International Journal of Periodontics & Restorative Dentistry, 04/1994

A number of controversies have arisen concerning the use of guided tissue regeneration in conjunction with implant fixtures. Three of these are the effect on the regenerative result of material exposure, the type of grafting material used, and whether the fixture is placed in an extraction socket or edentulous ridge. This study examines these issues in 237 consecutive sites treated with guided tissue regeneration.

Results using the supraperiosteal envelope in soft tissue grafting for root coverage are reported, along with three illustrative case reports. Treatment of 23 sites in 12 patients resulted in average root coverage of 84%. Total coverage was achieved in 61% of sites treated. The percentage of root coverage tended to decrease with increasing depth and width of recession. The supraperiosteal envelope reduces surgical trauma to the recipient site, maintains intact papillae, and produces consistent color blending of involved tissues in single and multiple adjacent areas of recession.

Successful prosthodontic treatment begins with an accurate diagnosis and thorough and comprehensive treatment planning. Osseointegration is an integral part of prosthodontic treatment planning. When use of the single tooth implant is anticipated, there are several procedure objectives that should be considered: elimination of pathosis; attainment of ideal fixture alignment and stability; protection of teh adjacent teeth; preservation or augmentation of the alveolar ridge; attainment of primary closure; and avoidance of mucosal pressure. Esthetic and biologic complications are discussed.

This study evaluated wound healing and osseointegration of dental implants placed in immediate postextraction sockets in humans. Ten healthy adults had one or more teeth extracted and replaced with ITI dental implants, which were centered in the residual socket and covered with a polytetrafluoroethylene membrane and a flap to attain primary closure. Measurements were made to document the relationship of bone to implant at the time of implant placement and at the 6-month reentry. All implants were clinically osseointegrated at the 6-month reentry procedure; narrow bony defects showed complete bone fill, while wide defects showed partial bone fill. There was less bone regeneration in areas of thin cortical bone or preexisting dehiscences and in implant sites with early membrane exposure. Implants placed in immediate postextraction sockets demonstrated successful osseointegration with irregular bone-healing patterns, which were related to variations in existing bony anatomy and socket location.

The case report of a woman with severe osteoporosis who was treated with dental implants is presented. Polyarthritis was diagnosed in 1955, and a corticosteroid medication treatment was started in 1960. During the years, the patient has undergone multiple joint surgeries. Dental implants were inserted in the maxilla in 1987 and in the mandible in 1988. Due to a compression of the spine, the patient lost 12 cm in body height between 1991 and 1993; a spontaneous femur fracture was diagnosed in December 1992. However, the arch bone has been stable; the 6- and 5-year follow-up results of the maxillary and mandibular implants, respectively, are presented.

The ultimate goal of periodontal therapy should not be limited to the establishment and maintenance of periodontal health. The potential regeneration of the hard and soft periodontal tissues lost to disease also should be considered. Two case reports are presented to demonstrate the potential of guided tissue regeneration for this purpose.

This study analyzed the difference in effectiveness of a well-known manual toothbrush and a counterrotational electric toothbrush over medium- and long-term periods. Six dental students and six patients with moderate periodontitis participated in a split-mouth, single-blind experiment with repeated recordings of pocket depths and plaque and gingivitis indices. During the experiment, the use of interdental aids or mouth rinses was forbidden. At all intervals up to week 34, manual brushing resulted in significantly less plaque removal, especially at approximal sites. Use of the counterrotational electric toothbrush resulted in a significantly greater reduction in gingival inflammation and significantly increased pocket reduction, especially in the periodontitis group. A crossover experiment confirmed the inferiority of the manual cleaning. The long-term observations showed a slight decrease in efficiency of both brushes, thereby justifying the need for regular motivation reinforcement. The results of the current study demonstrate the long-term superiority of a counterrotational electric toothbrush over the manual toothbrush.