bluuebunny/crossref_metadata_2025 huggingface dataset:
Decision Making in Gingival Recession Treatment: Scientific Evidence and Clinical Experience
Authors: Rasperini Giulio , Acunzo Raffaele , Limiroli Enrico
Published: April 2012

Focused Clinical Question: What are the key considerations for selecting the best surgical approach in mucogingival plastic surgery?

Summary: Treatment of gingival recession has become an important therapeutic issue due to the increasing number of cosmetic requests from patients. The dual goals of mucogingival treatment include complete root coverage, up to the cemento‐enamel junction, and blending of tissue color between the treated area and non‐treated adjacent tissues. Even though the connective tissue graft is commonly considered the “gold standard” for treatment of recession defects, it may not always be the best surgical option for every case.

Conclusions: Under non‐experimental conditions, all root coverage procedures may be effective in terms of complete root coverage and excellent esthetics. Careful analyses of patient‐ and defect‐related factors, however, are key considerations prior to selecting an appropriate surgical technique.
Histologic Evidence of Connective Tissue Integration on Laser Microgrooved Abutments in Humans
Authors: Geurs Nicolaas C. , Vassilopoulos Philip J. , Reddy Michael S.
Published: April 2012

Introduction: Human histology and scanning electron microscopy (SEM) are presented, outlining the soft tissue integration to a laser microgrooved abutment surface.

Case Presentation: In two patients, prosthetic abutments with a laser microgrooved surface were placed on osseointegrated implants. After 6 weeks of healing, the abutments and the surrounding soft tissue were removed and prepared for histology and SEM. The most apical epithelium was found coronal to this surface. Connective tissue demonstrated collagen fibers oriented perpendicular to the microgrooved surface. There was intimate contact between the connective tissues and the microgrooved abutment surface.

Conclusion: The abutments in these patients had connective tissue integration with functionally oriented fibers to the microgrooved surface.
Use of the Pocket‐Lining Tissue as a Pedicle Flap to Facilitate Wound Closure After Extraction to Preserve the Alveolar Ridge or Protect an Implant Site
Authors: McCrea Shane J.
Published: April 2012

Introduction: Because hard‐ and soft‐tissue remodeling and resorption follows tooth extraction, postextraction ridge deficiencies and abnormalities may require correction before implants can be placed. Equally, where immediate implants are placed, alveolar bone and gingival soft tissue must be protected; thus, primary wound closure of an extraction site is desirable but remains challenging. Guided bone regeneration has made ridge preservation possible and more predictable. However, where barrier membranes remain exposed, infection and graft failure can occur. The technique presented here uses the pocket‐lining epithelium that is found at periodontally compromised sites to facilitate primary wound closure. To my knowledge, this is the first report of this technique.

Case Presentations: All presented cases had periodontally compromised teeth that were extracted. After extractions, the pocket‐lining epithelium was dissected and pedicalized (using the pocket‐lining pedicle flap [PLPF] procedure). All vacated sockets were prepared, and dental implants were immediately placed. Guided bone regeneration was used to circumferentially fill the remaining alveolar voids and any bony defects. The well‐vascularized attached epithelium was used to provide primary wound coverage at the surgical site. Wound healing was uneventful in all the considered cases. Sutures were removed at 4 weeks in all cases. No tissue sloughing occurred, and, when visible, early keratinization was apparent. No soft‐tissue dehiscence formation occurred.

Conclusions: In this case report, the PLPF provided successful soft‐tissue wound closure at extraction sites where implants were immediately placed. The technique appears to visually stabilize the position of the mucogingival junction and may well preserve or enhance the width of keratinized gingival tissue, thus aiding optimal esthetics.
Host Modulation for Smokers Undergoing Periodontal Maintenance: A Review of Current Evidence
Authors: Geisinger Maria L. , Holmes Carolyn M. , Geurs Nicolaas C. , Vassilopoulos Philip J. , Reddy Michael S.
Published: April 2012

Focused Clinical Question

In patients presenting with generalized moderate to severe chronic periodontitis and continuing to smoke, does host modulation improve the maintenance of alveolar bone support and clinical attachment level?

Clinical Scenario

A 45‐year‐old woman with a 25–pack‐year history of smoking presents for comprehensive periodontal therapy including four quadrants of regenerative surgery and is now receiving supportive care at 3‐month intervals. Clinical examination reveals excellent oral hygiene, and the patient resists a referral for smoking cessation. The patient is anxious about the potential for tooth loss. See Figures 1 to 3 for clinical presentation.
Comprehensive Oral Rehabilitation of a Patient With Dentinogenesis Imperfecta
Authors: Dam Hamasat Gheddaf , Papaspyridakos Panagiotis , Chen Chun‐Jung , Benic Goran , Gallucci German , Weber Hans‐Peter
Published: April 2012

Introduction: The treatment of dentinogenesis imperfecta is complex and requires a team approach. The aim of this case report is to describe the steps taken in the long‐term rehabilitation of a middle‐aged female with dentinogenesis imperfecta with severe attrition. This treatment included an initial temporary treatment to restore esthetic appearance and function followed by a complete prosthetic rehabilitation with implants in the second stage.

