International Journal of Periodontics & Restorative Dentistry, 02/2016

Osteosynthesis screws and titanium or resorbable pins have been recommended for fixing guided bone regeneration (GBR) membranes and stabilizing the graft. However, the removal of fixation screws or pins often requires an additional surgical procedure. This article presents a periosteal suturing technique with resorbable sutures for the fixation of grafts and membranes in GBR in single implant sites. This technique avoids potential complications of using fixation screws or pins, such as perforation of the roots when inserting the pins, and eliminates the need for a second retrieval surgery.

The aim of this study was to introduce a new surgical technique to regenerate the papilla adjacent to multiple or single implants using a novel instrument and a new incision design. A total of 10 consecutively treated patients with maxillary anterior implant-supported provisional restorations and missing interproximal papillae received a subepithelial connective tissue graft. The recipient site was prepared with a buccal incision apical to the mucogingival junction and to the defective papilla, and a palatal incision, followed by buccolingual tunneling performed with a translingual curette (EBINA). A total of 10 sites were treated and evaluated pre- and postoperatively with the papilla score based on the Jemt classification. The final prosthesis was delivered 3 months after the papilla regeneration surgical procedure. An average improvement in papilla index score from 0.8 to 2.4 was found after an average follow-up period of 16.3 months. This case series demonstrated that interimplant papilla regeneration can be successful over a period of 11 to 30 months postloading. Long-term prospective studies on tissue stability and esthetic outcomes are needed to corroborate the findings in this study.

A multicenter prospective consecutive case series study was conducted to evaluate the effectiveness of placental allografts to correct moderate to severe buccogingival recession defects. Nineteen healthy patients, 13 women and 6 men, ranging in age from 29 to 63 years, with 43 maxillary and mandibular gingival recession defects of > 4 mm deep were included. Clinical examination at multiple postsurgery time points revealed healthy maturation of gingival tissues with normal color and texture matched to adjacent soft tissue areas. Complete root coverage was not achieved in all cases in this proof of principle evaluation. Severe buccal bone loss had occurred in most of the selected cases, which may have negatively influenced the results. Nonetheless, it was possible to achieve root coverage and demonstrate gain in clinical attachment level and height of keratinized tissue when placental allograft was used. Future randomized clinical trials are needed to further explore the potential of placental allografts for treatment of localized gingival recession defects.

The aim of this investigation was to evaluate a new resorbable, monolayer, noncross-linked collagen barrier membrane for immobilizing bone augmentation material during horizontal guided bone regeneration (GBR) procedures. GBR was performed on 36 consecutive patients in 49 sites, with 103 implants placed either simultaneously or after a healing period. Healing time, suture retention, postoperative complications, and functional outcome after GBR, implant placement, and prosthesis loading were assessed. A wound dehiscence rate of only 12% and a graft failure rate of 4% occurred. Mean healing time was 5.8 months for simultaneous placement and 7.9 + 4.8 months for two-stage procedures. The implant survival rate was 100% after a mean follow-up of 18.3 months from implantation. These early data demonstrate a low dehiscence rate and excellent potential of this new noncross-linked collagen membrane for use with horizontal ridge augmentation.

A total of 25 patients were treated with a nonsurgical periodontal treatment protocol (NSPTP) consisting of four appointments (three within 1 week and one approximately 30 days later). Nonsurgical periodontal instrumentation was implemented, with the adjunctive use of thermal diode lasers (wavelength of 808 or 980 nm). The patients were scheduled for recall visits every 3 months and reevaluated 1 year post-NSPTP. They were subsequently monitored at 4-month intervals for the remaining 2-year follow-up maintenance period. In total, 698 teeth (210 multirooted and 488 single-rooted) were included in the study. The mean bleeding on probing was 43% at baseline and decreased to 12% at 12 months and to 8% at 3 years. The initial ≥ 6-mm probing pocket depth (PPD) in single-rooted teeth decreased from 6.2 mm at baseline to a mean of 1.8 mm at 12 months and remained at 1.8 mm at 3 years, with a mean clinical attachment level (CAL) gain of 4.4 mm. In multirooted teeth, the PPD decreased from 6.7 mm to a mean of 3.9 mm at 12 months and 3.6 mm at 3 years, with a mean CAL gain of 2.9 mm. The mean overall recession was 0.3 mm at baseline, 0.1 mm at 1 year, and 0.3 mm at the 3-year follow-up. In the short-term followup period, uniform and consistent implementation of the NSPTP used here with adjunctive use of thermal diode lasers seemed to convey therapeutic benefits, stable periodontal soft tissue levels, and satisfactory esthetics in patients with moderate to severe chronic periodontitis. The present protocol is relevant as a treatment option for medically compromised patients, those who refuse or delay surgical treatment, or those who present with other limitations.

