The International journal of periodontics & restorative dentistry最新文献

This prospective study assesses the clinical outcomes of a novel xenogeneic acellular dermal matrix (ADM) for the treatment of multiple adjacent gingival recessions. Thirteen patients with 25 RT1 and 10 RT2 defects were treated using CAF + ADM. Clinical outcomes included recession reduction (RR), mean root coverage (MRC), complete root coverage (CRC), change in keratinized tissue width (KTW), and aesthetic evaluation (RES score). Patients' pain perception was evaluated through a visual analog scale at day 1 and 7 post-surgery. At 12 months post-surgery, the mean residual recession was 0.65 ± 0.87 mm, with an RR of 1.8 ± 1.1 mm. The MRC was 70.5 ± 54.2%, and CRC was achieved in 62.9% of cases. The total RES score was 7.5 ± 2.5. For RT1 and RT2, MRC was 71.3 ± 61.3% and 68.7 ± 32.4%, with a CRC of 72.0% and 40.0%, respectively. These findings indicate favorable improvement in mucogingival parameters over 12 months, suggesting that the use of ADM in combination with a coronally advanced flap may represent a viable therapeutic option for root coverage.

Purpose: The consecutive clinical study evaluates the long-term results of vertical autogenous bone grafting in the esthetic partial edentulous anterior maxilla according to the Split Bone Block Technique. The first outcome was to evaluate the primary results of the Split Bone Block Technique for vertical bone augmentation in the partially edentulous anterior maxilla, including the healing complication rate and the amount of the vertical bone gain. Among the secondary outcomes, the analysis was conducted for the long-term stability of the vertical bone gain and implant survival.

Materials and methods: Autogenous bone blocks were harvested from the mandibular external oblique ridge following the MicroSaw protocol. The harvested bone blocks were split longitudinally according to the split bone block (SBB) technique and grafted for vertical bone reconstruction. Implants were inserted and exposed after every 3 months and prosthetic restoration was performed. Patients were followed up for at least 10 years post operatively. Peri-implant bone loss was assessed using mostly periapical but also panoramic radiographs, depending on data availability.

Results: A total of 229 grafted sites in 210 consecutive treated patients were investigated up to 20 years postoperative. Preoperative soft tissue augmentation with a pedicle palatal connective tissue flap was performed in 181 (79%) grafted sites. Early complications with or without bone exposure occurred in 7 sites (3%) leading to loss of graft in one patient (0,4%). Late graft exposure occurred in 4 cases (1,7 %) without negative influence on the clinical result. The average preoperative clinical vertical defect was 8.47 ± 2.07 mm and horizontal width 2.23 ± 0.84 mm. Postoperatively, the average vertical hard tissue gain was 8.33 ± 1.99 mm and horizontal 8.03 ± 0.35 mm. Three months after grafting a total of 322 implants were inserted. Average of peri-implant bone loss after 1 year was 0.53 ± 0.24 mm, after 5 years 0.68 ± 0.19 mm and after 10 years 0.70 ± 0.19 mm. With patient dropout of 21.9% and loss of 2 implants in one patient, average vertically grafted bone was stable at 7.27 ± 1.71 mm after 10 years, corresponding a resorption rate of 8.5%.

Conclusions: The results of this study confirm the predictability and long-term volumetric alveolar stability of using autogenous mandibular bone blocks, grafted according to the split bone block technique, for vertical bone reconstruction in the anterior maxilla. The improvement of the soft tissue quality and quantity using a pedicled palatal connective tissue flap enables reducing dehiscence and ensuring safe healing of the grafted bone, but also increases the volume of the soft tissue for better esthetics.

Objective: To present a proof-of-concept technique combining a novel Muscle Evicted Tunneling Approach (META) with the Crossed Belt & Suspenders (CBS) suture design to achieve simultaneous apical and lateral closure for root coverage in a challenging isolated mandibular recession.

Clinical considerations: A 32-year-old female with a RT2 recession at tooth 31 (thin phenotype; absent attached keratinized tissue; shallow vestibule) was treated with supra-muscular partial-thickness tunneling with myotomy and apicalization of muscle fibers (META), intraoral deepithelialized connective tissue graft, and Crossed Belt & Suspender (CBS) sutures to centralize the flap-graft complex without using vertical releases.

