International Journal of Periodontics & Restorative Dentistry, 03/2000

This case report histologically examines the type of attachment that can occur after root coverage of a long-standing facial recession defect on a maxillary premolar with a subepithelial connective tissue graft. Histologic findings suggest that various types of tissue attachment, including periodontal regeneration, may occur over a recession defect after placement of a subepithelial connective tissue graft. In the present case, it was noteworthy that after 1 year the greatest area of exposed root surface was covered by a connective tissue attachment (adhesion), which had remained intact during orthodontic movement and distal drifting of the tooth.

This article reports a successful clinical regimen of treatment for the Class II furcation defect. Twenty-eight patients with molar teeth demonstrating Class II furcations were treated with regenerative therapy with the goal of regenerating lost interradicular periodontium. The treatment selected included scaling and root planing, surgical flap design that would enable the flap to completely cover the surgical site, complete enucleation of granulation tissue, tetracycline root conditioning, a particulate autogenous bone graft, and an expanded polytetrafluoroethylene (e-PTFE) membrane. Of the twenty-eight consecutive patients treated, twenty-five demonstrated no postoperative clinical evidence of furcation invasion, for a success rate of 89%. Eleven sites were reopened 8 to 9 months postsurgical and presented complete furcation fill with a hard, bone-like tissue. Three teeth were judged to be failures because clinical assessment revealed persistent furcation invasion. The absence of histologic evidence precludes the presumption that complete periodontal regeneration occurred.

The efficacy of Bio-Oss as a graft material for sinus floor elevation was studied in 15 patients. A total of 20 sinus augmentation procedures was performed, and 6 months later 57 implants were placed into the augmented sinuses. New bone formation was confirmed in biopsies of 3 patients (new bone: 21.08% ± 7.25% after 6 mo, 27.55% ± 4.88% after 12 mo; Bio-Oss: 39.17% ± 4.36% after 6 mo, 27.01% ± 11.64% after 12 mo). After a mean loading period of 4.0 ± 0.5 years (range 3.2 to 4.8 y), 56 implants remained in place. This study confirms Bio-Oss's good osteoconductive properties.

The aim of the present study was to investigate clinical and radiographic data of patients treated with implants in the posterior maxilla in combination with sinus augmentation. Study parameters included Periotest values, radiographic analysis, and survival/success rates up to 5 years. Clinical and radiographic criteria resulted in a success rate of 92.7% for sinus implants. Radiographically, the sinus implants showed a mean coronal bone loss of 0.5 mm at 6 months and 1.2 mm at 48 months. The results showed stable periimplant parameters for sinus implants during the observation period of 5 years. The success rates showed no significant differences regarding different implant-supported treatment options for the posterior maxillary region.

A mandibular canine with significant gingival recession was selected for a pilot study to measure the attachment modalities resulting from mucogingival surgery. The tooth had 6 mm of recession as measured from the cementoenamel junction to the gingival margin, minimal pocketing, and no keratinized gingiva. The treatment regimen consisted of a subepithelial connective tissue graft (SCTG) plus Emdogain applied to the root surface. The tooth was extracted en bloc 6 months after surgery and processed histologically in a buccolingual plane. The tooth demonstrated a 2-mm gain of attachment and a 3-mm gain in keratinized tissue. The histologic study evidenced the migration of the junctional epithelium 1.2 mm apical to the sulcus. New cementum, evidence of newly formed woven bone, and connective tissue fibers anchored in the new cementum were evident.

In this study, ninety extracted endodontically treated mandibular molars were mounted in acrylic resin blocks. Five groups of eighteen extracted teeth were prepared by two different techniques. A peripheral shelf 2 mm deep and 1.4 mm wide was prepared as a first technique, while TMS pins were used in the second group. The teeth were then restored with five different core materials: silver-reinforced glass-ionomer, resin-modified glass-ionomer, self-cured glass-ionomer, polyacid-modified composite resin, and titanium-reinforced composite resin. An Instron testing machine was used to apply shear force at a crosshead speed of 2 mm/min until fracture occurred. The results were obtained statistically using analysis of variance and least significant difference tests. According to the results of this study, Ti-core and composite resin were the strongest core materials when subjected to shear forces, and the most retentive preparation design was the vertical-pin design. The fractures of these materials with a vertical-pin design were mostly seen at the core and the tooth.

In this study, 24 furcation defects in 12 patients were treated by either (1) a polylactide resorbable membrane (Guidor) plus a polyglactin mesh (Vicryl) and demineralized freeze-dried bone allograft (DFDBA), or (2) a polylactide resorbable membrane and DFDBA. All defects were reentered after 9 months. Class III furcations closed 66% of the time when treated by the first method, while the closure rate was only 33% when treated by the second method (no polyglactin mesh). Defects with a vertical opening less than or equal to 4 mm closed 74% of the time, while those with vertical openings > 4 mm closed only 11% of the time.

The use of connective tissue grafts for root coverage and ridge augmentation is a proven, effective treatment modality. Complications associated with the palatal donor site can arise because of incomplete primary closure of the palatal wound or sloughing of the overlying tissue. This article presents a new technique for the atraumatic harvesting of connective tissue grafts from palatal donor sites. The main advantage of this single-incision technique is the primary closure of the palatal flap, resulting in less pain and sensitivity and fewer postoperative complications. A review of the technique and its indications, rationale, and limitations is presented.

The purpose of this study was to evaluate the effect of early spontaneous exposure of 2-stage implants upon subsequent histologic bone contact following occlusal loading. As part of a study comparing 2 types of metallic threaded implants, 48 implants (24 CPTi and 24 Ti-13Nb-13Zr) were placed in maxillary and mandibular posterior sites in 6 baboons. Implant exposure was evaluated at time of placement and at each weekly visit for the first 3 weeks, then at 1, 2, and 3 months, and also at 6 months for the maxilla. Block sections were removed 6 months after the implant restoration was placed into function. One third (33%) of the maxillary implants became exposed, while 66.5% of the mandibular implants became exposed, mostly at 1 to 3 weeks. For all maxillary implants, fibrous tissue contact in the unintentionally exposed group (20.0%) was significantly greater than in the group that remained submerged (7.7%). Maxillary implants remaining submerged exhibited more sinus contact. For all mandibular implants, bone contact in the exposed group (38.9%) was significantly greater than in the submerged group (24.3%). Similarly, exposed implants exhibited less fibrous tissue contact. All other parameters in both maxillary and mandibular arches were statistically similar when comparing unintentionally exposed implants to those that remained submerged. This study suggests that accidental exposure of 2-stage implants should result in overall similarities in postloading bone contact to 2-stage implants that remain submerged during the early postoperative healing period.