International Journal of Periodontics & Restorative Dentistry, 04/2012

The purpose of this research was to quantify the visual display (presence) or lack of display (absence) of interdental papillae during maximum smiling in a patient population aged 10 to 89 years. Four hundred twenty digital single-lens reflex photographs of patients were taken and examined for the visual display of interdental papillae between the maxillary anterior teeth during maximum smiling. Three digital photographs were taken per patient from the frontal, right frontal-lateral, and left frontal-lateral views. The data set of photographs was examined by two examiners for the presence or absence of the visual display of papillae. The visual display of interdental papillae during maximum smiling occurred in 380 of the 420 patients examined in this study, equivalent to a 91% occurrence rate. Eighty-seven percent of all patients categorized as having a low gingival smile line (n = 303) were found to display the interdental papillae upon smiling. Differences were noted for individual age groups according to the decade of life as well as a trend toward decreasing papillary display with increasing age. The importance of interdental papillae display during dynamic smiling should not be left undiagnosed since it is visible in over 91% of older patients and in 87% of patients with a low gingival smile line, representing a common and important esthetic element that needs to be assessed during smile analysis of the patient.

Previous preclinical and clinical studies have demonstrated the effectiveness of precisely configured laser-ablated microgrooves placed on implant collars to allow direct connective tissue attachment to the implant surface. A recent canine study examining laser-ablated microgrooves placed in a defined healing abutment area demonstrated similar findings. In both instances, direct connective tissue attachment to the implant-abutment surface served as an obstacle to the apical migration of the junctional epithelium, thus preventing crestal bone resorption. The current case report examines the effectiveness of abutment-positioned laser-ablated microgrooves in human subjects. As in the preclinical trial, precisely defined laser-ablated microgrooves allowed direct connective tissue attachment to the altered abutment surface, prevented apical migration of the junctional epithelium, and thus protected the crestal bone from premature resorption.

This article presents a clinical case of bilateral partial edentulism in the posterior mandible with severe horizontal and moderate vertical bone atrophy. A new technique using rapid orthodontics after ridge splitting is presented. The splitcrest technique was carried out using piezosurgical instruments in the first molar and second premolar areas to widen the bone crest and open a channel for tooth movement. Immediately after, orthodontic appliances were used to move the first premolars distally and the second molars mesially into the surgical site. The rationale was to facilitate and accelerate orthodontic movement of the teeth, which is otherwise difficult in a cortical knife-edged ridge. The bone defect was filled with the alveolar bone of the adjacent teeth that were moved into the surgically opened path. Adequate bone volume for implant placement was generated in the first premolar area. Implants were then inserted, and the patient was rehabilitated.

The aim of this study was to evaluate the potential of an allogeneic bone matrix to regenerate new bone, cementum, and periodontal ligament around a previously diseased root surface. Four patients with severe chronic periodontitis and teeth with hopeless periodontal or restorative prognoses participated in this study. One tooth with a severe intraosseous defect was selected per patient. At baseline, measurements of probing depth, gingival recession, and clinical attachment level were obtained. Following flap reflection, a root notch was placed at the apical extent of the calculus; the root was debrided, and the allogeneic bone graft material was placed into the defect. After a minimum of 6 months of healing, the teeth were removed en bloc and prepared for histologic examination. Two of four teeth demonstrated regeneration of new bone, cementum, and periodontal ligament. One tooth healed by new connective tissue attachment, and another by junctional epthelium.

The aim of this case report study was to demonstrate the use of a new collagen matrix as an alternative to the connective tissue graft for the treatment of multiple gingival recessions. Three women showing 11 maxillary gingival recessions were treated by means of the envelope flap technique associated with a novel collagen matrix as a substitute for the connective tissue graft. At 1 year, complete root coverage was achieved in 9 treated sites, with a mean keratinized tissue width of 3.1 mm, complete resolution of dental hypersensitivity, and a high level of esthetic satisfaction.

