Outcomes of Undersized Implant Surgical Preparation: A Systematic Review.
Sloped Marginal Contour Implant System Placed in Healed Sites.
Subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART)
Combined Regenerative and Mucogingival Treatment of Deep Intrabony Defects
Saving an Integrating Implant Involved with Endodontic Implant Pathology
Hybrid Implants in Healthy and Periodontally Compromised Patients
Aesthetic outcome of immediately restored single implants in maxillary anterior
Relationship Between Frequent Recreational Cannabis Use and Periodontitis
Healing at Molar Extraction Sites With and Without Ridge Preservation
Post-extraction mesio-distal gap reduction assessment by CLSM
Treatment Concept for a Patient with a High Smile Line and Gingival Pigmentation
Single-Tooth Implant Restorations in Fresh Extraction Sockets of the Maxillary Esthetic Zone
Topic: Implants NO ARTICLE Undersized Implant
Authors: Stocchero M, Toia M, Cecchinato D, Becktor JP, Coelho PG, Jimbo R.
Title: Biomechanical, Biologic, and Clinical Outcomes of Undersized Implant Surgical Preparation: A
Systematic Review.
Source: Int J Oral Maxillofac Implants. 2016 Nov/Dec;31(6):1247-1263.
Type: Systematic Review
Rating: Good
Keywords: dental implant, primary stability, secondary stability, surgical protocol, systematic review,
undersized osteotomy
Purpose: To compile the current evidence on biomechanical, biologic, and clinical outcomes of
undersized surgical preparation protocols in dental implant surgery.
Method: An electronic search using three different databases (PubMed, Web of Science, and Cochrane
Library) and a manual hand search were performed including in vitro, animal, and clinical studies
published prior to October 2015. Studies in which an undersized drilling protocol was compared with a
nonundersized drilling protocol were included.
Results: Of 1,655 titles, 29 studies met the inclusion criteria, including 14 biomechanical, 7 biologic, 6
biologic and biomechanical, and 2 clinical. Due to methodologic variation, meta-analysis was not
performed. Several studies showed that implants inserted with an undersized drilling approach reached a
significantly higher insertion torque value than conventional drilling in low-density substrates, while this
effect is less evident if a thick cortical layer is present. Similar results in terms of bone-to-implant contact
(BIC) were achieved in the longer term between implants inserted with undersized and nonundersized
protocols. Results in the short term were inconclusive. Clinical studies did not show negative outcomes
for undersized drilling, although clinical evidence was sparse. No data are available on marginal bone
loss.
Conclusion: From the biomechanical standpoint, an undersized drilling protocol is effective in increasing
insertion torque in low-density bone. Biologic response in long-term healing after undersized implant
placement is comparable to that in the nonundersized surgical drilling protocol. Clinical studies indicate
that performing an undersized drilling protocol on low-density bone is a safe procedure; however, more
extensive studies are needed to confirm these data.
Topic: Implants NO ARTICLE Sloped Marginal Contour Implant
Authors: Lee PK, Siu AS.
Title: A Two-Year Evaluation of a Sloped Marginal Contour Implant System Placed in Healed Sites.
Source: Int J Oral Maxillofac Implants. 2016 Nov/Dec;31(6):1423-1428
Type: Clinical
Rating: Good
Keywords: dental implant, marginal bone, sloped marginal contour
Purpose: The purpose of this clinical trial was to evaluate the survival rate, bone remodeling, and soft
tissue health around sloped marginal contour implants when placed in healed sites posteriorly in the
mouth.
Method: Osseospeed TX Profile Implants were placed in healed sites at premolar and molar regions.
After a 3-month osseointegration period, definitive prostheses were connected. Clinical and radiographic
examinations were performed at implant placement and then 1, 3, 6, 12, and 24 months after implant
placement. An assessment of implant stability, peri-implant mucosa, level of attached gingivae, occlusion,
proximal contact, and marginal bone levels was performed at each respective visit.
Results: 14 patients were treated and restored with 18 single crowns. The cumulative survival rate was
100% after 2 years. The mean marginal bone remodeling was 0.04 ± 0.26 mm (n = 18). The attached
gingival change was +0.33 ± 0.35 mm.
