International Journal of Periodontics & Restorative Dentistry, 06/2018

Root resection and hemisection is a well-documented treatment option for extending the life span of furcated molars. The aim of the present study was to retrospectively evaluate the long-term results of root resection and hemisection of 195 patients with up to 40 years of follow-up. Records of 195 patients who had undergone root resection or hemisection were reviewed. A minimum follow-up of 5 years was needed. A molar was recorded as a survival if it was still present and functional without any signs of discomfort, pain, or pathology from restorative, endodontic, and periodontal points of view. Ninety-eight patients were excluded for not accomplishing the minimum 5-year observation period. Of the 97 remaining patients, 5 teeth were lost during the first 5 years of treatment and 92 teeth survived the follow-up period, ranging from 5 to 40 years. The overall survival rate was 94.8%. When up to 40 years of follow-up data were analyzed, it was found that high survival rates can be obtained with root resection and hemisection. The results are satisfying when a proper case selection, endodontic treatment, restorative design, and good maintenance program are given. This treatment option should always be considered before every extraction and implant placement.

Inadequate restorative space can result in mechanical, biologic, and esthetic complications with full-arch fixed implant-supported prosthetics. As such, clinicians often reduce bone to create clearance. The aim of this paper was to present a protocol using stacking computer-aided design/computerassisted manufacturing (CAD/CAM) guides to minimize and accurately obtain the desired bone reduction, immediately place prosthetically guided implants, and load a provisional that replicates predetermined tissue contour. This protocol can help clinicians minimize bone reduction and place the implants in an ideal position that allows them to emerge from the soft tissue interface with a natural, pink-free zirconia fixed dental prostheses.

The aim of this study was to investigate the long-term clinical conditions of periodontally compromised teeth treated by means of orthodontics after periodontal regeneration (GTR). Forty-eight patients affected by severe periodontitis who presented at least one nonmolar, malpositioned tooth with a pocket depth (PD) ≥ 7 mm, were consecutively enrolled in a private specialist practice. The treatment consisted of the following steps: infection control, provisional splinting, GTR, orthodontic treatment, final splinting, and supportive periodontal therapy (SPT). Thirty-six patients completed the 10-year study, as 12 were lost to follow-up. The total number of sites with PD ≥ 7 mm decreased from 25.4 ± 16.7 to 1.8 ± 2.1. PD of the teeth involved in the orthoperio treatment significantly decreased from 6.3 ± 1.5 mm to 3.1 ± 0.6 mm. One test tooth had to be extracted before the final examination due to root fracture, while two teeth lost vitality and received a root canal treatment. Eight episodes of recurrence, which required additional treatment, occurred during the 10 years of follow-up. The results of this study suggest that if a periodontal infection is under control, the orthodontic treatment does not reduce the long-term benefits of periodontal regeneration, even where the disease has caused massive tissue destruction.

Vertical ridge augmentation (VRA) using titanium-reinforced dense polytetrafluorethylene (d-PTFE) membranes has been associated with promising clinical outcomes. This retrospective multicenter case series was prepared for the purpose of identifying the elements that contribute to the predictability of this surgical technique. VRA procedures were carried out in 35 patients (13 male and 22 female) with an age range of 43 to 76 years. The average bone gain was 5.44 mm. In the Kaplan-Meier estimates of cumulative survival calculated at 15 months, membrane exposure (P = .045) was a predictor for VRA.

Gingival recession can cause an esthetic impairment or dentin hypersensitivity due to root surface exposure to the oral cavity. These conditions may require specific surgical interventions to achieve root coverage. This controlled clinical trial on 20 subjects compared coronally advanced flap (CAF) technique and CAF plus subepithelial connective tissue graft (CTG) for the treatment of single maxillary gingival recession. Recession height (REC) and complete root coverage (CRC) were considered as primary outcomes. The residual REC was 2.90 ± 0.99 mm at baseline, 1.10 ± 0.99 mm after 1 year, and 1.15 ± 1.06 mm after 5 years in the CAF group and 2.70 ± 0.48 mm at baseline, 0.55 ± 0.69 mm after 1 year, and 0.44 ± 0.62 mm after 5 years in the CAF + CTG group. The differences between groups at 5 years of follow-up was statistically significant. CRC was obtained in 60% of teeth in the CAF group and in 70% of teeth in the CAF + CTG group at the 5-year followup. The results showed a significant difference between CAF and CAF + CTG techniques for the treatment of single recession with regard to REC; no significant difference was found in the percentage of teeth presenting CRC after 5 years.