In advanced stages of dentinogenesis imperfecta, patients can benefit from full‐mouth rehabilitation where the deteriorated – yet still present – teeth can be used as abutments for a fixed, temporary restoration throughout the stages of treatment. Detailed pretreatment planning of how much bone and soft tissue are to be removed and an accurate determination of where the implants should be placed must be considered very thoroughly.

Case Presentation: All teeth were ultimately extracted and replaced with fixed implant‐supported prostheses in a staged approach using remaining teeth for interim support and/or retention of provisional prostheses.

Conclusions: Early and accurate diagnosis of dentinogenesis imperfecta is essential to enable preventive interventions. In many patients, this has not occurred and severe loss of tooth structure, esthetics, and function results. If restorability and prognosis of these teeth are questionable or poor, their replacement with implant‐supported fixed or removable prostheses should be the treatment of choice in modern dentistry. Given the appropriate indication and availability of financial means, a fixed solution appears preferable for reasons documented in this case presentation.
Cyst in Alveolar Mucosa Adjacent to a Dental Implant Following Connective Tissue Grafting for Ridge Augmentation
Authors: Fletcher Paul , Saito Hanae , Tarnow Dennis , Brown Marion
Published: April 2012

Introduction: When the soft tissue around an implant is inadequate or poorly contoured, soft tissue augmentation techniques such as connective tissue grafts are used to enhance the gingiva and gingival contour around an implant‐supported restoration. There have been some case reports of cystic lesions occurring after a connective tissue graft, but this appears to be the first case report of a cyst in alveolar mucosa adjacent to an implant.

Case Presentation: Following the placement of implants in the #6 and #7 positions, a cosmetic soft tissue deficiency was visible and inadequate papilla height was evident interproximally. The #7 implant was subsequently submerged, and multiple connective tissue grafts were placed to reconstruct the soft tissue on the buccal aspect of #5 to #7. Four years later the patient returned for evaluation of a 6 × 3 mm raised, fluid‐filled vesicle on the alveolar mucosa, buccal to the submerged #7 implant. A submarginal incision with a semilunar design was placed from #6 to #8. A 6 × 3.5 mm cystic‐appearing lesion was enucleated from the inner aspect of the flap opposite the submerged #7 implant and sent for biopsy. Histologic evaluation showed the lesion to be a gingival cyst of the buccal mucosa.

Conclusion: While subepithelial connective tissue grafting is highly predictable, complications can occur. What causes the epithelium to proliferate and subsequently develop into a cyst is still unknown.
A New Index Proposed for Determination of Outcome of Recession Coverage Procedures
Authors: Pandit Nymphea , Gaba Amit K. , Malik Rajvir , Pandit I. K.
Published: April 2012

Focused Clinical Question: How can the clinical outcome of recession coverage procedures be determined in cases of malaligned and rotated teeth?

Summary: The primary impetus that led to the development of the various indices of gingival recession coverage procedures was to correlate the prognosis to the anatomic features. Two important anatomic features, i.e. rotation and proclination of teeth, affect the topography of the labial bony plate as well as the biotype of the soft tissue overlying the root surface and consequently the treatment outcome. The purpose of this article is to propose an index for predetermination of the outcome of gingival recession coverage procedures, depending on the extent of rotation or proclination of the teeth to be treated. The study population consisted of 12 patients (22 sites) with Miller Class I and Class II recession of mandibular/maxillary teeth. These recession defects were treated with subepithelial connective tissue graft procedures. Clinical parameters assessed were percentage of recession coverage achieved at 6 months post‐surgically. A malalignment index (MI) was devised and interpreted for its prognostic value with respect to the treatment executed for the recession coverage procedure. The Pearson correlation between percentages of recession coverage achieved and the MI scores assessed was 0.015, which is statistically significant.

Conclusion: This clinical study concludes that the proposed MI will be of high prognostic value, in predetermination of the success of the root recession coverage procedures in proclined and rotated teeth.
Trisomy 21–Associated Aggressive Periodontitis: A Five‐Year Follow‐Up
Authors: Frydman Alon , Verdugo Fernando , Simonian Krikor , Kar Kian
Published: April 2012

Introduction: This report explores the effective treatment of aggressive periodontitis in a 23‐year‐old male with Trisomy 21.

Case Presentation: A 23‐year‐old male with Trisomy 21 presented with his mother with the chief complaint of “bleeding gums and bad breath.” Periodontal evaluation along with anaerobic microbiological culture was performed. Systemic antibiotics were given after the completion of the initial mechanical scaling and root planing (SRP). After reevaluation, the patient was placed on a 2‐month recall in which antimicrobial therapy in the form of diluted sodium hypochlorite (1:40) and povidone‐iodine (10%) was delivered subgingivally in addition to SRP. The patient remained on a 1‐ to 2‐month recall.

A reduction of mean probing depths, from 4.2 ±1.3 mm at baseline to 2.98 ± 0.89 mm, at 5 years (P <0.05) was observed. Percentage of sites with bleeding on probing showed a reduction from 100% at baseline to 16.66% at 5 years (P <0.05). The number of sites with probing depths measuring ≥6 mm was reduced from 23 to four after 5 years.

