The International journal of periodontics & restorative dentistry最新文献

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.

This retrospective study aimed to compare extended sinus elevation and extramaxillary surgical protocols for restoring severely atrophic maxillae with zygomatic implants (ZIs) and evaluate their clinical effectiveness. The study included patients who were treated at a dental clinic in Italy from 2012 to 2022 who received fixed screw-retained complete dentures supported by either two or four ZIs. The patients underwent a minimum 1-year follow-up after 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 elevation and extramaxillary techniques, using the ZAGA approach for ZI placement. The results showed that out of 19 patients with a mean age of 65.3 years, a total of 56 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. Both the extended sinus elevation and extramaxillary protocols demonstrated comparable clinical outcomes and minimal complications in the restoration of severely atrophic maxillae with ZIs. However, further extensive studies involving larger, multicenter designs and longer follow-up periods are needed to validate and refine these outcomes.

Biocompatibility has been defined by Williams as “the ability of a biomaterial to perform its desired function with respect to a medical therapy, without eliciting any undesirable local or systemic effects in the recipient … and optimizing the clinically relevant performance of that therapy.”1 Monolithic zirconia (MZ) is often described as the most biocompatible ceramic option for indirect dentistry.2 This assertion is typically presented with no attached citations, implying that it is a generally known fact. The purpose of this commentary is to explore the biocompatibility of MZ not only as it relates to localized cellular response, but also within the context of the broader stomatognathic system.

A recent update in periodontal terminology includes a shift from the term biotype, replacing it with the term phenotype. Periodontal phenotype evaluation and diagnosis is possible when findings from the clinical examination to establish the gingival phenotype are combined with assessment of the bone morphotype, commonly using CBCT imaging technology. Such analysis is critical to treatment planning, particularly for interdisciplinary dentofacial therapy (IDT) patients whose treatment often involves clinical interventions such as surgery, orthodontic tooth movement, and/or extensive restorative treatment. This paper highlights how this shift in terminology can also be considered an evolution of thought process, as the phenotype offers a more comprehensive way to guide planning at the foundational level and offers an updated approach for diagnosing and planning treatment for IDT patients. Being able to identify a patient with a seemingly intact periodontal phenotype that will become susceptible or deficient over time without planned intervention is critical. Until now, there has been no established protocol recommended for risk assessment regarding iatrogenic sequelae on the periodontium involving tooth movement. A systematic approach, phenotype-driven treatment planning (PDTP), is introduced here, and an updated outcome of treatment, termed optimized periodontal phenotype, is suggested.

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 nonsurgical and surgical treatment of peri-implant diseases. A literature search was conducted to identify investigations that fulfilled a set of predefined eligibility criteria based on the following PICOS question: What is the effect of SPIC upon peri-implant tissue stability following nonsurgical 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 were included, comprising 288 patients and 512 implants previously diagnosed with peri-implantitis. No studies including peri-implant mucositis fit the eligibility criteria. Clinical and radiographic outcomes were similar, independent 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: 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. Regardless of the SPIC interval and protocol, disease recurrence tends to increase over time after the treatment of peri-implantitis, occasionally requiring additional interventions.

This paper introduces the continuous crossing mattress periosteal suture technique (CMPST), designed to enhance flap adaptation and maintain the established apical displacement of the flap during various periodontal resective surgeries, particularly restorative-driven (or functional) crown lengthening in multiple teeth at anterior or posterior areas. This suture technique securely positions the flap apically, just coronal to the bone, and anchors it at the periosteum, combining the advantages of both continuous and cross-compression sutures without compromising the esthetic results. By eliminating flap mobility, it ensures stable and intimate contact with underlying tissues. Further controlled studies are needed to assess the clinical applicability of this technique compared to other suture techniques.

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 predominantly target 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 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 coronally anchoring the tunnel-like flap using sutures, reconstruction of both the infrabony defect and the interdental papilla were achieved. The papillary coronal anchorage technique is effective, as it enables the simultaneous reconstruction of both the infrabony defect and the interdental papilla.

Exosomes, the smallest subset of extracellular vesicles, play a crucial role in cell signaling and communication throughout the body. Their regenerative potential has sparked tremendous interest, with over 5,000 articles on exosomes published yearly, primarily focused on in vitro and preclinical studies. However, to date, no study has investigated their use in humans for dental applications. In this first case report, horizontal ridge augmentation was performed using a novel combination of bone allografts, platelet-rich fibrin, and a specialized subset of exosomes (Periosomes). Implants were placed at 3 months postsurgery, during which a core biopsy sample was taken for histologic analysis. Additionally, CBCT scans were obtained at 1, 2, 3, and 6 months, revealing marked and progressive bone growth. To the authors' knowledge, this study represents the first documented use of exosomes in human alveolar bone regeneration. This case highlights the promising potential of exosomes in regenerative dentistry, opening new avenues for their application in guided bone re-generation procedures.