The Use of Enamel Matrix Derivative to Modulate Wound Healing of Periimplant Soft Tissues

Following implant placement, at healing abutment connection, a soft tissue barrier defined peri-implant mucosa will form. The dimension of this anatomical structure seems to play a key role in maintaining long- term peri-implant and marginal bone level stability. In its early stages, soft tissue healing is a process involving many cellular and molecular events. Enamel Matrix Derivative (EMD) may improve and fasten soft tissue wound healing and inflammatory resolution. In the present split-mouth randomized clinical trial, EMD was used to influence the early phase of soft tissue healing around dental implants placed with a single-stage approach into a completely healed ridge. A total of sixty implants were inserted in thirty patients. In the test group, EMD was administered around the healing abutment before soft tissues were sutured. Soft tissue healing index (HI), together with secondary endpoints (clinical, radiographic and PROMs), was measured. Better outcomes were recorded in patients receiving EMD when considering all parameters. Data here presented supports the use of EMD improve and accelerate soft tissue wound healing around implants.

Synergy of Regenerative Periodontal Surgery and Orthodontics Improves Quality of Life of Patients with Stage IV Periodontitis: 24-Month Outcomes of a Multicenter RCT

In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery.

Clinical and Radiologic Evaluation of a Fully Tapered Implant with Immediate Placement in the Esthetic Zone: A Prospective Case Series Study

A fully tapered implant was recently introduced to increase primary stability and to be used in challenging situations. Twenty single implants were inserted in maxillary postextraction sockets, from premolar to premolar, and immediately restored. Marginal bone level (MBL) and probing depth (PD) were evaluated over a 12-month follow-up period. All implants osseointegrated, achieving a success rate of 100%. The difference in MBL between implant placement and 1 year later was 0.20 ± 0.04 mm, while PD was 2.82 ± 0.51 mm at 1 year. The data reported here support the use of a fully tapered implant for immediate placement and immediate provisionalization for single-tooth replacements in the esthetic area.

Bone and Soft Tissue Modifications in Immediate Implants Versus Delayed Implants Inserted Following Alveolar Ridge Preservation: A Randomized Controlled Clinical Trial. Part II: Radiographic Outcomes

This study evaluated the radiographic alterations that occur in immediate postextraction implants and in delayed implants inserted in a preserved ridge. In group A, an implant was placed immediately after tooth extraction, grafting the bone-to-implant gap. In group B, alveolar ridge preservation was performed after tooth extraction, and delayed implant placement was performed 4 months later. The final follow-up was 1 year after prosthetic loading in both groups. The marginal bone level (MBL) was measured at implant insertion (T1), at loading (T2), and at the final follow-up, 12 months after prosthetic loading (T3). At tooth extraction (T0) and T3, the horizontal ridge width (HW) was measured on CBCT scans at three different levels. No statistically significant differences in MBL or HW were found between the two study groups. The outcomes suggest that it is possible to maintain MBL and alveolar bone volumes regardless of whether the procedure is performed through immediate postextraction implant placement or through delayed implant placement in a preserved ridge.

Bone and Soft Tissue Modifications in Immediate Implants Versus Delayed Implants Inserted Following Alveolar Ridge Preservation: A Randomized Controlled Clinical Trial. Part I: Esthetic Outcomes

Soft tissue changes were evaluated over a period of 1 year in 48 patients who required extraction of a single tooth in the anterior maxillary arch (premolar to premolar) and its replacement with an implant. The patients were randomly divided into two groups: In group A, an immediate postextraction implant was placed, and the bone-to-implant gap was filled with bovine bone mineral; in group B, the alveolar ridge preservation technique was performed after extraction, and the implant was placed 4 months later. On the day of tooth extraction (T0) and 1 year after tooth extraction (T1), the soft tissue horizontal width, mesial and distal papillary levels, midfacial gingival level, and Pink Esthetic Score were evaluated in both groups. No significant differences were observed between the groups in any of the considered parameters. Statistically significant differences were found in the soft tissue horizontal width between T0 and T1. The clinical results of the two procedures were similar and comparable over time. When evaluating the stability of the soft tissue contour, and considering the specific indications of the two techniques, it is possible to choose either an immediate implant or an alveolar ridge preservation technique with staged placement.

