Clinical Advances in Periodontics最新文献

Background: Various surgical approaches have been employed to manage gingival recession, including subepithelial connective tissue grafting, which has yielded favorable outcomes.

Methods and results: We present the case of a 17-year-old patient who developed gingival recession on tooth #6 following an esthetic crown lengthening procedure. The recession was treated with a subepithelial connective tissue graft; however, this case details the occurrence of two epithelial cysts adjacent to the region subjected to the surgical procedure, 6 months after surgery. The treatment involved periodontal surgical intervention, during which the lesions were completely excised and the associated osseous defect was filled using an inorganic bovine bone matrix along with a collagen membrane. The healing progressed without any complications. Histopathological analysis revealed the presence of cystic lesions, which were characterized by a cystic cavity lined with stratified orthokeratinized epithelium with cuboidal cells in some areas surrounded by fibrous connective tissue. The patient's progress was monitored through tomography performed 6 months, 1 year, and 5 years post-procedure, all of which demonstrated the absence of any signs of lesion recurrence.

Conclusion: This case study emphasizes the effectiveness and predictability of subepithelial connective tissue grafting in the treatment of gingival recession. However, dental professionals should be cautious about the potential risk of gingival recession following esthetic crown lengthening procedures and recognize the potential complications associated with subepithelial connective tissue grafting, such as the observed development of epithelial cysts in this specific case.

Key points: Why is this case new information? We present a case of an epithelial cyst following a subepithelial connective tissue graft, which resulted in buccal cortical bone resorption. The treatment involved excisional biopsy and the use of an inorganic bovine bone matrix with a collagen membrane. What are the keys to the successful management of this case? Successful treatment included periodontal surgery, bone defect filling using an inorganic bovine bone matrix and a collagen membrane, and regular monitoring with CT scans at 6 months, 1 year, and 5 years post-surgery; all showed no recurrence. Success factors included careful surgery, appropriate biomaterial usage, and ongoing follow-up. What are the primary limitations to success in this case? The limitations involve potential complications from subepithelial connective tissue grafting such as cyst development. This report stresses the importance of meticulous patient selection and periodontal phenotype evaluation to minimize risks. Continuous follow-up is critical to detect recurrence and other issues.

Background: The aim of this study is to measure, in vivo, the supracrestal tissue attachment dimensions (STADs) by means of a noninvasive digital method and to investigate the association between STADs and gingival thickness (GT), tooth position, tooth length, tooth width, keratinized tissue width (KTW), buccal bone thickness (BBT), and bone crest (BC) level.

Methods: Nineteen periodontally healthy subjects who previously received full mouth periodontal charting, cone beam computed tomography, and intraoral scan for the purpose of implant planning were included in the study. A digital imaging software was used for the superimposition of Digital Imaging and Communications in Medicine and stereolithography files, along with hard and soft tissue measurements. Pearson's correlation and ANOVA statistical analyses were used to investigate potential trends between STADs and other dentogingival components.

Results: A total of 203 teeth were assessed, with an average STADs of 2.05 mm (±0.99 mm). STADs were larger in mandibular than maxillary teeth (p-value <0.001) and decreased from anterior to posterior teeth. STADs exhibited an inverse relationship with BBTs and GTs (p-value <0.001) and the KTW (p-value = 0.05). Positive correlations were found between GT and BBT (p-value <0.001), whereas both were negatively correlated with the distance between the cementoenamel junction and BC (p-values 0.019 and 0.006, respectively) and positively correlated with KTW (p-value <0.001).

Conclusions: This study highlighted the dynamic nature of STA relative to tooth position. Additionally, it explored the intricate relationships of STADs with various dentogingival components.

Key points: To the best of the authors' knowledge, this study represents the first application of CBCTs, intraoral scans, and clinical probe depths for noninvasive supracrestal tissue attachment measurements. This study advocates for a personalized assessment of supracrestal attachments, incorporating tooth position and other dentogingival components. The study emphasizes the importance for practitioners to consider the specific patient gingival phenotypes during restorative or surgical planning to avoid adverse outcomes.

Background: Gingival clefts, once known as "Stillman's Cleft", now considered an obsolete phenomenon, cannot be neglected in clinical practice, especially when it is persistent and epithelialized. The attached gingiva and alveolar mucosa are composed of epithelial layers with subjacent connective tissue. Gingival clefts, notwithstanding their intrinsic differences, may exhibit keratinized or non-keratinized tissue. Coupled with additional risk factors, it can result in progressive attachment loss and gingival recession.

