The International journal of periodontics & restorative dentistry最新文献

This study presents the Biologic Reset Protocol (BRP), a reproducible workflow that integrates prosthetic and surgical phases to improve the predictability of regenerative treatment in intrabony peri-implantitis lesions. The protocol is designed to re-establish peri-implant conditions favorable to long-term tissue stability and proper implant function. The BRP is structured into three sequential phases: (1) a pre-surgical phase, involving the removal of the existing prosthesis to improve diagnostic accuracy, facilitate non-surgical decontamination, and promote soft tissue healing; (2) a regenerative surgical phase based on principles of guided bone and tissue regeneration, favoring a submerged healing approach. This phase involves meticulous implant surface decontamination using air-polishing to preserve the fixture's original biocompatibility, followed by the placement of particulate bone grafting combined, when necessary, with a stabilized membrane; and (3) a final prosthetic phase which may include prosthetic refinement or replacement to ensure biologically favorable design and prevent disease recurrence. By integrating current evidence with comprehensive biological, surgical, and prosthetic principles, the BRP offers a structured and predictable framework for the treatment of complex peri-implantitis cases, promoting both regenerative success and the long-term preservation of implant health.

Activated charcoal (AC)-containing products have been widely advertised over the internet, but evidence of their efficacy and safety are still scarce. Few studies have addressed their abrasivity and whitening efficacy, but none has addressed their staining potential. Therefore, this study aimed to report irreversible staining caused on enamel white spot lesions (WSLs) after orthodontic treatment caused by AC powder used for toothbrushing. A fifteen year-old patient sought the dental clinic complaining about dark discolorations on maxillary anterior teeth after toothbrushing with a fluoride-free AC powder. The patient reported that white discolorations were present after the orthodontic appliances removal and started using the product due to its 'whitening' claims. Then, due to the dark discoloration, the patient sought another dental professional who conducted microabrasion, but the stains were not completely removed. Therefore, direct veneers were conducted using self-etching adhesive system (FL Bond II) and resin composites (Beautifil II A2O, B2 and incisal) to successfully cover the remaining discoloration. After 4 years, no staining was observed. In conclusion, AC-containing products might not be safe for patients with WSL after orthodontic treatment, and their use might irreversibly stain the demineralized enamel, leading to more invasive treatments to solve the resulting discoloration.

During supportive periodontal care, teeth with Class III furcation involvement are at a higher risk of loss. When performing surgery on molars with through-and-through furcation defects, elevating the flaps on both sides of the tooth may result in tissue wall loss, gingival recession, and exposure of the furcation entrance. This case report presents the Single Buccal Envelope Flap with Connective Tissue Graft (CTG) Wall Technique for the treatment of mandibular Class III furcation defects. We used a single-flap approach for the buccal side, while preserving the lingual side as an intact soft tissue wall. After thorough debridement of the furcation area, fibroblast growth factor-2 was first applied to the tooth surface and then mixed with autogenous bone, which was grafted into the defect. A CTG was placed on the buccal side, followed by buccal flap suturing. Preoperatively, the probing depths at the furcation sites were 7 mm and 9 mm on the buccal and lingual sides, respectively. At 12 months postoperatively, these were reduced to 4 mm and 3 mm, respectively. The radiographic comparison with preoperative images revealed bone regeneration within the defect area. Furthermore, the furcation entrance remained unexposed and stable during the 12-month follow-up period.

Aims: This prospectively-collected longitudinal service evaluation assessed the outcomes of periodontal regenerative surgery performed by periodontology trainees in the MClinDent program at Guy's Hospital, London. The primary aim was to evaluate 12-month clinical outcomes, with secondary aims to explore predictors of success and (reported separately) assess the feasibility of predicting defect morphology radiographically.

Materials and methods: Data from 173 intrabony defects in 133 patients (October 2020-May 2023) were analysed. Primary outcomes were pocket closure (PC; PPD ≤4 mm, no BoP) and composite outcome measure (COM; PC + CAL gain ≥3 mm). Descriptive and multilevel multivariate analyses were performed, with univariate analyses interpreted as exploratory.

Results: At 12 months, mean CAL gain was 2.78 mm, PPD reduction 3.27 mm, with PC in 58% and COM in 45% of sites. Radiographically, mean intrabony reduction was 3.3 mm, with ≥3 mm reduction in 52% of sites. Multivariate models identified full-mouth plaque score (p=0.024) and suprabony defect depth (p=0.036) as predictors of COM, and intrabony defect depth as predictor of PC (p=0.002).

Conclusion: Regenerative surgery performed by trainees achieved meaningful clinical and radiographic improvements, with outcomes comparable to published ranges but slightly less predictable than in specialist-led trials. Plaque control and defect morphology were key determinants of success, highlighting the importance of case selection and supportive care. The exploratory nature of predictor analyses, constrained by sample size and subgroup representation, underscores the need for validation in larger, controlled studies.