Osseointegrated dental implants have become an integral factor in the replacement of missing teeth. These implants have demonstrated long-term success for periodontally compromised patients, who require a high level of success to maintain a sense of optimism. This case report offers 32-year results of implant treatment in the maxilla and 25-year results in the mandible. Some maxillary implants suffered a few threads of bone loss, but all seven mandibular implants met Albrektsson's definition of success after 25 years. The purpose of this case report is to provide evidence that further supports the findings of osseointegrated implant treatment's longevity and success, as reported in other studies.

Interdental papilla reconstruction is one of the most challenging clinical procedures in periodontal plastic surgery. Several surgical approaches have been proposed but have varying degrees of success. It has long been acknowledged that the narrowness of the interdental papilla and the limited blood supply are major impediments to achieving predictable outcomes. Advances in microsurgery could offer an opportunity to overcome these anatomic and biologic barriers. The authors propose an original microsurgical technique based on interproximal tunneling combined with utilization of a customized tissue graft for interdental papilla reconstruction.

Prosthetic rehabilitation of malpositioned anterior dental implants can be challenging. Interdisciplinary treatment planning and precise execution of biologically acceptable prosthetic and surgical protocols are essential to achieve optimal esthetic results and while avoiding and managing esthetic complications. This case study focuses on the restorative aspect. Two sets of custom gold abutments were used prior to and following surgical correction of a pre-existing soft and hard tissue ridge defect surrounding maxillary central incisor implant restorations. A stable and esthetically pleasing result was documented 7 years following delivery of definitive esthetic central incisor implant restorations.

Since periodontal plastic surgery's recent emergence and continuous, extensive development, various treatment modalities and materials have been developed alongside it to help clinicians pursue optimal esthetics and long-term stability around natural teeth and dental implants. To achieve satisfying and predictable long-term outcomes, promote more predictable results, and reduce complications following periodontal plastic surgery procedures, the authors reviewed articles published in peer-reviewed journals to better understand the biologic principles and potential of the soft tissue grafting materials and techniques being applied. That information was used to support a new classification system. This system aims to give clinicians guidance when selecting the most appropriate grafting materials and techniques for periodontal plastic surgery, using the graft materials' two most important features to guide the consideration/decision process: the source of blood supply and whether the grafts contain vital cells.

The purpose of this in vitro study was to measure the marginal and internal fit of single-unit all-ceramic zirconia copings (ZCs) fabricated through three different computer-aided design/computer-assisted manufacture (CAD/CAM) systems using microcomputed tomography (microCT). A total of 10 ZCs were produced for each experimental group. Scanning of the stainless steel (SS) model with its respective copings was conducted with a SkyScan machine. DataViewer software was used to acquire cross-sectional images. Locations of cross-sections for all specimens were standardized to reduce errors. Seven different cross-section locations were selected: four transverse and three sagittal. Adobe Photoshop CS3 was used for the measurements. One-way analysis of variance and Tukey post hoc test were used for the statistical analysis for each group. In addition, t test (α = .05) was used to compare values at each measurement location for the different groups. The results of this study show significant differences in the precision of fit of the experimental groups at the axio-occlusal transition (AOT) location, with a significant gap present in the DeguDent CAD/CAM System compared to the other two systems. Tukey test results indicate a significant difference in the marginal gap between the DeguDent CAD/CAM System and KaVo Everest Dental CAD/CAM System (P = .004). In addition, there is a significant difference in gap size values in the sagittal sections distal to the midline between the DeguDent CAD/CAM System and the Lava Ultimate CAD/CAM System (P = .002). The different CAD/CAM systems showed a clinically acceptable internal fit and marginal adaptation. Different levels of fit were found between the experimental groups. Marginal adaptation was the best in all experimental groups. The gap at the AOT area varied among the three groups, with the DeguDent CAD/CAM System showing the greatest value.

