International Journal of Periodontics & Restorative Dentistry, 04/2007

Many articles address the predictability of immediate implant placement into extraction sockets; however, there are only a few reports that mention the indications and limitations of this technique. The aim of this article is to re-examine specific indications for immediate implant placement and to clarify the timing or "fourth dimension" relative to extraction and implant placement. The expanded concept of four-dimensional implant treatment planning involves the new axis of time, which must be considered along with the traditional spatial or threedimensional management of implant positioning.

Eight patients with malocclusions were treated with a new orthodontic-surgical technique that reduces the duration of treatment compared to conventional techniques. The monocortical tooth dislocation and ligament distraction (MTDLD) technique combines two different dental movements that work separately but simultaneously on opposite root surfaces. On the root surface corresponding to the direction of movement, vertical and horizontal microsurgical corticotomies are performed around each tooth root with a piezosurgical microsaw to eliminate cortical bone resistance. The immediate application of strong biomechanical forces produces rapid dislocation of the root and the cortical bone together. On the root surface opposite the direction of movement, the force of dislocation produces rapid distraction of ligament fibers. During the osteogenic process that follows, application of normal orthodontic biomechanics achieves the final tooth movement. All eight patients underwent periodontal and radiologic examinations for more than 1 year after treatment. No periodontal defects were observed in any of the patients, including one with a severe malocclusion and a thin periodontal tissue biotype. Compared to traditional orthodontic therapy, the average treatment time with the MTDLD technique in the mandible and maxilla was reduced by 60% and 70%, respectively.

The purpose of this study was to compare the clinical root coverage achieved with two connective tissue grafts that were removed from the same donor area at different times and used in subepithelial grafts for root coverage. Sixty patients, each of whom had two connective tissue grafts removed from the same donor area at different times, were included in this study. The connective tissue grafts were used in two different subepithelial grafts for root coverage. The subepithelial grafts with both the first and second connective tissue grafts produced statistically significant changes in recession, probing depth, width of keratinized tissue, and attachment level. The changes obtained in the clinical measurements were not statistically significantly different between the first and second connective tissue grafts. The mean percentages of root coverage with the first and second connective tissue grafts were 95.4% and 98.2%, respectively, a statistically significant difference. None of the factors evaluated (sex, age, smoking history, and time between the two surgeries) could be related to statistically significant differences in the mean root coverage obtained. In this study, the second connective tissue graft produced greater mean root coverage than the first connective tissue graft.

Clinical results with acellular dermal matrix graft (ADMG) in periodontal surgeries suggest that the material is incorporated by the host tissues. However, histologic studies of the ADMG incorporation process are limited. The objective of this study was to evaluate the incorporation of ADMG into gingival tissues in a dog model. Gingival recession-type defects were created at the canines of six dogs. After 6 weeks, periodontal surgeries to repair the defects were performed using ADMG. Two animals each were sacrificed after 4, 8, and 12 weeks. At 4 weeks, thick collagen fibers from the ADMG were clearly seen in the connective tissue, and some blood vessels were penetrating into the ADMG. At 8 weeks, blood vessel penetration was enhanced, and collagen fiber bundles from the ADMG were seen sending branches into the connective tissue in all directions. After 12 weeks, the ADMG and the connective tissue seemed to be well integrated into a single highly vascularized structure, indicating almost complete incorporation of the ADMG.

This study investigated the influence of changes in tooth color on judgments of facial attractiveness. Standardized photographs were presented, and teeth were digitally manipulated (main categories: original, whitened, colored; filler category: impaired). Participants were instructed to evaluate the faces for attractiveness. Additionally, they were asked to name facial features they found either positive or negative with regard to attractiveness. Whitened teeth were mentioned more often in a positive way but did not improve participants' assessment of attractiveness. A colored tooth did not attract attention, and the attractiveness judgment did not worsen. Tooth color is thus not necessarily perceived and does not have a major impact on facial attractiveness.

The purpose of this article is to report on the long-term clinical evaluation of patients treated with dental implants. A total of 106 implants were placed in 34 patients and restored with fixed partial dentures and overdentures. The 12-year cumulative implant survival and success rates were 95.2% and 90.2%, respectively. Probing depths around mandibular implants were significantly lower than those around maxillary implants (P .05). The cumulative implant success rate in nonsmokers was 97.7%, but this dropped to 75.81% in smokers. Also, patients rehabilitated with implant-supported overdentures had more peri-implant tissue inflammation than patients with fixed prostheses.

Many studies have shown success with immediate loading of dental implants. The purpose of this paper is to report on a procedure that places implants with a sandblasted and acid-etched surface and loads them with a fixed, provisional, immediately loaded mandibular complete denture, all in a single day. The various surgical, prosthetic, and laboratory phases are explained, with particular attention paid to a luting technique that is able to reduce prosthetic misfit. A series of 14 patients was treated with this protocol and followed for a mean of 28.2 months. A 100% implant survival rate was achieved, and all prostheses were in place and functioning at the most recent follow-up.

The coronally advanced flap (CAF), either by itself or combined with other soft tissue grafts, provides predictable root coverage. However, it is a major challenge to suture and secure the flap coronally and stabilize its position over the entire healing period. Thus, the purpose of this study was to introduce a modified incision design and a suturing technique (sling and tag [SAT]) to enhance the results of CAF for root coverage. Ten patients with Miller Class I gingival recession defects (>= 2.5 mm) were treated. Clinical parameters assessed included recession depth (RD), recession width (RW), clinical attachment level (CAL), probing depth (PD), gingival tissue thickness (GT), and keratinized gingiva width (KGW). Measurements were taken at baseline and 6 months and 1 year later. The paired t test was used to compare presurgical and postsurgical results. Statistically significant (P .05) reductions in RD (2.6 ± 0.5 mm) and RW (2.9 ± 0.9 mm) were observed at 1 year. An average of 93.0% ± 14.8% root coverage was achieved. In addition, a statistically significant CAL gain of 3.3 ± 1.0 mm was obtained. No statistically significant differences were found in PD and KGW before and after therapy. The newly introduced flap design and SAT suturing technique may enhance the results of CAF for root coverage.

The potential benefits of platelet-rich plasma in the healing of isolated defects are unclear. The purpose of this study was to evaluate the effects of PRP on bone healing in titanium bone chambers, which represented isolated defects. PRP was prepared from blood collected from six adult female albino New Zealand rabbits. Titanium bone chambers with a 4-mm inner diameter were implanted into the tibiae of each animal at baseline and 2 weeks later; chambers healed for 6 or 8 weeks, either with PRP (test) or without PRP (control). Bone chambers were harvested from each animal and processed for histologic evaluation. Bone formation in 8-week test samples was not significantly different from that of the 6-week test samples. In control samples, more bone formation was seen at 8 weeks than at 6 weeks. The fibrous tissue content in control samples was higher than that of the test group in superficial sections, revealing that the tissue differentiation rate was higher in the test chambers. Time-dependent bone tissue differentiation in bone chambers augmented with PRP is higher than in normal wound healing, and PRP seems to increase the rate of tissue differentiation in early healing.