The International journal of periodontics & restorative dentistry最新文献

A total of 57 interproximal restorations invading the supracrestal tissue attachment were evaluated in terms of crestal bone loss over a mean period of 15 years (10 to 23 years). The distance from the cavity margin to the bone was measured at T0 (after the restoration; baseline) and controlled using radiographs and a measurable landmark. The mean vertical bone loss was 0.46 mm, with a 96.49% survival rate. Smoking habits (P = .02) and tooth type (P = .03) significantly affected bone loss. The proposed technique could help the clinician in adopting a minimally invasive approach in the treatment of heavily compromised teeth. Future research with rigorous study designs would be interesting to guide the clinical decision-making.

Volumetric resorption of the alveolar ridge often occurs in both horizontal and vertical directions following tooth extraction. There is a specific lack of evidence for alveolar ridge reconstruction at molar and premolar sites with severe bone resorption. This randomized controlled trial used 3D and linear analyses to evaluate volumetric changes of the alveolar bone following alveolar ridge reconstruction (ARR) at molar and premolar sites with severe bone resorption as compared to unassisted socket healing before implant placement. A total of 31 patients (15 men, 16 women) with > 50% hard tissue loss in one or more socket walls were recruited and randomized into either a test group (postextraction ARR using deproteinized bovine bone mineral with 10% collagen [DBBM-C] and platelet-rich fibrin [PRF] with a resorbable collagen membrane) or a control group (natural healing after extraction). The clinical, linear, and volumetric implant-related and patient-reported outcomes were analyzed after 4 months of healing. Linear bone assessments revealed significantly greater ridge width gains in the test group (25% in the mesial, midfacial, and distal aspects) and less reduction of vertical bone ridge than in the control group (P < .05). Further, volumetric bone remodeling was significantly higher in the test group (35.1% ± 34.9% for ARR, 14.2% ± 12.8% for control; P < .05). Patient-reported discomfort and keratinized mucosal changes were comparable between groups. ARR with a combination of DBBM-C, PRF, and a resorbable membrane at posterior sites with a severe socket wall deficiency (> 50% bone loss) is a safe and more capable therapeutic method when compared to natural healing and unassisted sockets. Collectively, the present analyses demonstrate that ARR represents an efficient method to maintain and augment crestal bone at posterior extraction sites with severe bone defects when assessed after 4 months of healing.

Gingival fenestration is a relatively uncommon soft tissue lesion in which the root apex is exposed in the oral environment after the destruction of the overlying buccal bone plate and mucosa. At present, no clear etiology or treatment guidelines exist for gingival fenestration. This article reports three successfully treated cases of gingival fenestration associated with chronic periapical infection and can help contribute to treatment guidelines for gingival fenestration. All cases were treated with apicoectomy in conjunction with a connective tissue graft (CTG), and the first steps of each case were as follows: endodontic therapy with root-end resection and retrograde filling, then regenerative surgical therapy. However, slightly different regenerative treatment methods were used during the operation according to the different patient conditions. In Case 1, gingival fenestration in the mandibular left first premolar was treated using a xenograft and CTG. In Case 2, gingival fenestration in the maxillary left lateral incisor was treated using advanced platelet-rich fibrin (A-PRF) and CTG. In Case 3, gingival fenestration in the mandibular left second premolar was treated using CTG. Endodontic treatment was combined with periodontal surgery to achieve predictable results. After 13 to 25 months of follow-up, all cases showed well-healed gingival fenestrations and no discomfort. These three cases show the possibility of using apical excision combined with a CTG and/or bone graft/A-PRF in the treatment of gingival fenestration. Reporting these three cases may help advance the field of gingival fenestration treatment.

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.