Libros

Surface contaminants on customized implant abutments could trigger an inflammatory response in the peri-implant tissues. The aim of this randomized controlled study was to assess the radiographic bone changes around implants restored with customized, platform-switched abutments, with and without autoclave treatment, 12 months after definitive restoration. Dental implants were placed 1 mm subcrestally in 64 systemically healthy patients (mean age: 63.3 ± 10.0 years; 31 patients had a history of periodontitis) to replace single or multiple missing teeth. According to a randomization list, abutments were subjected to steam and autoclave sterilization (43 implants, test group) or steam cleaning alone (44 implants, control group). Periapical standardized radiographs were taken at implant placement, prosthetic abutment connection, and 12 months after definitive cement-retained restoration. All implants were clinically stable without any sign of infection at the 12-month follow-up. An average marginal bone loss of 0.25 ± 0.19 mm was found in the test group compared to 0.35 ± 0.23 mm in the control group (no statistically significant difference), while the percentage of bleeding sites was significantly higher in the control group (8.7% ± 13.1% vs 19.1% ± 19.8%; P = .035). Autoclave treatment of customized abutments seems to reduce the inflammatory response around subcrestally placed implants. Palabras clave: bone loss, platform switching, dental implant, subcrestal, sterilization

Die vorliegende retrospektive Studie untersucht die Wirkung einer kombinierten parodontalen und kieferorthopädischen Behandlung anhand der klinischen und röntgenologischen Ergebnisse sowie Patient-reported Outcomes (PRO) bei 40 Parodontitispatienten im Stadium IV mit fortgeschrittenem Attachmentverlust und pathologischer Wanderung der Frontzähne. Hierzu wurde jeweils nach der Diagnose (Baseline: T0), nach Abschluss der aktiven Parodontaltherapie (APT: T1), nach Abschluss der kieferorthopädischen Behandlung (KFO: T2) und nach der letzten Sitzung der unterstützenden Parodontitistherapie (UPT: T3) ein vollständiger Parodontalstatus erhoben. Zudem wurde für die Zeitpunkte T0, T2 und T3 ein Röntgenstatus erstellt. Insgesamt 115 Zähne gingen im Verlauf der Studie verloren, darunter fünf als kieferorthopädische Verankerung genutzte Molaren zum Zeitpunkt T2 sowie zehn Prämolaren (aufgrund von Wurzelfrakturen) bis zum Zeitpunkt T3. Alle gewanderten Frontzähne waren zum Zeitpunkt T3 (nach durchschnittlich 9,5 Jahren) in Funktion. Nach der APT waren eine signifikante Reduktion der mittleren Sondierungstiefen (1,5 ± 1,1 mm) und ein Attachmentgewinn (0,9 ± 1,0 mm) zu beobachten. Auch die KFO und UPT gingen mit kleinen Änderungen einher. Das Alveolarknochenniveau zum Zeitpunkt T3 war gegenüber den T0-Werten leicht erhöht. Die PRO zeigten eine signifikante subjektive Verbesserung der Ästhetik und Kaufunktion. Eine kieferorthopädische Behandlung sollte als essenzieller Bestandteil des Gesamtbehandlungsplans betrachtet werden, um die Prognose stark geschädigter Zähne bei Patienten mit Stadium-IV-Parodontitis zu verbessern. Originalbeitrag: Aimetti M, Garbo D, Vidotto C, Bongiovanni L, Citterio F, Mariani GM et al. Combined periodontal and orthodontic treatment of severely compromised teeth in stage IV periodontitis patients: How far can we go? Int J Periodontics Restorative Dent 2022;42:731–738. Palabras clave: Parodontitis, Stadium IV, kieferorthopädische Behandlung, Parodontaltherapie, kombinierte parodontal-orthodontische Behandlung

A 12-month prospective consecutive case series study was conducted to evaluate the effectiveness of a novel porcine collagen matrix to correct moderate to severe buccogingival recession defects. A total of 10 healthy patients (8 women and 2 men; age range: 30 to 68 years) with 26 maxillary and mandibular recession gingival defects > 4 mm deep were included. Healthy maturation of gingival tissues with natural color and texture matching the adjacent soft tissue areas were observed at all reevaluation visits. Complete root coverage was not achieved in all cases, possibly due to severe buccal bone loss in most of the selected cases, which negatively impacted the results. Nevertheless, when a novel porcine collagen matrix was used, a mean root coverage of 63.15% was achieved, and gains in clinical attachment level and keratinized tissue height were seen. Future randomized clinical trials are needed to further explore the potential of porcine collagen matrix for treatment of localized gingival recession defects.

