International Journal of Periodontics & Restorative Dentistry, 01/2004

A 37-year-old woman presented with severe ridge resportion of the mandibular left first molar and requested placement of a dental implant in lieu of a traditional fixed partial denture. The patient preferred an allograft to avoid a second surgical site to harvest an autogenous bone graft. A new solvent-dehydrated, allogeneic, corticocancellous bone graft material was selected for the case. The allograft was shaped to fit the defect, rehydrated in sterile saline, stabilized with fixation screws, and covered with platelet-rich plasma and a resorbable collagen membrane prior to soft tissue closure. Four months later, the bone graft was incorporated into the host tissue without complications and effectively expanded the ridge from 3 to 9 mm. The implant osseointegrated and was restored with a computer- milled abutment and single crown. The allograft maintained its strength and structural integrity, and was well-tolerated by the host tissues. A screwdesign implant was placed in the previously augmented bone site and successfully restored with a computer-milled post and cemented single-tooth prosthesis. The allograft material was a highly effective modality for restoring the case, and it may significantly reduce the need to obtain autogenous bone from a secondary site.

This study evaluated the dimensions and characteristics of the cementoenamel junction (CEJ) of maxillary anterior teeth; the natural CEJ was compared to current implant design and used for design optimization. Standardized digital images of 137 extracted human teeth (45 central incisors, 46 lateral incisors, and 46 canines) were used to measure cervical dimensions, CEJ curvature, and distance from zenith of CEJ to interdental contact on proximal views. The x- and y-coordinates of the CEJ contour were digitized before mathematic processing to allow the representation of a single average curve for buccal, palatal, mesial, and distal surfaces for each tooth type. These measurements were combined to existing data related to dentogingival and "implantomucosal" junction to extrapolate specific biologic landmarks around teeth and implants. Mean cervical dimensions, distance from zenith of CEJ to interdental contact, and CEJ curvature were compared. Cervical dimensions significantly differed, with a more symmetric cervical cross-section for central incisors, slightly more rectangular shape for lateral incisors, and distinctly rectangular shape for canines. CEJ curvature was statistically different between all tooth groups (centrals > laterals > canines); within groups, curvature value was always superior at the mesial aspect compared to distally (3.46 mm vs 3.13 mm for centrals, 2.97 mm vs 2.38 mm for laterals, and 2.55 mm vs 1.60 mm for canines). Toothimplant biologic width discrepancies ranged from 4.10 to 5.96 mm and were different between all groups of teeth (centrals > laterals > canines); within groups, the discrepancy was always superior at the mesial aspect compared to distally. Current implant design featuring a flat, rotation-symmetric shoulder should be reconsidered in view of natural CEJ contour to improve biologic considerations and related esthetics.

The unpredictability of current surgical procedures for papilla reconstruction has been a matter of concern for both periodontists and patients. This case report presents a complete papilla reconstruction in a 20-year-old woman using an interposed subepithelial connective tissue graft. The results show that this technique can be successfully used in treating the loss of papillae and achieving long-term stability. The objective of this report is to describe the surgical technique and comment on the factors that may have influenced the final result.

A modification of the surgical extrusion technique to treat fractured teeth was realized as an alternative periodontal therapy to avoid ostectomy following orthodontic extrusion of teeth with their biologic widths compromised by different etiologic involvements. After delicate luxation and arrested avulsion, the teeth were coronally positioned to allow room for a new biologic width. Clinical and radiographic monitoring showed the ability of the periodontium to adapt function and esthetic recovery. The advantages and disadvantages of this therapeutic procedure for resolution of a periodontal involvement are presented.

The effect of buccolingual staggered implant placement on stress distribution within the supporting structure was examined photoelastically. Two photoelastic models of a human mandible, edentulous distal to the canine, were fabricated. Three screw-type implants were embedded into the edentulous region of each model. The implants were placed in a straight line in one model and in a buccolingual staggered configuration in the other. Vertical and lateral loads were applied to a fixed partial denture superstructure. No clear biomechanical advantage to a staggered 1.5 mm buccal and lingual offset placement configuration was observed.

