The International journal of periodontics & restorative dentistry最新文献

This case report details the successful treatment of multiple recession type (RT) 3 gingival reces-sions in periodontally compromised mandibular anterior teeth with limited keratinized tissue. A 35-year-old man with stage III, grade C periodontitis underwent a two-stage intervention. Initially, a modification of the connective tissue graft (m-CTG) wall technique was used as part of phenotype modification therapy. The CTG acted as a protective 'wall,' securing space for periodontal regener-ation and thereby enhancing root coverage, soft tissue thickness, and keratinized mucosal width. Recombinant human fibroblast growth factor-2 and carbonate apatite promoted periodontal regen-eration. This procedure successfully facilitated periodontal regeneration, resulting in the transition from RT3 to RT2 gingival recession and achieving adequate keratinized mucosal width. Eighteen months later, the second surgery used a tunneled coronally advanced flap (TCAF) for root coverage. TCAF involved combining a coronally advanced flap and tunnel technique by elevating the trapezoi-dal surgical papilla and using a deepithelialized CTG inserted beneath the tunneled flap. Root con-ditioning with ethylenediaminetetraacetic acid and enamel matrix derivative gel application were performed. Consequently, the mean clinical attachment level gain was 5.3 mm, mean root coverage was 4.5 mm in height, and the gingival phenotype at the treated sites had improved at the 12-month follow-up. This staged approach addresses the challenges of treating RT3 gingival recession with promising outcomes.

Impairment or loss of the interdental papilla is a common issue in patients with periodontal disease, leading to phonetic, functional, and esthetic concerns. Numerous techniques have been explored to reconstruct and regenerate interdental papillae, but consistent success remains challenging. This arti-cle 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 esthetic 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 in-cisions, application of amelogenins, and a trapezoid-shaped 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 col-lapse into the defect area, enhancing the position and volume of the interdental papilla. Results at the 6- and 12-month follow-ups 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.

This case report presents a papillary reconstructive surgical procedure based on the use of a double subepithelial connective tissue pedicle graft (SCTPG) in conjunction with a coronally advanced tunnel flap (CATF) for root coverage of gingival recession defects (GRDs) with interproximal tissue loss and adjacent collapsed papillae. Two GRDs (teeth 12 and 13; FDI numbering system) with interproximal tissue loss and collapsed papillae were treated by means of a bilaminar approach, based on the use of a palatal double SCTPG rotated and inserted into a palatal-buccal tunnel flap at the level of the mesial and distal papillae of the maxillary right lateral incisor, associated with a CATF. Seven months after surgery, complete root coverage was achieved in both GRDs. Concerning the reconstruction of tooth 12's papillae, the distance from the contact point to the tip of the distal and mesial papillae decreased from 5 to 2 mm and from 4 to 2 mm, respectively. Overall, the patient was highly satisfied with the outcome. Within the limits of this case report, it could be demonstrated that the double SCTPG + CATF promoted prominent clinical and esthetic improvements to the baseline conditions of both the GRDs and collapsed papillae.

This case report presents the 37-year follow-up results of a gingival recession (GR) treatment in the maxillary esthetic zone. In 1987, a healthy 20-year-old woman with a history of orthodontic treatment presented with a chief complaint of GR on the facial area of tooth 21 (FDI numbering system). There was no occlusal trauma, hypersensitivity, or parafunctional habit. Clinically, there was a 4-mm GR on the facial surface, classified as Miller class I (RT1), with a probing depth of 1 mm and no bleeding on probing. A partial-thickness flap was reflected around the teeth to be grafted. The donor site (palate) provided a subepithelial connective tissue graft (SCTG), as per the Langer and Langer protocol. A 2-mm-thick graft was harvested and surgically placed on the recipient site; the flap was then reposi-tioned. The patient was evaluated after 6 months (GR: -0.5 mm), 27 years (GR: 1.0 mm), and 37 years (GR: 1.5 mm). This was a successful long-term result. However, a relapse was noted, possibly exac-erbated by orthodontic treatment associated with the thin overall phenotype in both arches. SCTG is a safe and effective modality for long-term root coverage, demonstrating tissue stability, thickness gain, and complete root coverage within 6 months after the procedure. A relapse of approximately 1.5 mm was noted on the facial surface after 37 years.

