International Journal of Periodontics & Restorative Dentistry, 01/2008

The most frequent intraoperative complication with sinus elevation is perforation of the schneiderian membrane. In most instances, the repair of this perforation is necessary to contain particulate grafting material and complete the procedure. New techniques are presented here for the management of large perforations of the schneiderian membrane. A bioabsorbable collagen membrane is stabilized outside the antrostomy and then folded inward to create either a new superior wall that can obliterate a large perforation or a "pouch" that can completely contain the particulate material. This can make it possible to complete a procedure that otherwise may have had to be aborted by preventing dispersion of the particulate graft within the sinus cavity. Clinical cases are shown, along with follow-up at 6 to 9 months, demonstrating histologic and/or radiographic evidence of success, continued sinus health, and superior vital bone formation. The authors have used this technique on 20 consecutive patients without experiencing any procedural failures.

Connective tissue grafts (CTGs) are generally viewed as the most successful technique for root coverage. The aim of this retrospective study was to assess the longterm clinical and patient-centered esthetic results of the envelope technique for CTG. Thirty-nine defects in 20 patients (22 to 57 years of age; mean 37.8 ± 11.5 years) had received CTG that had been harvested from the palate and grafted according to the envelope technique of Raetzke. Factors influencing root coverage were identified by multilevel analysis. The patients were also asked to judge the results of treatment. Follow-up examinations were performed 6 to 22 years (mean, 11.4 ± 5.4 years) after surgery. Mean baseline recession was 3.1 ± 1.3 mm (range, 1 to 6 mm). Clinical re-examination revealed mean root coverage of 89.7% ± 25.1%. In 32 of 39 defects (82%), complete root coverage was achieved. Recessions were statistically significantly reduced by a mean of 2.7 ± 1.2 mm (P .001), to a postsurgical mean of 0.4 ± 0.94 mm. Higher baseline Miller classes resulted in less favorable prognoses for complete and relative root coverage. Baseline recession height had a negative influence and location at a canine had a positive influence on the percentage of relative root coverage. All patients judged the situation at the respective teeth as improved.

This article aimed to evaluate whether normal osseointegration occurs in immediate loading following secondary stabilization obtained by means of conical copings and adaptation of patients' old dentures. Two clinical cases of immediate loading of implant-supported prostheses in the edentulous mandible are presented. Prostheses were positioned within 24 hours, with secondary splinting of primary conical copings screwed onto implants. For this purpose, the patients' old removable prostheses were adapted and lined to fit within the secondary acrylic resin copings, which perfectly matched the primary copings screwed onto the implants and milled to 2 degrees.

This paper documents the treatment of a patient for whom a tissue engineering approach was used for both soft and hard tissue implant site development following the extraction of a failing maxillary left central incisor. The tooth had advanced pocketing and recurrent abscess formation secondary to failing endodontic treatment. Extraction revealed a lack of buccal plate as well as insufficient soft tissue for anterior esthetics. After extraction, the bony defect was filled with freeze-dried mineralized bone allograft mixed with recombinant human platelet-derived growth factor (rhPDGF), and a titanium-reinforced expanded polytetrafluoroethylene membrane was placed over it. The soft tissue deficiency was corrected with a pediculated connective tissue graft, and the graft bed was rinsed with rhPDGF. Seven months after surgery, the site was re-entered for implant placement. The grafted site was trephined for histologic analysis and an implant was placed. Subsequently, the implant osseointegrated and was restored. The radiographic and clinical results were acceptable. Histologic analysis revealed bone regeneration. Although this approach needs further investigation, this report emphasizes the potential for the use of rhPDGF for simultaneous soft and hard tissue implant site preparation.

