The International journal of periodontics & restorative dentistry最新文献

A 45-year-old woman presented with a lack of interimplant papilla after a partially edentulous ante-rior area was rehabilitated with dental implants. The soft tissue phenotype and interimplant papilla were augmented using the 'iceberg' connective tissue graft (iCTG), followed by a second surgical procedure wherein a strip gingival graft was combined with a CTG inserted underneath a pouch prepared into the previous iCTG at the level of the crest (the garage approach), further enhancing soft tissue volume in that region. This technique aims to improve mucosal thickness and supra- crestal tissue height while addressing esthetic concerns associated with multiple implants placed in the anterior region. The final esthetic outcome was excellent and achieved harmonious soft tissue with appropriate thickness, symmetry with adjacent teeth, well-shaped interdental and interimplant papillae, and high patient satisfaction, making this approach a valuable addition to the surgical armamentarium. Future clinical studies are needed to evaluate the performance of this novel approach.

Computer-assisted implant planning allows for a comprehensive treatment plan by combining radiographic data provided by CBCT with surface optical scan data that includes the patient's intraoral situation and the intended restorative planning. Integrating a tailored restorative de-sign with the patient's anatomical conditions through virtual implant planning allows for an ideal biorestorative treatment planning that maximizes biologic, functional, and esthetic outcomes. This article discusses dataset registration techniques that combine radiographic CBCT data with re-storative information as the main path to create a virtual patient. The described techniques include the use of removable radiographic templates with radiopaque markers, the dual scan technique, and direct digital file registration of intraoral scans using anatomical references. Depending on the individual clinical situation, different factors must be considered to appropriately select methods that achieve an optimal registration of diverse datasets. An inherent challenge lies in the presence of scattering artifacts in CBCT scans. Two approaches are proposed for these situations: the use of chairside-fabricated composite resin markers or adhesive spot-markers fabricated for use with computed tomography scans. Both techniques exhibit limitations that must be considered. Further approaches should be developed for situations involving scattering in CBCT scans.

The management of severe mucogingival deformities surrounding malpositioned implants rep-resents a complex issue with a high risk of esthetic failure. The present case report describes a mucogingival and restorative approach for the treatment of severe localized peri-implant tissue defi-ciencies with interproximal bone loss combined with an interproximal gingival recession on the ad-jacent natural tooth. This approach consists of maintaining a nonrestorable malpositioned implant, submerging it through one or multiple vertical soft tissue augmentations according to the defect severity, and delivering a tooth-supported bridge involving the adjacent natural teeth. The step-by-step surgical technique adopted for implant submergence and vertical soft tissue grafting, as well as the subsequent surgical and prosthetic interventions, are described, presenting results at 5 years from implant submergence and 3 years from prosthetic finalization.

The necessity of a minimum volume of keratinized tissue around implants to maintain tissue sta-bility remains a matter of debate. This case series aims to showcase the outcomes and long-term maintenance of implants that received soft tissue augmentation. Three cases of stage-two surgery following implant placement were evaluated to determine the amount of keratinized tissue around the implant. Based on the Ono-Nevins classification described herein, treatment was rendered, including keratinized tissue grafting. The cases were followed for 10, 18, and 28 years. Each case demonstrated maintenance of the soft and hard tissue profiles around the implants with no inci-dence of peri-implantitis, as evidenced on clinical examination and periapical radiographs. Soft tis-sue management around implants may play a key role in the long-term maintenance of peri-implant health and prevention of peri-implantitis.