The aim of this retrospective study was to report preliminary outcomes of a modified technique for transcrestal sinus floor elevation with simultaneous implant placement. A total of 165 implants were placed in 110 patients using a modified Summers technique. During implant site preparation, after fracturing the sinus floor, a small perforation of the membrane was made using the first osteotome. After grafting with anorganic bovine bone mixed with venous blood, standard-length implants were inserted. The prosthetic phase occurred after 4 to 5 months. Patients were followed for at least 2 years after loading. During the follow-up, sinus condition was assessed by cone beam computed tomography. Periapical radiographs were taken to assess graft height and peri-implant bone levels. Three implants failed within 2 months of placement, yielding an overall implant survival of 98.2%. The mean follow-up was 38.3 months (range: 28 to 60 months) from placement. All other implants were stable and peri-implant soft tissues were healthy throughout the observation period. Peri-implant bone loss averaged 0.62 ± 0.26 mm after 1 year of function. No biologic or biomechanical complications occurred. No evidence of graft material dispersion into the sinus space was detected, except for two cases that resolved spontaneously. After 1 year of loading the graft height averaged 4.8 ± 1.3 mm above the sinus floor level. In the presence of sinus membrane perforation, the proposed modified osteotome technique may allow a predictable rehabilitation of the atrophic posterior maxilla by means of standard length implants without the occurrence of adverse events.

In 60 healthy subjects, 720 interdental papilla sites in maxillary anterior teeth were investigated. Interdental papilla heights were measured from the gingival zenith along the clinical crown lengths. Radiovisiography was used to measure the relative bone length. Percentage of papilla height to crown length and radiographic bone length to crown length were computed and defined as papilla proportion (PP) and crestal papilla proportion (cPP), respectively. The overall mean mesial PP was 44.95 ± 6.80% and distal PP was 45.70 ± 7.87%. The total mean mesial cPP was 54.12 ± 9.50% and distal cPP was 54.95 ± 9.28%. Taken together, the cPP was around 55% and the PP was around 45% for all tooth groups.

The purpose of this study was to investigate peri-implant tissue adaptation on platform-switched implants with a Morse cone-type connection, after 3 and 12 weeks of healing in dogs. Ten weeks after mandibular premolar extractions, eight beagle dogs received three implants each. At each biopsy interval, four animals were sacrificed and biopsies were processed for histologic analysis. The height of the peri-implant mucosa was 2.32 mm and 2.88 mm, respectively, whereas the bone level in relation to the implant platform was −0.39 mm and −0.67 mm, respectively, after 3 and 12 weeks of healing. Within the limits of the present study, platform-switched implants exhibited reduced values of biologic width and marginal bone loss when compared with previous data.

The objective of this study was to clinically evaluate and compare the efficacy of the vestibular incision subperiosteal tunnel access (VISTA) technique using Bio-Gide (Geistlich) membrane enhanced with GEM 21S (Osteohealth) with periosteal pedicle graft (PPG) using a coronally advanced flap. Multiple gingival recession sites in 15 individuals were randomly assigned either to experimental site A (VISTA) or experimental site B (PPG) in a split-mouth design. The clinical parameters were recorded at baseline and 9 months postoperatively. Repeated measures analysis of variance with post hoc Bonferroni correction and paired t test were used to assess statistical significance (P < .05). Mean recession depth significantly decreased from 4.21 ± 1.08 mm (presurgery) to 0.61 ± 0.92 mm (9 months) with VISTA (87.37 ± 17.78% root coverage) and from 4.17 ± 1.18 mm (presurgery) to 1.16 ± 0.92 mm (9 months) with PPG (71.84 ± 19.25% root coverage). Width of keratinized tissue and clinical attachment gain were significantly higher in the VISTA group compared with the PPG group. Within the limits of the study both VISTA and PPG groups resulted in a significant amount of root coverage. The VISTA technique was less invasive and required minimal time and clinical maneuvering. It also resulted in a superior esthetic outcome.

The aim of this article is to report the orthodontic treatment of a woman aged 53 years 6 months whose chief complaint involved her facial esthetics and crowding. She presented a moderate reduction in bone support, but no periodontal disease, over the past 15 years. The maxillary left first premolar and both mandibular first premolars were extracted. The dental protrusion was reduced and all the spaces were closed, resulting in a significant improvement in facial esthetics. After 16 months, the satisfactory results in terms of the functional position of the teeth were maintained with the bone level remaining unchanged.

The objective of this split-mouth clinical study was to compare a combination of in-office and at-home dental bleaching with at-home bleaching alone. Two applications of inoffice bleaching were performed, with one appointment per week, using 38% hydrogen peroxide. At-home bleaching was performed with or without in-office bleaching using 10% carbamide peroxide in a custom-made tray every night for 2 weeks. The factor studied was the bleaching technique on two levels: Technique 1 (in-office bleaching combined with home bleaching) and Technique 2 (home bleaching only). The response variables were color change, dental sensitivity, morphology, and surface roughness. The maxillary right and left hemiarches of the participants were submitted to in-office placebo treatment and in-office bleaching, respectively (Phase 1), and at-home bleaching (Phase 2) treatment was performed on both hemiarches, characterizing a split-mouth design. Enamel surface changes and roughness were analyzed with scanning electron microscopy (SEM) and optical interferometry (IFM) using epoxy replicas. No statistically significant differences were observed between the bleaching techniques for either the visual or the digital analyses. There was a significant difference in dental sensitivity when both dental bleaching techniques were used, with in-office bleaching producing the highest levels of dental sensitivity after the baseline. Microscopic analysis of the morphology and roughness of the enamel surface showed no significant changes between the bleaching techniques. The two techniques produced similar results in color change, and the combination technique produced the highest levels of sensitivity. Neither technique promoted changes in morphology or surface roughness of enamel.