The purpose of this study was to report on the tunnel technique, an approach to alveolar ridge augmentation in partially edentulous patients that uses bone blocks immobilized with titanium screws prior to implant placement. Twenty patients (7 men and 13 women) between the ages of 35 and 65 years were treated during a 2-year period with the tunnel technique. The technique consists of creating the tunnel, exposing the crestal defect, harvesting the graft, and final adaptation and stabilization of the graft in the defect site. Nineteen of the 20 patients treated had an adequate level of bone postoperatively to place implants 3.75 or 4 mm in diameter and at least 10 mm in length. None of the patients reported temporary or permanent lower lip paresthesia. There were also no infections reported in the donor sites. This method eliminates the need for a membrane because the integrity of the periosteum is preserved, and it greatly reduces patient discomfort since only one surgical field is needed. The learning curve for this procedure is relatively short.

This randomized, blinded study compared, contralaterally, the dimensions of supracrestal gingival tissue (SGT) in healthy human periodontium. Sulcular probing reaching the crestal bone was performed in 100 dental students (400 teeth [first molars and second premolars] and 1,600 sites). Contralateral measurements were statistically analyzed by one-way analysis of variance. SGT measurements ranged from 1.0 to 6.0 mm. Contralateral measurements showed no statistical difference (P = .096). Measurement of SGT contralaterally prior to crown lengthening or restorative procedures may dictate the needed amount of bone removal or tooth preparation into the sulcus.

New materials (restorative and adhesive) for the treatment of cervical abrasions have produced better results in terms of esthetics (choice and stability of colors) and duration (marginal fit and wear resistance). Nevertheless, conservative restoration of cervical abrasion cannot be considered the most suitable treatment in certain clinical situations: (1) when the abrasion defect involves the root surface, either exclusively or primarily; (2) when a site has difficult esthetic demands resulting from excessive tooth length with gingival recession; and (3) in the presence of root caries. The aim of this case report is to describe the application of the bilaminar technique to treat a deep cervical abrasion associated with a recession-type defect. The bilaminar surgical approach shown here consisted of a connective tissue graft covered by a coronally advanced pedicle flap. The connective tissue graft was placed inside the root concavity to compensate the abrasion space and to prevent soft tissue flap collapse internally. The graft, by acting as a "biologic filler" or space maintainer inside the concave abrasion area, stabilized the covering flap and helped restore a correct tooth emergence profile.

Since the osteotome technique with simultaneous implant placement becomes less predictable when there is less than 5 mm of preexisting alveolar bone height beneath the sinus, a staged approach has been recommended for this situation. The purpose of the present article is to describe the osteotome technique as a site development method where the edentulous posterior maxilla radiographically showed less than 5 mm of bone between the alveolar crest and the sinus floor.

This report presents a case of reconstructing and augmenting a buccal fenestration defect associated with simultaneous implant placement using recombinant human platelet-derived growth factor BB (rhPDGF-BB) combined with the synthetic alloplast beta-tricalcium phosphate (ß-TCP) and collagen membrane. Fenestration and fracture of the labial plate occurred at the time of implant placement at the maxillary left lateral incisor position. The sandwich bone augmentation technique was applied using autogenous bone as the inner grafting material and rhPDGF-BB + ß-TCP as the outer grafting material. A collagen barrier membrane was then tented over these materials. After approximately 5 months of healing, second-stage surgery was performed, showing complete healing at the defect site. This case suggests that the combination of rhPDGF-BB and ß-TCP can be a suitable material for predictable bone augmentation, especially during sandwich bone augmentation.

This case involved the intentional reimplantation of a tooth with severe periodontal involvement using regenerative therapies. The maxillary left central incisor was intentionally extracted, enamel matrix derivative (EMD) was applied, and the tooth was repositioned accurately. The bone defect was filled with a xenograft and a demineralized freeze-dried bone allograft, and a guided tissue regeneration membrane was adapted over the site. After 5 years, a reduction in probing depth and a gain in clinical attachment were observed. Conventional radiographs and cone-beam computerized tomographs showed hard tissue improvement. Favorable clinical results were obtained with reimplantation with applied EMD, combined with regenerative therapies, for treating a tooth with severe periodontal involvement.