The International journal of periodontics & restorative dentistry最新文献

Impairment or loss of interdental papilla is a common issue in patients with periodontal disease, leading to phonetic, functional, and aesthetic concerns. Numerous techniques have been explored to reconstruct and regenerate interdental papillae, but consistent success remains challenging. This article 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 aesthetic 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 incisions, application of amelogenins, and a trapezoidal shape 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 collapse into the defect area, enhancing the position and volume of the interdental papilla. Results at 6- and 12-months follow-up 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.

The purpose of this technical report is to describe a modified tunnel surgical approach and connective tissue graft (CTG) stabilization technique for the treatment of gingival recessions with interproximal clinical attachment loss (ICAL). The partial-full-thickness (PFT) tunnel technique utilizes multiple vestibular incisions to facilitate creation of a split-mucoperiosteal tunnel that enhances tissue passivity and allows for coronal advancement of soft tissue with minimal tension. The supra-crestal sling (SCS) suture engages only the CTG, independent of the overlying tissue and stabilizes the CTG around the buccal and proximal root surfaces. The treatment approach of PFT tunnel preparation and CTG stabilization with the SCS suture was designed to optimize blood supply and maximize wound stability, resulting in complete root coverage with satisfactory clinical outcomes in RT2 and RT3 gingival recession. It is suggested that the PFT tunnel preparation with graft stabilization via the SCS suture has the potential to treat recessions with anatomical limitations associated with ICAL.

Aim: to assess clinical and radiographical outcomes of single tooth posterior implants with a dehiscence defect treated with or without guided bone regeneration (GBR).

Methods: In a randomized clinical trial of 59 patients, single-tooth posterior implants were placed. For the subanalysis of 16 patients with a buccal dehiscence defect (≤ 5mm), the implants were randomly assigned to GBR or spontaneous healing (SH). In 8 patients, the implants were surrounded by native bone (Native bone). A transmucosal healing approach was chosen for all sites. Patients were examined at restoration delivery (RD) and at one year (1y). Measurements included: soft tissue thickness (STT), bone tissue thickness (BTT) and buccal contour, based on cone-beam computed tomography (CBCT), optical scans, clinical parameters. All data were analyzed descriptively.

Results: The mean STT at implant shoulder (IS) showed a gain of 0.15 mm (Q1: - 0.16, Q3: 0.49) for the GBR group and 0.03 mm (Q1: -0.49, Q3: 0.13) for the SH group. The mean BBT 1 mm below IS showed a loss of 0.25 mm (Q1: -0.85, Q3: -0.09) for the GBR group and 0.04 mm (Q1: -0.14, Q3: 0.17) for the SH group. All peri-implant soft tissue parameters indicated healthy peri-implant tissues with no clinically relevant differences between the groups. Patient-reported outcomes regarding pain one day after surgery were similar among the study groups.

Conclusions: The present sub-analysis resulted in a similar buccal contour and similar radiographic outcomes as well as peri-implant health for sites treated with or without GBR.

Background: The necessity of a minimum volume of keratinized tissue around implants to maintain tissue stability remains a matter of debate. The aim of this case series is to showcase the outcome and long-term maintenance of dental implants that received soft tissue augmentation.

Case presentation: Three cases of second stage following dental implant placement were evaluated for amount of keratinized tissue. Based on the Ono-Nevins classification described here, treatment was rendered including keratinized tissue grafting. The cases were followed for 10, 18 and 28 years. Each case demonstrated maintenance of soft and hard tissue profile around the dental implants with no incidence of peri-implantitis as evidenced on clinical examination and use of peri-apical radiographs.

Conclusion: Soft tissue management around dental implants may play a key role in long-term maintenance of peri-implant health and prevention of peri-implantitis.

This study prospectively evaluated the effect of keratinized mucosa (KM) on the healing of the peri- implant 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 and measurements at 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 month post-operatively, 1 year, 2 years, and 3 years after the surgical intervention. All clinical parameters improved and marginal bone levels remained stable 3 years after therapy. The width of the KM 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.

