Treatment of peri-implant defects with the vertical ridge augmentation procedure: a patient report.

Most clinical patient reports apply the biologic principles of guided bone regeneration, in addition to defect filling with autogenous bone grafts or bone graft substitutes, in peri-implantitis therapy. Not infrequently, sites with membrane coverage have revealed early exposure, with subsequent infections, premature membrane removal, and insufficient bone regeneration. The present patient report demonstrates another surgical approach that uses the clinical principles and soft tissue management of vertical ridge augmentation, strictly following the same surgical protocol, on previously cleaned implant surfaces. The successful outcome of this surgical approach in one patient supports the feasibility of the selected treatment method in maintaining both the implants and the prosthetic reconstruction involved with peri-implantitis.

A bioresorbable barrier in the treatment of gingival recession: description of a new resorbable dome device.

The biologic principle of guided tissue regeneration has been expanded to mucogingival surgery, using resorbable barrier membranes for the treatment of gingival recessions. Space provision is one of the main problems in non-space making defects, considering the softness of resorbable membranes. In this study, we tested the possibility to create and maintain a secluded space using a slow, long-lasting resorbable suture so that a resorbable dome device could support the barrier and immediately become a space-making device. Ten purely mucogingival recessions in ten patients were treated. At 12 months, the results were evaluated. In five subjects the gingival margin was within 1 mm of the cementoenamel junction, in four patients it was within 2 mm, and in one case a residual gingival recession was present (where the membrane became exposed). The mean root coverage obtained was 70.4%, while the mean gain of clinical attachment was 3.3 mm.

Histologic evaluation of guided vertical ridge augmentation around implants in humans.

Recent experimental and clinical case reports demonstrated vertical ridge regeneration in atrophic posterior mandibles and maxillae. Although the results from these clinical cases are quite encouraging there is a lack of human histologic data on the newly regenerated tissue around commercially available titanium implants. The aim of the present study was to perform a qualitative and quantitative histologic analysis of the bone response to previously exposed implant threads after treatment with guided bone regeneration in a series of patients. A total of 30 Nobel Biocare implants were consecutively placed in 6 patients with partially edentulous mandibles. Of these implants, 6 were planned for removal after 1 year, whereas the remaining 24 implants were inserted to function as support for a fixed partial denture. The 6 experimental implants were intentionally allowed to protrude occlusally 5 to 7 mm from the bone crest without counter-sinking. The exposed implant threads were completely covered by autogenous bone chips. After a 12-month healing period the 6 experimental implants were removed with trephine burs. Bone-to-metal contact and bone density in the implant threads were measured. Clinically, all implants were stable and there was complete tissue fill of the space underneath the membranes. Histologically, a substantial amount of new bone had formed underneath the membrane in all cases. Histomorphometrically, there was a lower bone-to-metal contact percentage in the exposed compared to the nonexposed region in every case. With respect to bone density, there was a mean of 43.2% in previously exposed regions compared to 60.3% in previously nonexposed regions.

Histologic evaluation of new attachment utilizing a titanium-reinforced barrier membrane in a mucogingival recession defect. A case report.

Guided tissue regeneration was USED to treat a localized, deep, buccal recession on a mandibular left central incisor. This tooth was labially displaced and scheduled for extraction for orthodontic reasons. The mucogingival defect had 7 mm of facial gingival recession, and 4 mm mid-buccal probing depths. The attachment loss was 11 mm. There was no attached gingiva. At surgery the root was notched as landmarks for assessing the histological examination. A titanium reinforced barrier membrane was left in place for 4 weeks. At the time of extraction, 9 months post-initial treatment, there was a gain of 3 mm of root coverage and 1 mm of gingiva. The tooth and facial tissues were removed by block section for histologic evaluation. The root surface exhibited a total amount of a histologic new connective tissue attachment of 5.6 mm and regeneration of a new bone growth of 6.7 mm of bone. The histologic findings demonstrated that the coronal extent of the new attachment and new facial bone, 9 months after guided tissue regeneration treatment, were located coronal to the preoperative location, in a root surface previously exposed by a deep, long-standing recession.

Vertical ridge augmentation: surgical protocol and retrospective evaluation of 48 consecutively inserted implants.

The aim of this retrospective study was to evaluate the predictability of obtaining a vertical ridge augmentation around dental implants, strictly following a surgical protocol. Fourteen partially and four fully edentulous patients were treated between July 1993 and November 1995. Forty-eight consecutive implants were placed so that the circumference of the upper part of the cover screw was exposed from 2 to 7 mm. In addition to bone chips, autogenous bone grafts harvested with a bone-filtering aspirator were placed around the exposed threads and completely covered with a barrier membrane. Flaps were coronally displaced to cover the regenerative materials. Three of the 22 membranes became exposed prematurely and were removed immediately. The remaining 19 membranes stayed in place for a 12-month healing period until the second-stage surgery. In these 19 cases, where the membrane remained completely covered by the soft tissue, all of the available space underneath the membrane was filled with regenerative tissue. In eight cases a histologic biopsy was performed. Histologic analysis demonstrated vital bone with regularly formed bone cells; in three cases the most coronal part (approximately 1 mm) of the regenerative tissue was connective tissue, and the remaining tissue was bone. This retrospective analysis showed that when the clinical protocol was accurately followed, the possibility of clinical complication was reduced and the results for achieving vertical ridge augmentation around implants were predictable.

