Cortellini, Pierpaolo

Double-sided Entire Papilla Preservation (DEPP) technique was designed to allow access into a bone defect without compromising the integrity of papilla, when the defect extends to palatal/lingual side. This case-series study aimed to evaluate the clinical and radiographic outcomes of periodontal regenerative therapy using DEPP technique for intrabony defects. DEPP was performed with two vertical incisions on both the buccal and palatal sites to access the bone defect. After debridement, recombinant human fibroblast growth factor 2 or enamel matrix derivatives were used in combination with carbonate apatite (CO3Ap) or deproteinized bovine bone mineral (DBBM) to treat the defect. Periodontal parameters were evaluated at baseline, 6, and 12 months postoperatively. Values for clinical attachment level (CAL) and probing depth (PD) were statistically significantly improved compared with baseline at 6 months (P < 0.05) and 12 months (P < 0.01) following surgery. At 12 months, the mean PD reduction was 5.0 ± 1.4 mm and CAL gain was 5.3 ± 1.8 mm. According to the Composite Outcome Measure, the outcomes of the treated sites were considered ‘successful’. This case series demonstrates that DEPP can be effectively combined with regenerative therapy for intrabony defects, yielding favorable clinical outcomes with minimal surgical complications.

Periodontal bony defects are classified as supraosseous (suprabony) or infraosseous (infrabony) according to the location of the base of the defect compared to the coronal part of the residual alveolar crest. Infraosseous defects are generally considered more challenging to treat and are thought to be associated with a higher risk of periodontal progression. The emergence and advancement of regenerative periodontal procedures have improved clinicians’ ability to manage infraosseous defects. However, limitations still exist. This paper reviews the definitions of periodontal osseous defects and provides a new classification framework for infraosseous defects, relating them to the chances of successful regenerative procedures and therefore to their treatment planning options. Infraosseous defects are hereby divided into intrabony and interroot defects. Factors affecting treatment response—such as the number of walls, depth, and extension into buccal and lingual surfaces— are added to the classification framework. Parole chiave: bone loss, infrabony, periodontitis, suprabony

This retrospective study evaluated the incidence of complications to determine the long-term survival rate of teeth with severely compromised clinical crowns treated with minimally invasive crown lengthening (MICL) and restorative treatment. A sample of 112 teeth in 86 patients was treated with MICL and restorative dentistry. Endodontic and orthodontic therapies were applied when needed. Clinical outcomes were assessed at baseline, 1 year, and in the long term. The application of MICL resulted in very limited radiographic bone resection (RBR; 1 ± 0.1 mm on average). Limited local inflammation and shallow probing depths were detected at 1 year (2.6 ± 0.5 mm) and in the long term (2.9 ± 1.0 mm). Most of the teeth (76.8%) maintained good dental and periodontal health over time. The negative events observed in 26 teeth were caries (8.9%), fractures (7.1%), endodontic problems (1.8%), periodontal problems (4.5%), and restoration problems/complications (0.9%). The survival rate was 90.2%. The outcomes of this long-term retrospective analysis (mean: 8.9 ± 0.9 years; range: 8 to 10 years) show high tooth survival rates and low incidence of complications for teeth treated with MICL and restoration of the clinical crown. Parole chiave: biologic width, clinical trial, crown lengthening, long term, microsurgery, reconstructive dentistry

The present study introduces a novel "anatomic recession ratio" (ARR) and evaluates the clinical outcomes of using a tunnel technique (TUN) with a connective tissue graft (CTG) for root coverage (RC). Sixteen systemically healthy patients contributing a total of 33 recession types 1 and 2 were treated with TUN + CTG. The predictive value of a panel of baseline clinical parameters (ARR) on RC was evaluated 12 months postoperatively. At 12 months, mean recession depth decreased from 2.74 ± 0.22 mm to 0.46 ± 0.13 mm (P < .0001); 19 sites (58%) showed complete RC, and the mean RC rate was 88.85% ± 2.73%. The mean ARR value was 0.74 ± 0.3, revealing a positive correlation with RC (r²: 0.73, P < .0001). The 12-month esthetic evaluation resulted in a score of 8.52 ± 1.75 using the root coverage esthetic score. TUN + CTG is effective in reducing recession depth and obtaining good esthetic outcomes. Within the limits of the present study, it may be suggested that ARR has potential as an analytical baseline parameter for RC outcomes with TUN + CTG.

