bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
Efficacy of Varying Concentrations of Subgingivally Delivered Metformin in the Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial
Authors: Pradeep A.R. , Rao Nishanth S. , Naik Savitha B. , Kumari Minal 
Published: April 2012

Background: Metformin (MF), a second‐generation biguanide, is a commonly used oral antidiabetic drug that has been shown recently to stimulate osteoblasts and reduce alveolar bone loss. The present study aims to explore the efficacy of 0.5%, 1%, and 1.5% MF gel as a local drug delivery system in adjunct to scaling and root planing (SRP) for treatment of intrabony defects (IBDs) in patients with chronic periodontitis.Methods: A total of 118 IBDs were treated with 0.5%, 1%, or 1.5% MF gel or placebo gel. Clinical parameters (modified sulcus bleeding index, plaque index, probing depth [PD], and clinical attachment level [CAL]) were recorded at baseline, 3 months, and 6 months, whereas radiographic parameters were recorded at baseline and 6 months. IBD depth at baseline and 6 months was calculated on standardized radiographs by using the image analysis software. The mean concentration of MF in gingival crevicular fluid was estimated by reverse‐phase high‐performance liquid chromatography.Results: Mean PD reduction and mean CAL gain was found to be greater in MF groups than the placebo group at both 3 and 6 months. Furthermore, significantly greater reduction of IBD depth was found in the MF groups compared to the placebo group, with greatest reduction in 1% MF.Conclusions: The results of the present study show that local delivery of MF into the periodontal pocket stimulated significant increase in the PD reduction, CAL gain, and improved IBD depth reduction compared to placebo in adjunct to SRP. This can provide a new direction in the field of periodontal healing.