International Journal of Periodontics & Restorative Dentistry, 06/2012

This article evaluates the long-term clinical performance of porcelain laminate veneers bonded to teeth prepared with the use of an additive mock-up and aesthetic pre-evaluative temporary (APT) technique over a 12-year period. Sixty-six patients were restored with 580 porcelain laminate veneers. The technique, used for diagnosis, esthetic design, tooth preparation, and provisional restoration fabrication, was based on the APT protocol. The influence of several factors on the durability of veneers was analyzed according to pre- and postoperative parameters. With utilization of the APT restoration, over 80% of tooth preparations were confined to the dental enamel. Over 12 years, 42 laminate veneers failed, but when the preparations were limited to the enamel, the failure rate resulting from debonding and microleakage decreased to 0%. Porcelain laminate veneers presented a successful clinical performance in terms of marginal adaptation, discoloration, gingival recession, secondary caries, postoperative sensitivity, and satisfaction with restoration shade at the end of 12 years. The APT technique facilitated diagnosis, communication, and preparation, providing predictability for the restorative treatment. Limiting the preparation depth to the enamel surface significantly increases the performance of porcelain laminate veneers.

The dental community's interest in early loading of endosseous implants provides the stimulation to test the ability of modified implant designs as well as surgical techniques to enhance the establishment and maintenance of implant stability. This preclinical canine study examined this potential by implementing several implant design and surgical technique modifications to an existing tapered implant system. The design and site preparation changes were intended to induce different compression states on the native bone, hypothetically affecting the primary stability and the rate and extent of osseointegration. The outcomes of the modifications were evaluated using resonance frequency analysis, radiographic analysis, light microscopy, and histomorphometric measurements. Three compression scenarios were tested, with each demonstrating excellent clinical, radiographic, and histologic results throughout the evaluation period. However, the scenario intended to induce a moderate degree of compression provided the best overall results, supporting its use in early loading protocols.

Limited evidence is available regarding the effect of the subepithelial connective tissue graft (SCTG) on root coverage in the mandibular anterior region. A technique is described using an SCTG with a coronally advanced flap (CAF) for the treatment of Miller Class II and III gingival recessions in mandibular central incisors. Fourteen Miller Class II and III recessions were treated in 10 patients using an SCTG with a CAF. After a mean follow-up of 11.7 months, 90.22% ± 12.36% root coverage was achieved. There were no statistically significant differences in root coverage for Miller Class II and III recession defects. Complete root coverage was achieved at five (71.42%) Miller Class II sites compared with three (42.85%) Class III defects. These results suggest that the combination of an SCTG and CAF is an effective technique to obtain root coverage in mandibular incisors with Class II and III recession defects, with excellent patient satisfaction regarding the esthetic appearance of the treated teeth.

Facial gingival tissue thickness (FGTT) is important for an esthetically pleasing anterior restoration since it determines the soft tissue's ability to conceal the underlying restorative material. The purpose of this study was to investigate the change in FGTT after immediate implant placement and provisionalization with and without a connective tissue graft. Patients with a failing maxillary anterior tooth planned for immediate implant placement and provisionalization with (CT group) or without (NCT group) a subepithelial connective tissue graft were included in this study. After tooth extraction, direct measurement of the FGTT was performed; subsequent measurements were performed at the time of definitive prosthesis placement. Data were analyzed using independent and paired t tests at a significance level of α = .05. There was no statistically significant difference in the mean FGTT at tooth extraction between the CT and NCT groups. At prosthesis delivery, the mean FGTT for the CT group was significantly greater than that of the NCT group. The mean FGTT of both groups at prosthesis delivery was significantly higher than that at tooth extraction. The mean change in FGTT in the CT group was also significantly greater than that in the NCT group. Immediate implant placement and provisionalization in conjunction with a connective tissue graft is more likely to result in sufficient peri-implant tissue thickness to conceal underlying implant restorative materials than when performed without a connective tissue graft.

