International Journal of Periodontics & Restorative Dentistry, 01/2009

The current study examined the histologic and microcomputed tomographic (micro CT) outcomes of the treatment of gingival recession defects with either a subepithelial connective tissue graft (CTG) or 0.3 mg/mL recombinant human platelet-derived growth factor (rhPDGF-BB) on a beta tricalcium phosphate (ß-TCP) matrix. Gingival recession defects were surgically created in six premolar teeth with no more than 3 mm of keratinized marginal tissue, an osseous crest 2 to 3 mm apical to the newly created gingival margin, and recession depth of at least 3 mm. The defects were left untouched for 2 months; then, four defects were grafted with rhPDGF-BB + ß-TCP + a wound healing dressing, and two defects received CTGs. A coronally advanced flap covered each grafted site. Nine months later, sections were obtained for examination. All four sites treated with rhPDGF-BB + ß-TCP showed connective tissue fibers (Sharpey fibers) perpendicularly inserting into newly formed cementum and alveolar bone. In the two sites treated with CTGs, a long junctional epithelium was seen coronal to the osseous crest and connective tissue fibers ran parallel to the adjacent root surfaces, with no evidence of insertion into cementum or bone. There was no evidence of regeneration of cementum, inserting connective tissue fibers, or supporting alveolar bone. Regeneration of the periodontium in gingival recession defects is possible through growth factor-mediated therapy.

The aim of this ongoing prospective study was to determine the 36-month survival rate of short porous implants in the posterior maxilla with 2 to 7 mm of initial bone height in 48 patients. Forty-eight implants were placed; 35 were in sites with a bone height of 5 mm or less and 13 patients required sinus elevation with osteotomes in addition to a xenograft. All implants were loaded with single crowns. At the end of the follow-up period the survival rate was 97.92%. The use of short porous implants showed good predictability in the treatment of the posterior maxilla in this interim 3-year report.

Bisphosphonates are pharmacologic compounds characterized by high tropism to bone tissue. They affect bone metabolism by inhibition of osteoclast recruitment, proliferation, differentiation, and function. Because they can reduce bone resorption, bisphosphonates are used mainly for the treatment of osteometabolic conditions, particularly osteoporosis, Paget disease, multiple myeloma, and other solid tumors with bone metastases. Their use has conferred great benefits to patients affected by these diseases, significantly improving their quality of life. Bisphosponates' inhibition of bone resorption might be exploited to maintain implant primary stability during the process of implant osseointegration. The aim of this histologic clinical study was to compare the response of bone tissue around an implant treated with a bisphosphonate solution (test) to that of the bone around an untreated implant (control). The bisphosphonate-treated implant showed more contact with newly formed bone than the control implant.

This study evaluated the effectiveness of a mineralized cancellous bone allograft (Puros) for the treatment of human periodontal osseous defects. Twenty patients with chronic periodontitis each contributed at least one intrabony defect. The surgical procedure consisted of flap reflection, debridement of the defect, root planing, and placement of the bone graft in the defect, followed by flap closure. Clinical and surgical measurements were taken at baseline and at the 6-month surgical reentry. The average probing depth reduction was 4.8 ± 1.3 mm and average gain in clinical attachment levels was 4.2 ± 1.5 mm; both changes were statistically significant. The average percent bone fill was 66.8% ± 26.2% and average percent defect resolution was 71.5% ± 25.5%. Mineralized cancellous bone allograft appears to be an effective material for the treatment of osseous defects in patients with chronic periodontitis.

The appearance and long-term stability of peri-implant bone, mucosa, and gingiva determine the success of implant-supported prostheses from both the esthetic and functional standpoints. Any surgical or prosthetic technique that takes into consideration only some variables, or that only intervenes in a limited phase of treatment, is a potential source of a partially successful and/or unpredictable clinical outcome. This article describes the underlying principles and surgical-prosthetic procedures of a systematic regenerative approach, edentulous site enhancement (ESE). The goal of this approach is to improve the anatomy of edentulous sites. Applied to implant dentistry, this approach enables peri-implant tissue to be managed predictably, optimizing the functional and esthetic result of restorations with regard to treatment time, number of surgical stages, long-term prognosis, and incidence of complications. The principles underlying the ESE approach, which are independent of any specific implant system, are applicable in the majority of clinical situations, regardless of the esthetic requirements.