Infection Control in Adult Periodontal Patients Using Ultrasonic Debridement and Erythritol Powder: A Randomized, Controlled, Split-Mouth Clinical Study

Ten patients with a diagnosis of generalized chronic periodontitis underwent nonsurgical periodontal therapy performed with the exclusive use of ultrasonic instrumentation and air polishing with erythritol powder. For each patient, four pockets with probing depths (PDs) of 4 to 10 mm were selected as experimental sites, and air polishing was performed either before (Group A) or after (Group B) ultrasonic scaling. PDs and clinical attachment levels significantly improved over a 12-month observation period. No significant difference was observed between the use of air polishing before or after ultrasonic instrumentation. The present clinical protocols could represent a suitable treatment for cause-related periodontal therapy.

Influence of Abutment Design and Platform Switching on Peri-implant Marginal Bone Level: A Randomized Controlled Clinical Trial with 1-Year Results

The purpose of this randomized clinical study was to evaluate the efficacy of platform-switching (PS) vs platform-matching (PM) implants when paired with a newly designed marginless abutment (MA) vs a conventional abutment (CA) in maintaining peri-implant tissue stability. Marginal bone level (MBL) and probing depth were measured up to 1 year postloading. Eighty implants were inserted in 42 patients and randomly assigned to one of four groups, each with a different implant/abutment configuration: Group 1 (PM+CA), Group 2 (PM+MA), Group 3 (PS+CA), and Group 4 (PS+MA). Data were collected at implant placement (T0), abutment placement (T1), final crown placement (T2), and 1 year postloading (T3). At the 1-year follow-up, MBL was more stable in Groups 3 and 4 compared to Groups 1 and 2. These results suggest that the role played by the implant-abutment connection (PS vs PM) is more important than the type of abutment preparation (MA vs CA).

The effect of timing of orthodontic therapy on the outcomes of regenerative periodontal surgery in patients with stage IV periodontitis: A multicenter randomized trial

AIM

To compare the outcomes after early (4 weeks post surgery) or late (6 months post surgery) orthodontic therapy (OT) following regenerative surgery of intra-bony defects (IDs).

MATERIALS AND METHODS

In a multi-center, parallel-group, randomized clinical trial, 43 patients with stage IV periodontitis were randomized to receive either early (n = 23) or late OT (n = 20) following regenerative surgery of IDs. Primary outcome was change in clinical attachment level (CAL) in one target ID at 12 months after surgery. Secondary outcomes were changes of probing pocket depth (PPD), bleeding on probing (BOP), and frequency of pocket closure.

RESULTS

No statistically significant differences between groups could be observed for CAL gain (5.4 mm [±2.1 mm] for early; 4.5 mm [±1.7 mm] for late OT). PPD was reduced by 4.2 mm (±1.9 mm) in the early group and by 3.9 mm (±1.5 mm) in the late group (p > .05). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects in early compared to 85% in late OT.

CONCLUSION

In the inter-disciplinary treatment of periodontitis stage IV, OT can be initiated already 4 weeks after regenerative surgery of IDs with favourable results, thus reducing the overall treatment time.

A Clinical Classification System for the Treatment of Postextraction Sites

A postextraction socket is always open to different treatment possibilities. A straightforward clinical classification may help evaluate which surgical approach is best suited for the case being treated. Four different classes are defined on the basis of the local anatomy of the site, available bone volume, and soft tissue level. For every clinical situation, either immediate placement, early placement, alveolar ridge preservation, or staged approach can be selected as a treatment modality according to the classifications listed.

Oral Care and Quality Evaluation: A Multicentric Study on Periodontal Treatment

PURPOSE

No information is available on the perception of the quality of care in patients treated for periodontitis. The purpose of this article was to assess how periodontitis-affected patients perceive the quality of periodontal treatment (PT) and to measure the factors which may influence it.

MATERIALS AND METHODS

306 subjects who completed PT were invited to participate. Questionnaires and visual analogic scales (VAS) evaluating perception of quality of care, symptoms, and oral health related quality of life (OHRQoL) were handed out. Oral and periodontal indicators were collected before and after treatment. The impact of different factors on perception of quality was assessed with a regression model.

RESULTS

Quality evaluation was high yet unrelated for both patients and clinicians (p = 0.983). Quality was negatively influenced by the number of residual oral infections (p < 0.001), patient's age (p = 0.07) and presence of residual pain at completion of PT (p = 0.02). Professionalism, kindness of the staff and communication skills were the characteristics mostly appreciated. The OHRQoL was influenced by the number of residual teeth (p < 0.001), increasing age of patients (p = 0.08), number of residual infections (p < 0.01) and pain (p = 0.04).

CONCLUSIONS

Patients' quality perception appeared to be influenced by clinical and emotional aspects. Oral care providers should be aware of the impact of non-clinical factors in patients' appreciation of quality of treatment.

