International Journal of Periodontics & Restorative Dentistry, 02/2013

This report describes a novel bone reconstructive technique based on guided bone regeneration for extensive three-dimensional hard tissue augmentation. This two-stage technique utilizes bioresorbable osteosynthesis plates, pins, and collagen membranes that form a physical barrier resembling a fence, which contains the bone graft biomaterials composed of a combination of deproteinized bovine bone matrix and autologous bone grafted from intraoral sites. This technique can result in significant bone regeneration with minimal patient discomfort. Four case reports are presented. Histologic analysis of specimens shows the presence of mature bone. This procedure yields favorable results for bone formation, implant placement, and patient satisfaction.

Rare disorders are conditions defined as either fatal or causing chronic functional impairment. There is limited evidence of the behavior of oral implants in patients suffering from such diseases, and the existing data are merely based on cases reports. This paper describes the outcome of implant treatment after up to 15 years of function in three patients afflicted with X-linked hypophosphatemia, two patients with Langerhans cell histiocytosis, and one patient with osteogenesis/dentinogenesis imperfecta.

Over the last few decades, many authors have investigated the effect of periodontal disease and treatment on pulpal status with controversial results. This study was conducted to verify whether periodontal disease in a deep intrabony defect and complex therapy, including aggressive root planing such as in periodontal regeneration, have an influence on tooth vitality. One hundred thirty-seven patients who fulfilled the requirements were included. The collected data did not support the need for "preventive" root canal treatment in severely compromised teeth that are planned to undergo periodontal regenerative surgery.

This report describes a successful implant prosthetic rehabilitation in an atrophic left posterior mandible in a 62-year-old man using a cancellous equine bone block as grafting material. Four months later, two bone specimens were retrieved for histologic evaluation and two dental implants were placed. Computed tomography and conventional radiography showed a 5-mm mean vertical bone gain. The biopsies showed new bone formation within the cancellous portion of the blocks and no foreign body reaction. Cancellous equine bone grafts may be an effective alternative to autogenous bone and inorganic bovine bone grafting for reconstruction of the posterior mandible using the inlay technique.

Lip repositioning surgery is a largely unknown and underutilized treatment modality for excessive gingival display. It involves precise resection of maxillary mucosal tissues with reattachment of the lip in a more coronal position. This limits lip elevation on smiling and increases lip fullness. While this is an elective treatment, no reported cases have yet offered patients the ability to preview the outcome in a reversible manner. This case series presents seven patients who were successfully managed with trial, and then definitive, lip repositioning.

This experiment was conducted to study the histologic feasibility and biologic impact of Ti02 impregnation of an extracellullar matrix (ECM) membrane in guided bone regeneration. Eighteen adult New Zealand White rabbits were used. Bilateral bone defects were created in edentulous areas of the maxilla. The defects were filled with demineralized freeze-dried bone (DFDB). ECM was randomly pretreated with a suspension containing saline and 3 mg Ti02 granules. A regular ECM membrane served as a control on the contralateral side. Healing periods were 2, 4, and 8 weeks. Histologic and histomorphometric analyses were performed. The parameters assessed were (1) zone of inflammatory cells adjacent to ECM membrane, (2) presence of cellullar ingrowth into ECM, and (3) presence of Ti02 particles within the ECM barrier membrane. In general, no adverse reactions toward both groups of ECM membranes could be noted. The Ti02 particles remained within the ECM after 8 weeks of healing, making histologic detection of ECM easy. Histomorphometric analysis revealed low numbers of inflammatory cells adjacent to the ECM surface and adequate preservation and integration of the barrier. Contrasting Ti02 particles impregnated into the ECM membrane can be a very useful tool for the detection of similar biologic materials in in vivo models.

To explore the role of the IL-23/IL-17 axis in the relationship between periodontitis and coronary heart disease (CHD), 97 subjects were recruited and divided into four groups: (1) CHD + periodontitis, (2) CHD, (3) periodontitus alone, and (4) healthy. The demographic characteristics and periodontal status of all subjects were recorded, and the serum levels of IL-23/IL-17 were detected by enzyme-linked immunoabsorbent assay. Results showed that the serum levels of IL-23/IL-17 in groups 1, 2, and 3 were higher compared with group 4. Group 1 manifested the highest level of serum IL-23/IL-17. A significant positive correlation between IL-23 and IL-17 levels was seen in the three patients groups; groups 1 and 3 also had significant positive correlations with probing depth and attachment loss. The results indicate that there may be an association between periodontitis and CHD, and the IL-23/IL-17 axis may play an important role in the pathologic process of both diseases.

