Treatment of Multiple RT1 Gingival Recessions Using a Coronally Advanced Flap Associated with L-PRF or Subgingival Connective Tissue Graft from Maxillary Tuberosity: A Randomized, Controlled Clinical Trial

The goal of plastic periodontal surgery is to obtain complete root coverage, increasing gingival thickness (GT), a positive prognostic factor for gingival margin stability over time. The aim of this study was to compare the effectiveness of the Coronally Advanced Flap (CAF) in RT1 (GR; gingival recession with no loss of interproximal attachment) when associated with a connective tissue graft from the maxillary tuberosity (tCTG) or with leukocyte and platelet-rich fibrin (L-PRF) membranes in obtaining root coverage and increasing the thickness and width of the keratinized tissue, along with aesthetic improvement, taking into account a number of patient-related outcomes. Thirty patients with two adjacent RT1 GRs (GRs with no loss of interproximal attachment) were each treated using CAF associated with tCTG (15 patients) or L-PRF. The main outcome was a GT increase; secondary outcomes were keratinized tissue width (KT), gingival recession (GR), probing depth (PD), clinical attachment level (CAL), root coverage percentage (RC%), complete root coverage (CRC), and root coverage esthetic score (RES). Patient-reported outcomes were discomfort (D), dentine hypersensitivity (DH), patient-related esthetic score (PRES), and overall treatment satisfaction (OTS). After 12 months, clinical and patient-reported parameters did not show significant differences between groups, with the only exception being a GT gain, which was significantly greater in the CAF + tCTG group. Our results showed that both techniques were effective in treating RT1 GRs, with comparable patient-related outcomes. However, the use of tCTG produces significantly thicker tissue, covering the exposed root surface.

Three-Dimensional Assessment and Comparison of the Maxillary Tuberosity Between Skeletal and Dental Class I and Class II Adults in Maxillary Third Molar Agenesis Using Cone Beam Computed Tomography: A Descriptive Cross-Sectional Human Study

AIM AND OBJECTIVE

The objective of this study was to assess and compare the dimensions (width (W), height (H), and length (L)) of the tuberosity distal to maxillary permanent second molar in individuals with skeletal and dental Class I and Class II malocclusions who had maxillary third molar agenesis.

METHODOLOGY

Cone beam computed tomography (CBCT) was used to measure the left (L) and right (R) anatomical tuberosity dimensions in three dimensions using the WillMaster software (HDX WILL Corporation, Korea). The measurements were compared between Class I (n = 35) and Class II (n = 35) normo-hypodivergent adult subjects. The dimensions were measured at regular 2 mm intervals from the cementoenamel junction (CEJ) and distovestibular root of the maxillary second molar in terms of the width (e.g., W1, W2, and W3), height (e.g., H1, H2, and H3), length (e.g., L1, L2, and L3) to the posterior limit of the tuberosity. Statistical analysis included descriptive statistics, Mann-Whitney U tests, and intraclass correlation coefficient tests.

RESULTS

The width of the tuberosity at LW0, LW1, and LW2 was significantly higher in Class I compared to that in Class II. The right tuberosity in Class II showed significantly higher values in height at all reference points. The right tuberosity at RL0 and RL1 exhibited significantly higher values in the length of the Class II group compared to the Class I group.

CONCLUSIONS

The dimensions of the maxillary tuberosity (width, height, and length) varied between the Class I and Class II groups. Wider maxillary tuberosities were observed in the Class I group, while the Class II group had greater height and length dimensions of the tuberosity.

Applications of maxillary tuberosity block autograft

OBJECTIVE

Autogenous bone grafts are considered the gold standard due to their compatibility and osteogenic potential to induce new bone formation through osteogenesis, osteoinduction, and osteoconduction. The aim of this paper was to describe clinical applications of the maxillary tuberosity block autograft in small and moderate localized defects of the alveolar process around implants and teeth.

CLINICAL CONSIDERATIONS

Maxillary tuberosity is often used as a particulate graft for augmentation of deficient alveolar ridge or maxillary sinus prior to or simultaneously with implant insertion, but not as a bone block graft. The maxillary tuberosity block autograft may also provide a valuable bone source for challenging situations such as immediate implant placement into types II and III extraction sockets, treatment of horizontal and vertical bone defects with simultaneous implantation, reconstruction of circumferential defects around implants, and preservation of alveolar ridge.

