International Journal of Periodontics & Restorative Dentistry, 02/1999

A human histologic study was conducted to compare the percentage of bone-to-implant contact (BIC) at 6 months for Osseotite and machined, commercially pure titanium implant surfaces. To eliminate potential influences caused by differences in bone density at different intraoral locations, 2 mm 3 5 mm, threaded, 2-surfaced titanium implants were manufactured; 1 side received the Osseotite surface modification and the opposite side maintained a machined surface. In each of 11 patients, 1 test implant was placed in the posterior maxilla (Types III and IV bone) during conventional dental implant surgery. Following 6 months of unloaded healing, the conventional implants were uncovered, and the test implants and surrounding hard tissue were removed. Histologic analysis indicated that at 6 months of unloaded healing, the mean BIC value for the Osseotite surfaces (72.96% ± 25.13%) was statistically significantly higher (P 0.05) than the mean BIC value for the machined surfaces (33.98% ± 31.04%). When the BIC values for the machined and Osseotite surface pairs were ranked from high to low based on the machined BIC value range of 93% to 0%, the upper 50th percentile (20 surface pairs) mean BIC value was 86.1% ± 16.7% for the Osseotite surfaces and 60.1% ± 18.3% for the machined surfaces. The lower 50th percentile (19 surface pairs) mean BIC value was 59.1% ± 25.3% for the Osseotite surfaces and 6.5% ± 10.8% for the machined surfaces. Differences between mean BIC values for the 2 surfaces in both the upper and lower 50th percentiles were statistically significant (P 0.05). The results of this study indicate that in the poorer quality bone typically found in the posterior maxilla, a statistically significantly higher percentage of bone contacts Osseotite surfaces when compared to opposing machined surfaces on the same implant.

The purpose of this study was to determine the feasibility of regenerating bone in patients with advanced horizontal bone loss. Demineralized freeze-dried bone allografts (DFDBA) in particle, strut, and laminar forms were used in combination with guided tissue regeneration. The cortical struts and strips were processed from long bones and were supplied in different widths and lengths. The strips were prepared in various thicknesses ranging from 100 to 500 µm; the struts ranged from 1 to 3 mm thick. These 2 materials provided structural support for the retention of DFDBA particles supracrestally, and they supported the gingival flap as a space maintainer, preventing the collapse of the tissue onto the roots and existing bone. The results indicated successful supracrestal regeneration of horizontal defects when combining existing techniques and materials. The mean attachment gain for the 7 patients studied ranged from 2.6 to 3.0 mm.

A case of congenitally missing maxillary lateral incisors is presented to illustrate a modification of Abrams's roll technique. Buccal releasing incisions are avoided by using an intrasulcular incision on the adjacent teeth. The tissue overlying the cover screw is transferred between the buccal cortical bone and the buccal masticatory mucosa, thus correcting the localized buccal ridge atrophy.

Over the years implant companies have provided more and more components to address the varied clinical situations that occur. While these new components have allowed for improved restorative designs, it can now be somewhat confusing to determine the most appropriate components, especially abutments. This article describes restorative steps for both single-implant and multiple-implant restorations; these steps help guide restorative dentists through the treatment process, enabling them to follow standard protocols for single- and multiple-implant restorations. With these protocols it is possible to select the most appropriate components and proceed with treatment in a time-efficient and cost-effective manner.

Enamel matrix proteins, including Emdogain, have been proposed as a new modality for regenerative periodontal treatment. However, limited information is available concerning the clinical applicability and therapeutic results with Emdogain. The aim of the present study was therefore to evaluate the clinical outcome following the application of Emdogain in the treatment of intrabony periodontal defects. Twenty-eight patients with marginal periodontitis (thirty-two 2- and 3-walled intrabony defects) were included in this study. The following parameters were evaluated prior to treatment and 8 months after treatment: probing pocket depth, recession of the gingival margin, and clinical attachment level. The postoperative healing phase was uneventful in all cases. There were no complications such as allergic reactions, abscess formation, or infections throughout the entire study period. The mean probing pocket depth was reduced from 8.7 ± 1.5 mm at baseline to 4.3 ± 1.6 mm after 8 months (P 0.001), the mean gingival recession increased from 1.8 ± 1.2 mm to 3.3 ± 0.9 mm, and the mean clinical attachment level changed from 10.6 ± 1.9 mm to 7.6 ± 1.8 mm (P 0.001). New hard tissue formation was radiographically observed in 26 of the 32 defects. The present results suggest that the treatment of intrabony periodontal defects with Emdogain may lead to significant improvements of all of the investigated clinical parameters. However, controlled histologic and clinical trials are needed to compare this treatment modality with other conventional and regenerative periodontal surgical methods.

The use of the mandibular symphysis for harvesting intraoral autografts in implant reconstruction cases is based on the ample supply of donor material, the proximity to the recipient site, and the ease of access to the tissue. This article discusses the technique of successful bone harvesting from the mandibular symphysis. As with other harvesting techniques, morbidity can occur. This report demonstrates a low morbidity rate and presents guidelines to help accomplish this.

This article describes a surgical procedure to predictably obtain primary closure over extraction sockets in the maxilla. The technique offers a valuable treatment approach for the achievement of primary soft tissue closure over bone grafts and/or occlusive osteopromotive membranes, although the use of an osteopromotive membrane may not always be necessary in cases of single-tooth extraction. The surgical technique is based on a split-thickness palatal flap in which the pediculated deep portion is rotated to cover the grafted alveolus or membrane. This procedure was used in a total of 40 sites in 32 consecutive patients; a barrier membrane was used in 20 sites. All treated sites allowed proper implant placement after healing. Two membranes became prematurely exposed and one was removed before implant surgery. Proper soft and hard tissue anatomy was predictably obtained prior to implant placement. This surgical procedure is useful in preserving and/or augmenting the alveolar ridge prior to or during implant placement in cases of advanced alveolar bone loss.

Clinical experience indicates that implant-supported crowns for the replacement of individual molars using the original, regular platform CeraOne protocol (Nobel Biocare) infrequently result in gold screws loosening. This article offers a technique that may prevent the CeraOne gold screw from working loose. It is intended to be a correction for a problem, not a first-time treatment. Also, this is a treatment that should be offered only after the prescribed Brånemark protocol for screw tightening and elimination of excursive contacts has proven ineffective.

This article presents the merits of the nonresilient hybrid removable prosthesis,which is the treatment of choice for the atrophic maxilla. The technique described may be adapted to yield a predictable outcome that provides functional and biomechanical stability that are superior to a resilient overdenture, along with a cosmetic and phonetic result that often proves superior to that of the fixed prosthesis.

This article describes a surgical periodontal plastic procedure for the coverage of multiple adjacent gingival recessions. This surgical technique is based on the construction of a tunnel under the gingival tissue by means of a sulcular incision beyond the mucogingival line without raising the papillae. A large connective tissue graft obtained from the palatal mucosa is introduced through this tunnel, covering the adjacent gingival recessions. A suturing technique to allow this graft to slip through the tunnel under the gingival tissues and to secure and stabilize the graft covering the recessions is described. Twelve-month postoperative results are presented from 21 teeth that were treated with this technique: 100% root coverage was achieved in 66.7% of the recessions treated, with a mean root surface coverage of 91.6%. This study suggests that the use of this surgical procedure allows the treatment of multiple adjacent recessions in a single procedure with adequate early healing and highly predictable root coverage results.