International Journal of Periodontics & Restorative Dentistry, 03/2020

The aim of this case series was the histologic evaluation of guided tissue regeneration utilizing deproteinized bovine bone mineral (DBBM) when regenerative surgery was combined with (test) or without (control) early orthodontic tooth movement. Core biopsy samples were harvested from previously defected sites after 9 months. The histologic section showed integration of DBBM particles in newly formed bone in the apical and middle thirds of the defect, while in the coronal part, graft materials were mainly embedded in connective tissues in the control patient. DBBM particles showed partial resorption with more de novo bone formation in test samples.

The aim of this present prospective study was to evaluate the outcomes of the multiple coronally advanced flap (MCAF) with a site-specific application of connective tissue graft (CTG) for the treatment of multiple gingival recession defects with or without the presence of noncarious cervical lesions (NCCLs). Analysis of periodontal conditions was performed in order to determine if the cementoenamel junction (CEJ) restorations could affect adequate plaque control as well as maintenance over time. A total of 93 gingival recessions were treated, 61% of which presented a NCCL restored with composite resin positioned 1 mm apical to the position of the anatomical CEJ. The surgical treatment involved MCAF+CTG for 54 sites and MCAF alone for 39 sites. At 12 months, complete root coverage (CRC) and periodontal parameters of restored and nonrestored teeth were assessed, and the differences between the two groups were not significant. It can be concluded that the proposed treatment modality does not produce a negative effect on periodontal condition and amount of CRC, thus resulting in a satisfactory esthetic result.

Dental implant therapy often requires bone augmentation to facilitate stable implantation with a predictable outcome. Traditionally, this is accomplished through guided bone regeneration (GBR), which is a series of surgical procedures that use barrier membrane technology to direct the growth of new hard and soft tissues in sites with insufficient volumes for the purpose of placing dental implants. GBR and implant placement can be performed in either one or two surgeries. This article will focus on a novel simultaneous approach that utilizes a custom milled cancellous allograft bone ring that is stabilized through the graft preparation and apical threads of the dental implant. Indications include simultaneous implant placement in a deficient sinus as well as horizontal and vertical four-, three-, two-, and one-wall defects.

Extraction and immediate implant placement/restoration in the esthetic zone is clinically challenging; benefits include fewer surgical appointments and maintenance of peri-implant soft tissues throughout the treatment period, and limitations include gingival recession and bone dehiscence during surgery. Macrohybrid implants (large-diameter apical/narrow-diameter occlusal) were placed in 19 patients immediately following the extraction of hopeless maxillary anterior teeth. Immediate restorations were fabricated without occlusal contacts. Pre- and postplacement cone beam computed tomography (CBCT) scans were taken. Nineteen implants were available for recall 13 to 25 months postoperatively. The overall implant cumulative survival rate was 100% (range: 13 to 25 months, mean: 19 months), and mean insertion torque value was 65 Ncm. Mean Pink Esthetic Score was 12.63 at 6 months, and was 13 at the 18- to 24-month follow-up. Mean mesial and distal tooth-to-implant distances immediately after implant placement were 2.55 ± 1.29 mm and 2.29 ± 0.82 mm, respectively. Interproximal bone crest width, distance, and height were maintained at implant platforms, mesially and distally, 18 to 24 months postoperative. The results of this study indicated that the macro-hybrid implant geometry for this immediate surgical/restorative protocol provided excellent and stable 2-year results relative to implant survival (100%), labial plate thickness via CBCT evaluations, tooth-to-implant distances immediately post-implant placement, PES, and interproximal bone crest width, distance, and heights, which were maintained at the implant platforms.

Twenty patients completed this randomized, controlled, blinded clinical trial comparing ridge preservation with a bioabsorbable polylactic acid membrane (PLA group) compared to an acellular dermal matrix membrane guided bone regeneration (ADMG group). An intrasocket corticocancellous allograft plus a facial overlay xenograft was used for both groups. Final crestal ridge width was significantly greater for the ADMG group (P < .05). Soft tissue thickness, conversely, was thicker for the PLA group. Vertical ridge height change increased significantly for the midbuccal site of the ADMG group. Histologic evaluation showed high percentages of vital bone for both groups.

