An Atraumatic Approach to Internal Sinus Lifting: The Motorized Expansion Drill Technique.

This case series demonstrates internal maxillary sinus elevation and placement of 37 posterior implants in 34 private practice patients using sequential motorized expander burs exclusively to infracture the sinus border and embed bone graft material (allograft or xenograft) for vertical augmentation. With this technique, manual osteotome/malleting was completely avoided, improving surgical control and the patient experience. Sinus borders were lifted by a mean of 3.92 mm in ridges that had an average residual height of 7.52 mm. All implants achieved high insertion torque values (≥90 Ncm), obtained primary stability, and were successfully restored without complications. Anecdotally, the type of bone graft used did not appear to influence the outcome.

Papillary Retention Flap Design for Pocket Reduction/Regeneration: Case Series With Long-Term Follow-Up.

Many papillary preservation flap techniques exist for both resective and regenerative purposes. This article describes a papillary retention design based on palatal access showing a successful long-term outcome. The papilla preservation approach detailed here, which is a modification of Friedman's beveled flap for the palate, circumvents any manipulation of interproximal or buccal tissue, leaving papillary tissue untouched. Indications for this approach are very specific and its application is somewhat limited. However, the aim of the papillary retention flap as discussed is to eradicate pocket depths exceeding 5 mm and possibly regenerate hard and connective tissue in these exclusive locations. This strategy may permit access to the labial portion of the interproximal root in particular cases.

Guided Gingival Growth: Improving Aesthetics During Second-Stage Surgery.

GGG is a conservative, efficient, and relatively straightforward treatment for mild soft-tissue deficits. When applied within its limitations, it may be a valuable tool for aesthetic refinement around dental implants.

Dental Implants.

Dental implants restore function to near normal in partially or completely edentulous patients. A root-form implant is the most frequently used type of dental implant today. The basis for dental implants is osseointegration, in which osteoblasts grow and directly integrate with the surface of titanium posts surgically embedded into the jaw. Radiologic assessment is critical in the preoperative evaluation of the dental implant patient, as the exact height, width, and contour of the alveolar ridge must be determined. Moreover, the precise locations of the maxillary sinuses and mandibular canals, as well as their relationships to the site of implant surgery must be ascertained. As such, radiologists must be familiar with implant design and surgical placement, as well as augmentation procedures utilized in those patients with insufficient bone in the maxilla and mandible to support dental implants.

The dependability of connective tissue grafting for the resolution of full-mouth recession.

Based on its ability to treat a broad range of mucogingival defects and predictability, autogenous subepithelial connective tissue grafting (CTG) remains the standard of care for gingival recession. Its advantages often outweigh the drawbacks, which include the preparation of a second surgical site (typically in the palate) for donor tissue collection and a finite volume of graft material available. Extensive recession requires multiple CTG surgeries and palatal re-entry. This case report documents successful full-mouth CTG performed in four sessions over 3 years. Complete root coverage was obtained around all but one of 24 teeth.

Medical contraindications to implant therapy: Part II: Relative contraindications.

Systemic conditions and habits influence dental implant survival to varying degrees. Illnesses that impair the normal healing cascade worsen surgical success. The mere presence of a disease, however, does not necessarily preclude implant therapy or affect significantly long-term outcomes. Certain disorders, when controlled, or other situations allow implant survival rates that match those in health. This paper reviews these relative contraindications, which include adolescence, aging, osteoporosis, smoking, diabetes, positive interleukin-1 genotype, human immunodeficiency virus positivity, cardiovascular disease, and hypothyroidism.

Medical contraindications to implant therapy: part I: absolute contraindications.