Conclusion: The 24-month results indicate that the sloped marginal contour implant performed well in
posterior healed sites with a 100% survival rate and good marginal bone maintenance.
Topic: SMART ARTICLE
Authors: Ernesto A. Lee
Title: Subperiosteal minimally invasive aesthetic ridge augmentation technique (SMART): a new standard for bone reconstruction of the jaw
Source: Int J Periodontics Restorative Dent
2017;37:165–173. doi: 10.11607/prd.3171
Type: new technique case
reports
Rating: Good
Keywords: Subperiosteal, minimally invasive, aesthetic ridge augmentation, technique, (SMART)
Purpose: The purpose of this article is to present the results of a case series where flapless ridge augmentation was performed using a minimally invasive subperiosteal aesthetic ridge augmentation technique (SMART) to treat single and multiple edentulous, dentate, and implant sites.
Materials and methods: 60 single and multiple edentulous, dentate, and implant sites on 21 patients and five treatment categories with a follow-up period ranging from 4 to 30 months.
The technique includes the use of a laparoscopic approach to deliver a growth factor rhPDGF-BB (Gem 21) /Xenograft (Straumann Xenograft) combination into a subperiosteal pouch.
No flap elevation, cell-occlusive membranes, space-maintaining devices, or decortication procedures were used.
A laparoscopic tunnel access and subperiosteal pouch must be surgically developed while preserving the integrity of the periosteum
Results: The results from this case series demonstrated predictable and
consistent bone regeneration. The average gain in ridge width
for all
treatment categories was 5.11 mm (SD 0.76 mm), which compares favorably with
previously published reports. Morbidity and complication rates were consistently
reduced as well. Human histology results show xenograft particles surrounded by
newly formed bone. The role of
Discussion: the periosteum contains a population of progenitor cells that mediate the repair of bone defects. The osteoinductive potential of the periosteum as a source of undifferentiated mesenchymal cells in bone repair also has been reported
Conclusion: The SMART method is a disruptive technology with the potential to af- fect jaw bone grafting procedures by substantially replacing the use of traditional GBR procedures.
Topic: Another Papilla preservation technique ARTICLE
Authors: Aslan, Suduneli, Cortellini
Title: Entire papilla preservation
technique: A novel surgical approach for regenerative treatment of deep and wide
intrabony defects
Source: Int J Periodontics Restorative Dent
2017;37:227–233. doi: 10.11607/prd.2584
Type: clinical report
Rating: Good
Keywords:
Purpose: This clinical report describes a novel tunnel-like surgical approach, the entire papilla preservation technique, for the regenerative treatment of deep and wide intrabony defects
Materials and methods: Three systemically healthy patients were included in this clinical report. Restorative or endodontic treatments were performed as required. The patients were reevaluated 3 months after completion of these treatment procedures. Clinical periodontal parameters were recorded at baseline, 3 months after completion of the nonsurgical periodontal therapy. Final clinical outcomes were recorded 8 months after the regenerative periodontal surgery.
Technique:
The entire papilla preservation technique is a tunnel-like approach to the defect-associated interdental papilla.
Following a buccal intracrevicular incision, a beveled vertical releasing incision was made in the buccal gingiva of the neighboring interdental space and extended just beyond the mucogingival line to provide appropriate mechanical access to the intrabony defect
A microsurgical periosteal elevator was used to elevate a buccal full-thickness mucoperiosteal flap extending from the vertical incision to the defect-associated papilla.
the interdental papilla elevation full thickness up to the lingual bone crest.
A microsurgical scissor was used to remove the granulation tissue from the inner aspect of the interdental papilla. The granulation tissue was removed with a mini-curette
EDTA gel and were applied on the biologically compatible and air-dried root surface.
Porcine- derived bone substitutes were placed into the defect, and the flap was sutured with simple interrupted sutures.
Results:
Conclusions: The entire papilla preservation procedure provides adequate mechanical access to interproximal deep and wide intrabony defects and an excellent and uneventful postoperative healing phase. The application of this technique sup- ports the use of amelogenins and grafting materials. Further research with evidence is required to evaluate and clarify the advantages and disadvantages of this technique.
Topic: Root Coverage Procedures NO ARTICLE Combined Regenerative
Authors: Santoro G, Zucchelli G, Gherlone E.
