International Journal of Periodontics & Restorative Dentistry, 02/1996

The current abundance of posterior esthetic restorative materials and techniques may be confusing. This paper describes a simple and logical global concept that assists clinicians in choosing the appropriate therapeutic modality according to well-defined clinical criteria. Practical considerations about cavity preparation, base-lining, filling, luting, and finishing procedures are reviewed.

This study evaluated histologically and clinically the use of decalcified freeze-dried bone allograft in conjunction with Gore-Tex Augmentation Material and Memfix bone pins for localized ridge augmentation in three cases. Biopsies taken at 3, 6, and 9 months were evaluated. It was concluded that: (1) guided bone regeneration may be performed at local immediate extraction sites when flap design permits primary wound closure; (2) decalcified freeze-dried bone allografts used in conjunction with supporting pins may contribute to successful bone regeneration either by osseoinduction or osseoconduction, and/or by maintaining the membrane-created space during the early events in wound healing; and (3) at 9 months, guided bone regeneration utilizing Gore-Tex Augmentation Material membranes and decalcified freeze-dried bone allografts resulted in the formation of dense, viable new bone.

Surgeons must become completely familiar with the anatomy of the palatal donor site to feel confident in providing the subepithelial connective tissue graft procedure. Variations in the size and shape of the hard palate affect the dimensions of donor tissue harvested, as well as the location of the greater palatine neurovascular bundle. This article classifies palatal vaults according to ehight as high, average, and shallow. Illustrations and cadaver dissection are utilized to demonstrate that surgeons can gain substantial donor tissue specimens without encountering the neurovascular bundle. Actions to be followed in the unlikely event that the neurovasculature is encountered are reviewed.

The authors report on the microscopic findings in two plasma-sprayed non-submerged implants retrieved from a patient 6 months after placement. One of the implants had been loaded for 3 months, while the otehr was left unloaded. Clinically, the peri-implant gingival tissues were in good health. The implants were sectioned according to the cutting-grinding system. Bone lined the titanium surface almost completely with 77.3% =- 5.1% of contact in the unloaded implant and 86.5% =- 3.3% of contact in the loaded implant. Signs of bone resorption with many macrophages and osteoclasts were present in the loaded implant, while in the unloaded implant only osteoclast resorption activity was demonstrable.

Three case reports are used to describe a new surgical technique that permits the combination of barrier removal and an apically repositioning flap procedure at implant exposure surgery of previously dehisced or fenestrated implant sites. The flap procedure allows the creation of an adequate zone of keratinized mucosa. In contrast to existing techniques, this method eliminates bone denudation on the interproximal and oral aspect by means of a split-thickness flap surgery. Advantages of this procedure are optimal protection of the bone and reduction of postsurgical discomfort by minimizing the possibility of infection and resorption processes on the bone surface. Furthermore, flap management and fixation are facilitated. Although the necessity of keratinized mucosa around implants i controversial, its presence is favorable in cases where esthetics is important.

The final color of all-ceramic restorations is dependent on the surrounding structures and on the ceramic itself. The degree that the layer of the composite luting agent contributes to this final color formation can only be estimated. Based on general optical physics, this paper reports on transmissivity of some commercially available composite luting resins and discusses how these theoretical results apply to clinical situations.

The utilization of resorbable membranes in the guided tissue regeneration technique allows unquestionable advantages for both the dentist and patient. Collagen is an important constitutive element of the human body and therefore is biodegradable. This study deals with a new slow-resorbing collagen membrane that, when used in conjunction with hydroxyapatite, brings about very interesting results for the treatment of periodontal and peri-implant defects.