International Journal of Periodontics & Restorative Dentistry, 04/2015

This retrospective case series describes a layered regenerative approach for five Class III and one borderline Class IV furcation, involving treatment consisting of root management that included conditioning with tetracycline solution followed by the topical application of recombinant platelet-derived growth factor BB. A composite allograft with mesenchymal stem cells was subsequently placed into the furcation and covered by a barrier derived from human amnion-chorion with flaps advanced to completely cover the site. Three furcations, including the one diagnosed as Class IV, had complete closure, two were converted to Class I, and in one instance, there was no improvement. This regenerative algorithm for mandibular Class III furcations may present the potential to save these teeth by altering the prognosis, which has traditionally been poor to hopeless, resulting in many of these teeth routinely being extracted.

The aim of this histologic, double-blind, parallel, randomized controlled trial was to compare anorganic bone mineral-collagen membranes (BB) and betatricalcium phosphate-pericardium collagen membranes (CJ) in a one-stage procedure for horizontal bone augmentation. A biopsy was performed in the regenerated area at abutment connection 6 months after surgery. Five patients were assigned and treated with the BB combination and five patients were treated with the CJ combination. At abutment connection, 6 months after grafting, no significant differences were evident in the histomorphometric comparisons, even if the percentage of residual graft, using the marrow spaces and soft tissue as a reference, tended to be greater in the CJ group (P = .0759).

The fabrication of a full-arch maxillary prosthesis has been associated with several prosthetic complications and difficulties. Even though it has been reported that phonetics, esthetics, and proper lip support are difficult to achieve, there is a scarcity in the literature regarding the clinical and laboratory procedures necessary to minimize these complications. This article provides clinical and laboratory steps that may enable the clinician to achieve more predictable restorative results when using computer-aided design/computer-assisted manufacture (CAD/CAM) to fabricate a full-arch maxillary implant-supported prosthesis. The technique presented here describes the use of an implant-retained diagnostic wax-up that is subsequently duplicated to an interim polymethylmethacrylate prosthesis using CAD/CAM before fabricating the definitive restoration.

In past decades, warnings about overprescription and misuse of antibiotics- which are now considered to be responsible for antimicrobial resistance, allergies, ineffectiveness, and suprainfections-have been made to both medical and dental clinicians. To help assess the antibiotic prescribing habits of dentists, a survey was created and emailed through the Survey Monkey tool to 102 randomly selected board-certified periodontists. Each was asked to answer multiple-choice questions regarding their use of an antibiotic protocol in 10 specific periodontal or implant-related clinical circumstances. This group of practitioners and the 10 clinical circumstances were chosen to limit the wide variety of clinical conditions treated by dentists and to narrow the scope of variables when antibiotics are considered. All 102 participants returned the questionnaire, and 96% to 100% of respondents reported that they had treated 8 of the 10 circumstances, with 89.9% and 80.8% having treated the other two conditions listed in the survey; this allowed subsequent questioning of the respondents on their antibiotic prescribing protocols. Although the validity of antibiotics for dental procedures may be questioned based on present information, as many as 50% or more of the dentists answering the survey prescribed antibiotics. The prescription, initiation, and duration of antibiotics varied considerably in many of the 10 specific circumstances, including treatment of acute and chronic periodontitis, sinus or ridge augmentation, and immediate or delayed implant placement. Based on the results of the survey, it was obvious that definitive guidelines and protocols are needed as well as expanded postgraduate training regarding antibiotic use.

Modified coronally advanced tunnel (MCAT) technique with connective tissue graft (CTG) was used in treating multiple adjacent Miller Class III gingival recessions in nine patients. Clinical evaluations were recorded at baseline and 12 months after surgery. The results showed that 50% of complete root coverage and 78% of mean root coverage were attained 1 year after surgery and interdental space fill was 73% at 12 months. The study demonstrated that CTG using the MCAT technique may be an efficient way to treat multiple adjacent Miller Class III gingival recessions, especially when aiming for interdental space fill. Success, however, seems to be related to the amount of tissue present initially.

The crestal bone level around an immediately loaded contemporary hybrid implant with a multisurface topography was examined 8 weeks after implant placement and loading. Histologic analysis showed tight contact between the implant surface and surrounding bone, and demonstrated radiographic and histologic features of successful osseointegration. Very high bone-toimplant contact without epithelial downgrowth was noted. The buccal and lingual bone levels coincided with the original bone relationship to the implant shoulder at the time of implant placement, with no signs of resorption.

