International Journal of Periodontics & Restorative Dentistry, Pre-Print
DOI: 10.11607/prd.7179, PubMed ID (PMID): 3905894426. Jul 2024,Pages 1-15, Language: EnglishUrban, Istvan A. / Di Martino, Maria / Rangel, Rodrigo / Latimer, Jessica / Forster, Andras / Tavelli, LorenzoA 45-year-old female patient presented with a lack of inter-implant papilla after a partially edentulous anterior area was rehabilitated with dental implants. The soft tissue phenotype and inter-implant papilla was augmented using the “iceberg” connective tissue graft, followed by a second surgical procedure where a strip gingival graft was combined with a connective tissue graft inserted underneath a pouch prepared into the previous “iceberg” connective tissue graft at the level of the crest (“garage” approach), further enhancing soft tissue volume in that region. This technique aims to improve mucosal thickness and supracrestal tissue height while addressing esthetic concerns associated with multiple implant placements in the anterior region. The final esthetic outcome was excellent, harmonious soft tissue with appropriate thickness, symmetry with adjacent teeth, well-shaped interdental and inter-implant papilla with high patient satisfaction, making this approach a valuable addition to a surgeon’s armamentarium. Future clinical studies are needed to evaluate the performance of this novel approach.
International Journal of Periodontics & Restorative Dentistry, Pre-Print
DOI: 10.11607/prd.7218, PubMed ID (PMID): 3905894326. Jul 2024,Pages 1-28, Language: EnglishWatanabe, Taito / Hasuike, Akira / Ogawa, Yudai / Barootchi, Shayan / Sato, Shuichi / Tavelli, LorenzoWe report the successful treatment of multiple recession type (RT) 3 gingival recessions in periodontally compromised mandibular anterior teeth with limited keratinized tissue. A 35-yearold man with stage III, grade C periodontitis underwent a two-stage intervention. Initially, a modification of the connective tissue graft (m-CTG) wall technique was used as part of phenotype modification therapy. The CTG acted as a protective “wall,” securing space for periodontal regeneration, enhancing root coverage, soft tissue thickness, and keratinized mucosal width. Recombinant human fibroblast growth factor-2 and carbonate apatite promoted periodontal regeneration. This procedure successfully facilitated periodontal regeneration, resulting in the transition from RT3 to RT2 gingival recession and adequate keratinized mucosal width. Eighteen months later, the second surgery used a tunneled coronally advanced flap (TCAF) for root coverage. TCAF involved combining a coronally advanced flap and tunnel technique by elevating the trapezoidal surgical papilla and using a de-epithelialized CTG inserted beneath the tunneled flap. Root conditioning with ethylenediaminetetraacetic acid and enamel matrix derivative gel application were performed. Consequently, mean CAL gain was 5.3 mm, mean root coverage was 4.5 mm in height, and the gingival phenotype improved at the treated sites by the 12-month follow-up. This staged approach addresses the challenges of treating RT3 gingival recession with promising outcomes.
