The pediculated connective tissue graft: a novel approach for the "blown-out'' site in the esthetic zone.

Management of the soft-tissue framework around an implant is key to achieving ideal esthetics in the maxillary anterior esthetic zone. When a patient has a tooth with advanced bone loss and recession in the esthetic zone, removing that tooth and replacing it with an implant often requires multiple surgical procedures to restore the lost hard and soft tissue. This article will discuss a novel approach to this dilemma, by means of a case treated with a single-stage surgical procedure using the pediculated connective tissue graft. The extraction of an anterior tooth with advanced bone loss, placement of an immediate implant, and reconstruction of the hard and soft tissue with one surgery will be demonstrated. Finally, the 2-year follow-up of the final prosthetic restoration that shows the stability of the soft tissue also will be presented.

The esthetic management of a severe isolated periodontal defect in the maxillary anterior.

A 30-plus year-old woman presented to the periodontist with a chief complaint concerning the esthetics of the black space between her maxillary right lateral and central incisors (Figure 1). The history of the problem dated back several years when her general dentist noted increased pocket depth in this area. The patient was referred to a periodontist who elected to attempt grafting in this site to improve both the bone and soft tissue. The patient reported that after the initial surgery the defect became significantly worse and a large quantity of gingival tissue was lost. The patient was then referred to a second periodontist who, after evaluation, also chose to attempt both a bone and soft tissue grafting procedure and again the defect became worse. At that point the second periOdontist referred the patient to the periodontist in our group for evaluation and treatment. At her initial consultation the patient indicated she had been managing the defect esthetically by placing pink wax into the large open space every day to minimize the appearance.

The inflationary effects of environmental fluctuations ensure the persistence of sink metapopulations.

Under current rates of environmental change many populations may be found in habitats of low quality and low conservation value, creating population sinks. We test recent theory that suggests, surprisingly, that stochastic environmental variability may enhance the long-term persistence of sink metapopulations. Using experimental populations of Paramecium aurelia we show that it is possible for a metapopulation comprised entirely of sink populations to persist for many generations in a random environment. In accordance with the theory, we show that positive temporal autocorrelation and low spatial correlation in the environment can ensure the long-term persistence and enhance the mean and maximum abundance of sink metapopulations. High levels of spatial correlation in the environment created strong population synchrony and limited the persistence time of the sink metapopulations. These results have important implications for the development of a theory underlying the synergistic effects of habitat fragmentation and environmental change on population persistence.