Preservation of Peri-implant Soft Tissues Following Immediate Postextraction Implant Placement. Part II: Clinical Evaluation

Soft tissue contour changes were evaluated in 20 patients who underwent immediate implant placement with provisional restoration. The bone-to-implant gap was accurately grafted with xenograft prior to implant placement, and enamel matrix derivative was applied prior to delivery of an immediate screw-retained restoration. No significant differences were observed between baseline and 1 year after implant placement in soft tissue contour measurements and the Pink Esthetic Score. Furthermore, no differences were observed between thin or thick biotypes. It was shown that the use of immediate single-tooth implants with immediate restoration resulted in the maintenance of the soft tissue contour and esthetics when compared to pretreatment independently from the soft tissue phenotype.

Preservation of Peri-implant Hard Tissues Following Immediate Postextraction Implant Placement. Part I: Radiologic Evaluation

Immediate implant placement may represent a possible treatment plan for single tooth restoration. This study evaluated the insertion of osseointegrated implants in intact fresh extraction sockets in the anterior maxilla. The bone-to-implant gap was accurately grafted with a bovine bone mineral prior to implant engagement, and an immediate screw-retained restoration was delivered. After 3 months, the provisional crown was replaced with the definitive ceramic crown. Marginal bone levels remained stable after 1 year. The horizontal ridge dimension was also evaluated at three levels using CBCT scans after 1 year. The horizontal width of the postextraction crest was well preserved independently from the thickness of the buccal bone plate at baseline.

New Bone Formation Using an Extracted Tooth as a Biomaterial: A Case Report with Histologic Evidence

This case report aims to demonstrate the regenerative potential of particles obtained from a crushed extracted tooth. Following tooth removal, the clean root was ground and the dentin and cementum granules were grafted into a fresh extraction socket for a ridge preservation procedure. After 24 weeks, a successful implant placement was allowed. Tissue healing was evaluated by histologic and radiologic analysis. The volume of the ridge was preserved. Histologically, a dentin-bone complex was reported. New bone formation was evident, with an intimate contact between bone and both dentin/cementum. This novel procedure suggests the use of tooth particles as graft material.

Alveolar Ridge Preservation Using Tridimensional Collagen Matrix and Deproteinized Bovine Bone Mineral in the Esthetic Area: A CBCT and Histologic Human Pilot Study

Alveolar ridge preservation is of great importance for successful implant therapy. This study investigated the effects of a xenogeneic tridimensional collagen matrix (CM) in conjunction with deproteinized bovine bone mineral blended with 10% collagen (DBBM-C) on the healing of 12 intact extraction sockets in the esthetic area. Cone beam computed tomograpy examinations revealed nearly stable alveolar ridge dimensions (> 90% of the ridge horizontal dimension was preserved). New bone formation of approximately 45% and adequate resorption of the grafted material were histologically observed. Thus, application of CM together with DBBM-C using minimally invasive flapless approach can preserve the original ridge volume and support bone formation, contributing to adequate bone volume for implant insertion.

The role of dental implant abutment design on the aesthetic outcome: preliminary 3-month post-loading results from a multicentre split-mouth randomised controlled trial comparing two different abutment designs

PURPOSE

To evaluate whether there are aesthetic and clinical benefits to using a newly designed abutment (Curvomax), over a conventional control abutment (GingiHue).

MATERIALS AND METHODS

A total of 49 patients, who required at least two implants, had two sites randomised according to a split-mouth design to receive one abutment of each type at seven different centres. The time of loading (immediate, early or delayed) and of prosthesis (provisional crowns of fixed prosthesis) was decided by the clinicians, but they had to restore both implants in a similar way. Provisional prostheses were replaced by definitive ones 3 months after initial loading, when the follow-up for the initial part of this study was completed. Outcome measures were: prosthesis failures, implant failures, complications, pink esthetic score (PES), peri-implant marginal bone level changes, and patient preference.

RESULTS

In total, 49 Curvomax and 49 GingiHue abutments were delivered. Two patients dropped out. No implant failure, prosthesis failure or complication was reported. There were no differences at 3 months post-loading for PES (difference = -0.15, 95% CI -0.55 to 0.25; P (paired t test) = 0.443) and marginal bone level changes (difference = -0.02 mm, 95% CI -0.20 to 0.16; P (paired t test) = 0.817). The majority of the patients (30) had no preference regarding the two abutment designs; 11 patients preferred the Curvomax, while five patients preferred the GingiHue abutments (P (McNemar test) = 0.210).