Conclusion: Trisomy 21–associated aggressive periodontitis can be successfully treated and maintained over the long term.
Supracrestal Bone Grafting Success With a Novel Application of an Absorbable Space‐Maintaining Material
Authors: London Robert M. , Mizuha Byron , Hong Sul Ki
Published: April 2012

Introduction: Developing regenerated ridge form with resorbable materials has been difficult because of a lack of space‐maintaining properties of available materials. Further combining the regeneration with the placement of implants to gain supracrestal ridge height can save the patient from additional procedures. This case series reports on the use of a shapeable, space‐forming absorbable material in conjunction with implant placement, bone grafting, and allogenic dermal material. To our knowledge, this is the first implant site development application of this type of absorbable space‐maintaining material.

Case Series: Cases were chosen from a larger group to demonstrate clinical outcomes and minor complication management. Patients with large ridge defects were treated with simultaneous implant placement and supracrestal bone reconstruction.

Conclusions: These cases demonstrate a favorable outcome with a unique material borrowed from cranial reconstruction. With careful surgical technique, this material may be used to gain adequate bone in a defined form, and implant placement may be considered simultaneously.
Cellular Allograft in the Treatment of a Severe Periodontal Intrabony Defect: A Case Report
Authors: Koo Samuel , Alshihri Abdulmonem , Karimbux Nadeem Y. , Maksoud Mohamed
Published: April 2012

Introduction: This report describes the use of allograft cellular bone matrix containing mesenchymal stem cells in the treatment of a severe periodontal defect. To our knowledge, this regenerative technique has not been reported in the periodontal literature in the past, and it offers an alternative to the commonly used regenerative techniques.

Case Presentation: The patient presented with generalized severe periodontitis with a severe radiographic defect on the distal aspect of tooth #9 extending to the apex of the tooth. Despite the depth of the defect, the tooth was vital. After thorough debridement, the defect was grafted with cellular allograft and covered with resorbable membrane. Nine months after grafting, the periapical radiograph demonstrated bone fill of the defect. The postoperative clinical examination revealed gain in the clinical attachment level and reduction in the probing depth. In addition, the tooth maintained its vitality.

Conclusion: This case report shows that a severe periodontal intrabony defect of single‐rooted tooth can be treated using cellular allograft with improvement of periodontal parameters and radiographic bone fill.
Regenerative Treatment for Recession Defects Using Purified Human Platelet‐Derived Growth Factor‐BB, Particulate Grafts, and Coronally Repositioned Flaps
Authors: Ganeles Jeffrey , Pette Gregory A
Published: April 2012

Introduction: Recession defects are typically characterized by loss of periodontal attachment, including gingiva, periodontal ligament, alveolar bone, and cementum. Numerous techniques have been developed for treatment of these defects using soft‐tissue grafting procedures with autogenous and allograft materials that generally heal with root coverage and repair of the defects. This case presentation illustrates a technique using a particulate carrier saturated with recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB) and coronally advanced gingival flaps to cover recession defects. Additionally, other scientific evidence from previous studies suggests that this technique may lead to periodontal regeneration, including cementum, periodontal ligament, and alveolar bone over previously exposed roots, which might be preferable to other methods that lead to periodontal repair.

Case Presentation: This article illustrates a technique to coronally position flaps in combination with rhPDGF‐BB‐saturated particulate graft material. Results show significant root coverage with excellent color and texture match to adjacent tissues. Additionally, the alveolus appeared thicker than non‐treated areas, suggesting appositional augmentation of the sites. Human histologic investigation of this technique in other studies confirms that periodontal regeneration can occur with this technique.

Conclusions: Coronally positioned flaps over rhPDGF‐BB‐soaked human freeze‐dried bone allograft, termed “recession regeneration,” can result in significant root coverage with excellent esthetics, even in demanding cases. Surgical reentry of one case shows significant regeneration of buccal alveolar bone over the previously exposed root surfaces, consistent with periodontal regeneration that is not ordinarily observed with other root coverage techniques unless biologic modifiers or cell occlusive barrier membranes are used.
Theoretical and Clinical Considerations for Autologous Blood Preparations: Platelet‐Rich Plasma, Fibrin Sealants, and Plasma‐Rich Growth Factors
Authors: Eskan Mehmet Akif , Greenwell Henry
Published: April 2012

Introduction: Growth factors may play a prominent role in wound healing. Concentrating these mediators and applying them to healing osseous or soft tissue may accelerate the process and improve the quality of the healing tissues. Methods of collecting and concentrating autologous platelets have been developed. Platelet‐rich plasma (PRP) is a technique that concentrates platelets and releases their growth factors when applied to healing tissues. There are some positive data about the effects of PRP on hard‐ and soft‐tissue healing, but there is also some literature that shows minimal or no effect. Fibrin sealants undergo a different preparation procedure than PRP and tend to concentrate fibrinogen rather than platelets. They can be applied to either hard or soft tissue. Studies of these agents are also conflicting and some show positive results, whereas others show minimal effect. A third technique is plasma‐rich growth factors (PRGFs). Like PRP, this preparation concentrates platelets but differs from PRP in that no leukocytes are included. Studies support its use to improve hard‐ and soft‐tissue healing, but these articles are primarily case reports.