Maxillary sinus augmentation is a procedure commonly performed in patients in need of maxillary posterior implants with loss of vertical ridge height and sinus pneumatization. Previous studies have identified some factors associated with sinus membrane perforation during lateral-wall sinus elevation procedures. Although membrane perforation does not directly link to future implant failure, it has been shown to have an association with postoperative complications. In order to promote more predictable results and reduce complications during the sinus elevation procedure, especially for the lateral window approach, articles published in peer-reviewed journals were reviewed to support the proposal of a new risk-evaluation system prior to the sinus surgery. This article reviews anatomical and patient-related factors that might affect the risk of perforation during the surgery and also aims to provide a risk assessment table to enable clinicians to analyze these factors prior to the lateral sinus augmentation surgery.

Immediate implant placement in extraction sockets requires management of postextraction alveolar resorption. This randomized controlled trial evaluated the facial alveolar bone dimension 10 months following immediate implant placement with or without the addition of anorganic xenograft at the time of flapless, one-stage placement of a sloped-platform implant. The primary outcome of facial crestal alveolar bone thickness revealed no difference in the mean dimension (no graft: 1.47 ± 0.85 mm; graft: 1.63 ± 0.71 mm; P = .950). Secondary outcomes, including pink esthetic score, were not different between the two groups. This study suggests that bone formation does occur along the facial surface of implants placed into extraction sockets.

A number of treatment options have been explored for peri-implantitis. Seven rough-surfaced implants that failed from peri-implantitis were retrieved. Surfaces were treated by different methods: saline, chlorhexidine, citric acid, 35% phosphoric acid etch gel, hydrogen peroxide, implantoplasty, airborne-particle abrasion, laser, and titanium brush. Implants were observed under scanning electron microscopy. Chemical agents failed to remove any biologic debris. Airborne-particle abrasion, laser, and titanium brush removed part of the biologic debris, and implantoplasty showed complete biologic debris removal. In ex vivo failed implants, implantoplasty showed complete disturbance and removal of bacterial biofilm.

Missing canines compromise function and esthetics and therefore should be restored. In case of a retained canine, there can be a conservative approach of classic orthodontic eruption. If that is not effective, an alternative treatment method is to remove the retained tooth, followed by implant placement or transalveolar autotransplantation of the retained canine. En bloc autotransplantation of a retained canine, with surrounding bone, preserves canine periodontium and increases chances for revascularization and vitality of the transplanted tooth. This paper presents an en bloc autotransplantation of retained canines in the mandible in two female patients resulting in canine vitality after 1.5 years with proper pocket depth, physiologic tooth mobility, and positive reaction to ethyl chloride.

Maintaining soft and hard tissues around dental implants after tooth extraction is one of the major challenges in implant dentistry. After tooth extraction, the subsequent loss of bone and soft tissue is inevitable due to the partial resorption of the buccal bone plate. The recently described socket shield technique addresses the problem by maintaining the buccal piece of the tooth in the extraction socket in order to preserve the buccal bone. As with every new technique, specific complications, like infection of the buccal piece of the tooth, can occur. Herein, the authors present a clinical case that developed a complication with the socket shield technique and the consequential surgical management.

The purpose of this clinical study was to evaluate, through clinical and radiographic parameters, the 2-year implant survival and success rates of single, narrow, immediately loaded implants (3.1-mm diameter) placed in fresh extraction sockets or healed sites in the anterior region. A total of 16 patients were treated with 16 narrow single implants in fresh extraction sockets and healed sites, and restored immediately with temporary crowns. After 3 months, the implants were finally restored with screw-retained or cemented lithium disilicate crowns. Implant success and survival rates were both 100% due to stable marginal bone levels and shallow probing pocket depths after 2 years of follow-up. Within the limits of this clinical study, narrow 3.1-mm dental implants can be used successfully as a minimally invasive alternative in healed sites with a thin bone crest and in the presence of a reduced interdental space. Provided that stability of soft and hard peri-implant tissues were obtained in postextraction sites of mandibular incisors and maxillary lateral incisors with immediate provisional restoration, the 2-year results can be successfully maintained over time.

A technology called Trace Registration (TR) has been introduced to allow dynamic navigation of implant placement without the need for a thermoplastic stent. This study was undertaken in order to validate the accuracy of the TR protocol for dynamically guided implant surgery. A retrospective, observational, in vivo study was performed using dynamic navigation via the TR protocol. The preoperative cone beam computed tomography (CBCT) plan was superimposed and registered (aligned) with the postoperative CBCT scan to assess accuracy parameters. A total of 136 implants were placed in 59 partially edentulous arches. Mean deviation between the planned and actual position for all implants was 0.67 mm at the coronal level (entry point), 0.9 mm at the apical level, and 0.55 mm in depth, with an angle discrepancy of 2.50 degrees. Tracing 5 to 6 teeth tended to improve accuracy results compared to tracing 3 to 4 teeth. TR is as accurate as traditional registration and statically guided methods for implant surgery.

