International Journal of Periodontics & Restorative Dentistry, 01/2019

Predictable and effective surgical techniques that aim to increase the width of keratinized gingiva, relocate the mucogingival junction, and deepen the vestibule often involve soft tissue autografts; however, soft tissue autograft supply is limited and its harvesting is associated with patient morbidity. With a strip autograft and xenogeneic collagen matrix (XCM) technique combination, autograft harvest requirements and patient morbidity are reduced. In this histologic evaluation, 12 strip autograft/XCM biopsy samples were compared with 3 reference samples of palatal strip autografts. Tissue morphology, keratin, and collagen expression appear identical, indicating that the combined grafting technique provides desired and physiologically normal keratinized gingiva.

The objective of this trial study was to assess whether submucosal veneering of internally connected zirconia abutments influences clinical, radiographic, and technical outcomes of single-tooth implant-borne reconstructions at 5 years after loading. A total of 20 patients with 20 single-tooth implants in the anterior or premolar area of the maxilla or mandible were included. The implants were randomly restored with fixed single-tooth reconstructions using either pinkveneered customized zirconia abutments (test group = 10) or nonveneered customized zirconia abutments (control group = 10). All reconstructions were adhesively cemented with all-ceramic crowns. Follow-up examinations were performed at baseline (7 to 10 days after crown insertion) and at 1, 3, and 5 years after loading, at which points the following were assessed: periodontal parameters such as probing depth (PD), bleeding on probing (BOP), and marginal bone levels, as well as technical outcomes using the modified United States Public Health Service (USPHS) criteria. Statistical comparisons were based on the Wilcoxon- Mann-Whitney test. Sixteen patients attended the 5-year follow-up. At 5 years, the implant survival rate was 100% and the prosthetic survival rate was 94.1% (one abutment fracture in the test group). Veneering of the submucosal part of zirconia abutments resulted in significantly higher mean PD values: 3.6 ± 0.4 mm (test group) and 3.0 ± 0.5 mm (control group), P = .042. Marginal bone levels at 5 years and changes up to 5 years were not significantly different between groups (P > .05). One crown exhibited an abutment fracture and two crowns a minor chipping (17.6% overall technical complication rate). Limited by a small sample size, veneering of the submucosal part of internally connected zirconia abutments led to outcomes that were less favorable biologically (PD, BOP, and KM), but similar to nonveneered abutments radiographically and technically.

A preclinical pilot study was performed to evaluate the safety, efficacy, primary stability, and wound healing of a hybrid dental implant with a unique macrogeometry design in which the coronal section is narrower and cylinder-shaped followed by a wider, tapered apical portion, each comprising approximately one half the length of the implant. Eighteen hybrid macrogeometry-designed dental implants were placed bilaterally into three foxhounds in the mandibular third and fourth premolar and first molar (P3, P4, and M1, respectively) extraction sockets of different dimensions immediately following full periosteal flap elevation and removal of teeth without socket grafting. Bone plate thickness, implant position and depth, gap distance, and insertion torque values were measured following implant installation. Surgical sites were healed uneventfully for 3 months, and then samples of soft and hard tissues surrounding the implants were retrieved to perform light microscopic and histomorphometric analyses. All 18 implants were stable and osseointegrated both clinically and radiographically. The analyses revealed that the amount of hard tissue alteration and bone fill that occurred during the healing period was significantly influenced by the thickness of the bone plate, the size of the horizontal buccal gap, and the implant diameter, position, and depth within the extraction socket. The P3 and P4 hybrid implants placed approximately 1.0 mm subcrestal from the interproximal height of bone with less gap distance (≤ 1.0 mm) exhibited minor to modest (1.5 to 2.0 mm) crestal bone remodeling relative to the implant platform. Conversely, M1 implants positioned with greater depth (≥ 2.0 mm) and gap distance (≥ 2.0 mm) that were evaluated in a buccal-lingual dimension exhibited minimal crestal change with first bone-to-implant contact within 1.0 mm (range: 0.00 to 0.89 mm) of the machined-collar surface. The thicker lingual bone plate on all M1 implants was relatively maintained and unaffected. The apical half of the implant provided high initial stability (range: 65 to 100 Ncm). The mean percentage of bone-to-implant contact was 56.34% (range: 40.15% to 72.04%). This preclinical study provided clinical and histologic evidence to support the safety and efficacy of a new hybrid macrogeometry implant design that achieved excellent primary and secondary stability in immediate extraction sockets without grafting.

