This paper presents a surgical treatment protocol known as EP-DDS (etiology identification, primary wound closure, debridement, decontamination, and stability of wound). The treatment protocol can be achieved in five steps. First, identify etiologic factors associated with peri-implantitis to determine whether or not the defects can be treated with this protocol. Second, in order to achieve primary wound coverage, ensure there is undisturbed wound healing, which may involve using procedures such as removing an existing prosthesis and performing tension-releasing flap design. Third, perform proper debridement of the inflamed granulomatous tissues to ensure the wound is free of any inflamed remnants. Fourth, conduct implant-surface decontamination by using a titanium brush or lasers. And finally, place appropriate space fillers (bone grafts and membrane) for wound stability. The three cases that have been successfully treated with the EP-DDS surgical protocol suggest it is a feasible surgical approach to obtain good infrabony defect bone fill (5.5-mm average) around the defects (buccal, mesial, lingual, and distal). Nonetheless, future randomized clinical trials with larger sample sizes and longer follow-ups are needed to further validate this treatment protocol.
This study evaluated the 6-year results of the subepithelial connective tissue graft (SCTG) plus envelope-type flap (modified coronally advanced flap; mCAF) or coronally advanced tunnel flap (CATF) in the treatment of multiple recessions. Thirty-six patients with at least two adjacent recessions were included. Complete root coverage (CRC), mean root coverage (MRC), and keratinized tissue (KT) width were recorded over the course of the study. Both groups presented similar CRC, MRC, and KT outcomes between the 1-year and 6-year follow-ups. MRC decreased from 96.90% to 94.16% for mCAF, and from 89.56% to 83.10% for CATF. Both surgical techniques were similarly efficient in treating multiple recessions in the short term, and in maintaining the stability of therapy in the medium and long term.
Immediate implant placement may represent a possible treatment plan for single tooth restoration. This study evaluated the insertion of osseointegrated implants in intact fresh extraction sockets in the anterior maxilla. The bone-toimplant gap was accurately grafted with a bovine bone mineral prior to implant engagement, and an immediate screw-retained restoration was delivered. After 3 months, the provisional crown was replaced with the definitive ceramic crown. Marginal bone levels remained stable after 1 year. The horizontal ridge dimension was also evaluated at three levels using CBCT scans after 1 year. The horizontal width of the postextraction crest was well preserved independently from the thickness of the buccal bone plate at baseline.
Twenty-four patients completed this randomized, controlled, blinded clinical trial comparing ridge preservation with a membrane (acellular dermal matrix graft [ADMG]) vs no membrane on buccal overlay graft technique. An intrasocket corticocancellous allograft with a facial overlay xenograft was used for both groups, and an ADMG was used as a membrane with guided bone regeneration in the ADMG group (control group). In the No Membrane group (test group), ADMG was used to cover only the occlusal surface for graft containment, with no membrane on the buccal overlay graft. Final crestal ridge width and vertical ridge height had no significant difference between groups (P > .05). Facial contour was preserved for the ADMG group compared to No Membrane group. Histologic examination showed a high percentage of vital bone for both groups with no significant difference between groups.
DOI: 10.11607/prd.4184, PubMed ID (PMID): 31449574Pages 651-656d, Language: EnglishGraves, Carmen V. / Harrel, Steve K. / Nunn, Martha E. / Gonzalez, Jorge A. / Kontogiorgos, Elias D. / Kerns, David G. / Rossmann, Jeffrey A.
The occlusal status of single-unit dental implants were evaluated using traditional and computerized methods. The type of occlusal contact in maximum intercuspation and the presence of occlusal contacts on the implant during eccentric movements were recorded. A digital sensor was used for computerized analysis of occlusion. Forty-four patients with 74 implants were included. Twentynine implants (39%) presented with "heavy" occlusal contacts, 40 implants (54.1%) presented with "light" contacts, and 5 implants (6.8%) presented with "no contact." No statistically significant association was found between the occlusal status and any of the soft and hard tissue condition variables (P > .05).
The aim of present study was to evaluate the efficacy of demineralized freeze-dried bone allograft (DFDBA) alone and in combination with chorion membrane (CM) in the treatment of Grade II furcation defects using cone beam computed tomography (CBCT). Sites were randomly assigned to Group I (DFDBA) and Group II (DFDBA + CM). Probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), and horizontal probing depth (HPD) were evaluated at 3 and 6 months and defect volume at 6 months. DFDBA + CM led to significant improvement in all parameters, indicating additional benefits of combination therapy.
