Clinical Advances in Periodontics最新文献

Background

The study was aimed to assess and compare hard and soft tissue augmentation clinicoradiographically with and without advanced platelet-rich fibrin + (A-PRF+) block for the treatment of multiple gingival recession using vestibular incision subperiosteal tunnel access (VISTA).

Methods

A total of 24 patients, exhibiting multiple Miller's Class I or II recessions in the maxillary esthetic zone were included. Participants were divided into two groups, Group 1 was treated with VISTA & A-PRF+ block whereas Group 2 was with VISTA technique alone. Clinical parameters probing depth, width of keratinized gingiva, gingival biotype, recession depth, and clinical attachment level were recorded at baseline and the end of 6 months. The radiographic cone beam computed tomography measurements of labial plate thickness were taken at baseline and 6 months postoperatively.

Results

From baseline to 6 months both the groups showed a clinical and statistical improvement in the parameters. However, a statistically significant difference between the treatment modalities was not observed. In the inter-group comparison radiographically, labial plate thickness was statistically significant at the end of 6 months when compared to the baseline.

Conclusion

A-PRF+ block along with the VISTA technique can be an alternative effective root coverage procedure for the management of multiple gingival recessions in the maxillary esthetic zone.

Key points

Why is this study new information?

To the best of our knowledge, this is the first study using advanced platelet-rich fibrin plus block for the treatment of multiple gingival recession with a thin labial plate.

What are the keys to the successful management of these types of cases?

Minimally invasive vestibular incision subperiosteal tunnel access technique, and avoidance of second surgical site morbidity are important factors for treatment and for patient compliance.

What are the primary limitations of this study?

Short study duration, small sample size, and no histological correlation can be considered as limitations of the study.

Background

Guided tissue regeneration (GTR) is a common treatment modality for correcting vertical or bony defects in furcations. Multiple materials are used in GTR with allografts and xenografts being the most widely used. Each material has distinctive properties affecting the regenerative potential. A new bone graft combination of xenogeneic/allogeneic may improve the outcome of GTR by providing space maintenance (Xenograft) and osteoinductive potential (Allograft). The aim of this case report is to evaluate the efficacy of the new combined xenogeneic/allogeneic material based on clinical and radiographic outcomes.

Methods

A 34-year-old healthy male presented with vertical bone loss interproximally between #’s 9 and 10. Clinical exam revealed 8 mm probing depth without mobility. The radiographic exam revealed a wide and deep vertical bony defect of 30%–50% bone loss. The defect was treated using a layering technique with xenogeneic/allogeneic bone graft and collagen membrane.

Results

The 6- and 12-month follow-ups revealed a significant reduction in probing depths and radiographic bone fill.

Conclusions

GTR using a layering technique of xenogeneic/allogeneic bone graft and collagen membrane showed proper correction of a deep and wide vertical bony defect. The 12-month follow-up revealed healthy periodontium with normal probing depths and bone level.

Background

Cervical external root resorption (CERR) is not a common occurrence, but can result in a hopeless tooth prognosis. Its etiology is poorly understood and its management can be challenging. The present case report describes the late presentation and management of CERR at both maxillary first premolar teeth following connective tissue grafting (CTG) procedures including use of citric acid as a chemical root surface conditioner.

Methods and Results

A 55-year-old female was diagnosed with bilateral external cervical root resorption of both maxillary first premolar teeth 28 years after CTG procedures that had included the use of citric acid root conditioning. As both teeth were asymptomatic, the patient opted for repair of the lesions via full-thickness flap elevation, meticulous removal of all granulation tissue, and restoration of the lesions with a resin-modified glass ionomer. A 2-year follow-up has been completed with no significant complications to report.

Conclusions

CERR usually develops asymptomatically and is found by chance in radiographs. Its etiology is unclear, but may appear some years after soft tissue grafting to manage gingival recession. Early detection is key to be able to repair the lesions with minimal intervention.

Background

Regenerative approaches performed in periodontics seems to be efficient in treating intrabony defects. There are, however, many factors that may affect the predictability of the regenerative procedures. The present article aimed to propose a new risk assessment tool for treating periodontal intrabony defects by regenerative therapy.

Methods

Different variables that could affect the success of a regenerative procedure were considered based on their impact on (i) the wound healing potential, promoting wound stability, cells, and angiogenesis, or (ii) the ability to clean the root surface and maintain an optimal plaque control or (iii) aesthetics (risk for gingival recession).

Results

The risk assessment variables were divided into a patient, tooth, defect, and operator level. Patient-related factors included medical conditions such as diabetes, smoking habit, plaque control, compliance with supportive care, and expectations. Tooth-related factors included prognosis, traumatic occlusal forces or mobility, endodontic status, root surface topography, soft tissue anatomy, and gingival phenotype. Defect-associated factors included local anatomy (number of residual bone walls, width, and depth), furcation involvement, cleansability, and number of sides of the root involved. Operator-related factors should not be neglected and included the clinician's level of experience, the presence of environmental stress factors, and the use of checklists in the daily routine.

Conclusions

Using a risk assessment comprised of patient-, tooth-, defect- and operator-level factors can aid the clinician in identifying challenging characteristics and in the treatment decision process.