International Journal of Periodontics & Restorative Dentistry, 04/2018

Predictable coverage of deep isolated mandibular gingival recessions is one of the most challenging endeavors in plastic-esthetic periodontal surgery, and limited data is available in the literature. The aim of this paper is to present the rationale, the step-by-step procedure, and the results obtained in a series of 24 patients treated by means of a novel surgical technique (the laterally closed tunnel [LCT]) specifically designed for deep isolated mandibular recessions. A total of 24 healthy patients (21 women and 3 men, mean age 25.75 ± 7.12 years) exhibiting one single deep mandibular Miller Class I (n = 4), II (n = 10), or III (n = 10) gingival recession ≥ 4 mm were consecutively treated with LCT in conjunction with an enamel matrix derivative (EMD) and palatal subepithelial connective tissue graft (SCTG). The following clinical parameters were assessed at baseline and 12 months postoperatively: probing depth (PD), clinical attachment level (CAL), complete root coverage (CRC), mean root coverage (MRC), recession depth (RD), and keratinized tissue width (KTW). The primary outcome variable was CRC. The postoperative morbidity was low, and no complications, such as bleeding, infections/abscesses, or loss of SCTG, occurred. At 12 months, CRC was obtained in 17 of the 24 defects (70.83%), while in the remaining 7 defects RC amounted to 80% to 90% (in 6 cases) and 79% (in 1 case). Of the 17 defects exhibiting CRC, 12 were central incisors and 5 were canines. With respect to defect type, CRC was found in 3 of the 4 Miller Class I, 8 of the 10 Class II, and in 6 of the 10 Class III defects. Mean RD changed from 5.14 ± 1.26 mm at baseline to 0.2 ± 0.37 mm at 12 months, while MRC amounted to 4.94 ± 1.19 mm, representing 96.11% (P .0001). Mean KTW increased from 1.41 ± 1.00 mm at baseline to 4.14 ± 1.67 mm (P .0001) at 12 months, yielding a KTW gain of 2.75 ± 1.52 (P .0001). No statistically significant changes in mean PD occurred following root coverage surgery (1.8 ± 0.2 mm at baseline and 2.1 ± 0.3 mm at 12 months). The present results suggest that the LCT is a valuable approach for the treatment of deep isolated mandibular Miller Class I, II, and III gingival recessions.

The goal of this retrospective investigation was to provide evidence of the longevity of machine-surfaced implants placed in native bone and treated with the original two-stage surgical protocol. The observation times of this study covered periods of 13 to 32 years. Consecutive cases were impossible; the patients' ages when treated reduced the number of available people as a result of death, relocation, being impossible to find, or refusal to cooperate. Mean marginal bone loss after 13 to 32 years was 1.9 ± 0.9 mm, survival rate was 97.7%, and success rate was 92.7%. Peri-implantitis occurred in a limited number of cases, with a prevalence of 1.8%. This study demonstrates long-term reliability of machined implants as a therapeutic choice.

The aim of this study was to investigate the survival rate of implants immediately placed in fresh extraction sockets of molars in the maxilla and mandible with a single-stage procedure. A total of 102 patients were treated, and 107 implants (53 in the maxilla and 54 in the mandible) were placed in a fresh molar extraction socket and connected to a healing abutment. After a mean follow-up of 3 years (range: 1 to 6 years) 1 implant failed, for a cumulative success rate of 99.06% (98.11% for the mandible and 100% for the maxilla). The results of this study support placement of an implant immediately after the extraction of a molar, applying a single-stage procedure.

Flap management is one of the key elements for success in periodontal surgeries and bone regeneration for dental implants. The aim of this article is to introduce a releasing incision method for effective flap advancement to obtain tension-free primary closure. The 'upward-motion scissors technique' (UMST) involves the use of surgical scissors handled with an upward motion to create multiple shallow incisions. The use of UMST is demonstrated in an anatomically challenging case requiring bone augmentation. This technique provides a novel approach for flap advancement and may reduce potential complications involved in releasing incisions. The true benefit of UMST needs to be evaluated in future studies.

