International Journal of Periodontics & Restorative Dentistry最新文献

Bone graft materials are often used in implant treatment for optimizing functional and esthetic outcomes. The requirements for bone grafting materials should be that they must be able to maintain space for bone regeneration to occur and must be resorbed by osteoclasts and replaced with new bone tissue occurring in passive chemolysis and bone remodeling. Carbonate apatite (CO3Ap) granules (Cytrans Granules, GC) are chemically synthetic bone graft material that are similar to autologous bone mineral and more biocompatible than allografts and xenografts. The aim of this report is to evaluate the efficacy of CO3Ap granules in implant treatments using CO3Ap granules in combination with autogenous bone or CO3Ap granules separately. This report will show the clinical findings as well as radiographic and histological assessments in three cases of immediate implant placement, lateral GBR and vertical GBR. These results demonstrated, although it was a short-term report, that in histological findings CO3Ap granules were efficiently resorbed and replaced bone in clinical use. Furthermore, the clinical findings showed that CO3Ap granules contributed to maintaining their morphology tissue around the implant. In this limited short-term case report, it was suggested that this bone substitute was effective. However, further clinical studies and long-term reports of this new biomaterial are needed.

Background: The idea of minimally invasive non-surgical treatment (MINST) is to remove the etiology with minimal damage to the healthy periodontium and provide the ideal healing environment. In this case series, the novel protocol of laser-assisted minimally invasive non-surgical therapy (LAMINST) is introduced that combines the benefit of minimally invasive and the dental laser to maximize the therapeutic potential.

Method: 25 patients (32 teeth) with advanced periodontal disease have enrolled in the study. All the patients have received periodontal treatment by following the laser-assisted minimally invasive non-surgical therapy protocol. Treated sites were evaluated by comprehensive Periodontal examination at the baseline and 6-month re-evaluation, including probing depth (PD), Recession, clinical attachment level (CAL), bleeding on probing (BOP), presence of plaque, and mobility. The diagnosis and prognosis of each tooth were assigned based on the Periodontal evaluation.

Result: All the cases were diagnosed as Stage III and Grade C Periodontitis according to the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The average probing depth reduction 6 months after completion of LAMINST was 4.44 mm and improved clinical attachment level by 4.38mm. There was the mobility of 1 (6 teeth), 2 (9 teeth), and 3 (3 teeth) in the beginning, and all of them decreased to 1 (5 teeth) or none (13 teeth). The prognosis was assigned based on McGuire and Nunn's system. The initial prognosis for teeth was assigned to hopeless (5) (15 teeth), questionable (4) (13 teeth), poor (3) (4 teeth), and it has improved to questionable (5 teeth), poor (12 teeth), fair (13 teeth), and good (2 teeth). Initially, there were 179 BOP sites. After treatment, it decreased to 12 sites. The plaque was found in 173 sites before the treatment and has reduced to 9 sites after the treatment.

Conclusion: All clinical parameters such as PD, CAL, BOP, presence of plaque, and mobility are improved by receiving the laser-assisted minimally invasive non-surgical therapy protocol. The application of LAMINST may overcome the traditional limitation of non-surgical treatment, such as poor accessibility.

Background: Gingival recession treatment is one of the major clinical challenges in periodontics, various surgical techniques were proposed to correct it. Most of these techniques are suitable for isolated recession sites and involve the harvesting of autogenous tissue graft; which increase patient morbidity and might result in inferior esthetics due to incision design. This study assessed the benefit of adding Platelets Rich Fibrin (PRF) to Vestibular Incision Subperiosteal Tunneling Approach (VISTA) in treating multiple gingival recession compared to using VISTA alone. Forty-one teeth with Miller Class I/II were randomized in a split mouth design. Multiple clinical parameters were tested including the change in gingival thickness over time, keratinized tissue width KTW and the gingival phenotype using the transparency of periodontal probe. Patient-centered outcomes were also assessed via Visual Analogue Scale VAS.

Conclusion: Multiple Miller Class 1 and Class 2 recessions in the maxilla can be effectively treated with VISTA. However, when used in conjunction with PRF no significant differences were detected in any parameter. VISTA has been shown to be associated with a low level of pain for patients following surgery and can be used for patients with high esthetic demand.

This study aims to compare the incidence of biologic and mechanical complication rates and the survival rates after at least 5 years of implants and implant-supported fixed complete dental prostheses (IFCDPs) placed during second-stage surgery using four and six implants. A total of 77 patients (33 men, 44 women) with a mean age of 60.6 ± 8.8 years (range: 39 to 80 years) were included, and the total of 92 IFCDPs were classified into two groups: 51 received four implants, and 41 received six implants. No implant failed in the four-implant group (0/204), and one implant failed in the six-implant group (1/246), with no statistically significant differences (P > .05). One prosthetic failure occurred in the four-implant group (1/51), and one failure occurred in the six-implant group (1/41). Both groups experienced some technical and biologic complications, with no statistically significant differences between the groups (P > .05). For both groups, veneer or resin fracture was the most frequent mechanical complication, and mucositis was the most frequent biologic complication. The use of four or six implants may represent a predictable treatment option in the rehabilitation of completely edentulous patients with IFCDPs in the medium-term.

