Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)最新文献

Various adhesive techniques and ceramic materials can be incorporated to create a biological, functional, and esthetic smile and occlusion. In this case report, a 37-year-old woman presented to a dental school clinic seeking treatment for missing teeth. She also was dissatisfied with the color of her existing teeth and desired a broader smile (buccal corridor). In addition, tooth No. 9 had external resorption and needed to be extracted and replaced. With a previous history of unsatisfactory orthodontic treatment, the patient declined orthodontics despite the benefits it could have provided. A multidisciplinary approach was taken to replace defective restorations, address missing mandibular teeth, and improve esthetics. Treatment involved at-home bleaching, implant placement, porcelain veneers, ceramic onlays, ceramic crowns, and bonded cantilever ceramic fixed dental prostheses (FDPs). Posterior occlusion would be established through the placement of ceramic onlays and crowns and posterior cantilever ceramic FDPs to restore her missing mandibular first premolars. Anterior esthetics were then enhanced by placing ceramic veneers and an implant-supported ceramic crown (No. 9). This article demonstrates the selection and use of various ceramic materials, the proper sequencing of the placement of each restoration, and appropriate adhesive application to achieve an esthetic, long-term result. It highlights the importance of proper planning for implant crowns in the esthetic zone, as the contouring of the provisional crown provides guidance to the laboratory for fabrication of the final restoration.

Alveolar bone loss threatens tooth stability and can lead to loss of function. When occurring in the esthetic zone, this can have acute social ramifications, decreasing the patient's quality of life. In the outlined case, a 65-year-old nonsmoking female patient with periodontitis presented with a periodontal defect in the anterior region, requiring bone regeneration. Treatment involved the application of an octacalcium phosphate-coated deproteinized bovine bone mineral consisting of 100% cancellous bone, along with adjuvant factors such as platelet concentrates and platelet-rich fibrin, to regenerate the atrophied ridge. The patient experienced uneventful healing with no documented complications. Long-term follow-up of 6.3 years revealed successful bone regeneration and stability. This case report demonstrates the long-term safety and reliability of xenograft material to support bone regeneration in a patient who was treated for alveolar bone loss due to periodontitis.

Clinical conditions known as desquamative gingivitis (DG) are characterized by erythema, ulceration, erosion, and blistering or desquamation of the marginal and attached gingiva, which can be localized or widespread. DG is a clinical description of oral lesions rather than a definitive diagnosis. In many common forms of DG, the initial presentation is typically desquamation or erosion on the labial surface of anterior teeth. Although DG may be caused by a broad range of local and systemic conditions, pemphigus vulgaris, oral lichen planus, and mucous membrane pemphigoid are the most common triggers. While DG does not directly cause attachment loss or alveolar bone destruction, it can lead to oral discomfort and impair proper oral hygiene, which poses a long-term risk to dental and periodontal health. Because many disorders associated with DG may involve systemic presentations, both oral and extraoral symptoms must be assessed. Further, some of these conditions demonstrate significant morbidity and, in some cases, lifethreatening complications. Given the wide range of possible manifestations and the complexity of diagnosis, identification and management of DG often requires a multidisciplinary approach to ensure optimal patient care. Initial recognition of DG and rapid identification of a definitive diagnosis is critical to ensuring patients' health and comfort. This article reviews the clinical characteristics, diagnostic approaches, and treatment protocols for mucocutaneous diseases associated with DG.

Dental implants have revolutionized contemporary dentistry by providing durable, esthetic, and functional solutions for tooth replacement. Their ability to osseointegrate with bone tissue enables stability and longevity to support a variety of fixed and removable prostheses. To ensure optimal implant success, including esthetics, phonetics, function, and resistance to periimplant disease, focus has shifted beyond osseointegration to the preservation and regeneration of surrounding hard and soft tissues. Oral regenerative procedures may be performed prior to surgical implant placement, simultaneous with implant surgery, and/or after implant placement or restoration. A paradigm shift from osseointegration to a more holistic assessment of implant success has placed an emphasis on biologically driven treatment approaches, accentuating optimal tissue regeneration, esthetic outcomes, and long-term peri-implant health.

Background: The purpose of this pilot study was to determine if recombinant human platelet-derived growth factor-ßß (rhPDGF-ßß) and recombinant human bone morphogenetic protein-2 (rhBMP-2) can be released over an extended timeframe from a biologic fibrin membrane capable of being used in a guided bone regeneration (GBR) procedure.

Methods: Human venous blood samples were placed into 10 9-ml silica-lined test tubes. Two of the tubes were doped with rhPDGF-ßß, two tubes were doped with rhBMP-2, and two were doped with alpha-2 antiplasmin plus rhBMP-2. Four tubes with no growth factors added served as controls. After centrifugation the blood clots were separated from the red blood cell fraction and platelet poor plasma. The clots were placed into wells with liquid growth medium except for the platelet poor plasma and the serum squeezed from the clots. These solutions were measured directly. One milliliter of growth medium from the clots was removed at 20 minutes, 4 hours, 72 hours, 168 hours, 312 hours, and 336 hours and replaced with 1 ml of fresh growth medium. All samples were analyzed using indirect ELISA assay. Six 9-ml plastic-lined test tubes were filled with venous blood. After centrifugation the uncoagulated plasma was separated from the red blood cell layer and placed into a surgical bowl. Coagulation was initiated with 500 µl of calcium chloride for 30 minutes.