This study involves a group of 168 teeth in 126 patients treated with crown lengthening and tooth reconstruction (experimental group), and a group of 75 teeth from 62 patients that were judged irrational to treat, extracted, and replaced (control group). In the control group, 13 teeth in 12 patients were not replaced; 37 were replaced with an implant-supported crown, 14 with a tooth-supported partial denture, 2 with a Maryland partial denture; and 9 patients requested a removable prosthesis. In the experimental group, 44 teeth in 37 patients received a conservative restoration (24 direct and 20 indirect), while 124 teeth in 94 patients received a full crown. All 168 teeth were surgically treated with minimally invasive crown lengthening. Endodontic treatment and orthodontic extrusion were applied when necessary. Treatment resulted in healthy periodontal and dental/implant conditions at the 1-year follow-up in both groups. Function and esthetics were described from satisfactory to extremely satisfactory by patients of both groups, with the exception of three patients in the control group who received a mobile prosthesis restoration and reported some difficulties in chewing. When comparing treatment cost and duration of the reconstructed teeth (experimental group) to the treatment cost and duration of extracted and replaced teeth (control group), the difference is significantly in favor of the preservation of natural teeth, both monetarily and in terms treatment time. Saving a tooth with a compromised crown is more favorable for the patient than extraction and replacement. This conservative approach is advisable to clinicians whenever the clinical conditions enable treatment.

The present article describes a treatment planning clinical strategy based on a flowchart developed to facilitate the treatment of teeth with severely compromised clinical crowns. The study comprised a group of 978 patients presenting with 2327 teeth needing clinical crown reconstruction. The patients were screened, diagnosed, and treated with a multidisciplinary approach according to a flowchart structure. A subgroup of 75 teeth in 62 patients was considered irrational to treat when a composite risk-evaluation model was applied. Another subgroup of 168 teeth in 126 patients required periodontal surgery and received a minimally invasive crown lengthening (MICL) procedure. Endodontic treatment was necessary for 73 teeth, and retreatment for 51. Most of the teeth (124 in 94 patients) received a full crown, while the remaining 44 teeth received a direct (24 teeth) or an indirect (20 teeth) reconstruction. Six teeth were orthodontically extruded before surgery. The 1-year average probing depth and clinical attachment level at the treated teeth was 2.5 ± 0.5 mm and 2.7 ± 0.6 mm, respectively. Bleeding on probing was detected in 19 sites (11.3%). No side effects or short-term recurrences were detected in 168 treated sites. Patients described function and esthetics as extremely satisfactory, very satisfactory, or satisfactory. In conclusion, an accurate screening based on a flowchart supported the clinical decision to treat 168 teeth with MICL and to replace 75 out of 2327 teeth presented at our clinic for restorations. The use of MICL and the high-quality restorations resulted in a healthy periodontal and dental condition of all the treated teeth as well as patient satisfaction at the 1-year follow-up.

Im vorliegenden Artikel wird eine Flussdiagramm-basierte Strategie zur Behandlungsplanung für Zähne mit stark zerstörter Krone vorgestellt. Die dazugehörige Studie umfasste 978 Patientinnen und Patienten mit 2327 Zähnen, deren Kronen rekonstruiert werden mussten. Die Patienten wurden gescreent, untersucht und nach einem multidisziplinären Ansatz auf Basis eines Flussdiagramms behandelt. Für eine Untergruppe von 75 Zähnen bei 62 Patienten wurde basierend auf einer kombinierten Risikoanalyse die Behandlung als nicht sinnvoll eingeschätzt. In einer weiteren Untergruppe von 168 Zähnen bei 126 Patienten waren parodontalchirurgische Maßnahmen erforderlich und eine minimalinvasive Kronenverlängerung (MIKV) wurde durchgeführt. Von diesen benötigten 73 Zähne eine Wurzelkanalbehandlung und 51 eine endodontische Revision. Die meisten Zähne dieser Gruppe (124 bei 94 Patienten) wurden voll überkront, während die übrigen 44 Zähne eine direkte (24 Zähne) oder indirekte (20 Zähne) Restauration erhielten. Sechs Zähne wurden vor der chirurgischen Maßnahme kieferorthopädisch extrudiert. Nach einem Jahr lag die durchschnittliche Sondierungstiefe bei 2,5 ± 0,5 mm, das klinische Attachmentniveau bei 2,7 ± 0,6 mm. Sondierungsbluten trat an 19 Stellen (11,3 %) auf. An den 168 behandelten Zähnen wurden keine Komplikationen oder kurzfristigen Rezidive beobachtet. Die Patientinnen und Patienten gaben an, mit der Funktion und Ästhetik „vollständig zufrieden“, „sehr zufrieden“ oder „zufrieden“ zu sein. Zusammengefasst führte in der Praxis der Autoren das exakte Flussdiagramm-basierte Screening von insgesamt 2327 Zähnen mit Restaurationsbedarf zu der Behandlung von 168 Zähnen mit einer MIKV und zur Extraktion und dem Ersatz von 75 weiteren Zähnen. Dank minimalinvasiver Kronenverlängerung und hochwertiger Restaurationen waren nach einjähriger Nachbeobachtung alle behandelten Zähne dental und parodontal gesund und die Patientenzufriedenheit hoch.

