International Journal of Periodontics & Restorative Dentistry, 04/2017

The aim of this retrospective study was to compare clinical and radiographic outcomes of the interpositional (inlay) augmentation technique in atrophic posterior partially edentulous mandibles using three different types of block bone grafts: autogenous bone block harvested from the iliac crest, deproteinized bovine bone mineral block, and collagenated equine bone block. A total of 115 patients were included with a 4.2-year mean after-loading follow-up. Data seem to suggest that heterologous bone blocks are similar in results to autogenous bone blocks, so they might be considered preferable as they avoid invasive harvesting surgeries.

The purpose of this retrospective radiographic study was to evaluate and correlate the dimensions and morphology of peri-implant bone defects as determined via cone beam computed tomography (CBCT) scans with regard to the selected treatment approach. Vertical and horizontal peri-implant bone defects (mesial, distal, mesio-oral, mesiobuccal, disto-oral, distobuccal, oral, and buccal) in peri-implantitis cases were measured. Three-dimensional data and defect morphology were correlated to the treatment approach chosen (explantation versus implant retention). A total of 19 patients and 28 implants met the inclusion criteria, resulting in a sample size of 224 sites and a total of 896 measurements. The mean percent bone loss did not correlate to the type of treatment chosen (P = .1286). In contrast, when only the maximum vertical values per implant were selected, maximum percent bone loss exhibited a significant correlation to the type of treatment chosen (P = .0021). The effect of the defect morphology on the treatment strategy chosen did not show a statistically significant correlation (P = .4685). Based on the data presented, the maximum bone loss around the implant seems to be a critical factor in deciding whether or not an implant should be explanted. The use of CBCT for treatment planning in cases of peri-implantitis can offer valuable additional information but should be considered only after initial clinical examination and two-dimensional imaging.

The aim of this study was to present the use of retroauricular full-thickness skin grafts in vestibuloplasty surgeries for dental implant rehabilitation in vascularized fibula grafts. Two patients underwent mandibular reconstruction with vascularized fibula grafts due to mandibular gunshot injuries. Inadequate sulcus gaps secondary to mandibular soft tissue deficiencies were managed by full-thickness autologous skin grafts harvested from the retroauricular region. Dental rehabilitation was achieved by implants placed in free fibula grafts. In both cases, complete graft survival was achieved. Cosmetic and functional outcomes were satisfactory. Owing to its high resiliency and elasticity and its thin and hairless structure, full-thickness retroauricular skin graft is an effective treatment modality in the management of intraoral soft tissue deficiencies. Patients with gunshot injuries present great functional and esthetic demands, and every report presenting new treatment modalities is helpful in the management of the condition.

The treatment of peri-implant disease is one of the most controversial topics in implant dentistry. The multifactorial etiology and the myriad proposed techniques for managing the problem make successful decontamination of an implant surface affected by peri-implantitis one of the more unpredictable challenges dental practitioners have to face. This article presents the first known published case report demonstrating human histologic evidence of reosseointegration using a plastic curette for mechanical debridement and dilute sodium hypochlorite, hydrogen peroxide, and sterile saline for chemical detoxification. Guided bone regeneration in the infrabony component of the peri-implantitis lesion was accomplished using calcium sulfate and bovine bone as grafting materials and a porcine collagen barrier for connective tissue and epithelial exclusion.

The aim of this study was to analyze changes in pink and white esthetics in the anterior zone through evaluation of an immediately placed zirconia implant using the Pink and White Esthetic Scores (PES and WES) in 20 patients. Two clinical photographs were compared: one taken directly after placement of the permanent crown (mean PES = 12.8; mean WES = 8.5) and the other taken at a later time (mean PES = 12.8; mean WES = 8.6; not significant). Volunteers found it difficult to correctly identify the implant. Patients completed a questionnaire regarding the pink and white implant esthetics. A mean outcome of 8.5 on a point scale of 0 to 10 was found. The esthetic appearance of a restored zirconia implant is excellent and stable over time. Patients are generally satisfied with the result.

