The International journal of periodontics & restorative dentistry最新文献

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.

This case series was aimed primarily at evaluating the outcomes of a reconstructive technique employing autogenous bone grafting using maxillary tuberosity (MT) donor sites for the management of extraction sockets adjacent to large incisive foramena (IFs) in the anterior maxillary region, with the purpose of addressing challenges associated with implant placement. In this series of four cases, we applied a reconstructive technique utilizing autogenous bone grafting using MT donor sites. Patients underwent a postoperative maintenance program, clinical examinations, and completion of a questionnaire to assess changes in the neurosensory function of the nasopalatine nerve. Study outcomes included the extent of bone reconstruction, postoperative neurosensory function of the nasopalatine nerve, and overall patient satisfaction. Cases were followed for a mean of 23.5±0.5 months. The technique consistently resulted in predictable bone reconstruction, either with delayed or immediate implantation and provisionalization. IF enucleation and reconstruction of the damaged extraction sockets resulted in no abnormal postoperative pain or paresthesia, and yielded high patient satisfaction. The use of autogenous bone grafts from the MT provides an optimal and simple solution for the management of extraction sockets adjacent to large IFs. Our findings illustrate the potential efficacy of this technique in complex scenarios associated with high esthetic implications, which should be further evaluated in future clinical trials.

Endodontic-periodontal lesions are characterized by the involvement of the pulp and periodontal disease in the same tooth. Despite successful root canal treatment, if the majority of bone support has been lost from periodontitis, the tooth may have a poor prognosis. In severe endodonticperiodontal lesions, the periodontal tissue regenerates poorly because of the significant loss of the periodontal ligament and cementum, poor tooth stability, and bone defect morphology that is unfavorable for bone regeneration. To overcome these difficult situations, osteotomy of the replantation bed and tooth replantation with horizontal rotation and deep placement may be performed. In the presented case, in order to improve periodontal regeneration, fibroblast growth factor-2 (FGF2) was applied to the artificially made periodontal defect. In addition, orthodontic extrusion of the deeply replaced tooth was performed for potential coronal migration of the periodontal tissue. This case presents a unique multidisciplinary method of treating severe endodontic-periodontal lesions using intentional replantation combined with FGF2 application and orthodontic extrusion.

Background: Immediate implant placement has become increasingly prevalent in clinical practice, and accurate assessment of placement quality is crucial to ensure successful outcomes. Bone-to-implant contact (BIC) is one of the critical determinants of primary stability following implantation. However, its correlation to the implant stability quotient (ISQ) is uncertain. This study aims to determine the relationship between ISQ measurements and BIC in immediately placed implants.

Materials and methods: An atraumatic extraction followed by immediate implant placements were performed on 33 teeth in seven human cadaver heads. The implant ISQ values were measured in four directions: buccal, lingual, mesial, and distal. The cadaver heads were imaged using cone-beam computed tomography (CBCT) to determine the linear BICs in the corresponding directions.

Results: Among the twenty-eight implants analyzed, no correlations were observed between directional BICs and the corresponding ISQ values. ISQ measurements did not significantly differ between maxillary and mandibular implants, nor among different anatomical locations. Additionally, when solid contact was present at the implant shoulder, the ISQ values remained stable despite the absence of apical BIC.

Conclusion: ISQ values alone appear to be poor predictors of BIC in immediately placed implants. Therefore, ISQ measurements should be interpreted alongside other assessment methods to more accurately evaluate implant stability.

Autogenous grafts are broadly regarded as the gold standard material for soft tissue augmentation in periodontal and implant-related surgery. However, intraoral harvesting of autogenous soft tissue grafts can pose challenges for clinicians due to technical complexity, limited available tissue, and the potential for patient morbidity, among other reasons. This comprehensive review explores key aspects of autogenous connective tissue graft harvesting with a particular focus on approaches involving the de-epithelialization of free masticatory mucosal grafts (DFMMGs), such as the main advantages and disadvantages of extra- and intraoral de-epithelialization, emerging technologies to assist and streamline harvesting, donor site healing dynamics, postoperative pain perception, wound management strategies, and common intra- and postoperative complications.

This study aimed to assess the differential clinical response to step 2 of periodontal therapy and repeated subgingival instrumentation between teeth with suprabony and intrabony defects. Electronic and manual searches were performed to identify studies reporting the differential clinical outcomes of nonsurgical periodontal therapy (NSPT) in the presence or absence of intrabony defects. The Cochrane Risk of Bias 2 and the Newcastle-Ottawa scale were used to assess the risk of bias. A total of 2,348 articles were initially screened, and a total of 5 articles were finally included. Regarding the primary outcome measure, two studies reported probing pocket depth (PPD) reductions at 6 months after step 2 of periodontal therapy, showing an opposite response of intrabony defects compared to suprabony defects (3.2 ± 1.9 mm intrabony vs 2.2 ± 1.7 mm suprabony in one study, and 0.48 ± 0.42 mm intrabony vs 0.72 ± 0.36 mm suprabony in the other), while one study reported no differences at 3 months. One study showed a negative association between the presence of an intrabony defect and PPD reduction at 9 months after nonsurgical step 3 (P < .05). Due to the limited number of studies and heterogeneity of the data, conflicting evidence emerged for the differential response to NSPT of intrabony and suprabony defects.

This prospective case series aimed to evaluate the feasibility of using a volume collagen matrix for soft tissue augmentation to increase mucosal thickness in single implants in smokers who consume more than 10 cigarettes per day. Participants had single submerged implants necessitating soft tissue thickening. Soft tissue augmentation was done using a collagen matrix in the second-stage surgery. The primary outcome was soft tissue thickness at 90 days post-surgery. Secondary outcomes included median thickness at 30 and 60 days, changes in buccal soft tissue profile (digital measurements) at 30, 60, and 90 days, and oral health-related quality of life using OHIP-14 up to 90 days post-surgery. Pain levels via VAS scale and adverse effects were also assessed. Ten participants (4 men, 6 women) aged 45.2 ± 13.18 years initially smoked 10-20 cigarettes daily (average: 14.70 ± 3.47 cigarettes/day). After 90 days, median soft tissue thickness increased to 3.00 (2.00;3.00) mm. Buccal soft tissue profile (median change in ROI) increased by 0.40 (0.25;0.62) mm at 90 days. Pain levels decreased, and oral health-related quality of life improved significantly. No complications were reported. The collagen matrix significantly augmented buccal soft tissue thickness at implant sites in smokers (>10 cigarettes/day), with favorable outcomes and no complications.