This analysis aimed to assess clinical and radiographic outcomes of single-tooth posterior implants with a dehiscence defect treated with or without guided bone regeneration (GBR). 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 (≤ 5 mm), the implants were randomly assigned to GBR or spontaneous healing (SH). In 8 patients, the implants were surrounded by native bone. A transmucosal healing approach was chosen for all sites. Patients were examined at restoration delivery (RD) and at 1 year, and the following measurements were included: soft tissue thickness (STT), bone tissue thickness (BTT), and buccal contour, based on CBCT imaging, optical scans, and clinical pa-rameters. All data were analyzed descriptively. The mean STT at the implant shoulder (IS) showed gains of 0.15 mm (Q1: -0.16 mm, Q3: 0.49 mm) for the GBR group and 0.03 mm (Q1: -0.49 mm, Q3: 0.13 mm) for the SH group. The mean BBT at 1 mm below the IS showed losses of 0.25 mm (Q1: -0.85 mm, Q3: -0.09 mm) for the GBR group and 0.04 mm (Q1: -0.14 mm, Q3: 0.17 mm) for the SH group. All peri-implant soft tissue parameters indicated healthy peri-implant tissues with no clinical-ly relevant differences between the groups. Patient-reported outcomes regarding pain at 1 day post-surgery were similar among the study groups. The present subanalysis resulted in a similar buccal contour, radiographic outcomes, and peri-implant health for sites treated with or without GBR.

The growth in bone reconstructive surgery has been unsurpassed in recent decades. However, most bone-regenerative products lack any potential for delivering site-specific morphologically driv-en augmentation. It was therefore the purpose of this study to evaluate the histologic and clinical incorporation of a novel CAD/CAM allogeneic block bone graft for the reconstruction of complex 3D alveolar defects. In addition, the clinical outcome of dental implants subsequently placed and load-ed within these grafts was assessed after up to 5 years in function. Results demonstrated that 4 of the initial 17 blocks failed (23.5%). The remaining 13 blocks plus an additional 2 replacement blocks were fully or partially incorporated within the recipient bone site (79%). Of the 32 implants placed within the integrated blocks, no failures occurred after up to 5 years in function, with a recorded mean marginal bone loss of -0.5 mm per implant.

The innervation of the hard and soft tissues of the anterior maxilla depends on the nasopalatine nerve. Due to its anatomy and proximity to implants in the esthetic area, it is essential to fully com-prehend its traits and possible effects while performing implant placement procedures. This review and meta-analysis aimed to assess the prevalence of neurosensorial alteration and the survival and success rates of dental implants in a relationship with the nasopalatine canal. A comprehensive search of the literature was conducted in MEDLINE, Web of Science, and Scopus databases. The included articles had to be case series or studies conducted in patients undergoing implant pro-cedures in the incisive canal region or who had undergone dental procedures with incisive canal deflation or neurovascular lateralization. A quantitative synthesis was performed using a meta-anal-ysis software program. Fixed- or random-effects models were applied based on the heterogeneity among studies. Four studies were included, and neurosensorial alterations were present in three of them. The range of neurosensorial alteration prevalence varied from 0% to 60%. A weighted mean of 29% ± 13% of neurosensorial alterations was calculated from the meta-analysis, and mean sur-vival and success rates were both 100%. Implant placement in the nasopalatine area is associated with high survival and success rates, as it is a safe procedure, but clinicians should be aware that neurosensorial alterations may be present when placing implants in this area.

This study explores the effect of Er,Cr:YSGG laser tooth etching vs that of conventional tooth sur-face treatment on the shear bond strength of ceramic laminate veneers. A total of 76 maxillary premolars were assigned to two groups (n = 38 per group) according to the type of enamel surface treatment approach: Group 1 comprised samples treated with the conventional acid-etch protocol, and Group 2 comprised samples subjected to Er,Cr:YSGG laser. Light-curing resin cement was used to bond the restoration to the tooth, and specimens were thermocycled for 30,000 cycles. Shear bond strength testing was conducted on all specimens. The samples were observed using a scanning electron microscope to record enamel topography and a stereomicroscope to monitor the mode of failure. P ≤ .05 was considered significant. There were no statistically significant differenc-es between the acid-etch and laser enamel surface treatment groups for the shear bond strength values at maximum load (P = .627). There was a significantly higher proportion of cohesive failure in the acid-etch group compared to the laser treatment group and a significantly lower proportion of mixed failure in Group 1 compared to Group 2 (P = .022). Concerning the laminate veneer bond strength, the effects of laser and traditional acid etching on the enamel surface were the same. Enamel surfaces can be successfully etched using a laser as an alternative to the traditional acid- etch method.