The International journal of periodontics & restorative dentistry最新文献

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.

Extensive posterior mandibular bone resorption can result in exposure of the inferior alveolar neurovascular bundle, challenging implant rehabilitation and increasing the risk of surgical complications. This case report describes the successful management of a severely atrophic posterior mandible with emergence of the mandibular canal by means of guided bone regeneration (GBR) using a perforated titanium-reinforced PTFE (Polytetrafluoroethylene) mesh and a combination of autogenous and xenogeneic bone grafts, followed by successful implant placement and prosthetic rehabilitation, with a 12-month follow-up. A bone deficiency coronal to the inferior alveolar nerve, resulting from a complication of a prior surgical intervention, led to an unintended communication between the neurovascular bundle and the overlying oral soft tissues. The "soft tissue island" technique, executed with the aid of a surgical guide to identify the defect, allowed complete isolation of this communication through precise manipulation of the vestibular flap. This technique facilitated the execution of all necessary procedures for bone augmentation and implant placement without inducing neurological complications. The described approach may serve as a valuable and less invasive alternative to conventional surgical techniques, which are often associated with a higher risk of post-operative complications involving the inferior alveolar neurovascular bundle.

The loss of interdental papillae in the anterior maxilla presents significant esthetic and functional challenges. This report introduces a refined, tunnel-like surgical technique using a vestibular access incision for three-dimensional papilla augmentation ('Papilla Reconstruction via Incision and Submucosal Mobilization' [PRISM]). Three patients (seven sites) with deficient papillae underwent treatment involving connective tissue grafts (CTGs) from the lateral palate and maxillary tuberosity. The technique aimed to enhance surgical access, preserve vascular integrity, and facilitate atraumatic graft placement. Outcomes were assessed through clinical indices (Papilla Presence Index), volumetric analysis via STL superimposition, and patient-reported esthetic and comfort scores. After 6 months, all sites demonstrated successful healing, significant volumetric gain (vertical: 0.8-1.7 mm; horizontal: 0.8-1.4 mm), and improved patient satisfaction. The proposed approach represents a promising option for papilla reconstruction, combining the advantages of a tunnel technique with a dual-graft harvesting strategy. The loss of interdental papillae in the anterior maxilla presents significant esthetic and functional challenges. This report introduces a refined, tunnel-like surgical technique using a vestibular access incision for three-dimensional papilla augmentation ('Papilla Reconstruction via Incision and Submucosal Mobilization' [PRISM]). Three patients (seven sites) with deficient papillae underwent treatment involving connective tissue grafts (CTGs) from the lateral palate and maxillary tuberosity. The technique aimed to enhance surgical access, preserve vascular integrity, and facilitate atraumatic graft placement. Outcomes were assessed through clinical indices (Papilla Presence Index), volumetric analysis via STL superimposition, and patient-reported esthetic and comfort scores. After 6 months, all sites demonstrated successful healing, significant volumetric gain (vertical: 0.8-1.7 mm; horizontal: 0.8-1.4 mm), and improved patient satisfaction. The proposed approach represents a promising option for papilla reconstruction, combining the advantages of a tunnel technique with a dual-graft harvesting strategy.

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.