International Journal of Periodontics & Restorative Dentistry, 03/2010

This retrospective case series presents results from eight patients treated with demineralized freeze-dried bone allograft particles and barrier membranes using either miniscrews or implants to support the membrane in seven patients. In all patients, the amount of vertical bone regeneration enabled placement of one or more implants in the graft sites, followed by loading with definitive prostheses at least 5.5 months after implant placement. Marginal bone heights around the implants have remained stable throughout 4 to 13 years of follow-up.

This study evaluated the reliability of assessing visually the facial gingival biotype of maxillary anterior teeth with and without the use of a periodontal probe in comparison with direct measurements. Forty-eight patients (20 men, 28 women) with a single failing maxillary anterior tooth participated in this study. Three methods were used to evaluate the thickness of the gingival biotype of the failing tooth: visual, periodontal probing, and direct measurement. Prior to extraction, the gingival biotype was identified as either thick or thin via visual assessment and assessment with a periodontal probe. After tooth extraction, direct measurement of the gingival thickness was performed to the nearest 0.1 mm using a tension-free caliper. The gingival biotype was considered thin if the measurement was = 1.0 mm and thick if it measured > 1.0 mm. The assessment methods were compared using the McNemar test at a significance level of α = .05. The mean gingival thickness obtained from direct measurements was 1.06 ± 0.27 mm, with an equal distribution (50%) of sites with gingival thicknesses of = 1 mm and > 1 mm. The McNemar test showed a statistically significant difference when comparing the visual assessment with assessment using a periodontal probe (P = .0117) and direct measurement (P = .0001). However, there was no statistically significant difference when comparing assessment with a periodontal probe and direct measurement (P = .146). Assessment with a periodontal probe is an adequately reliable and objective method in evaluating gingival biotype, whereas visual assessment of the gingival biotype by itself is not sufficiently reliable compared to direct measurement.

Previous research has demonstrated the effectiveness of laser-ablated microgrooves placed on implant collars to support direct connective tissue attachments to altered implant surfaces. Such a direct connective tissue attachment serves as a physiologic barrier to the apical migration of the junctional epithelium and prevents crestal bone resorption. The current prospective preclinical trial sought to evaluate bone and soft tissue healing patterns when laser-ablated microgrooves were placed on the abutment. A canine model was selected for comparison to previous investigations that examined the negative bone and soft tissue sequelae of the implant-abutment microgap. The results demonstrate significant improvement in peri-implant hard and soft tissue healing compared to traditional machined abutment surfaces.

The aim of this article was to present the treatment of an unesthetic smile in a 27-year-old woman showing gingival recession, gingival asymmetry, and an altered passive eruption in the natural dentition. First, an apically positioned flap with osseous resective surgery was applied to correct the gingival asymmetry at the maxillary right incisors. The amount of bone resection was determined by means of bone sounding at the maxillary left incisors. Six weeks later, a coronally advanced flap procedure was performed to cover the gingival recession at the maxillary right canine, along with an enamelplasty and a direct composite resin restoration. The patient was satisfied with the final treatment outcome.

This study compared the dimensional alterations, the need for sinus floor elevation, and the histologic wound healing of augmented and nonaugmented alveolar sockets. Sixteen human extraction sockets were either grafted or left untreated. At baseline and 3 and 6 months postextraction, alveolar ridge alterations were evaluated; at 3, 6, and 9 months, histologic analyses were conducted. Implant placement with or without sinus floor augmentation was decided at 6 months. Three of eight patients in the control group underwent sinus floor augmentation compared to one of six in the experimental group. The alveolar ridge augmentation procedure presented here increases the possibility of inserting implants without the need for a sinus augmentation procedure.