The presence of a localized alveolar ridge defect, especially in the maxillary anterior dentition, may complicate an esthetic rehabilitation. The goal of this case report is to describe a novel subepithelial connective tissue graft technique for soft tissue augmentation in Class III ridge defects. Surgical intervention consisted of in situ maintenance of a connective tissue "platform" at the edentulous space, which facilitated the stabilization and suturing of the connective tissue grafts used for soft tissue augmentation. Adequate graft thickness to treat the deep horizontal soft tissue loss was obtained by doubling the width of a de-epithelialized free gingival graft that was subsequently folded on itself. The soft tissue conditioning at the level of the pontic began 9 months after surgery by shaping the soft tissue with a bur and filling the space with flowable composite resin applied above the pontic. The final prosthetic phase began 14 months after surgery. A reproduction of the anatomical cementoenamel junction in the provisional and definitive restorations was performed to improve the soft tissue emergence profile. Nine months after surgery, a soft tissue augmentation of 5 mm in the vertical and 4 mm in the horizontal dimension was accomplished. The suggested surgical technique was able to accomplish horizontal and vertical soft tissue augmentation in a single surgical step.

Marginal bone changes around titanium plasma-sprayed implants (n = 240) placed in the mandibular interforaminal regions of 120 edentulous patients were assessed over 5 years of follow-up, with emphasis on the influence of the locations of the microgap and rough/smooth border. Marginal bone changes were measured on standardized radiographs. Locations of the microgap and the rough/smooth border were both shown not to be major contributing factors in determining the marginal bone level around implants.

Increased knowledge of specific cellular responses and functions has led to the development of numerous treatment modalities based on the use of growth factors. This controlled clinical and radiographic study aimed to evaluate the effectiveness of recombinant human platelet-derived growth factor BB (rhPDGF-BB) + ß-tricalcium phosphate (ß-TCP) in the treatment of human infrabony defects and compare it with hydroxyapatite (HA) + ß-TCP. A total of 18 interproximal defects in 18 patients with chronic periodontitis were included. The test group was treated by open flap debridement in combination with rhPDGF-BB + ß-TCP, while the control group was treated by open flap debridement along with HA + ß-TCP. At 12 months, both the test and control groups showed a significant mean probing pocket depth (PPD) reduction and gain in clinical attachment level (CAL). There was a statistically significantly greater PPD reduction in the test group compared to the control. The observed differences between baseline CAL and CAL at 12 months were found to be statistically significant in both groups. The mean CAL gain in the test group was significantly greater than that in the control group. Radiographic linear bone growth was significantly improved in the test group compared to the control group. Percent bone fill was significantly increased at 12 months postsurgery in the test group compared to the control group. The treatment with rh-PDGF-BB + ß-TCP resulted in a significantly higher CAL gain and PPD reduction in comparison with HA + ß-TCP.

Primary wound closure is difficult in the posterior mandible when insufficient soft tissue is available. Primary wound closure using a buccinator musculomucosal flap after implant placement and guided bone regeneration was performed in a patient with an atrophic alveolar ridge in the posterior mandible. Implants were placed at the bone level of neighboring teeth to protect the inferior alveolar nerve, and exposed threads were covered using guided bone regeneration. A posterior-based buccinator musculomucosal flap was raised and placed over the alveolar crest, which resulted in a satisfactory clinical outcome.

Buccal wall defects following tooth removal are frequent in the anterior portions of the mandible and maxilla. Common reasons for such defects include thin buccal bone, preexisting periodontal disease, bundle bone resorption, difficult orthodontic movement, and traumatic extractions. Regeneration of the postextraction defect with vital, well-vascularized, dense bone is critical to a successful implant-supported restoration. This case report examines the effectiveness of using a composite graft of freeze-dried bone allograft and ß-tricalcium phosphate plus recombinant human platelet-derived growth factor BB to regenerate healthy, dense bone in a large mandibular anterior buccal wall defect. The importance of access to the overlying periosteum as a readily available source of osteogenic cells in growth factor-mediated bone regenerative procedures is emphasized.

The restoration of endodontically treated anterior teeth (ETAT) may pose a significant clinical challenge given the wide variety of therapeutic options available. Accurate analysis of the remaining tooth structure is critical in the diagnostic process, leading to selection of the proper treatment option. A novel, simple, and precise classification that allows the evaluation of ETAT is presented. Important factors related to the crown or abutment such as height, wall thickness, and circumferential integrity and rootrelated factors such as diameter of the canal, depth of the preparation, and canal shape are discussed. This classification may serve to establish a comprehensive diagnosis and assign prognosis to ETAT, which may be helpful for interclinician communication and standardized comparisons in clinical research.