This study compared the results following treatment of gingival recessions by a coronally advanced flap procedure alone (CAF) or combined with a bioabsorbable membrane and a demineralized xenograft (GTRF). Sixteen nonsmokers with 20 Miller Class I or Class II buccal gingival recessions at canines or premolars were included in the study. Sites were randomly assigned to either CAF treatment (control, n = 10) or GTRF treatment (test, n = 10) and examined at baseline and at 6 months postoperatively. Both treatments resulted in a significant reduction in recession and gain in clinical attachment level; there was no significant difference between treatments. No differences were found in probing depths among or between the groups. The increase in keratinized tissue from baseline to 6 months was slightly greater for the GTRF group than for the CAF group, but without statistical significance. The test group experienced a statistically significant increase in gingival thickness from baseline to the 6-month evaluation, while little gain was detected in the control group; the between-group difference was statistically significant in favor of the test group. Both procedures offer a predictable, simple, and convenient means of root coverage in Miller Class I and II recession defects, but the GTRF-supported procedure resulted in more keratinized tissue and a significant increase in gingival thickness than the CAF-only approach.

This article reports the longitudinal follow-up of a familial case of aggressive periodontitis treated by a combined regenerative approach that consisted of root conditioning, bone grafting, and membrane positioning. Treatment resulted in attachment level gain, reduction of probing depth, absence of bleeding on probing, and complete bone filling of the defect. The short-term results obtained after surgery were maintained after 6 years, suggesting that the combined regenerative approach is able to completely arrest the disease with long-term stability

Grafting of the maxillary sinus in both one- and two-stage protocols has become a highly predictable surgical technique for site development and for the placement of implants to support dentures. However, despite the predictability and high success rates reported for dental implants placed either simultaneously with or after a sinus floor elevation (SFE) procedure, complications have been reported. The aim of the following case report is to present an uncommon complication in a staged SFE procedure: the displacement of a dental implant into the maxillary sinus during insertion. As implant dentistry is becoming more and more popular among practitioners, and ever more demanding procedures for initial site development in jaws with bony deficiencies are being introduced into daily practice, the displacement of dental implants into the maxillary sinus during implant placement may become a more frequent complication. Management of this complication is presented, discussed, and evaluated in light of the current literature.

Localized aggressive periodontitis is a distinct entity of periodontal disease and is characterized by deep vertical bony defects that typically affect the first molars and incisors of young patients. Therapy is usually aimed at reducing the pathogenic microflora through scaling and root planing and the administration of systemic antibiotics. However, conservative periodontal therapy may result in reparative wound healing with limited regeneration of the lost tissues. Periodontal surgery combined with enamel matrix derivative has been introduced as a method to promote regeneration of the lost periodontium and has been studied extensively in the treatment of chronic periodontitis. This case report describes the treatment of a 27-year-old patient displaying severe localized aggressive periodontitis with documented disease progression. After initial therapy consisting of scaling and root planing and systemic administration of amoxicillin and metronidazole, the vertical defects were treated by minimally invasive access flaps combined with application of enamel matrix derivative. Clinical, microbiologic, and radiographic findings are reported for up to 1.5 years after initial therapy, indicating good efficacy of the therapeutic strategy and stability of the treatment outcome.

Concerns have been raised about the degradation of hydroxyapatite (HA) coatings on dental implants over time. It has been speculated that the resorption of HA could produce a space between implant and bone, resulting in mechanical instability and implant failure. A screw-shaped HA-coated implant was retrieved after the abutment had fractured after a loading period of 15 years, and was evaluated histologically. At the interface with the implant, compact mature bone, with small marrow spaces, was present. Higher magnification showed that only a few osteoblasts were present. No multinucleated giant cells were present. Bone remodeling was evidenced by the presence of many secondary osteons close to the implant surface and many reversal lines. No fibrous or granulation tissues were present at the interface. The HA coating had been completely resorbed, and just 5.1% ± 2.3% of the implant surface was covered by the HA coating. The boneimplant contact percentage was 77.6% ± 5.1%. The almost complete resorption of the HA coating did not appear to have interfered with osseointegration. The implant was osseointegrated and was still providing adequate function; thus the HA coating resorption probably had little clinical significance.