International Journal of Periodontics & Restorative Dentistry, 4/2022
DOI: 10.11607/prd.5833Pages 471-477, Language: English
Common challenges encountered for atrophic maxilla rehabilitation are the inadequate width and height of attached keratinized mucosa (AKM) and shallow vestibular depth. This study presents a buccally displaced palatal (BDP) flap technique to increase the tissue thickness and AKM width at the second-stage surgery and reestablish the correct fornix depth. The peri-implant pocket depths, modified Plaque Index score, modified sulcus Bleeding Index score, and soft tissue recession were evaluated 6 and 12 months after prostheses loading. A total of 52 implants were placed and analyzed, and no implant failures were found. No significant changes in peri-implant parameters were observed between 6 and 12 months, and mean recession was less than 0.2 mm after 12 months. Though this change was statistically significant, it was clinically irrelevant. The results demonstrate that adequately healthy peri-implant soft tissues and substantial dimensional stability of vestibular soft tissues at the 1-year follow-up were achieved with the BDP flap technique. The BDP flap could represent a viable option for increasing the width and the height of AKM and establishing the correct maxillary fornix depth.
International Journal of Periodontics & Restorative Dentistry, 3/2022
DOI: 10.11607/prd.5268Pages 393-399, Language: English
Autogenous soft tissue grafting is a commonly performed procedure in periodontal and implant surgery. Reharvesting a connective tissue graft (CTG) from the same palatal donor site is often required, but little is known about the volumetric changes that occur after harvesting a free gingival graft and how long the palatal mucosa takes to regain its original form and thickness. This study evaluated the volumetric changes that occur at the palatal donor site after harvesting a soft tissue graft with a noninvasive digital technology. Nineteen patients needing a CTG for a single site were enrolled. Intraoral digital scans of the palatal donor sites were obtained at baseline and at 1, 3, 6, and 12 months. The digital scans were imported and analyzed with an imaging software to evaluate volumetric changes. Average volume losses of 5.82 ± 2.63 mm3 and 11.03 ± 5.47 mm3 were observed after 1 and 3 months, respectively. Only minor changes were observed at 6 and 12 months. Linear dimensional changes at 5 and 7 mm from the gingival margin were substantially higher than the changes at 3 mm for the 1- and 3-month interval comparisons compared to baseline. Graft dimension was associated with volume loss at 1 and 3 months (P < .01). After palatal harvesting, the donor site undergoes volumetric changes, mostly during the first 3 months, and is attenuated thereafter.
International Journal of Periodontics & Restorative Dentistry, 1/2022
DOI: 10.11607/prd.5404Pages 25-33, Language: English
Tooth malposition negatively affects the outcome of root coverage procedures, limiting chances for complete root coverage (CRC). This case series introduces a combined orthodontic-mucogingival approach for the treatment of deep (> 4 mm) isolated gingival recession defects affecting mandibular incisors with a buccally displaced root. Twenty patients were treated with a novel orthodontic device (FZ Root Torque Controller) for selective correction of tooth malposition at the affected site, turning all isolated recessions into Miller Classes I and II. Subsequent surgical treatment of the gingival recession with a vertically-coronally advanced flap plus a connective tissue graft achieved 90% CRC at the 1-year follow-up, with a recession reduction of 5.6 ± 1.5 mm, a 1.24 ± 0.24 mm increase in gingival thickness, and improved esthetic outcomes.
International Journal of Periodontics & Restorative Dentistry, 5/2021
DOI: 10.11607/prd.5283Pages 719-726, Language: English
The gingival thickness (GT) and keratinized tissue width (KTW) constitute the gingival phenotype, a concept that has received a great deal of appreciation in recent years. Gingival phenotype modification has been achieved via different surgical techniques and grafting materials. Despite the superiority of autogenous grafts, their increased patient morbidity and limited recourse has led to the development of graft substitutes. The human dermal matrix is a notable example that, depending on its processing method, can become freeze-dried or solvent-dehydrated acellular dermal matrix (FDADM and SDADM, respectively). This article reports the 9-year outcomes of a randomized clinical trial regarding gingival phenotype modification following root coverage with FDADM and SDADM. Twelve of the original 20 patients were available at the 9-year follow-up. Overall, the outcomes of gingival phenotype modification were maintained in both groups and at all sites after 9 years. For KTW, an incremental increase was observed over time in both groups, and minimal or no changes were noted in GT from the 1-year recall to the 9-year recall. However, the gingival margin level showed an apical shift for both groups.
International Journal of Oral Implantology, 4/2021
PubMed ID (PMID): 34726846Pages 351-365, Language: English
The coronally advanced flap technique is one of the most commonly used approaches for treating gingival recession. Several modifications of the technique have been proposed over the years, making it a highly predictable treatment option for gingival recession; however, as dental implants are structurally and biologically different from natural teeth, a further modification of the conventional coronally advanced flap technique has been suggested to overcome the challenges posed by the treatment of peri-implant soft tissue dehiscences. The present article aims to describe the state of the art of the technique at implant sites presenting with peri-implant soft tissue dehiscences, and highlight the main differences between this and the coronally advanced flap approach in natural teeth. The timing of crown removal and abutment modification/replacement are discussed, along with the different methods for management of the flap and connective tissue graft that are recommended at implant sites. The outcomes of this approach compared to the conventional coronally advanced flap technique, and other approaches are also presented.
Keywords: connective tissue graft, dental implants, gingival recession, soft tissue augmentation, surgical flap
Conflict-of-interest statement: The authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper.
The International Journal of Oral & Maxillofacial Implants, 4/2021
DOI: 10.11607/jomi.8887Pages 793-798, Language: English
Purpose: The purpose of this cone beam computed tomography (CBCT) study was to investigate the probability of using straight screw-channel screw-retained restorations following an immediate implant placement and provisionalization protocol in maxillary anterior teeth utilizing implant planning software.
