Clinical Advances in Periodontics最新文献

Background: This work aims to present a 10-year follow-up of a young patient who underwent treatment with collagen matrix (CM) combined with enamel matrix derivative (EMD) for bilateral gingival recessions in the maxillary canine region.

Methods: The patient, a 25-year-old woman, presented with bilateral Cairo type 1 recessions. A porcine-derived CM in combination with EMD was applied to the affected area after coronally positioned flaps. Over the subsequent decade, the patient was monitored for key follow-up parameters, that is, wound closure, root coverage, functional and aesthetic outcomes, and adverse events.

Results: Clinical evaluations at regular intervals demonstrated complete and sustained root coverage, stable tissue volume, excellent functional and aesthetic recovery, and absence of any complications.

Conclusions: This long-term follow-up suggests that the use of CM in combination with EMD may provide a durable and effective solution for soft tissue defects, with sustained positive results observed over a 10-year period. These findings reinforce the long-term efficacy and safety of the combined use of CM and EMD for the treatment of gingival recessions.

Key points: Successful use of biomaterials (collagen matrix and enamel matrix-derived proteins) in covering exposed roots. Rare postoperative follow-up of a decade of combined use of biomaterials in soft tissue reconstruction.

Plain language summary: This case demonstrates a decade-long follow-up of the combined use of a collagen matrix and enamel matrix-derived proteins in coronally advanced flaps for soft tissue reconstruction to cover exposed roots. This follow-up will help clinicians choose biomaterials to replace autogenous connective tissue grafts, thereby reducing surgical time, pain, and postoperative discomfort for the patient, while avoiding adverse events such as excessive bleeding, analgesic consumption, and the risk of tissue necrosis in donor sites.

Background: The aim of the study is to report clinical outcomes of autogenous tooth transplantation (ATT) of fully developed third molars following the extraction of periodontally hopeless teeth as a part of the treatment of a stage III, grade C, molar-incisor pattern (MIP) periodontitis case.

Methods: A 24-year-old female with stage III, grade C, MIP periodontitis was treated at Operative Unity of Dentistry, Azienda Unità Sanitaria Locale, Ferrara. Despite steps I and II of periodontal therapy, deep pockets and severe mobility remained at maxillary and mandibular right first molars, which were scheduled for extraction due to a hopeless periodontal prognosis. At the time of extraction, the maxillary and mandibular right third molars (18 and 48) were transplanted in the severely compromised sockets of 16 and 46, respectively. The patient received supportive periodontal care with a 4-month frequency.

Results: At 24 months, both transplanted teeth efficiently contributed to the masticatory function. The monitoring of periodontal parameters showed periodontal depth (PD) ≤ 4 mm, and the bone level amounted to more than 50% of the root length at both sites. A clinical attachment loss of 5 mm was recorded only at the buccal site of the donor tooth 48. No signs of root resorption or endodontic lesions were present. Overall, the number of pockets with PD ≥ 4 decreased from 32 to 4, and the full mouth bleeding score from 76% to 32%.

Conclusions: ATT can be a viable option to replace periodontally hopeless teeth in patients with severe periodontitis, contributing to the overall improvement of periodontal conditions.

Key points: Autogenous tooth transplantation may represent a viable alternative for the rehabilitation of sites severely compromised by periodontitis in molar-incisor pattern patients. The periodontal ligament of the donor tooth can induce bone formation and regenerate periodontal tissues.

Plain language summary: This case report describes a 24-year-old woman affected by a severe and rapidly progressing form of periodontitis mainly involving the molars. Despite conventional periodontal therapy, two molars were considered hopeless and required extraction. As part of the rehabilitation plan, the patient's wisdom teeth were used as donor teeth and transplanted into the extraction sites through autogenous tooth transplantation (ATT). After 2 years of follow-up and regular supportive periodontal care, both transplanted teeth remained stable and functional, showing no signs of complications. Moreover, the patient's overall periodontal condition showed marked improvement. This case highlights that, in carefully selected patients, ATT can represent a viable alternative to conventional tooth replacement methods for managing advanced periodontitis.

Background: Effective flap management is crucial for successful bone regeneration procedures. Traditional flap release has been performed by the deep split design; recently, the superficial split design revives for its proposed anatomical and biomechanical advantages. To understand the risk of this new flap management design on flap vitality, the aim of this case report is to investigate the perfusion of the flap with ultrasound.

Methods: A single patient with an edentulous ridge exhibiting a horizontal bone deficiency underwent a regenerative procedure utilizing the superficial split technique (Secured Anatomy-Driven Flap Extension [SAFE] technique). Ultrasonography assessments were conducted before the surgery (baseline [BL]) and at days (D) 3, 10, 21, and at 5 months (MO) post-surgery. They included brightness-mode and color velocity/power (CV/CP) at the buccal flap. CV and CP cine loops (videos) were recorded to assess tissue perfusion by surrogate. Three distinct regions of interest were selected, i.e., keratinized mucosa (KM), lining mucosa (LM), and muscle (M).

Results: KM perfusion (CV) increased significantly at D3, then decreased at D10 and D21. The 5MO value was insignificant from BL. LM perfusion non-significantly decreased at D3 and D10, and returned to BL at D21 and 5MO. Muscle perfusion showed a nonsignificant decreasing trend. CP showed nonsignificant changes post-surgery relative to BL for the three regions.

Conclusion: Ultrasound could be able to longitudinally quantify post-surgery tissue perfusion with sufficient spatial resolution to assess KM, LM, and M separately. This pilot ultrasonography study may ease the concern that the superficial split flap design jeopardizes flap vitality.

Key points: Preliminary ultrasound data suggested that the Secured Anatomy-Driven Flap Extension (SAFE) technique, based on the superficial split approach, does not jeopardize flap vitality. Ultrasound may be a valuable tool for monitoring oral wound healing and guiding treatment decisions.

Plain language summary: Ultrasound imaging technology, being a superior modality for evaluating soft tissue characteristics and able to quantify blood perfusion, is becoming a promising research tool to study oral wound healing. This case report used dental ultrasound to monitor the blood flow of an oral wound for 5 months after a jawbone augmentation procedure. Ultrasound showed gum blood flow peaked at day 3 after the surgery and decreased exponentially until 5 months. Mucosa and muscle may have various blood perfusion recovery patterns than gum tissues that deserve further investigation.

Background: Traumatic dental injury (TDI) most often requires complex and interdisciplinary management. Several factors are associated with the success of TDI treatment, including proper treatment planning and periodontal maintenance.

Methods: The present 16-year follow-up report describes the interdisciplinary management of an extrusive luxation of teeth #8 and #9 in a 9-year-old-patient.

Results: After the extrusion, endodontic treatment was performed on teeth #8 and #9 and then periodontal treatment with supra and subgingival debridement associated with locally antibiotic application was done. Once periodontal treatment was stable, orthodontic treatment started. During orthodontic treatment, the patient was advised to have periodontal maintenance every 3-4 months. At the 16-year follow-up appointment, both teeth were in function and in acceptable esthetic condition.

Conclusion: This report demonstrates that proper diagnosis combined with interdisciplinary therapeutic approaches and periodontal maintenance could lead to long-term successful and stable outcomes.

Key points: The effective management and proper treatment of dental trauma depend on an accurate diagnosis. Interdisciplinary management is essential for successful treatment of dental trauma. Patient adherence to periodontal maintenance directly influences outcomes.

Plain language summary: When dental injuries are diagnosed correctly and treated with the help of different dental specialists-along with regular periodontal care-the long-term results can be stable and successful.