After tooth extraction, varying amounts of bone resorption occur because of qualitative and quantitative changes at the edentulous site of the alveolar process. The aims of this randomized controlled clinical trial were (1) to compare the postextraction changes in residual ridge dimensions during spontaneous healing with those during socket preservation, (2) to analyze the histologic and histomorphometric aspects of the grafted sockets, and (3) to compare probing procket depth (PPD) and clinical attachment level (CAL) changes at teeth adjacent to extraction sites. Forty-eight teeth were extracted from 41 patients referred for extraction of 1 or more maxillary or mandibular premolars or molars. The edentulous sites were randomly assigned to the control (EXT, extraction alone) or experimental groups (SP, extraction and socket preservation). In the SP group, the sockets were filled with bovine bone mineral and covered with porcine collagen membrane. At baseline and after 4 months, PPD, gingival recession (REC), and CAL were measured at teeth adjacent to the edentulous sites. The changes in ridge dimensions from baseline to 4 months were assessed on dental casts. At 4 months, bone was harvested from the grafted areas in the SP group and the edentulous areas in the EXT group. PPD, REC, and CAL were comparable between groups. However, from baseline to 4 months, the SP group showed significantly less reduction in ridge width (1.04 ± 1.08 mm vs 4.48 ± 0.65 mm, P .001) and height (0.46 ± 0.46 mm vs 1.54 ± 0.33 mm, P .001). Histologically, the grafted sockets exhibited various stages of bone maturation and formation without inflammatory responses. No significant difference in the mineralized and nonmineralized fractions was noted between the groups. Socket preservation using bovine bone mineral and porcine collagen membrane considerably limits the amount of horizontal and vertical bone resorption when compared with extraction alone.

The aim of this case report is to histologically evaluate periapical healing after combined endodontic-periodontic treatment. A maxillary left central incisor was treated with conventional endodontic therapy, followed by periodontal surgery. The facial bony defect was filled with a mixture of autologous bone and Bio-Oss. A resorbable membrane was used. Histology showed the presence of new cementum, ligament, and bone around the apex of the treated tooth. This finding was clinically associated with minimal residual probing depth and maximum attachment gain. This histologic report demonstrates the possibility of true regeneration in a case of severe periodontal attachment loss resulting from an endodonticperiodontic lesion.

Treatment of gingival recessions has become one of the most challenging procedures in periodontal plastic surgery. Various surgical options with predictable outcomes are available, but in cases with cervical lesions or restorations, optimal functional and esthetic results may require the combination of periodontal and restorative procedures. In this case report, one patient treated with acellular dermal matrix allograft and a coronally positioned flap in combination with compomer cervical restorations is presented. Clinical parameters were recorded immediately prior to surgery and after 12 months. Postoperatively, significant root coverage, reductions in probing depths, and gains in clinical attachment were observed. The final clinical results, esthetics, color match, and tissue contours were acceptable to both the patient and clinicians.

Few histologic and histomorphometric reports are present in the literature regarding the peri-implant bone response around implants inserted in sinuses grafted with different biomaterials. Anorganic bovine bone (ABB) and anorganic bovine matrix with the addition of an active cell-binding peptide (PepGen P-15) are xenogenic materials that have been reported to present biocompatibility and osteoconductivity. A monolateral sinus augmentation procedure with ABB (50%) and PepGen P-15 (50%) was performed in a 54-year-old man. Two titanium implants with a sandblasted and acid-etched surface were inserted after 6 months. After an additional 6 months, a fixed prosthetic restoration was fabricated. One implant fractured in the coronal portion after an 8-year loading period and was removed using a 5-mm trephine bur. Few particles of both grafting materials were present in the peri-implant bone. No graft material particles were found in contact with the implant surface, and bone was always interposed between the graft materials and surface. No inflammatory cell infiltrate, multinucleated giant cells, or foreign body reaction cells were found. The tissues around the implant were composed of 51.4% ± 4.8% bone, 6.2% ± 0.7% ABB particles, 2.4% ± 0.5% PepGen P-15, and 40.0% ± 7.1% marrow spaces. The bone-implant contact percentage was 78.4% ± 4.1%. A sinus augmentation procedure using ABB and PepGen P-15 produced bone formation with subsequent implant osseointegration, which was still present after 8 years of implant loading.

