Clinical Advances in Periodontics最新文献

Background: Gingival recession (GR) poses esthetic and functional challenges for patients, particularly in cases of multiple adjacent defects. Traditional surgical approaches, such as the modified coronally advanced flap (MCAF) with connective tissue grafts (CTG), demand high levels of precision and skill, making outcomes reliant on clinician expertize. The integration of digital technologies, including cone-beam computed tomography (CBCT) and computer-aided design and manufacturing (CAD-CAM), offers a novel, standardized approach to enhance procedural accuracy and predictability.

Methods: This case study describes the use of the guided-modified coronally advanced flap (g-MCAF) for the treatment of multiple GR defects. A patient whose main concern was the esthetic appearance of her teeth was treated. Using an intraoral scanner, CBCT data, and CAD-CAM software, surgical guides were designed and 3D printed using a dedicated resin, assuring precise adaptation to the patients' teeth. The guides delineated MCAF oblique incisions and free gingival graft dimensions tailored to fit into the area, facilitating flap design, and graft harvesting.

Results: The guided MCAF (g-MCAF) procedure successfully achieved complete root coverage. At the 6-month follow-up, recession reduction was observed, measuring 2.22 mm for tooth #5, 2.59 mm for tooth #6, and 2.26 mm for tooth #7. Gingival thickness also increased, reaching 1.23, 1.16, and 1.45 mm, respectively. Additionally, the patient reported improved esthetics and reduced hypersensitivity.

Conclusion: The g-MCAF technique may have the potential to serve as a reliable aid to execute MCAF in the management of multiple GR defects.

Key points: A guided surgical approach (g-MCAF) using digital technologies allows for precise flap design and graft harvesting, which may help control variability and minimize errors during root coverage procedures. The integration of CBCT, intraoral scanning, and CAD-CAM technologies supports preoperative planning, potentially contributing to safer and more predictable outcomes, particularly in cases requiring connective tissue grafts. This innovative approach may assist in simplifying complex surgical techniques, improving clinician confidence, and serving as both a clinical and an educational tool for periodontal plastic surgery.

Background: Bone regeneration and simultaneous implant placement in severely damaged sockets are challenging and may require multiple grafting. Periosteal-guided bone regeneration enhances osteogenesis and wound healing shortening immediate and delay implant protocols. Clinical outcomes of a group of individuals that entered a longitudinal clinical trial from 2019 to 2021 are reported describing a novel surgical approach of simultaneous reconstruction and implant placement.

Methods and results: Eight individuals requiring an implant and presenting severe facial bone loss were followed for 2-4 years (37-month average) after the completion of a 12-month longitudinal clinical trial NCT04827693. Socket reconstruction and simultaneous implant placement were performed by encasing the implant in a customized shield of autogenous cortical bone. Peri-implant tissues and pink esthetics data were assessed following established success criteria. Mean healing time, before second stage surgery, after implant placement and reconstruction, was 12.5 ± 0.9 weeks (range: 12-14 weeks). Success rates were 100% at 2-4 years. Cone beam computed tomography (CBCT) data showed stable facial cortical bone >2.1 mm in thickness. Pink esthetic scores (PESs) were above optimal (9.5 ± 0.5, range: 9-10), with no significant difference between delayed and immediate individuals (p > 0.05). Facial implant transparency at follow-up was absent and all had a band of keratinized tissue >2 mm with healthy probing depths ranging from 3 to 4 mm.

Conclusion: Facial bone regeneration and simultaneous implant placement are feasible through periosteal-guided bone regeneration after a short healing period in severely damaged sockets following immediate or delay protocols. The assisted regenerated intrasocket bone provides high pink esthetics and functional implant stability.

Key points: Regeneration and simultaneous implant placement of severely damaged sockets is feasible. Periosteal-guide bone regeneration can shorten healing times. Teeth with fragile alveolar foundation can be successfully reconstructed achieving high pink esthetics.

Plain language summary: Simultaneous dental implant placement and bone regeneration are possible in severely damaged sockets that require reconstruction achieving, after a short healing period, highly esthetic outcomes.

Background: Periodontal defect reconstruction often relies on bone or bone substitutes to fill defects, membranes to exclude tissues unsupportive of new bone and attachment, and biologics to stimulate cells for healing and tissue formation. The scaffold we used is a nonparticulate osteoconductive bone substitute for repairing defects without migration of particles and maintaining volume above the walls and confines of the periodontal treatment site. This may provide a more predictable option for rebuilding lost supporting bone, especially in less contained defects.

Methods: A case of periodontitis stage III grade A at tooth no. 5 treated with intentional defect overfill to sustain interdental papilla with filling of the defect. Established guided tissue regeneration techniques were used.

Results: After 15 days, complete soft tissue closure at the defect site and root coverage at tooth 6 due to coronal advancement of the flap were observed. After 1 year, the papilla between teeth 6 and 5 filled the interproximal space, recession at 6 and 5 was 0 mm, and clinical attachment level gain at 5 was 4 mm. Soft-tissue maturation continued over 2 years, showing increasing thickness and healthy aspect. Over 24 months, increasingly defined bone-like imagery of the infrabony defect was obtained on X-ray without probing.

