The International journal of periodontics & restorative dentistry最新文献

Background: Various surgical options have been described for gingival recession management, namely the coronally advanced flap (CAF) or tunnel (TUN) surgical techniques, combined or not with connective tissue grafts (CTG) - CTGs can be obtained by de epithelializing a free gingival graft (dFGG). Nevertheless, none of them are exempt from postoperative complications, particularly when dFGG is combined with TUN techniques. Most common complications include the re-epithelialization of the marginal graft, resulting in undesirable esthetic outcomes. This paper describes the modified orientation of the dFGG under the tunnel, with the lamina propria layer facing the tooth's root (inverted graft), aiming to minimize the risk of esthetic complications.

Methods: 10 non-smoking patients with no comorbidities, presenting a total of 15 Miller class I/II (RT1) gingival recessions cases, were subjected to root coverage surgical treatment with the introduced technique (TUN+ inverted dFGG). After 6-months, each case was accessed using the root coverage esthetic score (RES).

Results: Regarding soft tissue integration parameters, the score was 3 out of 3 for all cases. Mean amount of root coverage was 97%. 13 recession defects (86%) achievedcomplete root coverage. The mean RES was 9.6, ranging from 7 to 10. 13 recession defects (86%) achieved a RES of 10.

Conclusions: The orientation of the dFGG under the tunnel, with the lamina propria layer facing the tooth's root (inverted graft), seems to present a promising aesthetic root coverage procedure and may be considered to minimize the risk of major esthetic complications when a dFGG is used under the TUN technique. Further studies are needed to address this proof of principle.

Objectives: As the dental profession shifts towards monolithic restorative materials, it is necessary to establish a clear understanding of the materials available and how they should be used clinically. The purpose of this investigation is to document the fracture toughness of a number of esthetic indirect restorative materials on the market and to provide recommendations for their application based on existing clinical and laboratory data sets.

Methods: Fifty-six monolithic esthetic restorative materials were tested for fracture toughness. Monolithic zirconia materials were tested using the Single Edge Pre-Cracked Beam (SEPB) method, while glass ceramics and resin-ceramic hybrids were tested using the Single Edge V-Notch method (SEVN).

Results: Fracture toughness values for monolithic zirconia correlated inversely with increasing yttria content. 3 mol % yttria-stabilized tetragonal zirconia polycrystal (3Y -MZ) had the highest fracture toughness range (5.55 - 5.64 MPa√m), followed by 4Y -MZ (4.02 - 4.15 MPa√m) and 5Y -MZ (2.43 - 2.70 MPa√m). For some 4Y -MZ and 5Y -MZ products, there was not a significant difference in toughness (p <0.05). Several lithium-based glass ceramics (LBC) had a similar fracture toughness (range of 2.46 - 2.68 MPa√m) to 5Y -MZ (p <0.05). Most LBCs had a fracture toughness range of 1.53 - 2.04 MPa√m, higher than that of other glass ceramics but less than that of 5Y -MZ (p<0.05). Results for resin-ceramic hybrids varied from 1.15 - 2.05 MPa√m, with none reaching the fracture toughness of the higher LBCs or 5Y -MZ (p <0.05).

Significance: Clinicians should be aware of the fracture toughness of the materials they use and adjust their preparation parameters accordingly. As fracture toughness decreases, thickness of the resultant restoration should be increased to accommodate the decrease in fracture resistance.

The clinical case demonstrates soft tissue augmentation after GBR in addressing an initially insufficient level of keratinized tissues using a graft with high-quality collagen obtained from the maxillary molar area to increase the volume of soft tissues in a single surgery. This augmentation protocol includes the use of an epithelial embossed connective tissue graft harvested from the maxillary molar area as well as the principle of flap formation involving a= displacement of the initial volume of keratinized tissues lingually and fixation of the graft under full thickness flap on the buccal side.

This case report describes the interdisciplinary management of a 58-year-old female patient with a misaligned dental implant in the left maxillary lateral incisor region, causing aesthetic and functional challenges. Initial assessments revealed significant bone loss around the compromised implant, an asymmetric smile, and excessive gingival display. The treatment included slow orthodontic extrusion to reposition adjacent teeth, promoting bone and periodontal regeneration, and orthodontic intrusion on the contralateral side to correct occlusal cant, and improve gingival aesthetics. Aligners with mini-screw anchorage ensured precise tooth movement and improved conditions for soft tissue grafting. Periodontal procedures enhanced tissue architecture and supported long-term stability, while the final prosthetic rehabilitation successfully restored function and aesthetics, emphasizing the importance of interdisciplinary collaboration for complex cases.

The reconstruction of interproximal papilla around implants is considered challenging with limited predictability due to the anatomical constraints and reduced blood supply to the interproximal area. This report introduces a minimally invasive tunneling approach, assisted by an operating microscope, to augment interproximal papillae and improve soft tissue contours. Four cases are included: Cases 1 and 2 demonstrate soft tissue grafting around adjacent implants, performed either during the second stage or after provisionalization, while Cases 3 and 4 address implant-pontic scenarios. After conditioning the peri-implant tissues using provisionals, all cases achieved satisfactory outcomes, maintaining stability over a period of six to nine years. The described microsurgical tunnel technique, with the combination of buccal and interproximal subepithelial connective tissue graft, appears to be a promising approach for reconstructing peri-implant papillae with reliable long-term stability.