The purpose of this study was to compare extraction sites augmented with bovine bone mineral (BBM) with and without resorbable membrane coverage. BBM particles were grafted in fresh human extraction sockets of 23 patients; in 12 of these patients, a guided tissue regeneration (GTR) membrane was applied. After 9 months of histomorphometric evaluation, cylindric hard tissue specimens were obtained. Percent bone area fractions (BAFs) of the crestal, middle, and apical sections from each specimen were calculated using the point-counting technique. Changes in values were compared. In sites augmented with BBM, the mean BAF ranged from 22.8% (coronal) to 36.3% (apical) compared to sites augmented with BBM and collagen membrane (35.2% [coronal] to 47% [apical]). Comparison between the different depths and the two groups showed a distinct increase in BAF from coronal to apical regions (P .001). This pattern was observed in both groups (P .001) and was significantly higher in the group augmented with BBM and collagen membrane (P .05). In the immediate postextraction phase, BBM as a grafted biomaterial preserved the socket volume and enabled newly formed bone for future implant site preparation. The amount of the osseous fraction increased with GTR membrane.

This study presents the results of a long-term clinical evaluation of conical crown-retained dentures fabricated using different technologies. Four different material connections between the outer and inner crowns were used: cast gold/cast gold, cast gold/electroforming, nonprecious alloy/electroforming, and titanium abutment/electroforming. Technical failures and retention values were assessed. The best clinical outcome was found with dentures in which both crowns were cast from gold alloy. The most frequent technical failures were observed in restorations with electroformed outer crowns. Better clinical outcomes were noted when the electroformed outer crowns were used in dentures retained by implants as compared to dentures on natural dentition.

A titanium implant with an acid-etched surface was placed simultaneously with sinus floor elevation in a severely resorbed ridge of a 52-year-old man. The height of the residual crest was less than 3 mm, and no bone substitute was used to graft the sinus cavity. Six months after placement, the implants were uncovered, and no signs of mobility were recorded. The implant at the second molar site and surrounding bone were removed for prosthetic convenience. The specimen was harvested and processed for undecalcified histologic analysis. Poor bone quality around the implant was evident, characterized by large marrow spaces and scarce trabeculation. Signs of osseointegration could be seen mainly toward the apical third of the implant. A cortical wall was present apical to the implant, suggesting the formation of a new sinus floor. The relationship between the histologic evidence and possible clinical implications are discussed.

This report presents human evidence of reattachment of the connective tissue when a laser-microgrooved healing abutment was replaced with a laser-microgrooved cylindric definitive abutment. No additional bone loss was noted 15 weeks after placement of the laser-microgrooved cylindric definitive abutment. Dense connective tissue was in intimate contact with the laser-microgrooved surface to the point of the soft tissue separation, and clear evidence of the junctional epithelium ending at the coronal-most position of the laser-microgrooved zone was identified.

This report describes a duplication technique of free gingival form from a provisional restoration to a zirconia crown. Three die casts were manufactured from a silicone impression with an acrylic resin ring tray. The first die cast was for the zirconia framework, the second for the provisionalized transfer coping, and the third for relining the provisional restoration. A free gingival impression was taken using a provisionalized transfer coping, and a soft gingival cast was manufactured. The depth of free gingival transparency was measured using a zirconia shade plate. Then, the zirconia framework was customized to allow for subgingival porcelain space. This technique seems to contribute to the clinicallaboratory interface in computer-aided design/computer-assisted manufacture restorations.

Although gingival pigmentation is physiologic in most cases, esthetic concerns regarding "black gums" are common among adolescents. Numerous procedures have been suggested to treat this problem. The aim of this study was to evaluate the efcacy of cryosurgery with liquid nitrogen for the removal of physiologic gingival pigmentation (PGP) in adolescents. Melanin pigmentation of the anterior segments in 15 patients was treated using liquid nitrogen. Standard digital photographs were taken preoperatively and at 3, 12, and 24 months postoperatively. Photographs were analyzed digitally and showed signicant differences in gingival color between the preoperative and postoperative follow-ups. Cryosurgery successfully removed PGP in adolescents.