Using simultaneous transplantation of bone graft materials, this study examined the long-term outcomes of a ridge augmentation technique applied to deficient labial alveolar bone plate in the esthetic zone. Results were based on a case series in which study cases (n = 10) were divided into two groups. Group 1 exhibited intact labial alveolar bone, while group 2 alveolar bone was dehiscent at the labial aspect. The clinical outcome was longitudinally monitored using cone beam computed tomography 4 to 7 years after the procedure. The final postoperative examination noted bone augmentation in labial bone width for groups 1 and 2 of 2.48 ± 0.60 and 2.62 ± 0.68 mm, respectively (Mann-Whitney U test, P = .40), indicating the effectiveness of this technique when applied to dehiscent labial bone. More importantly, these measurements did not significantly change during the last 2 to 4 years of follow-up monitoring, suggesting the success of this technique when applied to immediate implant placement.

Periodontal biotype is a key element influencing esthetic treatment outcomes in clinical practice. However, while the soft and hard tissue thicknesses of maxillary anterior teeth have been widely studied, information regarding mandibular anterior teeth is scarce. Therefore, the aim of this study was to determine whether there is a relationship in terms of hard and soft tissue thickness between maxillary and mandibular anterior teeth. The present study included 90 maxillary and 90 mandibular anterior teeth in 15 healthy patients. Clinical and cone beam computed tomography measurements were taken to determine gingival and buccal bone thickness, respectively, and a correlation was made between maxillary and mandibular anterior teeth. No statistically significant differences were found when comparing gingival and buccal bone thickness at the crestal third and midpoint of maxillary and mandibular teeth (P > .05). However, some differences were observed at the apical third between the two groups. The results suggest that soft and hard tissue dimensions of maxillary and mandibular anterior teeth are comparable, especially in the coronal third. However, more studies are necessary to confirm that maxillary anterior teeth can be used as a reference when dealing with mandibular incisors and canines.

Treatments for enhancing surface energy were studied in an effort to create a more favorable environment for cell adhesion. Cold argon plasma (CAP) is able to improve titanium-cell contact, producing hydrophilic surfaces with higher wettability. The aim of this in vitro study was to estimate the early cell morphology after CAP treatment of different commercially available titanium surfaces. Surface wettability was significantly augmented in all the treated samples. The authors investigated how CAP affected the behavior of osteoblasts by evaluating the cell morphology outcome. Cell surface areas differed in a statistically significant way when plasma-treated samples were compared to the untreated ones. The positive effect of CAP was shown on smooth, moderately rough, and rough implant surfaces.

The goal of this study was to histologically evaluate the healing process of subepithelial connective tissue graft in humans. A sample of 16 patients with Miller Class I or II localized gingival recession defects were consecutively treated with a bilaminar technique. At baseline and after 2 months, tissue samples were taken from the donor and recipient sites. The revascularization and reinnervation of the graft were examined by means of hematoxylin-eosin and immunohistochemical techniques. After 2 months of healing, the integration of the grafted tissue was evident with the connective tissue expressing features belonging to both the recipient (cellular component) and the donor site (extracellular matrix) in the inner and superficial layers, respectively. This was accompanied by increased neovascularization and reduction in intraepithelial free nerve endings.

Major and minor chipping of veneering porcelain are two of the most frequent complications in all-ceramic restorations with zirconia frameworks. In cases of major chipping, replacement of the affected restoration may be necessary. High-strength lithium disilicate ceramic offers new options to serve as veneering material in a sintering technique or as repair material for chipping in combination with the adhesive technique. The purpose of three case presentations here was to describe the use of lithium disilicate ceramic on zirconia frameworks for reliable and esthetic veneering in the posterior region and to repair extended chipping in conventional veneering materials.

Acellular dermal matrix allografts (ADMs) have been hypothesized to create a zone of immobile connective tissue (ICT) extending apical to the mucogingival junction (MGJ). This 12-month prospective randomized trial investigated the presence of ICT after the use of two commercially available ADMs with coronally advanced flaps in the treatment of Miller Class I and II recession defects. This study demonstrated that the use of either type of ADM resulted in predictable root coverage and a zone of ICT extending apical to the MGJ by 1.88 to 2.69 mm. Hence, minimal keratinized gingival width should not preclude the use of ADMs.

