Background: This case report presents the management of an esthetic complication of a peri-implant soft tissue dehiscence (PSTD) through a combined prosthetic-surgical approach.
Methods and results: A 53-year-old healthy Hispanic male presented to our practice for the treatment of an implant esthetic complication. A diagnosis of PSTD class III C was established. The abutment and crown were first modified to accommodate the tissue graft and support the coronally advanced flap (CAF). Then, a CAF with tuberosity connective tissue graft was performed. A definitive abutment and crown were fabricated 8 months after healing. Significant improvement of the PSTD, improvement of the peri-implant soft tissue dimensions, and patient satisfaction have been achieved.
Conclusion: A combined prosthetic-surgical approach constitutes a valid treatment modality for PSTD class III C where there is abundant interproximal tissue available.
Key points: Integrated treatment approach: A combined prosthetic-surgical technique offers an effective solution for managing peri-implant soft tissue dehiscence (PSTD), ensuring improved tissue thickness and stability.
Clinical considerations: The bucco-lingual implant position and interproximal tissue quality are key factors in determining the optimal treatment strategy. Predictable outcomes: Coronally advanced flap combined with connective tissue grafting can enhance esthetic and functional results for management of PSTD.
Plain language summary: Peri-implant soft tissue complications can affect both the function and appearance of dental implants. This case study explores an approach that combines surgical and prosthetic techniques to improve the gingival tissue surrounding an implant. A 53-year-old patient had an esthetic concern due to gum recession around his implant. To correct this, his dental crown and abutment were adjusted. Then, a gingival grafting procedure to reposition the gingival tissue and enhance its thickness was performed. After healing for eight months, the implant was permanently restored with a final crown. The results showed significant improvements in gingival tissue health, thickness, and appearance, leading to patient satisfaction. The findings highlight how combining surgical techniques with prosthetic adjustments can help manage similar cases, offering a predictable solution to improve both the appearance and stability of dental implants.
Background: Cheilitis granulomatosa (CG) and plasma cell gingivitis (PCG) are uncommon inflammatory conditions affecting the oral regions. CG manifests as chronic lip swelling with granulomatous inflammation, while PCG presents as erythematous gingiva or gingival enlargement linked to hypersensitivity reactions. Their simultaneous occurrence is exceedingly rare, posing diagnostic and therapeutic challenges.
Methods: A 32-year-old woman presented with recurrent upper lip swelling and gingival enlargement. Clinical examination revealed erythematous gingiva with a cobblestone texture and angular cheilitis. Biopsies confirmed orofacial granulomatosis with epithelioid granulomas and PCG with plasma cell infiltration. Management consists of diet modification and periodontal intervention. Postoperative outcomes demonstrated significant improvement, and allergen elimination strategies were implemented to reduce recurrence.
Results: At 9 months of follow-up of the patient, there was significant improvement in signs and symptoms with no signs of recurrence.
Conclusion: This case highlights the rare co-existence of CG and PCG, emphasizing the need for a comprehensive diagnostic approach to exclude systemic causes. Successful management requires pharmacological treatment, surgical interventions, and dietary modifications. Long-term follow-up is essential to monitor recurrences and maintain clinical stability.
Key points: Because of the rare co-occurrence of cheilitis granulomatosis (CG) and plasma cell gingivitis (PCG), which creates unique diagnostic and therapeutic hurdles, this case offers new information. Additionally, it presents an effective treatment plan that concurrently addresses both problems. A comprehensive strategy is necessary for the successful management of PCG and CG. Systemic disorders must be ruled out since they might exhibit similar symptoms. Dietary changes, nonsurgical, and surgical periodontal therapy are all part of the therapy plan. In order to avoid recurrence and guarantee a long-lasting recovery, long-term monitoring and regular elimination of allergens and irritants are essential. The possibility of the problem recurring is one of the main obstacles to this case's success. Reducing the chance of recurrence requires adhering to dietary changes and getting rid of allergens. Additionally, before initiating any kind of treatment, systemic disorders must be ruled out.
Plain language summary: Cheilitis granulomatosa (CG) and plasma cell gingivitis (PCG) are two uncommon conditions that affect the oral cavity. In this case report, a 32-year-old female patient presented with swelling of the lip and enlargement of the gums. There was a presence of cracks at the corners of the mouth, along with redness of gums with uneven texture. Investigations were done to rule out other possible causes of the same. His
Background: Periodontally accelerated osteogenic orthodontics (PAOO) or surgically facilitated orthodontics involves corticotomies and bone grafts during orthodontic treatment. It aims to enhance the range and rate of tooth movement and improve alveolar bone dimension and gingival architecture. Limited evidence exists on bone dimension changes due to PAOO. This retrospective study assesses PAOO's effects on alveolar bone thickness.
Methods: Patient records from 15 arches treated with PAOO were compared to 15 age and sex-matched control arches treated without PAOO. Pre- and post-orthodontic cone-beam computed tomography images measured radicular bone thickness at central and lateral incisors in sagittal sections at 3, 6, 9, and 12 mm from the cemento-enamel junction (CEJ). The vertical distance of crestal bone from CEJ was also measured. Fenestrations or dehiscence were quantified on buccal root surface cross-sections.
Results: Of the 15 PAOO-treated arches, 10 were augmented on the compression side of tooth movement, while five were augmented on the tension side. In cases augmented on the compression side, the PAOO group showed a significant increase in the buccal radicular bone at 3, 6, and 9 mm from the CEJ. A significant loss in lingual crestal bone height was observed in the PAOO group. Additionally, there was a significant reduction in fenestrations and dehiscence in the PAOO group.