Immediate implant placement often requires tissue augmentation simultaneously. Both hard and soft tissue grafting can improve long-term physiologic and esthetic outcomes. Bone replacement grafts are frequently combined with barrier membranes (guided bone regeneration [GBR]). When these materials are resorbable, they are often composed of collagen or synthetic polymers. These techniques do not address the need for soft tissue augmentation, and harvesting of autogenous soft tissue grafts is required. The use of a dermal allograft composed of natural, non-cross-linked collagen eliminates the need for the second surgical site to harvest autogenous soft tissue. This article demonstrates the dual functionality of a dermal allograft serving as both a GBR membrane and a biologically incorporated soft tissue biomaterial in immediate implant therapy.

This preliminary study was designed to test the clinical efficacy of a modified Ti-mesh combined with particulate allograft for vertical ridge augmentation (VRA). Five healthy patients with vertical ridge deficiency in the posterior mandible were recruited. Preoperative width of the keratinized mucosa (KM) and mucosal thickness (MT) were measured. Cone beam computed tomography (CBCT) scans were taken preoperatively, immediately, and 5 months after VRA. The amount of vertical bone gain was measured on CBCT scans. Bone core biopsies were taken for histomorphometric examinations. The mean ± standard deviation KM on the facial and lingual sides was 3.9 ± 1.7 mm and 3.3 ± 1.3 mm, respectively. The mean thickness of the flaps, measured at the facial, lingual, and crestal sites, was 2.9 ± 0.8 mm, 1.8 ± 0.8 mm, and 3.2 ± 1.2 mm, respectively. The mean vertical gain was 3.4 ± 1.9 mm when only the sites with the greatest vertical defect in each subject were studied. Histometric analysis of the bone cores revealed that percentages of the soft tissue, residual allograft, and new bone were 42.2% ± 10.0%, 25.2% ± 13.5%, and 32.6% ± 4.9%. The use of a Ti-mesh and particulate allograft may be a viable option for vertical augmentation of sites with slight to moderate ridge deficiency.

The aim of this pilot study was to compare a direct and an indirect technique for fabricating customized impression copings. The accuracy of these techniques to capture the tissue contours that have been developed using implant-supported fixed interim restorations (ISFIRs) in single implants for their esthetic value were evaluated. Five patients presenting with maxillary central incisor ISFIRs were enrolled in the study. Customized impression copings were fabricated using a direct and an indirect technique. Specimens of experimental (direct and indirect technique) and control groups (ISFIR) were compared in terms of linear measurements on their buccolingual (BL) and mesiodistal (MD) dimensions at three different levels: platform, middle, and gingival margin. Statistically significant differences were detected between the control group and the direct technique specimens on both the gingival margin and middle levels (P .05). Between the direct and indirect techniques, statistically significant differences were found in their MD and BL dimensions at the gingival margin level (G-MD, G-BL) and the buccolingual dimension at the middle level (M-BL) (P .05). The indirect technique used for the fabrication of customized implant impression copings seems to be more accurate in capturing the profile of the ISFIR at all three levels (platform, middle, and gingival margin). The direct technique is accurate only at the platform level.

Implant-retained overdentures have been provided on both splinted and freestanding implants. For the mandible, a long history shows that both approaches can be successful over the long term. For the maxilla, many clinicians prefer to splint the implants because of concerns about softer bone quality and insufficient data supporting the use of freestanding overdenture abutments. However, a few investigations have found survival rates for unsplinted maxillary overdentures to be comparable to those for splinted ones. The present study analyzed records of consecutive patients who were treated with unsplinted maxillary and mandibular overdentures and followed for 4 to 107 months. A total of 31 overdentures were identified, 15 maxillary and 16 mandibular, supported by 129 implants. All the overdentures, along with all the implants, survived throughout the follow-up period.