This report introduces an innovative approach for optimizing esthetics and minimizing soft tissue changes in clinical scenarios that involve extensive site preparation and submerged implants. The existing soft tissue morphology is registered at the time of implant uncovery, and an optimal peri-implant transmucosal contour is created indirectly in the lab. The customized definitive abutment is inserted during stage-two surgery and subsequently guides the peri-implant soft tissue, replicating an optimal emergence profile. The concept is demonstrated through the presentation of two clinical cases.

This study evaluated the immediate provisionalization of mini-implants with friction-engaging abutments in the mandibular anterior region. A total of 43 mini-implants placed in 30 consecutive patients had a survival rate of 100% over a follow-up period of 1 to 4 years. The overall change in marginal bone level from definitive restoration delivery to 1 year for a single-tooth mini-implant replacement was -0.17 ± 0.42 mm, demonstrating bone gain. The mean changes in marginal bone level on the mesial and distal aspects were -0.18 ± 0.46 mm and -0.16 ± 0.40 mm, respectively, also representing bone gain. The difference between the mesial and distal change in bone level was not statistically significant (P = .93). The peri-implant soft tissue remained relatively unchanged at 1 year posttreatment.

The aim of this study was to assess the color alteration and sensitivity of teeth throughout and following in-office bleaching. Twenty-two volunteers participated in this clinical trial of bleaching treatment (35% hydrogen peroxide bleaching gel and placebo) applied on maxillary incisors and canines. According to a splitmouth design, the volunteers' maxillary hemi-arches received either the bleaching or placebo agent, applied four times, at 1-week intervals. Color alteration and tooth sensitivity were assessed throughout and following bleaching. Statistical calculations were performed using gamma distribution and repeated-measures ANOVA. There was a statistically significant difference between teeth submitted to a bleaching agent and placebo (P .001). At the end of the first, second, third, and fourth sessions, the bleached teeth presented color scores statistically lower than those observed immediately before bleaching. There was no difference in the color scale scores of the bleached teeth between bleaching sessions. The sensitivity data test showed a significant difference among treatments (P .0001). Color alteration and dental sensitivity were altered by the bleaching agent.

Open flap debridement with flap repositioning may result in significant gingival recession. Patients with chronic periodontitis were treated with open flap debridement followed by placement of an acellular dermal matrix allograft (ADMA) underneath the flap to minimize the occurrence of postsurgical gingival recession. Ten patients (total, 60 teeth) with periodontal pockets in the anterior dentition underwent open flap debridement combined with ADMA. Probing pocket depth, relative attachment level, and relative gingival margin level were recorded at baseline and 6 months postsurgery. The mean probing pocket depth at baseline and 6 months was 4.4 and 1.7 mm, respectively (P .05); the mean relative attachment level at baseline and 6 months was 12.9 and 10.7 mm, respectively (P .05); and the mean relative gingival margin level at baseline and 6 months was 8.4 and 9.0 mm, respectively. ADMA underneath the flap when combined with open flap debridement effectively minimizes postsurgical gingival recession.

The aim of this study was to compare the effectiveness of two bone substitute materials for socket preservation after tooth extraction. Extraction sockets in 10 patients were filled with either inorganic bovine bone material (Bio-Oss) or with synthetic material consisting of hydroxyapatite and silicon dioxide (NanoBone). Extraction sockets without filling served as the control. The results demonstrate the effectiveness of the presented protocol for socket preservation and that the choice of a suitable bone substitute material is crucial. The dimensions of the alveolar ridge were significantly better preserved with Bio-Oss than with NanoBone or without treatment. Bio-Oss treatment resulted in better bone quality and quantity for successful implant placement.