DOI: 10.11607/prd.4243, PubMed ID (PMID): 31449577Pages 669-674, Language: EnglishLowy, Jeremy / Kwon, Hyuk Sang / Patel, Abhishek / Greenwell, Henry / Hill, Margaret / Katwal, Diksha / Rademacher, Anthony Charles / Mendoza, Juan
Twenty patients were randomly assigned to receive either a platform-switched or platform-matched implant to replace a single maxillary anterior tooth. Primary outcome variables were the implant interproximal bone loss, facial recession, and papilla fill at 12 months. The platform-switched group showed crestal bone loss of 0.1 ± 0.3 (mesial) and 0 mm (distal) while the platformmatched group showed losses of 0.6 ± 0.5 mm (mesial) and 0.7 ± 0.7 mm (distal) (P < .05). Facial recessions for the platform-switched and platformmatched groups were 0.1 ± 0.3 mm and 0.4 ± 0.8 mm, respectively.
DOI: 10.11607/prd.4110, PubMed ID (PMID): 31449578Pages 675-683, Language: EnglishBruschi, Ernesto / Manicone, Paolo Francesco / De Angelis, Paolo / Papett, Laura / Pastorino, i Roberta / D'Addona, Antonio
This study sought to evaluate gingival volume changes following root coverage with the vestibular incision subperiosteal tunnel access (VISTA) procedure. Pre- and postoperative surface scans of 21 patients (154 teeth) treated with VISTA using various graft materials were digitally superimposed to quantify volumetric changes. A linear gingival thickness gain of approximately 1 mm and volumetric gain of 5.47 mm3 were achieved. A negative correlation was found between linear thickness gain and root prominence. The thickness achieved was not different with various graft materials. Since gingival thickness has been identified as an important predictor of periodontal root coverage, the methodology described in the present study, along with the identification of predictors of outcome, has important therapeutic implications.
The objective of this clinical study was to assess the outcomes of autologous tooth structure in alveolar ridge preservation procedures. Extraction sites were grafted with autologous tooth structure prepared from the extracted teeth, and histologic samples were obtained at varying intervals to allow observation of bone-healing dynamics over time. Grafted areas were occupied by dentin particles that had begun to connect via bridges of woven bone at 3 months posthealing, and vital bone was in direct contact with residual particles with no inflammatory infiltrate. Further clinical investigation is warranted on the comparative effectiveness of autologous tooth structure against established bone-substitute biomaterials.
Peri-implant bone remodeling occurs in all osseointegrated implants and can be defined as an adaptive process of bone around the implant in response to functional loading. This retrospective study evaluated the marginal bone remodeling around dental implants with external hexagonal connections in function for more than 10 years. The sample consisted of 17 implants placed in the posterior region of the mandible to replace one or several teeth. For all cases, the initial periapical radiograph was assessed together with a subsequent follow-up periapical radiograph. Image analysis was performed using ImageJ software to establish the initial bone measurements and subsequent bone loss. The data were statistically analyzed using paired t test at a significance level of 5%. There was significant bone remodeling when the baseline and follow-up were compared (P < .001). The mean values of peri-implant bone remodeling on the mesial aspect were 0.90 ± 0.63 mm vertically and 1.17 ± 0.60 mm horizontally. The distal aspect of the implants showed 1.01 ± 0.82 mm and 1.06 ± 0.75 mm of marginal bone remodeling vertically and horizontally, respectively. Within the limitations of this study, marginal bone remodeling was visible, and bone levels around the external hexagon implants remain stable after 10 years of function.
Piezocision can set in motion a cascade of physiologic events that lead to accelerated orthodontics, but do all ultrasonic frequencies generate the same effects on bone? Two different Piezotome modulation frequencies (10 and 30 Hz) were tested on the rat maxilla. The animals were sacrificed at days 1, 3, 7, 14, 28, and 70, and MRI, histologic, and biochemical analyses were performed. The results indicated that at 30 Hz, the demineralization process started at day 1 and peaked at day 7, and was initiated by osteocyte apoptosis. The process was different in the two groups, with bone demineralization increasing significantly in the 30-Hz group compared to the 10-Hz group (P < .05). These results could indicate that bone biomodification is frequency-dependent.
This case series demonstrated the regeneration of peri-implant keratinized mucosa (KM) in the posterior mandibles by a modified apically positioned flap and xenogeneic collagen matrix (CM). This modified surgical approach includes a midcrestal incision in the residual KM, partial-thickness flap reflection and apical positioning, removal of submucosal tissue, and CM adaptation. Six patients with 18 implants were recruited. The mean regenerated KM width was 4.81 ± 0.69 mm after 3 months of healing. Histologic analysis of the regenerated KM revealed similar architecture to the native KM.
The aim of the present report was to evaluate the clinical outcomes of edentulous jaws rehabilitated with the Brånemark Novum protocol over a 16-year period. Between April and November 2001, four patients (three males, one female) were rehabilitated with fixed full-arch rehabilitations supported by three immediately loaded implants following the Brånemark Novum protocol. Cumulative survival rates (CSRs) of the implants and prosthesis, bleeding on probing (BOP), Plaque Index (PI), probing depth (PD), implant stability quotient (ISQ; as measured through resonance frequency analysis [RFA]), and peri-implant bone resorption were evaluated over time, up to the 16-year follow-up. At 16 years of follow-up, no implant failed (CSR 100%) and no prosthesis needed to be substituted (CSR 100%). During the period between the 11th and 16th year of follow-up, bone level (mean: 2.2 mm at 16 years) and RFA values remained stable. At the 16-year follow-up, the implants presented high PI (79.2%) but low BOP (10.4%) values. Mean PD was 3.30 mm (range: 2 to 6 mm). One biologic complication was detected on a central implant (crater-form bone destruction), and several prosthodontic complications occurred during the 16 years (fractures of resin or teeth), the majority of which were registered on the same parafunctional patient. This is the first description of the Brånemark Novum protocol rehabilitation with a 16-year followup. The outcomes demonstrated very good long-term outcomes for this protocol.
