International Journal of Periodontics & Restorative Dentistry, 01/1998

This study investigated the effect on vertical bone regeneration of the addition of demineralized freeze-dried bone allograft or autogenous bone chips to a membrane technique. Twenty partially edentulous patients with vertical jawbone deficiencies were selected for this study. The patients were divided into two groups of 10 individuals. The 10 patients of Group A received 26 Branemark implants in 10 surgical sites. The 10 patients of Group B received 32 implants in 12 surgical sites. Fifty-two out of 58 implants (22 in Group A and 30 in Group B) extended 1.5 to 7.5 mm superior to the bone crest. Titanium-reinforced expanded polytetrafluoroethylene membranes were used to cover the implants and, before complete membrane fixation, demineralized freeze-dried bone allograft particles were condensed under the membrane in Group A, and autogenous bone chips were used in Group B. At the reentry after 7 to 11 months the membranes were removed and a small biopsy was co llected from 11 sites comprehending the miniscrews. The clinical measurments from Group A demonstrated a mean vertical bone gain of 3.1 mm (SD = 0.9 mm, range 1 to 5 mm) with a mean percentage of bone gain of 124% (SD = 46.6%). The measurements from Group B showed a mean vertical bone gain of 5.02 mm (SD = 2.3 mm, range 1 to 8.5 mm) with a mean percentage of bone gain of 95% (SD = 26.8%). Histomorphometric analysis of the rpesent study clearly demonstrated a direct correlation between the density of the pre-existing bone and the density of the regenerated bone. The mean percentage of new bone-titanium contact was from 39.1% to 63.2%, depending on the quality of the pre-existing bone. Both the clinical and histologic res ults indicate a beneficial effect of the addition of demineralized freeze-dried bone allograft or autogenous bone particles to vertical ridge augmentation procedures in humans.

This case report clinically and histologically evaluated the regeneration of gingival tissues with the use of resorbable membranes. The study was performed on a premolar for which extraction was planned. The exposed root surface was thoroughly cleaned and planed with curettes and rotary instruments, and two notches were created on the facial aspect of the exposed root surface. A resorbable Resolute membrane (WL Gore) was applid above the defect to allow for gingival regeneration. After a 6-month healing period, a block section containing the root and the regenerated tissues was removed. The biopsy specimen was processed to obtain thin ground sections. The histologic analysis demonstrated the formation of a newly generated periodontal tissue from the deepest notch toward the coronal gingiva. The newly formed tissue was composed of a coronal area of connective tissue attachment and an apical area of bone fibers and cementum. The rpesent report histologically demonstrates the ability of a resorbable membrane to allow complete regeneration of the periodontal ligament in the coverage of gingival recessions.

This retrospective multicenter study analyzed 526 implants placed and loaded in regenerated bone. Both autogenous and all ogeneic bone grafts were used in combination with a barrier membrane to reconstruct bone using either a simultaneous or staged approach. Implants were followed from 6 to more than 74 months postloading. Eight of the implants were lost, for a success rate of 97.5%. The type of graft material did not affect the clinical success of the implants, nor did the use of submerged versus nonsubmerged implants or a staged versus a simultaneous approa ch. In conclusion, regenerated bone reacted to implant placement in a manner that was clinically similar to native bone.

Dental literature supports the concept that vertical dimension of occlusion is normally not lost in severely worn d entition, and the bite should generally not be opened to facilitate dental reconstruction. However, restoration of a periodontally sound but severely worn dentition, at existing vertical dimension, frequently presents unique challenges in patient management, diagnosis, treatment planning, and restorative methodology. This report reviews and demonstrates an integrated and planned approach to this complex treatment situation that can lead to a favorable and predictable prognosis. The approach also allows a practitioner free use of various techniques if certain goals of occlusion are followed.

In Part I, a computer imaging technique was used to measure the volumetric fill that occurred in surgically created grade II molar furcation defects after they had been treated using the principles of guided tissue regeneration. In Part II, the volumetric fill for each of the specific tissues comprising the defect fill (epithelium, connective tissue, bone, and cementum) was compared. The histologic material consisted of defects treated using one of three types of surgical treatment as well as untreated control sites. All volumetric measurements were expressed as a percentage of the original surgcially created defect size, with 100% indicating complete healing of the defect. The results indicate that none of the defects achieved complete healing. Teeth receiving flap debridement had the most overall defect fill (79.50% comprised of 17.13% bone, 35.81% connective tissue, 37.35% epithelium, and 9.71% cementu m). Teeth that received a biodegradable barrier showed a mean overall defect fill of 74.98% (7.41% bone, 47.13% connective tissue, 36.20% epithelium, and 9.26% cementum). Sites treated with an exclusion barrier showed 70.75% overall fill (9.63% bone, 40.89% connective tissue, 39.00% epithelium, and 10.48% cementum). The untreated control teeth showed a mean overall fill of 78.70% (5.56% bone, 59.11% connective tissue, 31.06% epithelium, and 4.27% cementum). No significant differences were found among teeth within the same animal and between treatment and controls. The following conclusions were drawn: (1) connective tissue comprised nearly one half of the total fill of the surgically created defects; (2) the percentage of new bone growth was significantly lower than anticipated; and (3) no significant differences were found amo ng the treatment modalities and the untreated control sites for each of the specific tissue types.

The restorative dentist treates patients with needs taht often transcend dental disciplines. This dentist will be responsible for long-term dental maintenance and should logically oversee interdisciplinary reconstruction. This case report demonstrates an integrated treatment approach and 5-year retrospective study involving a patient with maxillary anterior excess, pronounced overjet, and advanced periodontitis. Extraction and radical alveolectomy with removable prosthesis is often considered in such cases; however, results are often less than optimum function, esthetics, and general oral health. In this case, a previously undescribed anterior maxillary rotating segmental ostectomy was integrated with restorative, periodontal, and removable full and partial denture procedures.

The clinical and histologic responses to periodontal treatment of gingival enlargements, induced when cyclosporine and nifedipine were administered singly or in combination, were evaluated. A significant corerlation was noted between plaque, gingivitis, and gingival overgrowth. Severity of enlargement appeared to be greater in patients on combined therapy. All treatment appraoches such as scaling, root planing, gingivectomy, and periodontal flaps, and a combination of therapies, wre effective in the management of gingival overgrowth up to 1 year after completion of treatment. Adjunctive use of chlorhexidine was found to be beneficial.

This study evaluated the histologic responses of two different adhesive systems on the teeth of seven healthy adult monkeys. Class V cavities in 128 teeth were observed at 7, 21 to 27, and 90 to 97 days. Statistical data showed no significant differences in pulp inflammation between the Optibond (Kerr), XR-Bond (Kerr), and IRM (Caulk) groups in pulps at the three time intervals. Some odon toblastic disruption and inflammation was seen in pulps restored with XR-Primer at the three time intervals. Pulp healing was similar in teeth treated with both direct-capped Optimbond and calcium hydroxide, and there was no significant increase in pulpal inflammation with time. No abscesses or necrotic pulps were seen in any teeth. Optibond and XR-Bond adhesive systems are biologically acceptable in nonhuman primate pulp tissue.