In order to ensure implant success, it is essential to select patients who do not possess local or systemic contraindications to therapy. Hence, it is the purpose of this paper to review the medical diseases that reportedly preclude conventional dental implant treatment. Absolute contraindications to implant rehabilitation include recent myocardial infarction and cerebrovascular accident, valvular prosthesis surgery, immunosuppression, bleeding issues, active treatment of malignancy, drug abuse, psychiatric illness, as well as intravenous bisphosphonate use. Any of these conditions bar elective oral surgery, and require judicious monitoring by the physician as well as the dental provider. Noncompliance to the suggested protocol may, in the worst possible case, result in patient mortality.

Flap thickness as a predictor of root coverage: a systematic review.

BACKGROUND: Thick gingival tissue eases manipulation, maintains vascularity, and promotes wound healing during and after surgery. A few recent case reports correlate greater flap thickness to mean and complete root coverage after mucogingival therapy for recession defects. The aim of this systematic review is to appraise the current literature on this subject and to combine existing data to verify the presence of any association between gingival thickness and root coverage outcomes. METHODS: Human studies that reported the number and class of recessions, measured flap thickness at a well-defined location, described the method of root coverage used, followed results for at least 3 months, and detailed mean root coverage underwent review and statistical analysis. Investigations were scored from 1 to 5 based on methodological quality. Weighted gingival thickness and weighted mean root coverage was calculated based on standard error. Statistical analysis used the Mann-Whitney test, analysis of variance (ANOVA), and linear regression to determine any correlation between a number of factors (i.e., thickness, treatment type, and follow-up time) and mean and complete root coverage. A significant P value was set at <0.05. RESULTS: Fifteen investigations met the inclusion criteria. All of these reported at least 0.7 mm of flap thickness, although measurement locations varied. Treatment modalities included coronally advanced flap, connective tissue graft, and guided tissue regeneration with and without adjuncts. A significant moderate correlation occurred between weighted flap thickness and weighted mean root coverage and weighted complete root coverage (r = 0.646 and 0.454, respectively). According to Mann-Whitney analysis, a critical threshold thickness >1.1 mm existed for weighted mean and complete root coverage (P <0.02). The type of treatment rendered also influenced root coverage. Further simple linear regression revealed a high correlation between weighted thickness and weighted mean root coverage in connective tissue grafting and guided tissue regeneration (r = 0.909 and 0.714, respectively) but not coronally advanced flap therapy. Study score and follow-up time did not affect the percentage of root coverage. CONCLUSION: Within the limits of this review, a positive association exists between weighted flap thickness and mean and complete root coverage.

Effects of ceramide inhibition on experimental radiation-induced oral mucositis.

OBJECTIVE: Oral mucositis (OM) is a common toxicity of ionizing radiation (IR), which is used as treatment for head and neck cancer. Ceramide-mediated apoptosis may contribute to the pathogenesis of mucositis. In response to IR or other cellular stresses, ceramide production occurs either by the hydrolytic action of sphingomyelinase (SMase) or de novo via ceramide synthase. STUDY DESIGN: Male golden Syrian hamsters (10 per group) exposed to a single dose of 40 Gy ionizing radiation (day 0) were treated with subcutaneous 0.2 mL injections of either neutral SMase, acidic SMase, or ceramide synthase inhibitor (5 mmol/L glutathione, 5 micromol/L desipramine, or 1 micromol/L fumonisin B1, respectively) from day -1 to day 16. A control group was treated with saline. Two blinded examiners assessed clinical OM development from day 6 to day 26. Two animals per group were killed on days 3, 10, and 16 for immunohistochemical detection of ceramide expression in both the epithelium and in the connective tissue. RESULTS: The group exposed to fumonisin B1 exhibited a statistically significant reduction in mean daily weight gain, mean mucositis score, duration of mucositis, and expression of ceramide in the epithelium on day 3 as well as in the connective tissue on days 10 and 16 relative to control. Immunohistologic analysis also revealed significant differences in ceramide expression on days 3 and 16 for animals treated with glutathione in both the epithelial and connective tissue when compared to the control. CONCLUSIONS: These results suggest that IR triggers early de novo ceramide production and that inhibition of this process attenuates OM on a clinical level.