Showing papers in "International Journal of Periodontics & Restorative Dentistry in 1995"

Immediate loading of bilaterally splinted titanium root-form implants in fixed prosthodontics--a technique reexamined: two case reports.

Abstract: A load-free healing period has been advocated as a prerequisite to achieving osseointegration. This article reports two cases in which immediate loading of a specially designated additional, or "expendable," set of titanium root-form implants was successfully utilized to support provisional fixed restorations in the maxilla and the mandible. This immediate-loading protocol is suggested as a reliable adjunctive therapeutic modality for offering implant patients access to fixed interim restorations during the healing phase of the primary fixtures. Another advantage of this approach is that it provides protection from potential transmucosal overload of the primary implants as well as any sites undergoing osseous regenerative procedures.

Bone formation utilizing titanium-reinforced barrier membranes.

Abstract: Advances in bone reconstructive techniques have increased the indications for implant placement in sites previously thought to be unsuitable. This clinical study evaluated a new surgical technique for the treatment of a variety of localized bone defects in four patients utilizing a titanium-reinforced membrane. The membrane material was developed to maintain a large protected space between the membrane and the bone surface without the need for a supportive device. Healing was uneventful in all sites, and the membranes were retrieved after 6 to 12 months. No residual defects were noted, resulting in an average change of implant exposure of 8.2 +/- 2.3 mm for sites with buccal dehiscences and from 5 to 6 mm ridge enlargement in localized bone defects. The quality of the regenerated tissue under the titanium-reinforced membrane appeared as bone structure with a superficial fibrous layer. This fibrous layer was more pronounced in sites treated with a membrane alone but was more than compensated by the quantity of new bone under the soft tissue. The results demonstrated that the use of a reinforced membrane appears to be a viable alternative for the clinical treatment of non-space-maintaining implant/bone defects. Further clinical and experimental investigations are recommended.

Guided bone regeneration of bone defects associated with implants: an evidence-based outcome assessment.

Abstract: Guided bone regeneration is a new technique that evolved following the guided tissue regeneration procedure for regeneration of lost periodontium. The objective of guided bone regeneration is to promote bone formation in osseous deformities either before or in conjunction with endosseous implant placement. Osseous defects consist mainly of extraction sites, dehiscences or fenestrations, and localized ridge deformities. In addition, bone defects may either provide natural spacemaking or be nonspacemaking. A plethora of publications indicate that the guided bone regeneration technique can be used successfully in all types of defects. Nonspacemaking defects usually require bone graft materials to assist in space maintenance and enhance bone formation. Fixation pins are also used, either with or without graft materials, in this regard. The scientific literature on guided bone regeneration was reviewed by a task force to determine techniques proven to increase predictability relative to successful patient outcomes and to develop specific evidence based diagnostic and treatment decision trees.

Periodontal regeneration of intrabony defects: an evidence-based treatment approach.

Abstract: A task force of periodontists established clinical and histologic outcomes (goals) for the treatment of intrabony defects and researched the literature for techniques that would most predictably achieve these goals. The group also identified factors that could influence predictability. The treatment outcomes selected by the task force included regeneration of a true attachment apparatus; gain in bone and probing attachment levels; reduction in probing pocket depth; minimal gingival recession; increased patient comfort; esthetic appearance and state of wellness; and maintenance of health, comfort, and function over time. Based on evidence, it was concluded that guided tissue regeneration, guided tissue regeneration combined with the use of decalcified freeze dried bone allografts and freeze-dried bone allografts alone are the most predictable regenerative procedures for achieving selected treatment outcomes. Various factors, such as patient characteristics, the morphology of the defect, and the surgical technique can influence the healing response of intrabony defects. Patient factors, such as plaque control, compliance, and cigarette smoking, can directly affect predictability of periodontal regeneration. Defect selection is critical, and deep and narrow defects are the most predictable response to regenerative procedures. The number of remaining bony walls is important in grafting procedures, but their influence is questionable in guided tissue regeneration. Various technical procedures, such as flap design, defect debridement, and wound protection, may influence the predictability of regeneration.

The accuracy of dental radiographic techniques used for evaluation of implant fixture placement.

Abstract: Periapical, panoramic, linear tomographic, and computerized tomographic radiographs were made of a partially dentate human mandible with four implants in place. Measurements taken from the radiographs and computer-generated images were compared to measurements made directly on the cross-sectioned test specimen. Periapical radiographs produced the most accurate measurements. Computerized and linear tomographic images provided the unique advantage of cross-sectional views of anatomic structures, but image blurring inherent to linear tomography and volume-averaging error inherent to computerized tomography affected the accuracy of measurements made from these images. The use of a dense dimensional reference object helped to compensate for radiographic distortion and is appropriate when projection radiographic techniques are used. The CT reference scale provided the most accurate method for interpreting measurements made from the computerized tomogram. The use of a dense dimensional reference object is inappropriate with CT because of its volume-averaging error.

Postoperative healing complications associated with Gore-Tex Periodontal Material. Part I. Incidence and characterization

Abstract: Guided tissue regeneration procedures with Gore-Tex Periodontal Material are associated with a unique set of postoperative healing characteristics. Five healing complications are described in this study examining 102 sites. The occurrence of pain and purulence were the most common. In purulent sites, the majority of bacteria cultured were Actinomyces and Streptococcus spp. Resistance to antibiotics was common. Prevention and treatment of the healing complications are discussed.

The histology of new attachment utilizing a thick autogenous soft tissue graft in an area of deep recession: a case report.

