International Journal of Periodontics & Restorative Dentistry, 01/2002

The present review article discusses the one- and two-stage surgical protocol for dental implant placement as well as the critical amount of micromotion at the bone-implant interface to obtain proper osseointegration. The relevant literature supporting the hypothesis that splinting of individual implants as soon as possible following installation via a rigid fixed device will most likely decrease the micromotion at the bone-implant interface thus facilitating proper bone healing (osseointegration) is reported. As a consequence of this approach, the treatment period can be significantly reduced. Finally, the importance of an objective evaluation of the bone quality and initial implant stability is highlighted. The information thus obtained via tools already available will facilitate the decision as to whether to load implants immediately, early, or late, and the term individual functional loading is coined.

It is the aim of this article to present a case report involving the biopsy and subsequent histologic analysis of an acellular dermal matrix. The area of the graft in contact with the root surface did not demonstrate a histologic attachment, but was defined as fibrous tissue apposition to the root surface. In addition, the coronal portion of the graft did not appear to be revascularized or revitalized as would be expected with an autogenous soft tissue graft. Finally, no new cementum formation was seen, but displacement of the junctional epithelium was observed.

The aim of the present work was the evaluation of implant stability and periimplant bone reaction by histologic and clinical evaluation after therapeutic orthodontic loads. Forty-one adult patients received titanium implants as an orthodontic anchorage device; 12 patients received a retromolar or palatal implant to obtain tooth movement. Seven implants were removed at the end of the orthodontic therapy, after 2, 4, 6, and 12 months of orthodontic load, and processed for histologic examination. It was possible to distalize maxillary and mandibular molars and a group of teeth (molars and premolars), and to obtain tipping, uprighting, intrusion, extrusion, and transfer of anchorage in other parts of the mouth. The results showed that orthodontic therapy is facilitated and quickened by the use of implants. All implants remained stable in the bone up to 12 months of loading, and all were osseointegrated. Microfractures, microcracks, and microcalli were observed around implants that had been placed in both low- and highdensity bone. The remodeling rate was still elevated after 18 months.

Platelet-rich plasma is an autologous product that is derived from whole blood through the process of gradient density centrifugation. The proposed value of this product in dental implantology and in bone augmentation procedures lies in the ability to incorporate high concentrations of the growth factors PDGF, TGF-ß1, TGF-ß2, and IGF, as well as fibrin, into the graft mixture. Research has shown an increased bone maturation rate and improved bone density when this product, or its recombinant growth factors, is added to small bony defects or to larger defects that use autogenous bone as the grafting material. This study tested the efficacy of platelet-rich plasma in three bilateral sinus graft cases with grafts of anorganic bovine bone that contained minimal or no autogenous bone. Histomorphometric analysis indicated that the addition of platelet-rich plasma to the grafts did not make a significant difference either in vital bone production or in interfacial bone contact on the test implants.

The purpose of this study was to evaluate the long-term stability of the results obtained when guided tissue regeneration (GTR) is used to obtain root coverage. A mean root coverage of 92.3% was obtained at 6 months postoperative. However, at the final postoperative visit (mean 25.3 months), the mean root coverage was reduced to 58.8%. This difference was statistically and clinically significant. There was a statistically significant increase in recession (1.4 mm) and a statistically significant loss in attachment levels (1.7 mm) between the 6-month and final postoperative evaluations. The results of this study question the long-term stability of the result when GTR is used for root coverage.

This article has been written to show the opportunity and eventually the predictability to obtain new papillae between implants and a better esthetic result by the use of a new suturing technique. After raising a full-thickness flap from the palatal to the vestibular side, it can be stabilized in such a position using a new suturing technique (ramp mattress suture) to apply pressure and tearing forces on the flap in an apicocoronal direction at the vestibular site and an opposite traction in a coronoapical direction at the palatal site. The ramp mattress suture seems to be capable of pulling the flap in an apicocoronal direction in the vestibular site, as well as in a coronoapical direction in the palatal site. Thanks to such a mattress suture, it will be possible to obtain a more coronal gingival margin. After an adequate healing period of approximately 5 weeks, a vestibular scalloped gingivectomy is performed around the vestibular surface of the abutment to create either a scalloped gingival margin or interproximal papillae only in the vestibular area, forming a gingival ramp in a palatovestibular direction to reasonably reduce the residual increased vestibular depth and optimize the esthetic result. Eight patients, for a total of 56 papillae, were treated with this new suturing technique. The esthetic results satisfied both clinician and patient expectations.

With the present knowledge of osseointegration and implants, it seems reasonable to hope that implants will be placed in a way that provides optimal function, esthetics, and phonetics. The esthetic objectives of implant dentistry should be similar to those of conventional prosthodontics, and the esthetics for implants begins with implant placement. Often, because of limitations in position and/or quality of bone, implants may have to be placed in locations that are not ideal in the axial position. Preangulated and customized abutments have been used in some situations primarily to salvage poorly placed implants. An adequate zone of attached gingiva is also necessary around these restorations to hide the periimplant restoration boundary and provide for a good soft tissue profile, which is the essence of esthetics. There are numerous situations where implants have been placed in areas of minimal keratinized gingiva. The crown margin around these areas of thin gingiva is usually supragingival; therefore, the esthetic appearance is poor. Three case reports, which are part of a preliminary study, outline a plastic surgical technique of tunneling/pouching and the use of submerged connective tissue grafts. This technique allows the thickening of the existing gingiva but is also useful for reconstructing interdental papillae around implant-supported restorations.

This article describes the clinical aspects and the histologic features of three cases of gingival cyst of the adult. The diagnostic problems of this rare entity are discussed. Radiographic examination to determine the presence of bone loss must be undertaken to differentiate the gingival cyst of the adult from the more frequent lateral periodontal cyst.

Clinical procedures designed to reestablish the idealized framework for the achievement of optimal esthetic restorative results have been frequently reported. Yet complex cases, where remarkable improvements of esthetic appearance are achievable in spite of preoperative conditions, are infrequently presented because the presentation standards appear to be set for idealized situations. If a classification system that reflects dental esthetic compromises and ideals existed, cases could be categorized accordingly, and realistic expectations could be applied to assess the effectiveness and results of a course of therapy. Considering that there is not currently a published classification system to this end, it is the purpose of this article to tender a classification of altered dental esthetics.