International Journal of Periodontics & Restorative Dentistry, 01/2003

This study evaluated the clinical, radiographic, and histologic response to Bio-Oss Collagen when used alone or in combination with Bio-Gide bilayer collagen membrane for the treatment of four intrabony defects (5 to 7 mm) around single-rooted teeth. After reflecting a full-thickness flap, thorough degranulation and root planing were accomplished. In all cases, Bio-Oss Collagen was then used to fill the defects, and in two cases, a Bio-Gide membrane was placed over the filled defect. Radiographs, clinical probing depths, and attachment levels were obtained before treatment and immediately preceding en bloc resection of teeth and surrounding tissues 9 months later. Reduction in pocket depth and gain in clinical attachment level were observed for both treatment protocols. The histologic evaluation demonstrated the formation of a complete new attachment apparatus, evidencing periodontal regeneration that varied with defect morphology. This human histologic study demonstrated that Bio-Oss Collagen has the capacity to induce regeneration of the periodontal attachment apparatus when placed in intrabony defects.

The objective of this study was to answer important questions about gingival responses to single-tooth implants: (1) Are papilla regeneration and sulcular recession expected results? (2) Do soft tissue profiles retain their sulcular form over an extended period? and (3) Do single-implant replacements require special restorative handling to achieve predictable soft tissue form? A retrospective, photographic examination was used to follow 55 single-implant restorations in 51 patients for a period from 1 to 9 years (mean 3.5 years). Papillae regenerated in 83.9% of implants for a mean growth of 0.65 mm mesially and 0.62 mm distally. The sulcular apex receded in 59% of patients for a mean of 0.06 mm. Complete papilla fill was noted in 75% of patients examined. Short- to long-term measurements revealed that papilla regrowth continued slightly and that sulcular recession abated. Papilla regeneration around single implants was a predictable outcome in this population; sulcular recession was not a predictable finding. Papilla levels demonstrated a tendency toward increasing height, and sulcular levels remained fairly constant over the long term. Predictable soft tissue profiles were achieved with a simplified implant prosthetic protocol, progressing directly from healing abutments to definitive crowns in most cases.

The purpose of this study was to evaluate the use of mineralized freeze-dried bone allograft (FDBA) in conjunction with a titanium-reinforced expanded polytetrafluoroethylene (TR e-PTFE) barrier in the treatment of localized alveolar ridge deficiencies prior to endosseous dental implant placement. Twelve patients (aged 23 to 65 years) requiring tooth replacement with ridge augmentation were recruited to participate in this study. During ridge augmentation surgery, measurements were made prior to grafting with FDBA plus a TR e-PTFE barrier. Six months later, ridge measurements were repeated, and suitability for implant placement was assessed. At each implant site, a biopsy was taken from the grafted site. The implants were placed and allowed to osseointegrate for 13 weeks prior to phasetwo surgery. Clinical data analyzed were horizontal ridge width changes and vertical ridge height changes. Histologic evaluation revealed the formation of new bone and residual particles in each graft site at the time of implant placement. Ten patients completed the study. The mean alveolar ridge width increased by 3.2 ± 1.0 mm (P .0005). Histomorphometric analysis revealed a range of new bone from 42.9% to 70.5%, with a mean of 47.6%. Graft particles remaining ranged from 29.5% to 57.1%, with a mean of 52.4%. The clinical and histologic findings of this study demonstrate that sites grafted with FDBA in conjunction with an e-PTFE barrier can provide a predictable way to augment deficient alveolar ridges prior to implant placement.

Although immediate loading of dental implants is increasingly gaining recognition as an important option for certain categories of implant patients, the maxillary arch has historically posed difficulties that have limited the number of immediate loading applications. To address the needs of patients who cannot tolerate maxillary removable complete dentures, an immediate loading protocol we call "Teeth in a Day" uses a conversion prosthesis that has been expanded to include completearch maxillary reconstruction. Use of a large number of implants to prevent micromotion at the bone-to-implant interface is a critical element in this protocol. A patient treatment is reported.