Title: Combined Regenerative and Mucogingival Treatment of Deep Intrabony Defects Associated with Buccal Gingival Recession: Two Case Reports
Source: Int J Periodontics Restorative Dent. 2016 Nov/Dec;36(6):849-857.
Type: Case report
Rating: Fair
Keywords: root coverage and regenerative procedures, biomaterials
P: The case reports presented in this article describe a surgical approach for improving root coverage and regenerative parameters in deep intrabony defects associated with buccal gingival recession. A mandibular canine and a maxillary premolar were treated.
M&M: The surgical technique consisted of a connective tissue graft (CTG) that was placed and sutured at the inner surface of a coronally advanced envelope flap (CAF), thickening the buccal soft tissue wall of the most coronal extension of the intrabony defect and treated with biomaterials as scaffold. No palatal/lingual flap was elevated.
R: Two years after the surgery, clinically significant root coverage, increased buccal keratinized tissue height and thickness, some minor improvement in the position of the interdental papilla, and clinical attachment level gain were achieved. The radiographs showed bone fill of the intrabony components of the defects.
BL: This report encourages a novel application of CAF + CTG + biomaterials to improve both esthetic and regenerative parameters in deep intrabony defects associated with gingival recessions.
Topic: Endodontic implant pathology NO ARTICLE
Authors: Chung SH, Park YS, Bae KS, Baek SH, Kum KY, Lee W, Shon WJ.
Title: Saving an Integrating Implant Involved with Endodontic Implant Pathology Using Surgical Treatment.
Source: Int J Periodontics Restorative Dent. 2016 Nov/Dec;36(6):893-898.
Type: Case report
Rating: Good
Keywords: endodontic implant pathology, endodontic implantitis, periapical lesion
BG: Endodontic implant pathology (EIP) refers to cases in which endodontic infections cause infections in adjacent implants, and vice versa.
P: This case report demonstrates the successful resolution of two types of EIPs, implant endodontitis and endodontic implantitis, by endodontic intervention with surgical treatment.
In case 1: the patient complained of tooth discomfort after implant placement in the adjacent tooth. The tooth was sensitive to percussion and showed slight mobility with a negative reaction
to an electric pulp test. The symptoms persisted despite conventional root canal treatment, and surgical treatment of the symptomatic tooth and implant lesion was performed.
In case 2: the patient suffered from repeated infection around a newly installed implant. The adjacent devitalized tooth exhibited a periapical lesion that was contiguous with the implant. Conventional root canal treatment and retreatment did not successfully resolve the symptoms. Surgical root canal therapy was then performed with regenerative biomaterials as needed.
D: Neither case showed radiographic or clinical evidence of failure after 4 and 5 years of follow-up, respectively, after the surgery and the adjacent implants were successfully osseointegrated.
BL: Endodontic intervention combined with surgical treatment resolved both types of EIPs and led to tooth preservation and successful osseointegration of adjacent implants.
Topic: Hybrid implants ARTICLE
Author: Spinato S., Bernadello F., et al
Title Hybrid Implants in Healthy and Periodontally Compromised Patients: A Preliminary Clinical and Radiographic Study
Source: Clinical Oral Implants Research, Volume 37, Number 2, 185-192
Type: Clinical Study
Rating: Good
Keywords: Hybrid restorations, implants, periodontitis, survivability
Purpose: To radiographically and clinically examine the marginal bone loss around “hybrid” implants (coronal 1/2 machined surface, apical ½ roughened surface) and examine the influence of prosthetic abutment height placed in two groups of partially edentulous patients: periodontally healthy and periodontally compromised.
Methods and Materials: A total of 93 patients requiring single or multiunit implant restorations, in the mandible or maxilla, were treated while undergoing cement-retained prosthetic restoration. All implants were restored with cement-retained prosthetics. Implant brand used: Shape1-Hybrid, i-RES (textured surface was sand-blasted, double etched, cold plasma decontaminated). A total of 54 implants (35 in the maxilla and 19 in the mandible) were placed in 45 periodontally healthy patients, and 56 implants (31 in the maxilla and 25 in the mandible) in 48 periodontally compromised patients. Oral hygiene maintenance program was completed every 4 months. Patients were evaluated clinically and radiographically at 12 months.