Reestablishing proximal contacts with composite resins may prove challenging since the applied adhesives may lead to resin coating that produces additional thickness. The aim of this study was to investigate the surface of metal matrix bands after application of adhesive systems and blowing or wiping off the adhesive before polymerization. Seventeen groups of matrix bands were prepared. The remnant particles were characterized by energy dispersive spectrum and scanning electron microscopy. Total etch and twostep self-etch adhesives did not leave any resin residues by wiping and blowing off. All-in-one adhesive revealed resin residues despite wiping off. Prime and Bond NT did not leave any remnant with compomer. Clinicians must be made aware of the consequences of possible adhesive remnants on matrix bands that may lead to a defective definitive restoration. The adhesive resin used for Class II restorations may leave resin coats on metal matrix bands after polymerization, resulting in additional thickness on the metal matrix bands and poor quality of the proximal surface of the definitive restoration when the adhesive system is incorporated in the restoration.

This study evaluated the histometric characteristics of the peri-implant mucosa of human subjects that received textured implant abutments with conventional (implant and abutment with same diameter) or platformswitched (implant diameter wider than that of the abutment) configurations. Wider and longer connective tissue around platform-switched implants was observed compared to that with conventional abutments. Despite the different dimensions between the two abutment types, the abutment-soft tissue interaction was similar for both groups at the histometric level.

The combination of osseous graft with barrier membrane and enamel matrix protein derivative (EMD) has the potential to result in a synergistic effect. Therefore, the aim of this study was to evaluate the effectiveness of EMD in combination with demineralized freeze-dried bone allograft (BG) and bioresorbable membrane (Biomesh) in the treatment of human mandibular Class II furcation defects over a period of 12 months. Thirty patients with chronic periodontitis and a single Class II furcation defect on the buccal or lingual surface of mandibular teeth were included. The clinical parameters evaluated were probing pocket depth (PPD), horizontal probing depth (HPD), vertical relative attachment level (V-RAL), and relative gingival margin level (RGML). three groups were created based on treatment method: EMD + BG + guided tissue regeneration (GTR), BG + GTR, and open flap debridement (OFD). All three groups showed a statistically significant PPD reduction of 1.74 ± 1.00 mm, 0.81 ± 0.31 mm, and 0.46 ± 0.52 mm at 12 months postsurgery. EMD + BG + GTR showed a significantly greater PPD reduction compared with BG + GTR, as well as OFD. EMD + BG + GTR showed a statistically significant vertical clinical attachment gain of 2.12 ± 1.07 mm at 12 months compared with BG + GTR as well as OFD. Significant reductions in mean HPD were observed for EMD + BG + GTR (2.10 mm) as well as BG + GTR (1.5 mm). The number of Class II furcation defects that closed or converted to Class I was greatest for EMD + BG + GTR. It can be concluded that EMD + BG + GTR resulted in a statistically significant reduction of PPD, V-RAL gain, and a nonsignificantly greater reduction of HPD compared to BG + GTR.

Internal root resorption (IRR) is characterized by progressive loss of tooth substance initiating at the root canal wall as a result of clastic activity. The use of periodontal surgery and mineral trioxide aggregate is a good approach to repair lesions with periodontal communication (perforating IRR). This case describes the treatment and follow-up of a maxillary central incisor with perforating IRR in a 56-year-old male patient where root canal treatment, periodontal surgery, and white mineral trioxide aggregate were employed to achieve complete repair and to restore function. Clinical findings and periapical radiographs indicated success after a 5-year follow-up.

The aim of this study was to evaluate the effects of an osteogenic medium supplemented with platelet-derived growth factor (PDGF) BB and osteogenic protein (OP) 1 on the proliferation and differentiation of mesenchymal stem cells (MSCs) in an anorganic bovine cancellous bone scaffold. At day 7, there was a statistically significant increase in the number of cells in the scaffolds in the group treated with the medium supplemented with both PDGF-BB and OP-1 when compared with the control groups. The highest alkaline phosphate levels, at 14 and 21 days, were recorded for the samples in medium supplemented with OP-1 alone reflecting osteogenic differentiation. The results commend OP-1, as well as PDGF-BB, for incorporation into porous mineral scaffolds for vertical ridge augmentation.