International Journal of Periodontics & Restorative Dentistry, 05/1996

Single-tooth implants were inserted in the maxillary anterior segments of three young patients aged 11.5 to 13 years. The patients were monitored for a period of 2.5 to 4.5 years. All implant-supported corwns ended up in an infraocclusion position relative to the adjacent teeth because of the continued vertical growth of the maxillary alveolar process. Between baseline examination and the date of recall, the distance from a fixed reference point located on the fixture to the crestal bone on the proximal surfaces of teeth adjacenet to the implant sites increased up to 3 mm. Transverse growth changes were also observed. Although the prostheses could be removed and modified to compensate for the resulting soft and hard tissue changes, complications may occur, altering the health of the mucogingival unit and the estehtic appearance of implant-supported restorations, and requiring further soft tissue correction procedures.

Six patients with buccal gingival recession (4 to 6 mm) were treated by means of the guided tissue regeneration technique utilizing a polyglycolactic membrane (Vicryl). Three months following the first surgical procedure, all sites were reentered to evaluate newly formed tissue above the exposed root. Complete root coverage was obtained in four out of six patients; 0.5 and 1.5 mm of recession were sti ll present in the remaining two.

This study evaluated the use of a bioresorbable membrane (Guidor USA) for treatment of periodontal angular bone defects in eight periodontitis patients. Presurgical measurements consisted of probing depth, clinical attachment levels, and digital radiographic imaging evaluation. Full-thickness buccal and lingual flaps were elevated allowing for soft tissue debridement, scaling, and root planing. Bioresorbable membranes were placed in at least one of the periodontal defects, and controls were left without barrier placement. Clinical and radiographic results 6 months after the surgical procedure showed clinical and radiographic improvement for control and test lesions. However, sites treated with bioresorbably membranes presented a significant gain in clinical attachment and bone mass when compared to sites that had received flap surgery alone.

Occasionally in clinical periodontics we are confronted with exceptional examples of the potential for healing. This is the report of one such instance in a young patient with a history of juvenile periodontitis and significant localized bone loss. Following relatively simple treatment, marked bone fill of a periodontal defect was observed over the course of 1 year. The factors which contributed to the remarkable healing response are considered, and the techniques used during therapy are presented.

Guided tissue regneration procedures often result in the loss of gingival tissue. This postoperative problem is associated with the treatment of interproximal periodontal defects. A surgical technique is presented which preserves the interproximal tissue, facilitating primary and sustained coverage of the guided tissue regeneration barrier. Twelve interproximal defects were treated with this technique using Gore-Tex Periodontal Material. The Gore-Tex Periodontal Material remained in place for 4 months. The sites were reentered at 1 year and clinical parameters were recorded. At 4 months, 11 of 12 sites demonstrated no exposure of the Gore-Tex Periodontal Material. Mean gain in bone fill was 95%, and three sites demonstrated supracrestal bone deposition. Only 0.58 mm of gingival recession occurred. This study suggests that with ideal gingival flap management, enhanced regenerative and esthetic results can be achieved.

The purpose of tis study was to histologically compare the healing of porcine skin incisions made by CO2 laser, electrosurgery, and conventional scalpel. Incisions were made on the dorsal thorax of two microswine at staggered time intervals allowing the harvest of specimens at 0, 4, 7, 14, and 21 days postsurgery at the time of sacrifice. Each of the following histologic zones were identified and measured for both laser and electrosurgery incisions: (1) zone of tissue ablation, (2) zone of thermal necrosis, and (3) width of surface damage. The depth of cut and width of surface opening was meausred for the scalpel incision. Furthermore, for each specimen, the presence and character of inflammatory cell infiltrate was noted, as well as the relative times at which bridging of the incision by connective tissue and coverage of the wound by an intact epithelial layer had occurred. Results showed that in this wound-healing model, the scalpel incisions produced more defined borders, healed more rapidly, and resulted in less collateral tissue damage than those produced by CO2 laser or electrosurgery. It was also noted that to create a wound 1. 29 mm in depth required at least five passes of the laser beam within the same line of incision using 206.4 J/cm2 (6 W. continuous mode).

Aging and medically compromised patients are retaining their teeth longer. With the prolonged use of medications that produce xerostomia, these patients become more caries sus ceptible. Root surface caries, which undermines abutment crowns, results in loss of abutments because it is difficult to detect incipient lesions and make appropriate repairs before a significant amount of coronal dentin is lost. With the absence of a significant amount of coronal dentin, routine preparation and impression techniques can result in failure and frustration. For many such patients crown lengthening is the treatment of choice. It provides the restorative dentist convenient access and visibility. However, surgery may be contraindicated because of unfavorable anatomy. It may also be refused by the patient, often upon the advice of a physician. This article provides predictable alternatives for routine preparation and impression techniques. Documentation substantiates the long-term efficacy of these alterantives.