The International journal of periodontics & restorative dentistry最新文献

Background: Oral implants require adequate bone support, which is often facilitated by bone augmentation when bone volume is insufficient. Autogenous bone (AB) has been considered the 'gold standard' for such procedures due to its osteogenic properties, but it necessitates a second surgical site, which increases patient morbidity. Trial Design and Methods: This study was a randomized, double-blind, split-mouth clinical trial comparing L PRF (leukocyte-platelet rich fibrin) bone-block grafts against a composite graft mixture of 50% AB with 50% deproteinized bovine bone mineral (DBBM) for vertical guided bone regeneration (GBR). The trial included 6 patients needing bilateral vertical GBR before implant placement. A dense polytetrafluoroethylene (d-PTFE) membrane was used for both test and control sites. The primary outcome measure was vertical bone height (VBH) gain, assessed via cone beam computed tomography (CBCT) at 9 and 25 months post-operation.

Results: There was no significant difference in VBH gain between the test and control sites at any time points, with a mean VBH gain at implant placement of 4.6 ± 3.0 mm for test sites and 5.2 ± 2.7 mm for control sites. At 1 year after loading of the implants the VBH gain was 3.0 ± 2.8 mm for test sites and 3.8 ± 2.6 mm for control sites (P value 0.96). Complications were minimal and included one implant loss due to infection in a test site.

Conclusions: The L-PRF bone block could be a viable alternative to the composite graft, potentially reducing the need for harvesting bone from a second surgical site. Future studies with larger sample sizes are needed to confirm these findings and to explore the biological benefits of integrating the L-PRF bone-block into bone graft materials for oral implantology.

As stability is a key determinant of successful regeneration, this paper introduces tack engagement as a novel alternative to conventional suturing techniques, aimed at improving the positioning and fixation of autogenous tissue grafts. Rigid tack engagement, a widely utilized technique in guided bone regeneration (GBR) protocols for securing membranes, offers a stable and time-efficient solution that mitigates the risks of early graft displacement resulting from suturing or delayed volume changes due to physiological healing processes or unintentional patient oral habits. Subperiosteal tissue tacking represents a promising alternative technique for managing small to moderate tissue defects, mitigating various biological and practical obstacles. Within the limitations of this current report, tacks provide a variety of practical benefits for tissue fixation, rendering them particularly useful in staged implant placement procedures. Further research is necessary to comprehensively assess the benefits and potential constraints of this innovative approach.

Constant efforts are made to trigger simpler, faster and less invasive surgical approaches to harvest autologous connective tissue grafts. While the palate is considered as a gold standard, its association with complications and patient discomfort have led clinicians to explore alternative sites like the tuberosity. However, current tuberosity harvesting techniques face several limitations. Through a multiple recessions clinical case intended as a proof of concept, this article describes a novel harvesting technique based on a gingivectomy that triggers the tuberosity tangentially. Clinical, aesthetic, and patient outcomes were monitored at 7 days, 14 days, 1 month, and 3 years at the grafted site as well as at the tuberosity. Multiple harvestings were conducted at the tuberosities offering connective tissue grafts suitable for micrografting. Harvested tuberosities healed completely without complication, and the patient reported no discomfort. At the grafted site, both aesthetic and functional results were maintained for up to 3 years. The Slice Harvesting Technique offers a promising alternative for tuberosity tissue harvesting, with critical advantages including high indication rate, simplicity, speed, safety, and the ability to provide user-friendly connective tissue grafts. Besides, the technique could also appear sustainable and favor the regrow of tuber for multiple rounds of harvesting.

The purpose of this retrospective study was to assess facial and palatal alveolar wall thickness (AWT) in relation to sagittal root position (SRP) of maxillary anterior teeth using CBCT. A total of 102 CBCT images (60 women, 42 men) of maxillary anterior teeth were reviewed. SRP was classified according to Kan's classification, and AWT was evaluated at coronal (4 mm from the CEJ), mid-root, and apical (2 mm from the apex) levels of the facial and palatal aspects. Sex, age, and tooth type were analyzed as secondary variables. The SRP distribution was 76.6% class I, 11.3% class II, 0.8% class III, and 11.3% class IV. AWT, from thickest to thinnest, was found in palatal apical, then mid-root, then coronal levels, followed by facial coronal, then mid-root, then apical levels. AWT was thickest in SRP class II, followed by classes I and III, and least thick in class IV at all measured areas (P < .05). A significantly higher AWT was associated with class I in central incisors, class II in canine teeth and in men, and class IV in central incisors and canines.

