International Journal of Periodontics & Restorative Dentistry, 01/2016

Patients under bisphosphonate (BP) treatment could be at high risk for implant treatment and bone augmentation due to the association between BPs and osteonecrosis of the jaws (BRONJ). Fifteen patients with BP intake in their anamnesis because of osteoporosis were treated with extensive bone grafting procedures and dental implants after selection according to their individual risk profile. In 47 sites, mandibular bone blocks were grafted according to the split bone block technique and 14 sinus floor elevations were performed. A total of 71 implants were placed and restored after 4 months. Most of the grafted bone healed as expected, and all implants could be placed as planned. Two patients showed incomplete healing of the grafted bone and were regrafted during implant placement. Two other patients showed limited soft tissue necrosis that was handled successfully with local treatments. One immediately loaded implant was lost. All in all, healing was uneventful and comparable to patients with no history of BP intake. At up to 6 years of follow-up, no major bone loss, BRONJ, infections, or peri-implantitis had occurred and all implants were still well osseointegrated clinically and radiologically. Depending on individual risk profile, bone augmentation could be successfully performed in patients taking low doses of BP treatment. More research and studies are needed.

Although cervical lesions are commonly treated using restorative materials, the esthetics and durability of the restoration can be problematic. Despite improvements in bonding to dentin, the performance of resin-based cervical restorations suffers from a variety of clinical problems. Biologic options using connective tissue grafts to replace the lost soft tissues have proven longevity and esthetic benefits. A collection of case reports is presented to demonstrate a surgical alternative to correct carious and noncarious cervical lesions. Clinicians should consider the biologic option of replacing the missing gingival tissue prior to placement of restorative materials on exposed root surfaces.

Two common dentoalveolar defects are managed by a novel treatment approach. This article explains how the underlying mechanism that regulates bone physiology can be recruited to improve the response to surgical healing and presents the theoretical basis of this treatment method. Modern investigators have revealed the likely anatomic pathways through which this system operates. A specific set of rules can be defined to guide surgeons to design procedures that have the optimum potential for a successful outcome. These cases demonstrate that if this treatment method is followed, successful healing can be achieved.

The aim of the present study was to assess the discoloration of the peri-implant mucosa caused by zirconia (Zr) and titanium (Ti) dental implants with and without soft tissue grafting (STG). Zr and Ti implants were inserted in edentulous areas in pig maxillae. Spectrophotometric measurements were performed prior to and after the insertion of the implants, and following the placement of a STG on the buccal side. A significant discoloration of the mucosa was observed with a mean ΔE of 8.05 (± 2.51) (Ti) and 4.93 (± 3.18) (Zr). In conjunction with a STG, ΔE values amounted to 5.31 ± 3.50 (Ti) and 5.95 (± 3.68) (Zr). The placement of Zr implants led to less discoloration of the mucosa than Ti implants without STG.

The use of an immediately placed provisional restoration that mirrors the cervical contours of the extracted tooth at the time of implant placement may provide a platform to promote peri-implant soft tissue healing. This study examined the association of sulcular bleeding at the time of initial disconnection of the provisional restoration with stability of the buccolingual ridge dimension following immediate implant placement. Eighteen immediate implants grafted with particulate bone were restored with a screw-retained, single-unit, provisional restoration and abutment. The presence of sulcular bleeding was recorded after 5 to 7 months of healing. Stability of the buccolingual ridge dimension at the level of the free marginal gingiva and 1, 2, 3, 5, 7, and 9 mm apical was estimated using the contralateral tooth as a control. Gingival bleeding was associated with the disconnection of the provisional restoration in 11 (61.1%) of the grafted implant sites. Bleeding upon initial disconnection of the provisional restoration was significantly correlated with smaller changes, or greater stability, in the buccolingual ridge dimension at each reference point from 0 to 3 mm apical to the free gingival margin. The use of anatomically contoured provisional restorations may provide a platform to promote peri-implant soft tissue healing and minimize remodeling of the buccolingual ridge dimension.