Results: Complete root coverage was achieved with clinical restoration of vestibular depth, attached tissues increased, soft-tissue thickness improved, and hypersensitivity resolved. Outcomes remained stable at 1 year, with improved hygiene and deepened vestibule.

Conclusion: In this proof-of-concept case, the combination of META and CBS was associated with stable root coverage and concurrent gains in attached tissue and vestibular depth over the observation period.

Clinical significance: This approach is indicated for RT1 and RT2 defects in mandibular incisors, where vestibule depth and muscle pull can compromise flap stability, enabling coronal positioning of the flap margin at the CEJ without vertical releases and supporting predictable esthetic and functional outcomes.

Large bone reconstruction often results in distortion of the position of the MGJ and limited residual keratinized mucosa (KM) width at the future implant(s) site. It is well known that an adequate band of KM plays a positive role on peri-implant health and tissue stability. Therefore, surgical techniques designed to reconstruct sufficient peri-implant soft tissue-not only on the buccal aspect but circumferentially around the implant-are highly recommended/advocated. The present manuscript depicts 4 variations of the strip gingival graft technique designed to achieve an adequate width of peri-implant KM and sufficient mucosal thickness (MT) following large bone reconstruction and implant placement at mandibular sites. The rationale for these surgical approaches over conventional techniques, along with anatomical, clinical, and patient-centered considerations related to augmentative procedures, is discussed.

Interproximal attachment plays a crucial role in diagnosing periodontal conditions and predicting their prognosis due to its significant impact. The loss of interproximal attachment, often accompanied by papilla loss, can lead to phonetic, functional, and esthetic challenges. However, existing literature provides limited data on treatment outcomes for interdental papilla reconstruction and root coverage. This technical case report presents a novel surgical approach utilizing labial mucosal vertical incisions and palatal marginal vertical incisions to facilitate creation of a partial-full-thickness (PFT) tunnel. Then, connective tissue grafts (CTGs), stabilized by supracrestal sling (SCS) sutures, are used to support and coronally advance the soft tissue overlying the graft to obtain root coverage and enhance papilla height and volume. This technique optimizes blood supply and maximizes wound stability, resulting in significant papilla augmentation and complete root coverage. It is suggested that PFT tunnel preparation via labial mucosal vertical incisions and palatal marginal vertical incisions, combined with CTG stabilization via the SCS suture, has the potential to treat gingival recessions with deficient papilla in the maxillary esthetic zone.

The most current data fails to elucidate the influence of the peri-implantitis-related bone morphology upon therapeutic outcomes as this has been an underreported area of clinical research. The aim of this concept paper is to provide further insight into the clinical influence of peri-implantitis lesion morphology on both the treatment approach and the likelihood for success. Numerous factors have been associated with defect configuration. Amongst them, implant axis in relation to the skeletal bony housing seems to be pivotal in selecting an effective therapeutic modality to address peri-implantitis. Considering that, a 10-stepwise approach is proposed to manage peri-implantitis. In summary, the surgical approach for managing peri-implantitis, whenever non-surgical measures have failed, must be dictated by defect configuration. Rarely does the morphology of a peri-implantitis lesion enable complete stability of a bone graft material and/or the clot. The bases for this are suboptimal implant position or a deficiency in alveolar ridge width at the time of placement. Hence, resective strategies are often essential combined with reconstructive measures, where possible, to achieve long-term successful outcomes.

