Clinical Advances in Periodontics最新文献

Background: Oroantral communication (OAC) can occur after a dental extraction. Occasionally, bony defects may persist despite successful soft tissue closure of the OAC. The absence of bone in these areas poses challenges for dental implant placement. This report describes a novel approach of vertical sinus elevation through the oroantral bony defect to address such scenarios.

Methods: A 36-year-old male (Patient 1) and a 62-year-old female (Patient 2) presented with OACs in the first maxillary molar region. Vertical sinus elevation was achieved through the existing defect. This was followed by placement of corticocancellous bone allograft mixed with platelet-rich fibrin (PRF) in the space surrounded by the elevated sinus membrane that was then covered with a resorbable collagen membrane. Implants were placed 9 and 6 months after the sinus lift in Patient 1 and Patient 2, respectively.

Results: In both cases, substantial radiographic bone fill of the oroantral bony defect was achieved allowing successful placement of dental implants. Following insertion of final restorations, the patients were satisfied with the esthetic outcomes and reported improved oral function.

Conclusions: Vertical sinus elevation through residual bony oroantral defects in conjunction with placement of bone allograft mixed with PRF yields sufficient alveolar bone for subsequent placement of dental implants.

Plain language summary: Bone defects secondary to oroantral communications resulting from dental extractions may persist despite successful soft tissue closure. Such oroantral communication (OAC) pose challenges for dental implant placement. This report describes a technique for repairing oroantral bony defects and subsequent placement of dental implants. Two patients presented with OACs in the first maxillary molar region. Vertical sinus elevation with corticocancellous bone allograft and platelet-rich fibrin, was achieved through the existing defect. Substantial radiographic bone fill of the oroantral bony defect was achieved and implants with final restorations were subsequently placed.

Key points: Elevation of the sinus membrane through an existing crestal defect resulting from an OAC allows the clinician to successfully elevated the sinus membrane for bone augmentation allowing eventual placement of an implant. The approach allows the clinician to achieve this goal without preparing a second window through a more invasive lateral approach.

Background: Newer generation platelet concentrates, such as advanced platelet-rich fibrin plus (A-PRF+) obtained following low-speed centrifugation concept and horizontal platelet-rich fibrin (H-PRF) obtained from swing out and bucket system, showed increased platelet entrapment and growth factor release in the in-vitro studies. This prospective study aimed to evaluate and compare the clinical outcomes of A-PRF+ and H-PRF membranes in the treatment of gingival recession defects. The objectives of this study were to compare the changes in the recession height (RH) and the mean root coverage percentage (MRC%) between and within the research groups.

Methods: Forty-four systemically healthy patients diagnosed with 84 Cairo's RT 1 and RT 2 gingival recession defects in the maxillary anterior and premolars were randomly treated with a combination of the coronally advanced flap (CAF) and A-PRF+ membrane (n = 22 subjects) or H-PRF membrane (n = 22 subjects). Patients were reviewed at 3 and 6 months postoperatively. Parameters including RH, MRC%, complete root coverage (CRC), gingival thickness, keratinized tissue height, and root coverage esthetic scores were documented.

Results: Both treatments resulted in a significant reduction in RH (p < 0.001). The CAF + A-PRF+ group demonstrated a reduction in RH from 2.47 ± 1.00 mm to 0.59 ± 0.52 mm and the MRC% was 76.33 ± 22.54%, at 6 months. In the CAF+H-PRF group, the mean RH decreased from 2.43 ± 1.01 mm to 0.38 ± 0.59 mm and the MRC% was 85.51 ± 19.87%. Three- and six-month intergroup analysis revealed statistically insignificant differences in the observed clinical parameters between the groups (p > 0.05).

Conclusions: The study found that both CAF + H-PRF and CAF + A-PRF+ protocols resulted in similar clinical outcomes while treating maxillary gingival recession defects.

Plain language summary: Numerous modifications have been proposed to improve the growth factor content in the platelet concentrates and thereby therapeutic potential. This study compared platelet-derived membranes obtained by two different spin protocols in the treatment of gum recession. Forty-four patients were treated with either platelet-derived membrane obtained by horizontal spin protocol (test group) or low-speed spin concept (control group). Both treatment methods resulted in satisfactory healing. At the end of 6 months, no differences were noted with regard to the changes in clinical measurements and root coverage percentage indicating similar clinical efficacy of both preparatory techniques.