Results: All 110 hybrid implants positioned in pristine bone provided a 100% survival rate in both periodontally healthy patients and periodontally compromised patients. No statistical differences were recorded comparing the marginal bone loss values of maxillae with those of mandibles. In healthy patients and compromised patients, a similar and limited amount of marginal bone loss was recorded, and it was found that the higher the abutment height, the less marginal bone loss.
Conclusion: Hybrid implants examined could reduce the risk of peri-implantitis due to their coronal machined surfaces and improve osseointegration due to their apical rough surfaces. Abutment height may also play a role in marginal bone stability and localized inflammation.
Topic: Anterior implant aesthetic stability ARTICLE
Author: Mangano FG., Mastrangelo P., et al
Title Aesthetic outcome of immediately restored single implants placed in extraction sockets and healed sites of the anterior maxilla: a retrospective study on 103 patients with 3 years of follow up
Source: Clinical Oral Implants Research, Volume 37, Number 2, 185-192
Type: Retrospective Study
Rating: Good
Keywords: anterior implants, aesthetics, pink score, white score
Purpose: To compare the aesthetic outcome of single implants in extraction sockets and healed ridges of the anterior maxilla by means of the pink aesthetic score/white aesthetic score (PES/WES) index.
Methods and Materials: This retrospective study was based on data from 103 patients (43 males,
60 females) aged 24–65 years who had been successfully treated with a single implant in the anterior maxilla. Forty-two patients were treated with a single immediate implant in a fresh post-extraction socket
while 61 patients were treated with a single implant in a healed site. Two independent calibrated examiners applied the PES/WES index to the 103 single-tooth restorations, respectively 3 months and 3 years after implant placement.
Pink Esthetic Score Criteria White Esthetic Score Criteria
(Bresler 2009)
Results: Biological (4.8%) and prosthetic (8.7%) complications were reported. Both the immediate implant group and healed implant group yielded satisfactory aesthetic outcomes. At the delivery of the final restoration, a PES/WES score of 16.6 2.6 and 15.73.0 was reported for immediate and healed groups, respectively: this difference was not statistically significant. A higher decrease in the PES/WES score was observed with healed group over time. At 3 years, a PES/WES score of 16.42.8 and 15.2 3.3 was reported for immediate group and conventional group, respectively: this difference was statistically significant. Immediate group seemed to yield better aesthetic outcomes in young patients (≤30 years), with implants placed in central incisor/cuspid areas, in the presence of bone contouring.
Conclusions: Both immediate and delayed single-implant treatment in the anterior maxilla
can yield satisfactory aesthetic outcomes, however immediately placed implants in fresh extraction sockets may provide more stable results.
Topic: Cannabis ARTICLE
Author: Shariff J, Ahluwalia K, Papapanou P
Title: Relationship Between Frequent Recreational Cannabis (Marijuana and Hashish) Use and Periodontitis in Adults in the United States: NHANES 2011 to 2012
Source: J Perio March 2017, Vol. 88, No. 3: 273-280. Doi: 10.1902/jop.2016.160370
Type: Survey
Rating: Good
Keywords: Cannabis; nutrition surveys; periodontitis; tobacco use
Purpose: To examine the relationship between frequent recreational cannabis (FRC) (Marijuana and hashish) use and periodontitis prevalence among adults in the United States.
Methods: Data from the NHANES 2011 and 2012 surveys were analyzed. The primary outcome (periodontal disease) was defined using the CDC and AAP classification. There was a continuous measurement of PD and CAL. The participants were divided between two groups based off their self-reported answer to the frequency of their cannabis use: “FRC use” versus “non-FRC use”. Age was stratified into three groups of 10-year intervals (30-39, 40-49, 50-59). They also accounted for sex, race/ethnicity, socioeconomic status, diabetes mellitus status, substance use (alcohol and tobacco) and past periodontal therapy. Statistical analysis was completed.
Results:
Frequency of PD and AL
FRC users had a significantly higher mean number of sites with PD >4, >6, and >8mm non-FRC users
FRC users had SS higher mean number of sites with AL >3, >5, and >8mm compared with non-FRC users
Pattern of mean AL
Mean AL was higher among FRC users (1.8mm) than among non-FRC users (1.6mm)
Bottom Line: FRC use is associated with deeper PDs, more CAL, and higher odds of having severe periodontitis.
