Clinical Advances in Periodontics最新文献

Background: Placement of a connective tissue graft (CTG) in the facial abutment‒socket gap without any flap/pouch preparation has been demonstrated to effectively increase mucosal thickness and maintain midfacial marginal stability. At sites where the mucosal margin must be coronally advanced to improve esthetics, a flapless/pouchless approach requires the graft to be left partially exposed, which increases the risk of graft necrosis. The purpose of this report is to introduce the labial overlay cervical composite (LOCC) to provide graft containment and stabilization in these challenging situations to improve graft survival.

Methods: A 67-year-old healthy, nonsmoking, Caucasian female presented with tooth #10 having external resorption that had progressed to the pulp, and the gingival margin 3‒4 mm apical to the gingival margin of the contralateral incisor. The tooth was extracted, and an immediate implant was placed flapless. The provisional restoration was fabricated ∼2 mm short of the mucosal margin. The implant‒socket gap was grafted with bone, and the abutment‒socket gap was grafted with a CTG, which was ∼2 mm exposed. The LOCC was fabricated by bonding flowable composite to the midfaciocervical surface of the provisional crown and extending it apically to cover the graft.

Results: The exposed CTG covered by the LOCC survived. Twenty-one months post-treatment, the midfacial mucosal margin remained consistent with the contralateral gingival margin, and the convex facial tissue contour was preserved.

Conclusion: The LOCC may effectively enhance graft survival and overall esthetic outcome when the CTG must be left exposed by providing containment and stabilization of the graft.

Key points: Labial overlay cervical composite (LOCC) is a simple addition to the provisional crown during treatment and can be easily removed during post-op. LOCC may effectively enhance graft survival and overall esthetic outcome when the connective tissue graft must be left partially exposed by providing containment and stabilization of the graft.

Plain language summary: A patient needed to have an upper left front tooth replaced with a dental implant. The gumline of the tooth to be replaced was 3‒4 mm higher than the gumline of the same tooth on the right side. The patient wanted the gumline from both sides to match. The tooth was extracted, and an implant was placed on the same day. The gap between the implant and tooth socket was grafted with bone from the bottom of the socket to the top of the implant, and a gum graft above the implant. The gum graft was partially sticking out so that the gumlines would match. A temporary crown was made and attached to the implant. To prevent the gum graft from dislodging, a labial overlay cervical composite (LOCC) was added to the temporary crown to cover and contain the gum graft. The treatment wa

Background: Oral leukoplakia is the most common oral potentially malignant disorder. Currently, there is still no consensus on the best approach for its treatment. Marginal gingival cases ("ring around the collar") can pose an additional challenge for treatment, being associated with high recurrence rates. This case series report 10 patients with "ring around the collar" lesions treated with diode laser excision in a single center.

Methods: Ten patients diagnosed with marginal gingival leukoplakia were treated with high-power diode laser excision. The demographic data were extracted from the medical charts and the patients were followed up every 3 months after treatment.

Results: Of the 10 patients, three were men and seven were women, with a mean age of 64.4 years. Five had a history of tobacco smoking and one reported alcohol consumption. Eight had multifocal lesions, with all of them being homogeneous. Eight cases were diagnosed as proliferative verrucous leukoplakia and two had previously undergone treatment for gingival squamous cell carcinoma. Postoperative complications were limited to mild pain within the first week. During an average follow-up of 27.4 months, seven patients experienced recurrence, occurring after a mean of 8.6 months, with smaller, homogeneous, and clinically less aggressive lesions. No malignant transformation was observed.

Conclusions: Marginal gingival leukoplakias, often associated with proliferative verrucous leukoplakia, are challenging to manage due to their high recurrence rates and malignant transformation risk. This case series suggests that high-power diode laser excision may offer better lesion control while minimizing gingival recession. However, further research is necessary to improve knowledge of this entity.

Key points: Marginal gingival leukoplakias, especially the "ring around the collar" type, are relatively uncommon, but can show an aggressive nature, being associated with high recurrence rates. Removing these lesions with a high-power diode laser, even with the chance of recurrence, may be a better option than more aggressive modalities. This method helps control recurring lesions and might reduce the chances of gingival recession.

Plain language summary: This case series suggests that removing these lesions with a high-power diode laser, even with the chance of recurrence, may be a better option than more aggressive modalities. This method helps control recurring lesions and might reduce the chances of gingival recession.

Background: Teeth with deep gingival recessions (GRs) associated with apex exposure present a challenging clinical scenario, often requiring a multidisciplinary approach to improve tooth prognosis. This case study presents seven RT1/RT2 deep GR (≥5 mm) associated with root apex exposure, treated with endodontic treatment, apicoectomy, and root coverage procedures.

Methods: For this retrospective study, all surgical procedures were performed using either the laterally positioned flap technique or the modified double papilla flap combined with a connective tissue graft (CTG).