The application of computed tomography (CT) and the use of computer software for dental implant therapy have significantly increased during the last several years. Dental implant positioning can be either "partially guided," where only osteotomy sites are prepared using sequential, removable surgical drilling guides (generated using computer software and through the process of stereolithography), or "totally guided," whereby one guide is used for osteotomy site preparation as well as implant delivery. Recently, the guided delivery of manufacturer-specific internalconnection implants has become available. Individualized protocols and specific instrumentation are employed under this approach to CT-based implant surgery. The purpose of this article is to expand on previous publications related to the use of prosthetically directed implant placement using computer software to ensure precise placement and predictable prosthetic outcomes. Three case reports are presented where precision-guided CT-based surgery was employed and the immediate delivery of a dental prosthesis was facilitated.

The reconstruction of the alveolar ridge with particulate bone collected from the torus palatinus is presented in this case report. Bone loss at the maxillary right permanent central incisor was rehabilitated with an implant-supported fixed prosthesis. The success of this approach demonstrates that the torus palatinus and torus mandibularis, found in approximately 20% and 27% of the population, respectively, are feasible options for bone regeneration, with several advantages compared to other sources of bone. Thus, surgeons should look for these bony growths, which result in surgery with less morbidity when included in the treatment plan.

The purpose of this study was to present a protocol for the replacement of single teeth lost in the molar area with immediate implantation in fresh extraction sockets, no flap reflections or grafting procedures, and immediate loading. Twentythree implants were placed in 20 patients between 2000 and 2006. No implants were lost and no signs of significant bone resorption, loss of osseointegration, or soft tissue complications were reported. The results of this study indicate that this protocol may be a feasible alternative for the replacement of condemned molars.

Genetic polymorphisms in the interleukin-6 (IL-6) gene are associated with bone homeostasis and diseases characterized by bone loss. The aim of this study was to investigate the correlation between the IL-6 -572C/G polymorphism and the risk of chronic periodontitis in a Chinese Han population. The IL-6 -572C/G polymorphism was genotyped in 93 patients suffering from chronic periodontitis and 96 control subjects by polymerase chain reaction-restriction fragment length polymorphism. DNA was extracted from the peripheral blood of patients and control subjects and amplified using a polymerase chain reaction. IL-6 genotypes were identified using gel electrophoresis. The IL-6 -572 GG genotype and the G allele were more frequent in chronic periodontitis patients than in control subjects (P .05). When compared with the CC genotype, the odds ratio for chronic periodontitis was 1.88 (95% confidence interval, 1.04 to 3.40; P .05) for the CG + GG genotype. The frequency of the -572CG + GG genotype was significantly different between the control group and the group with chronic periodontitis. Therefore, the IL-6 -572C/G polymorphism may contribute to the susceptibility to chronic periodontitis in the Chinese Han population.

The purpose of this study was to evaluate the clinical and radiographic parameters as well as the esthetic outcome of two adjacent implant-supported restorations and the surrounding peri-implant mucosa in the maxillary esthetic zone. Ten patients were treated with two adjacent implants in the anterior maxillary zone according to the same protocol. Only patients who had been subjected to a separate previous augmentation procedure with autogenous bone were included in this study. The following parameters were analyzed: implant survival, marginal bone level, vertical distance between the contact point and the bone crest, Papilla Index, probing depth, Aesthetic Index, and patient satisfaction. Implant survival was 100%. The interimplant bone crest level was positioned significantly more apical than the bone crest level between the implant and its neighboring tooth. In addition, complete filling of the interproximal space was observed between two adjacent implant-supported restorations in only 1 of 10 patients, whereas the papilla between the implant and its neighboring natural tooth was present in 70% of patients. Furthermore, patients rated the esthetic outcome of their implant-supported restorations and the surrounding mucosa in all cases as "acceptable," while the clinicians, using the Implant Crown Aesthetic Index, determined six to be "acceptable" and four "unacceptable." Although many patients were satisfied with the esthetic result, it is difficult to establish an acceptable esthetic result with two adjacent implant-supported restorations in the esthetic zone in patients who needed a separate augmentation procedure, according to the contemporary standards of dental professionals.