Topic: Furcations ARTICLE 1.2% Rosuvastatin
Author: Garg S, Pradeep AR
Title: 1.2% Rosuvastatin and 1.2% Atorvastatin Gel Local Drug Delivery and Redelivery in the Treatment of Class II Furcation Defects: A Randomized Controlled Clinical Trial
Source: J Perio March 2017, Vol. 88, No. 3: 260-265. Doi: 10.1902/jop.2016.160399
Type: Randomized Controlled Trial
Rating: Good
Keywords: Clinical trial; dental scaling; hydroxymethylglutaryl-CoA reductase inhibitors; periodontitis; root planing; statins
Background: Rosuvastatin (RSV) and Atorvastatin (ATV) have shown bone stimulatory and anti-inflammatory effects. Statins also help in promoting angiogenesis and inhibiting tumor growth and metastasis. They encourage the production of BMP-2 and assist in osteoblastic differentiation. Osteoblastic differentiation and anti-inflammatory actions of statins can be used to treat periodontitis.
Purpose: To explore the efficacy of 1.2% RSV and 1.2% ATV gels as a local drug delivery and redelivery system adjunct to SRP for treatment of class II furcation defects.
Methods: 90 patients with mandibular buccal class II furcation defects were randomly allocated to one of three treatment groups:
Group 1- SRP with placebo gel
Group 2- SRP with 1.2% RSV gel
Group 3- SRP with 1.2% ATV gel
Clinical parameters measured at baseline included: 1) modified sulcus bleeding index (mSBI); 2) full-mouth plaque index; 3) PD; 4) relative vertical CAL (RVCAL); 5) relative horizontal CAL (RHCAL). SRP was done, followed by respective gel placement for each patient. All parameters were measured again at 6 and 9 months. Custom splint was fabricated to standardized measures of PD and RVCAL. Standardized radiographs were used to assess defect depth reduction. Gels were redelivered at the respective sites at 6 month recall appointment.
Results:
SS improvement in PI and mSBI in all three groups.
The decrease in mSBI was SS greater in the RSV group than in the ATV group at 6 and 9 months.
Greater mean PD reduction and greater mean gain in RVCAL and HVCAL were seen in the RSV group than in the ATV group at 6 and 9 months.
SS greater mean percentage of defect depth reduction (DDR) was found in the RSV group than in the ATV group at 6 and 9 months.
Bottom Line: The RSV group shows SS improvement in all clinical parameters and SS greater DDR compared with the ATV group in treatment of mandibular class II furcation defects as an adjunct to SRP.
Topic: Ridge preservation ARTICLE Healing at Molar Extraction
Authors: Walker CJ, Prihoda TJ, Mealey BL, Lasho DJ, Noujeim M, Huynh-Ba G
Title: Evaluation of Healing at Molar Extraction Sites With and Without Ridge Preservation: A Randomized Controlled Clinical Trial
Source: Journal of Periodontology March 2017, Vol. 88, No. 3: 241-249. doi: 10.1902/jop.2016.160445
Type: Randomized clinical trial
Rating: Fair
Keywords: Allografts, bone, cone beam computed tomography, dental implants, molar, tooth extraction
Purpose: To determine dimensional alveolar changes radiographically and to clinically determine changes in soft tissue found after molar extraction with and without ridge preservation (RP).
Methods: 40 patients at UTHSCSA were used in this study. Patients were required to have at least 10 mm of radiographic alveolar bone height and enough vertical space for a dental implant. Prior to extraction, a custom stent was made for CT measurements. At the time of extraction, KG baseline was measured. A full thickness flap was raised and teeth were extracted. Patients drew envelops to determine if they would be in the control or ridge preservation group. Control participants received an absorbable collagen sponge in the socket, followed by pre-extraction flap reapproximation. In the RP group, sockets were filled with FDBA and covered with a nonresorbable dPTFE membrane before flaps were repositioned. A CBCT was taken with the stent within 72 hours of extraction. Membranes were removed between 21 and 28 days post op. A second CBCT was taken 3 months after the initial procedure, with implant placement following 3 weeks later. KG was remeasured at time of implant placement and grafting was performed when indicated. A final CT was taken and radiographic measurements compared.
