The International journal of periodontics & restorative dentistry最新文献

Background: SPAL technique in combination with a xenograft has been successfully used to correct a peri-implant bone dehiscence (PIBD) and increase peri-implant buccal tissue thickness. The purpose of the present study was to determine the histological nature of the newly formed tissue at sites treated using SPAL in association with particulate deproteinized bovine bone mineral (pDBBM).

Methods: 6 patients were consecutively selected for treatment with the SPAL technique combined with pDBBM. At 6-month re-entry, samples were harvested from the areas included in the bone augmentation procedure for histological qualitative and quantitative analysis.

Results: Well organized newly formed bone was present in close contact with the residual graft in all patients. However, a variability in the percentage of new bone was found among patients, ranging from 35.54% to 65.68%. Medullary spaces were populated by osteoblast-like cells and blood vessels running close to the residual graft and newly formed bone. No signs of pathological inflammatory infiltrate were observed.

Conclusion: The histological analysis indicated that the SPAL technique leads to a variable amount of newly formed bone which showed a well-organized and mature architecture, even within a relatively short healing period, in close contact to the residual DBBM particles.

Maintaining sharp periodontal instruments is critical for effective scaling and root planing, yet little data exist on how different sharpening methods affect instrument and root surface roughness. This in-vitro study examined the effects of various manual sharpening diamond- coated cards (medium, fine, extra-fine) and synthetic stones (medium India, fine ceramic) on the roughness of Gracey 11/12 curette edges and instrumented root surfaces. All instruments were sharpened by a single operator using a standardized stationary instrument, moving stone (SIMS) technique. Root planing was then performed on mounted extracted teeth. Using optical profilometry, surface roughness was quantified. Results showed that fine grit abrasives produced smoother cutting edges and root surfaces compared to coarse grit abrasives (p < 0.05). Curettes sharpened with the extra-fine diamond card yielded the lowest roughness on both the instrument edge and the root surface. The orientation of the sharpening card influenced outcomes with a vertical orientation resulting in a significantly smoother edge than a horizontal orientation. Sequential sharpening, using fine then extra fine cards, further reduced edge and root roughness compared with using only a single fine grit. These findings highlight the importance of using extra-fine grit sharpening tools and proper sharpening technique to produce a smooth root surface.

Background: Various surgical options have been described for gingival recession management, namely the coronally advanced flap (CAF) or tunnel (TUN) surgical techniques, combined or not with connective tissue grafts (CTG) - CTGs can be obtained by de epithelializing a free gingival graft (dFGG). Nevertheless, none of them are exempt from postoperative complications, particularly when dFGG is combined with TUN techniques. Most common complications include the re-epithelialization of the marginal graft, resulting in undesirable esthetic outcomes. This paper describes the modified orientation of the dFGG under the tunnel, with the lamina propria layer facing the tooth's root (inverted graft), aiming to minimize the risk of esthetic complications.

Methods: 10 non-smoking patients with no comorbidities, presenting a total of 15 Miller class I/II (RT1) gingival recessions cases, were subjected to root coverage surgical treatment with the introduced technique (TUN+ inverted dFGG). After 6-months, each case was accessed using the root coverage esthetic score (RES).

Results: Regarding soft tissue integration parameters, the score was 3 out of 3 for all cases. Mean amount of root coverage was 97%. 13 recession defects (86%) achievedcomplete root coverage. The mean RES was 9.6, ranging from 7 to 10. 13 recession defects (86%) achieved a RES of 10.

Conclusions: The orientation of the dFGG under the tunnel, with the lamina propria layer facing the tooth's root (inverted graft), seems to present a promising aesthetic root coverage procedure and may be considered to minimize the risk of major esthetic complications when a dFGG is used under the TUN technique. Further studies are needed to address this proof of principle.

Objectives: As the dental profession shifts towards monolithic restorative materials, it is necessary to establish a clear understanding of the materials available and how they should be used clinically. The purpose of this investigation is to document the fracture toughness of a number of esthetic indirect restorative materials on the market and to provide recommendations for their application based on existing clinical and laboratory data sets.

Methods: Fifty-six monolithic esthetic restorative materials were tested for fracture toughness. Monolithic zirconia materials were tested using the Single Edge Pre-Cracked Beam (SEPB) method, while glass ceramics and resin-ceramic hybrids were tested using the Single Edge V-Notch method (SEVN).

Results: Fracture toughness values for monolithic zirconia correlated inversely with increasing yttria content. 3 mol % yttria-stabilized tetragonal zirconia polycrystal (3Y -MZ) had the highest fracture toughness range (5.55 - 5.64 MPa√m), followed by 4Y -MZ (4.02 - 4.15 MPa√m) and 5Y -MZ (2.43 - 2.70 MPa√m). For some 4Y -MZ and 5Y -MZ products, there was not a significant difference in toughness (p <0.05). Several lithium-based glass ceramics (LBC) had a similar fracture toughness (range of 2.46 - 2.68 MPa√m) to 5Y -MZ (p <0.05). Most LBCs had a fracture toughness range of 1.53 - 2.04 MPa√m, higher than that of other glass ceramics but less than that of 5Y -MZ (p<0.05). Results for resin-ceramic hybrids varied from 1.15 - 2.05 MPa√m, with none reaching the fracture toughness of the higher LBCs or 5Y -MZ (p <0.05).