Conclusions: Within our study's limitations, results suggest that PAOO increases alveolar bone thickness and reduces fenestration and dehiscence incidence when performed on the compression side of orthodontic movement. However, it is associated with lingual crestal bone loss. Further prospective studies with standardized protocols are needed to better define PAOO's efficacy.
Key points: Periodontally accelerated osteogenic orthodontics (PAOO) increases the thickness of alveolar bone when performed on the compression side of the orthodontic tooth movement. PAOO may prevent alveolar fenestrations and dehiscence of root surfaces after orthodontic treatment. PAOO may reduce orthodontic treatment time in select cases.
Plain language summary: With an improved awareness of dental esthetics and function, an increased number of adult individuals are seeking orthodontic therapy. Adult patients present with unique challenges for the treating orthodontist such as extensive restorative work, missing teeth, thin alveolar bone, and thin gingival tissues. This might result in increased recession, bone loss and fenestration, and dehiscence. Periodontally accelerated osteogenic orthodontics (PAOO) allows for quicker tooth movement, as well as increasing alveolar bone thickness to prevent subsequent hard and soft tissue deficiencies. In this retrospective study, we compared the effects of orthodontic treatment completed with and without PAOO on alve
Background: Prevention and treatment of interproximal recessions after periodontal therapy has been challenging and is important because the resulting black triangles are unesthetic. Traditional treatment options include orthodontic, restorative, surgical, and combined approaches. This case report aims to describe an approach using periodontal plastic surgery combined with prosthetic treatment for the management of a papillary deficiency in the esthetic zone.
Methods: A healthy, 64-year-old female presented with esthetic concerns related to a black triangle between the maxillary right canine and first premolar as a result of periodontal therapy. A Class III recession defect was present. A de-epithelialized connective tissue graft harvested from the maxillary tuberosity was placed interproximally and combined with a coronally advanced flap and enamel matrix derivative. Following 6 months, the restorative phase was initiated including diagnostic wax-up, direct composite restoration the mesial of the premolar, followed by facial veneer preparation on the canine using an incisal butt joint design. After the provisional phase, a lithium disilicate ceramic veneer was fabricated and cemented with adhesive technique.
Results: Following 18 months of follow-up, we observed a nearly complete closure of the embrasure space.
Conclusions: The successful closure of the interproximal tissue deficiency, as evidenced by this case report, demonstrates the potential of this approach utilizing an interproximal connective tissue graft along with prosthetic treatment to manage significant papillary defects; this report reinforces the role combined prosthodontic and periodontic approaches may have in treatment outcomes.
Key points: The connective tissue cube technique showed potential for treatment of severe papillary deficiencies. Combined surgical-restorative approaches might be needed for complete closure of black triangles. Further clinical studies with stronger level of evidence are needed.
Plain language summary: This case report discusses a treatment for a common issue after periodontal therapy: black triangles (open gingival embrasures) between teeth that can be unappealing. The patient, a 64-year-old woman, had a black triangle between her maxillary right canine and first premolar due to loss of interproximal periodontal support. The treatment combined surgery (tissue and bone grafting with biologic material) and restorative treatment. After 6 months, dental restorations were complete, with a provisional period prior to definitive restoration to evaluate tissue fill and esthetics. The restorative treatment involved the use of a single veneer and single interproximal composite restoration. Eighteen months postsurgical therapy, the gap was nearly closed and remained stable for an additional 6 months. The report highlights that com
Background: This retrospective case series evaluated linear and volumetric bone changes in alveolar bone defects treated with guided bone regeneration (GBR) using a next-generation customized three-dimensional (3D)-printed titanium mesh.
Methods: Medical history, surgical details, and cone beam computed tomography (CBCT) data were collected from patients undergoing GBR with the customized 3D-printed titanium mesh. CBCT subtraction analysis was performed using 3D digital models, created via spatial registration and semi-automatic segmentation. Outcomes included complication rates, linear bone measurements, volumetric hard tissue gain, graft volume stability, and augmentation efficacy.
Results: Nine cases were included: five combined large defects, two vertical large defects, and two combined medium defects. Two cases showed no complications, while seven had mesh exposure. Two cases experienced complete early mesh exposure (22.2%), resulting in total graft loss and premature removal. The mean linear vertical bone gain at the defect's middle plane was 5.7 ± 2.3 mm for large defects, 2.7 ± 0.5 mm for medium defects, and 4.8 ± 2.4 mm for both. The overall volumetric gain was 0.49 ± 0.20 cm3, with graft volume stability at 87.9 ± 19.5% and augmentation efficacy of 0.037 ± 0.012 cm3/mm.
Conclusions: Customized 3D-printed titanium mesh is a feasible and effective option for augmenting defective edentulous ridges, providing predictable outcomes in linear and volumetric gains. Mesh exposure is the most common complication.
Key points: Novelty and Contribution of These Cases This case series provides important insights into GBR using customized 3D-printed titanium meshes. These devices aim to overcome several limitations commonly associated with traditional non-resorbable membranes and conventional titanium meshes. The inclusion of comprehensive, CBCT-based linear and volumetric measurements of hard tissue gain adds valuable quantitative data to the field, supporting the clinical utility of customized titanium meshes in alveolar ridge augmentation. Key Factors for Successful Case Management Successful outcomes in these cases were associated with several critical factors: Thorough preoperative planning Precise execution of the surgical technique Effective management of potential postoperative mesh exposure Primary Limitations to Treatment Success The main limitations that impacted treatment outcomes included: Compromised systemic health or medical history Improper adaptation or seating of the mesh Premature and complete mesh exposure during the healing period PLAIN LANGUAGE SUMMARY: This study looked at a new way to rebuild lost bone in the jaw using a custom-made, three-dimensional (3D)-printed titanium mesh. Nine patients with different types of bone defects were treated, and detailed scans were taken before and after surger
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