This study evaluated the association between the emergence profile angle (EPA) and the phenotypic characteristics of maxillary anterior teeth. Cone-beam computed tomography (CBCT) scans of adult subjects were analyzed to measure EPA, buccal gingival thickness (GT) at different levels, supracrestal tissue height (STH), cementoenamel junction-bone crest distance (CEJ-BC), and bucco-lingual tooth dimensions. Standardized intraoral photographs were used to assess the gingival architecture (GA) and tooth shape. Statistical analyses were performed to explore the correlations between the recorded variables. A total of 100 subjects and 600 maxillary non-molar teeth were included. The overall mean EPA was 14.4° ± 3.06, with significant variation across tooth types (ANOVA, p < 0.001). Sites with a thick gingiva exhibited significantly lower EPA values than those with a thin gingiva. Triangular teeth (15.02°) and teeth with a pronounced scalloped GA (15.9°) had higher EPA than square teeth (13.92°) and those with a flat GA (14.6°) (p < 0.05). EPA revealed a significant negative correlation with GT and STH (Pearson's p < 0.05). Linear regression analysis confirmed that EPA was a predictor of supracrestal soft tissue height (p < 0.001). Therefore, this study concluded that EPA varies according to tooth type, shape, gingival thickness, and architecture, and is inversely correlated with GT and STH.

Aims: This prospective case series evaluated whether hard tissue radiographic parameters influence treatment outcomes of deep mandibular gingival recessions (≥5 mm) treated with connective tissue grafts (CTG) using either a double-papilla envelope (DPE) or lateral sliding flap (LSF).

Methods: Fifteen patients received CTG+DPE (n=7) or CTG+LSF (n=8). Clinical parameters-recession depth (RD), root coverage (RC), complete root coverage (CRC), and keratinized tissue width (KT)-were measured at baseline and 12 months. Pre-treatment CBCT scans assessed root width, mesiodistal root circumference, buccal prominence, and interproximal distance to correlate with outcomes.

Results: No significant differences in clinical outcomes were found between flap designs. When data were pooled, RD significantly decreased from 6.8±1.7 mm to 0.9±0.9 mm (RC=85.8%, p<0.05), and KT increased from 0.1±0.3 mm to 3.6±1.5 mm (p<0.05). Greater baseline RD correlated with more RD reduction (p<0.05). However, none of the radiographic parameters showed significant correlation with root coverage outcomes. RT1 defects achieved 93% of root coverage while RT2 defects achieved 77.6% (p=0.06).

Conclusion: Within study limitations, the examined radiographic parameters did not affect outcomes. Deep mandibular gingival recessions can be effectively treated using either CTG+DPE or CTG+LSF.

Gingival recessions characterized by interproximal clinical attachment loss, as seen in recession types 2 and 3 (RT2 and RT3), present a clinical challenge for achieving complete root coverage. This report presents a microsurgical approach for treating adjacent RT2/RT3 defects with isolated papillary deficiency. The technique involves the use of a tunneled coronally advanced flap (TCAF) to enhance tissue mobility and create an interdental tunnel underneath the deficient papilla. A papillary connective tissue graft (CTG) is contoured to fit the interdental architecture and inserted into the interdental tunnel to 'tent up' the deficient papilla. A facial CTG is placed and stabilized on the facial surface to support the papillary CTG and to obtain root coverage. Clinical outcomes at the 12-month follow-up of cases treated with this approach demonstrated significant improvements in interproximal clinical attachment levels, tissue thickness, and root coverage. The mean root coverage reached 97.6%, with complete root coverage achieved in 94.4% of sites. These findings suggest that combining the TCAF with dual-site CTGs may represent an effective alternative approach for managing complex adjacent gingival recessions with isolated papillary deficiencies.

This study prospectively evaluated the effect of keratinized mucosa (KM) on the healing of periimplant tissues after resective surgical therapy for peri-implantitis. It addressed the question of whether the absence of KM has a negative effect on peri-implant tissue stability after treatment. Patients referred to a private practice for peri-implantitis treatment were surgically treated with resective flap surgery and implantoplasty. They were followed for 3 years. Measurements at the implant level included presence of plaque, bleeding on probing, probing pocket depth, radiographically visible bone loss, and the presence and width of KM before therapy, 3 months postoperatively, and 1, 2, and 3 years after the surgical intervention. All clinical parameters improved, and marginal bone levels remained stable 3 years after therapy. The KM width decreased significantly after the therapy. Soft tissue recession was frequently observed. The absence of KM does not seem to have a negative effect on healing after therapy for the studied period of 3 years. The authors conclude that resective surgery combined with implantoplasty seems to be a reliable method for arresting the progression of peri-implantitis.