This case report describes the periodontal management of a patient with endstage liver disease undergoing liver transplantation. In the first part of this article, all medical and dental findings are reported to elaborate adequate diagnoses. A patient-specific treatment plan was structured given the challenging periodontal and systemic scenarios. The second part describes the periodontal therapy delivered in close interaction with the referring physicians. Last, the article reviews current principles and protocols in managing these patients.

Screw loosening can damage the interfaces of implant components, resulting in susceptibility to contamination of the internal parts by microorganisms. The aim of this study was to investigate the impact of abutment screw retightening on the leakage of two different types of bacteria, Streptococcus sanguinis and Fusobacterium nucleatum, and of the yeast Candida albicans. Two types of implantabutment systems with tube-in-tube interfaces were tested. Groups A and B each used a different type of system that consisted of 20 different pieces that were assembled according to the manufacturer's torque recommendations; four samples in each group were closed just one time, four samples three times, four samples five times, four samples seven times, and four samples nine times. The implants of groups A and B were contaminated with 0.1 μL of microbial solution just before being assembled for the last time to minimize the possibility of contamination. Results showed a direct correlation between the number of colony-forming units grown in the plates and the closing/opening cycles of the implant-abutment systems. Within the limitations of this study, the results indicate the possibility that repeated closing/opening cycles of the implant-abutment unit may influence bacterial/yeast leakage, most likely as a consequence of decreased precision of the coupling between the abutment and the internal part of the dental implant. These findings suggest that a one-time abutment technique may avoid microbiologic leakage in cases of implant-abutment systems with tube-in-tube interfaces.

The aim of this study was to analyze through clinical and histomorphometric parameters the use of acellular dermal matrix (ADM) with or without mineralized bone allograft (AB) on bone formation in human alveoli after a 6- to 8-month healing period. A total of 19 patients in need of extraction of the maxillary anterior teeth were selected and randomly assigned to the test group (ADM plus AB) or to the control group (ADM only). Clinical and histomorphometric measurements and histologic analysis were recorded 6 to 8 months after ridge preservation procedures. Clinical parameters and amount of mineralized and nonmineralized tissue were measured and analyzed. In the clinical measurements, the test group showed reduced bone loss in the buccopalatal dimension after 6 to 8 months (intragroup analysis P < .01). Histologic findings showed higher percentages of mineralized tissue and lower percentages of nonmineralized tissue in the test group when compared with the control group (P < .05). In this randomized controlled clinical and histomorphometric study in humans, acellular dermal matrix in association with mineralized bone allograft reduced alveolar bone loss in the anterior maxillae both in height and width after a follow-up period of 6 to 8 months.

The aim of this case report is to expand on previous studies of flapless immediate implant placement in sites with a large gap distance, without the application of regenerative materials. In this case report, an immediate implant was placed in a fresh molar extraction site with a large gap distance from the implant surface to the socket walls without the use of a bone graft, membrane, or coronal flap advancement for primary closure. Clinical healing was consistent with spontaneous extraction socket healing. Uncovery at 3 months revealed complete socket fill and secondary stability of the implant. After 2 years and 2 months, bone levels remain stable. This case report demonstrates the natural healing potential of an extraction socket, which can provide sufficient bone healing and dimensional stability for implant osseointegration and a functional restoration.

Maxillary protrusion usually requires orthodontic therapy and orthognathic surgery. However, for some exceptional cases, a prosthodontics-centered multidisciplinary approach could serve as an alternative. This case report describes a 53-year-old patient with protrusive and proclined maxillary incisors, compensatory eruption of mandibular incisors, color and morphologic abnormalities of anterior teeth lip incompetence, and gummy smile. Final esthetic improvement was achieved in this patient by means of a multidisciplinary approach involving endodontic and periodontal procedures before prosthodontic treatment. Accurate diagnosis, comprehensive communication, a sophisticated treatment plan, and state-of-the-art therapeutic processes are all important factors for achieving a predictable esthetic result.

This study was performed to investigate the shape, characteristics, and correlation of labial grooves on anterior maxillary dentition. Individual teeth (N = 621) were investigated using a microscopic three-dimensional digital image correlation system. The average length, width, and depth of grooves were quantified, and groove patterns in anterior maxillary teeth and the symmetry and correlation of grooves in anterior maxillary dentition were studied. There were nine common groove patterns in central incisors, eight in lateral incisors, and nine in canines. A good symmetry of grooves was found between the left and right dentition. The number of grooves and the groove pattern were correlated among central incisors, lateral incisors, and canines. This study may provide guidance for clinical design of labial grooves.