CONCLUSIONS

The advantages of the maxillary tuberosity include intraoral corticocancellous autogenous graft with fewer intraoperative difficulties, no need for donor site restoration, less morbidity, and an excellent correction of localized alveolar ridge defects.

CLINICAL SIGNIFICANCE

Within the limitations of the presented case reports, the use of maxillary tuberosity block autograft has shown to be successful in alveolar ridges augmentation that lack both width and height.

An innovative approach in the management of alveolar clefts with bone graft harvest from maxillary tuberosity and mandibular wisdom molar odontectomy sites: A case report

Alveolar bone grafting is a complex procedure utilized in alveolar cleft repair; however, the ideal site of bone graft material remains highly debated. In this study, we describe the management of a 14-year-old girl with bilateral alveolar clefts using alternative intraoral donor sites for bone graft harvest.

Comparison of maxillary setback by maxillary tuberosity removal or intentional pterygoid plate fracture in Le Fort I osteotomy: a long-term evaluation

The purpose of the study was to investigate the clinical application and long-term stability of maxillary setback in Le Fort I osteotomy using maxillary tuberosity removal or intentional pterygoid plate fracture (IPPF). Eighty adult class II patients who underwent Le Fort I osteotomy with bilateral sagittal split ramus osteotomy by the same surgeon between January 2013 and January 2019 were included in this retrospective study. Traditional maxillary tuberosity removal was performed in 40 patients (group I), and the other 40 patients (group II) underwent IPPF to set back the maxilla according to surgeon preference. An obvious change in profile was observed for all of the patients, with no significant relapse at 1year postoperative. The operation time and intraoperative blood loss were significantly higher in group I than in group II (P= 0.037 and P= 0.021, respectively). In group II, the most superior point of the fracture line was at a mean distance of 12.25 ± 2.04 mm above the most inferior point of the pterygoid plate. More bone fragments were noted when the fracture level was low than when it was high. In conclusion, both maxillary tuberosity removal and IPPF resulted in sufficient and stable maxillary setback, with IPPF showing less blood loss and a shorter operative time.

Comparison of posterior alveolar canal location measured on computer tomography scan with cadaveric measurement of posterior superior alveolar foramen in Japanese samples

The aim of this study was to analyse anatomical characteristics of the most posterior alveolar canal (PAC) on computed tomography (CT) images and the posterior superior alveolar foramen (PSAF) physically identified in cadaveric samples, to avoid injuring the posterior superior alveolar artery (PSAA) during surgery in the maxillary tuberosity region. The study included 125 hemi-heads of 64 Japanese cadavers. Simple CT data of the maxillary bone region of the samples were obtained and analysed using measurement software. The alveolar crest (AC) and the PAC were identified to calculate the shortest distance between the AC and the PAC (AC-PAC). Then the samples were dissected to measure physically the shortest distance between the AC and the PSAF (AC-PSAF). The data were analysed statistically. The mean value and standard deviation were 20.7±4.2mm for AC-PAC and 20.7±4.3mm for AC-PSAF. The intraclass correlation coefficient between AC-PAC and AC-PSAF was 0.98. The CT-measured PAC locations were found to be almost identical to the PSAF positions identified physically in the samples. Preoperative CT localization of the PAC aids in avoiding injury to PSAA, while preoperative CT evaluation is important for each case due to significant individual variability in the anatomical PAC and PSAF locations.

Firearm Projectile in the Maxillary Tuberosity Located by Adjunctive Examination of Wide-Field Optical Fluorescence

OBJECTIVE

Demonstrate the use of wide-field optical fluorescence as an adjunctive examination in a clinical routine to oral diagnosis.

BACKGROUND DATA

Use of wide-field optical fluorescence in the oral cavity has been restricted to topics related to the detection and diagnosis of oral cancer.

MATERIALS AND METHODS

In a regular medical appointment, a 58-year-old female patient, without any complaint or oral symptom, underwent the complementary examination by wide-field optical fluorescence. A device with high-power light-emitting diode emitting light centered at a wavelength of (400 ± 10) nm and maximum irradiance of (0.040 ± 0.008) W/cm² was used for fluorescence visualization.

RESULTS

We report the location of a firearm projectile, intraosseous, in the maxillary tuberosity using wide-field optical fluorescence.

CONCLUSIONS

It is evidenced that wide-field optical fluorescence, within a clinical routine, can provide relevant images and data, with an immediate result, without the use of ionizing radiation, enabling an efficient oral diagnosis.