This case report details the successful treatment of multiple recession type (RT) 3 gingival reces-sions in periodontally compromised mandibular anterior teeth with limited keratinized tissue. A 35-year-old man with stage III, grade C periodontitis underwent a two-stage intervention. Initially, a modification of the connective tissue graft (m-CTG) wall technique was used as part of phenotype modification therapy. The CTG acted as a protective 'wall,' securing space for periodontal regener-ation and thereby enhancing root coverage, soft tissue thickness, and keratinized mucosal width. Recombinant human fibroblast growth factor-2 and carbonate apatite promoted periodontal regen-eration. This procedure successfully facilitated periodontal regeneration, resulting in the transition from RT3 to RT2 gingival recession and achieving adequate keratinized mucosal width. Eighteen months later, the second surgery used a tunneled coronally advanced flap (TCAF) for root coverage. TCAF involved combining a coronally advanced flap and tunnel technique by elevating the trapezoi-dal surgical papilla and using a deepithelialized CTG inserted beneath the tunneled flap. Root con-ditioning with ethylenediaminetetraacetic acid and enamel matrix derivative gel application were performed. Consequently, the mean clinical attachment level gain was 5.3 mm, mean root coverage was 4.5 mm in height, and the gingival phenotype at the treated sites had improved at the 12-month follow-up. This staged approach addresses the challenges of treating RT3 gingival recession with promising outcomes.

Impairment or loss of the interdental papilla is a common issue in patients with periodontal disease, leading to phonetic, functional, and esthetic concerns. Numerous techniques have been explored to reconstruct and regenerate interdental papillae, but consistent success remains challenging. This arti-cle presents a novel surgical approach that applies the principles of the connective tissue graft (CTG) wall technique to enhance papilla volume when interdental clinical attachment loss is present in the esthetic zone. The case of a 35-year-old woman with an RT3 recession defect associated with loss of interdental hard and soft tissues is discussed. The patient underwent a procedure involving palatal in-cisions, application of amelogenins, and a trapezoid-shaped CTG fixed at the base of the papilla under a coronally advanced flap. This approach aimed to stabilize the blood clot and prevent soft tissue col-lapse into the defect area, enhancing the position and volume of the interdental papilla. Results at the 6- and 12-month follow-ups indicated significant improvement in papilla appearance and complete root coverage. This case suggests that the modified CTG wall technique can effectively treat buccal and interdental gingival recessions associated with horizontal or infrabony defects. Further clinical trials are necessary to confirm these findings and establish the most effective approach for interdental papilla reconstruction.

This case report presents a papillary reconstructive surgical procedure based on the use of a double subepithelial connective tissue pedicle graft (SCTPG) in conjunction with a coronally advanced tunnel flap (CATF) for root coverage of gingival recession defects (GRDs) with interproximal tissue loss and adjacent collapsed papillae. Two GRDs (teeth 12 and 13; FDI numbering system) with interproximal tissue loss and collapsed papillae were treated by means of a bilaminar approach, based on the use of a palatal double SCTPG rotated and inserted into a palatal-buccal tunnel flap at the level of the mesial and distal papillae of the maxillary right lateral incisor, associated with a CATF. Seven months after surgery, complete root coverage was achieved in both GRDs. Concerning the reconstruction of tooth 12's papillae, the distance from the contact point to the tip of the distal and mesial papillae decreased from 5 to 2 mm and from 4 to 2 mm, respectively. Overall, the patient was highly satisfied with the outcome. Within the limits of this case report, it could be demonstrated that the double SCTPG + CATF promoted prominent clinical and esthetic improvements to the baseline conditions of both the GRDs and collapsed papillae.

This case report presents the 37-year follow-up results of a gingival recession (GR) treatment in the maxillary esthetic zone. In 1987, a healthy 20-year-old woman with a history of orthodontic treatment presented with a chief complaint of GR on the facial area of tooth 21 (FDI numbering system). There was no occlusal trauma, hypersensitivity, or parafunctional habit. Clinically, there was a 4-mm GR on the facial surface, classified as Miller class I (RT1), with a probing depth of 1 mm and no bleeding on probing. A partial-thickness flap was reflected around the teeth to be grafted. The donor site (palate) provided a subepithelial connective tissue graft (SCTG), as per the Langer and Langer protocol. A 2-mm-thick graft was harvested and surgically placed on the recipient site; the flap was then reposi-tioned. The patient was evaluated after 6 months (GR: -0.5 mm), 27 years (GR: 1.0 mm), and 37 years (GR: 1.5 mm). This was a successful long-term result. However, a relapse was noted, possibly exac-erbated by orthodontic treatment associated with the thin overall phenotype in both arches. SCTG is a safe and effective modality for long-term root coverage, demonstrating tissue stability, thickness gain, and complete root coverage within 6 months after the procedure. A relapse of approximately 1.5 mm was noted on the facial surface after 37 years.