The International journal of periodontics & restorative dentistry最新文献

The missing maxillary lateral incisor is one of the most common teeth to require replacement in the adolescent/young adult. The dental implant is a common method of replacing this tooth. However, there are significant disadvantages associated with this treatment. In the current environment where minimally invasive dentistry is emphasized, there are more conservative treatment options, which include canine substitution and the bonded bridge. This article will discuss both treatments with an emphasis on diagnosis and treatment planning as well as technique recommendations.

Statement of problem: When performing a facially driven oral rehabilitation, the interpupillary line (IL) is usually the main reference to establish esthetic and occlusal planes (EP and OP) in a frontal view. However, literature is not conclusive yet to determine the prevalence of tilted IL in natural head position (NHP) and its possible consequences on diagnosis and treatment planning.

Purpose: The aim of this study is to determine the prevalence of discrepancy between IL and real horizon (HOR) in Natural Head Position (NHP).

Materials and methods: Calibrated facial photographs in NHP using an external vertical reference of 235 participants were taken. Two horizontal lines were drawn on each image (IL and HOR) and the angle between them was measured. The participants were allocated in six groups, depending on the discrepancy angle, starting from 0 to 5 degrees.

Results: The discrepancy frequence between IL and HOR was: 20,4% presented 0° deviation (n=48); 30,6% presented ±1° (n=72); 25,9% presented ±2° (n=61); 15,3% presented ±3° (n=36); 5,9% presented ±4° (n=14); and 1,7% presented ±5° (n=4). The prevalence of individuals with 2 or more degrees of discrepancy between IL and HOR in NHP (which is perceptible by the human eye) was 49% of the sample.

Conclusions: Within the limitations of this study, we might conclude that almost half of the population has 2 or more degrees of discrepancy between IL and HOR in NHP, which is a risk for a inaccurate digital treatment plan when exclusively based on IL. Further research is necessary to validate these findings.

This single-center pilot randomized clinical trial compared ridge dimensional changes following alveolar ridge preservation (ARP) with allograft (AG) versus xenograft (XG) in non molar sites with buccal dehiscence defects. 12 patients (6 per group) needing a single rooted tooth extraction were included. After extraction, sockets were grafted with the assigned bone substitute, covered with an absorbable membrane and collagen matrix. Cone beam computed tomography (CBCT) scans were taken at two time points: immediately post surgery and six months later. The need for additional bone augmentation at the time of implant placement was evaluated using implant planning software. Six months after ARP, AG demonstrated significantly better ridge width preservation (0.41 mm vs. 1.78 mm for XG, measured at 2 mm below the crest; p = 0.007). A trend favoring XG for better preservation of buccal and palatal/lingual ridge height was observed, though differences were not statistically significant (p = 0.11 and 0.58, respectively). Only one site (8.3%), from the AG group, required additional bone augmentation at implant placement. This pilot clinical trial suggests allograft and xenograft were both able to minimize dimensional changes when used for ARP in non-molar extraction sites with buccal dehiscence defect. Allograft may be more effective in minimizing ridge width reduction 2 mm from the crest while the xenograft appears to better preserve ridge height. Both bone graft materials are effective in reducing the need for additional bone augmentation; however, larger clinical studies are needed to confirm these findings.

Digital implant planning-utilizing the convergence of digital surface scanners, CBCT scans, and advanced planning software-has transformed dental implantology. The merging of these datasets through triangulation of landmarks provides a detailed digital model of the dental arches, facilitating precise implant positioning in edentulous areas. A critical step in this digital workflow is the accurate merging of DICOM files with .STL/.PLY/.OBJ files, which underpins the design and fabrication of surgical templates for accurate implant placement. Errors in this phase can lead to implant mispositioning or damage to adjacent structures. Particularly in partial edentulism, the merging is based on the occlusal topography of the remaining teeth, but scattering in the CBCT data-caused by interactions of radiation with radiodense materials-can complicate this process or even render it impossible. The present article presents a technique utilizing radiopaque markers to overcome scattering effects, ensuring accurate dataset superimposition in the mandible.

Achieving initial implant stability at a molar extraction site can be challenging due to the bone width and quality, as well as anatomical limitations like the maxillary sinus and inferior alveolar nerve. The implant placement should achieve precise centralization with the interradicular septum to facilitate implant stabilization and postextraction alveolar ridge preservation/regeneration with bone grafting. Immediate nonocclusal crown placement aids peri-implant tissue maturation for the desired outcome. This retrospective series introduces guidelines for treating sockets based on alveolar septum types. The approach involves immediate dentoalveolar restoration (IDR) and osseodensification (OD) with an autogenous graft for bone preservation. A new protocol for the treatment of the molar interradicular septum during immediate implant placement and/or alveolar ridge preservation/ reconstruction was applied in 12 cases. Preoperative and postoperative CBCT examinations were performed. Socket width was measured and compared between timepoints. At the follow-up (mean: 23.58 ± 9.70 months), the mean preoperative and postoperative socket widths were 9.51 ± 0.40 mm and 11.16 ± 0.30 mm, respectively (17.35% increase; P < .05). IDR with OD is a predictable approach to treat molar sockets during implant placement.

