The apically incised coronally advanced surgical technique (AICAST) for periodontal regeneration in isolated defects: a case series.

OBJECTIVES: The aim of this retrospective case series was to report the performance up to 5 years of an innovative surgical design (the apically incised coronally advanced surgical technique [AICAST]) for the regenerative treatment of one- or two-walled intrabony periodontal lesions. METHOD AND MATERIALS: After completion of standard step I to II periodontal therapy, nine isolated periodontal defects were treated through AICAST. The following clinical outcome measurements were collected before the surgical intervention and at the last available follow-up: probing pocket depth (PPD), recession depth (REC), and clinical attachment level (CAL). Periapical radiographs of the treated teeth were also taken at baseline and at the last available follow-up (18 months or 5 years postoperatively). RESULTS: A mean (± standard deviation) PPD reduction of 6.05 ± 1.76 mm (P < .01), REC reduction of 1.15 ± 1.97 mm (P = .119), and CAL gain of 7.20 ± 2.13 mm (P < .01) were attained when comparing preoperative results with the last follow-up visit. CAL gain of 6 mm or more was reached in eight out of nine treated cases (88.9%), with a residual PPD of 2 to 3 mm in all the cases. Complete radiographic fill of the intrabony component was present in all the defects, while detectable suprabony radiographic filling was identified in two cases. CONCLUSION: AICAST represents an innovative surgical design for the treatment of deep intrabony defects and the eventual reduction of the associated gingival recessions. Preliminary results show good performance in terms of clinical attachment gains and maintenance of the marginal tissues.

Immediate placement and restoration of implants in the esthetic zone: Trimodal Approach therapeutic options.

Recently, a number of clinical and animal studies have been published suggesting the advantages of using immediate post-extraction implants under a flapless protocol, followed by the simultaneous placement of an implant-supported provisional restoration (Trimodal Approach [TA]). Indications and risk of complications of this therapeutic option have also been thoroughly discussed in the literature. Different protocols have been advocated in order to minimize the possible esthetic impact of the post-extraction remodeling of the bundle bone. These include a correct implant position, a flapless approach, the use of an immediate implant-supported provisional restoration, and filling the osseous gap with different biomaterials or thickening the mucosal compartment through soft-tissue grafts. These techniques have been mostly indicated when intact alveolar walls are present at the time of tooth extraction. In this article, the conventional TA is described. Thereafter, variations of this option are discussed, being the modification of the osseous compartment (TAO), and the modification of the mucosal and osseous compartments (TAOM).