The computer-assisted design/computer-assisted manufactured compound prosthesis involves designing and milling a cement-retained prosthesis over milled titanium bars. In the presented clinical case report, a diagnostic wax pattern was made to assess esthetics, contours, and occlusion. A total of eight maxillary root-form implants were restored by following the combined prosthesis design concept. The mandibular arch was restored with a screwretained implant-supported zirconia fixed prosthesis. A milled polymethyl methacrylate (PMMA) maxillary interim prosthesis was fabricated to intraorally confirm the diagnostic wax pattern. The interim PMMA prosthesis was then scanned, and three screw-retained titanium milled bars were designed that provided the substructure of the definitive restoration. A cement-retained milled zirconia prosthesis was then designed and fabricated. The zirconia prosthesis provided the superstructure of the definitive complete-arch restoration. After confirming esthetics, phonetics, occlusion, and accessibility for oral hygiene, the superstructure was cemented with temporary cement to enable retrievability.

Double lip is a rare deformity that mainly affects the upper lip. The typical clinical image involves bilateral mucosal pads separated by a central groove that appear superimposed over the maxillary incisors. The deformity is rather noticeable and esthetically disturbing. Most cases of double lip are congenital, but syndromic appearance of double lip has been described. Surgical reduction of the tissue surplus is the treatment method of choice. The literature suggests excision of excess mucosa and the underlying tissues to correct double upper lip. This report discusses the advantages and pitfalls of resective techniques and suggests a novel, mucosa-sparing, transvestibular approach to correct double upper lip.

This article describes two case reports of immediate full-arch dental implant- supported prostheses using facial parameters to determine the anticipated incisal edge (AIE) position. Treatment planning the terminal dentition is driven by several facial parameters. A frontal photo is obtained to assess the facial thirds and the symmetry in the lower third. A profile photo allows the clinician to measure Holdaway's angle, nasolabial angle, and labiomental sulcus depth and anatomy. Facial assessment is a diagnostic tool that assists the clinician in addressing the challenges of ideal tooth position in the absence of dental landmarks to achieve dentofacial esthetics.

This study sought to qualitatively and quantitatively evaluate the effect of osteotomy preparation by conventional (control group) or OD (OD group) instrumentation on osteotomy healing. An incision of 10 cm was made in the anteroposterior direction over the hip in five sheep, and 15 osteotomies were prepared in the left ilium of the sheep (n = 3/sheep). Three different instrumentation techniques were utilized: (1) conventional/regular drilling (R [recommended by manufacturer]) in a 3-step series of a 2-mm pilot, 3.2-mm, and 3.8-mm twist drills; (2) OD clockwise (OD-CW) drilling with Densah Bur (Versah) 2.0-mm pilot, 2.8-mm, and 3.8-mm multi-fluted tapered burs; and (3) OD counterclockwise (OD-CCW) drilling with Densah Bur 2.0-mm pilot, 2.8-mm, and 3.8-mm multifluted tapered burs. Drilling was performed at 1,100 rpm with saline irrigation. Qualitative histomorphometric analysis of the osteotomies after 6 weeks did not show any healing impairment due to the instrumentation. Histologic analysis shows bone remodeling and growth in all samples, irrespective of osteotomy preparation technique, with the presence of bone chips observed along the length of the osteotomy wall in sites subjected to osseodensification drilling.

This case report presents treatment of a severe localized horizontal bone loss combined with infrabony defects adjacent to pathologically migrated teeth by orthodontic intrusion following a graft of enamel matrix derivative (EMD) without root surface conditioning. The patient was diagnosed with Angle Class II malocclusion, anterior spacing, and pathologically migrated incisors. Graft of EMD mixed with bone materials was applied for periodontal regeneration before orthodontic treatment, and periapical radiographs were taken every 3 months for radiographic evaluation. After closure of anterior spaces by orthodontic treatment, infrabony defects improved dramatically, with a favorable alveolar bone level and periodontal pocket depth.

