International Journal of Periodontics & Restorative Dentistry最新文献

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.

Gingival recessions with noncarious cervical lesions (NCCLs), also called combined defects, are common problems, and patients often seek treatment due to esthetic concerns or dentin hypersensitivity. This case series evaluates the effectiveness of the non-coronally advanced flap (CAF) technique combined with restorative treatment for Miller Class III gingival recessions with NCCLs. A total of 16 combined defects were included. The combined defect height (CDH), recession depth (RD), pocket depth (PD), keratinized tissue width (KTW), and presence of dentin hypersensitivity were recorded at baseline and 6 months postsurgery. The mean root coverage (mRC) was 83%, and 50% of defects presented complete root coverage (CRC). In the group with an initial KTW ≥ 2 mm, mRC and CRC were significantly higher. Further randomized controlled studies with larger sample sizes are needed to verify the prognostic factor of combined non-CAF techniques and restorative treatment for gingival recessions with NCCLs.

The aim of this study was to assess changes in the horizontal dimension of the alveolar ridge when the autogenous bone block (ABB) or periosteal pocket flap (PPF) techniques were performed prior to implant placement. This randomized trial study was conducted on 25 patients in need of horizontal bone augmentation, who were randomly divided into two groups as follows: 13 patients underwent ridge augmentation using ABB, allograft, and a collagen membrane, while the remaining 12 underwent horizontal bone augmentation via the PPF technique. For all patients, radiographic examinations via CBCT were performed both before and 26 weeks after the operation. Following the surgery, dimensional changes in the ridge width were measured both within and between the two groups in the three regions of 0, 3, and 5 mm from the top of the alveolar crest. A total of 11 patients in the ABB group and 12 patients in the PPF group successfully completed the study. Statistical analysis showed that the increase in alveolar ridge width in each group was significant, but not significantly different between the two groups at any of the measured spots (0 mm from the crest, P = .25; 3 mm, P = .38; and 5 mm, P = .73). However, more postoperative complications were observed with the ABB technique. According to the results of the present study, there was no statistically significant difference between the PPF and ABB techniques in terms of horizontal bone gain.

Various techniques have been proposed to regenerate deficient ridges after tooth removal, including guided bone regeneration, block grafting, distraction osteogenesis, and ridge splitting. However, these procedures are technique-sensitive and often present complications which prevent reconstruction of the deficient ridge and implant placement. In an atrophic anterior or posterior maxilla, these techniques often fail to produce satisfactory long-term outcomes due to the poor bone quality, pneumatization of the maxillary sinus, and the highly cosmetic patient demands. The customized alveolar ridge-splitting (CARS) technique was introduced to improve outcomes and minimize the risk of complications. The synergistic combination of this technique with another augmentation procedure-including lateral window sinus augmentation and guided bone regeneration-allows implant placement into ridges with deficient bone volume both vertically and horizontally. This study presents two case reports that were successfully treated with the CARS technique and additional augmentation techniques to treat severely atrophic ridges in the anterior and posterior maxilla.

Currently, there are several techniques being used in the posterior mandible to increase alveolar bone height and width. However, each of these has potential complications and limitations. The purpose of the current study was to present the surgical technique and restorative considerations for implant placement lateral to the inferior alveolar nerve (IAN) in cases of severely atrophic edentulous posterior mandibles. In the current study, 26 implants in 16 patients were successfully placed lateral to IAN and restored with splinted screw-retained prostheses with a follow-up time after loading ranging from 3 months to 6 years. Two patients reported complications. One patient had a temporary paresthesia that resolved 3 months after implant placement and the second patient had minor paresthesia which was reduced after implant removal but remained in a small area on the left corner of her lip.

The aim of this prospective case series was to evaluate the efficacy and safety of a xenogeneic cortical bone lamina utilized as a "shell" on the buccal aspect of narrow alveolar ridges for horizontal bone augmentation. Fifteen patients requiring multiple implant restorations at sites with moderate to severe horizontal bone deficiency were consecutively enrolled. Horizontal bone augmentation was performed using a xenogeneic cortical bone lamina (XCBL), that was fixed on the buccal aspect of the ridge using titanium screws, and a mixture of particulate autogenous bone graft and porcine hydroxyapatite. Cone-beam computed tomography (CBCT) scans were taken at baseline and 6 months after bone augmentation. The healing was uneventful, with no intra- or post-operative complications. Twenty-seven dental implants were placed in the augmented sites. The calculated average horizontal bone gain from CBCT scans was 4.79 ± 1.64 mm, 5.59 ± 1.51 mm, and 5.79 ± 2.53 mm at 1-, 3- and 5-mm reference points apical to the buccal bone crest, respectively. The present case series demonstrated that the shell technique with the xenogeneic cortical bone lamina and particulate bone graft can be an effective approach for horizontal bone augmentation prior to implant placement.

The aim of this randomized controlled trial (RCT) was to evaluate whether placement of a soft tissue graft substitute (STGS) could decrease peri-implant tissue shrinkage at immediate postextractive implants. Twenty patients with one missing tooth between two adjacent healthy teeth in esthetic areas and at least 4 mm of bone apical to the tooth apex were randomly allocated (after tooth extraction) to receive (n = 10; test group) or not receive (n = 10; control group) a subepithelial buccal STGS. Implants were inserted with a torque of at least 30 Ncm, and sites were grafted with a cancellous particulate allograft. All patients were restored with nonoccluding immediate provisional screw-retained crowns, replaced after 6 months by definitive metal-ceramic crowns. One year after loading, no dropouts, crown or implant failure, or complications occurred. No statistically significant difference or trends in volume shrinkage, esthetics, peri-implant marginal bone loss, and keratinized mucosa heights between the two groups were observed. Acknowledging that the sample size was small, no clinical benefit could be observed for the use of a STGS in immediate postextractive implants.

Adequate implant primary stability is a key factor to obtain osseointegration and can be measured at insertion by insertion torque (IT) and at different timepoints with resonance frequency analysis (RFA), expressed as an implant stability quotient (ISQ). This retrospective study investigated the correlation between ISQ and IT at implant insertion. All patients who were eligible for this single-cohort retrospective clinical trial were treated with an immediate implant. IT parameters were recorded at implant insertion, and ISQ values were recorded at insertion and at 2-, 4-, and 12-month follow-ups. The study comprised 23 patients who received 32 implants. The mean IT value was 46.87 ± 9.66 Ncm (range: 25 to 65 Ncm), and the mean ISQ value at implant insertion was 71.45 ± 4.24 (range: 63 to 78); these values showed a statistically significant correlation (P < .0001). According to the present data and considering the implant design used in this trial, there is a statistically significant and positive correlation between IT and ISQ values. Thus, ISQ can be used as a reliable method to measure implant stability over time.