Materials and methods: A retrospective review of CBCT images was done. The midsagittal images of maxillary anterior teeth (right canine to left canine) were created in implant planning software, screen-captured, and transferred to a presentation program. The digital implant templates were created for 3.5-mm-diameter (used for central and lateral incisors) and 4.5-mm-diameter (used for central incisors and canines) tapered implants with lengths of 13, 15, and 18 mm. The frequency percentages of immediate implant placement and provisionalization and immediate implant placement and provisionalization with straight screw-channel screw-retained restorations were recorded and compared among all maxillary anterior teeth.
Results: CBCT images from 1,200 teeth were evaluated. The overall frequency percentages of immediate implant placement and provisionalization and immediate implant placement and provisionalization with straight screw-channel screw-retained restoration were 84% (range = 74% to 92%) and 14% (range = 10% to 24%), respectively.
Conclusion: Although the probability of being able to employ immediate implant placement and provisionalization with a straight screw-channel screw-retained restoration in the esthetic zone is low, the use of smaller-diameter implants can substantially increase the probability.
Keywords: cone beam computed tomography, dental implantation, dental implants, esthetics, immediate placement, prosthodontics
International Journal of Periodontics & Restorative Dentistry, 3/2021
Pages 325-333, Language: English
Treatment of gingival recessions affecting mandibular incisors is scarcely documented. Despite a shallow vestibule depth being considered a poor anatomical condition, it has never been measured nor deemed a clinical parameter affecting the outcome of root coverage procedures. This study describes a vertically and coronally advanced flap (V-CAF) + connective tissue graft (CTG) technique to obtain root coverage and increased vestibule depth in the treatment of gingival recessions affecting mandibular incisors. Twenty patients with single gingival recessions were treated. The results showed that V-CAF+CTG is effective in increasing residual vestibule depth and in reducing recession depth. Immediately after surgery, a vestibule-depth increase of 5.9 ± 1.2 mm was reported, which was statistically significant compared to baseline, and it remained stable after 12 months (4.8 ± 1.1 mm). The mean percentage of root coverage was 98.3% ± 5.2% for all treated recessions, and complete root coverage (CRC) was achieved in 90% of cases (18 of 20). V-CAF+CTG could be considered a successful technique in terms of vestibule depth increase and CRC for the treatment of single gingival recessions in the mandibular incisors.
International Journal of Periodontics & Restorative Dentistry, 1/2021
Pages 71-77, Language: English
In everyday practice, surgeons have to deal with bone atrophy. These rehabilitations are even more complex in the posterior mandible, and it is still unclear in the literature which fixed rehabilitation option is best. The purpose of this article was to help oral surgeons to choose the proper and updated treatment for their atrophic patients. Posterior mandible bone atrophies were divided into four main groups depending on the bone height measured above the inferior alveolar nerve: (1) ≤ 4 mm; (2) > 4 mm ≤ 5 mm; (3) > 5 mm ≤ 6 mm; (4) > 6 mm < 7 mm. Different approaches were proposed for each group, considering patient expectations. If ≤ 4 mm of bone height was available, guided bone regeneration was used as the adequate approach. For bone heights > 4 mm and ≤ 6 mm, the “sandwich” technique and/or short implants were used, depending on esthetics. In cases with > 6 mm and < 7 mm above the mandibular canal, short implants might be the proper option. The authors’ clinical experience and the literature were considered in order to suggest a possible correct treatment decision based on the residual bone height in the posterior mandible.
International Journal of Periodontics & Restorative Dentistry, 6/2020
DOI: 10.11607/prd.4929, PubMed ID (PMID): 33151183Pages 795-803, Language: English
When it comes to complete root coverage of exposed root surfaces, several limiting factors have been suggested. Although tooth malposition and papillae dimension are capable of influencing root coverage, they have not received sufficient emphasis in the literature. Therefore, the aim of the present commentary is to discuss the impact of tooth malposition and papillae dimension on rootcoverage outcomes. This commentary combines evidence from the literature with the authors' experience. Limited evidence is available in the literature regarding the influence of tooth malposition on root-coverage outcomes. Severe buccal displacement and tooth extrusion and/or rotation may limit the amount of achievable root coverage, and the cementoenamel junction should no longer be considered the landmark for root coverage in these cases. The relationship between papillae dimension and root coverage has been tested in different clinical conditions and by applying different root-coverage approaches, thereby resulting in contradictory outcomes. The clinical experience of the authors suggests that having wider papillae is advantageous for coronally advanced flap and tunnel flap preparations and connective tissue graft stabilization. Although scientific evidence and the authors' clinical experience suggest that papillae dimension can play a major role in determining the surgical management of soft tissues and the amount of achievable root coverage, further studies are necessary to evaluate to which extent papillae dimensions contribute to treatment outcomes.
International Journal of Periodontics & Restorative Dentistry, 6/2020
Online OnlyDOI: 10.11607/prd.4957, PubMed ID (PMID): 33151196Pages e235-e240, Language: English
This case report describes the rehabilitation of an extremely atrophic posterior mandible using 4-mm ultrashort implants and reports clinical and radiographic outcomes 7 years after loading. The patient refused to undergo any other treatment, from the removable prosthesis to the reconstructive surgery, and asked for a fixed, minimally invasive solution in the shortest possible time. The residual bone height above the alveolar nerve was an average of about 5 mm, so it was decided to treat the patient with four 4-mm ultrashort implants. Within the limitations of this case report, this procedure appears successful at 7 years after loading in this specific case and could reduce invasiveness, rehabilitative times, and costs. However, longer follow-ups on a large number of patients coming from randomized controlled clinical trials are necessary before making more reliable recommendations.