This study describes a clinical strategy based on a flowchart developed to facilitate the treatment of teeth with a severely compromised clinical crown. A group of 168 teeth in 126 patients required periodontal surgery and received a minimally invasive crown-lengthening procedure with the aim to reach a minimal supracrestal tissue attachment width of 2.5 mm, including a free space between the cervical margin of the restoration and the bottom of the sulcus. Surgery was performed with the aid of an operating microscope and microsurgical instruments, trying to reduce bone surgery and invasiveness as much as possible. An average postsurgical radiographic bone resection of 1 ± 0.6 mm was measured. Endodontic treatment was necessary in 73 teeth, re-treatment in 51. Most of the teeth (124 in 94 patients) received a full crown, while the remaining 44 received a direct (24 teeth) or an indirect (20 teeth) reconstruction. Six teeth were orthodontically extruded before surgery. The 1-year average pocket depth at the treated units was 2.5 ± 0.5 mm, resulting in a reduction of 0.7 ± 0.9 mm compared to the preoperative measurement (P < .0001). Bleeding on probing was detected in 19 sites (11.3%) and was significantly reduced from the preoperative condition (57 sites, 33.9%). The distance between the apical margin of the restoration and the gingival margin was 0.2 ± 0.4 mm (range: 0 to 1 mm); clinical attachment level was 2.7 ± 0.6 mm. A clinical approach based on minimally invasive crown lengthening with minimal or no ostectomy and high-quality restorative dentistry resulted in healthy periodontal and dental condition of all the treated units at the 1-year follow-up.

When it comes to complete root coverage of exposed root surfaces, several limiting factors have been suggested. Although tooth malposition and papillae dimension are capable of influencing root coverage, they have not received sufficient emphasis in the literature. Therefore, the aim of the present commentary is to discuss the impact of tooth malposition and papillae dimension on rootcoverage outcomes. This commentary combines evidence from the literature with the authors' experience. Limited evidence is available in the literature regarding the influence of tooth malposition on root-coverage outcomes. Severe buccal displacement and tooth extrusion and/or rotation may limit the amount of achievable root coverage, and the cementoenamel junction should no longer be considered the landmark for root coverage in these cases. The relationship between papillae dimension and root coverage has been tested in different clinical conditions and by applying different root-coverage approaches, thereby resulting in contradictory outcomes. The clinical experience of the authors suggests that having wider papillae is advantageous for coronally advanced flap and tunnel flap preparations and connective tissue graft stabilization. Although scientific evidence and the authors' clinical experience suggest that papillae dimension can play a major role in determining the surgical management of soft tissues and the amount of achievable root coverage, further studies are necessary to evaluate to which extent papillae dimensions contribute to treatment outcomes.

Primary wound closure and uneventful early wound stability over the biomaterials are the most critical elements of successful periodontal regeneration. Yet the surgical elevation of the interdental papilla to access deep and wide intrabony defects entails an impairment of the papillary blood supply that can result in difficult healing due to a lack of primary closure in the early healing period. This negative event might complicate the healing process, favoring bacterial contamination. A novel modified tunnel surgical technique designed to maintain the integrity of the interdental papilla is presented in this article, with the aim of providing an optimal environment for wound healing in regenerative procedures. Entire papilla preservation is described and applied in three different cases, in association with the use of a combination of bone substitutes and enamel matrix derivative for periodontal regeneration. The entire papilla preservation technique was successfully applied to the three selected cases, resulting in an uneventful postsurgical period and a substantial defect fill over the 8-month follow-up. This tunnel-like technique can be recommended for further research to support the success identified in this case series.