A Fixed Reconstruction of Partially Edentulous Patient With Systemic Scleroderma: A 4.8-year Follow-Up Case Report.

INTRODUCTION: Systemic scleroderma (SSc) is a progressive autoimmune multisystem disease affecting several organs. In the oral cavity, its manifestations include enlarged periodontal ligament, xerostomia, microsomia, alveolar bone loss, and premature teeth loss. A removable prosthesis would not be a treatment option due to loss of hand dexterity, reduced chewing capacity, microsomia, and xerostomia in these patients. Alternatively, implant-supported fixed restorations are a plausible treatment for these patients. However, there is very limited literature showing implant survival rate in patients with SSc for a long follow-up. CASE PRESENTATION: A 57-year-old female patient with SSc presented to our clinic. She was diagnosed with SSc 25 years ago. Initial clinical and radiological examination revealed that she showed slight to moderate chronic periodontitis, tooth cavities, remaining tooth tips, and a partial edentulism in the posterior areas. A total of seven implants were placed at different time points. The remaining upper teeth were crowned. At 4.8 years follow-up, the placed implants showed no sign of peri-implant disease. CONCLUSION: This case report indicated that 4.8 years of follow-up revealed good oral hygiene and clinically or radiologically no sign of peri-implant disease around the implants in a patient with SSc. Implant-supported fixed restoration could be a viable treatment approach in these patients.

A fixed reconstruction of fully edentulous patients with immediate function using an apically tapered implant design: a retrospective clinical study.

BACKGROUND: Immediate function has become an accepted treatment modality for fixed restorations in completely edentulous jaws. It is known that implant microtopography (surface) may enhance osseointegration, while implant macrotopography (macrodesign) plays an important role in primary stability in the patient requiring an immediate loading. The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of the edentulous subjects treated with narrow and/or regular diameter, which placed and loaded immediately. METHODS: Forty-two consecutive patients received 171 implants, including regular and narrow diameter implants (NDIs). Each jaw, 19 mandibles and 24 maxillae, was treated with a fixed-full arch prosthesis according to the Straumann® Pro Arch concept. The majority (95%) of the restorations were supported by four implants, of which the posterior two implants were tilted. A provisional functional acrylic prosthesis was delivered on the day of surgery. All patients were followed up to 55 months. Cumulative survival rate was determined using Kaplan-Meier analysis. Radiological measurement of marginal bone level was performed. RESULTS: The overall follow-up time for survival rate was up to 55 months. Four implants (3 implants in maxilla, 1 implant in mandible) were lost, resulting in an overall cumulative implant survival rate of 97.7%. Implant survival rate in the axial and tilted implants was not statistically significant. The mean of interproximal marginal bone loss was 0.15 mm after 24 months. Good soft tissue health was observed in almost 99% of patients. The final prosthesis survival rate was 100%. CONCLUSIONS: The results of this retrospective pilot study indicated that total edentulous patients requiring an immediate implant placement and loading can be successfully treated with this implant design. The improved mechanical properties of these implants might give a more conservative treatment option for the jaws showing a severe horizontal alveolar bone resorption.

Salivary Del-1, IL-17, and LFA-1 levels in periodontal health and disease.

OBJECTIVE AND BACKGROUND: Developmental endothelial locus-1 (Del-1), lymphocyte function-associated antigen-1 (LFA-1), and interleukin 17 (IL-17) play critical roles in transendothelial migration of neutrophils in periodontal diseases. The aim of this study was to evaluate salivary Del-1, IL-17, and LFA-1 protein levels in patients with gingivitis (G), chronic periodontitis (CP), and generalized aggressive periodontitis (GAP). METHODS: A total of 180 systemically healthy, non-smoking patients (45 periodontally healthy (H) and 45 G, 50 CP, and 40 GAP) individuals (between March 2014 and February 2016) were included in this study according to Armitage's (1999) classification. Clinical periodontal parameters, including clinical attachment level, probing depth, plaque index, and gingival index, were recorded. Del-1, IL-17, and LFA-1 protein expression levels were measured in unstimulated saliva samples collected from patients by using enzyme-linked immunosorbent assays. Kruskal-Wallis and Mann-Whitney U tests were used for multiple comparisons and post hoc statistical analyses, respectively. ROC curve analysis was used to evaluate the sensitivity and specificity of Del-1, IL-17, and LFA-1 in distinguishing periodontal disease from health and gingivitis. RESULTS: It was found a high level of IL-17 and a low level of Del-1 in the CP and GAP, as compared to the G and H groups (P < .001). Nevertheless, we found LFA-1 levels were higher in the GAP than in the CP or G groups (P = .00). Consistently, LFA-1 levels were lower in the H and G groups than in the CP and GAP groups (P = .00). The combination of three biomarkers was found as the best predictor yielded exhibited the highest AUC [0.893, 0.845-0.94 (%95 CI) P < .001] in discriminating periodontal disease from health and gingivitis. CONCLUSION: Salivary Del-1, LFA-1, and IL-17 levels might be useful markers for determining the clinical health and disease status of patients with periodontitis. However, further studies that evaluate the level of salivary Del-1, LFA-1, and IL-17 before and after periodontal therapy are required to understand the exact roles of these cytokines during the periodontal healing period.

