International Journal of Periodontics & Restorative Dentistry, 06/2017

A significant number of articles have been published to describe a variety of techniques for the treatment of peri-implant disease, with varying success. Previous reports have presented limited data on the use of lasers for the decontamination of implant surfaces prior to defect augmentation using guided bone regeneration techniques. The current study is a prospective closed cohort study of 20 patients with a follow-up of 1 year. It was established to assess the efficacy of the Er:YAG water-cooled laser following initially promising reports suggesting the laser can decontaminate and sterilize the implant surface and allow for reosseointegration of the affected portion of the implant.

The aim of this study was to retrospectively evaluate the periodontal response of periodontally healthy teeth prosthetically restored using a featheredge finish line preparation combined with a light rotary curettage (gingittage). A total of 137 restored teeth were included in the study. Mean follow-up time was 18.2 months (range: 6 to 60 months). Bleeding on probing was noted in 18% of cases, while the Plaque Index was found to be 11%. The probing depth in 99.4% of cases was ≤ 3 mm. In only 7 cases (5.1%), a slight restoration margin exposure was recorded. Although randomized controlled studies with longer follow-up are advocated, the present investigation seems to suggest that this protocol is a viable procedure.

Buccal plate thickness is an important clinical parameter for postextraction implant treatment planning. The purpose of this study was to assess buccal plate thickness of the posterior maxilla and mandible using cone beam computed tomography (CBCT). A total of 265 patients and 934 teeth met the inclusion criteria for this study. CBCT volumes were taken and aligned for measurement at the ideal midsagittal cross-section. Buccal plate thickness was measured at 1, 3, and 5 mm apical to the alveolar crest. The frequency of thick (≥ 1 mm), thin ( 1 mm), and radiographic absence of the buccal plate were determined. The frequency of thin buccal plate decreases from anterior to posterior, with first premolars and first molar mesial roots most affected. Radiographic absence of the buccal plate was more common in the mandible, at first premolars, and among women. Thin and absent buccal plate are not uncommon in the posterior jaws; consequently, ridge preservation may be indicated even at posterior teeth.

In cases of single missing teeth, implant rehabilitation is generally the preferred treatment option. However, obtaining pleasing esthetic results in the anterior maxillary region and maintaining or rebuilding peri-implant papillae remain challenging tasks. The loss of papillae may cause not just functional but also phonetic and esthetic problems. There is scarce information on the reliability of surgical approaches concerning the peri-implant papilla. The purpose of this case report is to present a modified prosthetic-surgical technique to enhance the convex facial contour of the peri-implant mucosa and volume and height of papillary tissue in an esthetically highly demanding patient.

The aim of this case report was to suggest an alternative minimally invasive surgical approach to an impacted maxillary canine using a 4-mm-long implant for a fixed prosthetic rehabilitation, avoiding tooth extraction or surgically forced extrusion and exploiting the 6 mm of coronal bone availability. At 4 years postloading, the implant was healthy and well integrated with stable marginal bone levels. The 4-mm length of the implant reduced operative times, postsurgical morbidity, possible complications, and costs. Short implants might be an alternative to traditional, more invasive surgical procedures used in the rehabilitative treatment of impacted maxillary canines.

The purpose of this study was to evaluate the efficacy and safety of equinederived bone matrix as a carrier for recombinant human platelet-derived growth factor BB (rhPDGF-BB) versus beta-tricalcium phosphate (β-TCP) for the treatment of intraosseous periodontal defects in adult patients. This study was performed on 32 adults with advanced periodontal disease. Eligible subjects were randomized in 1:1 ratio into a test (rhPDGF-BB-coated equine-derived bone matrix) or control group (rhPDGF-BB-coated β-TCP). Probing pocket depth (PD), clinical attachment level (CAL), gingival recession (GR), and defect depth on radiographs were measured at 2 weeks before surgery, on the day of surgery (DOS), and 6 months postsurgery (6MPS). The clinical and radiographic data were analyzed over the test period. Statistically significant PD reductions and CAL gain between baseline and 6MPS and between ODS and 6MPS were seen in both groups (P .01). No statistically significant differences in PD reduction were found between groups. However, the test group showed significant CAL gain between DOS and 6MPS. The radiographic bone level change was statistically significant compared to baseline (P .01) in both groups. The results suggested that equine-derived bone matrix is a viable, effective, and safe carrier scaffold for rhPDGF in periodontal defects.

