Clinical Advances in Periodontics最新文献

Focused clinical question

What are the appropriate preparation protocols for autologous blood products to support their clinical utilization?

Summary

Autologous blood products provide a unique clinical benefit. Their popularity among the professions is growing. However, as this is a rapidly evolving field, multiple modalities are presented within the literature. Frequently there is no demonstrated superiority to previous iterations. This brief review attempts to offer a concise chronology on their evolution, preparation, and where possible, evidence to support their clinical utilization.

Conclusions

The field of autologous blood products is expanding rapidly. These products appear to yield variable clinical benefits in specific indications. However, evidence supporting their universal application is scant, and the superiority of one formulation versus another is yet to be demonstrated.

Introduction

Gingival depigmentation procedure has gained widespread popularity in the recent years due to increased esthetic demands among patients. Among the various depigmentation procedures, cryosurgery is inexpensive and straightforward method. This case report discusses a rare complication associated with tetrafluoroethane (TFE) cryosurgical depigmentation method.

Case Presentation

A 27-year-old systemically healthy male patient reported with the complaint of esthetic concerns associated with gingival melanin pigmentation. Cryosurgery with TFE was planned for the maxillary first quadrant. The patient developed angioedema immediately after exposure to the TFE cryogen during the procedure. Cold urticaria was considered, and the patient was prescribed nonsedating antihistamines for a week. One month follow-up showed completely healed and depigmented gingiva without any recession or attachment loss.

Conclusions

TFE cryosurgery depigmentation was found to be an effective depigmentation procedure. However, various complications including cold urticaria have been associated with its application. Therefore, the procedure's success depends on the proper case selection, complete isolation of the operating area, and preoperative test for gingival tissue response.

Key points

Background

The purpose of this review was aimed at providing the rationale supported with a series of cases to apply biologics to enhance orchestrating the healing process at implant removal sites.

Summary

Implant removal is commonly applied on a daily basis, in particular, in cases that exhibit esthetic failures linked to inadequate implant position or in cases of advanced peri-implantitis. Implant removal sites differ substantially from tooth extraction sockets. Implants are ankylosed within the alveolar bone, which therefore have neither mechanoreception nor the elasticity provided by periodontal ligament fibers. As a result, the bone-to-implant contact must be disrupted by means of using a reverse-torque device to minimize trauma. It is possible that the surrounding bone provides limited vascularity, which may interfere with the healing and bone forming process within the socket. Therefore, the use of biologics may enhance this healing and accelerate bone formation in sites where implants are removed due to hopeless functional or esthetic prognoses.

Conclusion

The use of biologics, in particular autologous blood-derived products, may enhance and boost the healing process to potentiate bone availability at a later stage during implant placement.

Background

Since the introduction of sinus augmentation in the 1970s the procedure has been performed with or without biomaterials. Autologous blood products (ABPs) for use in sinus augmentation was first introduced in the 2000s, to aid potentially in bone and soft tissue healing.

Methods

Three different applications of leukocyte- and platelet-rich fibrin (L-PRF) in maxillary sinus augmentation are presented in this case series. In case 1, L-PRF is used in bilateral sinus augmentation to support placement of implants to support a maxillary hybrid denture. Case 2 highlights the use of L-PRF in a complication associate with Schneiderian membrane elevation. Case 3 provides histology taken at the time of implant placement 6 months following L-PRF/xenograft sinus augmentation.

Results

All cases resulted in the successful placement of dental implants. In case 2, an osseodensification procedure was performed with freeze-dried bone allograft, which provided an approximate 4 mm of additional vertical height for implant placement. Histology from case 3 at 6 months post sinus augmentation demonstrated the presence of new vital bone in contact with the xenograft.

Conclusion

To date, there is only a limited amount of evidence reporting on platelet-rich fibrin (PRF) or L-PRF use in maxillary sinus augmentation. Bone gain from either product has ranged from 3.2 to 11.8 mm, with the percentage of newly formed bone reported in case series as 33% ± 5%. Despite the lack of strong evidence, L-PRF appears to have beneficial effects on bone regeneration when used in sinus augmentation.

Introduction

The case report presents a new possibility of treatment for a gummy smile in a patient with multiple etiologies, such as altered passive eruption and hypermobility upper lip. At first, crown lengthening was not sufficient to achieve the desired aesthetic result, being necessary its combination with lip repositioning.

Case Presentation

Crown lengthening surgery (CLS) was performed in a 20-year-old woman, with a gingival display of 7.5 mm, having her gingival exposure reduced to 5.5 mm. Because the patient continued unsatisfied after 6 months, a new procedure was adopted. To reduce even more her gingival exposure, lip repositioning technique was performed associated with myotomy and the insertion of polyester threads as a physical barrier to prevent relapse.

Conclusion

The result of the gingival display was reduced to 2.5 mm, removing the condition of a gummy smile after the combination of both techniques: crown lengthening, and lip repositioning.

Key points

Background

Delivery of a high-quality provisional restoration at a maxillary anterior immediate implant site enhances patient-centered outcomes and promotes development of favorable hard and soft tissue architecture. The purpose of this report is to present a protocol relying upon compatible guided surgery and laboratory systems for fabrication of a custom provisional crown prior to immediate implant surgery in the esthetic zone.

Methods and Results

A female patient, aged 33 years, presented to the Army Postgraduate Dental School, Fort Gordon, Georgia, with an unfavorable prognosis for tooth #9. The patient elected extraction with immediate implant placement. Prior to the surgery, we utilized a cone-beam computed tomography volume, stone models, implant planning software, and an implant indexing system to fabricate a custom provisional crown. Following extraction of tooth #9 and immediate implant placement, the provisional crown exhibited excellent fit and finish, requiring virtually no chairside adjustment. We noted minimal change in baseline mucosal contours throughout the healing phase.

Conclusion

The clinical/restorative protocol described in this report assured accurate three-dimensional implant positioning and permitted indirect fabrication of a high-quality custom provisional crown in advance of surgery. The laboratory workflow—which dental technicians/auxiliaries can master—has the potential to shorten surgery, enhance treatment outcomes, and increase patient satisfaction.

Key points