International Journal of Periodontics & Restorative Dentistry, 06/2019

Vertical bone augmentation techniques are more invasive than other procedures, and success rates often vary according to the surgical expertise of the clinician. As a result, there has been a trend over time towards minimally invasive treatment options in implant dentistry. This article discusses a "graft less" treatment philosophy that emphasizes the use of less-demanding augmentation techniques for the purpose of placing shorter implants in atrophic posterior sites, avoiding more complicated procedures for implant placement. In the posterior maxilla and mandible, the use of short implants ( 8.0 mm) can reduce the need for vertical bone grafting. Patients often prefer this strategy over more complex procedures that can cause complications, increase morbidity, and require longer treatment times with higher costs. When inadequate available bone is present for implant placement, planned bone augmentation procedures may be performed for the purpose of placing shorter implants; these procedures are less demanding, less invasive, and more predictable, allowing long-term outcomes for the implant-supported restoration.

This case report presents the preliminary results of combining a modification of the nonincised papillae surgical approach (NIPSA), attempting to improve outcomes in the treatment of teeth with advanced periodontal support loss. The modification added a connective tissue graft (CTG) in the buccal aspect of these unfavorable cases caused by deep buccal bone dehiscence, soft tissue deficiencies, or tooth malposition (especially when positioned outside the bony contour). Deep, intrabony, noncontained defects affecting the maxillary incisors were treated in four patients. At the 1-year follow-up, all cases showed an improvement in the marginal soft tissue with considerable reductions in periodontal pocket depth and gains in clinical attachment. NIPSA plus CTG seem to improve clinical outcomes in deep, noncontained intrabony defects.

Soft tissue contour changes were evaluated in 20 patients who underwent immediate implant placement with provisional restoration. The bone-to-implant gap was accurately grafted with xenograft prior to implant placement, and enamel matrix derivative was applied prior to delivery of an immediate screw-retained restoration. No significant differences were observed between baseline and 1 year after implant placement in soft tissue contour measurements and the Pink Esthetic Score. Furthermore, no differences were observed between thin or thick biotypes. It was shown that the use of immediate single-tooth implants with immediate restoration resulted in the maintenance of the soft tissue contour and esthetics when compared to pretreatment independently from the soft tissue phenotype.

The aim of this study is to evaluate the long-term performance of anodized surface implants placed in native bone and followed-up for up to 17 years. Success and survival rates, prevalence of peri-implantitis, and the correlation between the presence of peri-implantitis and other clinical and demographic variables were calculated. After a mean follow-up time of 10.4 years (range: 5 to 17 years), 91.7% of 223 analyzed implants were still in function. Periimplantitis affected 63 implants (28.3%) in 26 patients (44%). Eleven implants with peri-implantitis (4.9%) failed. Within the limits of this retrospective analysis, anodized implants appear to be prone to peri-implantitis, mainly in the posterior mandible and in patients with unsatisfactory plaque control.

Using interim restorations to remodel the peri-implant gingiva contour has been a common procedure in esthetic implant treatment. During the interim restoration delivery, the pressure between the restoration and gingiva typically causes ischemia. Adequate restoration should allow the tissue to recover from ischemia over a certain time. To assess the time needed for peri-implant soft tissue recovery, interim restorations were delivered on 25 single implant sites 2 weeks after stage-two surgery, and the gingiva appearance changes after delivery were recorded for 15 minutes using a video camera. Gingiva color changes along the time were measured and analyzed. The color differences between peri-implant mucosa at 10 min and 0 min, as well as between adjacent tooth gingiva, were all within a clinically acceptable range of color difference. The adaptive pressure technique by two-stage contouring exhibited an optimal peri-implant soft tissue profile within 10 minutes of the adaptive time.

The objective of this study was to evaluate the influence of two finish lines on the fracture resistance and periodontal response of porcelain zirconia crowns. Ethical committee approval was obtained, and 50 zirconia single crowns were placed in posterior regions. Abutments were randomly distributed into two groups: Group 1 (feather-edge preparation) and Group 2 (chamfer preparation). Patients were recalled after 1 month, 6 months, and 1, 2, 3, and 4 years. The function, esthetics, and marginal adaptation of the restorations were evaluated. Bleeding on probing (BoP) and distance of margins from the bone crest were recorded. Statistical analyses were performed for survival and success rates. Group 1 had an 80% success rate (21/25 crowns) and a 96% survival rate (24/25 crowns; 1 encountered irreparable fracture of ceramic layer); Group 2 had a 76% success rate (20/25 crowns) and a 100% survival rate (25/25 crowns). Chippings were noticed on 4 crowns in Group 1 (one crown replacement). Five chippings occurred in Group 2, without any replacement. There were no statistically significant differences between the two groups. BoP was found in 18 of the 25 crowns in Group 1 (72%) and in 12 of the 25 crowns in Group 2 (48%). A statistically significant correlation between BoP and the distance of the margin to the bone crest was found. It was concluded that: (1) clinical survival and success rates of the two preparation methods on crowns are not significantly different; (2) due to the statistically significant correlation between BoP and the distance of the margin to the bone crest, margins should be placed at least 3 mm from the bone crest; and (3) higher probability of BoP is expected in cases with feather-edge preparation.