CONCLUSIONS

The preliminary results of the comparison between two different abutment designs did not disclose any statistically significant differences between the evaluated abutments. However the large number of missing radiographs and clinical pictures casts doubt on the reliability of the results. Longer follow-ups of wider patient populations are needed to better understand whether there is an effective advantage with one of the two abutment designs.

Recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis

Air polishing was introduced as an alternative approach for the supra- and submucosal biofilm management at dental implants. An international expert meeting involving competent clinicians and researchers took place during the EUROPERIO 8 conference in London, UK, on 4 June 2015. Prior to this meeting a comprehensive systematic review dealing with the efficacy of air polishing in the treatment of peri-implant mucositis and peri-implantitis was prepared and served as a basis for the group discussions. This paper summarizes the consensus statements and practical recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis.

Evaluation of Dental Implants Placed in Preserved and Nonpreserved Postextraction Ridges: A 12-Month Postloading Study

Forty-eight single dental implants were inserted 4 months after tooth extraction following ridge preservation (RP; n = 24) or spontaneous healing (EXT; n = 24). During surgery, 1 (7%) of 24 implants in the RP group and 14 (58%) of 24 in the EXT group required additional bone grafting, and the implant stability quotient value was similar in the two groups. The survival rate of the implants in both groups was 100% at the 1-year follow-up. The success rate was 95.83% in the RP group and 91.66% in the EXT group. No statistically significant differences in the marginal bone level were detected between the two groups. Similar outcomes of implants inserted in preserved or spontaneously healed ridges can be anticipated, but the use of an RP procedure reduces the need for further bone augmentation.

Relationship between the buccal bone plate thickness and the healing of postextraction sockets with/without ridge preservation

In 48 postextraction sites, sockets were grafted with bovine bone mineral plus collagen membrane (test) or had spontaneous healing (control). After 4 months, horizontal ridge width reduction was 0.71 mm in the test group and 4.04 mm in the control group, while vertical ridge loss was 0.58 mm and 1.67 mm, respectively. No correlation was found between the thickness of the buccal bone wall and the alveolar bone loss in the test group, while an inverse correlation was found in the control group. Ridge preservation compensated for postextraction alveolar ridge resorption irrespective of the buccal plate thickness, whereas leaving the extraction socket undisturbed may result in alveolar bone loss.

Socket preservation using bovine bone mineral and collagen membrane: a randomized controlled clinical trial with histologic analysis

After tooth extraction, varying amounts of bone resorption occur because of qualitative and quantitative changes at the edentulous site of the alveolar process. The aims of this randomized controlled clinical trial were (1) to compare the postextraction changes in residual ridge dimensions during spontaneous healing with those during socket preservation, (2) to analyze the histologic and histomorphometric aspects of the grafted sockets, and (3) to compare probing procket depth (PPD) and clinical attachment level (CAL) changes at teeth adjacent to extraction sites. Forty-eight teeth were extracted from 41 patients referred for extraction of 1 or more maxillary or mandibular premolars or molars. The edentulous sites were randomly assigned to the control (EXT, extraction alone) or experimental groups (SP, extraction and socket preservation). In the SP group, the sockets were filled with bovine bone mineral and covered with porcine collagen membrane. At baseline and after 4 months, PPD, gingival recession (REC), and CAL were measured at teeth adjacent to the edentulous sites. The changes in ridge dimensions from baseline to 4 months were assessed on dental casts. At 4 months, bone was harvested from the grafted areas in the SP group and the edentulous areas in the EXT group. PPD, REC, and CAL were comparable between groups. However, from baseline to 4 months, the SP group showed significantly less reduction in ridge width (1.04 ± 1.08 mm vs 4.48 ± 0.65 mm, P < .001) and height (0.46 ± 0.46 mm vs 1.54 ± 0.33 mm, P < .001). Histologically, the grafted sockets exhibited various stages of bone maturation and formation without inflammatory responses. No significant difference in the mineralized and nonmineralized fractions was noted between the groups. Socket preservation using bovine bone mineral and porcine collagen membrane considerably limits the amount of horizontal and vertical bone resorption when compared with extraction alone.

Vertical ridge augmentation with the use of recombinant human platelet-derived growth factor-BB and bovine bone mineral: a case report

The present paper reports on a patient who underwent vertical ridge augmentation using recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in combination with a scaffold made of deproteinized bovine bone block. Forty-five days after the extraction of a mandibular central incisor, an NT (tapered profile) Osseotite implant was inserted into the extraction socket. A 9-mm vertical bone defect was present and treated with the use of a xenograft block infused with rhPDGF-BB. The soft tissues showed perfect healing after 2 weeks. After 6 months, reentry surgery was performed. At this time the clinical evaluation showed complete bone regeneration, with the presence of hard bonelike tissue all around the implant. Radiographic evaluation showed integration of the bovine xenograft with the residual basal bone, together with optimal bone-to-implant contact and a reorganization of the lamina dura on the interproximal sites of the adjacent teeth. The implant was then successfully restored with a metal-ceramic crown. This human report supports the use of rhPDGF-BB in combination with a bovine bone block for accomplishing challenging vertical ridge augmentation.