Alveolar ridge preservation procedures have been shown to significantly reduce the loss of ridge dimension of an extraction socket. As of yet, none of the alveolar ridge preservation techniques have been proven totally effective in preserving ridge morphology. The Periosteal Inhibition technique for alveolar ridge preservation involves placing a high-density polytetrafluoroethylene (d-PTFE) membrane between the periosteum and the buccal bone plate of an extraction socket. The authors hypothesize that the nonresorbable d-PTFE membrane, because of its much smaller pore diameter as compared to the size of the osteoclast precursor cells, inhibits the migration of the osteoclast precursor cells from the periosteum to the bony surface and, subsequently, their fusion to form osteoclasts. As a result, osteolytic activity on the outer surface of the socket is inhibited. The Periosteal Inhibition technique for alveolar ridge preservation is presented along with immediate implant treatment results using this treatment concept. The resulting stable ridge dimensions in these cases demonstrate a possibility that the d-PTFE membrane may effectively prevent modeling of the extraction socket by inhibiting the formation of osteoclasts on the outer bony surface.
A strategic surgical approach is necessary for patients who cannot undergo maxillary sinus augmentation due to a large perforation of the sinus membrane as a result of complex sinus septa. The technique includes partial cutting and removal of the sinus septum and graftless mucosal elevation of the concavity area. Six months after the procedure, bone growth was observed in the area where the septum had been partially removed. The sinus mucosa was slightly thicker because of scarring; consequently, maxillary sinus augmentation was safely achieved. This two-step procedure is effective for safe maxillary sinus augmentation in patients with complex sinus morphology.
Using tissue graft substitutes in root coverage procedures can avoid complications associated with harvesting an autogenous tissue graft. However, the resulting coverage rate and volume stability are generally lower when using tissue graft substitutes as compared to autogenous tissue grafts. A new volumestable porcine collagen matrix has recently been introduced for soft tissue thickening around dental implants; however, use of this matrix in recession coverage has not been reported. This case series demonstrates a novel surgical technique and reports clinical outcomes (7 to 12 months) of a minimally invasive root coverage procedure that uses vestibular incision subperiosteal tunnel access in combination with a volume-stable collagen matrix (VISTA-X).
This case report describes a patient with severe (11-mm) mandibular anterior crowding who received periodontally accelerated osteogenic orthodontics (PAOO) nonextraction treatment, showing 5-year follow-up. A 15-year-old female presented with severe dental crowding, Angle Class I skeletal and molar relationships and a Class II canine relationship, and excessive overjet and overbite. Following fixed-appliance placement (0.022-inch, MBT prescription), full-thickness periosteal flaps beyond the tooth apices were raised bilaterally from the second molars in both arches, and selective decortication of cortical bone was performed on the facial and lingual sides using a surgical tool. Bone grafting material, comprised of a mixture of demineralized freeze-dried bone allograft (DFDBA) and bovine bone (Bio Oss, Geistlich), was placed at the corticotomy sites. The patient was seen every 2 weeks after the surgery for orthodontic adjustments; the total active orthodontic treatment time was 9 months. Limits of tooth movement (the scope of treatment) were increased by the bone-graft augmentation. At the 5-year follow-up, cephalometric comparisons to baseline conditions showed dramatic incisor changes and stable dentoalveolar effects. This case demonstrates the efficacy of PAOO as a useful adjunct orthodontic strategy for adult patients who require treatment of severe crowding, ie, treatment that would be considered unreasonable if conventional orthodontics were employed. When conventional orthodontics cannot achieve the treatment goal and orthognathic surgery is not feasible, PAOO expands the scope of conventional orthodontic treatment in the adult 2-fold to 3-fold in most spatial dimensions.
The purpose of this study was to evaluate ceramic dental implants using different esthetic scores. A total of 53 ceramic dental implants were evaluated using the Pink Esthetic Score (PES), White Esthetic Score (WES), and Peri- Implant and Crown Index (PICI). Prosthodontists, orthodontists, oral surgeons, and dentistry students independently performed assessments. The mean value of combined PES + WES was 17.4 points, and the PICI was 523.2 points. Orthodontists assessed a significantly lower result in both indices compared to all other assessor groups (P ≤ .05). Patient satisfaction was very high. The esthetic scores around ceramic implants were considerably higher than the suggested threshold of clinical acceptability.