The International journal of periodontics & restorative dentistry最新文献

The present clinical report introduces a novel surgical procedure, the apical tooth replantation with surgical intrusion technique (ATR-SIT), for managing teeth with a hopeless prognosis compromised with a severe endoperiodontal lesion, pathologic tooth migration, and gingival recession. Two cases are presented that manage teeth diagnosed with a hopeless prognosis. ATR-SIT involves tooth extraction, extraoral root debridement, root surface conditioning, apicoectomy, retrograde filling, and the application of enamel matrix derivatives prior to reimplantation. Following reimplantation, the teeth are covered with a combination of autogenous bone chips and bone substitute materials, then covered with resorbable membranes. After ATR-SIT, the patients received either orthodontic treatment or tooth-supported fixed dental prostheses. The described ATR-SIT effectively improved the initially hopeless prognosis of the teeth and maintained periodontal health over time, evidenced by favorable clinical and radiographic outcomes. ATR-SIT might be a potential alternative to extraction of hopeless teeth in patients with stage IV periodontitis.

Purpose: The study aimed to compare the short-term outcomes (3.7±0.4yrs) of full-arch immediately loaded fixed maxillary prostheses supported by conventional and unilateral single zygomatic implants versus those supported by conventional and bilateral single zygomatic implants.

Methods: A retrospective analysis was conducted on patients suffering severe bone loss in the posterior area of the maxilla. The success of zygomatic implants was defined following Offset-Rhinosinusitis-Infection-Stability (ORIS) criteria. The criteria used to define success of standard dental implants were absence of mobility, pain, discomfort/neurologic disorder, and of persistent or chronic infection. The level of significance was 0.01.

Results: Thirty-eight patients received 2-5 standard implants plus two zygomatic implants (bilateral), whereas 10 patients had 3-5 standard implants plus a single zygomatic implant (unilateral). The cumulative success rate for standard implants was 99% and 97.3%, respectively, in the bilateral and unilateral groups. Four patients showed symptoms of acute rhinosinusitis (R-criterion): 1 in the unilateral and 3 in the bilateral group. Following the O-criterion, just 2 dental implants in the bilateral group showed a success grade 1. One zygomatic implant, belonging to the group bilateral, developed peri-implant mucositis with a success grade 3 (I-criterion). All zygomatic implants were checked individually and did not show either any signs of mobility or rotation after applying forces to the implant (S-criterion). The ORIS criteria divided the implants into three groups according to the success grades I,II,III: 32,36,8 for the bilateral, and 6,1,3 for the unilateral group, with no significant difference between the two groups. No zygomatic implant failure occurred so that the same zygomatic implant success rate (100%) was recorded for both groups. A prosthetic failure was registered in the unilateral group. The overall prosthesis success rates were 89.5% and 70%, respectively, in the bilateral and unilateral groups.

Conclusions: A high degree of success was achieved for both groups treated with zygomatic implants, although in group unilateral there was one failure of a standard dental implant placed in the posterior area. This suggested that the use of zygomatic implants could provide adequate support to the fixed full-arch prostheses even in the configuration with a single unilateral zygomatic implant.

Background: The adjunctive use of connective tissue grafts (CTGs) in the periodontal regeneration of intrabony defects has been proposed to prevent or limit postoperative gingival recession. However, there is limited evidence regarding the long-term clinical performance of this approach.

Methods: This article presents the five-year follow-up outcomes of a combination therapy using CTG, bone substitutes, and biologics for the treatment of deep intrabony defects associated with gingival recession. Twelve healthy, non-smoking patients with 12 deep intrabony defects participated in the study. These patients had a mean clinical attachment loss (CAL) of 9.9 ± 2.1 mm, a mean probing depth (PPD) of 7.8 ± 1.5 mm, and a mean buccal recession (REC) of 2.3 ± 1.8 mm at baseline, before= undergoing the described treatment regimen.

Results: After five years, the mean clinical attachment level (CAL) gain was 5.7 ± 3.2 mm (p < 0.001), the mean reduction in probing pocket depth (PPD) was 5.1 ± 1.6 mm (p < 0.001), and the mean reduction in recession (REC) was 1.2 ± 2.1 mm (p = 0.07) Ninety-one percent of sites achieved CAL gain of ≥3 mm and PPD ≤ 4 mm. Compared to baseline, 7 out of 12 sites showed a REC reduction of ≥1 mm, while three sites remained stable, and two sites experienced an increase in gingival recession depth of 1 and 2 mm respectively.