This PRISMA-compliant systematic review aimed to investigate the effect of supportive peri- implant care (SPIC) on peri-implant tissue health and disease recurrence following the non surgical and surgical treatment of peri-implant diseases. The protocol of this review was registered in PROSPERO (CRD42023468656). A literature search was conducted to identify investigations that fulfilled a set of pre-defined eligibility criteria based on the PICO question: what is the effect of SPIC upon peri-implant tissue stability following non-surgical and surgical interventions for the treatment of peri-implant diseases in adult human subjects? Data on SPIC (protocol, frequency, and compliance), clinical and radiographic outcomes, and other variables of interest were extracted and subsequently categorized and analyzed. A total of 8 studies, with 288 patients and 512 implants previously diagnosed with peri-implantitis were included. No studies including peri-implant mucositis fit the eligibility criteria. Clinical and radiographic outcomes were similar independently of specific SPIC features. Nevertheless, a 3-month recall interval was generally associated with a slightly lower percentage of disease recurrence. The absence of disease recurrence at the final follow-up period (mean of 58.7±25.7 months) ranged between 23.3% and 90.3%. However, when the most favorable definition of disease recurrence reported in the selected studies was used, mean disease recurrence was 28.5% at baseline, considered 1 year after treatment for this investigation, and increased to 47.2% after 2 years of follow-up. In conclusion, regardless of the SPIC interval and protocol, disease recurrence tends to increase over time after the treatment of peri-implantitis, occasionally requiring additional interventions.

Esthetic issues and phonetic disturbances frequently occur after periodontal regeneration of the anterior teeth, even if treatment is supposed to be successful. Conventional regenerative techniques are predominantly targeted at infrabony defects and often inadequately address the loss of the interdental papilla. This study introduces the papillary coronal anchorage technique, a novel modified tunnel surgical procedure, to facilitate the reconstruction of the interdental papilla. This method allows for coronal movement of the entire interdental papilla without incisions at the papilla to facilitate primary wound healing. Using a combination of bone grafts and recombinant human fibroblast growth factor 2 and anchoring the tunnel-like flap coronally using sutures, we successfully achieved a reconstruction of the infrabony defects as well as the interdental papilla. The papillary coronal anchorage technique is effective as it enables the simultaneous reconstruction of both the infrabony defect and the interdental papilla.

This prospective, preliminary controlled clinical trial investigates the comparative effectiveness of platform-switching (PS) versus traditional butt-joint or platform-matching (PM) implant-abutment connections on peri-implant crestal bone stability. Utilizing a split mouth design, 10 systemically healthy patients (n= 20 implants) had adjacent non-restorable maxillary anterior teeth replaced with two different implants (butt-joint connections and platform-switching interfaces). Patients underwent alveolar ridge preservation, followed by implant placement: platform-matching implants were inserted at crestal bone level, and platform-switching implants were placed 1mm subcrestally. Customized Zirconia crowns were then fabricated for both systems. Outcome measures included bleeding on probing (BOP), probing pocket depth (PPD), and marginal bone loss (MBL), which were evaluated through standardized periapical radiographs over 3-year timeframe. Results showed significantly higher initial MBL in the PM group (0.86 ± 0.13 mm) compared to the PS group (0.34±0.29 mm) [p value: p<0.01]. Moreover, at the three-year follow-up, the crestal bone levels remained above the implant shoulder until the third year of the study for the PS subcrestal group (PS: -0.15±0.39 mm) and slightly below the implant platform in the PM crestal group (PM: 0.55±0.19). After 3 years, the PS group also exhibited lower mean BOP percentages (12%) than the butt-joint group (17%). This study suggests that subcrestal placement with PS and internal connections can provide better long-term peri- implant bone preservation, thereby potentially improving implant success and aesthetic outcomes in the anterior maxillary region.