The aim of this study was to assess the powdering technique and its effects on the flexural strength of bilayered zirconia. Bars made of zirconia partially stabilized by yttrium (Y-TZP) received porcelain by the following techniques (n = 10 per group): (1) L: VM9 application; (2) P: powdering technique + VM9 application; (3) C: Y-TZP coloring before sintering + Y-TZP sintering + VM9 application; or (4) CP: Y-TZP coloring before sintering + Y-TZP sintering + powdering technique + VM9 application. The powdering technique consisted of the application of VM9 margin powder followed by sintering. The samples were subjected to a 4-point flexural strength test and contact angle. Data were analyzed by one-way ANOVA and Tukey test (α = 5%). Surface treatments did not affect the flexural strength of bilayered specimens (P = .1264), but contact angle was affected by surface treatments (P < .0001), wherein the association of coloring and powdering (CP) reached higher values of wettability. Powdering did not affect the flexural strength of bilayered specimens, but did increase the Y-TZP wettability.

The aim of this case-control study was to evaluate the influence of soft tissue thickness at implant placement (thin [< 3 mm] vs thick [≥ 3 mm]) and bone volume (abundant vs limited) on initial crestal bone remodeling of immediate postextraction and delayed (healed site) implants in immediate loading situations. A total of 67 patients with 133 implants could be evaluated, of which 77 were placed immediately after extraction and 56 in healed ridges. If sufficient bone volume is present and primary stability is achieved, immediate loading of the implant yields good clinical and radiographic outcomes, yet implants placed in healed ridges with thin soft tissues are more prone to initial crestal bone loss.

Porous tantalum trabecular-structured metal (PTTM) has been applied to titanium orthopedic and dental implants. This study evaluated the healing pattern of bone growth into experimental PTTM cylinders (N = 24; 3.0 × 5.0 mm) implanted in the partially edentulous jaws of 23 healthy volunteers divided into four groups. Six PTTM cylinders per group were explanted, prepared, and analyzed histologically/metrically after 2, 3, 6, and 12 weeks of submerged healing. PTTM implant osseoincorporation resulted from the formation of an osteogenic tissue network that over the course of 12 weeks resulted in vascular bone volume levels in PTTM that are comparable to clinically observed mean trabecular volumes in edentulous posterior jaws.

This case series describes a treatment method in which the natural tooth was used as the temporary and permanent reconstruction after immediate implantation in the esthetic zone of periodontally compromised patients. Five patients with a hopeless tooth in the esthetic zone due to periodontal causes were included. The tooth was extracted, and immediate implantation protocol was followed. The extracted tooth was adapted over a temporary abutment during the osseointegration period, and the same tooth served as the final prosthetic reconstruction with a customized zirconia abutment. Esthetic outcome was satisfactory to the patients, and no biologic or prosthetic complications were observed up to 3 years. The technique could be recommended, especially in the esthetic area of periodontally compromised patients who have intact clinical crowns.

This study investigated the effect of different cavity lining techniques on the marginal sealing of Class II composite restorations. A total of 36 human molar teeth, free of caries and fillings, were each prepared with two proximal Class II boxes mesially and distally. In mesial boxes, cavity liners were applied as follows: in group 1, separately cured flowable composite; in group 2, co-cured flowable composite; and in group 3, resin-modified glass ionomer (RMGI). The remaining cavities were filled incrementally with a universal restorative composite. The distal boxes were filled with no liner as controls. After thermocycling, the specimens were immersed in a silver nitrate solution and the microleakage was evaluated. Analysis of variance showed that the degree of microleakage for group 3 was significantly lower than that of the other groups. Based on the results, it was concluded that the use of RMGI as a cavity liner under composite restorations showed the least microleakage. Flowable composites, whether co-cured or separately cured, had no influence on the marginal sealing.

