International Journal of Periodontics & Restorative Dentistry, 01/2011

The esthetic outcome of an implant-supported restoration is first of all dependent on the soft tissue volume. Since the labial bone plate resorbs in every direction after tooth extraction, even when an implant is placed immediately, most patients end up with compromised esthetics. Twenty-four patients were treated consecutively with implants placed in the maxillary anterior area at the time of tooth extraction using two different treatment modalities. The first 12 patients were treated without raising a flap, whereas a subepithelial connective tissue graft was placed using the tunnel technique in the labial area of the subsequent 12 patients at the time of tooth extraction and implant placement. The dimension of the labial volume was measured before treatment and 6 months after implant placement. The results show an average loss of volume in the nongrafted group of 1.063 mm, whereas in the grafted group, there was a slight gain of 0.34 mm. These results demonstrate the effectiveness of placing a soft tissue graft at the time of immediate implant placement in the esthetic zone.

A combination of hard and soft tissue grafting is used to augment a thin biotype. A 26-year-old woman with mandibular anterior flaring and Miller Class I and III recessions requested interceptive treatment. Surgery included a full-thickness buccal flap, intramarrow penetrations, bone graft placement, and primary flap closure. Postoperative visits were at 2 and 4 weeks and 2, 3, and 6 months. Stage-two surgery consisted of submerged connective tissue graft placement. Postoperative visits were completed at 2, 4, 6, and 8 weeks and 1 year. Follow-up was completed 3 years after the initial surgery. Interradicular concavities were resolved and gingival biotype was augmented. Soft tissue recession remained at 6 months. Reentry revealed clinical labial plate augmentation; 2 mm was achieved at the lateral incisors and the left central incisor and 3 mm was achieved at the right canine. No bone augmentation was achieved on the left canine and right central incisor. The dehiscence at the right central incisor appeared narrower. Overall, a 2- to 3-mm gain in alveolar bone thickness/height was observed. Two months after stage-two surgery, near complete root coverage was achieved; 1 mm of recession remained on the left central incisor. There was a soft tissue thickness gain of 2 mm without any visual difference in keratinized tissue height. Interradicular concavities were eliminated; the soft tissue was augmented and the gingival biotype was altered. Interdental soft tissue craters remained. One year after connective tissue graft placement, there was near complete root coverage at the left central incisor, which at 2 months experienced residual recession. Interradicular concavities and interdental soft tissue craters were eliminated with soft tissue augmentation, including clinical reestablishment of the mucogingival junction. Clinical stability remained 3 years after the initial surgery, with the patient noting comfort during mastication and routine oral hygiene. A clinical increase in labial plate thickness, in conjunction with soft tissue augmentation, appears to provide for continued stability and decreased potential for future clinical attachment loss.

To perform advanced periodontal therapy to save a natural tooth or to extract it and place an implant-which is best? Several considerations need to be made to make the proper decision. Endodontic conditions, proper reconstruction of a devitalized tooth, and the possibility of correct prosthetic treatment are all factors to be considered. From a strictly periodontal point of view, in the presence of a stable, vital, intact, periodontally involved, single-rooted tooth, a few fundamental criteria need to be considered to make the proper decision. These criteria will be discussed through analysis of therapy outcomes over a period of at least 10 years.

An investigation was conducted to test the feasibility of demineralized bone matrix and cancellous bone chips in a reverse-phase medium carrier (DynaBlast) in concert with an extracellular matrix membrane (DynaMatrix) to provide hard and soft tissue regeneration for the purpose of a ridge preservation procedure. Nine patients requiring extraction of 30 maxillary teeth were grafted with DynaBlast and DynaMatrix. Twenty sites attained primary flap closure over the grafted area (primary healing intention group), while 10 sites were assigned randomly to the secondary healing intention group, in which primary flap closure over the membrane was not achieved. Clinical and radiographic evaluations at 6 months revealed comparable bone formation for both groups. Histologic analyses of 21 harvested soft and hard tissue core biopsies revealed absence of the remnant membrane and consistent patterns of new bone formation. The efficacy and safety of DynaBlast and DynaMatrix have been validated clinically and histologically to preserve the dimensions of the alveolar process.