Results: 20 patients were allocated to each treatment group. 5/20 in the control group and 2/20 in the test group required grafting at the time of implant placement. No significant differences were noted between groups in regards to changes in KG. Buccal ridge height loss was significantly less in the test group, but no significant differences were noted in the lingual ridge height. Decreases in ridge width were also not significantly different between groups based on radiographic observations, however in control sites, 2/3 of the reduction was located on the buccal aspect of the ridge, while in the test group the reduction was seen more on the lingual.
Conclusion: The data from this study suggests that after molar extraction, ridge preservation did not significantly impact vertical width change, but significantly decreased buccal vertical height reduction compared with natural healing. Grafting at the time of implant placement was also more common in the control group.
Topic: Furcation defects ARTICLE Platelet-Rich Fibrin
Authors: Kanoriya D, Pradeep AR, Garg V, Singhal S
Title: Mandibular Degree II Furcation Defects Treatment With Platelet-Rich Fibrin and 1% Alendronate Gel Combination: A Randomized Controlled Clinical Trial
Source: Journal of Periodontology March 2017, Vol. 88, No. 3: 250-258. doi: 10.1902/jop.2016.160269
Type: Randomized clinical trial
Rating: Good
Keywords: Alendronate, chronic periodontitis, furcation defects, growth factors, osteoclasts, regeneration
Purpose: To investigate the efficacy of platelet rich fibrin (PRF) and 1% alendronate in the regeneration of class II furcation defects.
Methods: 72 patients were selected for this study. Inclusion criteria included presence of class II furcation in vital, asymptomatic mandibular first and second molars with a radiolucent furcation area on an intraoral periapical radiograph with a vertical probing depth ≥ 5 mm and horizontal probing depth ≥ 3 mm after phase I treatment. Patients received one of three treatments: access/debridement alone, access/debridement + PRF, access/debridement + PRF + 1% alendronate. PRF was used as membrane in groups 2 and 3. Flaps were repositioned and post-op instructions given. Plaque index, modified sulcus bleeding index, probing depth and relative vertical/horizontal attachment level were measured at baseline and 9 months later.
Results: Plaque index and bleeding index improved in all three groups at 9 months. Probing depth reduction was significantly greater in groups 2 and 3, with group 3 having the greatest reduction. Groups 2 and 3 also had greater gains in vertical and horizontal attachment levels, with group 3 again showing the greatest increase. Group 3 had the highest percentage of bone fill (56.01%) compared to group 2 (49.43%) and group 1 (10.25%).
Conclusion: There was a greater reduction in probing depth, more vertical/horizontal attachment gain, and significant bone defect fill when PFR and 1% alendronate were used to treat degree II furcation defects compared to access and debridement alone.
Topic: root coverage NO ARTICLE trapezoidal flap
Authors: Santamaria MP, Neves FL, Silveira CA, Mathias IF, Fernandes-Dias SB,
Title: Connective tissue graft and tunnel or trapezoidal flap for the treatment of single maxillary gingival recessions.
Source: J Clin Periodontol. 2017 Feb 23. doi: 10.1111/jcpe.12714. [Epub ahead of print]
Type: randomized clinical trial.
Rating: good
Keywords: Dental esthetics; Dentin Sensitivity; Gingival recession; Maxilla; Pain Measurement; Surgical flaps
Background: Although connective tissue grafts are the most predictable treatment for gingival recession (GR) defects, evidence regarding the most appropriate flap design to be used with such grafts is limited. Although the trapezoidal flap is one of the common approaches to CAF+CTG, not enough studies have assessed direct comparison of this technique and TUN+CTG.
Purpose: To compare the outcomes of trapezoidal coronally advanced flap (CAF) and coronally advanced tunnel flap (TUN) when used in conjunction with CTG in the treatment of gingival recessions.