Case Presentations: Pictures of two cases are shown in Figures 2 through 5. One shows the use of PRP with ridge augmentation, whereas the other demonstrates the use of PRP with root coverage.

Conclusion: All of these agents, PRP, fibrin sealants, and PRGF, need additional study to determine the best indications to obtain a predictable wound healing benefit.
Clinical Applications of Recombinant Human Bone Morphogenetic Protein‐2 for Bone Augmentation Before Dental Implant Placement
Authors: Misch Craig , Wang Hom‐Lay
Published: April 2012

Introduction: Bone morphogenetic proteins (BMPs) are members of the transforming growth factor‐β superfamily. They are involved in the differentiation of pluripotent mesenchymal cells, and new bone is formed through osteoblastic induction. Therefore, BMPs are commonly implicated in bone remodeling and regeneration. Recombinant human BMP‐2 with absorbable collagen sponge (rhBMP‐2/ACS) as its carrier recently received Food and Drug Administration approval for clinical use in sinus augmentations and localized ridge preservation after extractions. This article discusses the clinical use of rhBMP‐2/ACS for alveolar ridge repair after extraction and ridge augmentation procedures before dental implant placement.

Case Presentation: Two clinical cases that required socket and ridge augmentation, before dental implant placement, were treated with rhBMP‐2/ACS. In socket augmentation, rhBMP‐2/ACS and 20% of mineralized cancellous and cortical bone allograft were used. For ridge augmentation, guided bone regeneration using titanium mesh with fixation pins and a mixture of rhBMP‐2/ACS and mineralized bone allograft was performed. Clinical and radiographic evaluation of the treated areas after 6 months of healing showed excellent bone regeneration that facilitated subsequent implant placement. In addition, healing of soft tissue at rhBMP‐2‐grafted sites appeared to be accelerated.

Conclusion: rhBMP‐2 can be an agent that is used to promote socket repair as well as ridge augmentation when combined with a small component of mineralized bone allograft.
Stability of Recombinant Human Platelet‐Derived Growth Factor‐BB– Regenerated Periodontal Defects: Sixty‐Month Clinical and Radiographic Observations
Authors: Kao Richard T. , Lynch Samuel E.
Published: April 2012

Introduction: The availability of recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB) plus β‐tricalcium phosphate (β‐TCP) for periodontal therapeutic use resulted from a large‐scale, prospective, masked, randomized clinical trial. This pivotal trial indicated that this combination can safely and effectively be used to treat advanced periodontal osseous defects. Previous reports demonstrated significant gain in clinical attachment level, linear bone gain, and percentage bone fill after 6 months. Subsequent evaluation of selected cases 24 months after treatment indicated the clinical gains were maintainable. Furthermore, there appeared to be substantial increase in linear bone gain and percentage bone fill. Radiographically, there was increased radiopacity and bone trabeculation, suggesting bone maturation.

Case Series: This report presents representative cases from the rhPDGF‐BB plus β‐TCP pivotal clinical trial after 60 months. Maximal regenerative results were achieved after 12 months and maintained ≥5 years. Sites treated with rhPDGF‐BB plus β‐TCP were generally healthy, with no evidence of ankylosis, root resorption, or abnormal tissue reaction. However, a limited number of cases deteriorated, suggesting that smoking and poor self/supportive care compliance can adversely affect periodontal regenerative results.

Conclusions: The use of rhPDGF‐BB plus β‐TCP was safe and effective in the treatment of periodontal osseous defects. The regenerated results are maintainable ≥5 years, with adverse events attributable to the treatment.
Ridge Width Alteration After Implant Placement Into the Fresh Extraction Socket With Deproteinized Bovine Bone Mineral and Acellular Dermal Matrix
Authors: Akimoto Ken M. , Schuler Ralf F.
Published: April 2012

Introduction: Immediate implant placement into a fresh extraction socket in an esthetic zone can be challenging because a reduction in ridge width after healing will result in gingival asymmetry.

Case Series: In this case series, 17 consecutively treated patients with 19 immediately placed implants between maxillary second bicuspids were included. Only sites with an intact facial plate were included. If dehiscence or fenestration was found on the facial plate during extraction, the site was excluded. The implant was placed toward the palatal side, allowing a ≥2 mm gap between the implant body and the facial plate. This gap was grafted with deproteinized bovine bone mineral (DBBM). Sharp dissection and grafting using acellular dermal matrix (ADM) were performed on the facial side. A custom‐made healing abutment was connected to the implant and allowed to heal for 3 months. Preoperative and 3‐month postoperative models were used to measure the alteration in the ridge width at 2 and 5 mm from the preoperative gingival margin at the midfacial point. All implants healed without complications and integrated appropriately. Measurement comparison showed a 0.1 mm reduction and a 0.5 mm increase in the ridge width at the 2‐ and 5‐mm positions, respectively. Biotype did not make difference in the outcome.

