The bone-added osteotome sinus floor elevation technique: multicenter retrospective report of consecutively treated patients.

A retrospective clinical evaluation of patients consecutively treated from multiple centers was performed. The treatment of these patients utilized the bone-added osteotome sinus floor elevation (BAOSFE) procedure with immediate implant fixation. The BAOSFE method employs a specific set of osteotome instruments to tent the sinus membrane with bone graft material placed through the osteotomy site. A total of 174 implants was placed in 101 patients. Implants were of both screw and cylinder shapes with machined, titanium plasma-sprayed, and hydroxyapatite surfaces from various manufacturers. The 9 participating clinicians used autografts, allografts, and xenografts alone or in various combinations, and the type of graft was selected by the individual clinicians. The choice of graft material did not appear to influence survival rates. Loading periods varied from 6 to 66 months. The survival rate was 96% or higher when pretreatment bone height was 5 mm or more and dropped to 85.7% when pretreatment bone height was 4 mm or less. The most important factor influencing implant survival with the BAOSFE was the preexisting bone height between the sinus floor and crest. This short-term retrospective investigation suggests that the BAOSFE can be a successful procedure with a wide variety of implant types and grafting procedures.

Regenerative therapy in the treatment of maxillary molar Class II furcations: case reports.

This report demonstrates the use of regenerative therapy in the treatment of maxillary molar Class II furcations. The predominant therapy provided was open debridement in combination with DFDBA, e-PTFE membranes, and citric acid root conditioning. Case reports of consecutively treated patients that include radiographs and reentry photographs demonstrate that maxillary molar furcations can be successfully treated with predictability.

Pedicle procedure use in the management of regenerative therapy problems.

Regenerating a periodontium that has been lost because of disease has been made possible by the use of demineralized freeze-dried bone allografts (DFDBA), guided tissue regeneration with e-PTFE membranes, and combination therapies involving DFDBA covered by either an e-PTFE membrane or calcium sulfate. During regenerative therapy, problems may arise because of an adverse mucogingival condition, loss of a papilla, or significant exposure of the membrane from soft-tissue recession, slough, or fenestration leading to direct exposure of the site to the oral environment. Pedicle procedures can be used to cover these regenerative sites while providing mucogingival repair.

Influence of smoking on long-term clinical results of intrabony defects treated with regenerative therapy.

This retrospective study compares the short-term (1 year) and long-term (2 to 5 year) clinical results of regenerative therapy in clinical private practice using a bone allograft for the treatment of intrabony defects in smokers and non-smokers. A total of 110 intrabony lesions were treated with demineralized freeze-dried bone allograft (DFDBA) following thorough defect debridement and root preparation in 53 patients (15 cigarette smokers and 38 non-smokers). Assessments of clinical attachment level (CAL) and probing depth (PD) were recorded at pre-treatment, 1 year post-treatment, and 2 to 5 years post-treatment. At 1 year post-treatment, significant gains in mean CAL were maintained for both smokers (2.7 mm) and non-smokers (3.4 mm). Similarly, significant reductions in mean PD were observed for smokers (3.0 mm) and non-smokers (3.8 mm) at the 1-year follow-up. However, when comparing relative improvements in clinical measures, smokers were found to exhibit significantly poorer treatment results (i.e., sites exhibited less CAL gain) at 1 year and 2 to 5 years follow-up. Relative to pre-treatment scores, differences in improvements observed for CAL at the 1-year evaluation (29.2% for smokers and 42.5% for non-smokers) were sustained in the subgroup of patients at 2 to 5 years follow-up (31.3% for smokers and 41.8% for non-smokers). Similar but non-significant trends were observed for relative reductions in probing depth for smokers and non-smokers at 1 year (41.9% for smokers and 49.3% for non-smokers) and 2 to 5 years follow-up (43.9% for smokers and 48.3% for non-smokers) for the subgroup of patients followed beyond 1 year. These results suggest that smoking adversely affects treatment outcome, as measured by gains in clinical attachment levels of intrabony defects treated by regenerative therapy using DFDBA.

Modifications of the subpedicle connective tissue graft technique: a predictable procedure for covering exposed roots.

This article reviews modifications to Nelson's technique for covering exposed roots using an autogenous connective tissue graft covered by a double papilla pedicle graft. Case reports will illustrate how this technique can be used for both root surfaces pathologically exposed to the oral environment and those previously restored with cosmetic bonding procedures. Enhancements of this procedure over Nelson's original description will be enumerated, and advantages over other root coverage modalities will be presented.

Adult orthodontics: periodontic and cosmetic enhancements.

Approximately 30 years ago it became apparent that the periodontal, occlusal, and restorative needs inherent in the therapeutic management of the stomatognathic system required repositioning the teeth or the entire dentition. Precedence in adult orthodontics concentrated on correcting diastemas and malpositioned teeth, leveling infrabony defects, reducing periodontal depths, leveling occlusal planes, and creating harmonious gingival-lip line relationships. The desired result can be obtained by any of these procedures, but the perception and acceptance of an improved appearance or a beautiful smile will determine the ultimate success for the patient.

Comprehensive treatment for a subcrestal fractured incisor in the mixed dentition.

This case report describes the treatment of a transversely fractured developing permanent central incisor in the mixed dentition of a 9-year-old patient. A comprehensive approach was followed combining endodontics, orthodontics, prosthodontics, and periodontics to maintain arch integrity and alleviate the need for tooth replacement by a fixed or removable prosthesis.