A patient with meningeal melanomatosis treated for periodontal disease with a bone regeneration procedure and dental implants: clinical and behavioral management to support medical compliance.

BACKGROUND: During the last three decades dental implants have become increasingly used in partially edentulous periodontally compromised patients. The type of bacteria in the peri-implant sulcus is influenced by the periodontal bacteria present on the surfaces of the remaining teeth. Peri-implant sulci of partially edentulous individuals harbour more motile rods and spirochetes than those of fully edentulous individuals. If Peri-implantitis arises, it may lead to implant failure. This complication occurs more frequently in patients with poor oral hygiene. This is a site-specific bacterial infection similar to that caused by periodontal bacteria around teeth and it should be prevented. AIM: This study was conducted to radiographically evaluate hard tissue response around 6 implants, over a 2-year period, in a previously surgically treated patient affected by severe chronic periodontitis. Psychological considerations and behavioral management of the patient are described. MATERIALS AND METHODS: A complex implant-perio-prosthodontic case of a 54-year-old man affected by meningeal melanomatosis with a history of generalized severe chronic periodontitis was recruited. A comprehensive periodontal examination around teeth was accomplished before periodontal and implant treatment. After diagnostic work-up, compromised teeth from 1.3 to 2.3 and from 3.2 to 4.2 were extracted. Tooth 1.7 was also extracted. Afterwards fixed provisional restoration rehabilitated all the natural dentition and the missing teeth. Endodonthic therapies were conducted on all the teeth due to high dentinal sensitivity and pre-prosthodontic crown reconstructions performed. Periodontal surgery with modified Widman flaps were then accomplished on all the teeth. Three months later four maxillary implants in position 1.3,1.1,2.1,2.3 and two mandibular implants in position 4.2,3.2 were inserted. During mandibular implants positioning, the mental mussels were isolated and detached to achieve proper guided bone regeneration. During implant surgery, due to systemic conditions concern, the patient underwent intravenous sedation. Five months later the implants and the teeth were rehabilitated with fixed metal-ceramic bridges. Regarding the upper prosthetic rehabilitation, the incisors marginal edges were kept vertical to the nasal spine, due to lack of previous reference points. According to the reference points previously determined, the difference in bone level between radiographs taken at implants insertion and at the maintenance appointments was calculated. RESULTS: The health of the periodontally treated teeth resulted greatly enhanced. The mean alveolar bore loss was 0,30 mm after a 2-year observation period. CONCLUSIONS: The control of the periodontal disease before implant insertion in patients with severe chronic periodontitis is of paramount importance, as well as a regular maintenance program is essential for the health of the periodontal and peri-implant tissues. The management of patients with complex needs requires a multidisciplinary team designed to meet all the patient's needs on various levels.

New technique for inter-implant papilla reconstruction between two or more implants in patients with variably reabsorbed ridges and flat anatomy. Preliminary results of a 9 consecutive clinical case series.

THE AIM OF THE WORK: Interimplant papilla reconstruction is difficult because the biologic width around an implant is apical to the implant-abutment connection and because the biologic width creates subcrestally. The aim of this study is to investigate whether the reconstruction of the interimplant papilla can be achieved by the use of an innovative surgical technique combined with scalloped implants, in the most severe surgical conditions, i.e. in variably reabsorbed ridges with flat anatomy. MATERIALS AND METHOD: Nine surgical sites, in eight consecutive patients, were treated with at least two adjacent scalloped implants and fixed prosthesis. 23 scalloped implants were placed using this new surgical technique on bone and soft tissue structures. One flat platform implant was also placed between two other scalloped implants. A total of 15 interimplant papillae were examined. RESULTS: 100% of papilla reconstruction at first prosthesis insertion. 13.3% failed to maintain interimplant papillae after 6 months and 20% after 12 months. Also, papilla reconstruction was maintained for 12 months in the mesial and distal embrasure spaces of the flat platform implant. CONCLUSION: The combination of the use of adjacent scalloped implants with this surgical approach, even in reabsorbed ridges with flat anatomy, may reform inter-implant bone peaks as support for the papillae.