International Journal of Periodontics & Restorative Dentistry, 01/2024

Surgical treatment of infrabony defects may result in gingival recession of the neighboring teeth. The aim of this clinical report is to describe a surgical technique to promote gingival margin stability in the treatment of infrabony defects at sites with a thin or medium gingival phenotype. A coronally advanced entire papilla preservation (CA-EPP) flap with a connective tissue graft (CTG) was executed in two different clinical cases. This technique substantially improved interproximal clinical attachment level and pocket closure, with no gingival recession. A CA-EPP flap using a CTG may promote gingival margin stability and can be recommended in regenerative periodontal procedures.

Vertical ridge augmentation in the anterior mandible is a technically delicate procedure that requires knowledge of some anatomical structures to reduce intra- and postoperative complications. Proper soft tissue management is one of the primary aspects to the success of these techniques, enabling tension-free primary wound closure and preventing membrane exposure. This cadaveric and clinical study provides an anatomical overview of the lingual portion of the anterior mandible. Moreover, there is a description of a novel surgical approach for release of the lingual flap that will help clinicians achieve primary closure without incurring intrasurgical complications.

The aim of this morphometric study was to precisely determine the 3D characteristics of the root complex of the posterior dentition. Extracted and well-preserved permanent posterior teeth were included in this analysis and grouped based on tooth type and arch location. All teeth were digitally scanned. Morphologic and dimensional features of the root complex were assessed, including length and surface area of the root trunk and individual roots, width of root concavities (RC), and furcation entrance, when present. A total of 240 posterior teeth comprised the study sample. The root complex of multirooted maxillary first premolars presented with a long root trunk (10.49 mm), representing 65.52% of the surface area, and two short roots comprising the remaining 34.8% of the surface area. Root trunks of mandibular molars were an average of 0.8 mm shorter than their maxillary counterparts. Class III furcation involvement is expected in all maxillary and mandibular molars, as well as multirooted maxillary first premolars, after 4.80 mm and 10.49 mm of clinical attachment loss, respectively. RCs were a common finding among the evaluated dentitions. The root complex morphology varies among the maxillary and mandibular posterior dentition. RCs are highly prevalent in both maxillary and mandibular dentition. The findings derived from this study can be utilized in daily clinical practice for the adequate management of posterior dentition and serve as a reference for future investigations in dental anatomy and digital technology. Also, these findings can guide the industry into creating and redefining tools that adequately adapt to the anatomical characteristics and variations of the specific tooth type.

Traditional GBR procedures have been associated with frequent complications and compromised peri-implant esthetics. Tunneling techniques have been proposed as a promising alternative in this regard. More recently, a subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART) was reported to have been clinically successful in a prospective case series. This technique includes the use of a bone graft/recombinant human platelet-derived growth factor-BB combination delivered to the site by a tunneling method. However, published histologic information regarding the nature of the regenerated tissue has been limited. The current study evaluated the histologic and histomorphometric findings of four human specimens harvested at 2, 5, 9, and 14 months after ridge augmentation using the SMART method. Evaluations of the wound healing and bone regeneration sequence over time found that the ridge augmentation was the result of extensive new bone formation that progressed through the woven bone to lamellar bone stages, with remodeling of the xenogeneic graft material and replacement by patient bone. This is the first study utilizing sequential human specimens to histologically examine the chronology of wound healing following alveolar ridge augmentation.

The ability for clinicians to adequately obtain primary stability in host bone is critical to the success of dental implants. Numerous conditions require dentists to perform multistage approaches to rebuild deficient bone volume prior to surgically placing implants. In many instances, implant placement cannot be achieved due to a lack of primary implant stability. Recently, a novel mineral-organic resorbable bone adhesive (MORBA) has demonstrated promising results in animal studies. MORBA is a synthetic, injectable, self-setting, load-bearing adhesive biomaterial that exhibits osteopromotive properties and bonds bone to bone and metal within 10 minutes and can fully resorb in 30 weeks. Its unique novel formulation was developed from biomimetic proteins found in marine animal creatures that possess distinct adhesive properties underwater. Excellent long-term results have shown its potential use for achieving primary stability in immediate implants. The present case report demonstrates the first use of MORBA in a human patient, utilized on a nonrestorable mandibular first molar. MORBA was utilized after placement of a mobile 5.8-mm implant to achieve stabilization. At 3 months postsurgery, both clinical and CBCT evaluations showed maintained implant stability. One year after implant placement, radiographic bone was seen on the buccal surface of the implant with continued long-term stabilization. This case report extends to 3 years whereby the use of MORBA, in an initially unstable situation, demonstrated an excellent long-term follow-up. MORBA provided immediate implant stability with resorbable characteristics, leading to successful long-term clinical outcomes up to 3 years. This innovative biomaterial offers a more efficient solution to a critical problem in implant dentistry, allowing optimal primary stability during immediate implant placement, thus reducing treatment times and costs.

Ultrathin ceramic veneers are a viable therapeutic option to manage esthetic challenges in the anterior zone. Proper conditioning of the intaglio surface of porcelain veneers is essential to achieve an adequate bonding. In clinical practice, this is typically done with chemical etching using an acid-containing agent, such as hydrofluoric acid. While it is well established that the etching effect is dependent on etching time and the acid concentration, little is known about the impact of etching time and the veneer fabrication method. The purpose of this pilot study was to evaluate, using scanning electron microscopy (SEM), the effect that different etching-time protocols have on the intaglio surface characteristics of ultrathin ceramic veneers fabricated with either the platinum foil technique or the refractory die technique. Several replicas of an ultrathin feldspathic ceramic veneer for a maxillary central incisor were fabricated. Individual specimens were processed according to different intaglio surface-etching protocols: no etching, etching for 90 seconds, etching for 120 seconds, and etching for 150 seconds (9.6% hydrofluoric acid used for all etching groups). It was observed that the 120-second etching protocol resulted in a favorable microroughness surface pattern in the platinum foil group. This pattern was comparable to that obtained by etching for 90 seconds with hydrofluoric acid the intaglio surface of veneers fabricated with the refractory die technique. Increasing the etching time to 150 seconds did not result in a more favorable roughness pattern.

