International Journal of Periodontics & Restorative Dentistry, 04/1999

In this case report a surgical technique for vertical ridge augmentation is presented. The procedure, performed in a 30-year-old woman with an atrophied alveolar ridge in the anterior portion of the mandible, is based on the biologic concept of osteogenesis distraction previously introduced in orthopedic and maxillofacial surgery. After elevation of a full-thickness flap a horizontal osteotomy was performed 7 to 8 mm from the top of the ridge. Two vertical osteotomies were prepared with drills of increasing diameter (2, 2.8, and 3.25 mm), tapping was performed for the first 5 to 6 mm, and two distractor base plugs were placed at the base of the osteotomies with a repositioning tool. An intraosseous distraction implant was then inserted and 2 inward vertical cuts were made in the bone to allow proper distraction to take place. Correct functioning of the device was checked by distracting the bone fragment 1 mm using the axial distraction screw. A latency distraction healing screw was inserted in each of the distraction implants and the area was left to heal for 5 days. Once primary healing had occurred, the distraction of the newly formed bone callus was activated each day for 10 days (1 mm per day). At the end of the distraction period a final distraction screw was left in place and a final healing screw was inserted. During this time there were no complications and the patient on no occasion complained of discomfort. The distractor device was removed 30 days later, leaving the base plugs in place. One month later a vertical augmentation of 7 mm had been achieved; the base plugs were removed, 3 intraosseous implants were inserted, and a biopsy of the newly formed tissue was obtained. Histologic evaluation of the biopsy specimen showed woven bone formation approximately 75 days after the initial procedure.

This article presents the rationale for the use of a preprosthetic surgical crown-lengthening procedure, particularly in the anterior region where esthetics is of great concern. Clinical cases illustrate the procedure and demonstrate how it can be used to provide enough sound tooth structure to restore teeth without impingement on the biologic width, at the same time reducing a 'gingival smile' and creating new papillae.

Modular Transitional Implants (MTI) are made from pure titanium and are used to support fixed provisional restorations during the osseointegration of definitive implants. This study histologically examined the jaw response to loaded MTIs in the dog mandible. Three implants were inserted transmucosally into each side of the mandible in 3 dogs. Stability was examined using a Periotest. Anterior and posterior implants were splinted using a cemented acrylic resin fixed partial denture to allow immediate loading. The middle implant remained unloaded and was used as a control. Dogs were sacrificed 11 to 12 weeks after implantation, and tissue blocks containing the implants were removed. Histologic examination showed that 10 of the 18 implants had good bone-to-implant contact, with the percentage of bone contacting the threaded portion of the implant varying from 30% to 65%. There was no statistical difference (P > 0.1) in percentage of bone-to-metal contact between loaded and unloaded implants. Six implants were entirely surrounded by connective tissue with or without inflammation; two implants were lost during the study. The success rate did not differ between loaded and unloaded implants. In the successful implants trabecular bone made good contact with the implant, forming supporting struts.There was bone remodeling in some bone-to-metal contact areas. It is believed that success was mainly influenced by the initial bone density at the implant site and by the uncontrolled load that the animals applied to the implants during the early healing stage.

Dentsply Cavitron Diamond Inserts provide improved efficacy in removing calculus from furcations. A total of 60 extracted human mandibular molar teeth had artificial calculus applied to the furcations, then were randomly treated with either sharp universal Gracey curettes (HAND), a plain ultrasonic TFI-10 tip in a cavitron instrument (CAV), or one of 2 diamond-coated cavitron instruments (TFI-10 fine-grit [FIN] and TFI-10 medium-grit [MED]). When the time needed to completely clean the furcations was evaluated, MED was the fastest, followed by FIN, CAV, and HAND, respectively. All of the powered instruments were faster than hand curettes with regard to effective in vitro calculus removal in furcations. The use of these types of instruments would reduce the time required to perform periodontal surgery and might improve regenerative therapy.