The aim of this study was to evaluate the performance of piezoelectric devices during sinus elevation to determine the percentage of sinus membrane perforation and the time required to perform the antrostomy and elevation of the membrane. A total of 35 patients and 40 grafted sinuses were included. The parameters recorded were bony window length and height, bone thickness, osteotomy area, operative time, and number of perforations. Seven (17.5%) membrane perforations were observed, which were repaired with resorbable membranes. The mean length, height, and thickness of the osteotomy were 13.8 ± 2.9 mm, 6.9 ± 1.4 mm, and 1.4 ± 0.4 mm, respectively. The mean osteotomy area was 96.8 ± 32.2 mm2, and the mean operative time was 10.3 ± 2.1 minutes. This study demonstrated that a piezoelectric device could be an attractive alternative for successful sinus augmentation.

The aim of this prospective study was to assess the suitability of immediate rehabilitation of the edentulous mandible using SynCone copings and the intraoral welding technique. Patients with an edentulous mandible were fitted with a removable restoration supported by an intraorally welded titanium bar. Copings were connected to their respective SynCone 5-degree abutments and then welded to a titanium bar using an intraoral welding unit. This framework was used to support the definitive restoration, which was delivered on the day of implant placement. Restoration success and survival, implant success, and biologic or technical complications were assessed immediately after surgery and at 6 and 12 months. Twenty-two patients were consecutively treated with 88 immediately loaded implants. No acrylic resin fractures or radiographically detectable alterations of the welded frameworks were present in the 22 restorations delivered. One implant (1.1%) failed 1 month after surgery; all remaining implants (98.9%) were clinically stable at the 12-month follow-up. Within its limitations, this pilot study demonstrated that it is possible to successfully rehabilitate the edentulous mandible on the day of surgery with a definitive restoration supported by an intraorally welded titanium framework and SynCone 5-degree abutments.

Immediate loading of dental implants can significantly decrease treatment time and thus increase patient acceptance. However, there is still a need to investigate whether an implant in which primary stability is achieved can be immediately loaded without the formation of connective fibrous tissue at the interface. Three transitional implants were placed in an edentulous mandible: two implants loaded immediately and one left unloaded. All transitional implants were retrieved after a period of 12 weeks to perform qualitative and quantitative analysis of the peri-implant tissue and bone-implant interface. Bone biopsy specimens containing the transitional implant were analyzed using microcomputed tomography (micro-CT). Subsequently, the same samples were analyzed using standard undecalcified histology. Micro-CT analysis showed that bone tissue was slightly detached from the surface of the loaded implant. Histology demonstrated the presence of a soft tissue layer inside the socket. Morphometric values of total bone volume, bone-implant contact, and bone connectivity were higher for the unloaded implant, which appeared to be covered by an almost continuous layer of bone. Micro-CT evaluation of some morphometric parameters and histologic results pertaining to small-diameter transitional implants showed that uncontrolled loading may produce untoward effects on peri-implant bone healing.

The purpose of this case report was to analyze the outcome of alveolar ridge reconstruction procedures with composite alloplastic biomaterial (biphasic calcium phosphate composed of 30% hydroxyapatite and 70% ß-tricalcium phosphate) for the treatment of large alveolar ridge defects. The clinical and histologic findings demonstrated that this alloplastic biomaterial can be used to potentially regenerate large alveolar ridge defects. This composite biomaterial appears to be safe, biocompatible, and osteoconductive.

Soft and hard tissue defects pose a therapeutic challenge in modern implant dentistry. There are a multitude of surgical techniques available, and it is necessary to match the problem with the solution. This report describes the reconstruction of the alveolar ridge in the esthetic zone with the help of autogenous bone blocks harvested from the chin that were shaped to fit and stabilized at the recipient site. The procedures were performed using Piezosurgery, which made it possible to introduce surgical modifications and had a significant impact on the accuracy of the procedure. An observation period of 2 to 7 years showed positive stable results for treatment in terms of function and esthetics.