Ridge augmentation with guided bone regeneration and GTAM case illustrations.

The principle of Guided Bone Regeneration (GBR) can be used for Ridge Augmentation. These case illustrations describe the technique using Autogenous Cortico-Cancellous Bone Grafts and stabilization with Miniscrews and placement of a GTAM Barrier Membrane. Nyman et al (1990) published the first report of enlargement of a reduced alveolar ridge. Becker & Becker, Jovanovic, Buser et al have documented successful regeneration of such ridges. A study by Lang et al established that: 1. An undisturbed healing period of at least six months is required for optimal bone regeneration. 2. Smaller defects (less than 70 mm.3) regenerate almost completely. 3. Larger defects (greater than 90 mm.3) regenerate 90-93 percent and bone grafts may enhance success in larger defects. 4. Premature membrane removal will result in incomplete regeneration. Buser et al have described the technique of GBR in detail. They found the creation and maintenance of a secluded space is essential for successful outcome with GBR procedures. This space allows for the in growth of osteogenic cells so that bone regeneration is undisturbed by competing non-osteogenic soft tissue cells. Space-making defects such as extraction sockets are simple to treat, but localized ridge augmentation may be difficult because the membrane is not supported by bony walls. E-PTFE membranes have been reinforced with titanium struts and mini screws have been developed as a way of dealing with membrane collapse. Buser et al began to utilize autogenous bone grafts to support the membrane and to act as an osseoinductive scaffold for bone regeneration. They utilized a cortico-cancellous block graft in the centre of the augmentative area with smaller chips to fill in the periphery. The cortical portion of the graft re-establishes the buccal cortex and the cancellous portion is placed against the host bone. The host bone is perforated to open the marrow spaces. Placement of membrane protects the bone graft (up to 50 percent of grafted bone is lost through resorption in augmentation procedures where membrane is not used).

Immediate implant post-surgical complications.

Immediate surgical implants provide a convenient means of replacing missing teeth without requiring hard tissue reduction of restoration-free potential fixed partial denture abutments. Although the procedure is described as "predictable," complications and failures do occur. This report presents four cases of immediate implant complications and their management, and discusses possible causes of the untoward results. Careful pre-operative planning, adequate surgical technique and post-surgical management, timely and suitable loading, and meticulous hygiene maintenance can serve to minimize implant complications and failures. The prospective immediate implant patient must be provided with sufficient information to allow informed consent to be given. Minimal requirements are a description of the procedures in terms the patient can understand, an explanation of potential risks and complications, and adequate disclosure of information about alternative therapies.

Acute periodontal abscess associated with an immediate implant site in the maintenance phase: a case report.

This article describes a complication that occurred with root-form implants: an acute periodontal abscess associated with an implant during the maintenance phase. The clinical treatment is outlined, as are the results achieved.

In vivo fracture of a basket-type osseointegrating dental implant: a case report.

Complete circumferential fracture of a basket-type implant 12 months postrestoration is described.

Effects of citric acid treatment on autogenous free graft coverage of localized recession.

Citric acid root conditioning prior to free gingival autograft (FGA) coverage of denuded roots may increase the likelihood of reattachment, but controlled studies to determine the value of the procedure have not been done on human subjects. This investigation was done to compare the effects of FGA root coverage with and without citric acid pretreatment. Nineteen patients with 30 affected teeth participated in the study. Fifteen teeth received FGAs without citric acid pretreatment and 15 teeth received FGAs with citric acid pretreatment. Measurements of gingival recession and sulcus depth were made preoperatively and 30, 60 and 90 days following the surgical procedure. Free gingival autografts with and without citric acid pretreatment each significantly reduced the amount of exposed root, but no differences between groups were found. Except for the 90-day single tooth control group, mean sulcus depths were significantly decreased at 30, 60 and 90 days, but there were no differences noted between single tooth citric acid and control groups or multiple tooth citric acid and control groups. Citric acid treatment of affected roots prior to FGA coverage does not appear to be justifiable.

Root resorption associated with placement of a ceramic implant. Report of a case.

Ceramic grafting material was used to treat a vertical osseous defect associated with a maxillary left lateral incisor tooth. The area was monitored at maintenance appointments. Root resorption was detected radiographically 12 months after grafting. At 18 months, resorption was evident clinically in the presence of moderate inflammation.

Effects of citric acid treatment on pedicle flap coverage of localized recession.

Citric acid conditioning of denuded roots prior to laterally positioned pedicle flap (LPPF) coverage may increase the likelihood of reattachment, but no controlled studies to determine the efficacy of the procedure in managing naturally occurring defects in humans have been reported. This investigation compared the effects of LPPF root coverage with and without citric acid (pH1) pretreatment in a group of patients with gingival recession and associated denuded roots. Thirty-six patients participated in the study. Eighteen received LPPFs without citric acid pretreatment and 18 received LPPFs with citric acid pretreatment. Gingival recession and sulcus depth were measured preoperatively and 30, 60 and 90 days after the surgical procedure. LPPFs both with and without citric acid pretreatment reduced significantly the amount of exposed root, but no differences between groups were found. For sulcus depth, the 90-day value for the citric acid group was significantly increased over the preoperative level, but no other changes were noted. There appears to be no clinical justification for using citric acid conditioning as an adjunct to LPPF coverage of denuded roots.