Buccal bone exostosis (BBE) is a late postoperative complication following soft tissue augmentations (STA), defined as localized peripheral benign bone overgrowth. While its occurrence has been reported after skin or free gingival grafts, its association with sub epithelial connective tissue grafts (sCTG) around teeth is less documented. To date, no cases of BBE following autologous tissue grafts, sCTG or de-epithelialized free gingiva grafts (DFGG), around dental implants have been reported. This case series presented five cases of BBE (two around implants, three around teeth) following STA around teeth and implants utilizing either sCTG or DFGG. The BBEs were surgically removed in three cases, and no recurrences were observed after four months to ten years postoperatively. Histological examinations were not conducted. Based on the fact that all cases involved partial-thickness flap, it could be speculated that periosteal tear during STA coupled with autologous tissue grafts triggers osteoinduction and osteoproliferation mechanisms, leading to BBE development.

This article reviews and contrasts resin composites and dental ceramics for anterior esthetic restorations, highlighting their fundamental properties, indications, and clinical performance. Resin composites excel in minor or localized cases-such as class III and IV cavities, minor contour modifications, or closure of small diastemas-owing to their straightforward application, color-matching capabilities, and minimal tooth preparation requirements. However, they are vulnerable to issues like discoloration, wear, and marginal staining, and often need periodic repolishing or repair. Dental ceramics demonstrate superior longevity, color stability, and resistance to wear, making them the preferred choice for extensive rehabilitations, larger restorations, and compromised teeth requiring crowns or bridges. While ceramics generally involve more invasive preparations and demand meticulous bonding procedures, their inert nature and high mechanical strength often result in outstanding long-term outcomes when properly executed. Clinical decision-making should account for factors such as tooth structure, occlusion, patient's age and habits (e.g., parafunctions), staining risk, and esthetic demands. Ultimately, striking the right balanc between biology, function, and esthetics is essential to avoid overtreatment and preserve natural dentition. Through illustrative case studies and a synthesis of relevant literature, this article provides practical guidelines for selecting the most appropriate material for each clinical scenario.

This case report describes an interdisciplinary approach to the aesthetic rehabilitation in a 45-year-old woman bothered by excessively long anterior teeth. Digital Smile Analysis (DSA) guided treatment planning, ensuring optimal proportions and soft tissue integration. Vertical Edgeless Preparation Technique (VEP) was used to establish the correct vertical position of the finishing line. Modified Coronally Advanced Tunnel (MCAT) combined with modified-Connective Tissue Grafts (Micro- and Split-CTG) was performed for root coverage and soft tissue augmentation. After uneventful healing, final ceramic restorations were seated. The integration of BOPT and MCAT optimized periodontal and prosthetic outcomes, achieving a natural, harmonious smile. This approach highlights the synergy between periodontal plastic surgery and prosthodontics in an aesthetically challenging case.

Teeth exhibiting internal root resorption or those with persistent large periapical lesions after non-surgical endodontic treatment are generally considered to have an unfavorable prognosis. Extraction of teeth with unfavorable prognosis, followed by dental implant placement, has become an acceptable treatment option. However, dental implants are not indicated for young people with growing jaws. Consequently, it is recommended that clinicians prioritize the preservation of natural dentition in younger patients and defer implant therapy until skeletal growth has ceased. In cases where tooth preservation is attempted despite severe periradicular defects, a surgical approach is often required to manage associated symptoms. However, modern periradicular surgery frequently leads to unaesthetic complications such as conspicuous scar formation or gingival recession. The introduction of novel combinatory surgery, including guided tissue regeneration (GTR), de epithelialized free gingival graft (DFGG), and coronally advanced flap (CAF) optimizes the clinical outcomes, addressing both the functional and aesthetic needs of the patient.

The stability and vascular integration of a free gingival graft (FGG) are critical for achieving predictable outcomes. The success of the technique relies on precise recipient site preparation, meticulous graft handling, and an optimized suturing protocol to ensure firm adaptation and immobilization to prevent micro-movements that could compromise healing. This case report introduces the 'Fishnet suture,' a novel microsuturing technique designed to enhance graft stabilization and provide uniform tension distribution. The approach utilizes a continuous interlocking suture with both vertical and horizontal components, creating a mesh-like pattern that anchors the graft to the periosteal bed, eliminating dead spaces, and promoting revascularization. The technique was applied in three clinical cases: a patient with multiple adjacent gingival recession defects in the anterior region of the mandible, a patient presenting peri-implant soft tissue deficiencies, and a patient with an insufficient width of keratinized tissue at an edentulous ridge. Postoperative healing was uneventful throughout, resulting in significant increase in keratinized tissue width. We interpret the favourable outcomes to be a result of effective graft stabilisation, facilitated by this novel suturing approach.