This report assesses the results following sinus floor augmentation performed 14 years previously in which bovine bone xenograft material was used without implant insertion. After sinus floor augmentation, using a 20:80 mixture of autogenous bone and inorganic bovine bone material (Bio-Oss), bone biopsy specimens were taken from the grafted site, processed with Donath's sawing and grinding technique, stained with toluidine blue, and mounted on high-sensitivity plates for histology and microradiography. Histologic and microradiographic analysis showed the ingrowth of newly formed bone into the graft with interspersed residual Bio-Oss granules. The percentage of Bio- Oss and newly formed bone was 10.18% and 9.32%, respectively, within a total surface area of 70.61 mm2 at the site of the corresponding missing first molar, and the percentage of Bio-Oss and newly formed bone was 11.47% and 14.96%, respectively, within a total surface area of 63.92 mm2 at the corresponding missing second molar. The newly formed bone was vital without signs of resorption. This study produced strong evidence that newly formed bone was distributed throughout the bone substitute material around all of its granules and that the grafted site consisted of vital bone even in its central parts. The differences in degradation rate and/or whether the effect of bone graft substitutes alone and/ or in combination with other types, shapes, and sizes of graft materials needs further clinical investigation, especially in regard to long-term changes.

Excessive gingival display (EGD) is an esthetic concern affecting a substantial portion of the population. Identification, diagnosis, and classification of all factors resulting in EGD are imperative for its appropriate management. While many authors have described these factors individually, the authors of the current study propose a simple classification, which includes major etiologies of EGD. Where EGD is associated with maxillary lip hypermobility, a proposal of a subclass 1-3 is offered. A "decision-making tree" to help guide clinicians in managing EGD is included. A detailed description of the lip stabilization technique (LipStaT), including indications, surgical guidelines, postsurgical management, and clinical cases with long-term follow-up, is presented.

The purpose of this article is to present a surgical and restorative protocol for the replacement of missing teeth in the esthetic zone. The ABC protocol consists of digitally guided implantation, autogenous bone graft (A), followed by bovine bone xenograft (B) and connective tissue graft (C). Autogenous bone is placed in contact with the implant surface to induce osseointegration; bovine bone xenograft is then applied to augment the ridge dimension and provide long-term stability. Connective tissue is used to provide additional volume. The ABC biomaterial sequence offers favorable hard and soft tissue dimensions and immediate provisional restoration predictably leads to an esthetically pleasing definitive prosthesis.

The attached gingiva is a desirable anatomical element for the maintenance of gingival health. The free gingival graft (FGG) and the modified apically repositioned flap (MARF) are predictable surgical techniques often employed to increase the zone of attached gingiva. This randomized study compared the FGG and the MARF in increasing the zone of attached gingiva in contralateral sides of 15 patients 1 year posttreatment. There was an increase in keratinized tissue and attached gingiva in both groups. Gingival recession did not significantly change between pre- and posttreatment levels in either group. The MARF surgical time was approximately half as long as that of the FGG. The authors conclude that both techniques are viable; however, the main advantages of the MARF were decreased surgical time and less postoperative discomfort.

The aim of this study was to evaluate the impact of conventional and digital diagnostic wax-up on the axial tooth contour. Dental models of 15 patients were collected. Each model received conventional wax-up and digital wax-up. The conventional wax-up was based on tooth modification with dental wax on actual models. The digital wax-up involved fitting an average tooth form on virtual pretreatment models. Each wax-up model was digitally superimposed on the corresponding pretreatment model. For each modified tooth, analysis planes were extracted at three locations: mesial line angle, midtooth, and distal line angle. The impact of the following variables was evaluated: interarch location (maxilla vs mandible), intra-arch location (anterior vs posterior), tooth category (incisors, canines, premolars, and molars), and tooth location (midtooth vs line angle). The axial contour of the modified teeth increased after each wax-up, and this increase was directly proportional to the distance from the gingival margin. There is a clear tendency for the digital wax-up to cause a greater contour increase than the conventional wax-up. The anterior teeth were associated with a greater tooth contour increase than posterior teeth and the contour of the molars was the least affected. Although the conventional wax-up contour alteration was significantly less than for the digital wax-up, the actual difference was minimal.

The blood supply to both the lateral wall of the maxillary sinus and the overlying membrane originates from the posterosuperior alveolar artery (PSAA) and the infraorbital artery. The purpose of the present study was to evaluate the anatomic characteristics of the PSAA in a large number of subjects of the Lebanese population. Images of 696 sinuses were analyzed using cone beam computed tomography (CT). Coronal, axial, and sagittal CT images were evaluated for the presence of an osseous canal in the lateral wall of the sinus, and the prevalence, position, and location of the canal were studied and presented.