This study reports the results obtained 36 months after treating deep periodontal defects with amelogenins. Results at 12 months have already been published. Sixteen of 21 patients completed the 3-year recall program. This study confirms after 3 years the results obtained at 1 year: Probing pocket depth decreased from 7.87 ± 2.03 mm to 2.93 ± 2.19 mm; recession increased from 2.20 ± 1.42 mm to 2.93 ± 1.87 mm; and attachment level decreased from 10.07 ± 2.28 to 5.87 ± 2.59 mm. No statistically significant difference was found between the data collected at 12 and 36 months. The standardized radiographs, digitized and analyzed with purpose-developed software, did not show any appreciable increase in bone volume, but only improved mineralization of the preexisting bone after 3 years using Emdogain without grafts.

The present study was undertaken to assess the width of keratinized tissue and root coverage achieved when orienting the superficial surface of a connective tissue graft toward either the gingival flap or the root surface. Sixteen pairs of bilateral gingival recessions (Miller Class I and II) in 13 subjects were divided into two groups. In each subject, one side received a connective tissue graft with its superficial surface facing the gingival flap, while the contralateral side received a connective tissue graft with its superficial surface facing the root surface. Plaque Index, Gingival Index, probing depth, gingival recession, and relative clinical attachment level were recorded at baseline and 3 months postoperative. Root length was measured on periapical radiographs to calculate the percentage of actual root coverage. ANOVA was used to detect significant differences between the two treatment groups. The results indicated that surface orientation of a connective tissue graft has no significant effect on the clinical outcome of either root coverage or gingival augmentation.

The periodontal condition of 72 non-insulin dependent diabetes patients was compared with that of 92 nondiabetic individuals. Plaque Index (PlI), Calculus Index (CI), Gingival Index (GI), and attachment loss (AL) were measured on four surfaces of six teeth in each subject. All four parameters were significantly higher in the diabetic group. No significant difference in the frequency of toothbrushing was found between the groups. For all age groups, GI and AL were higher in the diabetic group. In each group, GI was not changed with age, while AL increased with age. Classification of the groups based on PlI showed that the diabetic group's GI was higher than the nondiabetic group for low, medium, or high PlI values. The diabetic group showed higher AL for only the medium and high PlI groups. Classification by CI revealed that the diabetic group's GI and AL were significantly higher than those of the nondiabetic group for subjects with low, medium, or high values of CI. Multiple regression analysis revealed that the main factor affecting GI was the presence or absence of diabetes. PlI and CI both showed a significant relationship with GI; age was the second most significant factor. The most significant factors influencing AL were CI and the presence or absence of diabetes; age was the second most significant factor. Patients who had had diabetes for more than 10 years had a higher AL than those who had suffered from diabetes for less than 10 years. Patients with average HbA1c values >= 10% had more serious mean GI values than those with HbA1c values 10%. In patients with diabetes, age, plaque accumulation, and calculus formation have more detrimental effects on the periodontal apparatus than in healthy individuals.

The purpose of this study was to compare clinically and radiographically the results obtained following application of (1) commercially available demineralized freeze-dried bone allograft (DFDBA), (2) guided tissue regeneration (GTR) using a bioabsorbable polylactic acid softened with citric acid ester barrier, and (3) enamel matrix derivative gel (EMD), in the treatment of two- and three-walled intrabony defects. The study included 39 patients-12 in the DFDBA group, 12 in the GTR group, and 15 in the EMD group-each with one treated defect. Clinical measurements, Plaque Index, Gingival Index, probing depths, clinical attachment levels, and recession were comparable in the three groups at baseline. Measurements were repeated 12 months postoperative. Surgical measurements were also comparable at baseline among the groups. Radiographs were taken at baseline and 12 months later, and they were compared after reconstruction of the postoperative radiograph by a software program that produces geometric standardization. No significant differences in clinical results among the three groups were found. Radiographic assessment indicated a slight, nonsignificant difference in mean crestal bone resorption and defect fill between the groups. However, the mean improvement in intrabony depth was greater in the GTR and EMD groups than in the DFDBA group. The three regenerative procedures appeared to be equally effective in treating intrabony defects, with the exception of radiographic defect resolution, which was significantly greater in the GTR and EMD groups than in the DFDBA group.