Prosthetic rehabilitation of the edentulous maxilla is known to be challenging and requires meticulous planning. The purpose of this article is to describe a novel classification system, the Lip-Tooth-Ridge (LTR), that offers a guidepost for treatment planning the edentulous maxilla for fixed or removable prostheses. This tool will help clinicians identify the final prosthetic design and will provide a case-specific risk assessment guide regarding two different areas. A high (HER) or low (LER) esthetic risk will be determined based on lip dynamics, as well as a high or low structural risk according to the prosthetic space availability.

The aim of this case series was to evaluate clinical and patient-centered outcomes when treating multiple recessions (Miller Class I, II, and III) affecting five or more teeth in a single procedure using acellular dermal matrix in 18 eligible participants (mean of 7.4 ± 1.7 recessions/patient). Low mean visual analog scale pain scores (0.7 ± 0.8) and analgesic consumption (2.3 ± 2.5 tablets) were reported from days 0 to 6 postoperatively. Mean baseline recession depth was 2.1 ± 1 mm. At 1 year postsurgery, mean percent root coverage was 87.1% ± 18.3%, and complete root coverage was achieved in 61.7% of recessions with statistically significant differences between smokers and nonsmokers.

Improvements in implant design, placement protocols, and sequences for reconstruction in the anterior region have enabled clinicians to provide their patients with esthetically acceptable results. Yet from a clinical standpoint, the predictable preservation of the peri-implant soft tissue remains challenging and tissue grafting is often necessary to compensate for ridge contour changes in postextraction sites. In animal and clinical studies, the socket shield technique has shown its potential to prevent resorption of buccal tissues. This 24-month follow-up case report presents a 47-yearold patient with a failing maxillary incisor replaced with an immediately placed single implant in conjunction with the socket shield technique.

This paper presents a technical description of the inlay technique performed with an allograft block in the reconstruction of a severely atrophic posterior mandible. It includes a histologic case series of five patients treated with the same grafting procedure and rehabilitated with dental implants 2 months after placement of the graft. The histologic analysis showed large amounts of newly formed bone in tight connection with the allograft and large marrow spaces with intense cellular activity and the presence of osteocytes. Allografts might serve as an alternative to autogenous and heterologous grafting in posterior mandible augmentation using the inlay technique.

An interdisciplinary approach to esthetics requires a comprehensive treatment plan formulated through evaluation of several restorative and periodontal parameters that influence the esthetic zone. A total of 25 subjects (13 women and 12 men, with an age range of 18 to 23 years) participated in the study. Parameters such as gingival biotype on the labial aspect, crown width to crown length ratio, and interdental papilla proportion, with respect to the maxillary anterior teeth, were determined. An attempt was made to establish a correlation between these components, and a positive correlation was found. A careful preoperative diagnosis of these parameters is thus essential, especially in the esthetic zone.

The purpose of this study was to prospectively evaluate the dimensional bone changes around implants placed immediately with buccal contour augmentation. Patients with hopeless maxillary anterior teeth were treated with extraction, immediate implant placement, and simultaneous buccal contour augmentation. Hard tissue measurements were recorded at the time of implant placement and after 3 months of healing. All implants (N = 18) successfully osseointegrated with a mean buccal bone thickness of 2.94 ± 0.21 mm (mean ± SE) at the implant platform. This was significantly greater compared to previous data on immediate implants placed without contour augmentation (2.32 ± 0.17 mm). Buccal contour augmentation in conjunction with immediate implant placement significantly increased peri-implant buccal bone thickness after 3 months of healing.