The aim of the present study was a histologic and histomorphometric analysis of the peri-implant tissue reactions and of the bone-titanium interface in successfully osseointegrated, clinically stable, and immobile retrieved titanium dental implants after a long loading period. Four successfully osseointegrated and stable implants with a sandblasted surface were retrieved from a patient due to fracture, two after 14 years of loading and two after 17 years. None of these implants has been previously reported. Mature, compact bone with a few marrow spaces was observed around all four implants. At low magnification, a high percentage of bone-implant contact (BIC) was present at the interface of almost all implants. BIC percentage for the four implants was 83%, 66%, 74%, and 65%. In almost all the implants, the space within the threads was almost completely filled by compact bone. Close, tight contact between bone and implant surface was observed in all specimens, and no gaps or fibrous connective tissue was found at the boneimplant interface. All implants appeared to be well integrated in the surrounding mineralized bone, and all showed adequate BIC percentages after a long loading history.

This report presents six consecutive cases of peri-implantitis associated with residual methacrylate cement. The cases responded to cement removal and disinfection procedures. Six patients, each presenting one methacrylate cementretained implant restoration and showing peri-implant inflammation and bone loss, were treated. All the cases were negative for bleeding on probing after 6 weeks, and this was maintained at 1 year of follow-up from nonsurgical therapy and crown refixation with alternative and resorbable cement. The treatment effectively solved the inflammation and led to complete restoration ad integrum, as evaluated clinically and radiographically, after 1 year.

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.

The aim of this split-mouth clinical and radiographic study was to evaluate and compare the regenerative potential of a combination of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and beta tricalcium phosphate (β-TCP) to the established technique of bone grafting with β-TCP alone in the surgical management of intraosseous defects. A total of 24 sites in 12 subjects with intraosseous defects were included and randomly divided into test (rhPDGF-BB + β-TCP) and control (β-TCP alone) sites. Clinical parameters were recorded at baseline, 3 months, and 6 months. Radiographic parameters were evaluated at baseline and 6 months. Both groups showed statistically significant reductions of all clinical parameters. Intergroup comparison demonstrated a significantly greater probing pocket depth reduction and clinical attachment level gain in the test group. The mean percentage defect fill was significantly greater in the test group than in the control group at 3 and 6 months, and greater improvement in defect angle was also evident in the test group. Although both groups showed definitive improvements in all parameters, the test group showed significantly better results when used to treat human periodontal intraosseous defects.

This retrospective study evaluated implant survival rate (SR) and marginal bone loss around dental implants placed with ultrasonic implant site preparation. A total of 156 implants were placed in 28 totally and partially edentulous patients. Bone loss was measured on intraoral paralleling digital radiographs taken at the impression phase and after 4 years of loading. As 3 implants (1.92%) failed at the second surgery stage, the SR was 98.08% after 4 years. The mean marginal bone loss was 0.52 ± 0.33 mm (0.51 ± 0.35 mm mesially and 0.53 ± 0.35 mm distally), with comparable values for implants inserted into the maxilla (0.52 ± 0.32 mm) and the mandible (0.52 ± 0.35 mm).

The aim of this study was to evaluate clinical and radiologic results up to 3 years in patients treated with early loading of anterior implants supporting single-tooth allceramic restorations. Twenty-four patients were treated with 29 screw-type implants in the anterior maxilla. The implants were evaluated by clinical and radiographic parameters. Clinical parameters Plaque Index (PI), Sulcus Bleeding Index (BI), peri-implant probing depth (PD), and marginal bone loss (MBL) were recorded. At the recall examinations, all implants were successfully integrated, demonstrating healthy peri-implant soft tissues as documented by standard clinical parameters. No biologic complications were observed. There was no statistically significant increase in MBL between the baseline and recall stages (P > .05). Early loaded maxillary anterior implants supporting single-tooth restorations reveal successful clinical and radiographic outcomes when treatment steps were performed.