Conclusion: Within the limitations of this case series, periodontal regenerative therapy incorporating the adjunctive use of CTG showed to be effective for treating deep non-contained periodontal intrabony defects and respectively stabilize or slightly improve the gingival margin over five years.

Sinus membrane perforations are among the most commonly reported intraoperative complications encountered during maxillary sinus floor elevation procedures performed via the lateral window approach. Large perforations (> 10 mm) can pose a major clinical challenge, and often result in failed bone augmentation and poorer long-term implant survival. Owing to these challenges, even a highly skilled oral implant surgeon with advanced training in implantology faced with such perforations may abandon grafting procedures in favor of a reentry approach. This article describes a novel approach to managing large perforations through the use of a collagen membrane stabilized by tacks on the medial and lateral walls that is permissive to simultaneous bone augmentation.

This split-mouth trial investigated the efficacy of treating bilateral gingival recessions with either a xenogeneic cross-linked collagen matrix (CCM), or recombinant human platelet derived growth factor (rhPDGF-BB) with a bone allograft (AG). Ten patients were treated with the coronally advanced flap (CAF), either with a CCM, or rhPDGF-BB + AG. The primary outcome was percentage of mean root coverage (mRC) at 12 months. Additional outcomes included clinical, volumetric, patient-reported outcome measures (PROMs) and ultrasonographic assessment of gingival thickness (GT) and position of the buccal bone (uBD). At 12 months, both groups showed significant improvements, with a mRC of 78.6% in the CCM group, and 82.3% for the rhPDGF-BB + AG sites. 3D analysis of both groups showed comparable volumetric gain. CCM-treated sites displayed higher ultrasonographic echogenicity in GT (p<.01) than rhPDGF-BB + AG sites. The rhPDGF-BB + AG group showed greater reduction in the buccal bone dehiscence (mean 2.03 mm, p<0.01), less swelling during the first three days, and slighty greater mean root coverage. CCM and rhPDGF-BB + AG showed to be effective in the treating multiple adjacent gingival recessions. CCM promotes greater gain in gingival thickness, while rhPDGF-BB + AG resulted in a significantly less buccal bone dehiscense.

The Pinhole Surgical Technique (PST) was first described in the International Journal of Periodontics and Restorative Dentistry (IJPRD) in October 2012, in a case series involving 43 patients with 121 recession defects, including follow-up data for 37 patients with 85 Miller Class I-II recession defects over an average period of 20.0 ± 6.7 months. The current study provides a long-term follow-up assessment of 28 patients with 68 Miller Class I-II sites from the original study, with an average follow-up period of 173.8 ± 32.2 months (14.5 ± 2.7 years). The percentage of complete root coverage (CRC) for Class I-II sites was 81.2% in the original study and 77.9% in this follow-up study. The mean root defect coverage was 94.0% ± 14.8% in the original study and 86.6% ± 27.4% in the follow-up study. Within the limitations of this study's design, PST demonstrates long-term predictability and effectiveness in achieving sustained root coverage over an average period of 14.5 years.

This study aimed to assess the effectiveness of repeated subgingival instrumentation combined with 980 nm diode laser decontamination in the non-surgical treatment of deep periodontal pockets. A total of 40 otherwise healthy patients with generalized periodontitis, encompassing 1,168 sites with deep pockets, were included and baseline PPD, bleeding on probing (BOP), gingival recession (REC), clinical attachment level (CAL), and plaque index (PI) were recorded. Each patient underwent non-surgical laser-assisted periodontal therapy and was enrolled in a maintenance program with three-month recall visits during the first year of follow-up. In non-responding sites, site-specific non-surgical instrumentation was repeated during follow-up visits. The achievement of pocket closure (PPD ≤ 4 mm with negative BOP) was evaluated as the primary outcome. Changes in the above parameters were also measured at 3 months (T1) and 1 year (T2). Additionally, a logistic regression model was constructed to explore the association of pocket closure at T2 with several predictor variables. At the three-month evaluation, 677 of the treated sites (57.96%) achieved pocket closure. This number increased significantly after one year, with 977 out of 1,168 sites (83.65%) requiring no further treatment. The logistic regression analysis indicated that a higher number of roots, older age, history of diabetes mellitus, and greater baseline PPD were associated with lower pocket closure at T2. Within its limitations, the present study demonstrates that the outcomes of initial non-surgical periodontal therapy can be further enhanced by repeated site-specific laser assisted non-surgical instrumentation, scheduled quarterly during the first year of follow-up.