The purpose of the present study was to describe a novel protocol for a minimally invasive pocket elimination surgery (MI-PES) in the posterior maxilla and mandible, which consists of the combined use of (1) an access flap based on an internally beveled gingivectomy with minimal to no papilla mobilization at the buccal aspect, and (2) a resective procedure with an apically positioned flap on the lingual aspect. The interproximal bone defects were accessed with a single (lingual) flap, and the bone architecture was modified by the adoption of piezoelectric inserts for controlled bone recontouring associated with fiber retention. Mean probing depth (PD) was 5.5 ± 0.8 mm before surgery and 2.7 ± 0.6 mm at the 6-month reevaluation. All treated pockets showed a postsurgical PD < 4 mm. Gingival recession (REC) was 0.3 ± 0.5 mm at baseline and increased to 1.6 ± 0.8 mm at 6 months. When buccal and lingual pockets were analyzed separately, a trend toward a similar PD reduction, less REC increase, and greater clinical attachment level gain was recorded for buccal pockets. These preliminary observations seem to support the use of MI-PES as a valuable option for pocket elimination, at least when residual pockets are associated with a shallow interproximal osseous crater in the posterior maxilla or mandible.

Successful rehabilitation of severely atrophic, short-span edentulous ridges in esthetic regions can seldom be done without some form of vertical ridge augmentation (VRA). The best available evidence shows that guided bone regeneration procedures may present a very predictable option with reduced potential for complications compared to alternative options. The present case series presents a novel technique to achieve predictable VRA with a low complication rate using tenting screws and cross-linked resorbable membranes. A total of 10 patients (5 men, 5 women) with severe vertical defects in the esthetic zone participated in this study. Following a mean healing time of 9.3 months, the mean defect resolution was 80%, with a mean vertical bone gain of 6.2 ± 1.61 mm. Only one case presented with reduced defect resolution (50%); however, the bone gain for this case was 6 mm.

Tooth autotransplantation is an effective treatment to replace missing teeth. Digital planning can facilitate successful autotransplantation. Guiding templates are highly recommended when performing cases in healed ridges in the posterior area to reduce excessive bone loss and increase the chances of fitting the donor tooth in the new socket. This case report highlights the use of 3D planning tools and fully guided drilling templates for successful tooth autotransplantation in the posterior area. Two tooth autotransplantations were performed in a 51-year-old patient using mandibular third molars to replace hopeless mandibular first and second molars. Root canal treatments were carried out before the surgeries, and different alveoloplasty techniques were used in each recipient area. The prosthetic phase was carried out after 9 months. Both teeth were asymptomatic, functional, and exhibited no signs of resorption or apical radiolucency and showed complete regeneration of the periodontal apparatus at the 2-year follow-up.

The present study assessed the impact of a fixed prosthetic rehabilitation on masticatory function in patients diagnosed with stage IV periodontitis. Eligible participants were adults in need of complex rehabilitation due to masticatory dysfunction. Masticatory function was evaluated using the two-colored chewing gum mixing ability test (VOH) at the diagnostic phase (T0), 1 week after delivery of the prosthetic prototype (T1), and 1 week after delivery of the final prosthetic solution (T2). Ten subjects were treated with a fixed prosthesis following periodontal and implant surgery using an individualized, fully digital workflow. Full-mouth plaque and bleeding scores, pocket depth, and clinical attachment level improved significantly. VOH was 0.472 ± 0.168 at T0, 0.358 ± 0.166 at T1, and 0.250 ± 0.123 at T2. A significant improvement in VOH was observed from T0 to T1 (difference: –0.114; 95% CI: –0.199 to –0.029; P = .014) and from T1 to T2 (difference: –0.108; 95% CI: –0.200 to –0.015; P = .027). From T0 to T2, VOH increased by 44.3%. Self-perceived assessment of masticatory function also improved from T0 to T2 (P = .002). The fixed prosthetic rehabilitation in patients with stage IV periodontitis allowed for a significant improvement in objective and subjective measurements of masticatory function.

The use of conventional scan bodies (SBs) with an intraoral scanner (IOS) to capture the position of a complete arch of dental implants has proven to be challenging. The literature is unclear about the accuracy of intraoral scanning techniques using SBs that are connected vertically to multiunit abutments (MUAs) for numerous adjacent implants in the same arch. Recently, there has been a paradigm shift from vertical SBs to horizontal SBs, which are positioned perpendicular to the long axis of the MUAs. Most IOSs available today can capture these horizontal SBs, called scan gauges (SGs), with better accuracy and consequently acquire the position of multiple adjacent implants using an effective scan path, thus reducing stitching and the number of images. The key to implementing this novel technology is to strategically arrange the SGs to optimize horizontal overlap of multiple adjacent SGs without touching each other. By superimposing two high-resolution intraoral scans of the SGs, an artificial intelligence (AI) algorithm is employed to produce a calibrated digital best-fit model on which a passive complete-arch prosthesis can be designed and fabricated. The advantages and disadvantages of SBs and SGs are discussed, and a case report using a digital workflow is presented.