The objective of this study was to investigate marginal bone level (MBL) changes as the primary outcome of implants placed following healing of extraction sockets treated with ridge preservation, compared to implants placed following unassisted healing. A total of 268 patients (contributing 572 implants) treated from April 2005 to March 2013 were included in this retrospective study. Following estimation of the overall success rate of implants placed in the practice, 129 patients (contributing 222 implants) met the inclusion and exclusion criteria to be further evaluated. Of these, 78 patients (contributing 105 implants) received ridge preservation procedures, which entailed placement of anorganic bovine bone mineral covered with polytetrafluoroethylene membrane. The other 51 patients (contributing 117 implants), with healed sites without history of bone grafting, served as controls. Digital radiographs were taken at the time of implant placement and during follow-up visits. The mean follow-up period for ridge preservation sites was 33.6 months (range: 7.5 to 61.5 months) and for healed sites was 36.3 months (range: 6 to 91.2 months). The survival rate of implants in sites following healing of ridge preservation was 97.3%, compared to 98.5% in the nongrafted healed sites. The mean MBL changes during the observation period were 0.11 and 0.07 mm on the mesial and 0.06 and 0.06 mm on the distal aspects of the ridge preservation and healed sites, respectively (P > .05). The mean crestal bone remodeling during the observation period was 0.63 and 0.45 mm on the mesial and 0.48 and 0.12 mm on the distal aspects in the ridge preservation and healed sites, respectively (P < .05). The results of this study demonstrated stable MBL and survival of implants placed in sites following ridge preservation with xenograft as well as nongrafted healed sites.

The objective of this systematic review was to search for scientific evidence regarding the impact of periodontal therapy on serum levels of interleukin 6 (IL-6) in type 2 diabetics. A survey was conducted in five databases. Two researchers read titles and abstracts for initial selection and full text for inclusion. Data extraction and methodological quality assessment were performed. Four hundred and fifty-five studies were identified and 15 were included. Significant divergence on the effect of periodontal intervention on IL-6 levels in diabetics was observed among studies. The evaluation results of studies that controlled obesity indicate that periodontal therapy seems to have beneficial effects on IL-6 levels.

Root resection and hemisection is a treatment option for furcated molars, and the prognosis of this technique has been well documented. The aim of the present paper is to systematically review studies examining the survival and/or failure rate of root resection and hemisection and to determine the factors behind the variability in the outcome reported. A Medline (PubMed), Embase, and Google Scholar search was undertaken, looking for articles published up to September 2016. A total of 1,012 publications were screened. Two reviewers analyzed the articles and extracted the data. Case series studies required a minimum of 5 cases, and all levels of evidence were accepted. A total of 22 studies met the inclusion criteria. Survival rate and follow-up times differed widely: survival rate ranged from 40.3% to 100% and follow-up from 6 months to 23 years. Half of the studies had a survival rate > 90% with a follow-up period ranging from 5 to 23 years. Therefore, root resection and hemisection are associated with high survival rates, making it a reliable option for treatment of furcated molars that should be considered before every extraction and implant placement. In a great number of studies, incomplete information was found concerning case selection and endodontic, restorative, and maintenance therapy, which makes one question the obtained results and the occasional reports of low survival rates. These concerns should encourage more detailed, long-term clinical trials, with respect to each phase requirement for the procedure, for a better assessment of survival rate.

Appropriate regeneration of periodontal tissues is the primary purpose of periodontal disease treatment. The present study assessed the impact of three key regenerative elements-platelet-rich plasma (PRP), canine bone marrow mesenchymal stem cells (cBM-MSCs), and fibrin glue-on periodontal regeneration. In each of the study's five dogs, Class II furcation defects were established on the buccal surface of five teeth. One tooth (five total) from each dog was placed into one of five groups: (1) PRP + fibrin glue, (2) PRP + fibrin glue + cBM-MSCs, (3) fibrin glue, (4) cBM-MSCs + fibrin glue, and (5) control (no treatment). Histologic and histometric evaluations were performed to assess the formation of new bone, cementum, and the periodontal ligament. Different types of new bone and cementum, the maximum thickness of new cementum and the periodontal ligament (PDL), the vitality of bone, and the presence of inflammation or foreign-body reactions were also elucidated. The histologic and histometric evaluations revealed substantial differences in all groups between the observed maximum thickness of newly formed cementum and PDL. The percentage of bone and cement formation drastically increased with the combined presence of stem cells, fibrin glue, and PRP. The results showed that the inherent regenerative capacity of periodontal tissues can be sufficient if their latent self-repair mechanisms are stimulated.