Partial extraction therapy (PET) is a set of surgical techniques that preserve a portion of the patient's own root structure to maintain blood supply derived from the periodontal ligament complex in order to maintain the periodontium and peri-implant tissues during restorative and implant therapy. PET includes the socket shield technique (SST), proximal shield technique (PrST), pontic shield technique (PtST), and root submergence technique (RST). In a traditional hybrid technique, total extraction and full-arch dental implant therapy often require significant bone reduction and palatal/lingual implant placement. In addition, postextraction preservation of the ridge architecture is a major challenge. This case series demonstrates the use of a combination of PET techniques with digital implant planning and guided implant surgery to achieve highly esthetic outcomes in full-arch implant therapy.

This randomized controlled clinical trial evaluated the pinhole surgical technique (PST) combined with platelet-rich fibrin (PRF) for the management of multiple recession defects compared to PST alone. Ten patients with 51 Miller Class I/ II or III gingival recessions were selected. Control sites were treated with PST alone, whereas test sites were treated with PST with PRF. Gingival recession depth (GRD), gingival recession width (GRW), probing depth (PD), clinical attachment level (CAL), keratinized tissue width (KTW), total soft tissue gain (TSTG), Plaque Index (PI), Gingival Index (GI), and gingival bleeding index (GBI) were measured at baseline and at 1, 3, and 6 months posttreatment. Both groups showed statistically significant root coverage. The mean recession coverage was 60.25% in the test group and 49.6% in the control group. The recession reduction from baseline was 2.50 mm for the test group and 1.88 mm for the control group. At the end of 6 months, all sites achieved adequate root coverage. PRF is a feasible alternative to connective tissue grafts as an adjunct to PST for the treatment of multiple recession defects.

Performing soft tissue augmentation (STA) at implant sites to improve esthetics, patient satisfaction, and peri-implant health is common. Several soft tissue grafting materials can be used to increase soft tissue thickness at the second-stage surgery, including human dermal matrices and xenogeneic collagen scaffolds. This study assessed and compared the volumetric outcomes, from second-stage surgery to crown delivery, around implants that received STA with a xenogeneic cross-linked collagen scaffold (XCCS) vs nonaugmented implant sites. Thirty-one patients (31 implant sites) completed the study. Intraoral digital scans were taken at the second stage and prior to crown delivery, and the STL files were imported in an image-analysis software to assess volumetric changes. XCCS-augmented implants showed significantly greater volumetric changes compared to control sites, which showed volume loss. The mean thickness of the XCCS-augmented area was 0.73 mm. There was no difference in patient-reported esthetic evaluations between groups. STA with XCCS provided significantly greater volumetric outcomes compared to nonaugmented sites. Further studies are needed to evaluate the long-term behavior of the augmented peri-implant mucosa and the effects of STA on peri-implant health.

This evaluation correlates maxillary sinus 3D morphology with bone regeneration. In 39 patients with crestal bone ≤ 2 mm, mineralized human bone allografts were used to augment the sinus floor through the crestal window sinus elevation approach. CBCT was used to measure the buccopalatal diameter (BPD), mesiodistal diameter (MDD), and hemi-ellipsoidal volume (Vh) in all sinuses. A bone core biopsy sample was taken at implant placement (4 to 5 months after sinus augmentation). Microradiographs of methacrylate-embedded sections were used to evaluate the amounts of bone, residual graft, and soft tissue. All 51 implants placed in the 39 patients successfully osseointegrated. A linear regression analysis showed that as BPD, MMD, and Vh increased, the amount of bone gain decreased and the amount of soft tissue increased (P < .05). The amount of residual graft was little affected by sinus morphology. Microradiographic data were grouped into four different sinus types (from small to great) using BPD and Vh medians. The best amount of bone formation was achieved in the narrow and short sinus type, while no great differences were found in the remaining three sinus types. Understanding of 3D sinus cavity morphology, especially the buccopalatal diameter and mesiodistal dimensions, is fundamental for achieving the best possible sinus augmentation outcomes.

Ehlers-Danlos Syndrome (EDS) is one of the most common congenital connective tissue disorders, affecting the synthesis and production of collagen cells. The medical implications for joints, muscles, soft tissue, and blood circulation have been documented in the literature. Many oral manifestations are displayed in EDS patients, including gingival recession, lack of attached gingiva, early severe periodontitis, and dental anomalies and dental caries. However, the literature is limited and oftentimes contradictory, and therefore provides no consensus for guidelines regarding prosthodontic, periodontal, and implant treatment of patients with EDS. Therefore, the aim of this systematic review was to analyze the pertinent literature regarding prosthodontics, periodontology, and implant dentistry in EDS patients.

Peri-implantitis is an inflammatory condition that involves the loss of attachment and support around dental implants. In this case report, a middle-aged woman presented with two implants in the mandibular right quadrant that were diagnosed with peri-implantitis. The patient also had tenderness around the implants and reported sensitivity when performing oral hygiene procedures. Surgical treatment comprised a free gingival graft to augment the keratinized tissue width around the implants, followed by a second procedure of implantoplasty and surface decontamination. The outcome showed radiographic resolution of the peri-implant defect around the premolar implant with a marked increase of keratinized tissue (> 4 mm) around both implants after 1 year of follow up. On a patient level, significantly reduced sensitivity around the implants and better home care were reported. This case report showed that the increase of keratinized tissue may benefit the clinical and patient outcomes of peri-implantitis treatment in terms of decreased probing depths, absence of inflammation, and improved radiographic crestal stability. The combined correction of both hard and soft tissue defects around peri-implantitis lesions may facilitate treatment success and help maintain peri-implant stability.