Clinical Advances in Periodontics最新文献

Background: Drug-induced gingival enlargement (DIGE) is a common side effect of medications such as anticonvulsants, calcium channel blockers, and immunosuppressants. The treatment of choice for the condition is drug withdrawal or substitution in combination with the nonsurgical phase. In some cases, additional internal or external bevel gingivectomy is needed to achieve periodontal health. Special approaches may be needed in severe DIGE cases superimposed on periodontitis. The aim of this report is to describe the dual-flap internal gingivectomy (DFIG) approach for the simultaneous management of soft and hard tissues via the simultaneous reduction of the connective tissue bulkiness from the superficial flap and preservation of keratinized tissues.

Methods: A generalized Stage IV grade C periodontitis with DIGE was treated.  An initial partial thickness flap was elevated and thinned out to a thickness of 1.0-1.5 mm. Then, a second partial-thickness flap was raised, and a thick band of connective tissue was removed. Proper positioning of the primary flap onto the periosteum was obtained and flap adaptation was achieved with localized gingivoplasty.

Results: Healthy soft tissue was developed with DFIG by debulking the enlarged connective tissues and apical gingival margin positioning with a predictable wide band of keratinized attached gingiva was achieved.    CONCLUSIONS: The DFIG surgical approach provides adequate access for root instrumentation and preserves KT width. The procedure effectively reduces soft tissue thickness and improves soft tissue contours, in DIGE cases superimposed to periodontitis.

Key points: Gingival enlargement is related to excessive production and deposition of collagen in the inner layer of the connective tissue and the surface of the alveolar bone. The dual-flap internal gingivectomy (DFIG) approach allows for targeted excision of the inner layer of the connective tissue from the buccal primary flap while preserving the width of the keratinized tissue. Adequate soft tissue contours and volume are obtained following the DFIG procedure.

Background: Free gingival graft harvested from the palate is considered the most predictable method to augment the keratinized tissue (KT). However, the anatomical limitations of the palate, and associated patient morbidity and complications restrict clinicians from performing these procedures in adolescents. Color mismatch with the native tissues resulting in poor esthetic appearance is another concern. To overcome these limitations, this article reports a surgical approach known as labial gingival graft (LGG) as an alternative to palatal graft.

Methods: Two adolescent patients presenting with absence of attached gingiva and shallow gingival recession in the mandibular incisor region were treated with LGG harvested from the labial KT of teeth adjacent to those requiring KT augmentation.

Results: The procedure was well tolerated by the patients. At the final follow-up (3.5- and 2 years from baseline), a significant gain in KT with complete root coverage was achieved in both patients. Both professional and patient-centered esthetic evaluations revealed excellent color match making the grafted area imperceptible from the adjacent mucosa.

Conclusions: The proposed technique was found to be simple and predictable, and was associated with minimal morbidity and no complications. Clinicians may consider performing LGG procedure when sufficient KT can be harvested from adjacent donor site. The selection of such techniques is of particular relevance in children who are vulnerable to complications associated with more invasive procedures.

Key points: Why are these cases new information? To the best of our knowledge, this article is the first to present the use of labial gingival graft harvested from adjacent keratinized mucosa in adolescent patients. What are the keys to successful management of these cases? Proper case selection in terms of sufficient amount of keratinized tissue to harvest as labial gingival graft from adjacent teeth. Use of smaller instruments, small-sized needles, and sutures under magnification to minimize trauma to the tissues /graft. Preparation of an immobile periosteal bed and suturing protocol that minimizes the dead space and ensures revascularization of graft. What are the primary limitations to success in these cases? A prerequisite of the presence of thick gingiva and sufficient dimensions of KT around the adjacent teeth further limits its applicability in all cases.

Background: Peri-implantitis poses significant challenges in clinical practice, necessitating effective therapeutic strategies. This case report presents a comprehensive treatment approach for managing peri-implantitis, focusing on resective surgery, including implantoplasty and long-term maintenance.

Methods: We describe the case of a 50-year-old female patient with peri-implantitis affecting a maxillary full-arch implant-supported rehabilitation. The treatment strategy involved resective surgery with implantoplasty, a new maxillary overdenture, and a regular maintenance care schedule of three to four visits per year. Clinical and radiographic assessments were performed over a 10-year follow-up period.

Results: Post-treatment, all maxillary implants demonstrated no probing depths exceeding 4 mm, absence of bleeding on probing or suppuration, minimal plaque accumulation, and no further bone loss. Resective surgery with implantoplasty seems to have effectively provided submucosal decontamination and created a supra-mucosal implant surface conducive to oral hygiene. Despite regular maintenance, some mandibular implants exhibited bone loss during the follow-up period and were managed using the same approach as for the maxillary implants.

Conclusions: The comprehensive treatment approach yielded favorable long-term clinical and radiographic outcomes, underscoring the effectiveness of the combined strategies in managing peri-implantitis. Nevertheless, the potential for recurrence or the development of peri-implantitis in new implants, even after a decade of successful treatment and strict maintenance, highlights the importance of ongoing, diligent care and regular evaluations to promptly diagnose and address these issues.

Key points: Why is this case new information? The long-term effectiveness of peri-implantitis treatments, particularly involving implantoplasty, remains under-documented. This case provides insights from a 10-year follow-up on the efficacy of a comprehensive approach for managing peri-implantitis. Furthermore, these findings illustrate the potential for new peri-implantitis to develop, regardless of sustained peri-implant health and rigorous maintenance. This finding highlights the critical role of continuous monitoring for the early diagnosis and treatment of new implants exhibiting peri-implantitis. What are the keys to the successful management of this case? The success of this case hinged on a comprehensive treatment approach that combines surgical intervention associated with implantoplasty to remove implant threads, thereby creating smoother surfaces, less retentive for plaque accumulation. A critical aspect of this approach was also the redesign of prosthetic components to improve hygiene accessibility, continuous monitoring, and consistent maintenance care. What are the primary limitations to success in this case? T