Vertical guided bone regeneration (GBR) using titanium-reinforced polytetrafluoroethylene (PTFE) membranes is a well-established technique and is considered technique sensitive. When using PTFE membranes, complications usually arise in the crestal incision or next to the neighboring tooth of the treated span. Most studies available describe either distal free end or multiple missing teeth span situations. Treating a single missing tooth span combines the challenge of two neighboring teeth and a smaller flap, which is more difficult to adapt to the augmented environment. This article describes 10 single span cases treated with vertical GBR using high-density PTFE membranes, highlighting clinical guidelines for preoperative care, flap design, and suturing.

Gingival recession is defined as an apical displacement of the gingival margin beyond the cementoenamel junction leading to serious consequences, including exposure of the root surface, loss of periodontal attachment, root sensitivity to hot and cold air, and esthetic problems. The aim of this study was to evaluate the long-term effect of pedicled buccal fat pad (PBFP) alone and with Emdogain in covering severe gingival recession defects and restoring tooth function. A total of 10 severe buccal recession defects in maxillary first molars were selected to be treated with PBFP, with Emdogain (group I; n = 5) or alone (group II; n = 5). Probing depth, clinical attachment level, depth of the gingival recession, width of the keratinized gingiva, and tooth mobility were recorded and statistically analyzed at baseline and during follow-up recalls until 2 years postoperatively. At 2 years, the percentage of root coverage was 60.18% and 59.07% for group I and group II, respectively, with significant differences compared to baseline and all follow-up times for each group but with statistically significant differences between groups (P > .05). Emdogain with PBFP did not show significant improvement compared to PBFP alone in terms of root coverage percentage. PBFP alone may be the better treatment for severe gingival recession defects.

The purpose of this study was to determine whether a single immediate implant placed into the postextraction palatal socket of a maxillary molar would be as efficacious as a single implant placed centrally in a staged approach. A total of 61 immediate implants were placed in 52 patients and restored after 6 months. Periotest and Osstell were used to determine implant stability, and cone beam computed tomography was used for marginal bone level assessment. During the 2-year follow-up, implant survival was 100%. It was concluded that immediate palatal implants can safely restore extracted molars in the maxilla.

The aim of this study was to investigate the clinical and radiologic efficacy of autologous platelet-rich fibrin (PRF) in the treatment of intrabony defects associated with localized aggressive periodontitis (LAP). A total of 30 sites, 2 sites per individual in 15 LAP patients, were treated with modified flap operation (MFO; Kirkland flap) alone or combined with autologous PRF. The study variables included plaque index, sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), and gingival marginal level at baseline and 12 months postoperatively. The radiographic bone fill (RBF) on standardized radiographs was assessed after a year using image analysis software. The improvements in PD, CAL, and RBF in test sites compared to control sites were statistically significant (P .05). Mean CAL gain and bone fill in the test sites were 4.0 ± 0.63 mm and 3.09 mm, respectively. Almost 80% of the PRF-treated sites showed ≥ 50% bone fill with minimal marginal tissue recession. Use of PRF significantly enhances the clinical and radiographic outcomes of open flap debridement in the treatment of periodontal intraosseous defects in patients affected by LAP.

Innovative digital diagnostic, design, and manufacturing technologies combined with high-performance polymers offer new possibilities to facilitate complex interdisciplinary treatment procedures. This article reports on the interaction of different digital technologies, from presurgical digital simulation of periodontal surgery to final prosthodontic rehabilitation, in a case of amelogenesis imperfecta in a 17-year-old girl. The aim was to digitally determine the treatment outcome by three-dimensional simulation of the soft tissue removal and to create computer-aided design/computer-assisted manufacture tooth-colored splints before the clinical treatment. The case report shows the synergy of the combination of multiple digital technologies for a predictable periodontal and prosthetic treatment outcome.