This retrospective study evaluated the effect of combined periodontal-orthodontic treatment in terms of clinical, radiographic, and patient-reported outcomes in 40 stage IV periodontitis patients with advanced attachment loss and pathologic migration of anterior teeth. Full-mouth periodontal parameters were recorded at baseline (after diagnosis; T0), at the end of active periodontal therapy (APT; T1), at completion of orthodontic tooth movement (OTM; T2), and at the last supportive periodontal care (SPC) visit (T3). Radiographic analysis was performed at T0, T2, and T3. A total of 115 teeth were lost during APT, including 5 molars at T2 (used as orthodontic anchorage) and 10 premolars at T3 (due to root fracture). All anterior migrated teeth were in function at T3 (mean duration: 9.5 years). Significant mean probing pocket depth reduction (1.5 ± 1.1 mm) and attachment level gain (0.9 ± 1.0 mm) were observed after APT, whereas OTM and SPC were associated with furthering small changes. The alveolar bone level at T3 was slightly increased from T0 values. Patient-reported outcome measurements significantly improved in terms of esthetics and masticatory function. OTM should be considered an essential part of the comprehensive treatment plan to change the prognosis of severely compromised teeth in stage IV periodontitis patients.

This investigation was designed to evaluate the long-term effectiveness of human placental allograft in root coverage procedures in terms of clinical and esthetic outcomes. Thirteen patients with 28 maxillary or mandibular recession defects > 4 mm deep were reexamined at 6 months and 5 years postoperatively. Overall, mean percentage of root coverage decreased from 65.58% ± 16.45% to 49.75% ± 19.40% with a greater stability of the gingival margin in the mandible. At 5 years, 18 sites maintained at least 2 mm of keratinized tissue. Gingival color and texture blended well with adjacent soft tissue area in 78.6% of treated sites.

The aim of this retrospective study was to evaluate long-term clinical and radiologic outcomes of submerged and nonsubmerged guided bone regenerative treatments for peri-implantitis lesions. Strict methods of implant-surface decontamination and detoxification were performed. Data on clinical probing depth, soft tissue measures, and marginal bone level that were documented by comparative radiographs were obtained from 45 patients, for a total of 57 implants prior to treatment and at the latest follow-up. The average followup period was 6.9 years (range: 2 to 21 years). Analysis of implant-based data revealed a success rate of 70.2% for a total of 40 implants. Recurrence of periimplantitis was observed on 9 implants, and 8 implants were removed. The regenerative procedures, under a strict periodontal control, were effective in the treatment of moderate to advanced peri-implantitis lesions.

This retrospective study evaluated the long-term response of periodontal tissues and survival rate of teeth with advanced attachment loss and pathologic migration in 21 periodontitis patients treated with combined periodontal and orthodontic treatment. All anterior migrated teeth were in function at the end of 10 to 15 years of maintenance. Residual probing depths and clinical attachment levels improved after treatment and remained stable through the follow-up. A total of 55 hopeless teeth were lost during active therapy, as well as 6 molars over the course of the supportive periodontal therapy (for nonperiodontal reasons). In highly compliant patients, all migrated teeth with initial unfavorable prognosis showed long-term clinical stability.

The present case series evaluated three-dimensional volumetric bone tissue changes and new bone formation in severely resorbed extraction sockets augmented with Bio-Oss collagen and a covering collagen membrane in nine chronic periodontitis patients. Healing was by secondary intention. After 12 months of healing, the augmentation procedure appeared not only to compensate for bone remodeling but also appeared to repair a significant portion of the buccal wall. The mineralized tissue filled the 91.49% ± 6.77% of the maximum volume for regeneration. Overall, a mean of 49.6% new bone, 27.1% residual graft material, and 23.3% connective tissue were detected.

This case series evaluated bone dimensional changes following the application of an occlusive titanium barrier on severely resorbed fresh extraction sockets to achieve bone regeneration. Six extraction sites with buccal bone loss were filled with a xenograft and covered with a titanium plate fixed by two miniscrews and left intentionally exposed. No infection occurred. After 4 months of healing, sufficient hard tissue had formed to allow implant insertion. Mean vertical bone gain was 7.3 ± 2.2 mm at the buccal side and 4.2 ± 1.2 mm at the lingual side. The average bone width augmentation was 23 ± 1.0 mm. At 24 months, all implants were clinically successful. Based on these preliminary findings, occlusive titanium barriers without primary closure may be successfully used in immediate alveolar reconstruction procedures.

This case series evaluated the healing of deep intrabony defects treated with a combination of enamel matrix derivative and autologous particulate bone harvested from the buccal and lingual/palatal cortical plate with a Piezosurgery device. A total of 15 defects with a predominantly one- or two-wall component were consecutively treated in 15 patients with advanced chronic periodontitis. In all selected sites, the three-wall component was ≤ 25% of the total defect depth. Clinical and radiographic parameters were recorded at baseline and 12 and 24 months postoperatively. All defects showed favorable clinical and radiographic outcomes at the 24-month follow-up. The probing depth reduction was 4.4 ± 1.6 mm, and more than 50% of the defects presented clinical attachment level gain of at least 5 mm. The bone fill was 3.1 ± 1.6 mm.