Background: The periosteum consists of an outer fibrous layer and an inner cellular layer, where bone cells reside. Hence, it has been suggested that applying periosteum to a periodontal defect may help new bone formation. The purpose of this case study is to present the clinical and radiographic outcomes of a vestibular regenerative approach and the application of a connective tissue graft (CTG) with periosteum to improve the periodontal prognosis of a pathologically migrated hopeless tooth with an endo-periodontal lesion (EPL).

Methods: A 35-year-old female presented with a hopeless tooth with EPL on #9. To preserve the papilla, a horizontal incision with two vertical releasing incisions was made on the buccal vestibule where the buccal bone was present. A CTG with periosteum was harvested from the tuberosity area. After applying enamel matrix derivative (EMD) and freeze-dried bone allograft (FDBA), the CTG was placed over the defect and stabilized with absorbable sutures. The flap was replaced and sutured, achieving primary closure and healing by primary intention.

Results: Following regenerative procedure, a localized orthodontic treatment was applied. A minimal ridge resorption, shallow probing depth, and radiographic stability of periodontal bone level were observed.

Conclusion: This case study shows the successful application of a multidisciplinary approach to save a hopeless tooth with severe bone destruction and a non-contained periodontal defect.

Key points: Multi-disciplinary approach including endodontic, orthodontic, and periodontal regenerative procedure can improve the prognosis of natural teeth. It would be beneficial to maintain the blood supply to the crestal part of the flap with apical incision. Connective tissue graft with periosteum could enhance the healing potential when used in adjunct with periodontal regeneration.

Plain language summary: The apical horizontal incision combined with periosteum graft could successfully save a tooth with severe bone destruction and a non-contained periodontal defect. The importance of wound stability on the papillae area was achieved with the vestibular approach with application of the room concept. This method would be beneficial to improve the periodontal prognosis of a severely periodontally compromised tooth.

Background: Various surgical techniques have recently been developed for periodontal tissue regeneration, especially those do not involve any incisions in the interdental papillae at the regeneration site. These techniques have significant advantages for obtaining clinical attachment gain with least amount of gingival recession, however, may also have disadvantages such as limited field of surgical view, difficulty in debridement, and limited access only from the buccal side. This case report addresses a 2-year follow-up with a novel surgical approach to achieve periodontal regeneration that overcomes these limitations: the flexible tunnel technique (FTT).

Methods: In a 66-year-old patient, in an enclosing infrabony defect extending to the root apex on the palatal side, which appeared to be an endodontic-periodontal lesion on tooth #5, four vertical incisions and a periosteal releasing incision were performed in order to make the interdental papillae easier to translocate over the abutment teeth, which led to obtain clearer operative field. After debridement, the enamel matrix derivative was applied to the root surface and the infrabony defect was filled with deproteinized bovine bone mineral. The flaps were relocated, and simple interrupted sutures were performed.

Results: One year later, pocket closure and improvement of bone defects were observed without gingival recession. After confirmation with improved mobility, a full zirconia crown was placed. During 2-year follow-up, periodontal tissue was maintained well without any complication.

Conclusions: The FTT can be used to approach endodontic-periodontal lesions and infrabony defects extending to the root apex without incision of the interdental papillae.

Key points: A more accessible tunnel technique can be performed by using four vertical incisions. If the tooth is abutment, interdental papillae can be flexible to translocate due to this tunnel technique with vertical incisions. Ensuring root surface debridement, application of regenerative materials, and wound stability are the keys to this regenerative procedure. The patient needs to understand the risks associated with the proposed periodontal regenerative surgery and the prognosis of tooth.

Plain language summary: Various surgical techniques have been developed recently to help regenerate the tissues that support teeth, especially methods that avoid making cuts in the gum tissue between the teeth at the treatment site. However, these techniques may have some drawbacks, such as limited visibility during surgery, difficulty cleaning the area, and access only from the outer side of the teeth. This case report addresses a 2-year follow-up of a new surgical method aimed at overcoming these challenges: the flexible tunnel technique (FTT). In a deep bone defect extending to the tip of the tooth root on the roof