Methods: Parallel arm, open-label randomized clinical trial with blinded outcome assessment. Pt pool = periodontology clinic of State University of Sao Paulo, Brazil. Inclusion criteria: adult (>18 years old); non-smoker; systemically healthy; no signs of active periodontal disease; full-mouth plaque and bleeding score ≤20%; single Miller Class I or II GR on a vital maxillary canine or premolar; visible cemento-enamel junction (CEJ); probing depth (PD) ≤3 mm in selected tooth. 42 patients with 42 single maxillary Miller class I and II gingival recession with complaints of hypersensitivity and/or aesthetic concerns were included. Defects randomly assigned to receive either CAF+CTG (21 defects) or TUN+CTG (21 defects). Clinical parameters (full-mouth visible plaque index (FMPI) full-mouth sulcus bleeding index (FMBI), BOP, PD, relative gingival recession (RGR), relative clinical attachment (RCAL) frequency of root coverage, keratinized tissue thickness, keratinized tissue width, were measured. Patient-centered and aesthetic outcomes were assessed using.
Results: Six months postoperatively, both groups resulted in significant reduction of recession depth and increases in keratinized tissue thickness and width. CAF+CTG and TUN+CTG mean root coverage was 87.2±27.1% and 77.4±20.4%, respectively (p=0.02). Complete root coverage was achieved in 71.4% and 28.6% of defects treated with CAF+CTG and TUN+CTG, respectively (p=0.01). At 7 days postoperatively, TUN+CTG patients reported significantly less pain experience (p=0.04). Both approaches reduced dentine hypersensitivity by approximately 85% (p<0.05). Patient-based aesthetic evaluation indicated significant improvement for both groups. Although patient- and professional-based aesthetic assessments revealed no differences between groups, tissue texture was significantly better for TUN+CTG (p=0.02).
Conclusion: Within the limits of this study, it can be concluded that both CAF+CTG and TUN+CTG can significantly reduce GR and associated dentine hypersensitivity and improve aesthetics in single GR defects. However, trapezoidal CAF+CTG was superior to TUN+CTG in percentage of root coverage and complete root coverage attained when treating maxillary canines and premolars. Future investigations should be performed to determine optimal flap approaches to be used with CTG in different clinical situations.
Topic: post-ext dimensional changes ARTICLE CLSM
Authors: García-Herraiz A, Silvestre FJ, Leiva-García R, Crespo-Abril F, García-Antón J.
Title: Post-extraction mesio-distal gap reduction assessment by CLSM - a clinical 3-month follow up study.
Source: J Clin Periodontol. 2017 Feb 16. doi: 10.1111/jcpe.12706. [Epub ahead of print]
Type: clinical descriptive
Rating: good
Keywords: Confocal Laser Scanning Microscopy; mesio-distal distance; post-extraction changes; socket healing
Purpose: The aim of this three-month follow up study is to quantify the reduction in the mesio-distal gap dimension (MDGD) that occurs after tooth extraction through image analysis of three-dimensional images obtained with the CLSM technique.
Methods:
Following tooth extraction, impressions of 79 patients one-month and 72 patients three-month after tooth extraction were obtained. Extractions had been done as atraumatic as possible to avoid damaging gingiva or alveolar bone support. No flaps but sectioned and curettaged if necessary. Sockets were healed by first intention (?) and were not sutured. A silicone print of socket was taken and a cast was made. Cast models were processed by The Confocal Laser Scanning Microscopy (CLSM) and MDGD changes between time points were measured (The Confocal Laser Scanning Microscopy (CLSM) technique consists of an optical microscope that includes a laser light as the light source and an electronic system for image collection). New silicone prints were taken one and three months after ext. data was analyzed.
Results:
The mean mesio-distal gap reduction one-month after tooth extraction was 343.4 μm and three-month after tooth extraction was 672.3 μm. The daily mean gap reduction rate during the first term (between baseline and one month post-extraction measurements) was 10.3 μm/day and during the second term (between one- and three-month) was 5.4 μm/day. Interdental contact and tooth type showed significant influence on the gap reduction. Age, gender, diseases, periodontal status and smoking status, location and reason for extraction did not affect MDGD one and three months after extraction.
Conclusion: The mesio-distal gap reduction is higher during the first month following the extraction and continues in time, but to a lesser extent. When the interdental contacts were absent the mesio-distal gap reduction is lower. When a molar tooth is extracted or the distal tooth to the edentulous space does not occlude with an antagonist the mesio-distal gap reduction is larger. The consideration of mesio-distal gap dimension changes can help improve dental treatment planning.