Spacemaking metal structures for nonresorbable membranes in guided bone regeneration around implants. Two case reports.

This article presents a surgical technique to promote bone regeneration and enlargement of localized alveolar ridge defects in the mandible. The purpose of this study was to investigate the use of spacemaking gold frames used in combination with expanded polytetrafluoroethylene Gore-Tex augmentation membranes (WL Gore) on two patients to create and maintain adequate space for the regeneration of bone. The membrane was sutured under the frame and the assembly was bent and adapted over the residual bony defect to create a dome and prevent the expanded polytetrafluoroethylene barrier membranes from collapsing into the defects. The framed membranes have also been positioned over dehisced implants. After a healing period of 12 months, a second-stage surgery procedure was performed to remove the gold frames and expanded polytetrafluoroethylene membranes and to connect the healing abutments. The gain of bone dimension was assessed by standardized measurements. On both patients the spaces created by the framed membranes were completely filled with newly regenerated bone. Biopsies from the treated sites revealed new bone formation.

The free rotated papilla autograft: a new bilaminar grafting procedure for the coverage of multiple shallow gingival recessions.

The aim of this clinical pilot study is to evaluate the possibility and from a statistical point of view, the predictability of a new mucogingival technique. The purpose of this surgical procedure is to cover the exposed buccal root surface with less than 5 mm clinical probing attachment loss either in corono-apical or mesio-distal aspects. This surgical procedure is particularly indicated in either single or multiple gingival recessions with perfectly preserved mesial and distal interproximal osseous crests, and with a papillary dimension not inferior to the defect which needs to be treated. A sharp incision is performed at a 90 degrees angle to the vestibule, following the mucogingival line. A sharp dissection is accomplished to create a partial thickness envelope flap on the underlying alveolar mucosa. The epithelium from the facial aspect of the papilla is debrided with a full thickness approach, the facial papillary tissue is removed from the underlying tissue bed. The papilla is then reversed in such a way that the base of the papilla is at the cemento-enamel junction (CEJ) and the apex is at the base of the gingival recession area. The papilla is then sutured in place and completely covered by a coronally displaced partial thickness flap. The results obtained either as root coverage, or as an aesthetic result, may be considered positive. This procedure has the decided advantage of a single surgical site, avoiding any palatal patient discomfort, good color compatibility with adjacent tissue, and healing by primary intention.

Vertical ridge augmentation: what is the limit?

The aim of this study is to show the possibility of achieving more than a 4-mm new vertical bone apposition on partially edentulous ridges. Six healthy, partially edentulous patients were treated from July 1993 to September 1993. After accurate radiographic investigation, all of the patients were treated using the Branemark System. After insertion, 14 fixtures were left circumferentially exposed for 37 mm. Autogenous bone graft harvested from a bone filter was placed around the exposed threads and completely covered with titanium-reinforced Gore-Tex augmentation membranes (TR-GTAM). Flaps were coronally displaced to passively cover the regenerative materials. Only one of the six membranes was exposed and it was removed immediately. After a 12-month healing period, the membranes were removed in conjunction with the second-stage surgical procedure. In the five cases where the membranes were kept covered, all of the available space underneath the TR-GTAM was filled with regenerative tissue. In all of the cases a histologic biopsy was performed. In one case all the space was filled with more than 7 mm of bone. In three cases all the space was filled with more than 5 mm of bone. In one case the most coronal part (approximately 1 mm) of the regenerative tissue was represented by connective tissue; the remaining tissue was represented by bone. The measurements demonstrated an average of vertical ridge augmentation of 4.95 mm. In the only case where the membrane underwent exposure and was then removed there was no regenerative tissue present.

Coronally positioned palatal sliding flap.

A new flap design, the coronally positioned palatal sliding flap, was used to cover barrier membrane placed over implants in one patient, and to provide localized ridge augmentation around implants in another patient. The method is a valid surgical approach because of the favorable risk-benefit ratio. The surgical technique is easy to to perform, and it is possible to obtain a sufficient sliding position of the palatal tissue. This new palatal flap design may be indicated for a variety of periodontal surgical procedures, including guided tissue regeneration and implant surgery.

Flap design considerations in the placement of single maxillary anterior implants: clinical report.

Existing flap designs can be modified to improve esthetics in resorbed anterior maxillary edentulous areas when single implants are treatment planned. A clinical report is presented.

The restoration of functional occlusion and esthetics.

Severe occlusal destruction, whether it results from attrition, abrasion, or erosion, must be met with definitive diagnosis and treatment. This case report illustrates the step-by-step diagnosis and treatment of a patient with severe occlusal wear. Restoration of a functional occlusion and esthetics involved endodontic treatment, reestablishment of the vertical dimension of occlusion, osseous periodontal surgery, and placement of single-tooth cast glass-ceramic crowns.

[Chlorhexidine in periodontal therapy]. / La clorexidina nella terapia parodontale.

Chlorhexidine a cationic antiseptic active against a wide spectrum of bacteria is widely and successfully used in the treatment of periodontal disease in the home and the outpatients' clinic. A review of the literature forms the basis for an assessment of the advantages and disadvantages of the various supra and subgingival application techniques with details of the limitations and risk/benefit ratio implicit in the various clinical situations.