The aim of this preliminary study was to show the treatment effect of the biofilm decontamination approach on acute periodontal abscesses. Clinical cases showing acute periodontitis were treated using an oral tissue decontaminant material that contains a concentrated aqueous mixture of hydroxybenzenesulfonic and hydroxymethoxybenzene acids and sulfuric acid. The material was positioned into the pocket on the root surface and left in the site for 30 seconds. No instrumentation was performed before the treatment. No systemic or local antibiotics were used in any of the cases. A questionnaire was used for each patient to record the pain/discomfort felt when the material was administered. All of the treated cases healed well and very rapidly. The infections were quickly resolved without complications, and the pockets associated with marginal tissue recession were also reduced. The momentary pain upon introduction of the material was generally well tolerated in the nonsurgically treated cases, and it completely disappeared after a few seconds. The biofilm decontamination approach seems to be a very promising technique for the treatment of acute periodontal abscess. The local application of this material avoids the use of systemic or local antibiotics.

Severely traumatized incisors in young adults are a very common problem, and one that is difficult to treat because healing of these teeth is not always predictable and implant placement has to be delayed until adulthood. This case report of a horizontal root fracture in an avulsed central incisor illustrates the ability to maintain crucial tooth structure. A lateral socket augmentation procedure after extraction of a root fragment combined with an endodontic and regenerative periodontal treatment approach could preserve natural esthetics and function, which are directly related to quality of life. The preservation of alveolar bone volume following partial root removal will eventually facilitate later placement of a dental implant with an improved esthetic and functional prosthodontic result in a patient with a high-risk esthetic profile.

In this study, the effectiveness of a corticocancellous block allograft for restoring alveolar ridge defects in preparation for the placement of dental implants was assessed. Significant ridge defects in four partially edentulous patients were reconstructed using an irradiated corticocancellous allogeneic block soaked in platelet-rich plasma, which was also covered with a resorbable collagen membrane. After 5 or 6 months, the sites were reentered and a trephine bone core specimen was obtained from each augmented site for histologic, histomorphometric, and immunohistochemical assessment. In all four cases, histologic evaluation of the augmented site showed areas of new vital bone formation around the graft material (mean newly formed bone fraction, 23.7%; mean total mineralized tissue fraction, 40.1%), in which osteocytes were frequently observed within the lacunae. Immunohistochemical analysis showed the presence of biomarkers commonly related to active bone formation (alkaline phosphatase, osteocalcin, and bone morphogenetic protein-2), confirming that the biochemical environment was conducive to new bone formation. The findings of this study demonstrate that the use of allogeneic block grafts for restoring alveolar ridge defects prior to the placement of dental implants may be an effective and advantageous alternative to autograft procedures.

When treating patients with severe periodontal disease, dentists often face the difficult dilemma of how to effectively treat the disease while satisfying patient esthetic demands. Care must be taken to evaluate the patient's periodontal anatomy and the position of the planned prosthetic margin to ensure proper development of the biologic architecture. The treatment goals for this patient included exposure of adequate tooth structure for the placement of a restorative margin, establishment of a healthy dentogingival complex, and the subsequent fabrication of a well-fitting, esthetically pleasing definitive restoration. This article presents a case where careful communication between the restorative dentist, the periodontal surgeon, and the laboratory technician resulted in a predictable esthetic and restorative outcome while improving the periodontal health of the patient. Key to this collaboration was the use of a structured treatment-planning protocol and the fabrication of a realistic cast, which represented the threedimensional anterior soft tissue architecture as it was present in the patient's mouth.

Reconstruction of anterior maxillary ridge defects involving both horizontal and vertical dimensions has always been a challenge. This case report proposes a novel approach to reconstruct labial bony walls with onlay bone blocks harvested in situ held by titanium mesh covered with concentrated growth factor. Favorable outcomes were shown because of better space maintenance and nutrition supply.

Invasive cervical resorption (ICR) lesion is an aggressive form of tooth destruction that usually begins immediately below the epithelial attachment. It has been described as a purely inflammatory reaction that can be started by microorganism infection, or an aseptic resorptive process that can be secondarily infected. The potential etiologic and predisposing factors for ICR are orthodontic treatment, traumatic injuries, bleaching, periodontal therapy, and idiopathic factors. This case series with a 3-year follow-up shows that Class 2 ICR lesions have a good prognosis in 100% of cases. Class 3 ICR lesions should be considered at risk. However, in the authors' experience, the treatment of Class 3 ICR lesions is compatible with tooth maintenance.