The purpose of the present case report study was to clinically and histologically evaluate the healing of deep intrabony defects following treatment with either a combination of an enamel matrix protein derivative (EMD) and a bovine-derived xenograft (BDX) or with BDX alone. Three female patients with generalized marginal periodontitis and presenting one advanced intrabony defect each were treated with either a combination of EMD + BDX (two defects) or with BDX alone (one defect). The postoperative healing was uneventful in all three cases. Six months after surgery, a gain of clinical attachment was measured at all treated sites. The histologic examination revealed that all three defects healed with a new connective tissue attachment (ie, new cellular cementum with inserting collagen fibers) and new bone. Most of the BDX particles were surrounded by a bonelike tissue. No direct contact between BDX particles and the root surface (cementum or dentin) was observed. Within their limits, the present data indicate that treatment with either EMD + BDX or with BDX alone may enhance the formation of new connective tissue attachment and new bone in human intrabony defects.

The development of an occlusal scheme with an appropriate number and location of occlusal contacts is of the utmost importance for the long-term success of any prosthetic rehabilitation. This, however, can be a time-consuming procedure. To avoid undue mistakes, a high degree of competence must be demonstrated by both the clinician and the technician. Especially when performing extensive rehabilitations, many operators believe that to have optimum control of the occlusal variables, it is necessary to employ rather sophisticated instruments and complicated procedures. This article presents a rationale for an approach that uses a simplified but sound instrumentation in the clinical and laboratory steps necessary to produce a successful prosthesis. In part 1, the registration of the spatial position of a patient's maxillary and mandibular arches is described.

The effect of the pure-phase beta-tricalcium phosphate (beta-TCP) Cerasorb on bone regeneration was evaluated in hollow titanium cylinders implanted in the posterior jaws of five volunteers. Beta-TCP particles were inserted inside the cylinders and harvested 6 months after placement. The density of the newly formed bone inside the bone-growing chambers measured 27.84% ± 24.67% in test and 17.90% ± 4.28% in control subjects, without a statistically significant difference. Analysis of the histologic specimens revealed that the density of the regenerated bone was related to the density of the surrounding bone. The present study demonstrates the spontaneous healing of infrabony artificial defects, 2.5 mm diameter, in the jaw. The pure beta-TCP was resorbed simultaneously with new bone formation, without interference with the bone matrix formation.

Cemental tears have been described as detachment of cementum caused by trauma or aging. They often result in severe periodontal lesions that may necessitate the extraction of the affected tooth. This case report describes the clinical resolution of a periodontal lesion associated with a cemental tear. A maxillary central incisor was subjected to endodontic treatment twice with no resolution of a deep distobuccal pocket and a palatal sinus tract from its apical region. The preoperative differential diagnosis for the condition present on the tooth included a vertical fracture and a combined periodontal-endodontic lesion. Surgical exploration of the area revealed a cemental tear on the apical third of the tooth. The cementum fragments were removed, root-end resection was performed, and the osseous lesion was treated with an osseous graft and guided tissue regeneration. Clinical examination of the area 1 year after surgery revealed resolution of both the prior pocket and sinus tract. Radiographic examination of the area showed increased radiopacity in the area of the original lesion, suggesting bone fill.

The goal of this case report was to evaluate the use of an acellular dermal matrix for soft tissue ridge augmentation. The technique used was a modification of the procedure proposed by Langer and Calagna and involved reflecting a partial-thickness pedicle, placing an acellular dermal matrix, and covering the acellular dermal matrix with the pedicle. The increases in the quantity of tissue obtained were adequate to permit placing an esthetic fixed restoration in four of the five cases treated. In one of the five cases, the acellular dermal matrix became exposed and partially sloughed. This resulted in less of an increase in tissue than in the other cases. Histologic evaluation of this case showed that the entire acellular dermal matrix did not slough; part of the acellular dermal matrix was incorporated into the result. The use of an acellular dermal matrix for soft tissue ridge augmentation is a clinically valuable technique.