Healing of gingival recessions using a collagen membrane with a hemineralized xenograft: a randomized controlled clinical trial

This study compared the results following treatment of gingival recessions by a coronally advanced flap procedure alone (CAF) or combined with a bioabsorbable membrane and a demineralized xenograft (GTRF). Sixteen nonsmokers with 20 Miller Class I or Class II buccal gingival recessions at canines or premolars were included in the study. Sites were randomly assigned to either CAF treatment (control, n = 10) or GTRF treatment (test, n = 10) and examined at baseline and at 6 months postoperatively. Both treatments resulted in a significant reduction in recession and gain in clinical attachment level; there was no significant difference between treatments. No differences were found in probing depths among or between the groups. The increase in keratinized tissue from baseline to 6 months was slightly greater for the GTRF group than for the CAF group, but without statistical significance. The test group experienced a statistically significant increase in gingival thickness from baseline to the 6-month evaluation, while little gain was detected in the control group; the between-group difference was statistically significant in favor of the test group. Both procedures offer a predictable, simple, and convenient means of root coverage in Miller Class I and II recession defects, but the GTRF-supported procedure resulted in more keratinized tissue and a significant increase in gingival thickness than the CAF-only approach.

Orthodontics for the adult periodontal patient: first or second choice treatment?

In adult periodontal patients, pathologic tooth migration can create serious functional and aesthetic problems. In such situations, a combined orthodontic and periodontal treatment is indicated. Key point for obtaining positive outcomes is a status of periodontal health prior and during the orthodontic treatment. Orthodontic therapy has been shown to be a reliable therapy for restoring compromised dentitions, for closing infrabony defects, for reducing gingival recessions and improve interdental papilla levels. Based on these evidences, orthodontics can be considered as a first choice for the treatment of periodontal patients with tooth migration.

Preservation of the postextraction alveolar ridge: a clinical and histologic study

The aim of this investigation was to assess the possibility of preserving the buccal and lingual plates of a postextraction socket from resorption using bone filler after tooth extraction. In 10 patients, 10 single extraction sites in the posterior area received a bone substitute. The osteoconductive material was covered by a collagen membrane in all cases. Contour changes of the alveolar process were evaluated intraorally using a surgical caliper over a 4-month period. Four months after extraction, a specimen was harvested from the area previously augmented with bone filler, and histologic analysis was performed. The results demonstrated that it was possible to preserve about 85% of the initial ridge dimensions, allowing for correct implant placement. From a histologic point of view, new bone formation was detected in all sites, with a 25% average residual presence of the graft particles. This investigation confirms the benefit of augmenting an extraction socket with bone substitutes.

Immediate placement of implant into impacted maxillary canine extraction socket

Impaction of a maxillary canine is common. Orthodontic realignment is not always the therapy of choice. Instead, the impacted tooth can be extracted and replaced by an implant. The replacement of a single tooth with an implant in the anterior maxilla is a topic of interest for clinicians because of its esthetic implications, mostly when immediate loading has been planned. This article describes a clinical case in which an impacted maxillary canine was replaced by an immediately restored osseointegrated implant. A 21-year-old woman with a palatally impacted maxillary canine and the corresponding primary tooth still remaining in the arch was treated. Both the primary and permanent teeth were surgically extracted. A conical-shaped blasted implant was immediately placed into the socket of the primary canine. A self-contained osseous defect remained on the palatal aspect and was filled with bovine bone mineral. The implant achieved excellent primary stability, so it was immediately restored with a provisional acrylic resin crown in light centric occlusion. After 6 months, the definitive metal-ceramic crown was placed. The therapy provided an excellent esthetic result, maintaining ideal soft tissue contours and papillary height. No signs of radiolucency were visible at the 1-year evaluation. The case presented supports the use of single implants for the replacement of extracted primary teeth, especially in areas where esthetics is a high priority. Furthermore, because the prosthetic restoration was done immediately, the overall time needed to restore the patient was considerably reduced in comparison with the time required for the conventional approach.