Results: The indirect ELISA assay for rhPDGF-ßß at 116 hours showed 1,583 pg/ml compared to 8 pg/ml from the average of the control samples with no growth factor added. The ELISA assay for rhBMP-2 at 324 hours showed 9,606 pg/ml, and for alpha-2 antiplasmin plus rhBMP-2 12,788 pg/ml, compared to no detectable growth factor from the controls. After 30 minutes of incubating the 25 ml of separated plasma, the coagulated clot produced a biologic membrane approximately 40 mm x 45 mm.

Conclusions: The current pilot study showed fibrin can bind and release rhBMP-2 and rhPDGF-ßß over a 7- to 14-day period allowing the fibrin matrix to become an osseoconductive scaffold. Both growth factors can be incorporated into fibrin to create a biologic membrane to be used for GBR, sinus augmentation, and ridge augmentation.

Myofascial pain, a prevalent condition that often involves trigger points in the craniofacial region, can significantly impair function and quality of life. This article reports on the case of a 69-year-old patient with chronic head and neck myofascial pain and limited mouth opening, which hindered dental care and obstructive sleep apnea management. Following a series of trigger point injections (TPIs), combined with pharmacologic and physical therapy, the patient experienced substantial symptom relief and improved jaw function, and was subsequently able to receive successful dental and sleep apnea treatment. The case underscores the importance of accurate diagnosis and multidisciplinary management of myofascial pain, highlighting TPI therapy as an effective, minimally invasive treatment within a multimodal care approach.

The increasing demand for esthetic restorations has driven advancements in adhesive dentistry, with rubber dam isolation emerging as a cornerstone for achieving long-lasting and predictable outcomes. While the benefits of the use of optical magnification when utilizing rubber dam have only been briefly described in previous literature, this article's main focus is on microscopically guided rubber dam integration (MGRI), a treatment protocol that highlights the precision of a dental operating microscope (DOM) during application of rubber dam isolation. By leveraging high magnification along with aligned illumination of the DOM, MGRI addresses challenges that clinicians commonly encounter during isolation procedures, thus enhancing accuracy, efficiency, and patient safety. The protocol emphasizes a step-by-step approach from clamp selection, clamp setting, soft-tissue coverage, and marginal inversion, to rubber dam removal, supported by four-handed dentistry for optimal execution. This minimally invasive method demonstrates how integration of the DOM can significantly elevate the standards of rubber dam application in restorative and esthetic dentistry.

Retrograde peri-implantitis (RPI) is characterized by atypical and often progressive bone loss at the periapex of a dental implant. Although RPI reportedly has a lower prevalence than marginal peri-implantitis, if left untreated it can lead to loss of dental implants. In this clinical case series, two patients with different presentations of RPI were treated with guided bone regeneration (GBR) using bone graft and collagen membrane. Longterm follow-up showed clinical and radiographic improvements that resulted in radiographic bone fill and reduced probing depths around implants. Observations reported herein suggest that GBR in defects caused by RPI is an effective treatment option.

Purpose: The aim of this retrospective pilot study was to use digital implant planning to assess radiographic outcomes of maxillary sinus augmentation bone grafting procedures (ideal, excess, or insufficient) in reference to the planned implant.

Materials and methods: After ethical approval was received, deidentified data for subjects treated for a maxillary sinus elevation procedure was extracted. Patient-specific variables (age group, gender, race, smoking, diabetes, and cardiovascular disease) and site-specific variables (type of bone graft, type of membrane, membrane perforation, and other complications) were collected, as recorded in the electronic health records. For the records that satisfied the inclusion criteria, preoperative and postoperative cone-beam computed tomography scans for lateral sinus augmentation procedures were retrieved, superimposed, and imported into the implant planning software. An ideal implant was planned digitally in a cross-sectional view by an expert in prosthodontics (KV). The implant measurements in apicocoronal (AC) and buccopalatal (BP) dimensions were kept standard for all cases and were confirmed by two previously calibrated co-investigators (GS, ID). Statistical analysis involved descriptive and bivariate analysis.

Results: A total of 350 electronic health records were reviewed and 26 were included. Descriptive analysis revealed that in the AC dimension, 40.63% of procedures resulted in insufficient amount of bone graft and 37.50% of procedures resulted in excess bone graft; 21.88% of procedures had ideal amount of bone graft in the AC dimension. For the BP dimension, 81.25% of procedures resulted in ideal and 18.75% in insufficient amounts of bone graft.

Conclusion: This study revealed that a limited number of maxillary sinus procedures resulted in ideal bone grafting in both the AC and BP dimensions when considering predetermined restorative guidelines for the final implant position. An excess and/or insufficient amount of bone grafting in at least one dimension resulted most of the times. With the use of technology and an interdisciplinary team of experts, future studies should aim to quantify the amount of bone graft needed for an ideal maxillary sinus elevation for upcoming implant placement.

This case report describes the use of a single resorbable biomaterial composite comprised of bovine collagen and bioactive calcium apatite in a combined complex defect highlighting oral tissue regeneration. Following standard-of-care procedures, a 68-year-old patient was treated in a private practice setting with the same biomaterial for two different therapeutic indications: alveolar ridge preservation in the edentulous site of tooth No. 12 and guided tissue regeneration on the mesial surface of tooth No. 13. No other biomaterials were used in the management of the combined complex defect. Healing was uneventful, and the patient was satisfied with the final treatment. The edentulous space No. 12 was treated further with a screw-retained implant-supported restoration. At the 16-month follow-up, clinical evaluation revealed preserved ridge volume and stable keratinized soft tissue. Radiographic analysis confirmed stable bone levels for implant No. 12 and positive radiographic changes of oral regeneration on the mesial of tooth No. 13, including the re-establishment of the periodontal ligament. Within the limitations of this case report, the biomaterial demonstrated efficacy, clinical manageability, and cost effectiveness as a single-modality approach, reducing the need for additional interventions.