Clinical Advances in Periodontics最新文献

Background: One of the most challenging aspects of the treatment of Cairo Recession Type (RT) 2/3 gingival recession is the loss of adjacent interdental tissue. Successful treatment can be achieved by repositioning the interdental tissue and applying a connective tissue graft (CTG).

Methods and results: Two patients with RT2/3 gingival recession were treated using the vertical incision tunnel (VIT) technique. Recombinant human fibroblast growth factor-2 (rhFGF-2)-soaked carbonate apatite (CO₃Ap) was placed in the interdental space, while rhFGF-2-soaked CTG was used to cover the exposed root surfaces. Over a follow-up period of up to 2 years, complete or significant root coverage was achieved in both cases. Interdental papillae were successfully reconstructed; however, complete papillary filling was not achieved.

Conclusions: The combination of rhFGF-2-soaked CO₃Ap in the interdental space and rhFGF-2-soaked CTG for root coverage represents an effective approach for treating RT3 gingival recessions.

Plain language summary: Gum recession is a common dental condition where the gums pull away from the teeth, leaving the roots exposed. This can lead to tooth sensitivity, increased risk of decay, and esthetic concerns. Treating advanced forms-classified as Type 2 and Type 3-is especially difficult because not only are the roots exposed, but the gum tissue between the teeth is also lost. In this case report, two patients with these advanced types of gum recession were treated using a novel approach that combines regenerative materials with a minimally invasive surgical technique. A tissue-regenerating protein called rhFGF-2 was applied to both a synthetic bone substitute (CO₃Ap) placed between the teeth and to soft tissue taken from the roof of the mouth. This tissue was used to cover the exposed roots. Over the course of follow-up, the treated areas healed well: most of the roots became re-covered with healthy gum tissue, and the tissue between the teeth, although not fully restored, showed clear signs of regeneration. While further studies are needed, this technique may provide a promising new option for patients with difficult-to-treat gum recession, especially in cases where traditional treatments have limited success due to loss of supporting structures.

Periodontal microsurgery is a refined enhancement of the various types of periodontal and implant surgery using a binocular surgical microscope, with techniques, instruments and sutures borrowed from medicine. A continuing education program on periodontal microsurgery was first presented to the American Academy of Periodontology Annual Meeting in Orlando in 1992. It has taken over 30 years to gain the attention of the Academy membership due to the additional specialized training, equipment and practice necessary to become and remain proficient in microsurgical techniques. True periodontal microsurgery exceeds surgery using surgical loupes. An operating surgical microscope offers varying magnifications from two and a half to 25 times normal vision. This enhances the surgeon's ability to perform more accurate, smaller initial butt joint incisions, achieve uniform flap thickness, remove all tissue tags, perform the various types of periodontal and implant surgery, and precisely reposition the postsurgical tissues for primary closure. Proficient periodontal microsurgical treatment results in less patient discomfort, faster healing, more predictable treatment results, and better patient acceptance. KEY POINTS: The incorporation of microscopic magnification into periodontal practices, with the necessary and appropriate training and practice, results in improved visual acuity, ergonomic benefits, increased precision in flap design, surgical detailing, and suture closure. The increased precision results in faster and improved healing results and enhanced patient acceptance.

Background: Molar incisor pattern periodontitis (MIPP) poses many challenges in the field of periodontics. Emerging evidence has shown promising results in regenerative therapy while treating such a patient population. The present case study demonstrates an effective implementation of recombinant human platelet-derived growth factor (rh-PDGF) for the successful regeneration of infrabony defects associated with MIPP.

Methods: A 17-year-old African-American male patient presented to the Periodontics Clinic at Nova Southeastern University, requiring periodontal evaluation prior to the initiation of orthodontic therapy. Upon examination, the patient was diagnosed as a localized stage III, grade C MIPP. Initially, the patient underwent phase I therapy. Subsequently, surgeries consisted of regenerative procedures including a combination of allograft bone graft, rh-PDGF, and collagen membrane. The patient was seen for regular follow-ups and supportive periodontal therapy during the healing periods.

Results: The regenerative procedures resulted in significant improvement in all periodontal parameters, including probing depth, clinical attachment level, radiographic bone levels, and clinical and radiographic furcation closure, allowing the patient to retain all compromised teeth.

Conclusion: The combination of surgical debridement with rh-PDGF serves as a plausible treatment approach for infrabony defects in patients with MIPP. Further investigation through well-designed randomized controlled clinical trials is warranted to provide clearer insights.

Key point: rh-PDGF combined with an allograft is a successful treatment option in MIPP patients.

Plain language summary: Molar incisor pattern periodontitis (MIPP) is a severe form of periodontal disease, often affecting specific teeth in the periodontium of young patients. The nature of the disease requires early diagnosis and treatment to avoid potential complications, including tooth loss. This case report highlights the diagnosis and management of a patient with MIPP affecting seven teeth. Upon completion of the referral to the Periodontics Department at Nova Southeastern University, the patient was treatment planned for phase 1 therapy, including oral hygiene instructions, localized deep cleaning, and reevaluation of results in a short follow-up. Following the reevaluation appointment, the patient underwent a surgical phase via regenerative therapies utilizing bone grafts, biologics, and membranes. All surgical procedures resulted in significant improvements in clinical and radiographic parameters and remained stable over a 2-year follow-up period. This case report highlights the successful use of rh-PDGF in the treatment of MIPP-associated periodontal defects. Further investigation through well-designed clinical trials is warranted to provide clearer insights.

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.