Bio-Oss collagen and orthodontic movement for the treatment of infrabony defects in the esthetic zone

The aim of the present study was to evaluate whether it is possible to orthodontically move migrated teeth into infrabony defects augmented with a biomaterial. Three adult patients suffering from chronic periodontitis were treated. Each of the patients presented with an infrabony defect adjacent to a migrated maxillary central incisor. After cause-related therapy was completed, a surgical procedure was performed using the papilla preservation technique. The defects were filled with a collagen bovine bone mineral; after 2 weeks, an orthodontic device was activated using light, continuous forces. Orthodontic treatment time varied from 4 to 9 months; during this period, patients were enrolled in an oral hygiene recall program. At baseline and 6 months after the end of therapy, probing pocket depths (PPD) and clinical attachment levels (CAL) were assessed. In addition, the vertical and horizontal dimensions of the defects were measured on standardized radiographs. Residual mean PPD was 3.33 mm, with a mean reduction of 3.67 mm. Mean CAL gain was 4.67 mm. Radiologic vertical and horizontal bone fills were, on average, 3.17 mm and 2.0 mm, respectively. The present case series shows the effectiveness of a combined periodontic-orthodontic approach for the treatment of infrabony defects. Reduction of PPD to physiologic values, CAL gain, and radiologic defect resolution were obtained. No detrimental effects from the orthodontic movement were observed on the augmentation material.

Interdental papilla augmentation procedure following orthodontic treatment in a periodontal patient

BACKGROUND

The absence of the interdental papilla is a situation that may alter patients' esthetics. Recession of interproximal gingival tissues may be a consequence of periodontal disease, but in some cases it may also be a consequence of periodontal therapy, as a result of surgical or non-surgical procedures.

METHODS

The authors present a new multidisciplinary approach for the treatment of migrated maxillary incisors presenting infrabony defects, extrusion, and loss of the interdental papilla.

RESULTS AND CONCLUSION

The proposed clinical protocol may reconstruct the interproximal soft tissue, with esthetic improvement of the papillary level, together with resolution of the periodontal defects.

The Papilla Presence Index (PPI): A New System to Assess Interproximal Papillary Levels

The present article describes a classification system used to assess the interdental papillary height on natural teeth; the index can also be used in cases of lack of contact points and presence of diastemata. This system is particularly useful to define the loss of the interdental papilla because of periodontal disease and papilla reconstruction after periodontal treatment, particularly if tooth repositioning is involved. The index, based on esthetic evaluations, measures interproximal soft tissue height in relation to the CEJ, adjacent teeth, and the point corresponding to the ideal contact point. The four index scores are useful for an easy clinical assessment with respect to patient esthetics.

Reconstruction of the maxillary midline papilla following a combined orthodontic-periodontic treatment in adult periodontal patients

OBJECTIVE

The aim of the present study was to evaluate the role of a combined orthodontic-periodontic treatment in determining the reconstruction of midline papilla lost following periodontitis.

MATERIAL AND METHODS

Twenty-eight patients, with infrabony defect and extrusion of one maxillary central incisor, were treated. At baseline, all patients presented opening of the interdental diastema and loss of the papilla. At 7-10 days after open-flap surgery, the intrusive movement started. For each patient, probing pocket depth (PPD), clinical attachment level (CAL) and papilla presence index (PI) were assessed at baseline, end of treatment and after 1 year. PI was also evaluated independently in patients with narrow or wide periodontal biotype (NPB-WPB).

RESULTS

All parameters showed statistical improvement between the initial and final measurements, and showed no changes at follow-up time. The mean residual PPD was 2.50 mm, with a decrease of 4.29 mm, while the mean CAL gain was 5.93 mm. Twenty-three out of 28 patients improved the PI score at the end of therapy. No statistical difference was recorded in PI values between groups NPB and WPB.

CONCLUSION

The presented clinical protocol resulted in the improvement of all parameters examined. At the end of orthodontic treatment, a predictable reconstruction of the interdental papilla was reported, both in patients with thin or wide gingiva.

Reduction of gingival recession following orthodontic intrusion in periodontally compromised patients

OBJECTIVES

To evaluate the role of orthodontic intrusion and alignment in the reduction of gingival recession (REC) around maxillary incisors of adult periodontal patients. Design - Prospective clinical study.

SETTING AND SAMPLE POPULATION

Twenty-eight consecutively treated adult patients, suffering from severe chronic periodontitis and with one upper central incisor extruded and infrabony defect on its mesial site. All patients were seen in a private practice in Turin, Italy. At baseline, all patients presented with REC on the buccal and mesial aspects of the treated teeth.