Keywords: RT3, gingival recession, case report, T-CAF, periodontal regeneration, connective tissue graft, CTG wall
International Journal of Periodontics & Restorative Dentistry, Pre-Print
DOI: 10.11607/prd.74767. Jan 2025,Pages 1-20, Language: EnglishUrban, Istvan A. / Mancini, Leonardo / Akhondi, Samuel / Tavelli, LorenzoIt is well known that keratinized mucosa (KM) plays a crucial role for maintaining peri implant health and esthetic outcomes. The Strip Gingival Graft (SGG) technique, which involved an apically positioned flap (APF), in combination with an autogenous SGG and a xenogeneic collagen matrix (XCM), demonstrated its efficacy in re-establishing an adequate amount of KM width at implant sites. Nevertheless, it is still unclear whether harvesting the SGG from the palate (pSGG) or from the buccal aspect of natural dentition (bSGG) affects the esthetic outcomes at the augmented implant sites. Therefore, the objective of the present study was to compare the esthetic outcomes of dental implants augmented with either bSGG + XCM or pSGG + XCM. The present study was designed as a single-center retrospective study, assessing the esthetic and colorimetric outcomes of peri-implant KM augmentation with either pSGG + XCM or bSGG + XCM in cohort of 49 subjects. The two groups were compared in terms of colorimetric outcomes, assessed on clinical photograph using specific software able to identify and quantify the predominant color within the peri implant soft tissue. Colorimetric comparisons with adjacent untreated sites were also investigated. In addition, the Pink Esthetic Score (PES) and the Subjective Esthetic Score (SEE) were performed to further assess the esthetic outcomes of pSGG + XCM and bSGG + XCM. The colorimetric analysis did not show statistically significant differences among sites augmented with pSGG + XCM, sites augmented with bSGG + XCM, and untreated sites. Implants treated with bSGG + XCM showed significantly greater PES (in terms of shape of the mesial and distal papilla, level of the soft tissue margin, soft tissue contour, anatomy of the alveolar process, and final PES) and SEE compared to implants augmented with pSGG + XCM. The present study demonstrated that implant sites augmented with APF with either pSGG + XCM or bSGG + XCM did not show different colorimetric outcomes compared to adjacent untreated sites, while bSGG + XCM obtained superior professional and subjective esthetic scores compared to pSGG + XCM.
International Journal of Periodontics & Restorative Dentistry, Pre-Print
DOI: 10.11607/prd.7197, PubMed ID (PMID): 3882027831. May 2024,Pages 1-22, Language: EnglishZwanzig, Kai / Akhondi, Samuel / Tavelli, Lorenzo / Lanis, AlejandroIntroduction: The presence of adequate keratinized mucosa (KM) around dental implants and natural
dentition is pivotal for the long-term success of dental restorations. Despite various techniques to
augment KM, challenges persist in achieving stable, keratinized, and adherent mucosa, especially in
the context of significant muscle pull or compromised tissue conditions. This study introduces a novel
application of titanium pins for the fixation of free gingival grafts (FGG) and apically repositioned
flaps (APF) during vestibuloplasty, aiming to overcome important limitations associated with
traditional suturing methods and shorten the treatment time and patient morbidity. Methods: Three
patients with insufficient KM width, presenting discomfort during oral hygiene and inflammation
around implant restorations and natural teeth, underwent soft tissue augmentation using titanium pins
traditionally used in guided bone regeneration (GBR) for the stabilization of FGGs and APFs. This
method ensures intimate contact between the graft and the periosteum, facilitating proper graft
perfusion and revascularization, minimizing shrinkage and the risk for necrosis of the graft. Results:
Postoperative follow-up revealed successful integration of the grafts, with minimal shrinkage and
increased width and depth of KM. The use of titanium pins allowed for reliable fixation in challenging
surgical sites, where traditional suturing methods were impractical due to the presence of extensive
muscle pull and an unstable recipient bed. Conclusion: The application of titanium pins for the fixation
of FGGs and APFs during vestibuloplasty provides a promising alternative to traditional suturing
techniques, particularly in complex cases where the recipient bed is suboptimal for suturing. This
method simplifies and shortens the procedure, offering a predictable outcome with increased
mechanical stability and minimal shrinkage of the graft. Randomized clinical trials are recommended
to further evaluate the efficacy of this technique.