Methods: Two cases with three distinct types of gingival clefts were described. Case 1 was identified as having a 2 mm white cleft coupled with lack of attached gingiva, while Case 2 was described as having a 3 mm white and red cleft which were treated with gingival cleft approximation subsequent to connective tissue grafting, non-surgical periodontal therapy and cleft approximation, respectively. The diagnostic confirmation was verified using an operating microscope set at a magnification of 5×, while the subsequent surgical stages were carried out with a magnification of 8×. These treatments yielded complete elimination and closure of the gingival clefts in addition to increased width of attached gingiva and soft tissue phenotype in Case 1 where bilaminar approach was utilized. The three clefts were effectively addressed using an operating microscope for both non-surgical and surgical interventions in the cleft management.

Results: All the three clefts exhibited complete elimination and closure of the gingival cleft. At 3 years follow up, there was reduction of the probing depth (1 mm) and attachment gain (1 mm) in all the three clefts. There was increase in width of attached gingiva to 3 mm and increase in soft tissue thickness in Case 1, where connective tissue graft was utilized. As microsurgical treatment approach was employed, the patients did not manifest with any intra-operative or postoperative complications. The first case showed the presence of soft tissue bulk at the treated site warranting debulking at 12 months postoperatively. The stability of the width of attached gingiva was maintained over the course of the 3-year follow-up period. The use of a microsurgical method in these settings enhances the predictability of outcomes than a macrosurgical approach.

Conclusions: The utilization of microsurgical techniques for the closure of gingival clefts allows for the accurate and meticulous insertion and placement of grafts, resulting in improved outcomes and enhanced aesthetic results. These techniques also minimize tissue trauma and postoperative discomfort. The treatment technique should be personalized to the individual's specific needs, considering factors such as type and extent of cleft, etiology and amount of attached gingiva. Nonetheless, microsurgical approaches for such cases are no more a discretion but an obligation.

Background: Periodontal plastic surgery aims to restore recessions and dehiscence around teeth and implants. Several techniques, such as subepithelial connective tissue graft (CTG), were proposed with the main outcome of improving volume and root coverage. Nevertheless, this surgery might not improve the keratinized tissue width. Thus, the primary aim of this case report was to describe the possible increase in keratinized tissue after a subepithelial CTG and simultaneously use the previously harvested graft as a source for covering an adjacent tooth.

Methods: A 38-year-old patient presented brushing discomfort 2 years after undergoing periodontal plastic surgery with a CTG from the palate to cover a recession. Despite the increased thickness of the soft tissue, brushing discomfort was not reduced because the tissue quality remained unchanged. Therefore, a surgical procedure in the area of teeth 3.2-3.4 was performed to remove the more superficial masticatory mucosa and to induce keratinization of the previously grafted connective tissue.

Results: After 6 months, the epithelium appears to be clinically and histologically keratinized, with characteristics comparable to those of the original tissue.

Conclusions: The connective tissue grafted maintains the potential to induce keratinization over time, if it is exposed.

Key points: Why is this case new information? To the best of our knowledge, this is the first case report in the literature with a histological evaluation in a human of the tissue grafted exposed after 2 years. What are the keys to successful management of this case? The graft covered by the alveolar mucosa did not induce keratinization of the epithelium of the overlying mucosa. What are the primary limitations to success in this case? The main limitation of this study is that it is a singular case report.

Background: Previous investigators have noted an increased risk of crestal bone loss and failure of the middle implant of 3-implant-splinted (3-IS) fixed dental prostheses (FDPs). Possible causes have included ill-fitting prostheses, unhygienic prosthetic contours, and discrepancies in prosthetic platform heights.

Methods & results: We identified four cases in which the middle implant of a 3-IS multiunit FDP suffered advanced bone loss, ultimately leading to implant removal. While more than one possible risk for implant failure existed in each case, a common thread was that the prosthetic platform of the middle implant for all patients was coronally positioned relative to the corresponding mesial and/or distal implants.

Conclusions: Splinting three adjacent implants into one prosthesis may add risk for a variety of reasons possibly including small differences in the heights of the three prosthetic tables.

Key points: Why are these cases new information? Our observations suggest that discrepancies between implant prosthetic platforms supporting 3-implant splinted, multiunit FDPs may be an added risk factor for middle implant failure. What are the keys to successful management of these cases? It is possible that small differences in apico-coronal implant positioning with 3-implant splinted multiunit FDPs may affect the success of the middle implants. What are the primary limitations to success in these cases? There is limited literature involving precise protocols and long-term outcomes of 3-implant splinted implant restorations. Studies comparing 3-implant splinted FDPs to other configurations are needed.