Comparison of acellular dermal matrix allografts and connective tissue autografts in soft-tissue augmentation around immediate implants: A pilot study.

Background: Immediate implant has multiple advantages but does not prevent the reduction in dimension of the labial cortical plate due to bone remodelling and soft-tissue collapse along with gingival recession. This Randomised Controlled Trial (RCT) was carried out to evaluate the changes in peri-implant soft-tissue dimensions after the immediate implant along with soft-tissue augmentation with acellular dermal matrix and connective tissue autografts. Methods: Twenty clinical cases requiring tooth extraction in the anterior region of the maxilla (single rooted tooth) were selected and randomly divided. An immediate implant with soft-tissue augmentation with acellular dermal matrix (group A) and connective tissue autografts (group B) was carried out. Clinical parameters such as thickness of the marginal gingiva (mm), width of the keratinized mucosa (KMW) (mm), dimensions of the interdental papilla between the implant and the adjacent teeth (mesial and distal) and gingival biotype around the implant at the baseline (before extraction of the tooth) and at 180 days (after implant placement during second-stage surgical exposure) were evaluated. Results: The mean postoperative gingival thickness and KMW were statistically higher in group B than in group A. There was statistically significant intragroup decrease in papillary height in both the groups; however, intergroup change was insignificant. In both the groups, there was an increase in thickness of gingival tissue, but the gingival biotype remained thin. Conclusion: Immediate implants augmented with connective tissue autografts showed an increase in thickness of the gingiva and KMW, reduced papillary collapse and improvement in tissue biotype as compared with the acellular dermal matrix.

Plasma cell gingivitis: A perplexing and rare clinical entity.

Plasma cell gingivitis (PCG) is a diagnostic dilemma for clinicians. It is also referred to as atypical gingivostomatitis, idiopathic gingivostomatitis, allergic gingivostomatitis, and plasma cell gingivostomatitis which are characterized by bright fiery red gingiva with spontaneous bleeding on slight provocation. It is often confused with inflammatory gingival enlargement, erythematosus lichen planus, and other lesions. One such rare and benign entity is discussed in this article and managed after thorough clinical, radiological, histopathology, immunohistochemistry analysis.

Management of inadequate keratinized gingiva and millers class III or IV gingival recession using two-stage free gingival graft procedure.

BACKGROUND: Prognosis in the management of Millers Class III or IV gingival recession is often fair to poor, which is further decreased by factors such as inadequate keratinized gingiva. Very few modalities show long-term success in the management of gingival recession with inadequate keratinized gingiva, free gingival graft (FGG) being one such technique. MATERIALS AND METHODS: Ten individuals with Millers Class III or IV recession and inadequate keratinized gingiva were recruited for the study. The first surgical procedure involved the FGG procedure to increase the width of keratinized gingiva (WOKG). Patients were recalled after 3 months for the second surgical procedure, where the flap was coronally advanced. They were recalled 9 months after the second surgery. WOKG was examined at baseline and 3 months (before the second surgical procedure). Recession depth (RD) and clinical attachment level (CAL) was examined at baseline, at 3 months (before the second surgical procedure) and at 12 months (9 months after the second surgical procedure). The percentage of root coverage was measured at 12 months from baseline. RESULTS: Significant increase in WOKG was seen at 3 months. Significant decrease in RD and CAL was observed at 12 months from baseline. The percentage of root coverage was 76.4%. CONCLUSION: Two-stage FGG procedure can be a successful modality in the management of Millers Class III or IV recession with inadequate keratinized gingiva. This technique improves the prognosis of such compromised cases.

Comparative evaluation of laser-microtextured implant versus machined collar implant for soft and hard tissue attachment: A clinical and radiological study.

BACKGROUND: Various mechanical modifications in the collar region of endosseous implants is a challenge for better performance and osseointegration. Here is a comparative evaluation being carried out to find out the effect of the machined collar (MC) and Laser-Lok (LL)-modified titanium implants on the success of implants being commonly advocated in partially edentulous among serving personnel and their families. MATERIALS AND METHODS: Twenty-four patients with appropriate inclusion and exclusion criteria were selected for placement of Biohorizons MC and LL implants in 12 cases each. Aseptic surgical procedure was followed for implant surgery, and clinical parameters such as clinical attachment loss, pocket depth (PD), bleeding on probing, and plaque index (PI), mobility parameters estimated by Periotest value, and radiographic assessment of crestal bone loss (CBL) at interval of 6 months and 1 year were recorded and compared by statistical analysis. RESULTS: Intragroup comparison at 6 and 12 months period for all the parameters were nonsignificant except CBL in Group A (CBL-MC) with 12 cases shows a mean of 0.917 and 1.500, respectively, standard deviation difference = 0.477 (significant) with P < 0.05. Similar significant difference in CBL was observed with superior result in LL implants. CONCLUSION: The presence of LASER textured with microgrooves on the collar of the implants did not increase the PI and sulcular bleeding index. The probing PD was much less as observed in the group of LASER-treated implants in comparison with that of MC group. LL implant had an edge over MC proving success of the laser treatment on collars of implants.

Immediate Non-functional Loading of Single Tooth Uniti™ Implants into Avulsed Tooth Sockets Following Ridge Augmentation in the Anterior Maxilla: A Case Series.

To assess the clinical effectiveness of immediate non-functional loading of single-tooth implant placed into avulsed tooth socket following ridge augmentation in the anterior maxilla with bioglass bone substitute and biocollagen membrane. The clinical outcome of immediate non-functional loaded implants up to 24 months after placement into avulsed tooth sockets in anterior maxilla were evaluated in 15 patients. Implants were immediately restored with acrylic resin provisional crowns. Post-operative follow-up and intraoral radiographs were obtained at 6, 12, 18 and 24 months. Survival rate, implant threads exposure immediately after placement and at 6 month interval using CT 3D reconstruction was assessed. Marginal bone loss did not extend beyond the first thread and 3D CT scan showed adequate bone mineral density with no signs of radiolucent lesion around the implant during 24 months follow-up having survival rate of 100 %. Within the limits of the present study, immediate non-functional loading of single tooth implant placed into avulsed tooth socket following augmentation with bioglass bone substitute and biocollagen membrane in the anterior maxilla is one of the viable treatment alternatives for rehabilitation of immediate loading implant.