Topic: Esthetics ARTICLE Gingival Pigmentation
Authors: Zarone F, Leone R, Ferrari M, Sorrentino R.
Tittle: Treatment Concept for a Patient with a High Smile Line and Gingival Pigmentation: A Case Report.
Source: Restorative Dent. 2017 Mar/Apr;37(2):e142-e148. doi: 10.11607/prd.2833.
Type: Case report
Rating: Fair
Keywords: high smile, hyperpigmentation
Purpose: to describe the multidisciplinary treatment of a woman who was unsatisfied with the shape of her central incisors and the dark gingival pigmentation displayed by a high smile line.
Case Description: 35 year-old dark-skinned Cuban woman expressed dissatisfaction with her smile. Pt showed an intense brownish pigmentation of the gingival tissues, combined with a high smile line. After 15 days of careful oral hygiene procedures (scaling, root planing, and oral hygiene instructions), the patient’s periodontal chart showed no signs of periodontal pathology. At the level of the maxillary central incisors, a probing depth of 4 mm was detected in the absence of periodontal bleeding. This was due to hyperplastic tissues further shortening the appearance of the incisors and resulting in a reverse smile line. The first treatment was crown-lengthening surgery, performed with a gingivoplasty.
After inducing local anesthesia, the pseudopockets were removed using a BP-15 scalpel to an extent of 3 mm with an external bevel incision, taking care not to damage the dento-gingival attachment. At that time, the patient asked for a last minute partial pigmentation removal, so the gingival tissues above the maxillary incisors were de-epithelized and the exposed connective tissue was covered with periodontal dressing.
After 30 days of healing, the gingival arches of the central incisors appeared symmetric and more apically and properly positioned and shaped; moreover, the keratinized adherent gingiva showed no inflammation and a light pink color with a complete absence of any visible melanic pigmentation. Two leucite-filled glass-ceramic were fabricated. After 2 months, the patient was satisfied with the results and asked for a reduction of the high smile line. Botulinum toxin was injected to reduce the activity of the lip elevator muscles and lower the smile line. After 2 weeks, the esthetic result was satisfactory.
After 3 years, the patient asked for removal of the residual gingival pigmentation at both arches. The same surgical procedure was used to completely remove the remaining brownish gingival areas as previously described.
At the 3-year follow-up, no major modifications were detected either at the level of the restorations or of the gingival color.
Conclusion: The described multidisciplinary was effective in solving the undesired high smile line and achieving patient satisfaction.
Topic: Esthetics ARTICLE Fresh Extraction Sockets
Authors: Ganeles J, Norkin FJ, Zfaz S.
Tittle: Single-Tooth Implant Restorations in Fresh Extraction Sockets of the Maxillary Esthetic Zone: Two-Year Results of a Prospective Cohort Study.
Source: Int J Periodontics Restorative Dent. 2017 Mar/Apr;37(2):e154-e162. doi: 10.11607/prd.3096.
Type: Prospective study
Rating: Fair
Keywords: Anterior, implant, soft tissues
Purpose: to document soft tissue conditions and marginal bone levels following immediate placement and restoration of single-tooth anterior maxillary extraction, with a followed up of 2 years.
Methods: 5 patients received 15 variable-thread tapered implants placed in fresh extraction sites in the maxillary esthetic zone and immediately were provisionalized out of occlusion. Of the 15 patients, 11 completed their 2-year follow-up. Inclusion criteria: immediate implant placement with a fixed provisional restoration between the first maxillary bicuspids, had natural teeth adjacent to the implant site, had sufficient bone volume and density to receive ≥ 3.5-mm-diameter, 10-mm-length implants without grafting, had an extraction socket with at least three intact walls, smoked ≤ 10 cigarettes per day, no severe bruxism. Patients were also excluded if the final implant torque was < 35 Ncm.
Results: At 2 years, the success and cumulative survival rates were both 100%, and the mean bone level gain was 0.83 mm. Soft tissue assessment showed no zero esthetic scores, improved papilla indices, and low bleeding on probing and plaque accumulation.
Conclusion: Overall, the study implants showed excellent hard tissue, soft tissue, and esthetic outcomes, indicating a healthy tissue response in single-tooth extraction sites in the maxillary esthetic zone.
