International Journal of Periodontics & Restorative Dentistry, Pre-Print
DOI: 10.11607/prd.7110, PubMed-ID: 387272473. Mai 2024,Seiten: 1-27, Sprache: EnglischUrban, Istvan A. / Mirsky, Nicholas / Serroni, Matteo / Tovar, Nick / Vivekanand Nayak, Vasudev / Witek, Lukasz / Marin, Charles / Saleh, Muhammad H. A. / Ravida, Andrea / Baczko, Istvan / Parkanyi, Laszlo / Nagy, Katalin / Coelho, Paulo G.
Background: Non-perforated Polytetrafluoroethylene (PTFE) membranes are effectively utilized in guided bone regeneration (GBR) but may hinder cell migration due to limited interaction with the periosteum. This study compared bone regeneration using occlusive or perforated membranes combined with acellular collagen sponge (ACS) and recombinant human bone morphogenic protein-2 (rhBMP-2) in a canine mandibular model. Material and Methods: Male beagle dogs (n=3) received two mandibular defects each to compare ACS/rhBMP-2 with experimental (perforated group) and control (non-perforated group) membranes (n=3 defects/group). Tissue healing was assessed histomorphologically, histomorphometrically and through volumetric reconstruction using microcomputed tomography. Results: The perforated group showed increased bone formation and reduced soft tissue formation compared to the non-perforated group. For the primary outcome, histomorphometric analysis revealed significantly greater total regenerated bone in the perforated group (67.08 ± 6.86%) relative to the nonperforated group (25.18 ± 22.44%) (p = 0.036). Perforated membranes had less soft tissue infiltration (32.91 ± 6.86%) compared to non-perforated membranes (74.82 ± 22.44%) (p = 0.036). Conclusion: The increased permeability of membranes in the perforated group potentially enabled periosteal precursor cells greater accessibility to rhBMP-2. The availability may have accelerated their differentiation into mature bone-forming cells, contributing to the stimulation of new bone production, relative to the non-perforated group.
Schlagwörter: Osteogenesis, periosteum, bone regeneration, polytetrafluoroethylene, implants
International Journal of Periodontics & Restorative Dentistry, Pre-Print
DOI: 10.11607/prd.7205, PubMed-ID: 3882027731. Mai 2024,Seiten: 1-22, Sprache: EnglischUrban, Istvan A. / Chen, Zhaozhao / Wang, Hom-Lay
Peri-implantitis, a common complication among patients receiving implant-supported restorative
therapy, often requires surgical intervention for effective treatment. Understanding the specific
configuration of peri-implant bony defect and adjacent bone peaks is crucial for tailoring treatment
strategies and improving outcomes. A decision tree for reconstructive peri-implantitis therapy has been
developed based on the new classification of defect configurations (Class I to V), guiding clinicians in
selecting treatment options, including biomaterials, techniques, and healing approaches. Furthermore,
clinicians are encouraged to consider various factors such as local predisposing factors (such as soft
tissue characteristics, prosthetic design, and implant position in three-dimensional perspective), clinical
factors (surgeon skill and experience), and patient-related factors (such as local and systemic health,
preferences, and cost) when evaluating reconstructive therapy options.
Schlagwörter: bone regeneration, dental implants, peri-implant defect, peri-implantitis, reconstructive therapy
International Journal of Periodontics & Restorative Dentistry, Pre-Print
DOI: 10.11607/prd.6731, PubMed-ID: 375521858. Aug. 2023,Seiten: 1-15, Sprache: EnglischUrban, Istvan A / Mancini, Leonardo / Wang, Hom-Lay / Tavelli, Lorenzo
Implants with deficient papillae and black triangle are common findings. The treatment of these esthetic complications is considered challenging, and with limited predictability. Therefore, the aim of the present report is to describe a novel technique for papilla augmentation (the "Iceberg" connective tissue graft [iCTG]) after extraction and interproximal bone reconstruction in the anterior region. A 35-year-old patient presented with a hopeless tooth with interproximal clinical attachment loss extending up the apical third of the adjacent tooth. Interproximal bone reconstruction was performed through alveolar ridge preservation by directly applying recombinant human platelet-derived growth factor-BB (rhPDGF-BB) to the exposed root surface of the adjacent tooth. A mixture of autogenous bone chips (obtained from the ramus) and bovine bone xenograft particles, previously mixed with the growth factor, was also used. The patient was able to come back for implant therapy only 2 years later. An incomplete regeneration of the interproximal bone was observed. Therefore, to compensate the interproximal deficiency, the iCTG approach, involving a double layer CTG with different origins, was utilized. Two small grafts from the tuberosity were sutured to the mesial and distal ends of a wider CTG harvested from the palate, aiming at gaining additional volume at the interproximal sites. The composite graft was then sutured on top of the implant platform, with the flap that was then released and closed by primary intention. After conditioning of the peri-implant tissues, the case was finalized with a satisfactory outcome. The described iCTG could be an effective approach for reconstructing peri-implant papilla following interproximal bone reconstruction.
International Journal of Periodontics & Restorative Dentistry, 2/2024
DOI: 10.11607/prd.6458, PubMed-ID: 37722007Seiten: 213-218, Sprache: EnglischShahbazi, Arvin / Windisch, Péter / Tubbs, R. Shane / Decater, Tess / Urbán, István A. / Baksa, Gábor / Iwanaga, Joe
Guided bone regeneration (GBR) requires a tension-free flap without damaging the collateral circulation in order to secure better surgical outcomes. Topographic knowledge regarding the neurovascular bundles in the posterior aspect of the mandible can prevent complications during lingual flap design. The lingual branch (LB) of the inferior alveolar or maxillary arteries is not sufficiently illustrated or described in the literature. Nevertheless, it has an intimate relationship with the lingual nerve (LN) during ridge augmentation and implant-related posterior mandible surgery. Therefore, this study aimed to clarify the morphology and topography of the LB related to GBR surgeries. In the present human cadaveric study, the LB was analyzed in 12 hemimandibles using latex injection and corrosion casting. Two types of LB were identified based on their origin and course. The LB was found in a common connective tissue sheath close to the LN. The LB assembled several anastomoses on the posterior lingual aspect of the mandible and retromolar area. The LB acted as an anatomical landmark in identifying LN at the posterior lingual aspect of the mandible.
