Staged Approach of Frenectomy Followed by Modified Tunnel and Subepithelial Connective Tissue Graft in Single Mandibular Anterior Recessions: A Clinical Report of Three Cases.

This case report proposes a unique approach for managing Cairo gingival recession types 1 and 2 (RT1 and RT2, respectively) in the mandibular anterior region, where anatomical features such as a high frenal attachment or a shallow vestibule preclude the use of a coronally advanced flap. Three systemically healthy patients presenting with Cairo RT1 and RT2 gingival recessions were included. The recessions were managed with a staged approach of frenectomy followed by a modified tunnel in combination with connective tissue graft. Significant root coverage was achieved in all three cases. This treatment approach allows for root coverage, relief of frenal pull, keratinized tissue gain, and increased vestibular depth in very challenging Cairo RT1 and RT2 gingival recessions in mandibular anterior teeth. A short-term follow-up of 3 to 6 months showed stable results in all presented cases.

Immediate versus delayed loading of mandibular implant-retained overdentures: A 60-month follow-up of a randomized clinical trial.

AIM: The purpose of this observational, post-trial follow-up study was to evaluate 60-month outcomes of a randomized controlled clinical trial that compared immediately and delayed loaded two unsplinted implants, supporting a locator-retained mandibular overdenture. MATERIALS AND METHODS: Patients from a randomized controlled clinical trial, treated with either immediate or delayed loading of two implants, supporting a locator-retained mandibular overdenture, were recalled for 60-month evaluation. Patients underwent a clinical and radiographic examination to evaluate the peri-implant soft tissue parameters and bone. Prosthetic maintenance needs and complications were also recorded. RESULTS: Twenty three of the 30 patients were available for the 60-month follow-up. The mean radiographic bone level change measured using standardized periapical radiographs from baseline to 60 months was 0.89 mm (±0.74) and 0.18 (±0.41) for delayed loading and immediate loading groups, respectively. A statistically significant difference was observed at 60 months with a smaller radiographic bone level change in the immediate loading group. No implants were lost between 12 and 60 months. At 60 months, per-protocol implant survival rate was 100% for both the groups. No difference was found in the peri-implant soft tissue parameters and prosthetic needs between the groups. CONCLUSION: Both immediately and delayed loaded implants supporting a locator-retained mandibular overdenture showed similar clinical outcomes.

Releasing Incisions Using Upward-Motion Scissors Technique for Flap Mobilization for Guided Bone Regeneration or Periodontal Surgery: Technical Introduction and a Case Report.

Flap management is one of the key elements for success in periodontal surgeries and bone regeneration for dental implants. The aim of this article is to introduce a releasing incision method for effective flap advancement to obtain tension-free primary closure. The 'upward-motion scissors technique' (UMST) involves the use of surgical scissors handled with an upward motion to create multiple shallow incisions. The use of UMST is demonstrated in an anatomically challenging case requiring bone augmentation. This technique provides a novel approach for flap advancement and may reduce potential complications involved in releasing incisions. The true benefit of UMST needs to be evaluated in future studies.

Marginal Bone Response Around Immediate- and Delayed-Loading Implants Supporting a Locator-Retained Mandibular Overdenture: A Randomized Controlled Study.

PURPOSE: Implant-supported mandibular overdentures (OVDs) have been proposed as the gold standard for the treatment of edentulous mandibles. There is limited evidence on the clinical outcomes of immediate loading of two unsplinted implants supporting a mandibular OVD. The purpose of this randomized controlled trial was to evaluate the performance of two unsplinted implants supporting a Locator-retained mandibular OVD over 12 months loaded immediately or after a delay. MATERIALS AND METHODS: Each patient received two implants 4.0 mm in diameter and 8 to 15 mm long. Locator-retained mandibular OVDs were connected to the implants either immediately (IL) or 3 months postsurgery (DL). The primary response variable was radiographic bone loss (RBL) at 6 and 12 months postsurgery. Implant length, insertion torque, implant failure, prevalence of maintenance visits, and prosthetic complications were also recorded. RESULTS: Thirty participants (15 in the IL and 15 in the DL groups) were evaluated at 12 months. The implant cumulative survival rates were 100% and 93% for DL and IL, respectively. The mean RBL from baseline to 1 year was 0.54 (± 0.5) mm and 0.25 (± 0.5) mm for DL and IL, respectively. A statistically significant difference was observed at 12 months, with less RBL in the IL group. Insertion torque and implant length were not correlated with RBL. Also, no difference in frequency of maintenance visits and prosthetic complications was reported between the groups. CONCLUSION: Immediate loading of two unsplinted implants supporting a Locator-retained mandibular OVD seems to be a suitable treatment option. Significantly less RBL was observed after 1 year of loading around IL implants than around DL implants. Furthermore, neither implant length nor insertion torque seemed to affect RBL 1 year after surgical placement.