This case report introduces a temporary denture with reduced extension stabilized in the edentulous maxilla as a possible treatment method for patients with a severe gag reflex, allowing them to test the function, esthetics, and tolerance of the denture prior to hard tissue augmentation and implant placement. A 4-mm implant was placed in the central anterior palate and allowed to heal for 3 months. During the complete treatment period, a denture with reduced extension can be delivered on a fixed Locator abutment. This method was successfully applied in three patients, and the palatal implant remained stable until the final removable prosthesis could be delivered.

The article describes complications following dental implant dislocation into the maxillary sinus and their management and attempts to elucidate the reasons for these complications and their prevention. This retrospective study presents 55 cases of dental implant migration into the maxillary sinus. Patients were 30 men and 25 women with average age of 58 years. Oroantral communication was found in 46 cases, primarily in cases without prior bone augmentation, in patients aged older than 60 years (mean), and medically compromised patients (ASA > 1). The dislocated implant and the infected tissue were removed from the sinus in most cases by Caldwell-luc intervention. The oroantral communication was closed by local and regional flaps. In most of the cases, the oroantral communication was closed by a single intervention. The conclusion was that oroantral communication and maxillary sinusitis are common findings following dental implant migration and dislocation into the maxillary sinus. The risk factors for these complications were dental implantation in the posterior maxilla without sufficient alveolar bone, implantation without prior maxillary sinus augmentation, and older and medically compromised patients. Successful closure of the communication is usually performed with local or regional flaps.

The aim of the present study was to compare clinical periodontal parameters and salivary interleukin (IL)-1β and IL-6 levels in patients with different obesity levels. A total of 419 individuals with class I, II, and III obesity and nonobese with chronic periodontitis were included. Clinical periodontal parameters were recorded, and whole salivary IL-1β and IL-6 were quantified using enzyme-linked immunosorbent assay. Clinical parameters and salivary cytokine concentrations were analyzed using one-way analysis of variance. For multiple comparisons, Bonferroni post hoc adjustment test was used. Clinical periodontal parameters and salivary IL-1β and IL-6 levels were statistically significant in class II and class III obese as compared to class I obese patients (P < .01) but were comparable between class II and class III obese individuals. These findings should be interpreted with caution due to the inclusion of hyperglycemic patients.

This clinical study was conducted to evaluate the impact of different hemostatic treatments following palatal gingival harvesting on patient discomfort. Fifty patients who needed a mucogingival surgery requiring gingival graft harvesting were enrolled and randomly assigned to one of five groups: (1) a control group in which only sutures were applied; (2) a cyanoacrylate group; (3) a periodontal dressing material group; (4) a hemostatic gelatin sponge group; and (5) a group in which the gelatin sponge and cyanoacrylate were combined. In the 2 weeks following the procedures, perception of pain, healing, consumption of drugs, and willingness to repeat the procedure were recorded through visual analog scale (VAS) by patients. Over the 2 weeks, lower pain (VAS) was found in all test groups compared to the control group (P < .01, value for time-group interaction). Notably, the gelatin sponge combined with cyanoacrylate group had very low pain (VAS ≤ 0.5 points) throughout the 14 days. The lowest healing scores at day 10 were associated with the control group (6.8 VAS points) in contrast to the four test groups (8.2 to 9.0 VAS points, P = .0001). Pain was inversely correlated with age (P < .05). Pain also depended on the apicocoronal dimension of the graft: the higher the graft, the more pain was experienced by the participants (0.4 VAS points per 1 mm, P < .05). Within the limitations of this study, palatal coverage appears to result in better outcomes when compared to suture alone. In particular, a double-layered protection of the palatal wound with a gelatin sponge combined with cyanoacrylate appeared to be the best option in reducing pain and postoperative discomfort.