Constant efforts are made to achieve simpler, faster, and less-invasive surgical approaches for harvesting autologous connective tissue grafts. While the palate is considered a gold-standard har-vesting site, its association with complications and patient discomfort have led clinicians to explore alternative sites, like the tuberosity. However, current tuberosity harvesting techniques face several limitations. Through a multiple-recessions clinical case intended as a proof of concept, this article describes a novel harvesting technique based on a gingivectomy that triggers the tuberosity tangen-tially. Clinical, esthetic, and patient outcomes were monitored at 7 days, 14 days, 1 month, and 3 years at the grafted site as well as at the tuberosity. Multiple harvests were conducted at the tuberosities, offering connective tissue grafts suitable for micrografting. Harvested tuberosities healed completely without complication, and the patient reported no discomfort. At the grafted site, both esthetic and functional results were maintained for up to 3 years. The Slice Harvesting Technique offers a prom-ising alternative for tuberosity tissue harvesting, with critical advantages such as a high indication rate, simplicity, speed, safety, and the ability to provide user-friendly connective tissue grafts. Further, the technique appears to be sustainable and could also favor tuberosity regrowth for multiple rounds of harvesting. I.

Periodontal therapy remains a cornerstone of dental practice. However, effectively managing periodontitis patients throughout the continuum of care can be challenging. This article proposes a communication framework and an integrated fee model designed to support evidence-based comprehensive treatment protocols while enhancing patient education, motivation, and long-term adherence. By emphasizing prevention and patient-centered care, the proposed approach contrasts with the dominant reactive model, often focused on surgical interventions and the extraction of salvageable teeth. Instead, this approach advocates for a shift toward a proactive, value-based paradigm that prioritizes periodontal health maintenance, aligns clinician and patient goals, and fosters sustained engagement throughout treatment.

Complex cases often require interdisciplinary specialist care when multiple structures in the stomatognathic system have developed significant problems. Treatment planning uses detailed problem and solution analysis and coordination of multiple clinicians for a predictable, practical result consistent with the patient's priorities. The foundation of this process is knowing exactly what each team member does in their practice. Restorative dentists can uniquely contribute to the diagnostic phase with quantified occlusal analysis and may abbreviate or replace specialist procedures with current restorative technique. This article presents 3 cases of active osteoarthritic condylar volume loss that amplified inter-arch occlusal problems, prompting the specialists on the interdisciplinary team to refer to the restorative dentist for evaluation and treatment. The rationale and technique of quantified occlusal analysis with mounted diagnostic casts, confirmation of mandibular stability and pain resolution by an occlusal splint with a digitally verified occlusion and definitive care with occlusal adjustment prior to restoration are presented.

In subepithelial connective tissue graft (SCTG) harvesting, some clinicians prefer to leave the periosteum at the donor site, anticipating faster healing of the palatal wound, though this assumption has not been clinically proven yet. This study aimed to compare early wound healing at palatal donor sites and patient-reported outcome measures (PROMs: pain perception, delayed bleeding and sensation loss) after harvesting SCTG with or without periosteum using the single-incision technique (SIT). Thirty-eight patients were randomly assigned to two groups: SCTG with periosteum (SCTGP+ group) and SCTG without periosteum (SCTGP- group). Assessment of donor site wound healing at one-week post-surgery using modified early healing index (EHI) was the primary outcome of the study and PROMs were the secondary outcomes. Thirty-four patients (17 in each group) were included in final analysis. The mean EHI for SCTGP+ group (2.88 ± 1.22) and for SCTGP- group (2.70 ± 1.10) did not differ significantly (p = 0.661). Palatal flap thickness was found to be negatively correlated with EHI (p < 0.001) and pain (p < 0.05). No statistically significant differences in pain perception were observed between the groups at any time point. None of the patients reported delayed bleeding. Sensation loss recovery was faster in SCTGP+ group with significant difference between the groups only at week 2 (p = 0.026). Within the limitations of our study, harvesting of SCTG with or without periosteum was not found to significantly influence the wound healing and pain perception at palatal donor site.

Teeth requiring endodontic treatment often present with loss of dental tissue due to caries and/or trauma. This loss compromises their strength and can lead to tooth fractures. The longer these teeth remain exposed and unprotected in the oral cavity, the greater the risk of contamination. Therefore, coronal reconstruction of structurally compromised teeth should be considered to reduce the risk of failure and ensure adequate endodontic intervention in cases of pulpal and/or periapical disease. This article presents a novel technique in which coronal reconstruction was performed prior to endodontic treatment in conjunction with immediate endodontic sealing (IES), allowing indirect restoration to be bonded to this reconstruction.