bluuebunny/crossref_metadata_2025_split huggingface dataset:
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 QuestionIn 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 ScenarioA 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.