It is well known that keratinized mucosa (KM) plays a crucial role for maintaining peri implant health and esthetic outcomes. The Strip Gingival Graft (SGG) technique, which involved an apically positioned flap (APF), in combination with an autogenous SGG and a xenogeneic collagen matrix (XCM), demonstrated its efficacy in re-establishing an adequate amount of KM width at implant sites. Nevertheless, it is still unclear whether harvesting the SGG from the palate (pSGG) or from the buccal aspect of natural dentition (bSGG) affects the esthetic outcomes at the augmented implant sites. Therefore, the objective of the present study was to compare the esthetic outcomes of dental implants augmented with either bSGG + XCM or pSGG + XCM. The present study was designed as a single-center retrospective study, assessing the esthetic and colorimetric outcomes of peri-implant KM augmentation with either pSGG + XCM or bSGG + XCM in cohort of 49 subjects. The two groups were compared in terms of colorimetric outcomes, assessed on clinical photograph using specific software able to identify and quantify the predominant color within the peri implant soft tissue. Colorimetric comparisons with adjacent untreated sites were also investigated. In addition, the Pink Esthetic Score (PES) and the Subjective Esthetic Score (SEE) were performed to further assess the esthetic outcomes of pSGG + XCM and bSGG + XCM. The colorimetric analysis did not show statistically significant differences among sites augmented with pSGG + XCM, sites augmented with bSGG + XCM, and untreated sites. Implants treated with bSGG + XCM showed significantly greater PES (in terms of shape of the mesial and distal papilla, level of the soft tissue margin, soft tissue contour, anatomy of the alveolar process, and final PES) and SEE compared to implants augmented with pSGG + XCM. The present study demonstrated that implant sites augmented with APF with either pSGG + XCM or bSGG + XCM did not show different colorimetric outcomes compared to adjacent untreated sites, while bSGG + XCM obtained superior professional and subjective esthetic scores compared to pSGG + XCM.

Purpose: This retrospective study aimed to compare extended sinus lift and extramaxilla surgical protocols for restoring severely atrophic maxillae with zygomatic implants (ZIs) and evaluate their clinical effectiveness.

Materials and methods: The study includes patients who were treated at a dental clinic in Italy from 2012 to 2022. These patients received fixed screw-retained complete dentures supported by either two or four zygomatic implants (ZIs). The patients underwent a minimum one-year follow-up post-loading, following two protocols: the hybrid and the quad protocol. Digital planning incorporated CBCT scans, intraoral scans, and digital prosthetic plans within implant planning software. Surgical techniques involved extended sinus lift and extramaxilla techniques methods, utilizing the ZAGA approach for ZI placement.

Results: The results showed that out of 19 patients with a mean age of 65.3, a total of 56 zygomatic implants (ZIs) and 20 standard implants were used, with no failures observed in either the implants or the definitive prostheses, resulting in a 100% survival rate. According to the ORIS criteria, overall success was achieved in terms of implant stability, sinus health, peri-implant soft tissue condition, and prosthetic function. Only two ZIs (3.6%) exhibited minor gingival recession and moderate thread exposure, which were closely monitored through professional hygiene maintenance.

Conclusion: Both the extended sinus lift and extramaxilla protocols demonstrated comparable clinical outcomes and minimal complications in the restoration of severely atrophic maxillae with Zygomatic Implants (ZIs). However, further extensive studies involving larger, multicenter designs and longer follow-up periods are needed to validate and refine these outcomes.

The integrity and phenotype of periodontal soft tissues significantly influence the outcome of surgical periodontal regenerative therapy. In cases with thin gingival phenotype, treating infrabony defects surgically can worsen gingival recession and loss of papillae. This report outlines a surgical approach for addressing infrabony defects at sites with gingival recession and thin phenotype. The treatment involves using a tunneled coronally advanced flap (TCAF) to obtain access for defect debridement, root instrumentation, graft placement, and tissue advancement for root coverage. A connective tissue graft (CTG) is secured to the two teeth flanking the infrabony defect with two subperiosteal sling (SPS) sutures to create a buccal soft tissue wall and to tent up the papilla overlying the defect to provide and maintain the necessary space for biomaterials and clot stability. The treatment significantly improved interproximal clinical attachment levels, tissue phenotype, and root coverage one-year post surgery. Treatment outcomes suggest that this approach may be used to effectively treat isolated infrabony defects associated with gingival recession.