International Journal of Periodontics & Restorative Dentistry, 03/2011

This study aimed to evaluate the influence of labial alveolar bone thickness and the corresponding vertical bone loss on postoperative gingival recessions around anterior maxillary dental implants. Using cone beam computed tomography (CBCT) scanning, the temporal changes of three-dimensional images of alveolar bone were monitored to determine hard and soft tissue outcomes of two different implant placement techniques: delayed two-stage and immediate placement. Furthermore, for the delayed two-stage placement, guided bone regeneration was applied using either nonresorbable or resorbable membranes combined with anorganic bovine bone matrix. The comparative results suggested that gingival recessions were significantly lower in delayed two-stage placement, especially when using a nonresorbable membrane, compared to immediate placement, and labial bone thickness, measured by CBCT, offered an effectual indicator to assess gingival recession in the anterior region.

The objective of this study was to investigate the potential of xenograft (cancellous bovine bone) granules to form vital bone in non-natural boneforming areas of maxillary sinuses. Fourteen sinus augmentations were performed in 14 patients. Surgical outcomes were uneventful, and sufficient radiopaque volume was present radiographically to place dental implants in all sites. Clinical reentry at 6 months revealed bone formation at the osteotomy site. Histologic evaluation of the obtained bone cores revealed that xenograft granules were integrated and surrounded by woven bone and lamellar bone that were in close contact with the particles. The average percentage of newly formed bone at 6 months was 27.5% ± 8.9%. Vital bone formation using the xenograft granules was supported by both clinical and histologic evidence.

The aim of this paper was to study, through a clinical case report, the behavior of deproteinized bovine bone (Bio-Oss) covered with a resorbable barrier membrane (Bio-Gide) when used as an onlay grafting material to obtain alveolar bone ridge enlargement. The presence of an existing bone edge allowed placement of an MK III groovy implant and creation of the required space for ridge enlargement, using xenograft particles (Bio-Oss) covered with a resorbable barrier membrane (Bio-Gide), during the same surgical stage. Recording of anatomical landmarks in the three dimensions of space in relation to implant position allowed precise assessment of the graft behavior during the tomodensitometric examinations performed at 6 and 18 months postsurgery. A biopsy was performed at 9 months postsurgery for histologic and histomorphometric analyses. The tomodensitometric images allowed observation of the preservation of the grafted bone volume. The histologic analysis revealed vital bone formation with the remaining Bio-Oss particles; the histomorphometric analysis, at this stage, provided similar percentages of Bio-Oss (27.94%) and newly formed bone (24.07%). This clinical example confirms the biocompatible and osseoconductive properties of Bio-Oss, as well as stability of the bone graft volume. These different elements testify to the advantage of its use for alveolar ridge enlargement.

The aim of this study was to clarify the adjunctive effect of enamel matrix derivative (EMD) on expanded polytetrafluoroethylene membrane guided tissue regeneration (GTR)-based root coverage by creating gingival recessions in beagle dogs. Recessions were treated with GTR + EMD, GTR alone, or neither GTR nor EMD (control). The control group was characterized by long junctional epithelium and little bone formation. The GTR + EMD group showed a statistically significant increase (P .01) in new bone and cementum formation compared with the GTR group. The results of the present investigation suggest that the adjunctive use of EMD with GTR promotes formation of new bone and cementum without root resorption in recessiontype defects in dogs.

Camlog tube-in-tube implants were introduced several years ago. This multicenter retrospective analysis evaluated the success rate of Root-Line and Screw-Line tube-in-tube implants in daily use. A total of 201 implants were placed in 96 patients with different indications and implantation procedures. Implants were analyzed retrospectively after a functional loading period of 12 to 78 months. At the end of the observation period, all but 1 implant fulfilled the success criteria, resulting in an implant survival rate of 99.5%. Individual case analysis of implants in special indications, such as immediate loading, short implants, and tilted implants, did not indicate any increased risk of implant failure.

The goal of classifying complications in guided bone regeneration procedures with nonresorbable membranes is to provide the clinician with an instrument for easier identification of both the problem and treatment modality. A standardized terminology represents a key point for proper communication among clinicians and provides guidelines for managing these drawbacks.

Bone harvesting from the mandibular retromolar area represents an attractive approach to obtaining corticocancellous bone blocks for reconstruction of a deficient alveolar ridge. Knowledge of the local anatomy, adherence to proper surgical techniques, and judicious use of appropriate surgical armamentarium are paramount to minimizing operative hazards. The objective of this article is to review pertinent surgical notes related to the safe harvesting of corticocancellous bone blocks from the retromolar area using a trephine bur technique.

Platelet-rich fibrin matrix (PRFM) is an autologous biologic material created by centrifugation of blood. This study quantified ridge changes associated with the healing of 21 extraction sites using PRFM alone as a graft. Standardized measurements of ridge width and height were recorded at extraction, after graft placement, and after 4 months of healing. Mean width resorption 3 and 5 mm apical to the crest was 0.32 mm (4.71% loss) and 0.57 mm (7.38% loss), respectively. Mean height resorption was 0.67 mm (7.13% loss). Sites grafted with PRFM alone displayed rapid clinical healing, minimal flap reopening, and excellent bone density. Advantages of PRFM alone include less surgical time, elimination of techniques and potential healing difficulties associated with membranes, and less resorption during healing, as compared to guided bone regeneration procedures.

Treatment of a woman suffering from oligodontia and multiple diastemata with insufficient alveolar ridges in both the maxilla and mandible is described in this clinical report. The total number of missing teeth was 11 (excluding the wisdom teeth). The treatment strategy consisted of an interdisciplinary team approach of orthodontic, surgical, and prosthodontic phases. Sinus floor augmentation, alveolar ridge augmentation via vertical alveolar distraction, and lateral augmentation with ramus graft procedures were performed after fixed orthodontic treatment and prior to dental implant placement. Oral rehabilitation of the patient was completed with the placement of fixed prostheses in the maxillary and mandibular posterior edentulous areas. Early dental intervention improved the patient's appearance and minimized the onset of emotional and psychosocial problems.

Periodontal plastic surgery is commonly performed for esthetic and physiologic reasons, such as alleviating root sensitivity, root caries, and cervical abrasion and facilitating plaque control at the affected site. Currently, there is a lack of information regarding the most appropriate treatment method for the various clinical situations encountered. The aims of this paper are to review and discuss the various clinical situations that require soft tissue grafting and to attempt to provide recommendations for the most predictable technique. Using MEDLINE and The Cochrane Library, a review of all available literature was performed. Papers published in peer-reviewed journals written in English were chosen and reviewed to validate the decision-making process when planning for soft tissue grafting. A decision tree was subsequently developed to guide clinicians to choose the most appropriate soft tissue grafting procedure by taking into consideration the following clinical parameters: etiology, purpose of the procedure, adjacent interproximal bone level, and overlying tissue thickness. The decision tree proposed serves as a guide for clinicians to select the most appropriate and predictable soft tissue grafting procedure to minimize unnecessary mistakes while providing the ultimate desired treatment outcome.