This article presents the results of a soft tissue color study on flapless immediate implant therapy from a sample of 23 patients who received either a provisional restoration alone or with bone grafting. The gingival color in clinical photographs was measured for the implant and for the contralateral tooth site at 2.0 and 5.0 mm below the free gingival margin using Photoshop software (Lightroom CC, Adobe). The average color difference (ΔE) values for the two groups were 2.6 and 2.4 at 2.0 mm and 1.9 and 2.5 at 5.0 mm from the free gingival margin, respectively. Approximately 80% of the sites were below the visibly perceptible threshold (ΔE = 3.1 ± 1.5) and not detectable by the human eye. The use of provisional restorations has shown positive outcomes on the stability of peri-implant soft tissue thickness and lower ΔE values. Further research is required to assess esthetic outcomes inclusive of color change relative to the clinical treatment rendered.

Attached gingiva is desirable for the maintenance of gingival health. Although many methods are used to increase the zone of attached gingiva, the modified apically repositioned flap (MARF) technique has the advantages of simplicity and predictability. The short-term follow-up of the MARF technique demonstrated an increase in keratinized tissue and attached gingiva. This study evaluated long-term results of the MARF technique as used to increase the apicocoronal dimensions of keratinized tissue and attached gingiva in 28 sites (25 patients; average follow-up of 9 years). There was a statistically significant increase in keratinized tissue and attached gingiva with no increase in probing depths or gingival recession. These results suggest that the MARF procedure predictably generates keratinized tissue and attached gingiva with long-term stability.

This study was aimed at comparing the most common two methods for gingival troughing: presaturated cord and lasers (including diode, Nd:YAG, and Er:YAG). A total of 108 anterior teeth (58 maxillary and 50 mandibular) in 50 patients were included in this study. Gingival treatment was carried out in the following four groups: presaturated cord, diode laser, Nd:YAG laser, and Er:YAG laser. The gingival width and gingival recession (GR) were measured at different times (at the time of treatment, after 1 week, and after 4 weeks). The presaturated cord resulted in significantly higher (P .05) GR than lasers and narrower gingival sulci. Er:YAG laser resulted in the quickest and most uneventful wound healing when compared to diode and Nd:YAG lasers.

To accurately assess the long-term performance of anodized-surface implants, more data monitoring is needed outside of clinical evaluations. This retrospective study evaluated long-term implant survival and bone remodeling after up to 12 years of function. Data from 195 implants placed in 60 patients over a follow-up period ranging from 0.6 to 12.1 years were included. The implantlevel survival rate was 99.0%. Marginal bone loss remained low across all follow-up cohorts. The data show that anodized-surface implants are a safe, reliable option with high implant survival rates and low levels of bone loss.

The aim of this prospective clinical study was to evaluate dimensional changes following immediate placement of a fixed ovate pontic provisional restoration into an intact extraction socket without grafting. The mean buccolingual dimensional change at 1 month was 0.51 ± 0.48 mm and 0.93 ± 0.55 mm at 3 months. The mean incisoapical dimensional change at 1 month was 0.68 mm ± 0.19 mm, and at 3 months, 1.64 ± 1.35 mm. The dental literature reports dimensional change of 3 to 5 mm in width and 1 to 4 mm in height for ridges with no treatment following extraction. This study provides validation for the use of ovate pontics in the preservation of tissue contour. Further research is needed to determine whether placing a graft into the socket with placement of an ovate pontic will decrease dimensional changes after extraction.

The objectives of this study were to determine the quantitative changes after different ridge preservation techniques (primary aim) and to assess the possibility of placing a dental implant, the bone quality, and the need for bone augmentation (secondary aim). A total of 35 patients who required extraction of at least one tooth (incisor, canine, or premolar) provided 35 single-gap extraction sites. After minimally invasive tooth removal, the sockets were randomly scheduled for one of four treatment modalities: placement of a deproteinized bovine bone mineral (DBBM; Endobon, Biomet 3i) covered with a soft tissue punch from the palate (T1); placement of DBBM alone (T2); placement of DBBM covered with a resorbable collagen membrane (OsseoGuard, Biomet 3i) (T3); or no additional treatment (T4). Silicone impressions were taken before and 6 months after extraction for quantitative-volumetric evaluation (primary outcome). The possibility of placing an implant, bone quality, and need for further bone augmentation were also noted (secondary outcomes). During the study period, no adverse events were observed. No statistically significant difference was found between the four treatments regarding the primary and secondary outcome parameters (P > .05). However, T4 showed double the buccal contour change, with the highest variance compared to the other three groups (T1 -0.874 ± 0.713; T2 -0.968 ± 0.344; T3 -1.26 ± 0.942; T4 -2.15 ± 1.349). Although no statistically significant difference was found between the four treatment modalities, placement of DBBM resulted in only half the contour change ( 1 mm) compared to control sites (> 2 mm). Ridge preservation with a DBBM with or without soft tissue punch should be considered in esthetically demanding cases and delayed or late implant placement.