The purpose of this article is to demonstrate an alternative method for sinus augmentation through a palatal approach when complications do not allow the use of traditional approaches. A 50-year-old male patient presented with multiple previous sinus augmentation attempts. A cone beam computed tomography scan revealed bone graft material had consolidated on the buccal aspect of the lateral sinus wall only, preventing implant placement while not allowing access via a conventional lateral window technique to improve the graft bulk. A palatal approach was adopted as an alternative method of sinus entry and is presented in this case report. The authors suggest that a palatal approach technique is a safe and effective method to complete a sinus augmentation where a buccal approach is impractical.

The purpose of this study was to compare the impact of resin restorations placed supragingivally or impinging periodontal biologic width (PBW). Ten patients (aged 19 to 35 years) with at least two contralateral teeth (premolars and molars) in need of proximal subgingival restorations participated. Test group (TG) (impingement of PBW with transsurgical restorations) and control croup (CG) (supragingival restorations after crown lengthening) were randomly assigned. Visible plaque (VP), bleeding on probing (BOP), periodontal probing depth (PPD), and clinical attachment loss (CAL) were evaluated at baseline and at 45, 90, and 180 days, and by transperiodontal probing at baseline and 180 days. Generalized estimating equations, Wald test, and t test were used (P ≤ .05). VP and BOP were reduced and maintained at low levels (less than 10% from day 45 on). PPD initially reduced in the TG. At day 180, no intra- or intergroup differences were observed (P > .05). CAL was higher in the CG after surgery (P < .05) and remained stable for both groups throughout the study. In conclusion, proximal bonded restorations infringing on the PBW may not require clinical crown lengthening.

This study aimed to evaluate the microleakage of a new universal adhesive used in self-etch (Se) and etch-and-rinse (Er) mode compared with conventional adhesive systems. Fifty standard Class V caries lesions were prepared on the buccal and lingual surfaces of premolar teeth and randomly divided into five groups (n = 10): Group 1 (control), Adper Single Bond 2 (SB); Group 2, Single Bond Universal applied as Er (SBUEr); Group 3, Single Bond Universal applied as Se (SBUSe); Group 4 (control), Clearfil SE (CSE); and Group 5, Xeno V (XE). On both enamel and dentin, XE showed the highest microleakage scores, and SBU showed similar leakage with the control group.

Single-tooth osteotomy is a surgical technique in which the tooth and adjacent bone with sufficient soft tissue are repositioned in a single step or moved orthodontically. It is not used in the maxillary posterior region because of poor accessibility, bleeding complications, and anatomical limitations such as the maxillary sinus. However, the development of piezoelectric surgical devices and the popularization of the sinus floor elevation procedure have simplified the approach to the posterior maxillary area. This article reports two cases of single-tooth osteotomy of ankylosed teeth that were performed safely in the posterior maxilla with the use of a piezoelectric device and a sinus membrane elevation. In addition, several merits of this approach as compared with conventional osteotomy are described.

The present article describes the treatment given to a patient who underwent horizontal ridge augmentation surgery in the maxillary anterior area due to the premature loss of the maxillary central incisors. The complete dehiscence of the buccal plate was detected after elevation of mucoperiosteal flaps. The lesion was overfilled with deproteinized bovine xenograft particles combined with recombinant human platelet-derived growth factor BB (rhPDGF-BB) and covered with a porcine collagen barrier hydrated with the same growth factor. The soft tissues healed with no adverse complications. After 12 months, reentry surgery was carried out to place endosseous implants. Complete bone regeneration with the presence of bone-like tissue was observed. Cross-sectional computed tomography scan images confirmed integration of the bone graft and reconstruction of the lost hard tissue volume. The implants were inserted in an optimal three-dimensional position, thus facilitating esthetic restoration. Two years after insertion of final crowns, cone beam computed tomography scans displayed the stability of regenerated hard tissues around the implants. Controlled clinical studies are necessary to determine the benefit of hydrating bovine bone particles and collagen barriers with rhPDGF-BB for predictable bone regeneration of horizontal lesions.