Platelet-rich plasma-assisted guided bone regeneration for ridge augmentation: a randomized, controlled clinical trial.

BACKGROUND: Platelet-rich plasma (PRP) contains a number of biologically active growth factors, and previous studies have reported conflicting ridge augmentation results. The primary aim of this randomized, controlled, masked, clinical trial was to determine if PRP combined with a rapidly resorbing cancellous allograft would enhance the regenerative result compared with an allograft without PRP. METHODS: Thirty-two patients with an edentulous ridge defect were sequentially entered into the study; four were excluded from data analysis. Fourteen patients received a cancellous allograft (CAN group) and the other 14 received a cancellous allograft mixed with PRP (PRP group). All 28 grafted sites were covered with a resorbable polylactide membrane. After elevation of a full-thickness flap, horizontal ridge dimensions were measured with a digital caliper at the crest and 5 mm apical to the crest. Vertical ridge dimensions were measured from a tooth-supported stent. All sites were reentered at 4 months, and a trephine core was obtained for histologic analysis before implant placement. RESULTS: The crestal ridge width for the CAN group had a mean gain of 2.0 ± 1.2 mm, whereas the PRP group gained 2.9 ± 1.0, and the difference was statistically significant between groups (P <0.05). The percent vital bone was 36% ± 14% for the CAN group compared with 51% ± 15% for the PRP group and was statistically significant between groups (P <0.05). Loss of augmented ridge width was 34% ± 17% for the CAN group and 28% ± 17% for the PRP group (P >0.05). CONCLUSION: These clinical and histologic findings suggest that PRP enhanced bone regeneration and resulted in increased horizontal bone gain and percentage vital bone.

Massive Gingival Fibrous Lesion Excision Using Acellular Dermal Matrix for Gingival Regeneration: A Case Report.

INTRODUCTION: Localized gingival fibrous lesions (GFLs) can be esthetically disfiguring and may be associated with specific local, systemic, or unknown factors. Treatment of GFLs includes wide excision of the lesion, followed by the often difficult task of restoring soft-tissue function and esthetics. This case report describes the use of acellular dermal matrix (ADM) for wound coverage after lesion removal. CASE PRESENTATION: A 50-year-old African-American female presented with a very large, facially located, GFL between teeth #10 and #11. She reported that a similar lesion had been removed twice before this recurrence. No local irritants were noted that might be associated with this type of lesion. The lesion was excised, including periosteum, leaving a large area of denuded bone that was covered with ADM. This resulted in regeneration of the gingiva and provided an excellent esthetic outcome for the patient. CONCLUSIONS: There was no evidence of recurrence of the lesion in the first 15 months. The etiology of the lesion is unknown, and it was difficult to classify histologically using the current classification system for these lesions. Using ADM improved postoperative pain management, facilitated healing of the denuded bone, and resulted in an acceptable functional and esthetic regeneration of the gingiva.

Recurrent gingival fibrous lesions: comparison of 2 cases and potential need for additional classification.

Historically, the classification of localized gingival fibrous lesions has been inconsistent, leading to multiple naming schemes and confusion among pathologists. Currently, lesions are broadly grouped into localized hyperplastic lesions and true neoplasms. Although some cases are clearly defined histologically (i.e., peripheral ossifying fibroma, peripheral odontogenic fibroma), another set of "reactive" fibrous lesions exhibit overlapping histologic features including nondistinctive fibrosis and inflammation. This group can exhibit recurrence, classically related to a local stimulus. However, when local factors are absent, recurrence suggests inherent neoplastic potential. Herein, we describe 2 recurrent fibrous gingival masses, one of which reportedly recurred 3 times with no obvious inciting agent. The histologic appearance of both lesions was similarly distinctive but not well classifiable, while the immunohistochemical profile indicated divergent lesions. This highlights the need for further study of recurrent gingival fibrous lesions to better predict independent growth potential.