Conclusions: Using a cross-linked, completely resorbable collagen scaffold covered with a membrane based on the same engineering promoted tissue growth above the walls of the defect. This was effective in bone regeneration of an intrabony defect.

Key points: Why is this case new information? This is a case report describing the use of a completely resorbable ossifying collagen sponge with intentional overfill of the periodontal defect. This surgical technique allowed the clinician to improve the reduced interdental papilla architecture together with filling of the defect. This outcome represents a difficult and unpredictable goal for traditional periodontal reconstructive therapy. What are the keys to successful management of this case? Proper diagnosis and treatment planning Adequate and minimally invasive nonsurgical preoperative preparation of the soft tissues Graft trimming and proper adaptation Soft tissue management with mucogingival approach (split thickness papilla incision-flap elevation-sutures) What are the primary limitations to success in this case? Inadequate preoperative nonsurgical therapy Poor handling of soft tissue Inadequate graft shaping Strict adherence to pre- and postoperative oral hygiene and maintenance PLAIN LANGUAGE SUMMARY: Bone or bone substitutes can be used to rebuild lost supporting bone in dental repairs. A female patient at risk of tooth loss because of gum infection and with a gap between two of her teeth was surgically treated with an ossifying collagen sponge (OSSIX Bone, Dentsply Sirona/Regenera

Background: A chronic wound occurs when it fails to heal resulting in a prolonged wound healing process. Traumatic and surgically induced wounds that do not heal as expected can be included in the term chronic wound. There is limited information about the management of this type of wound involving the periodontal tissues. These case studies show how soft tissue grafting may be used as a strategy to assist in the closure and enhancement of large wounds that present a chronic and complicated healing process.

Methods and results: Two healthy adult patients presented open wounds induced by trauma following the dental treatment. These wounds were treated with autogenous soft tissue grafting to enhance and stimulate the healing process. In one case, enamel matrix derivative was applied in conjunction with a gingival graft. Both cases demonstrated a successful and rapid wound closure at the 1-week post-treatment.

Conclusion: Using autogenous soft tissue grafting should be considered a treatment alternative when dealing with a chronic and problematic open wound. This study describes the success of two cases utilizing this approach. However, an understanding of the biological process of wound healing is critical when selecting a surgical technique for the treatment of a chronic wound.

Key points: There is limited information in the periodontal literature about the management of chronic wounds caused by trauma. Critical understanding of the biological process of wound healing and application of surgical principles are essential in using autogenous soft tissue grafts to treat these wounds. Surgical factors such as extent, location of wound, and limited amount of autogenous donor tissue are primary limitations to the successful treatment of these cases.

Plain language summary: Two cases that presented chronic wounds related to the periodontal tissues which were the result of surgical trauma are reported. These complicated healing wounds were managed with free autogenous soft tissue grafts. The grafts assisted the problematic wounds in healing by replacing missing tissue and providing growth factors. This mode of treatment for a chronic wound proved to be a successful approach in the management of this type of chronic wound.

Background: The ultimate objective of implant dentistry is to position the implant in a three-dimensional, prosthetic-driven location. This case highlights a guided approach for harvesting and positioning an autogenous bone block to restore a horizontal bone defect in the anterior maxilla.

Methods: This case report describes a 55-year-old patient with horizontal bone deficiency in the anterior maxilla following teeth loss. Using specialized software, a surgical guide was designed to facilitate the harvesting of an autogenous bone block from the subnasal region in the same location where implants were planned to be placed. The graft was then repositioned and fixed with titanium screws, and the gaps were grafted with xenogenic bone particles and covered with an absorbable collagen membrane. After 6 months, the implants were placed, followed by prosthetic restoration.

Results: A one-stage implant placement was performed after an uneventful healing period. The bone augmentation resulted in a ridge width of 8 mm for a net gain of 5 mm. After 4 months, the implants were loaded with a screw-retained zirconia bridge.

Conclusion: Guided transpositional bone blocks offer a predictable approach to treating horizontal bone defects in the esthetic zone. Utilizing digital planning and surgical guides enhances precision, making the result more predictable.

Key points: This case provides new information as it highlights a novel guided approach for harvesting and positioning an autogenous bone block to restore a horizontal bone defect in the anterior maxilla using a surgical guide. The keys to successful management of this case include using precise digital planning, the design and use of a surgical guide to accurately harvest the autogenous bone block, proper fixation of the graft and ensuring an uneventful healing period before implant placement and prosthetic restoration. The primary limitations to success in this case could involve the challenge of having adequate distance away from the nasal floor for harvesting and repositioning the autogenous bone block and potential complications during the healing period.

Plain lanuage summary: This report describes a modern technique for addressing bone loss in the upper front part of the mouth, crucial for placing dental implants correctly. A 55-year-old patient with insufficient bone was treated using a digital plan to precisely guide the movement of a bone piece from a nearby area to where it was needed. This guided approach involved designing a custom guide with computer software, securely attaching the bone, and using special materials to aid healing. After 6 months, the dental implants were successfully placed and fitted with new teeth, resulting in a stable and natural-looking outcome.