The purpose of this study was to evaluate a composite graft of ChronOS, a betatricalcium phosphate (β-TCP), mixed 1:1 with an autogenous bone graft in human maxillary sinus augmentation. A total of 12 maxillary sinuses were grafted with an autogenous bone graft (control group), and 9 maxillary sinuses were grafted with ChronOS mixed 1:1 with an autogenous bone graft (test group). After 6 months, biopsy samples were obtained concurrent to the placement of dental implants and were subjected to histomorphometric and immunohistochemical analyses for Runtrelated transcription factor 2 (RUNX2), vascular endothelial growth factor (VEGF), tartrate-resistant acid phosphatase, and osteocalcin. Histologic analysis of samples obtained from the test group revealed the presence of immature bone, while samples from the control group indicated lamellar bone formation. However, both types of bone grafts were well vascularized. The new bone formation averaged 25.4% ± 6.4% in the test group and 38.6% ± 10.5% in the control group (P = .001). Immunostaining of samples in the test group showed high cellular turnover. The outcomes of this study demonstrate a delay in bone formation but intense cellular differentiation after 6 months of bone graft healing in the test group. The amount of immature bone and the immunostaining for RUNX2 and VEGF provide evidence of an osteogenic pathway that can improve the bone formation rate.

Maxillary sinus floor elevation has been documented as a safe and predictable procedure for gaining vertical bone height in the atrophic posterior maxillae. Conversely, there is a lack of basic research on the characteristics of the union between the sinus membrane (SM) and the bone. Clinical implications of an impaired union in healthy or pathologic membranes remain unknown. The objective of this study was to present a comprehensive histologic and morphologic description of the sinus membrane-lateral bone wall complex. In 14 fresh cadaver heads, 28 lateral wall sinus augmentation procedures were performed to obtain SM samples. Samples were assessed using hematoxylin-eosin, Masson trichrome, and toluidine blue staining and immunofluorescence and immunohistochemistry procedures. Specimens were coded and studied by a trained examiner using an optical microscope at ×4, ×10, ×40, and ×100 objectives. Thickness and inflammation status were assessed in these samples. Overall SM thickness of the samples was 0.40 ± 0.12 mm and was positively correlated to the inflammatory condition of the membranes. Such low values are the consequence of limited inflammation. Most of the fibers and cells in the deeper layers of the SM ran in a horizontal direction, oriented parallel to the underlying bone wall. In the immunohistochemistry study, 3 out of 7 samples showed a certain degree of nestin expression, suggesting osteogenic potential in spite of the elderly specimens. Large variations in thickness across the SM were found. These were noted to be partially correlated to the SM inflammatory status. The vast majority of the fibers were oriented parallel to the maxillary lateral wall, and only a few isolated areas showed a stronger perpendicular attachment. This might indicate the surpassing importance of the SM inflammatory status, operator skill, and other anatomical factors over the sinus membrane-maxillary lateral wall complex interface. Moreover, about half of the SM investigated were positive for nestin, indicating their osteogenic potential.

This study investigated the effect of dentin-desensitizing treatment with a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste on shear bond strength (SBS) of two types of self-adhering (SA) restorative materials: resin-modified glass-ionomer (Fuji II LC, GC) and self-adhering flowable composite resin (Vertise Flow, Kerr). Flat and smear layer-free dentin surfaces from 48 extracted molars were prepared and divided into four groups (n = 12 per group) according to Fuji II LC or Vertise Flow and CPP-ACP pretreatment or not. After SBS testing, data were statistically analyzed. The adhesive interfaces were examined by scanning electron microscopy. SBS was significantly affected by CPP-ACP treatment (P .001) and SA material (P .05). The interaction of the two factors was not significant. The results suggested that the CPP-ACP pretreatment of the exposed dentin could have a beneficial effect on bonding ability and interfacial integrity of both SA materials so that intimately adapted interfaces were observed in CPP-ACP groups.

Periodontal examination in growing patients with unilateral cleft lip and palate was performed in a split-mouth study design. Higher plaque acumulation and bleeding indices were recorded for teeth on the cleft side. Pocket probing depth (PPD) and clinical attachment level (CAL) values were higher at lateral incisors and canines adjacent to the cleft. Keratinized gingiva and depth of the vestibule were lower adjacent to the cleft. This study shows that growing patients with clefts present differences regarding periodontal parameters between the cleft and the control side. These alterations affected patients' ability to maintain proper oral hygiene and resulted in differences in PPD and CAL.