International Journal of Periodontics & Restorative Dentistry, 04/1995

Although regenerative and osseous procedures have different objectives, they can often be used in combination to achieve predictable results in certain bony defects. This article describes the anatomy of three-walled bony defects and explains the theory behind the combined regenerative-osseous surgical treatment of such lesions.

A load-free healing period has been advocated as a prerequisite to achieving osseointegration. This article reports two cases in whch immediate loading of a specially designated additional, or expendable, set of titanium root-form implants was successfully utilized to support provisional fixed restorations in the maxilla and the mandible. This immediate-loading protocol is suggested as a reliable adjunctive therapeutic modality for offering implant patients access to fixed interim restorations during the healing phase of the primary fixtures. Another advantage of this approach is that it provides protection from potential transmucosal overload of the primary implants as well as any sites undergoing osseous regenerative procedures.

Guided tissue regeneration procedures with Gore-Tex Periodontal Material are associated with a unique set of postoperative healing characteristics. Five healing complications are described in this study examining 102 sites. The occurence of pain and purulence were the most common. In Purulent sites, the majority of bacteria cultured were Actinomyces and Strepococcus spp. Resistance to antibiotics was common. Prevention and treatment of the healing complications are discussed.

The successful treatment of a large endodontically induced periradicular defect and soft tisseu fenestration by combined endodontic and periodontal therapy is described. Endodontics was performed on the mandibular left central incisor, the apex was resected, and a retrograde amalgam was placed. This defect was thoroughly described and the exposed root surface was planed with curettes. Deminerilized freeze-dried bone allograft and a nonresorbable membrane were placed over the defect and the exposed root surface. The membrane was removed in 6 months and there appeared to be bone regeneration with complete closure of the soft tissue fenestration. Endodontic therapy in combination with guided tissue regeneration ans bone grafting may provide another modality of treatment for endodontically related hard and soft tissue defects.

Three case reports of treatment of the failing implant are presented. The immobile but had lost a significant amount of osseous support. The cause of failure was determined to be a combination of bacterial and occlusal tramatogenic insult. The defects were debrided and the implant surface was detoxified with tetracycline. Decalcified freeze-dried bone allograft was implanted into the osseous defects and covered with expanded polytetrafluoroethylene material in accordance with principles of guided tissue regeneration. The barrier membrane was removed 6 to 8 weeks after placement. Eight months to 1 year posttreatment, all sites demonstrated a substantial reduction in probing depth, a gain inclinical attachment, and bone fill of the defects adjacent to the implant.

This case report demonstrates the use of osseointegrated implants to replace the mandibular left second premolar and first and second molars removed during a surgical resection of a walnut-sized ameloblastoma. The first-stage surgery was performed 2 years after the oncologic surgery, and it was necessary to laterally repositon the inferior alveolar nerve prior to placement of implants. The patient has been restored to full dental function. There was no occurrence of paraesthesia at any time. The treatment plan and the treatment were a collaboration of an oral surgeon, a periodontist, and a restorative dentist, located in Sweden, the United States, and Italy, respectively, and is an indication of what can be accomplished to the benefit of the patient when teamwork is exercised.

This case report describes the use of a strip gingival autograft to transplant narrow strips of keratinized gingiva around dental implants. Replacement of unattached, nonkeratinized mucosa with keratinized gingiva resulted in firmly attached gingiva and an improved seal around implants that was healthier and more ressitat to imflammation. The strip gingival autograft technique is a simple surgery that results in less discomfort for the patient and provides predictable results.