International Journal of Periodontics & Restorative Dentistry, 06/1997

This report demonstrates the use of regenerative therapy in the treatment of maxillary molar Class II furcations. The predominant therapy provided was open debridement in combination with DFDBA, e-PTFE membranes, and citric acid root conditioning. Case reports of consecutively treated patients that include radiographs and reentry photographs demonstrate that maxillary molar furcations can be successfully treated with predictability.

This report concerns long-term (4 to 5 years) clinical evaluation of 22 resolved (complete bone closure) mandibular Class 2 furcation defects following coronally advanced flap procedures and citric acid root treatment with or without adjunctive implantation of freeze-dried, demineralized allogeneic bone. Sixteen buccal furcation sites in 12 patients were available for the follow-up evaluation. The furcation involvement was independently evaluated by a panel of three examiners, each using three furcation index systems. Oral hygiene standards, gingival health, pobing depth, clinical attachment level, gingival recession, tooth vitality, and detectable caries or root resorption were also recorded. Mean attachment level at the furcation sites was 5.8 ± 2.9 mm, compared to 4.5 ± 2.2 mm and 3.5 ± 1.3 mm over the prominence of the mesial and distal roots, respectively. The clinical examination further revealed that 12 out of 16 sites exhibited recurrent Class 2 furcation involvement. Of the 16 teeth examined, one had received endodontic treatment, while the rem aining 15 responded within the normal range to pulp testing. One tooth had developed caries in the furcation region. No teeth demonstrated periradicular pathology. The results of this study question the long-term stability of furcation bone regeneration following coronally advanced flap procedures.

Indirect restorative procedures usually require temporary restorations for protection of the pulp and for restoring the patients esthetic and functional needs. The use of temporary cements, either with or without eugenol, however, considerably decreases the adhesion of the bond on dentin if - according to the conventional technique - such dentin bonding systems are applied once at the moment of final cementation. With a dual application of the dentin bonding agents a considerable increase in bond strength values was discovered. This article presents a modified luting procedure called the dual bonding technique.

A patient with a localized gingival recession suffering from e sthetic and hypersensitivity problems was selected for treatment with the guided tissue regeneration procedure. The use of a bioresorbable membrane (Guidor) made reentry surgery for membrane removal unnecessary. A complete root coverage was obtained, and 6 mm of clinical attachment gain was recorded after 6 months. The guided tissue regeneration procedure may reporesent an effective alternative to traditional mucogingival therapy for the treatment of recessions and permit the management of severe bone destruction with minimal soft tissue retraction. Furthermore, the guided tissue regeneration technique is likely to result in a greater amount of new connective attachment formation, although clinical relevance m ust still be confirmed by long-term trials.

This study assessed the relationship between the surfaces of a hollow cylindrical titanium implant and the consequent bone organization around it. A human bone maxillary specimen was taken that enclosed an implant which had lasted 28 months under prosthetic loading. The implant was removed because of fracture that prevented the implant from being used as a supporting element for new prosthetic aims. The bone block-section was fixed and embedded, several sections were obtained, and each section was analyzed using three different histologic analyses: optical microscopy under ordinary light and polarized light, and microradiography. Comparative analyses were required on every single section to provide a complete morphostructural analysis of the peri-implant bone. Data retried by this research showed the presence of woven bone in the bone layer facing the external implant surface several months after its surgical fitting and functionalization. This finding demonstrates the importance of woven bone, first as holding sheath in the immediate postsurgical stage, and second as a mold for the subsequent centripetal accrementition of secondary lamellar bone.

This study clinically evaluated a bioabsorbable barrier membrane designed for periodontal regeneration. Ten Class II furcations and 12 interproximal infrabony defects were treated by flap debridement and placement of a bioabsorbable barrier membrane using the principles of guided tissue regeneration. Treatment was evaluated in terms of changes in vertical probing depth, horizontal attachment level, clinical attachment level, and recession. Baseline data were collected on the day of surgery, and outcome measurements were performed at the 1-year appointment. The mean initial probing depth for the Class II furcations was 6.5 mm. At 1 year, the mean probing depth was reduced to 2.9 mm, a 3.6 mm change. These differences were clinically and statistically significant (P 0.01). There was a mean gain of 2.4 mm in clinical attachment level (P 0.01) and a mean 3.4-mm change in horizontal attachment level (P 0.01). Recession increased 1.2 mm. For interproximal infrabony defects, there was a mean probing depth reduction of 5.0 mm (P 0.01), a mean gain of clinical attachment level of 3.8 mm (P 0.01), and a mean increase of 1.2 mm in recession (P .04). The results indicate that significant improvements occurred after treatment of Class II furcations and interproximal infrabony defects with the use of a bioabsorbable barrier membrane and guided tissue regeneration.

This article presents the components and treatment protocol for the Astra Tech Single-Tooth Implant System, whose concept and designs has been tailored to the specific needs of single-tooth replacement. Since July 1991 the author has consecutively placed 39 single-tooth implants, of which 27 are restored and in function. To date there have been no recorded fixture failures, and the bone loss seen around fixtures in the first and subsequent years is insignificant. Two crowns have had to be replaced, and three were recemented over the follow-up period. All patients have expressed considerable satisfaction with their restorations from an esthetic perspect ive, and the system has been shown to avoid undesirable complications when employed in patients with normal masticatory function.

It is well known that guided soft tissue healing with a provisional restoration is essential to obtain optimal anterior esthetics in the implant prosthesis. What is not well known is how to transfer a record of beautiful anatomical ly healed tissue to the laboratory. With the advent of emergence profile healing abutments and corresponding impression copings, there has been a dramatic improvement over the original 4.0-mm diameter design. This is a great improvement, however, it still does not accurately transfer a record of anatomically healed tissue, which is often triangularly shaped, to the laboratory, because the impression coping is a round cylinder. This article explains how to fabricate a custom impression coping that is an exact record of anatomically healed tissue for accurate duplication. This technique is sign ificant because it allows an even closer replication of the natural dentition.

Rotating instruments are becoming increasingly significant in the scaling and planing of the root surface. The objective of this in vitro study was to test various root-planing instruments on extracted teeth and then to compare the treated surfaces using scanning electron microscopy. Two manual instruments (scaler and curette) and five mechanically rotating instruments (Desmo-Clean; Perio-Set; Viking-Set; and 40-um and 15-um diamond finishers) were investigated. From a total of 42 teeth, six ro ot surfaces were treated with each instrument. The results confirm the clear superiority of the manual instruments (especially the curette). The manual instruments permit good root planing with minimum ablation from the root surface and only a thin smear layer (a compound of grindign dust, dentinal fluid, and water). The best planing results by rotating instruments were achieved with the Desmo-Clean and the 15-um diamond finisher, whose performance was almost equal to that of the manual instruments. The rotating instruments, however, were associated with higher ablation and a marked smear layer. Manual instruments remain the media of choice on easily accessible root surfaces; however, rotating instruments are of advantage in inaccessible areas (eg, furactions) because of their handling properties.