Significance: Clinicians should be aware of the fracture toughness of the materials they use and adjust their preparation parameters accordingly. As fracture toughness decreases, thickness of the resultant restoration should be increased to accommodate the decrease in fracture resistance.

The clinical case demonstrates soft tissue augmentation after GBR in addressing an initially insufficient level of keratinized tissues using a graft with high-quality collagen obtained from the maxillary molar area to increase the volume of soft tissues in a single surgery. This augmentation protocol includes the use of an epithelial embossed connective tissue graft harvested from the maxillary molar area as well as the principle of flap formation involving a= displacement of the initial volume of keratinized tissues lingually and fixation of the graft under full thickness flap on the buccal side.

This case report describes the interdisciplinary management of a 58-year-old female patient with a misaligned dental implant in the left maxillary lateral incisor region, causing aesthetic and functional challenges. Initial assessments revealed significant bone loss around the compromised implant, an asymmetric smile, and excessive gingival display. The treatment included slow orthodontic extrusion to reposition adjacent teeth, promoting bone and periodontal regeneration, and orthodontic intrusion on the contralateral side to correct occlusal cant, and improve gingival aesthetics. Aligners with mini-screw anchorage ensured precise tooth movement and improved conditions for soft tissue grafting. Periodontal procedures enhanced tissue architecture and supported long-term stability, while the final prosthetic rehabilitation successfully restored function and aesthetics, emphasizing the importance of interdisciplinary collaboration for complex cases.

The reconstruction of interproximal papilla around implants is considered challenging with limited predictability due to the anatomical constraints and reduced blood supply to the interproximal area. This report introduces a minimally invasive tunneling approach, assisted by an operating microscope, to augment interproximal papillae and improve soft tissue contours. Four cases are included: Cases 1 and 2 demonstrate soft tissue grafting around adjacent implants, performed either during the second stage or after provisionalization, while Cases 3 and 4 address implant-pontic scenarios. After conditioning the peri-implant tissues using provisionals, all cases achieved satisfactory outcomes, maintaining stability over a period of six to nine years. The described microsurgical tunnel technique, with the combination of buccal and interproximal subepithelial connective tissue graft, appears to be a promising approach for reconstructing peri-implant papillae with reliable long-term stability.

Buccal bone exostosis (BBE) is a late postoperative complication following soft tissue augmentations (STA), defined as localized peripheral benign bone overgrowth. While its occurrence has been reported after skin or free gingival grafts, its association with sub epithelial connective tissue grafts (sCTG) around teeth is less documented. To date, no cases of BBE following autologous tissue grafts, sCTG or de-epithelialized free gingiva grafts (DFGG), around dental implants have been reported. This case series presented five cases of BBE (two around implants, three around teeth) following STA around teeth and implants utilizing either sCTG or DFGG. The BBEs were surgically removed in three cases, and no recurrences were observed after four months to ten years postoperatively. Histological examinations were not conducted. Based on the fact that all cases involved partial-thickness flap, it could be speculated that periosteal tear during STA coupled with autologous tissue grafts triggers osteoinduction and osteoproliferation mechanisms, leading to BBE development.

This article reviews and contrasts resin composites and dental ceramics for anterior esthetic restorations, highlighting their fundamental properties, indications, and clinical performance. Resin composites excel in minor or localized cases-such as class III and IV cavities, minor contour modifications, or closure of small diastemas-owing to their straightforward application, color-matching capabilities, and minimal tooth preparation requirements. However, they are vulnerable to issues like discoloration, wear, and marginal staining, and often need periodic repolishing or repair. Dental ceramics demonstrate superior longevity, color stability, and resistance to wear, making them the preferred choice for extensive rehabilitations, larger restorations, and compromised teeth requiring crowns or bridges. While ceramics generally involve more invasive preparations and demand meticulous bonding procedures, their inert nature and high mechanical strength often result in outstanding long-term outcomes when properly executed. Clinical decision-making should account for factors such as tooth structure, occlusion, patient's age and habits (e.g., parafunctions), staining risk, and esthetic demands. Ultimately, striking the right balanc between biology, function, and esthetics is essential to avoid overtreatment and preserve natural dentition. Through illustrative case studies and a synthesis of relevant literature, this article provides practical guidelines for selecting the most appropriate material for each clinical scenario.

This case report describes an interdisciplinary approach to the aesthetic rehabilitation in a 45-year-old woman bothered by excessively long anterior teeth. Digital Smile Analysis (DSA) guided treatment planning, ensuring optimal proportions and soft tissue integration. Vertical Edgeless Preparation Technique (VEP) was used to establish the correct vertical position of the finishing line. Modified Coronally Advanced Tunnel (MCAT) combined with modified-Connective Tissue Grafts (Micro- and Split-CTG) was performed for root coverage and soft tissue augmentation. After uneventful healing, final ceramic restorations were seated. The integration of BOPT and MCAT optimized periodontal and prosthetic outcomes, achieving a natural, harmonious smile. This approach highlights the synergy between periodontal plastic surgery and prosthodontics in an aesthetically challenging case.