Results: After a mean follow-up period of 3.86 years (ranging from 1 to 11 years), a mean GR reduction of 7.57 mm was observed, with four cases achieving complete root coverage. No teeth required extraction during the follow-up period and the prognosis for all teeth was improved.

Conclusion: This case study highlights the effectiveness of treating teeth with severe mucogingival defects through root coverage surgery combined with CTG and apicoectomy.

Key points: Mucogingival procedures and interdisciplinary treatment can successfully change the tooth prognosis. Currently, there is limited information on managing teeth with a deep recession and apex involvement and even less on long-term outcomes for these cases. This case study fills these gaps, demonstrating that root coverage using an autogenous connective tissue graft combined with apicoectomy can yield successful and stable outcomes. Clinicians might consider the lateral-positioned flap or the modified double papilla flap, both of which may require specialized training and experience. However, other treatment alternatives, such as extraction and subsequent hard-and soft-tissue reconstruction, would involve more surgical procedures to rebuild all the lost tissues, increasing treatment complexity, time, and morbidity. Thus, mucogingival treatment should be prioritized as the first-line approach.

Plain language summary: This study showed that teeth with severe gum recession, reaching the tip of the root, can be successfully treated with surgery to cover the exposed root, combined with tissue grafting and a procedure to remove the root tip. These treatments provided long-lasting results.

Background: Interdental papilla reconstruction is frequently discussed in the literature, with techniques like tunnelization commonly used. However, tunnelization presents significant challenges in flap positioning, stabilization, and ensuring adequate blood supply to maintain the graft. The approach described in this article provides enhanced visualization, allowing better graft positioning, proper vascularization, and increased procedural stability.

Methods: This case report details the interdental papilla reconstruction in a healthy 53-year-old female patient using a combination of techniques from the literature, adapted for optimized outcomes. The patient presented with a loss of gingival tissue between the lower left central incisor (24) and the lower right central incisor (25), resulting in a large black triangle. The reconstructive procedure involved papilla preservation via flap elevation, allowing wide visualization and precise graft placement. Composite resin was used to close the diastema after surgery.

Results: The final outcome showed significant papillary gain, filling approximately 50% of the black triangle. The remaining space was covered with composite resin. After 2 years of follow-up, the procedure remained stable, with no signs of gingival recession.

Conclusions: The combination of techniques used in this case is effective for papilla reconstruction in large interdental spaces, achieving a satisfactory outcome and resolving the patient's main concern. The method should be further replicated to refine its precision and viability, as various cases require tailored approaches, integrating both periodontics and restorative dentistry.

Key findings: This case report demonstrates a combination of surgical and restorative techniques that effectively reconstructed the interdental papilla. A 50% papillary fill was achieved with stable results over two years. The proposed approach proves to be viable for the treatment of large black triangles using combined techniques.

Key points: Enhanced visualization for precise graft placement, integrating surgical and restorative approaches, long-term stability.

Plain language summary: This article discusses a case where the small tissue between the lower front teeth was lost and explores the benefits of a new type of surgical method for fixing it. A case report was done to look at different treatment options and compare the new method to existing methods in research. This surgical method has advantages, like better placement of the tissue graft. The case had good results, but more studies are needed to confirm how effective and reliable the technique is. The authors believe this could be a new and effective way to fix gaps between teeth.

Background: The primary purpose of this paper is to introduce a new flap design to improve keratinized tissue (KT) around implants in the posterior mandible, avoiding the need for harvesting tissue from the palate, which is associated with significant discomfort for patients.

Methods: Eleven patients requiring implants in the molar regions with a KT width (KTW) < 2 mm at the buccal aspect were treated using this surgical technique. Outcomes, including the increase in KT width and postoperative discomfort, were measured at intervals of 1, 4, and 10 months.

Results: An average increase of 4.2 mm in KT width was achieved. Postoperative pain was minimal, with most patients reporting low scores on the Visual Numerical Scale. No significant reduction in KT width was observed during follow-up.

Conclusion: Within the limitations of the present case series, the data suggest that this flap is a promising and less invasive technique for treating KT deficiency around implants, eliminating the need for palate harvesting. Further long-term studies are needed to confirm the stability of the results.

Plain language summary: This case series presents a new surgical method designed to improve the protective gum tissue (called keratinized gingiva) around dental implants in the back part of the lower jaw. This type of gum tissue is important because it helps keep implants stable and healthy over time. Traditionally, the best way to add this tissue is by taking a piece from the roof of the mouth, but that can be painful and lead to complications. In recent years, researchers have explored less invasive options, but most haven't matched the effectiveness of using the patient's own tissue. In this study, the new approach allowed the treatment of 11 patients who had too little gum tissue around their implants. The technique used the patient's own gum tissue but avoided taking it from the palate, making the procedure more comfortable. The results showed that this method was effective in increasing the amount of healthy gum tissue, offering a promising alternative that prioritizes both results and patient comfort.

Key points: Effective strategies for increasing keratinized tissue in Mandibular posterior areas. Minimal postoperative discomfort; minimally invasive surgery Stability of peri-implant tissues.