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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