MEASUREMENTS AND RESULTS

For each patient probing pocket depth (PPD) and REC were assessed at baseline, at the end of treatment and 1-year after the end of treatment. REC was also evaluated independently in patients with narrow (NPB) or wide periodontal biotype (WPB). All parameters showed improvement between initial and final measurements statistically, and showed no changes between final and follow-up measurements. Mean mesial PPD decrease was 4.29 mm, with a residual PPD of 2.50 mm. Mean REC reduction was 0.96 mm on the buccal sites and 1.71 mm on the mesial. No statistical difference was recorded on REC values between groups NPB and WPB.

CONCLUSION

The presented clinical protocol resulted in improvement of all parameters examined. At the end of orthodontic treatment a predictable reduction of REC was reported, both in patients with thin or wide gingiva.

Orthodontic Movement into Infrabony Defects in Patients with Advanced Periodontal Disease: A Clinical and Radiological Study

BACKGROUND

In cases of advanced periodontal disease with a pathologic flaring of frontal teeth, a combined periodontic-orthodontic therapy may be a reliable approach in order to solve both functional and esthetic problems. The aim of the present study was to evaluate the periodontal tissue alterations following periodontal surgery and orthodontic intrusion in migrated upper central incisors with intrabony defects.

METHODS

Ten patients with advanced periodontal disease and an extruded maxillary central incisor infrabony defect at its mesial aspect and probing depth (PD) > or = 6 mm were included in the present study. At baseline, PD and clinical attachment level (CAL) were measured. The vertical and horizontal dimensions of the defects were assessed on standardized radiographs. Seven to 10 days after surgery the active orthodontic treatment started using the segmented arch technique, in order to intrude and move the teeth into the defects. Maintenance therapy was performed every 2 to 3 months until the orthodontic treatment was completed.

RESULTS

At the end of treatment, mean PD reduction was 4.35 mm, with a residual mean PD of 2.80 mm. Mean CAL gain was 5.50 mm. The mean radiological vertical and horizontal bone fills were, respectively, 1.35 mm and 1.40 mm. All differences were of statistical significance (P<0.001).

CONCLUSION

The present study showed that the combined orthodontic and periodontic therapy performed resulted in the realignment of extruded teeth with infrabony defects, obtaining a significant probing depth reduction, clinical attachment gain, and radiological bone fill.

The use of orthodontic intrusive movement to reduce infrabony pockets in adult periodontal patients: a case report

Clinicians often encounter osseous defects that are best treated by conventional surgical techniques, including bone grafting and guided tissue regeneration, with a goal of establishing a new connective tissue attachment. On occasion, the recognition of an infrabony defect proximal to a tooth with a large diastema may present an opportunity to consider resolution by orthodontic tooth movement. Ideally, the tooth could be moved in the proximal direction until there was no further radiographic or clinical evidence of the predisposing defect. The authors decided to treat an advanced case of adult periodontitis, with extrusion and migration of a maxillary central incisor, using a multidisciplinary approach. Radiologically, a large infrabony defect was present on the mesial aspect of the incisor, with an initial probing depth of 9 mm. After the surgical periodontal therapy, the orthodontic movement started and the incisor was repositioned using an intrusive mechanism, also leading to the closure of the diastema. At the end of the treatment, there was a significant clinical decrease in the probing depth values, and radiographs showed a remarkable reduction of the infrabony defect volume.

Orthodontic movement into bone defects augmented with bovine bone mineral and fibrin sealer: a reentry case report

Periodontal disease can lead to migration of anterior teeth with the presence of infrabony defects. This creates the opportunity for treating such patients with a combined orthodontic-periodontic treatment. In the presented clinical case, an adult periodontal patient with extrusion of the maxillary central incisors and an infrabony defect on their lingual aspects was treated. During the surgical procedure, the bone defects were augmented with a combination of porous bovine bone mineral (Bio-Oss) and a fibrin-fibronectin sealing system (Tissucol). Ten days after surgery, the active orthodontic treatment started, and the teeth were intruded and realigned, moving the roots into the defects. After 6 months, the orthodontic appliances were removed and the teeth were retained by means of a resin-bonded splint. At this time, reduction in probing pocket depth and gingival recession was detected. Twelve months after the initial surgery, a reentry procedure was performed, showing complete filling of the predisposing defects with the presence of bone-like hard tissue. These clinical results suggest that teeth can be successfully moved and intruded into bone defects previously augmented with bovine bone substitute and fibrin glue. During the orthodontic treatment, this combined augmentation material was able to be replaced by bone-like hard tissue. At the end of the therapy, an improvement in esthetics and periodontal health status was registered.