A variety of biomaterials are used when performing sinus augmentation techniques. Bovine hydroxyapatite (BH) has already been demonstrated to present osteoconductive properties. The aim of this article is to provide a histologic and histomorphometric analysis, at 26 months, of a bone specimen extracted from a BH maxillary sinus graft. Histomorphometric results showed 64.4% bone density and 24.4% biomaterial density. Histologic analysis revealed marked bone formation and high osteoconductive properties in the BH particles, with no associated signs of inflammation. Resorption appeared minimal. BH seems to present high biocompatibility and osteoconductive properties.

This paper introduces a three-stage split-crest (TSSC) technique for horizontal ridge augmentation in the atrophic posterior mandible. The first stage consists of splitting the ridge. Following a 3- to 4-week healing interval, the second stage consists of expansion of the cortical plate (without elevating the periosteum) and placement of a bone replacement graft material. After 3 to 4 months of healing, the implants are placed. The advantages of this three-stage technique are increased vascularization to the surgical area, a decrease in procedure complications, and improved implant survival rates. An extended treatment time is the main disadvantage. The purpose of this retrospective case series is to review and discuss a new step-by-step surgical procedure of a TSSC technique using a delayed implant placement protocol. The results, advantages, and limitations are also presented.

The purpose of this case series was to assess safety and feasibility of a novel resorbable collagen matrix (CMX) to enhance tissue thickness simultaneous with implant placement and guided bone regeneration (GBR) in esthetic sites over an 8-week healing period. Soft tissue thickness at implant sites and adjacent teeth was monitored with an ultrasonic device. Overall tissue contour changes were assessed by sequential digital surface model superimpositions. Periodontal parameters and patient-related outcomes revealed no significant changes. Combining a novel CMX and GBR revealed a significant soft tissue thickness increase of 1.56 mm at implant sites after 8 weeks, with no significant decrease between 4 and 8 weeks. The overall tissue contour increase was most significant at a distance of 5 mm from the mucosal margin, corresponding to a tissue increase at the implant shoulder area. No effect was observed at adjacent teeth after 8 weeks.

Bone regeneration and reosseointegration around a dental implant were radiographically and histologically analyzed after regenerative treatment for peri-implantitis, using a case from a human autopsy. A block specimen including the tissue around the implants was obtained from the patient, who died from cancer 20 months after regenerative surgery using a synthetic bone substitute to treat peri-implantitis. Microcomputed tomographic and histologic analyses were performed. Three-wall intrabony defects at the implant placed at the site of the mandibular left first molar and a circumferential defect at the implant at the site of the mandibular left second molar were substantially filled with newly formed bone and residual bone substitute particles, and reosseointegration on the previously exposed implant surface was histologically observed.

The purpose of this study was to evaluate clinical and radiologic outcomes using a newly developed device for maxillary sinus membrane elevation. Patients with a residual bone height of at least 3 mm were enrolled. Crestal sinus lift elevation and sinus graft were performed using the crestal approach sinus (CAS) kit. Graft was avoided if the residual bone crest was ≤ 2 mm less than the length of the planned implant. Outcome measures were implant and prosthesis failure, any biologic or technical complications, and marginal bone loss (MBL). A total of 35 consecutive patients underwent 49 crestal elevations of the sinus membrane. All the implants were followed for at least 2 years after placement (mean follow-up 37.3 months; range 24 to 54 months). No implants or prostheses failed during follow-up, and no membrane tears or other intraoperative or postoperative adverse events were observed. At the 2-year follow-up, mean MBL was 0.33 ± 0.24 mm (95% confidence interval: 0.08 to 0.30 mm). A total of 32 implants were placed after filling the sinus with anorganic bovine bone, while 17 implants were placed without grafting the sinus. Post-hoc analysis was performed using the sinus grafting remodeling index (SGRI) to evaluate radiographically the tissue remodeling patterns. The SGRI was statistically significantly higher when the sinus was grafted (P = .000). The CAS kit may provide a new option for minimally invasive crestal sinus surgery. Long-term randomized controlled trials with larger sample size are needed to confirm these preliminary results.