Keywords: Free Gingival Graft, Dental Implants , Apically repositioned flap, Titanium pins, Vestibuloplasty, Graft Survival, Periodontal Surgery, Titanium Pins, Transplants
International Journal of Periodontics & Restorative Dentistry, Pre-Print
DOI: 10.11607/prd.74797. Jan 2025,Pages 1-30, Language: EnglishKuo, Po-Jan / Ogawa, Yudai / Do, Jonathan H. / Wu, Tsung-Hsun / Chang, Nancy Nie-Shiuh / Tavelli, LorenzoThe integrity and phenotype of periodontal soft tissues significantly influence the outcome of surgical periodontal regenerative therapy. In cases with thin gingival phenotype, treating infrabony defects surgically can worsen gingival recession and loss of papillae. This report outlines a surgical approach for addressing infrabony defects at sites with gingival recession and thin phenotype. The treatment involves using a tunneled coronally advanced flap (TCAF) to obtain access for defect debridement, root instrumentation, graft placement, and tissue advancement for root coverage. A connective tissue graft (CTG) is secured to the two teeth flanking the infrabony defect with two subperiosteal sling (SPS) sutures to create a buccal soft tissue wall and to tent up the papilla overlying the defect to provide and maintain the necessary space for biomaterials and clot stability. The treatment significantly improved interproximal clinical attachment levels, tissue phenotype, and root coverage one-year post surgery. Treatment outcomes suggest that this approach may be used to effectively treat isolated infrabony defects associated with gingival recession.
Keywords: connective tissue graft, osseous defects, periodontal diseases, periodontal regeneration
International Journal of Periodontics & Restorative Dentistry, 5/2024
DOI: 10.11607/prd.6731, PubMed ID (PMID): 37552185Pages 510-519, Language: EnglishUrban, Istvan A / Mancini, Leonardo / Wang, Hom-Lay / Tavelli, LorenzoImplants with deficient papillae and black triangles are common findings. The treatment of these esthetic complications is considered to be challenging with limited predictability. Therefore, the present report aims 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 to 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 return for implant therapy only 2 years later, at which time an incomplete regeneration of the interproximal bone was observed. Therefore, to compensate the interproximal deficiency, the iCTG approach was utilized, involving a double layer of CTG with different origins. Two small grafts from the tuberosity were sutured to the mesial and distal ends of a wider CTG harvested from the palate, aiming to gain additional volume at the interproximal sites. The composite graft was then sutured on top of the implant platform, and the flap was then released and closed by primary intention. After conditioning the peri-implant tissues, the case was finalized with a satisfactory outcome. The described iCTG could be an effective approach for reconstructing peri-implant papillae following interproximal bone reconstruction.
International Journal of Periodontics & Restorative Dentistry, 4/2024
DOI: 10.11607/prd.6721, PubMed ID (PMID): 37471153Pages 376-387a, Language: EnglishBarootchi, Shayan / Mancini, Leonardo / Sabri, Hamoun / Wang, Hom-Lay / Tavelli, Corrado / Tavelli, LorenzoMultiple adjacent gingival recessions (MAGRs) are commonly treated with autogenous grafts. However, several intra- and postsurgical complications have been described following autogenous grafts, leading clinicians to explore the use of different biomaterials to treat these conditions. The aim of the present study was to evaluate the root coverage outcomes of a novel porcine-derived acellular dermal matrix (PADM) in combination with the tunneled coronally advanced flap (TCAF) for the treatment of MAGRs. Ten patients with 33 type 1 recession defects (RT1s) were treated with PADM + TCAF. The outcomes of interest included the mean root coverage (mRC), the frequency of complete root coverage (CRC), changes in keratinized tissue width, volumetric gain at the treated sites (assessed with digital intraoral scanning), and patient-reported outcome measures. All treated sites healed uneventfully, and no complications were noted throughout the study. At 6 months, a statistically significant reduction in recession was noted at the treated sites, exhibiting an overall mRC of 89.14% ± 19.15% and a CRC of 72.7%. The average volume gain after 6 months was 26.28 ± 11.71 mm3, and the mean distance between the surface/mean thickness of the reconstructed volume (DD) was 0.63 ± 0.28 mm. The region-specific volumetric analysis revealed an overall higher linear dimensional gain at the midroot aspect (range: 0.72 to 0.78 mm, assessed 1 to 4 mm apical to the cementoenamel junction) compared to the other regions. The present study presents the clinical and volumetric outcomes of PADM + TCAF for the treatment of MAGRs. A significant amount of volumetric gain was also observed at 6 months as a result of the treatment, along with satisfactory esthetic and patient-reported outcomes.