Dental autotransplantation (ATT) of mature teeth in adult patients has recently been supported by a growing body of evidence. Thus, ATT can be considered as an alternative to single implants for the replacement of a compromised tooth. This case series aims to provide an initial comparison between ATT (test group) and immediate implant treatment (IIT; control group) in terms of volumetric changes and patient-related outcome measures (PROMs). A total of 31 interventions (29 patients) were grouped into two similar cohorts. Measurements were made on the superimposed STL files before and at least 6 months after treatment, and PROMs were obtained from a questionnaire in two follow-up checks. Data were analyzed using descriptive and inferential statistics. Adverse events and complications were also recorded. Volume reduction was 3 to 4 times less in the ATT group than in the ITT group (P < .05). Patients in the ATT group reported higher levels of perceived inflammation than the IIT group (P = .015), though patients rated satisfaction similarly between the two treatments (9+ on a scale of 1 to 10). Although this research should be considered an initial step and requires larger samples and follow-up, it supports the trend of including ATT as an alternative option to IIT in molar replacement.

The primary goal of this pilot study was to evaluate, via 3D analysis, the scan body precision of an intraoral digital scan utilizing a custom multifunctional scan body compared to that of digitized stone models fabricated from a conventional open tray impression in the fully edentulous maxilla and mandible. The secondary goal of this study was to showcase a method for utilizing the scan body library to generate a fixed fiducial marker for the cross-mount of an edentulous arch. Comparative analysis was performed as a case-control study. A custom scan body was utilized to generate the positions of the titanium bases from the intraoral models and digitized stone models of three maxillary arches (all-on-6, all-on-5, and all-on-4) and two mandibular arches (both all-on-4). The titanium base positions were compared using advanced 3D inspection software. The mean ± SD deviation was 30.38 ± 17.78 μm (95% CI: 14.8 to 45.97 μm), with mean deviations of 38.73 ± 19.24 μm (95% CI: 16.96 to 60.5 μm) in the maxilla and 17.85 ± 0.92 μm (95% CI: 16.58 to 19.12 μm) in the mandible. The present results were promising, showing that deviations between the intraoral impressions and the digitized stone models fell within established tolerance ranges. Initial studies showed promising results that the digital workflow could be implemented with success similar to the conventional approach. Using the scan body library to generate a fiducial marker successfully demonstrated an efficient method for cross-mounting the edentulous arch.

Gingival depigmentation impacts patient self-confidence and quality of life. This study compares the Er,Cr:YSGG laser to the traditional scalpel technique for reducing gingival hyperpigmentation, assessing their effectiveness and other relevant factors. For this double-blind randomized trial with a splitmouth design, 40 participants were selected from a university dental clinic and randomly assigned to receive treatment via an Er,Cr:YSGG laser (2,780 nm) or surgical scalpel. Treatment duration was evaluated, and pain intensity and smile satisfaction were assessed postsurgery. The Dummett Oral Pigmentation Index (DOPI) was used to determine the initial severity of pigmentation and track both reduction and potential repigmentation over time. The Gingival Melanosis Record (GMR) was used to evaluate the presence and extent of pigmentation and monitor recurrence after 1 and 12 months. Both the Er,Cr:YSGG laser and surgical scalpel similarly reduced GMR and DOPI scores over time, without significant differences at 12 months (P > .05). Significant examiner variability was noted in GMR scoring (β = -1.2 for Examiner 2; P < .001). Power analysis indicated a higher confidence for detecting treatment effects in DOPI (75%) compared to GMR (55%). The Er,Cr:YSGG laser required longer surgery times (P < .001), treatment type did not influence postoperative pain levels, and patient smile satisfaction significantly improved (P < .001). Under the present conditions, the Er,Cr:YSGG laser and surgical scalpel were equally effective in reducing gingival hyperpigmentation. Although lasers offer better bleeding control and require less anesthesia than the scalpel technique, clinicians should also consider surgery duration, cost, and expertise when selecting a treatment method. Future research should focus on long-term outcomes and economic evaluations, utilizing standardized clinical measures.

Peri-implantitis is a common complication among patients receiving implant-supported restorative therapy, and it often requires surgical intervention for effective treatment. Understanding the specific configuration of the peri-implant bony defect and adjacent bone peaks is crucial for tailoring treatment strategies and improving outcomes. A decision tree for reconstructive peri-implantitis therapy has been developed based on the new classification of defect configurations (Classes I to V), guiding clinicians in selecting treatment options, including biomaterials, techniques, and healing approaches. Furthermore, clinicians are encouraged to consider various factors such as local predisposing factors (including soft tissue characteristics, prosthetic design, and implant position in a 3D perspective), clinical factors (surgeon skill and experience), and patient-related factors (such as local and systemic health, preferences, and cost) when evaluating reconstructive therapy options.

Multiple adjacent gingival recessions are a challenge to the practitioner. Although the gold standard is still the bilaminar technique, where a coronally advanced flap (CAF) is associated with autogenous connective tissue graft (CTG), the morbidity of the procedure may lead clinicians to look for CTG substitutes. In this study, a prospective case series, 16 patients presenting multiple adjacent gingival recession were treated using CAF plus a volume stable collagen matrix (VXCM) soaked with a gel made of polynucleotides and hyaluronic acid (PNHA). Clinical measurements (probing depth, recession, attachment level, keratinised mucosa) were performed at baseline (T0), six months (T1) and twelve months (T2) post-operatively. Change in gingival thickness (dGT) was also measured using intraolar scans at T0 and T2, together with secondary variables, such as wound healing indices, patient-reported outcomes (pain, esthetics), and adverse events. Statistical analysis has been performed, setting significance with p<0.05. At one year evaluation, mean recession depth decreased of 2.42 ± 0.45, the percentage of root coverage was 96.02 + 0.09% (80.59% complete root coverage) , while gingival thickness dGT increased by 1.14 ± 0.34 mm, indicating that VXCM and PN-HA plus CAF are a suitable option for the treatment of multiple adjacent gingival recessions.