Hydraulic sinus lift and augmentation may be successfully performed using a dedicated implant device designed according to residual bone height (RBH). The aim of this study was to evaluate whether a flapless surgical approach might negatively influence the outcome. A total of 40 consecutive patients (16 men and 24 women) were included in the study, 20 in each group (minimal flap/control versus flapless/ study). Inclusion criteria were ≥ 3 mm RBH, ≥ 6 mm width of the residual alveolar ridge according to preoperative cone beam computerized tomography, and ≥ 8 mm buccopalatal keratinized gingiva for the flapless group. Primary outcome parameters included intraoperative membrane perforation. Secondary outcome parameters included postoperative infection, soft tissue healing, bone gain, and short-term dental implant survival. Mean RBH was 4.6 mm. No intraoperative membrane perforations and no postoperative infections were observed. Mean bone gain height was similar for both groups, at 11 mm. Soft tissue healing was observed within 2 months. In all cases, second-stage surgery allowed generation of at least 2 mm of keratinized gingiva buccally. All implants were osseointegrated at second-stage surgery. The use of a flapless approach to maxillary sinus augmentation using an implant device based on RBH yields predictable results.

The present study was performed to evaluate the impact of smoking status on 6-month clinical outcomes of a regenerative procedure based on enamel matrix derivative and deproteinized bovine bone mineral in the treatment of intraosseous defects accessed with buccal single flap approach. A total of 22 defects were selected in smoking (n = 11) and nonsmoking (n = 11) patients. Regenerative treatment resulted in similar clinical attachment level (CAL) gain in both smokers and nonsmokers. A trend toward lower 6-month CAL gain and probing depth reduction was observed in patients smoking 11 to 20 cigarettes per day compared to those smoking 1 to 10 cigarettes per day.

Owing to an increased demand for safe and esthetically pleasing dental materials, ceramics have been developed and optimized to rehabilitate anterior and posterior teeth. This evolution in ceramic materials is directly related to the development of sophisticated processing technologies and systems for use in dental medicine, particularly computer-aided design/computer-assisted manufacture (CAD/CAM) technology. This study is a systematic review outlining long-term clinical survival rates of single-tooth restorations fabricated with CAD/CAM technology with a minimum follow-up of 3 years. A bibliographic search up to September 2016 was performed using two databases: MEDLINE (PubMed) and Embase. Selected keywords and well-defined inclusion and exclusion criteria guided the search of relevant results. All articles were first reviewed by title, then by abstract, and subsequently by a full text reading. Data were assessed and extracted through a standardized form. The pooled results were statistically analyzed, and the overall failure rate was calculated by random effects model. Reported failures were analyzed by CAD/CAM system, type of restoration, restorative material, and luting agent. From a total of 2,916 single-tooth restorations with a mean exposure time of 7.0 years and 351 failures, the failure rate was 2.17% per year, estimated per 100 restoration years (95% confidence interval [CI]: 1.35% to 3.51%). The estimated total survival rate after 5 years was 89.7% (95% CI: 88.1% to 91.1%). The overall survival rate of single-tooth ceramic restorations fabricated with CAD/CAM technology was similar to those conventionally manufactured.

This study evaluated the influence of polishing protocols on the surface roughness of flowable and regular bulk fill composites. Five bulk fill composites were tested: SureFil SDR Flow (SDR), Tetric EvoFlow Bulk fill (TEF), Filtek Bulk Fill Flowable (FIF), Tetric EvoCeram Bulk Fill (TEC), and Filtek Bulk Fill Posterior (FIP). Two polishing protocols were tested: Sof-Lex and Astropol. Astropol created a smoother surface for FIP (P .05); however, the polishing protocol did not influence surface roughness on TEC (P > .05). SDR, TEF, and FIF exhibited rougher surfaces when polished. Sof-Lex created rougher surfaces for bulk fill composites. It was concluded that surface roughness was related to material composition rather than the polishing system.