Conclusion: This case series demonstrates that, when DBBM and ADM were used during immediate implant placement into an intact extraction socket, minimal to no alteration in the ridge width was observed after 3 months of healing.
Implant Microsurgery: Immediate Implant Placement With Implant‐Supported Provisional
Authors: Shanelec Dennis A. , Tibbetts Leonard S.
Published: April 2012

Introduction: Implants have become the preferred method of single tooth replacement. One of the challenges is the ability to do immediate implant placement and provisionalization on the day of extraction in a consistent and esthetically predictable manner.

Case Presentations: Using a newly developed microsurgical approach, the SMILE (Simplified Microsurgical Implant Lifelike Esthetics) Technique, successful outcome of 298 of 300 cases has been achieved. The success is attributed to microsurgical precision associated with this technique. The goal of this technique report is to establish some of the benefits and versatility of dental implant microsurgery and the SMILE Technique for these esthetically challenging situations.

Conclusions: With the SMILE Technique, a clinician has an orderly treatment sequence for providing immediate implant placement and provisionalization. It results in excellent esthetics, as well as predictable success of dental implant osseointegration.
Future Prospects for Periodontal Bioengineering Using Growth Factors
Authors: Giannobile William V. , Hollister Scott J. , Ma Peter X.
Published: April 2012

Polypeptide growth factors have demonstrated strong potential to repair defects associated with teeth and dental implants. Over the past two decades, intense research efforts have led to the clinical development of several growth factors or biologic agents, including bone morphogenetic proteins, platelet‐derived growth factor, fibroblast growth factors, and enamel matrix proteins. Several of these growth factors are now being used clinically for a variety of applications, such as the promotion of periodontal regeneration, sinus floor augmentation, and root coverage procedures. Although clinical results have been promising and growth factors add another dimension to clinical care, optimization of growth factor targeting approaches to periodontal wounds remains a challenge. Enhancement of growth factor local application to improve bioavailability, bioactivity, and allowance of three‐dimensional reconstruction of complex anatomic defects is a goal. This article will highlight developments for growth factor delivery to better stimulate the wound healing response for periodontal and bone regeneration in the maxillofacial region.
Trans‐Socket Elevation/Fracture/Perforation of the Sinus Floor Through the “Infected” Maxillary Tooth Socket to Facilitate Bicortical Fixation of Dental Implants
Authors: McCrea Shane J.
Published: April 2012

Introduction: In the region of the posterior maxilla, a reduced bone depth implies a need for bone augmentation. Such augmentation has been performed via the lateral window approach or a transcrestal approach. Historically, the inferior bony crest opposite the maxilla has been edentulous and free of infection. This case series demonstrates that the maxillary extraction socket can be used predictably as the conduit for an intentional sinus penetration/perforation or fracture (sinus elevation) even in the presence of apical infection. This allows the full use of all the available bony depth below the sinus floor and the floor itself, to achieve acceptable primary fixation of an immediately placed dental implant. To the best of my knowledge, this is the first clinical and radiologic report of such a procedure.

Case Series: All 10 cases presented had maxillary teeth whose extraction was planned. All teeth had areas of radiolucency (or infection) in close proximity to the sinus floor. The available depth of bone at all sites exceeded 5 mm. All the vacated sockets were prepared for implant placement, 1 to 2 mm below the sinus floor. Osteotomes were used through the socket to penetrate or fracture the sinus floor. No bone substitutes were used to augment the bone depth. The implants were immediately placed into the prepared sites with high primary stability.

Conclusions: This case series demonstrates that the presence of radiolucencies or infection does not contraindicate using the socket as a conduit for sinus floor penetration or fracture. The technique will be easily managed by clinicians who practice conventional sinus floor elevation.
Amlodipine‐Induced Gingival Overgrowth in a Patient With Uncontrolled Type 2 Diabetes Mellitus With Hypercholesterolemia: A Case Report
Authors: Smitha K.
Published: April 2012

Introduction: Gingival overgrowth, with its potential cosmetic implications and for providing new niches for the growth of microorganisms, is a serious concern for both patients and clinicians. Amlodipine is a comparatively new calcium channel blocker and is being used with increasing frequency in the management of hypertension and angina. Although amlodipine is considered a safe drug, it may induce gingival overgrowth in some individuals.

Case Presentation: A rare case of amlodipine‐induced gingival overgrowth in a 60‐year‐old Indian woman who was on amlodipine for 3 years and subsequent periodontal management of the overgrowth is reported here. The patient did not have any gingival overgrowth for 2 years despite the fact that she was taking amlodipine, but she developed the gingival overgrowth 9 months before her initial visit, coincident with uncontrolled diabetes mellitus and use of a cholesterol‐lowering drug. She was treated with drug substitution for the systemic condition and surgical treatment for the overgrowth. She was followed up for 1 year, regularly.

Conclusion: We speculate that overgrowth could have been triggered by uncontrolled type 2 diabetes mellitus and by altered pharmacokinetics of amlodipine resulting from the drug interaction of amlodipine with a cholesterol‐lowering drug.
Intentional Gingival Retraction With Provisional Direct Restoration: A Novel Approach to Facial Crown Lengthening
Authors: Nozawa Takeshi , Ito Koichi
Published: April 2012

Introduction: Achieving a harmonious marginal gingiva is an important factor in esthetic dentistry. However, surgical crown lengthening of single teeth risks asymmetry of the gingival outline in the esthetic zone. In restorative dentistry, excessive gingival retraction or deep subgingival preparation can cause facial gingival recession. This case report describes a novel approach for facial crown lengthening of single teeth using intentional gingival retraction and provisional direct restoration.