International Journal of Periodontics & Restorative Dentistry, 1/2024
DOI: 10.11607/prd.6667, PubMed-ID: 37552184Seiten: 17-25, Sprache: EnglischUrban, Istvan A. / Saleh, Muhammad H. A. / Serroni, Matteo / Shahbazi, Arvin / Baksa, Gabor / Szoke, Peter / Ravida, Andrea
Vertical ridge augmentation in the anterior mandible is a technically delicate procedure that requires knowledge of some anatomical structures to reduce intra- and postoperative complications. Proper soft tissue management is one of the primary aspects to the success of these techniques, enabling tension-free primary wound closure and preventing membrane exposure. This cadaveric and clinical study provides an anatomical overview of the lingual portion of the anterior mandible. Moreover, there is a description of a novel surgical approach for release of the lingual flap that will help clinicians achieve primary closure without incurring intrasurgical complications.
International Journal of Esthetic Dentistry (DE), 4/2023
The Last PageSeiten: 442, Sprache: DeutschUrban, Istvan
International Journal of Esthetic Dentistry (EN), 4/2023
The Last PagePubMed-ID: 37819570Seiten: 418, Sprache: EnglischUrban, Istvan
International Journal of Periodontics & Restorative Dentistry, 3/2023
DOI: 10.11607/prd.6336, PubMed-ID: 37141085Seiten: 291-299, Sprache: EnglischVroom, Melle G / Gründemann, Lodewijk J M M / Urban, Istvan
This pilot case series study reports the dimensional alveolar bone changes after reconstruction of severely resorbed postextraction sockets treated with a mixture of particulate bone allograft and xenograft in combination with titanium-reinforced dense polytetrafluoroethylene (Ti-d-PTFE) membranes. Ten subjects who required premolar or molar extraction were included. Bone grafts were protected with Ti-d-PTFE membranes, utilizing an open-healing environment; membranes were removed 4 to 6 weeks after extraction, and implants were placed 6.7 months (mean) after extraction (T1). One patient required additional augmentation to correct an apical undercut of the alveolar process that was present preextraction. All implants integrated well and showed an implant stability quotient (ISQ) value between 71 and 83. The mean horizontal ridge width reduction from baseline (extraction) to T1 was 0.8 mm. Throughout the study, the mean vertical bone gain increase ranged from 0.2 mm to 2.8 mm (mean keratinized tissue width increase: 5.8 mm). The ridge preservation/restoration technique showed good preservation and restoration of severely resorbed sockets as well as improved amounts of keratinized tissue. If implant therapy is required after tooth extraction and severely resorbed sockets are present, the use of a Ti-d-PTFE membrane is a realistic option.
International Journal of Oral Implantology, 1/2023
PubMed-ID: 36861681Seiten: 55-64, Sprache: EnglischSaleh, Muhammad H A / Urban, Istvan A / Alrmali, Abdusalam / Ravidà, Andrea
Introduction: Papilla reformation is one of the most difficult and elusive surgical techniques for clinicians. Although it involves similar tenets to those applied for soft tissue grafting at recession defects, crafting a small tissue in restricted space remains unpredictable. Numerous grafting techniques have been developed to correct interproximal and buccal recession, but so far, only a limited number of techniques have been prescribed for interproximal remediation.
Case presentation: This report describes in detail a modern technique (the vertical interproximal tunnel approach) for reforming the interproximal papilla and treating interproximal recession. It also documents three challenging cases of papilla loss. The first case presented Class II papilla loss and a recession type 3 gingival defect adjacent to a dental implant, managed using the vertical interproximal tunnel approach through a short vertical incision. A 6-mm increase in attachment level and almost complete papilla fill were observed in this case with this surgical technique for papilla reconstruction. The second and third cases presented Class II papilla loss between two adjacent teeth, managed using the vertical interproximal tunnel approach through a semilunar incision and achieving full papilla reconstruction.
Conclusion: Both described incision designs for the vertical interproximal tunnel approach require technical meticulousness. When executed carefully and using the most beneficial pattern of blood supply, predictable reconstruction of the interproximal papilla can be achieved. It also helps alleviate concerns associated with inadequate flap thickness, blood supply and flap retraction.
Schlagwörter: complications, gingival recession, peri-implantitis, root coverage
The authors declare they have no conflicts of interest. They do not have any financial interests, either directly or indirectly, in the products or information listed in the paper.
International Journal of Periodontics & Restorative Dentistry, 6/2022
DOI: 10.11607/prd.5921Seiten: 753-759, Sprache: EnglischUrban, Istvan A / Sommer, Celia / Wang, I-Ching / Wang, Hom-Lay
Various surgical flap advancement techniques for bone regeneration have been described in the literature; however, the clinical challenges of managing tissue that contains scars or embedded foreign materials have not been thoroughly described, especially around metal foramen. Fibrotic and thickened scar periosteum as well as mental foramen restrict the tissue from responding in the same way as native tissue. Therefore, additional considerations and approaches must be considered to achieve tension-free flap closure. This article presents a flap advancement classification that describes three common clinical scenarios based on the periosteum and soft tissue quality and provides surgical approaches for tissue management in each classification, with a focus on flap advancement around the mental foramen.