The International journal of periodontics & restorative dentistry最新文献

This article introduces a novel 3D-printed guide for harvesting subepithelial connective tissue grafts (CTGs) from the lateral palate. A digital simulation of CTG harvesting was conducted on a patient's integrated model using a single-incision technique. The model incorporates crucial anatomical information, such as the location of the greater palatine artery and palatal gingival thickness, ensur-ing that planned incisions avoid critical structures and that a donor tissue of sufficient size (length, width, and thickness) is harvested. The guide was designed and 3D printed to replicate the sim-ulated procedures in the intraoral environment, enhancing surgical precision. During surgery, the CTG palate guide facilitates the successful harvesting of a graft of sufficient size, as preoperatively planned, without causing any complications. This study suggests that the CTG palate guide can reduce complications and surgical time while maximizing the dimensions of the donor tissue.

If a prosthetically guided implant rehabilitation is to be carried out, the patient must have adequate bone volume, which is not always present due to bone resorption in the alveolar process. An ef-fective technique in regenerative surgery involves the use of titanium mesh to recreate the missing bone volume. A new generation of meshes have been created, presenting a new texture with mi-croholes and possessing space-making and barrier effects. The primary objective of this study was to measure the height and width of the regenerated bone following the use of a new-generation customized titanium mesh. This retrospective case series involved 18 patients (23 bone atrophies) who underwent bone-regeneration surgery with a titanium mesh and received subsequent implant placement. An average vertical bone gain of 5.2 ± 2.9 mm and an average horizontal bone gain of 12.3 ± 2.6 mm were achieved, as well as an average regenerated bone volume of 3.2 ± 1.3 cm3. One failure occurred (4.3%), and in three cases (13%) it was necessary to perform a minor second surgery. The average follow-up time for implants after loading was 22.3 ± 15.6 months. This study shows the innovation of new-generation titanium mesh and its microperforated texture that offers both a space-making effect and a partial barrier effect. This has led to excellent regeneration results, with a significant improvement in treated vertical and horizontal defects and reduced operating times. Future studies with longer follow-ups are necessary to confirm these findings.

Objective: This prospective clinical case series investigates whether pre-extractive interradicular implant bed preparation for immediate implant placement in molar sites provides technical advantages with regard to sufficient implant primary stability and correct implant positioning without being disadvantageous in terms of survival and success rates.

Methods: 27 untreatable molars were replaced by immediate implants following pre-extractive interradicular implant bed preparation. Implant survival and success were evaluated. Success was defined by sufficient implant primary stability for transmucosal healing (final insertion torque value ≥ 15 Ncm), correct three-dimensional implant position enabling an occlusally screw-retained restoration, peri-implant probing depths ≤ 5 mm, and absence of clinical signs of inflammation two years after immediate implant placement.

Results: Survival rate two years after immediate implant placement was 100%. Transmucosal healing as well as occlusally screw-retained restorations were achieved in all cases. The success rate was 96.3% due to one patient presenting a biological complication with increased peri-implant probing depths and clinical signs of inflammation.

Conclusion: The proposed clinical protocol of pre-extractive interradicular implant bed preparation in molar sites provides advantages in terms of achieving implant primary stability for transmucosal healing and correct three-dimensional implant position, without being disadvantageous with regard to survival and success rates two years after treatment.

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.