Early orthodontic tooth movement following regenerative surgery is controversial. In this case, during protraction of the maxillary right first premolar to substitute for the long-term missing maxillary right canine, Bio-Oss and Bio-Gide were used for lateral ridge augmentation at the area of the maxillary right lateral incisor and to cover the denuded surface at the buccal side of the first premolar. Orthodontic tooth movement (OTM) commenced 2 weeks after regenerative surgery. After 8 months, new bone formation was observed on the root surface of the first premolar during implant surgery. A cone beam computed tomography scan taken 1.5 years postsurgery revealed good maintenance of regenerative bone at the same site. This satisfactory outcome of early OTM following regenerative surgery suggests biomechanical stimulation may not jeopardize the regenerative effect.

Inaccuracy of computer-guided implant placement may lead to complications when combined with an immediately loaded prefabricated prosthesis. The aim of this case series was to describe the use of an intraoral welding technique to increase the predictability of immediately loaded implants supporting a fixed full-arch prosthesis after computer-guided flapless implant placement. A total of 60 Ankylos plus implants (Dentsply) with a width of 3.5 mm and a length of 8 to 14 mm were placed consecutively in 10 patients. The implants were functionally loaded using the intraoral welding technique on the day of surgery. The accuracy of guided implant placement was assessed by matching the planning cone beam computed tomography (CBCT) scans with postoperative CBCT scans. No mechanical or biologic complications were registered at the 1-year follow-up. The global coronal deviation of implant placement from the guide plan ranged from 0.25 to 2.84 mm (SD: 0.6 mm), with a mean of 1.28 mm. Average angle deviation was 3.42 degrees (range 0.38-7.82 degrees; SD: 1.52 degrees). The global apical deviation ranged between 0.36 and 3.85 mm (SD: 0.71 mm), with a mean of 1.65 mm. Despite the inaccuracy registered, this guided-welded approach allowed successful achievement of a passive fit of the full-arch prosthesis on the inserted implants the same day of the surgery and provided a high implant and prosthetic survival rate at the 1-year follow-up.

The purpose of this case series is to describe a restorative and surgical approach to treat the combined defect (CD)-gingival recession associated with noncarious cervical lesions (NCCL)-through connective tissue graft in combination with partial resin composite filling, restoring the crown zone plus 1 mm of the NCCL. A total of 10 patients were included. Bleeding on probing, probing depth, relative gingival recession, clinical attachment level, CD height, and dentin hypersensitivity were measured. The treatment provided statistically significant gain in clinical attachment level and shallow probing depths. The percentage of the combined defect coverage was 70% ± 20.2%. It can be concluded that this treatment protocol, in the presence of a partial resin composite restoration, can be used successfully to treat CD.

The purpose of this study was to investigate the effect of radiant heat, ultrasonic treatment, and 42.7 wt% CaCl2 solution on fluoride release and surface hardness in three conventional glass-ionomer cements (GICs). The fluoride release patterns of each GIC were evaluated during a 28-day period using a fluoride ion-selective electrode. The surface hardness of the tested GICs was evaluated 24 hours after preparation of the specimens using Vickers hardness test. Statistical analysis of the data was made using analysis of variance and Bonferroni post hoc test (α = .05). Radiant heat, ultrasonic, and CaCl2 solution treatments reduced fluoride release and increased the surface hardness of the tested GICs (P .05). Among the tested GICs, differences in fluoride release and surface hardness were observed (P .05). The clinical treatments investigated may be effective methods for improving the setting reaction of GICs and may achieve sufficient initial mechanical properties earlier. Although a reduction in fluoride release occurs after the treatments, anticariogenic properties of the GICs may not be significantly affected.

