The International journal of periodontics & restorative dentistry最新文献

This case series evaluated the laterally positioned multiple papilla flap (LPMPF) combined with a connective tissue graft (CTG) for the treatment of multiple adjacent gingival recessions (MAGRs) with a 10-year follow-up. Seventeen systemically healthy, non-smoking adults with RT1 MAGRs were treated. Recession depth (REC), Keratinized tissue width (KTW), percentage of root coverage (RC), achievement of complete root coverage (CRC) and Root Coverage Esthetic Score (RES) were assessed 1, 5, and 10 years after the surgery. At 1 year, mean RC was 92.8% with 80% CRC; outcomes remained stable over time, with 91.5% RC (p = 0.457) and 66% CRC at 10 years (p = 0.172). REC significantly decreased from 2.37 ± 1.16 mm at baseline to 0.19 ± 0.44 mm at 1 year (p < 0.001), with no significant change at 5 or 10 years (p = 1.000). KTW significantly increased from 1.46 ± 0.69 mm at baseline to 2.75 ± 1.08 mm at 1 year (p < 0.001) and remained stable thereafter (p = 1.000). Esthetic outcomes were consistently high (RES ≥ 8.8) and stable across timepoints (p = 0.839). Baseline REC and KTW were not associated with RC or CRC (p > 0.1); greater baseline REC correlated with lower RES at 1 year only (ρ = -0.410; p = 0.003). Within the limitations of the present study, LPMPF + CTG appears to be a reliable treatment for MAGRs, providing favorable long-term outcomes in terms of esthetics and root coverage over a decade.

This case report introduces a novel open-source-based digital workflow for esthetic crown lengthening (ECL) utilizing a customized 3D-printed surgical guide. A 35-year-old female patient with excessive gingival display underwent ECL planned through an integrated model combining intraoral scanning and cone-beam computed tomography data. Virtual simulation enabled precise measurement of periodontal structures, and a surgical guide termed the gingivectomy with osseous resective surgery template (GORST) was designed using free software. The GORST integrated a gingivectomy guiding line and bone reduction windows, allowing soft and hard tissue management in a single stent. Surgical execution followed the preoperative plan accurately, resulting in significant esthetic improvement with elongated clinical crowns, symmetrical gingival contours, and no postoperative hypersensitivity. This workflow offers a cost-effective, predictable approach for esthetic periodontal surgery while also reducing the surgical time. Further clinical studies are warranted to validate its broader applicability.

Aims: To document the clinical and radiographic outcomes of a conservative mucogingival surgical protocol-combining coronally advanced flap, defect debridement, bioceramic repair material, and connective tissue graft-in the management of external cervical root resorption, with emphasis on soft-tissue stability, esthetics, and pulp vitality preservation.

Methods: Ten patients with external cervical root resorption diagnosed by cone-beam computed tomography were classified according to Patel's three-dimensional system. Treatment involved a coronally advanced flap, defect debridement, application of bioceramic material to repair the defect, and a connective tissue graft. Clinical and radiographic outcomes were monitored over a three-year follow-up period.

Results: All treated teeth remained functional and asymptomatic after three years. The protocol preserved soft-tissue esthetics with minimal gingival recession. Pulp vitality was maintained in eight cases, likely related to the biocompatibility of the bioceramic material.

Conclusions: Within the limitations of this case series, the combined surgical approach appeared to be associated with favorable clinical outcomes, including maintenance of tooth vitality, soft-tissue stability, and satisfactory esthetics. These preliminary findings should be interpreted cautiously and confirmed in controlled clinical studies.

The long-term success of implant-supported restorations depends on achieving both esthetic and biologic stability through proper management of the transmucosal space. This article introduces a novel concept for comprehensive surgical, restorative, and laboratory interpretation of the subgingival implant complex by dividing it into two functional compartments: the Biological Room (BR) and the Restorative Room (RR). The BR, located immediately coronal from the bone-to-implant contact, is responsible for peri-implant tissue integration which serves as a biologic barrier. This biologic barrier is achieved by the connective tissue and apical peri-implant epithelium which is populated by hemidesmosomal attachments. It must be managed using biocompatible materials (eg, titanium or zirconia) with specific surface properties (roughness 0.1-0.2 microns) to promote stable mucointegration. A minimum height of 2.0 mm is recommended for optimal hemidesmosomal function. The RR, located coronal to the BR, supports soft tissue architecture and esthetics and extends up to 3.0 mm. The prosthetic component in the RR is shaped to accommodate restorative needs and optimize the esthetic interface. Materials used here must balance esthetics, cleanability, and biocompatibility with highly polished surfaces to minimize plaque accumulation. This biologically driven framework enables clinicians and dental technicians to provide implant restorations that respect both esthetic and biologic principles, while promoting long-term peri-implant tissue health and clinical success. Previously, these concepts were described separately, but the Biological Room and Restorative Room concept serves as a guideline for all team members to achieve a desirable implant therapy.

Periodontitis stage IV may be characterized by pathological tooth migration (PTM) which, when orthodontic correction is needed, represents the conditions to define the type 2 phenotype according to the EFP Clinical Practice Guideline. Here, 4 clinical cases of patients with stage IV type 2 periodontitis and deep intrabony defects adjacent to the migrated teeth are presented. After successful steps 1 and 2 of periodontal treatment, the intrabony defects were subjected to regenerative periodontal surgery, and active orthodontic movement began early (2-4 weeks) after surgery. Follow-ups of up to 24 months demonstrate the effectiveness of interdisciplinary periodontal-orthodontic treatment in controlling inflammation, regenerating intrabony defects, realigning pathologically migrated teeth and thereby restoring esthetics and function for the patient.