Computer-aided design/computer-assisted manufacture technology is changing the way clinicians are planning treatment and delivering dental implant therapy. Although the current technology is impressive and successful clinically, there are limitations in the design that prevent all patients from benefiting immediately from this computer-designed modality. This article describes a unique prosthetically driven protocol that will allow the delivery of a prefabricated screw-retained allacrylic prosthesis immediately after an alveoplasty with the immediate placement of dental implants.

Endosseous dental implants have revolutionized the methods clinicians use to treat edentulous and partially edentulous patients. Traditional implant protocol specifies a healing period of several months after tooth extraction, as well as an unloaded healing period prior to restoration. Over the last decade, numerous studies have documented successful immediate placement of endosseous dental implants in fresh extraction sites and have found positive results with early functional loading. The purpose of this article is to present a clinical treatment protocol for the immediate placement and early loading of dental implants and to report the clinical and radiographic outcomes of the SLActive surface Straumann Bone Level implant placed in either maxillary or mandibular fresh extraction sockets.

Twenty extraction sockets in 16 patients were included in this study. Ten were treated with buccal plate preservation (BPP, test group), which consisted of placing a bone graft overlying the buccal plate in a surgically created pouch, and 10 were left untreated (control). Pre- and postoperative differences in buccolingual dimension at the midpoint of the extraction area were calculated using study casts. Statistically significant differences were found between the test group (mean, 0.85 ± 0.75 mm) and control group (mean, 0.9 ± 0.65 mm, P .5). Clinically, BPP after extraction may help to maintain or augment the soft tissue appearance compared to nontreatment.

This study evaluated the clinical and radiographic results of the intentional replantation of periodontally hopeless teeth with combined enamel matrix derivative and demineralized freeze-dried bone allograft therapy. Eleven patients (five female, six male; age range, 13 to 53 years) with 12 periodontally hopeless teeth resulting from extensive alveolar bone loss and vertical defects extending to the apexes were studied. At the 12-month clinical and radiologic follow-up, significant improvement was observed for all clinical and radiographic parameters except gingival recession (P .05). These preliminary findings show that intentional replantation combined with regenerative techniques is a successful alternative to tooth extraction.

After tooth loss, alveolar bone resorption occurs and causes soft tissue collapse. In the anterior maxilla, this situation becomes a great challenge. Bone volume must be reestablished to allow for proper implant placement. Another challenge is achieving primary closure and improving soft tissue esthetics. Nine patients who were partially edentulous in the anterior maxilla and received 10 palatal incisive vessel-based connective tissue flaps were included in this study. Primary closure was successfully achieved in four patients who received simultaneous onlay block grafting in the surgical area. Total treatment time was shortened as an added benefit, since a secondary procedure for soft tissue augmentation was not necessary. In two patients with improper implant angulation, this technique resulted in improved esthetics.

The purpose of this study was to evaluate the characteristics of diseased root surfaces treated by the association of scaling and the application of Carisolv. Twenty-four uniradicular periodontally involved teeth were used in this study. The teeth were divided randomly into three groups: eight teeth were scaled and root planed until there was a complete visible removal of calculus (group 1), Carisolv was applied on the root surfaces of eight teeth twice for 30 seconds before scaling with a sharp curette (group 2), and eight teeth received the same treatment as in group 2 but with a blunt curette (group 3). Specimens were examined using scanning electron microscopy. The superficial aspect of the roots from group 1 presented scratches that mirrored the curette cutting edge, and the smear layer completely covered the surface. Root surfaces from groups 2 and 3 also presented a smear layer that covered the surface completely, but it was somewhat smoother than group 1. The use of Carisolv as an adjunct to scaling and root planing presented no advantage for smear layer removal over scaling alone, suggesting that no benefit is obtained by the use of Carisolv during periodontal mechanical treatment.

Gingival squamous cell carcinoma (GSCC) is relatively rare, representing less than 10% of oral cavity squamous cell carcinomas. Because of its proximity to the teeth and periodontium, the tumor can mimic tooth-related benign inflammatory conditions. In this article, a case of GSCC with clinical features very similar to those of periodontal disease in an 86-year-old nonsmoking woman is presented. Consequently, clinicians should be aware of this pathology to play an important role in the early detection of gingival cancer.