The safety and bone-regenerative capacity of a resorbable membrane (Resolut) was evaluated by a nonrandomized prospective clinical study of patients with periodontal defects. Prior to surgical management all patients underwent scaling and root planing and were instructed on oral hygiene. The study included 18 patients (31 periodontal defects) who received surgical treatment by guided tissue regeneration (GTR) using resorbable membranes. The results were evaluated 12 months after surgery in terms of Plaque Index, bleeding index, probing depth, gingival recession, clinical attachment level, and dental mobility. The results obtained show that the use of resorbable membranes in GTR causes few complications. The mean gain in clinical attachment level (4.06 ± 1.91 mm), with an attachment level gain of more than 3 mm in 81.2% of the defects, suggests the presence of 'new attachment.' This difference was clinically and statistically significant (t = 11.03, P = 0). The multivariate regression study showed that 60% of the observed variability (F = 11.48, P 0.001) in clinical attachment level gain was accounted for by the variable's initial probing depth, the Plaque Index of the tooth subjected to GTR, and the infrabony component of the defect.

The present study tested the hypothesis that treatment-resistant periodontitis patients present with a more intense inflammatory response to marginal bacterial plaque as a sign of an inflammatory overreaction. Patients with severe marginal periodontitis (Gingival Index > 20%) who had not responded to treatment showed almost no positive response to lipid A in a skin-prick test, which was significantly different from the results from patients with severe marginal periodontitis who had responded to treatment and from healthy control individuals without marginal periodontitis. This finding can be interpreted as an impaired inflammatory reactivity to periodontitis pathogens in treatment-resistant patients, rejecting the hypothesis.

The aim of this preliminary study was to analyze, in vitro, the forces developed by practitioners during amalgam condensation. Standardized Class II cavities were drilled into 40 freshly extracted teeth. The forces exerted during condensation were then measured by means of a new device, the Endographe, and plotted online or offline as a function of time on Endogrammes. The work techniques of the different practitioners revealed similarities. The mean values of the vertical forces (± SEM) were: 15 ± 2 N for manual compaction of capsule amalgam; 8 ± 3 N for manual compaction of amalgam with a higher mercury-to-alloy ratio; 6 ± 4 N for mechanical compaction of encapsulated amalgam; and 4 ± 2 N for mechanical compaction of the modiffed amalgam. For the horizontal components, the forces were, respectively, 5 ± 2 N, 0.1 ± 0.05 N, 3 ± 1 N, and 0.7 ± 0.2 N. The mean values of condensation time were 20 ± 15 s for each incremental application, with a great variation in durations between the beginning and end of condensation. By visually depicting forces as a function of time, the Endographe can be used to analyze the process of amalgam insertion and condensation. Future research will study the relationship between the forces developed during condensation and the adaptation of the amalgam to the walls of the cavity.

It is generally accepted that a more ideal and functional soft tissue-implant interface can be established if there is an adequate zone of keratinized mucosa around endosseous dental implants. The purpose of this article was to describe a surgical procedure, based on the use of a split palatal flap, which predictably creates or increases the zone of keratinized tissue around implants at the time of implant uncovering. It is especially useful for maxillary implants with a nonexistent or minimal width of keratinized buccal tissue. The study comprised 34 implants in the maxillae of 8 patients, who were chosen because they had minimal or nonexistent buccal keratinized gingiva prior to implant uncovering. Following healing, between 2 and 5 mm of keratinized gingiva (mean 3.7 mm) could be measured buccally at all abutments. Postsurgical inconveniences were minimal. The use of a split palatal flap at implant uncovering minimizes the number of surgical stages and sites necessary, while predictably providing an adequate zone of buccal keratinized gingiva.

Modern esthetic dentistry involves not only the restoration of lost teeth and their associated hard tissues, but increasingly the management and reconstruction of the encasing gingiva with adequate surgical techniques. The loss of interproximal dental papillae may cause functional, phonetic, and devastating esthetic problems. Complete and predictable restoration of lost interdental papillae remains one of the biggest challenges in periodontal reconstructive surgery. On reviewing the literature, publications involving surgical and nonsurgical techniques for papilla reconstruction are basically case presentations. Very little scientific data concerning long-term success and predictability of specific techniques has been published so far. Starting with facts about the anatomy and morphology of the interdental tissues, this article gives an overview of surgical and nonsurgical techniques to restore lost interproximal dental papillae.