Excessive gingival display (EGD) is a common esthetic concern. Lip repositioning surgery (LRS) was introduced as one of the treatment options to manage EGD. LRS can be used for skeletally and/or muscularly induced EGD. The present case series applied LRS using an Er,Cr:YSGG laser to treat 24 patients with minor vertical maxillary overgrowth or a hypermobile lip. At 6 months, the gingival display had decreased by 3.79 ± 1.59 mm (mean ± standard deviation), and the visible lip body when smiling had increased by 1.23 ± 0.74 mm. A questionnaire revealed that the level of satisfaction with the smile increased among the patients and that they had a positive attitude toward Er,Cr:YSGG laser–assisted LRS.

The purpose of the present study was to (1) investigate the micro-shear bond strength and failure mode of a novel methacryloxydecyl-dihydrogen-phosphate (MDP) calcium-fluoride–releasing self-adhesive resin cement (TheraCem, BISCO) to a tooth structure (enamel and dentin) and to yttrium-stabilized zirconia after thermocycling, and to (2) compare the results with a universal non–MDP-containing self-adhesive resin cement (RelyX Unicem, 3M ESPE) as a control. Enamel and dentin specimens (20 discs each) were obtained by using a diamond saw (IsoMet 4000, Buehler) with copious water coolant. Twenty zirconia plates were obtained from IPS e.max ZirCAD blocks (Ivoclar Vivadent) and sintered in an inFire HTC speed hightemperature furnace (Dentsply Sirona). Resin-cement micro-cylinders were created on the bonded surface and filled with the tested cements (n = 10 for each surface/ cement combination): Group A (control) used non–MDP-containing RelyX, while group B (tested cement) used MDP-containing TheraCem MDP. Cements were left to self-cure for 5 minutes. All specimens were thermocycled for 5,000 cycles (THE- 1100, SD Mechatronik). Micro-shear bond strength was measured using a universal testing machine, and debonded surfaces were examined for failure mode analysis with all morphologic and ultrastructure changes using a scanning electron microscope (Quanta 250 Field Emission Gun, FEI) attached with an energy dispersive x-ray (EDX) unit. The results were statistically analyzed. TheraCem had a slightly higher micro-shear bond strength (MPa) value than RelyX. Within enamel, TheraCem (6.46 ± 1.37 MPa) had a significantly higher mean μ-SBS value than RelyX (3.04 ± 0.99 MPa) (P = .002). Similarly, TheraCem in dentin (10.67 ± 1.27 MPa) had a significantly higher mean value than RelyX (6.46 ± 1.74 MPa) (P = .014). As for zirconia, TheraCem (39.76 ± 1.18 MPa) had a significantly higher mean μ-SBS value than RelyX (27.04 ± 1.92 MPa) (P < .001). Using MDP-containing calcium-fluoride–releasing self-adhesive resin cement (TheraCem) may improve bond strength to all tested substrates (enamel, dentin, and zirconia) and can be considered a promising cement for many clinicians. Further clinical studies are required to provide long-term clinical success data.

Exposure of maxillary gingiva more than 3 mm while smiling is referred to as "excessive gingival display" or "gummy smile." Various treatment options for excessive gingival display are published in the literature, including lip repositioning, crown lengthening, botulinum toxin-A injections, and orthognathic surgeries. This case report aims to present a novel approach to the lip-repositioning procedure for treatment of excessive gingival display. The patient, who visited the department to demand a more esthetic smile, was diagnosed with excessive gingival display caused by hyperactivity of upper lip muscles. Lip repositioning procedure was considered. While evaluating the patient's smile, the amount of gingival display for each tooth region varied. A novel tooth-based modification was planned for the patient for a more precise result. No complication was noted during 10- and 30-day follow-ups. The amount of gingival display while smiling was less than 3 mm for each tooth region. The tooth-based lip-repositioning technique may provide an opportunity to more precisely treat patients with gummy smile.