Partial-thickness double pedicle flap and connective tissue graft (CTG) is a procedure to treat single gingival recession in the anterior mandible. However, long-term data have not been reported. Patients who had been treated by the same periodontist in a private practice in Belgium between 2002 and 2009 were invited to return for a clinical examination in 2017. Seventeen patients (15 females, 2 males; mean age: 34.6 years) with a total of 23 treated single recessions were reexamined after 8 to 15 years of follow-up. Between 1 and 8 to 15 years of follow-up, mean and complete root coverage did not differ and amounted to 75% and 44% at study termination, respectively (P = .204). The esthetic outcome was mediocre, given a final mean root coverage esthetic score of 6.52. The Mucosal Scarring Index demonstrated a significant reduction in scarring between 1 and 8 to 15 years of follow-up; however, 31% of the cases still demonstrated some scarring in the end. Patients were less critical than clinicians, as they expressed high esthetic (mean: 81) and low scarring (mean 14) scores on visual analog scales. Partial-thickness double pedicle flap and CTG is an effective root-coverage procedure. However, alternative techniques may need to be considered for esthetically demanding patients.

The aim of this split-mouth, randomized controlled clinical trial was to evaluate the efficacy of low-level laser therapy (LLLT) and photodynamic therapy (PDT) as an adjunct to scaling and root planing (SRP) in treatment of chronic periodontitis. Each quadrant was categorized into control group (SRP alone; two quadrants per patient), test group 1 (SRP + PDT), and test group 2 (SRP + LLLT. The test groups showed significantly higher reductions in Gingival Index, probing depth, and clinical attachment level as well as reductions in Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans counts at 1-, 3-, 6-, and 9-month follow-ups when compared with the control group.

The objective of this study was to compare the novel extraction-site development (XSD) technique with spontaneous healing. Advanced alveolar defects (extraction defect sounding, classes 3 and 4) at 33 single-rooted teeth were treated by XSD (test), and 21 extraction sites of single-rooted teeth were left for spontaneous healing (control). In pre- and postoperative cone beam computed tomography (CBCT) data sets, orovestibular and vertical socket dimensions were assessed, as were socket areas. XSD resulted in complication-free healing with significantly higher radiographic bone fill compared to spontaneous healing. Application of the XSD approach may reduce the need for augmentative procedures during implant placement.

The purpose of this article is to compare the larger (8 × 10-mm single implant and 15 × 20-mm multiple implant) lateral window designs used in the sinus elevation procedure with a newly proposed, less-invasive window design and discuss the advantages and limitations of the new design. The less-invasive window designs differ from the larger window designs in both the size and shape of lateral windows. Following creation of a round-window osteotomy, the quality of the sinus membrane and its ability to be elevated are assessed. The initial window can then be enlarged as a vertical oval window for a single implant or a horizontal oval window for multiple implants. The advantages of these window designs include the preservation of the lateral walls, blood supply to bone grafts, and better containment of the graft material. The limitations of these window designs are decreased visibility, accessibility for correcting a membrane perforation, and access for draining a sinus infection if one occurs. These complications necessitate increasing the size of the window as needed for successful treatment. The proposed less-invasive window design provides distinct advantages for a successful sinus elevation procedure and decreased patient morbidity.

This retrospective study sought to compare a new implant (Astra Tech OsseoSpeed EV, Dentsply Sirona) with its predecessor (Astra Tech OsseoSpeed TX) by scanning electron microscopy and interferometry. Radiographic data from 19 patients who underwent implant restoration with EV (n = 49) with a median follow-up of 16 months were evaluated for mean bone level (MBL) changes from delivery of the definitive prosthesis. EV and TX did not differ in surface roughness, and both systems had a tight seal at the implant-abutment interface. The median MBL change of the EV was −0.02 mm mesiodistally after a median follow-up period of 16 months. Greater maintenance of MBL was found in the screw-retained restorations (n = 17) compared to cemented (0.35 ± 0.33 mm and −0.38 ± 0.76 mm, respectively; P = .03). The data suggest that EV shows minimal levels of bone loss and high implant survival.

The aim of the present prospective study was to evaluate the stability of periimplant soft tissue and the stability of the implant-gingival unit (IGU) around one-stage titanium implants with a laser-microgrooved collar surface following 3 years of loading. Thirty one-stage titanium implants with a laser-microgrooved collar surface were placed in 30 partially edentulous patients. Clinical and radiographic examinations were carried out at implant placement, after a period of 4 to 6 months free of masticatory loading, and after 3 years of function. Plaque Index (PI), modified sulcus bleeding index (SBI), probing depth (PD), distance between the implant coronal margin and the mucosal margin (DIM), clinical attachment level (CAL), and keratinized tissue width (KTW) and thickness (KTT) were recorded. Radiographic marginal bone levels (MBL) were assessed at the mesial (MI) and distal (DI) aspects of implant sites. In addition, the influence of KTT on IGU stability was investigated. No implants failed during the follow-up period. Compared to baseline, PI, BPI, PD, DIM, CAL, KTW, MBL, and IGU showed differences that were not statistically significant (P > .05). Moreover, IGU didn't show a statistical correlation with KTT. Within the limitations of the present study, it can be concluded that around one-stage implants with laser-microgrooved collar, the peri-implant tissues and IGU remain stable over the three evaluation periods.

