International Journal of Periodontics & Restorative Dentistry, 03/2004

This clinical study retrospectively evaluated, after 1 to 7 years of prosthetic loading, 38 implants consecutively placed in 16 surgical sites, where severe atrophy of the posterior maxilla was treated by combining sinus elevation with the vertical ridge regenerative procedure. Two different surgical techniques were adopted. In seven patients (16 implants), implants were placed at the same stage as the regenerative procedures. In the other seven patients (22 implants), implant placement was performed at second-stage surgery, after 6 to 13 months of submerged membrane healing. Each implant was classified as a success, survival, or failure. The distance between the top of the implant shoulder and the first visible bone-implant contact was assessed radiographically for every implant at the mesial and distal sides. Two membranes became exposed during the healing process (12.5%). In the remaining 14 sites (87.5%), the membrane remained covered for a 6- to 13-month healing period. The survival rate of the implants was 92.1%, whereas the success rate was 76.3%. Three implants (7.9%) failed. A comparison of the implant shoulder-boneimplant contact distances between abutment connection and the last examination showed a mean crestal loss of 1.65 mm at the mesial side and 1.68 mm at the distal side. The bone regenerated vertically by means of sinus floor elevation and vertical ridge augmentation showed the same biologic behavior as native, nonregenerated bone; however, in a few cases, its remodeling pattern seemed to determine slightly higher bone crest resorption.

This study tested the shade match of single porcelain-fused-to-metal restorations with the adjacent dentition when the restorations were fabricated according to data from conventional visual shade matching or from a new spectrophotometric system. The samples of a Vita Classic shade guide were measured with the spectrophotometer to determine the CIE L*a*b* color parameters. Three clinicians independently selected the best match to a maxillary right or left incisor needing a restoration in 10 patients. The 10 incisors were then measured using a reflectance spectrophotometer. CIE L*a*b* coordinates were directly recorded on the spectrophotometer's detector area using a standard light source. Resulting conventional and spectrophotometric restorations were tested intraorally for best match with the adjacent incisor using conventional shade matching versus spectrophotometric measuring. Total color difference was calculated, and all groups were statistically analyzed. Initial shade evaluation matched for all three visual shade selections in two cases. In six cases only two evaluators matched, and in the remaining two cases all three visual selections differed. In contrast, in nine of 10 cases all three spectrophotometric shade selections matched. Additionally, in nine of 10 cases ΔE values of visually assessed tooth shades were higher than spectrophotometrically assessed ΔE values. Resulting ΔE values for conventional crowns compared to spectrophotometric crowns were significantly higher. Finally, in nine of 10 cases spectrophotometric crowns were preferred over conventional crowns for definitive cementation when evaluated visually. Spectrophotometric shade analysis and communication can be used efficiently for fabrication of porcelain-fused-to-metal restorations.

The aim of this article is to present a new technique for augmentation of deficient alveolar ridges and/or correction of osseous defects around dental implants. Current knowledge regarding bone augmentation for treatment of osseous defects prior to and in combination with dental implant placement is critically appraised. The "sandwich" bone augmentation technique is demonstrated step by step. Five pilot cases with implant dehiscence defects averaging 10.5 mm were treated with the technique. At 6 months, the sites were uncovered, and complete defect fill was noted in all cases. Results from this pilot case study indicated that the sandwich bone augmentation technique appears to enhance the outcomes of bone augmentation by using the positive properties of each applied material (autograft, DFDBA, hydroxyapatite, and collagen membrane). Future clinical trials for comparison of this approach with other bone augmentation techniques and histologic evaluation of the outcomes are needed to validate these findings.

Several reasons contribute to the loss of interdental papillae and the establishment of "black triangles" between teeth. The most common reason in the adult population is loss of periodontal support because of plaque-associated lesions. However, abnormal tooth shape, improper contours of prosthetic restorations, and traumatic oral hygiene procedures may also negatively influence the outline of the interdental soft tissues. Several surgical and nonsurgical techniques have been proposed to treat soft tissue deformities and manage the interproximal space. The nonsurgical approaches (orthodontic, prosthetic, and restorative procedures) modify the interproximal space, thereby inducing modifications to the soft tissues. The surgical techniques aim to recontour, preserve, or reconstruct the soft tissue between teeth and implants. This review categorizes the various approaches in different clinical situations.