Case Presentation: After administration of anesthesia, facial bone sounding was performed. Gingival retraction cords were pressed into the connective tissue attachment from the mesial to the distal line angle. A provisional direct restoration was then performed. These procedures were repeated until an ideal gingival outline was achieved.

Conclusion: Intentional gingival retraction with provisional direct restoration appears to be useful for facial crown lengthening of single teeth in periodontal biotypes with thin bone.
Mechanical Debridement of a Peri‐Implant Osseous Defect With a Novel Titanium Brush and Reconstruction With Porous Titanium Granules: A Case Report With Reentry Surgery
Authors: Wohlfahrt J. Caspar , Lyngstadaas S. Petter
Published: April 2012

Introduction: The scientific evidence for one specific treatment strategy for peri‐implant osseous defects is scarce. It will be important to develop methods for efficient decontamination of ailing implants and for reconstruction of lost peri‐implant osseous attachment. Access for instrumentation of narrow peri‐implant defects is difficult, and to the best of our knowledge, this case report describes, for the first time, the use of a novel titanium brush for mechanical debridement of the implant surface and the defect. Histologic evidence that porous titanium granules (PTGs) support reosseointegration has recently been reported.

Case Presentation: A healthy female patient had two implants placed for prosthetic rehabilitation of teeth #21 and #23. In conjunction with second‐stage surgery, a buccal osseous defect was disclosed at the most anterior implant. The narrow and deep defect was debrided with a novel titanium brush, chemically decontaminated with 3% H2O2, and filled with PTGs. In conjunction with second‐stage surgery, after 6 months of submerged healing, the peri‐implant defect was almost completely healed, with only a 3 mm osseous defect remaining at the coronal part of the implant. The PTG bone replacement graft appeared completely integrated in new bone, with no signs of loose particles. At clinical and radiographic examinations, 24 months after surgical treatment, no signs of inflammation or reoccurring bone loss were seen.

Conclusion: To the best of our knowledge, this case report demonstrates, for the first time, that debridement with a titanium brush, 3% H2O2, and reconstruction with PTGs is a potential treatment modality of narrow peri‐implant osseous defects.
Clinical and Histologic Long‐Term Evaluation of a Subepithelial Connective Tissue Graft Used as Treatment for a Mucogingival Defect: A Case Report
Authors: Carnio João , Camargo Paulo M.
Published: April 2012

Introduction: The objective of this case report is to examine the epithelial surface characteristics of a fully submerged subepithelial connective tissue graft (CTG) that was initially performed to treat a mucogingival problem seven years earlier. Surface keratinization of a fully submerged CTG may be desirable, but its predictability is still subject to debate.

Case Presentation: Two adjacent lower teeth were treated for recession and minimal amount of keratinized tissue. The surgical technique included flap advancement and the CTG was completely covered with a flap that had mostly a non‐keratinized surface. At 18 months after surgery, the surface of the healed CTG showed mostly no clinical or histologic signs of epithelial keratinization; at that point, the surface epithelium of the whole grafted area was surgically excised and allowed to heal by secondary intention. The absence of keratinization persisted after the second surgical procedure.

Conclusion: When fully submerged, a CTG may not induce keratinization of its overlying epithelial surface.
Platelet‐Rich Fibrin in the Treatment of Bilateral Gingival Recessions
Authors: Eren Gülnihal , Atilla Gül
Published: April 2012

Introduction: Subepithelial connective tissue graft (SCTG) + coronally advanced flap (CAF) has been suggested as the most predictable technique for treatment of recession defects. However, the SCTG technique necessitates a second surgical site and increases the risk of morbidity linked with harvesting the autogenous palatal donor mucosa. Platelet‐rich fibrin (PRF) has been shown to accelerate soft‐tissue healing. The use of PRF in treatment of gingival recessions eliminates the requirement of a donor site. The aim of this case report is to evaluate the clinical effectiveness of the CAF+PRF combined technique and CAF+SCTG in the treatment of bilateral gingival recessions.

Case Presentation: The surgical treatment of a 23‐year‐old female patient with bilateral gingival recessions in maxillary cuspids is discussed in this case report. Sites were randomly assigned to CAF+PRF (test) or CAF+SCTG (control) sites. Clinical periodontal parameters were recorded and clinical photographs were taken at baseline; 1, 3, and 6 months; and 1 year. The recession area was analyzed with a digital image analysis program. In addition, gingival thickness was evaluated at baseline and at 1 year.