This study evaluated the microhardness of two resin cements and a low-viscosity resin composite when light-cured under different ceramic thicknesses. A total of 20 samples (10.0 × 1.0 mm) of each material were polymerized by means of a LED light source with an intensity of 1,100 mW/cm2 for 20 seconds. For each experimental group, different ceramic thicknesses (0.5 mm, 1.0 mm, and 1.5 mm) were applied to each sample. For the control group, the samples were polymerized without the presence of ceramics. Each material was then stored in dry vials that inhibited the passage of light for a period of 24 hours. After that time, each sample underwent Vickers hardness test (HMV, Shimadzu: 25 g/10 seconds). The data were collected and analyzed using analysis of variance and Tukey test (P .05). For the control group, RelyX Veneer (3m ESPE), Filtek Flow Z350XT (3M ESPE), and Allcem Veneer (FGM) showed mean microhardness values and standard deviations of 44.42 ± 4.9, 44.25 ± 2.4, and 31.71 ± 2.4, respectively. The lowest microhardness value (24.13) was found when the greatest ceramic thickness (1.5 mm) was used on the Allcem Veneer cement (P .01). The microhardness of resin-based materials was affected when the 1.5-mm-thick ceramic material was interposed during photoactivation.

This article reports on a case of a glandular odontogenic cyst (GOC) in the posterior mandible of a 25-year-old male treated with peripheral ostectomy, bone allograft, and an implant-supported fixed dental prosthesis. During a routine 3-month postoperative visit, a radiograph suggested vertical bone loss on the implant in the location of the mandibular right first molar. The three-walled defect was surgically treated with debridement, bone allograft, and a membrane. Healing of this site has been uneventful. This case report demonstrates that implants can be successfully placed and restored in previously affected GOC sites.

This retrospective study aimed to compare the effectiveness of an equine collagen matrix (ECM) with that of a subepithelial connective tissue graft (CTG) in patients affected by Class I and II gingival recessions treated with a coronally advanced flap (CAF) technique. Records of 50 consecutive patients were analyzed. Recession depth, probing depth, keratinized tissue width, and percentage of root coverage had been recorded at baseline and at the 1-year follow-up. The number of patients that achieved complete root coverage was also assessed. According to the investigated parameters, ECM and CTG provide similar results when used in association with a CAF technique.

This meta-analysis aims to compare the effect of the application of enamel matrix derivative (EMD) used alone with that of its use in combination with alloplastic materials in the treatment of periodontal intrabony defects. Relevant studies were retrieved from PubMed, the Cochrane Library, and Embase through November 2015. The main clinical outcomes were pocket probing depth (PPD) reduction, clinical attachment level (CAL) gain, gingival recession (REC) increase, and defect fill gain. Two separate meta-analyses were performed according to the length of follow-up. Nine articles were included. The results demonstrated that in the short-term follow-up group (≤ 1 year), in terms of PPD reduction (P .05) and REC increase (P .05), the application of an EMD combined with alloplastic materials provided advantages compared to EMD used alone. For CAL gain (P = .17) and gain of defect fill (P = .07), no significant differences were observed. In the long-term follow-up group (> 1 year), no significant differences in terms of REC increase (P = .05) were found between the groups, but combined therapy exhibited an advantage in terms of PPD reduction (P .05), CAL gain (P .05), and gain in defect fill (P .05). Within its limitations, this meta-analysis indicated that the additional benefit of combined therapy in the treatment of periodontal intrabony defects compared with EMD used alone cannot be proven.

A preclinical trial was conducted to treat 54 mandibular critical-sized alveolar ridge defects in 27 canines. Each hemimandible was randomized to be treated with two different anorganic bovine bone grafts (group A = InterOss [SigmaGraft]; group B = Bio-Oss [Geistlich]) or negative control (group C = empty defect) followed by a 4-, 8-, or 12-week observation period. Microcomputed tomography, histology, histopathology, and histomorphometric analyses were performed to evaluate the safety and efficacy of these treatments. By all the parameters assessed in this study, the biocompatibility and healing of group A treated defects were indistinguishable from those in group B. Radiographic comparison of graft resorption and bony integration demonstrated similar mean scores for both treatment groups. Likewise, no statistical differences were observed between the two groups with respect to percent mineralized volume and density. When compared to the critical-sized empty controls, both treatment groups showed statistically greater amounts of bone present in the defect sites and appeared to help preserve the mesial and distal alveolar walls of the defect. Histomorphometry also supported the similarity in performance of both tested groups as no statistically significant differences were observed with regard to percent bone, percent residual implant, and percent bone marrow values. While not statistically different, on average group A had more than twice the mean amount of bone present at 8 and 12 weeks compared to group B. Overall, group A had a good biocompatibility response, similar to group B. Clinical studies are recommended to confirm these findings.