Alveolar bone resorption and maxillary sinus pneumatization occurring after dental extraction in the posterior region of the maxilla may be problematic when planning implant-supported rehabilitation. Various regenerative options are available, including guided bone regeneration, bone block grafts, and lateral sinus augmentation. These procedures are associated with significant complication rates, high morbidity, increased therapy duration, and high cost. Less invasive approaches, such as transcrestal sinus floor elevation, and using short implants have been proposed in an attempt to reduce these drawbacks. The aim of this study is to analyze available evidence to suggest predictable options and identify minimally invasive management of implant-supported rehabilitation in the posterior maxilla. This article concerns biologic mechanisms regulating new bone formation after maxillary sinus augmentation and examines characteristics of available implants and grafting materials to help the clinician select the most rational and convenient surgical approach according to specific situations.

Insufficient crestal bone is a common feature encountered in the edentulous posterior maxilla due to atrophy of the alveolar ridge and maxillary sinus pneumatization. Numerous surgical techniques, grafting materials, and timing protocols have been proposed for implant-supported rehabilitation of posterior maxillae with limited bone height. In the majority of potential implant sites, residual bone height is less than 8 mm and the clinician has to select either a lateral or transcrestal sinus-elevation technique or placing short implants as the correct surgical option. Nevertheless, guidelines for selecting the best option remains mostly based on the personal experience and skills of the surgeon. The role of sinus anatomy in healing and graft remodeling after sinus floor augmentation is crucial. In addition to the evaluation of residual bone height, the clinician should consider that histologic and clinical outcomes are also influenced by the buccal-palatal bone wall distance. Therefore, three main clinical scenarios may be identified and treated with either a lateral or transcrestal sinus-elevation technique or short implants. This article introduces a new decision tree for a minimally invasive approach based on current evidence to help the clinician safely and predictably manage implant-supported treatment of the atrophic posterior maxilla.

The aim of this study was to compare the use of gingival unit graft (GUG) with free gingival graft (FGG) for treating wide gingival recession and increasing keratinized tissue. This randomized controlled trial with a split-mouth design included 30 localized bilateral recessions (Miller Classes I and II) that were randomly treated with GUG or FGG. Both grafts were fixed by cyanoacrylate glue. Probing depth, clinical attachment level, vertical recession depth, and keratinized tissue width were recorded at baseline and 1 and 6 months after surgery. The postoperative mean percentage of root coverage at 1 and 6 months was better on GUG side, and KTW significantly increased on the same side 1 month after surgery (P < .05). GUG might be an acceptable modality for increasing keratinized tissue and treating recession.

Agenesis of the permanent dentition is rare. This report describes a 20-yearold woman with 19 deciduous teeth, a single permanent mandibular premolar, and other physical traits associated with ectodermal dysplasia. The patient demonstrated esthetic parameters associated with maxillomandibular alveolar insufficiency, and her chief complaints were directed toward esthetics and the potential impact of restorative choices on function. Three typical options for restoration include overdentures, removable partial dentures, or implantsupported prostheses replacing her natural dentition. This report illustrates a fully integrated digital approach to treatment planning, the fabrication of a computer-aided design/computer-assisted manufacture surgical guide and provisional restoration, guided implant placement, and definitive restoration using monolithic zirconia implant-supported fixed dental prostheses. The lifelong management of this rehabilitation is an acknowledged challenge.

This study evaluates the microbial colonization in the peri-implant sulci and in implant-abutment interfaces of Laser-Lok implants (BioHorizons) with lasermicrogrooved abutments (test group) and machined abutments (control group) 18 months after functional loading Real-time polymerase chain reaction revealed significantly greater total and specific microbial load in both the periimplant sulcus and implant-abutment interface in the control group (P ≤ .05) Similarly, there was a significant reduction in the radiographic crestal bone loss in the test group (P ≤ .05) In total, 14 patients were assessed for clinical and radiographic parameters and microbial evaluation Peptostreptococcus micros and Porphyromonas gingivalis were positively correlated with site-specific plaque scores and bleeding scores, and mean crestal bone loss, respectively Hence, the authors propose using Laser-Lok implants with laser-microgrooved abutments to reduce microbial colonization and consequently preserve the crestal bone levels.

The aim of this systematic review was to assess in patients with gingival recessions and noncarious cervical lesions (NCCLs) whether restoration of NCCLs may influence the percentage of root coverage following surgical root coverage procedures compared to surgical root coverage procedures without subsequent restoration. Four studies (randomized controlled trials) assessing the effects of NCCL restoration in combination with surgical root coverage procedures were included. Meta-analyses showed no significant differences in overall root coverage, CAL gain, and KTW change between test and control groups. In teeth with NCCLs and gingival recessions, restoration of NCCLs does not affect the clinical outcomes of surgical root coverage.