International Journal of Periodontics & Restorative Dentistry, 02/2002

This prospective clinical study evaluated the 5-year survival and success rates of 66 titanium implants placed in bone that had been previously augmented with autografts and nonresorbable barrier membranes. During the observation period, three patients with five implants dropped out of the study. None of the remaining 61 implants were lost during the follow-up period (implant survival rate of 100%). One implant exhibited a periimplant infection, whereas 60 implants were considered clinically successful at the 5-year examination, resulting in a 5-year success rate of 98.3%. It can be concluded that the clinical results of implants in regenerated bone are comparable to those of implants in nonregenerated bone.

The use of guided tissue regeneration (GTR) procedures for the treatment of gingival recession has shown encouraging results and is gaining clinical acceptance. However, attaining space maintenance beneath the membrane remains a problem for clinicians. Hence, the purpose of this pilot case study was to evaluate the effect of adjunctive demineralized freeze-dried bone allograft (DFDBA) placement during collagen membrane GTR-based root coverage procedures. Five patients with Miller Class I or II defects were treated with a combination of DFDBA and collagen membrane. Clinical parameters monitored include recession depth, probing attachment level, probing depth, width of keratinized gingiva, and recession width. Measurements were taken at baseline and 6 months. A statistically significant reduction in recession depth (3.1 ± 0.7 mm) was observed at 6 months, representing 93.4% total attainable root coverage. A significant reduction of recession width (3.5 ± 1.2 mm) after 6 months was also noted. Clinically, a statistically significant mean gain of 3.3 ± 0.6 mm in clinical attachment and 0.8 ± 0.9 mm in keratinized gingiva were obtained at 6 months. No statistically significant difference was found in probing depth between baseline and 6 months postoperative. Plaque and gingival indices remained low and showed no statistically significant change throughout the study period. Results from this pilot case study indicate that use of DFDBA during collagen membrane GTR-based root coverage could be beneficial.

Osseointegrated implants have been used with outstanding success in periodontally healthy patients in recent years and have thus become an established part of prosthetic treatment. Whereas initial reports were confined to their use in edentulous patients, in particular in the mandibular area, first results on their application in the oral rehabilitation of partially edentulous patients were published in the mid-1980s. Whether the positive results reported in periodontally healthy patients are also applicable to patients with progressive periodontal disease has yet to be clarified. As only a few controlled longitudinal studies dealing with the success of implants in periodontally involved patients have been published to date, detailed case reports are of great importance.

Periodontal disease can lead to migration of anterior teeth with the presence of infrabony defects. This creates the opportunity for treating such patients with a combined orthodontic-periodontic treatment. In the presented clinical case, an adult periodontal patient with extrusion of the maxillary central incisors and an infrabony defect on their lingual aspects was treated. During the surgical procedure, the bone defects were augmented with a combination of porous bovine bone mineral (Bio-Oss) and a fibrin- fibronectin sealing system (Tissucol). Ten days after surgery, the active orthodontic treatment started, and the teeth were intruded and realigned, moving the roots into the defects. After 6 months, the orthodontic appliances were removed and the teeth were retained by means of a resinbonded splint. At this time, reduction in probing pocket depth and gingival recession was detected. Twelve months after the initial surgery, a reentry procedure was performed, showing complete filling of the predisposing defects with the presence of bone-like hard tissue. These clinical results suggest that teeth can be successfully moved and intruded into bone defects previously augmented with bovine bone substitute and fibrin glue. During the orthodontic treatment, this combined augmentation material was able to be replaced by bone-like hard tissue. At the end of the therapy, an improvement in esthetics and periodontal health status was registered.

ABM/P-15 is a combination of a natural anorganic bovine-derived hydroxyapatite matrix (ABM) and a synthetic cell-binding peptide (P-15; PepGen P-15) that has shown the capacity to encourage substantial clinical fill of periodontal infrabony defects. Human histology following its use has not been evaluated on pathologic root surfaces. A maxillary lateral incisor with advanced adult periodontitis that was treatment planned for extraction was treated with sulcular incisions, full-thickness flap reflection, debridement of granulomatous tissue from the defect, placement of a notch in the root at the apical extent of calculus, mechanical root planing, brief cleansing with citric acid, grafting with ABM/P-15, wound closure with sutures, and placement of a periodontal dressing. Biweekly to monthly recalls were made until removal of a small block section biopsy at about 6 months. Histologic evaluation of the region coronal to the apical edge of the calculus notch showed evidence of regeneration (new cementum, bone, and periodontal ligament). Graft particles were still present at 6 months, but no evidence of root resorption, ankylosis, or untoward inflammation was seen. This case report fulfills the proof of principle that use of ABM/P-15 can result in periodontal regeneration on previously diseased root surfaces in humans.

The goal of this study was to evaluate the long-term stability of the root coverage results obtained with an acellular dermal matrix. The mean root coverage at 12 weeks postoperative was 91.7%. The mean root coverage at the final postoperative evaluation (mean 18.6 months) was 87.0%. This difference was not statistically or clinically significant. The root coverage results obtained with an acellular dermal matrix were predictable, esthetic, and stable over time.

This study analyzed the interfacial human bone response to retrieved implants that had been functionally loaded in the human environment. A solid-screw titanium plasma-sprayed (TPS) implant was removed 5 years after implantation the implant and the crown. A sandblasted acid-etched titanium implant (SLA) was used as an anchorage for orthodontic treatment. At the end of the treatment, the SLA implant was removed. Both types were functionally loaded without any symptoms expressed by the patients. Histology showed bone contact between the TPS or the SLA implant and surrounding bone, but the SLA implant revealed much more interfacial bone contact. The contact microradiograms showed that the bone surrounding the TPS and SLA implants was highly calcified. The measured percentage of bone-implant contact around the SLA implant was significantly higher (P .05) than that around the TPS implant.

In recent years, the dimensions of different parts of the masticatory mucosa have become the subject of considerable interest in periodontics from both an epidemiologic and a therapeutic point of view. In the present article, the clinical relevance of the thickness of the masticatory mucosa for the development of gingival recessions, surgical root coverage, as well as graft harvesting will be reviewed. The concept of different periodontal phenotypes has recently been substantiated by experimental evidence using a novel, commercially distributed, ultrasonic measuring device. Based on observations made in a series of investigations, it has become clear that individuals with thin and vulnerable gingival tissue prone to the development of recession often also present with thin palatal mucosa that might not be very suitable for obtaining connective tissue of proper thickness for plastic periodontal surgery. Periodontal phenotypes are closely associated with, and are in fact an expression of, the so-called biologic width, which should be considered during subgingival placement of restorations in particular. Thus, a detailed analysis of the thickness of the masticatory mucosa may be necessary in several clinical situations.

Fifty patients received 151 short, porous-surfaced implants in the partially edentulous maxilla. Periotest values (PTV) were recorded at baseline and after 6 months and 1 and 2 years. For this, prostheses were removed and a standard abutment attached and tightened (20-Ncm force) to each implant. Data analysis indicated significant relationships between time in function vs PTV and implant diameter (3.5, 4.1, or 5.0 mm) vs PTV. There was no relationship between PTV and implant length. PTVs were more favorable in the posterior than anterior maxilla, and better PTVs were obtained with nonsplinted as opposed to splinted implants.