Keywords: Gingival recession, Acellular Dermal Matrix, Surgical flap, volumetric analysis, optical scanning
International Journal of Periodontics & Restorative Dentistry, 4/2023
DOI: 10.11607/prd.6058, PubMed ID (PMID): 37552200Pages 415-422, Language: EnglishTavelli, Lorenzo / Barootchi, Shayan / Rodriguez, Maria Vera / Meneghetti, Priscila Ceolin / Mendonça, Gustavo / Wang, Hom-LayPerforming soft tissue augmentation (STA) at implant sites to improve esthetics, patient satisfaction, and peri-implant health is common. Several soft tissue grafting materials can be used to increase soft tissue thickness at the second-stage surgery, including human dermal matrices and xenogeneic collagen scaffolds. This study assessed and compared the volumetric outcomes, from second-stage surgery to crown delivery, around implants that received STA with a xenogeneic cross-linked collagen scaffold (XCCS) vs nonaugmented implant sites. Thirty-one patients (31 implant sites) completed the study. Intraoral digital scans were taken at the second stage and prior to crown delivery, and the STL files were imported in an image-analysis software to assess volumetric changes. XCCS-augmented implants showed significantly greater volumetric changes compared to control sites, which showed volume loss. The mean thickness of the XCCS-augmented area was 0.73 mm. There was no difference in patient-reported esthetic evaluations between groups. STA with XCCS provided significantly greater volumetric outcomes compared to nonaugmented sites. Further studies are needed to evaluate the long-term behavior of the augmented peri-implant mucosa and the effects of STA on peri-implant health.
International Journal of Periodontics & Restorative Dentistry, 4/2023
DOI: 10.11607/prd.5671, PubMed ID (PMID): 36520135Pages 435-441, Language: EnglishVilla, Gabriele / Rizzacasa, Andrea / Bessa, Luis / Spina, Paolo / Barootchi, Shayan / Tavelli, Lorenzo / Wang, Hom-LayThe aim of this prospective case series was to evaluate the efficacy and safety of a xenogeneic cortical bone lamina utilized as a “shell” on the buccal aspect of narrow alveolar ridges for horizontal bone augmentation. Fifteen patients requiring multiple implant restorations at sites with moderate to severe horizontal bone deficiency were consecutively enrolled. Horizontal bone augmentation was performed using a xenogeneic cortical bone lamina (XCBL), which was fixed on the buccal aspect of the ridge using titanium screws, and a mixture of particulate autogenous bone graft and porcine hydroxyapatite. CBCT scans were taken at baseline and 6 months after bone augmentation. The healing was uneventful, with no intra- or postoperative complications. Twenty-seven implants were placed in the augmented sites. The calculated average horizontal bone gain from CBCT scans was 4.79 ± 1.64 mm, 5.59 ± 1.51 mm, and 5.79 ± 2.53 mm at 1-, 3-, and 5-mm reference points apical to the buccal bone crest, respectively. The present case series demonstrated that the shell technique with the XCBL and particulate bone graft can be an effective approach for horizontal bone augmentation prior to implant placement.
International Journal of Periodontics & Restorative Dentistry, 3/2023
DOI: 10.11607/prd.6538, PubMed ID (PMID): 37141083Pages 281-288, Language: EnglishTavelli, Lorenzo / Heck, Teresa / De Souza, André B / Stefanini, Martina / Zucchelli, Giovanni / Barootchi, ShayanImplant esthetic complications can negatively affect a patient's perception of implant therapy and their quality of life. This article discusses the etiology, prevalence, and strategies for the treatment of peri-implant soft tissue dehiscences/deficiencies (PSTDs). Three common scenarios of implant esthetic complications were identified and described, in which PSTDs could be managed without removing the crown (scenario I), with the surgical-prosthetic approach (crown removal; scenario II), and/or with the horizontal and vertical soft tissue augmentation and submerged healing (scenario III).