Intrusion of migrated incisors with infrabony defects in adult periodontal patients

This report describes the orthodontic treatment of 10 adult patients who had severe periodontal disease, with migration and radiological evidence of an infrabony defect on a maxillary central incisor. Orthodontic tooth movement, using light and continuous forces, was initiated 7 to 10 days after periodontal surgical therapy. Mean orthodontic treatment time was 10 months. Before surgery and at the end of orthodontic treatment, the following parameters were registered clinically and with standardized intraoral radiographs: probing depth, clinical crown length, marginal bone level, bone defect radiological dimension, and root length. Comparison of pre- and posttreatment values showed a statistically significant improvement for all parameters without a remarkable decrease of root length. The mean residual probing depth was 2.80 mm, and the mean intrusion of the incisors was 2.05 mm. Moreover, radiographs showed a reduction of the infrabony defects. These results show the efficacy of a combined orthodontic-periodontal approach. Intrusive movement, after proper periodontal surgical therapy, can positively modify both the alveolar bone and the soft periodontal tissues.

Bodily tooth movement through the maxillary sinus with implant anchorage for single tooth replacement

Movement of teeth through anatomic limitations, such as the maxillary sinus, can be a reliable therapeutic protocol if suitable force systems are used. We report here the outcome of a treatment based on this concept. The patient exhibited pneumatization of the maxillary sinus resulting from earlier extractions. She was treated using an endosseous implant inserted in the retromolar region to serve as orthodontic anchorage and a T-loop appliance fabricated from TMA wire to bodily move an upper second premolar through the sinus. After 6 months, at the end of the displacement, a titanium implant was inserted in the alveolus of the moved tooth and a single crown restoration was placed. The premolar moved through the sinus maintaining its support apparatus and bone. At the end of treatment the implant used for anchorage was still osseointegrated.

Resin-bonded fixed partial dentures and splints in periodontally compromised patients: a 10-year follow-up

In the present study, 139 periodontally compromised patients received a complete periodontal treatment; in 104 cases this was followed by orthodontic treatment. At the end of the entire therapy, a total of 150 Maryland restorations (69 resin-bonded fixed partial dentures and 81 resin-bonded splints) was placed and then followed for a period of up to 10 years (mean 6.7 y). Thirteen fixed partial dentures and 16 splints failed during the observation period; the 10-year cumulative survival rate from lifetable analysis was 76.2% (70.6% for fixed partial dentures and 80.7% for splints).

Long-term evaluation of osseointegrated implants in regenerated and nonregenerated bone

This investigation evaluated the predictability of dental implants subjected to bone regeneration procedures at the time of insertion. Fifty-two test implants were inserted into sites with periimplant bone defects. A calcium carbonate allograft material with or without a fibrin-fibronectin sealing system was used to fill the defects. Sixty control implants were inserted into an adequate volume of nonaugmented bone. Each of the 29 study patients received at least one test implant and one control implant. At the second-stage surgery, fill of the bone defect was assessed as complete or incomplete. The cumulative success rate was 91.7% (mean follow-up 55 mo) for the test implants and 93.2% (mean follow-up 59 mo) for the control implants. Within the test group, implants with complete bone fill achieved 97.6% success versus 59.1% success for implants with incomplete bone fill. These preliminary results suggest that implants placed with simultaneous bone regeneration procedures achieve long-term predictability that is comparable to that of implants placed in an adequate volume of bone, provided that complete bone fill of the periimplant defect is achieved. Long-term studies with other augmentation materials are needed to fully validate these findings.

Orthodontic treatment in periodontally compromised patients: 12-year report

This work describes the therapeutic protocol of combined orthodontic-periodontal treatment and evaluates the effectiveness of surgical and nonsurgical periodontal therapy in the maintenance of a healthy periodontal status after the orthodontic treatment. Surgical periodontal treatment was performed in 267 patients affected by severe periodontal disease, and 128 patients had nonsurgical treatment. For each patient the mean value of probing depth (mPPD) and the rate of positive bleeding on probing (%BoP) of the teeth involved in the orthodontic movement were registered before the start of the periodontal treatment, at the end of the orthodontic treatment, and 2, 4, 6, 10, and 12 years after the end of the orthodontic treatment. Comparison between pretreatment and posttreatment values and between pretreatment and follow-up values showed a decrease in mPPD and %BoP that was of statistical significance. The difference between posttreatment and follow-up values was not statistically significant. These results suggest that orthodontic treatment is no longer a contraindication in the therapy of severe adult periodontitis. In these cases orthodontics improve the possibilities of saving and restoring a deteriorated dentition.