International Journal of Periodontics & Restorative Dentistry, 02/1993

This paper presents an evaluation of the use of the principles of guided tissue regeneration to correct the osseous defects associated with the placement of dental implants. The biologic rationale for the use of supplemental materials, such as decalcified freeze-dried bone allograft, is discussed. The results of this investigation suggest that the use of a physical barrier in combination with a bone allograft can produce successful results in 97% of the defects treated.

This paper discusses whether autogenous tooth transplantation can survive as an option in the future dental armamentaria. Clinically, successful transplants must show a radiolucent space between the roots and surrounding bone. There must be no evidence of ankylosis, no permanent root resorption, and no inflammation. Histologically, the criterion of success is a normal and functional periodontal ligament between the root surfaces of transplants and the bone or gingival connective tissues. Case reports are presented to illustrate replantation or transplantation of teeth. Possible donor teeth are those with the proper amount of viable periodontal ligament, single-rooted teeth, third molars, and malpositioned or impacted teeth. The transplantation procedure involves extraction of the donor tooth, measurement of the root form and amount of periodontal ligament, preservation of donor tooth, preparation of recipient socket, positioning of donor tooth, suturing, and temporary splinting.

This study examines and characterizes the soft tissue wall of periodontal pockets after a 10-day in vivo exposure to monolithic tetracycline-impregnated fibers, with and without root planing. Four teeth from each of eight patients were randomly assigned to (1) nontreatment (controls), (2) treatment by root planing only, (3) treatment by tetracycline fiber only, or (4) treatment by scaling and root planing and tetracycline fibers. Ten days after initial therapy, all teeth were extracted with associated soft tissue pocket walls intact. Three specimens were obtained from each tooth for examination by scanning microscopy, energy dispersive spectroscopy, and light microscopy. Results indicated that use of tetracycline-impregnated fibers over a 10-day period did not adversely affect the epithelial lining and had no significant effect on the density or character of the inflammatory response present in adjacent soft tissue and confirmed the antimicrobial effects of the fibers.

In the two cases described, the problems of insufficient bone and insufficient soft tissue in the edentulous ridge were addressed concurrently. Freeze-dried demineralized bone was used to fill the osseous defect. Freeze-dried fascia lata was used to prevent epithelial migration into the defect, act as a barrier, and eliminate a second surgery for membrane removal. This regeneration procedure can provide increased alveolar bone for better implant placement and esthetics.

In keeping with the concept of rapid epithelialization of close wound edges, the strip technique was developed to maximize the area of gingival grafting with less trauma to the donor site or the recipient site. An incision is made and a partial-thickness flap is reflected so that stable periosteum is left. The apical mucosal border of the recipient site is sutured to the periosteum. Donor tissues are obtained in 2-mm-wide strips, transferred to the recipient site, and sutured. Dry foil and surgical packing are used to stabilize and protect the site during healing. The donor site is rapidly epithelialized (within 10 days) and produces minimal patient discomfort.

The in vitro effect of citric acid application on periodontally involved root surfaces was investigated using scanning electron microscopy. Teeth were selected following specific criteria. The specimens were prepared for observation, and the features of the root surface were studied. The results demonstrated that a 3-minute application of citric acid (pH = 1.0) to the root surface after scaling and root planing demineralized the outer root surface, opened the dentinal tubules, and exposed collagen fibers. Scaling and root planing alone left the surface with a smear layer, scattered islands of cementum, and no collagen fibers or exposed dentinal tubules.