Conclusions: Root coverage amount, gingival thickness, and keratinized tissue width were improved in both sites. The outcomes remained stable for 1 year. CAF+PRF presents an alternative to CAF+SCTG in the treatment of gingival recessions. The PRF method is practical and simple to perform. Additionally, PRF seems to be superior to SCTG since it eliminates the requirement of a donor site.
Titanium Particles in Peri‐Implant Tissues: Surface Analysis and Histologic Response
Authors: Tawse‐Smith Andrew , Ma Sunyoung , Siddiqi Allauddin , Duncan Warwick J. , Girvan Liz , Hussaini Haizal M.
Published: April 2012

Introduction: The role of bacteria in the etiology of peri‐implantitis has been reported in the literature. However, the influence of confounding factors on the disease remains unclear. The following case series discusses the presence of metal particles in diseased peri‐implant mucosa.

Case Series: Four patients with peri‐implantitis underwent surgical peri‐implant therapy and diode laser surface decontamination procedures. Peri‐implant mucosa was excised under local anesthesia and samples were prepared for histology, scanning electron microscopy (SEM), and energy dispersive spectroscopy (EDS) to evaluate peri‐implant tissues and identify deposits of foreign materials. Histologic examination demonstrated cellular fibrous connective tissue, with or without overlying stratified squamous epithelium. An inflammatory infiltrate consisting of a mixture of acute and chronic inflammatory cells was observed. Numerous deposits of granular foreign material were scattered within the connective tissue immediately below the epithelium. The presence of metal particles was evident in the SEM and confirmed by EDS. The size of titanium particles ranged from 2 to 15 μm. Additional particles, such as aluminum, phosphorous, and sulfur, were also found in some of the samples.

Conclusions: All four cases yielded peri‐implant soft‐tissue specimens containing particulate black foreign material. SEM and EDS examination of histologic specimens confirmed the presence titanium particles and other elements in the peri‐implant tissues. Whether the presence of titanium particles in the surrounding tissue constitutes a biocompatibility issue is still a question that needs to be clearly evaluated.
Creeping Attachment in Miller Class III Recessions: A Report of Five Cases
Authors: Kochar Deepak , Narula Satish , Sharma Rajinder Kumar , Tewari Shikha , Chopra Deepak
Published: April 2012

Introduction: Creeping attachment, a postoperative migration of gingival marginal tissue in a coronal direction, is best observed in mandibular anterior teeth with narrow recessions. In this case report, recession coverage through creeping attachment is observed in wide gingival recessions (GRs) belonging to Miller Class III cases, when gingival augmentation by free gingival graft (FGG) apical to the recession area was attempted.

Case Presentation: Five patients (four males and one female, aged 27 to 30 years) with Miller Class III GRs on both mandibular central incisors, underwent FGG for gingival augmentation. The graft was placed apical to the recession. Clinical parameters were evaluated 1 year after surgery. At the end of 1 year, vestibular deepening with an increase of 3.5 to 5.5 mm of keratinized gingiva was achieved, and root coverage through creeping attachment was noticed in range of 0.4 to 2.8 mm.

Conclusion: Partial root coverage through creeping attachment can be anticipated in isolated Miller Class III recession when FGG is done for augmenting the keratinized tissue apical to the GR.
Orthodontic Treatment After Induced Periodontal Regeneration in Deep Infrabony Defects
Authors: Ghezzi Carlo , Viganò Valeria M. , Francinetti Paola , Zanotti Gianfranco , Masiero Silvia
Published: April 2012

Introduction: Limited studies investigated whether orthodontic movement should be performed in patients with periodontal disease and severe intrabony defects. The purpose of this study is to assess the stability of the periodontal complex combining regeneration treatment with enamel matrix derivative (EMD) and collagen bovine mineral bone, followed by early orthodontic movement.

Case Series: In a prospective case series, 10 patients with radiographic vertical defects with probing depths (PDs) ≥6 mm and pathologic tooth migration were enrolled. Each patient contributed one infrabony defect treated with a combination of EMD and collagen bovine mineral bone. All patients started the alignment stage 1 month after periodontal surgery with 0.014 nickel–titanium wires, and the treatment lasted a mean time of 9 ± 3.2 months. Clinical measurements (PD, clinical attachment level [CAL], and gingival recession) were calculated from baseline to the end of orthodontic treatment. Mean PD reduction was 3.7 ± 1.77 mm, with an average residual PD of 4 ± 1.05 mm; mean CAL gain was 4.4 ± 1.71 mm, with a residual CAL of 5.5 ± 1.72 mm. Both differences are statistically significant (P <0.001).

Conclusions: A reconstructive procedure that combines EMD and collagen bovine mineral bone as a periodontal preorthodontic procedure seem to provide excellent clinical results. In this clinical case series, early orthodontic movement, even if it takes place in immature bone during the healing time, has not adversely affected the maturation process of the entire periodontal apparatus.
Effect of a Collagen Membrane Combined With a Porous Titanium Membrane on Exophytic New Bone Formation in a Rabbit Calvarial Model
Authors: Shin Seung‐Il , Herr Yeek , Kwon Young‐Hyuk , Chung Jong‐Hyuk
Published: April 2012

Background: Previous studies showed that the use of a porous titanium membrane (TM) for exophytic bone regeneration does not effectively inhibit the infiltration of undesired tissue. Therefore, this study examines the effect of resorbable collagen membranes, such as cross‐linked type I collagen membrane (BA) and double‐layered porcine collagen membrane (BG), on the promotion of exophytic bone formation in guided bone regeneration when used in conjunction with a porous TM.