This prospective pilot study presents a novel method using the dentin shell technique for the three-dimensional reconstruction of alveolar bone defects. Autogenous dentin shell (≤ 2 mm) harvested from impacted third molars was fixed at the recipient site as an external barrier. The space between the dentin shell and residual bone was filled with deproteinized bovine bone mineral particles mixed with concentrated growth factor (CGF) pieces. Autogenous bone (gold standard for bone graft) was applied to prepare shell grafts as the control. A total of 13 patients were included in the study and received bone reconstruction with the dentin shell technique (dentin group, n = 7) or bone shell technique (bone group, n = 6), respectively. At 24 weeks postsurgery, cone beam computed tomography results showed no statistically significant difference between the two groups regarding vertical bone gain and vertical and horizontal bone resorption. Histologic and microcomputed tomography analyses revealed significant newly formed bone connecting directly to the resorbed dentin shells. The dentin shell technique restored bone volume successfully without major complications.

This case report demonstrates long-term implant stability associated with focal cemento-osseous dysplasia (FCOD). The nature of the cementum-like tissue (CLT) of FCOD around the titanium surface of the implant is described clinically, radiologically, and histologically. A dental implant placed directly into the FCOD lesion was successfully integrated, and the stability was maintained for 15 years. However, at the 16-year follow-up, the implant and a sclerotic mass were removed due to peri-implantitis, and the entire specimen was evaluated with conventional histology and microcomputed tomography. The analysis revealed that the sclerotic mass attached to the implant was CLT that was free of any intervening soft tissue. The implant placed into the FCOD lesion achieved integration similar to that of conventional osseointegration. Rather than bone, the CLT was in direct contact with the titanium surface. The integrity of the union was maintained for up to 16 years.

Tunnel (TUN) technique is normally performed in combination with soft tissue grafts, either autogenous connective tissue graft (CTG) or substitutes, regardless of a patient's biotype. The aim of this study was to investigate the efficacy of graftless TUN in the treatment of multiple gingival recessions (GRs) characterized by thick or very thick biotype. Twenty-seven GRs were treated in seven patients using graftless TUN. At 6-month postoperative evaluations, the mean root coverage (mRC) was 84.57 ± 31.1%, while complete root coverage (CRC) was achieved in 77.8% of treated GR sites and in six out of seven patients. On average, the esthetic evaluation performed using the root coverage esthetic score (RES) resulted in a final score of 9.1 ± 1.4. Sixteen sites achieved the maximum RES score, and in six patients, an RES ≥ 9 was observed in all sites. Graftless TUN showed predictable root coverage and improved esthetics in treating GRs in patients with a thick or very thick biotype. Nevertheless, further studies with a large number of subjects are needed to support these preliminary outcomes.

The aim of this study is to evaluate the anatomical characteristics of the posterior region of the mandible and their surgical relevance related to bone harvesting procedures. Fifty retromolar cone beam computed tomography scans were analyzed considering the donor site anatomies. For each site, linear measurements were taken of cross-sectional scans to record perpendicular distances between the mandibular canal (MC) and the vestibular and crestal bone walls. Data showed that the distance from the MC to the vestibular bone wall is lower in the ramus area than in the external oblique ridge area ( 2.00 mm in 26% of cases). However, the distance between the MC and the crestal bone wall is higher in the ramus area than in the external oblique ridge area. There is less bone thickness in the ramus area, and this could expose the inferior alveolar nerve to damage if osteotomies are performed with fewer depth limitations, as reported in the literature.

Several methods are used for periodontal regeneration and alveolar ridge reconstruction. This study aimed to compare the bone regeneration capacities of MinerOss X, Bio-Oss, and autograft in rabbit calvaria. In this animal study, four defects measuring 8 mm in diameter were created in the calvaria of 10 rabbits using a trephine bur. Three defects were randomly filled with MinerOss X, Bio- Oss, and autogenous bone. The fourth defect remained empty as a control. The rabbits were sacrificed after 4 or 8 weeks. Calvarial samples were taken and histopathologically evaluated. The mean number of osteoblasts and the amount of newly formed bone in all groups were higher at 8 compared to 4 weeks. At 4 and 8 weeks, the amount of newly formed bone and number of osteoblasts and osteocytes in MinerOss X group were significantly greater than the corresponding values in other groups, and MinerOss X was superior to Bio-Oss and autograft in all the assessed variables at both 4 and 8 weeks (P .001). Within the limitations of this study, the results showed that the number of osteoblasts and osteocytes and the amount of newly formed bone in the MinerOss X group were higher than those in Bio-Oss and autograft groups. However, further clinical studies are warranted.