The technical report described a novel treatment protocol for multiple recessions with anatomy- driven complexity from pre-operative evaluation, flap preparation, and the combination use of grafting materials. Clinical examination and cone-beam computed tomography were used to perform the comprehensive assessment before surgery. During surgical approach, sequentially combined bilaminar tunnel technique(cTUN) was performed. Firstly, tunneled coronally advanced flap (tCAF) was made at the most severe tooth sites, and the combination of modified tunnel technique with modified tunnel and vestibular incision subperiosteal tunnel access (mVISTA) was used to bypass the anatomic obstacles from two directions. Lastly, the de-epithelialized free gingival graft (DCTG) was sutured at coronal part for gingival recession coverage, and the volume-stable collagen matrix (VSCM) was placed at apical partially thickness flap to fill the concavities. When high complexity with anatomic difficulties was determined, the cTUN technique, combined tCAF and mVISTA approaches, effectively led to the preservation of flap integrity during flap preparation, favorable clinical outcomes of root coverage, and the stability of soft tissue at 6-month follow-up based on the reported cases.

Rehabilitation of severely atrophic maxillae with zygomatic implants requires wide surgical access and precise soft tissue management to minimize dehiscence and promote long-term stability. The ZAGA Concept emphasizes individualized incision and flap design based on anatomical and prosthetic parameters.

Materials and methods: A decision tree was constructed to guide incision and flap selection during primary surgery, based on five anatomical factors: bone discontinuities identified on CBCT, palatal mucosa thickness, expected implant platform position (channel vs. tunnel), buccal keratinized tissue width, and skeletal or dental Class III relationships. Five flap types were defined: ZAGA Palatal Roll Flap, Partial Thickness Flap, Double Pedicle Flap, Buccal Fat Pad Flap, and Scarf Graft.

Results: Each flap showed specific indications depending on the anatomical context. When properly selected, incision and flap designs improved soft tissue coverage, preserved or increased keratinized mucosa, and reduced soft tissue complications. The decision tree enabled systematic and reproducible selection of main incision and flap type based on patient-specific anatomy.

Conclusions: Integrating incision and flap design into surgical planning allows for individualized soft tissue management in zygomatic implant therapy. The proposed decision tree offers a practical, anatomy-driven protocol to optimize outcomes in the rehabilitation of the atrophic maxilla.

This review evaluated the methodology, quality, and outcomes of systematic reviews (SRs) assessing the efficacy of treatments for molar class II furcation defects. An electronic search was conducted across Cochrane Library, Medline/PubMed, Scopus, and Web of Science. AMSTAR 2 and ROBIS tools were used. Eleven SRs, encompassing a total of 98 randomized clinical trials (RCTs) were included. Three SRs were rated as high quality and low to moderate risk of bias according to the AMSTAR 2 and ROBIS assessments, respectively. Most SRs were rated as moderate by both tools. Open flap debridement (OFD) alone demonstrated limited clinical benefit. Guided tissue regeneration (GTR), using either resorbable or non-resorbable membranes, showed greater efficacy, particularly when combined with bone grafting materials, resulting in superior horizontal and vertical attachment and bone level gains compared to OFD. The efficacy of adjunctive therapies including enamel matrix derivatives and platelet concentrates remains inconclusive. Regenerative techniques, especially GTR combined with grafting, appear to be the most effective treatment for class II furcation defects. The heterogeneity among the RCTs reported in the included SRs highlights the importance of standardized methodologies in future research to strengthen the evidence base and enhance clinical recommendations. This review was registered in PROSPERO (CRD420251029622).

This retrospective case report documents the successful use of a mineralized allograft hydrated by a combination of recombinant human platelet derived growth factor-BB and enamel matrix derivative to regenerate the buccal furcations of two adjacent maxillary molars. Twelve years later, despite the complete fill with bone in both furcations, the second molar developed a resorptive lesion near the furcation area requiring its removal. The surgical procedure to replace it with a dental implant enabled visual inspection of the furcations on both teeth and histologic evaluation of the second molar's complete furcation fill. The findings from this case present the potential to regenerate a stable new attachment apparatus. The histologic findings further elucidate both the long term fate of this graft-biologic combination which did not completely turnover to host bone as well as the contribution that it may play in guided tissue regenerative therapy.

Objectives: To estimate the feasibility of immediate (IIP) and early (EIP) implant placement based on retrospectively collected intra-oral radiographic data, and to compare their 'estimated' feasibility to the 'true' feasibility based on optimal virtual implant planning in CBCT software.

Materials and methods: Data from 100 patients (59 women, 41 men, all Caucasians) aged between 19 and 81 years old who had been consecutively treated with a single implant in the premaxilla (13-23) in one private periodontal practice were retrospectively collected. Demographic data, diagnostic information and linear measurements were extracted from patient files, CBCTs and intra-oral radiographs. The 'true' feasibility of IIP and EIP was determined on the basis of optimal virtual implant planning in CBCT software and pre-defined selection criteria. The feasibility of both treatment options was estimated based on intra-oral radiography.

Results: The positive predictive value and negative predictive value for intra-oral radiography in assessing the feasibility of IIP amounted to 0.70 (95% CI [0.57-0.81]) and 0.70 (95% CI [0.55-0.81]), respectively. Fourteen percent false negatives and 16% false positives were found. False negatives could be explained by significant overestimation of the true root length (0.84mm) and by a buccal position of the tooth in the alveolar process in all cases, masking critical bone for implant anchorage at the palatal aspect of the root. False positives could be explained by significant overestimation of the availability of apical bone (2.57mm) and by significant underestimation of the dimension of an apical lucency (0.85mm). Similar data were found for EIP.

Conclusion: Intra-oral radiography may be considered an appropriate method to assess the feasibility of IIP and EIP in the premaxilla, yet clinicians should be aware of missing information and possible misinterpretations in about one third of the cases.