International Journal of Periodontics & Restorative Dentistry, 01/1995

The principle of guided bone regeneration can be applied for localized ridge augmentation in a staged approach. The surgical procedure for the mandible is presented through three case reports. Incision technique and flap design, utilization of autogenous bone grafts as a membrane-supporting devise and osteoconductive scaffold, proper placement of barrier membranes and their stabilization with miniscrews, and wound closure are all emphasized. Furthermore, factors essential for achieving predictable results with barrier membranes for localized ridge augmentation and the benifits of combining barrier membranes with autogenous bone grafts are discussed.

The application of implant dentistry to the treatment of partial edentulism has necessitated the development of new components and techniques. This article reviews the various systems and techniques used to fabricate successful anterior single-tooth implant restorations. Placement techniques for nonsegmented, screw-retained abutments; segmented, screw-retained abutments; and segmented, cement-retained abutments are illustrated.

This study evauated guided tissue regeneration in Class II furcation defects after use of a polylactic acid biodegradable barrier innine patients with mandibular molare defects. Following an initial hygenic phase, surgical flaps were evaluated, and the sites were scaled and root planed. Defect perimeter was measured, and a customized barrier (600 to 750 mm thick) that adhered directly to tooth and bone was applied. At baseline, sites were measured for probing depth (6.2± 0.5 mm), gingival margin location (-0.6 ± 0.6 mm), and attachment level both vertically (6.9 ± 0.7 mm) and horizontally (5.3±0.5mm). Clinically, barriers fragmented and became displaced in 3 to 6 weeks. Substantial granulation tissue was sometimes present between barrier and root surfaces. Six months postsurgery, gingival margin location was close to the presurgical level (-0.4 ± 0.8mm). There was clinically and statistically significant improvement in all other parameters: a mean reduction of 3.1 mm in probing depth, a gain of 3.3 mm in vertical attachment level, and a gain of 3.0 mm in horizontal attachment level. These results suggested favorable regenerative outcomes.

Advances in bone reconstructive techniqeu hae increased the indications for implant placement in sites previously thought to be unsuitable. This clinical study evaluated a new surgical technique for the treatment of a variety of localized bone defects in four patients utilizing a titanium-reinforced membrane. The membrane material was developed to maintain a large protected space between the membrane and the bone surface without the need for a supportive device. Healing was uneventful in all sites, and the membranes were retrieved after 6 to 12 months. No residual defects were noted, resulting in an average change of implant exposure of 8.2 ± 2.3 mm for sites with buccal dehiscences and from 5 to 6 mm ridge enlargement in localized bone defects. The quality of the regenerated tissue under the titanium-reinforced membrane appeared as bone structure with a superficial fibrous layer. This fibrous layer was more pronounced in sites treated with a membrane alone but was more than pronounced in sites treated with a membrane alone but was more than compensated by the quantity of new bone under soft tissue. The results demonstrated that the use of a reinforced membrane appears to be a viable alternative for the clinical treatment of non-space-maintaining implant/bone defects. Further clinical and experimental investigations are recommended.

This article is first in a series of reports describing an evidence-based approach for evaluating information associated with periodontal treatment. Two main differences distinguish this approach from the traditional one, which is based largely on clinical experience. The evidence-based approach requires that investigators emphasize the importance unibiased data (evidence) and use specific rules of evidence to quantigy their recommendations. Search, evaluate, and rank are the three steps used for gathering information from the literature. The information (evidence) can then be used to formulate new decision pathways, practice guidelined, and treatment recommendations.

Created periodontal defects in baboons were treated with one of four possible treatment modes:(1) root preparation and Epi-Guide biodegradable polyactic acid barrier, (2) root preparation and Gore-Tex e-PTFE membrane, (3) root preparation only(no barrier), and (4) no root preparation and no barrier (control). Root preparation consisted of hand instrumentation and use of finishing burs. Measurements of gingival recession were recorded from color photographic slides taken weekly for 6 weeks following barrier placement. Block sections were removed from one animal 6 weeks after barrier placement and prepared for histologic evaluation. Significantly more gingival recession was observed at the Gore-Tex sites than at the Epi-Guide sites. There were no significant differences in gingival recession between the Epi-Guide sites and root preparation-only sites or control sites. Both types of barriers were histologically acceptable. At 6 weeks, the Epi-Guide material was present histologically in a partially resorbed state. There was a mild inflammatory reaction in the surrounding connective tissues.