Methods: Thirty‐six male New Zealand white rabbits were used in this study. Six rabbits were allotted to each test group. After decorticating the parietal bone, with or without filling the inner space with a freeze‐dried cortical bone allograft (OG), the collagen membranes were fixed with metal pins. The experimental groups were divided into the following six groups: TM only, TM + OG, TM + BA, TM + BG, TM + OG + BA, and TM + OG + BG. The experimental animals were sacrificed at 8 and 16 weeks after surgery. Non‐decalcified specimens were prepared and processed for histologic observations. The newly formed bone (percentage) was measured histomorphometrically.

Results: BG combined with TM promoted new bone formation and maturation by inhibiting the infiltration of connective tissue. However, BA had no significant effect on new bone formation. The amount of new bone formation was higher at 16 weeks than at 8 weeks, but the difference was not significant. At 16 weeks, the best result for newly formed bone was with TM + OG + BG, with a significant difference from TM alone and TM + BA.

Conclusions: Regardless of the use of graft materials, BG combined with TM promoted more bone formation than BA combined with TM or TM alone. Thus, using a commercial collagen membrane to cover a TM can promote new exophytic bone formation.
Immediate Implant Placement in Infected Sites: A Case Series
Authors: Marconcini Simone , Barone Antonio , Gelpi Federico , Briguglio Francesco , Covani Ugo
Published: April 2012

Background: Immediate implant placement has several advantages, such as reduction in the number of surgical treatments and reduction of the time between tooth extraction and the placement of the definitive prosthesis. However, there are still some situations that could jeopardize the success of the aforesaid therapy, such as the presence of an infection caused by periodontal disease or periapical lesions. The aim of this case series is to evaluate the clinical success of implants placed in fresh extraction sockets that showed clinical signs of periodontal disease.

Methods: Thirteen patients (six males and seven females, 24 to 65 years old) are included in this case series. After initial examination and treatment planning, all patients underwent the periodontal treatment deemed necessary to facilitate wound healing. Twenty teeth were extracted as a result of an infection. Second‐stage surgery was performed 4 months after the initial procedure. The following clinical parameters were evaluated for each patient at the time of implant placement and at the end of the 12‐month follow‐up period: 1) clinical attachment level (CAL); 2) presence or absence of mobility; 3) presence or absence of pain; and 4) presence or absence of suppuration. The bone level was measured as the distance from the implant shoulder to the first bone–implant contact (distance bone–implant [DIB]) by periapical radiographs. The stability and health of the soft tissue were clinically evaluated by means of the plaque score.

Results: The healing period was uneventful for all the patients. All the implants were osseointegrated. At the end of the 12‐month follow‐up period, patients were asymptomatic and showed no signs of infection or bleeding when probed. The mean CAL at the mid‐buccal location per implant was 0.8 mm at baseline and 0.9 mm at the end of the follow‐up. The mean width of keratinized mucosa measured at the mid‐buccal location per implant at baseline and 1‐year visits was 3.2 ± 0.4 mm and 3.3 ± 0.5 mm, respectively. The periapical radiographs, obtained in a standardized manner, revealed a mean increase of 0.5 mm in the DIB value. At the 12‐month follow‐up, the presence of plaque was observed in 44 of the 80 sites analyzed.

Conclusion: Based on the results of this case series, placement of implants in fresh extraction sockets affected by infection may be a valid operative technique that leads to predictable results if adequate preoperative and postoperative care is taken.
Quality Assessment of Systematic Reviews on Periodontal Regeneration in Humans
Authors: Elangovan Satheesh , Avila‐Ortiz Gustavo , Johnson Georgia K. , Karimbux Nadeem , Allareddy Veerasathpurush
Published: April 2012

Background: Systematic reviews represent the highest form of evidence in the current hierarchy of evidence‐based dentistry. Critical analysis of published systematic reviews may help to analyze their strengths and weaknesses and to identify areas that need future improvement. The aim of this overview is to determine and compare the quality of systematic reviews published in the field of periodontal regeneration using established checklists, such as the Assessment of Multiple Systematic Reviews (AMSTAR) guidelines.

Methods: A systematic search was conducted to retrieve reviews on periodontal regeneration in humans. A total of 14 systematic reviews were selected using a set of inclusion and exclusion criteria. Two independent reviewers appraised the quality of the selected reviews using AMSTAR guidelines. Each article was given an AMSTAR total score, based on the number of AMSTAR criteria that were fulfilled. The quality of included reviews was further assessed using a checklist proposed in 2003.

Results: Only one of the selected systematic reviews satisfied all the AMSTAR guidelines, whereas two reviews satisfied just two of the 11 items. This study shows that published systematic reviews on periodontal regeneration exhibit significant structural and methodologic variability. Quality assessment using the additional checklist further confirmed the variability in the way systematic reviews were conducted and/or reported.

Conclusion: Consideration of guidelines for quality assessment, such as AMSTAR, when designing and conducting systematic reviews may increase the validity and clinical applicability of future reviews.