Current concepts in periodontology emphasize the interproximal attachment as an important distinguishing aspect with significant influence, making it a key diagnostic and prognostic factor. Complete regeneration of the interproximal clinical attachment has become a primary determinant of periodontal success. Since the mid-20th century, numerous articles have been published on root coverage procedures, mostly for nonproximal gingival recessions. When it comes to the interdental area, the literature does not inspire the same level of confidence. This case series introduces an innovative 3D tunneling surgical technique for gingival papilla reconstruction and supra-alveolar interproximal attachment regeneration. The technique is described step by step and shown with three selected clinical cases of multiple bilateral adjacent gingival recessions (types 2 and 3) in the anterior mandible with 6.5 years of follow-up. A total of 18 proximal, midbuccal, and midlingual recessions were treated simultaneously. Up to 88.9% of mean root coverage was achieved in the proximal area. Within its limits, this case series demonstrates the possibility of treating gingival recessions with deficient papillae in the anterior mandible, achieving a significant clinical improvement with long-term stability.

A clinical observation usually encountered after vestibuloplasty, or after interventions aiming to deepen the vestibule with or without simultaneous free epithelialized grafts in the posterior ridges, is that the vestibule can be subjected to major dimensional changes attributed to the buccinator fiber attachment. Therefore, this study aimed to assess the attachment of the buccinator muscles in relation to other anatomical landmarks. An ex vivo study was performed in cadaver heads to explore the association of fiber attachment in relation to the distance from the crestal aspect of the edentulous alveolar process (CAP) and the vestibular depth (VD), crestal band of keratinized mucosa (KM), and ridge height (RH). Interestingly, VD and KM were found to be strongly correlated. Likewise, VD/ KM and CAP-BUC (CAP to the most coronal insertion of the buccinator muscle) were also correlated. CAP-BUC was negatively correlated with RH. Accordingly, the more atrophic the alveolar ridge (ie, more noticeable in the mandible), the shallower the vestibule, the smaller the crestal band of KM, and the greater crestal attachment of the buccinator muscular fibers. This may be the reason why the graft is subjected to major dimensional changes whenever a free epithelialized graft is performed in the posterior ridges to enhance the peri-implant soft tissue phenotype and deepen the vestibule.

This study evaluated the impact of using calcium hydroxide or antioxidant agents on the bond strength of adhesive restorations to bleached dentin. A total of 40 teeth were prepared and allocated into eight groups, first divided according to the surface treatment after bleaching (no treatment or application of calcium hydroxide, 10% sodium ascorbate, or 5% sodium thiosulfate for 10 minutes) and then according to the time of final restoration after treatment (immediate or after 7 days). Sodium perborate with 20% hydrogen peroxide was applied for 3 weeks using a developed artificial pulp chamber, with peroxide replacements provided every week. Composite resin restoration was performed, followed by a microtensile test. Then, specimens were analyzed using a stereomicroscope and scanning electron microscopy (SEM). Data were submitted to Kruskal-Wallis and Dunn tests (P < .05). The bond strength of nonbleached teeth was similar to the groups restored after 7 days of bleaching (P < .05). The lowest bond strength values were seen in groups restored immediately after bleaching (P < .05). In all groups, there was a considerable predominance of adhesive fractures. Delaying the final restoration of teeth submitted to nonvital bleaching by 7 days increased the bond strength. The immediate restoration of bleached teeth after using 10% sodium ascorbate or 5% sodium thiosulfate for 10 minutes showed unsatisfactory results. Irrespective of the dentin protocol applied before adhesion, bond strength values will be satisfactory when delaying the final restoration and unsatisfactory when immediately performing the final restoration. Therefore, after nonvital tooth bleaching, clinicians should always delay the final restoration for a minimum period of 7 days.

Collagen matrices have been developed as possible connective tissue graft substitutes to overcome patient discomfort, undesired palatal healing, and the limited amount of donor tissue. The aim of this case series is to assess a coronally advanced flap (CAF) with a volume-stable collagen matrix (VCMX) to treat single gingival recessions (GRs) associated with partially restored noncarious cervical lesions (NCCLs). Twelve patients diagnosed with single GRs (type 1; RT1) + NCCL (B+) were included in this study and received a restorative approach (partial composite resin with an apical margin 1 mm beyond the estimated cementoenamel junction [CEJ]) and a surgical approach (CAF+VCMX). Clinical and patient-centered assessments were recorded from 10 patients at baseline and 6 months postoperatively. Significant recession reduction (2.1 mm), clinical attachment level gain (1.34 mm), and combined defect coverage (51.67%) were observed at 6 months. The estimated root coverage was 69.48%, obtained using the estimated CEJ. No difference in keratinized tissue width was observed over time. A 0.42-mm gain in gingival thickness was observed after 6 months (P = .002) as well as an improvement in patient satisfaction due to better esthetics (P < .001). Within the present study's limitations, CAF+VCMX provided a significant improvement in treating single GRs combined with a partially restored NCCL (B+).