The aim of this study was to compare the tensile bond strength of tooth-colored ceramic and carbon-fiber post materials as well as titanium and stainless steel post materials luted with three different kinds of luting cements. Disks of alloy post materials were polished with 600-grit SiC paper, air abraded, and ultrasonically cleaned. Ceramic surfaces were pretreated with hydrofluoric acid and silanized. Panavia F, Vitremer, and ProTec Cem cements were bonded to the post specimens and placed in a humidor for 24 hours. Specimens were placed in a jig, and the debonding values were obtained using a universal testing machine. Means and standard deviations were analyzed by two-way ANOVA. Panavia F provided the highest bond strengths for all types of post materials. ProTec Cem bonded more strongly to stainless steel and titanium than to zirconium oxide. Vitremer results were the lowest. Bonds to carbon-fiber post materials were weaker than to metallic post materials, but stronger than to zirconium oxide. In general, higher bond strengths resulted in a higher percentage of cohesive failures.

A new classification of bone defects adjacent to dental implants is proposed. The classification highlights the importance of defect anatomy in the progression of the regenerative process. Defects were divided into two main groups: (1) closed defects, characterized by the maintenance of intact surrounding bone walls; and (2) open defects, which lack one or more bone walls. The open defect group was then divided into several subgroups that include the majority of situations encountered in clinical practice. The classification could be a useful tool for planning the correct regenerative procedure for each type of defect.

The coronally advanced flap combined with a free connective tissue graft is a predictable method for achieving root coverage in buccal gingival recession. Nevertheless, this procedure conventionally requires involvement of a second surgical site; the latter is avoided by the proposed technique. Sixteen isolated gingival recessions (2.5 to 4.0 mm deep) were surgically treated with a coronally advanced flap associated with a connective tissue graft harvested from one adjacent papilla whose dimensions matched those of the exposed root area. Procedures were performed with the aid of a surgical microscope. Recession depth, probing depth, periodontal attachment level, and keratinized tissue width were recorded at baseline and 12 months after surgery. Mean recession moved from 3.38 ± 0.72 mm at baseline to 0.13 ± 0.29 mm at 12 months, a gain of 97.03%. In 13 of the 16 cases 12 months after surgery, the gingival margin was located at the CEJ or coronal to it, while in two cases the residual recession was less than 1.0 mm and in another case it was 1.0 mm. Mean periodontal attachment level was 4.72 ± 1.00 mm at baseline and 1.03 ± 0.59 mm at follow-up. Mean keratinized tissue increased from 1.25 ± 0.75 mm to 3.47 ± 0.87 mm. All differences between 12 months and baseline were statistically significant. No pockets were present at baseline, and this situation remained stable during the observation period. All 16 isolated recessions treated showed an excellent gain in root coverage without requiring a second surgical site and thus reducing patient morbidity.

Localized defects of the alveolar crest are deformities that impair prosthetic restoration of the damaged ridge area, causing esthetic, phonetic, and oral hygiene complications. Among the alternatives that have been proposed to restore the damaged ridge area and dentition to normal form, function, and esthetics, the procedures that involve ridge augmentation with soft tissues have been widely accepted. The present clinical report describes a novel surgical procedure to treat these deformities.

Hereditary hemorrhagic telangiectasia (HHT) is an inherited vascular malformation commonly found in the oral region. The symptoms range from minor epistaxis to severe, life-threatening hemorrhage. Red spots on the skin and in the mouth could lead to a diagnosis of HHT. The telangiectases can be irritated by normal dental procedures, and prophylactic antibiotics should be administered. The gingival HHT in this case demonstrates its significance to the dental community. A knowledgeable practitioner could be the first to recognize the potential diagnosis of HHT. Lesion variables will determine treatment parameters. Sequential photocoagulation with an argon laser appears to be an appropriate treatment algorithm.