 mm); Type 2 (regular tissue between 1 and 2 mm); and Type 3 (irregular tissue or tissue > 2 mm). Histologic analyses were performed to identify the features of pseudo-periosteum. Out of 40 patients, 36 (n = 19 in Group A; n = 17 in Group B) with 99 implants were analyzed after GBR and according to the study protocol. The vertical bone gain was 4.2 ± 1.0 mm in Group A and 4.1 ± 1.0 mm in Group B. Group A had a higher bone density and greater amounts of type 1 periosteum than Group B (P = .01 for both). The preliminary results of this study show that both d-PTFE membranes and Ti-mesh plus collagen membranes are two valid options for bone augmentation in the mandible. However, nonresorbable membranes achieve higher bone density and a thinner pseudo-periosteum layer above the newly formed bone.

The objective of this article is to review ideal injection point and ideal dose of botulinum toxin-A injections to treat different types of gummy smile, and to present a case treated with the recommended method. An electronic search of literature was carried out by using PubMed, Embase, and Google Scholar. Reference lists of studies were also hand-searched for relevance. According to inclusion and exclusion criteria, five prospective studies with 135 subjects were included in this systematic review. Injection of botulinum toxin-A is a noninvasive and temporary treatment option for gummy smile, and the Yonsei point is a safe and reproducible injection point for treatment by practitioners of all types of gummy smile.