Abstract: An area of deep, long-standing recession on a mandibular first premolar was treated for root coverage in a 40-year-old woman. The recession was 6.0 mm deep with a probing depth of 2.0 mm, and there was no attached gingiva. A thick (1.5-mm) free autogenous epithelium and connective tissue graft from the palate was placed to the cementoenamel junction of the tooth after instrumentation and tetracycline conditioning of the root surface. The tooth and facial soft tissues were removed in block section 10.5 months later. At the time of extraction, there had been a gain of 5.0 mm of root coverage, and there was 5.0 mm of keratinized gingiva on the facial aspect. The probing depth was 1 mm. Histologic measurement showed 4.4 mm of new attachment and 4.0 mm of new bone growth. The coronal extent of the new attachment and new bone were in an area previously exposed by recession.

Resorbable membrane in the treatment of human buccal recession: a nine-case report.

Abstract: Recent studies have reported the successful use of guided tissue regeneration procedures with nonresorbable barrier membranes to treat buccal recession in humans. Nonresorbable membranes, however, require a reentry procedure for removal, disturbing the delicate healing process. Resorbable membranes were used in a guided tissue regeneration procedure in nine patients with one site of buccal recession each. The resorbable barrier yielded satisfactory clinical results, providing significant gains in probing attachment and root coverage. However, both the surgical technique and the design of the barrier used require improvement for application at sites of buccal recession.

Histologic evaluation of osseointegrated implants restored in nonaxial functional occlusion with preangled abutments.

Abstract: Of concern with the use of preangled abutments on implants is the transmission of masticatory forces and the angle at which they occur. Nineteen endosseous implants were placed in two subhuman primates. After 6 months, to allow for osseointegration, the implants were fitted with preangled abutments of various degrees and restored with type IV alloy castings. Straight abutments were used as control. Histologic evaluation revealed that, after 1 year of service, the implants exhibited complete osseointegration. Implants, whether restored with straight or preangled abutments, had no adverse effect on the surrounding bone. Soft tissue pockets measured, on average, from 2.2 to 2.6 mm; acute and chronic inflammatory cells were present. When crown loss was observed, it was caused by mechanical failure of components, such as gold screws and the screws used to secure the preangled abutments to the implants. Preangled abutments appear to be a valuable adjunct in implant dentistry, although long-term studies are needed for confirmation.

Successful regeneration of mandibular Class II furcation defects: an evidence-based treatment approach

Abstract: The purpose of the present evidence-based critical review was to define goals and outcomes for regenerative therapy of Class II furcation defects and rank the efficacy of current regenerative procedures based on the available literature Meta-analysis was employed to quantitate the mean overall expected changes and compare various techniques The evidence presented in the literature was used to determine factors affecting regeneration of Class II furcation defects These factors were used to establish decision-making trees to enhance success and highlight potential shortcomings of the technique Guided tissue regeneration, used alone or in combination with bone replacement grafts, had the highest overall ranking Mean reduction in probing depths and gains in vertical and horizontal attachment levels were all statistically significant at 6 months Similar results were obtained in the 12-month studies Compared to flap debridement, guided tissue regeneration resulted in greater reduction in probing depths and greater gains in vertical and horizontal attachment levels Guided tissue regeneration provided almost identical results whether used with or without root conditioning, suggesting that root conditioning does not offer an adjunctive effect A combination of guided tissue regeneration and bone replacement grafts yielded better results than did guided tissue regeneration alone in reducing probing depths and increasing vertical attachment levels The decision-making trees derived from analysis of these results may assist the clinician in improving success and predictability of guided tissue regeneration procedures in Class II furcation defects

Coronally positioned palatal sliding flap.

Abstract: A new flap design, the coronally positioned palatal sliding flap, was used to cover barrier membrane placed over implants in one patient, and to provide localized ridge augmentation around implants in another patient. The method is a valid surgical approach because of the favorable risk-benefit ratio. The surgical technique is easy to to perform, and it is possible to obtain a sufficient sliding position of the palatal tissue. This new palatal flap design may be indicated for a variety of periodontal surgical procedures, including guided tissue regeneration and implant surgery.

Clinical and histologic observation of replacement of biphasic calcium phosphate by bone tissue in monkeys.

Abstract: Biphasic calcium phosphate, consisting of beta-tricalcium phosphate and hydroxyapatite, was implanted in wide and deep periodontal osseous defects of monkeys in combination with the guided tissue regeneration technique. After 12 weeks, sites treated with a combination of biphasic calcium phosphate and guided tissue regeneration maintained the shape of the ridge, but both guided tissue regeneration and control sites (untreated) showed extreme resorption. A histopathologic investigation revealed that numerous macrophages contained small particles of ceramic within their vesicles and the active bone replacement occurred from the surrounding bone. Biphasic calcium phosphate has osteoconductive potential and this potential may be related to degradation by macrophage phagocytosis.

Histologic evaluation of alveolar bone following CO2 laser removal of connective tissue from periodontal defects.

Abstract: This study was undertaken to examine histologically the healing response of alveolar bone following removal of granulation and/or connective tissues from interproximal craters by manual curettage or ablation by carbon dioxide laser. The time required to complete each type of degranulation procedure was also compared. Four interproximal treatment sites in each quadrant of two dogs were randomly assigned to each treatment modality. Neither treatment modality was totally effective in removing all suprabony connective tissue. Healing was clinically uneventful and histologically similar for both treatment groups at all time intervals. Laser-treated specimens exhibited little or no inflammatory cell infiltrate, areas of heat-induced tissue necrosis, accumulations of carbonized debris that initially was surrounded by macrophages and eventually phagocytized by multi-nucleated giant cells, and spicules of nonvital bone that exhibited a surface layer of osteoid. Although manual curettage was found to be statistically significantly faster, the difference between mean times was roughly 55 seconds and therefore unlikely to be clinically significant.

Anterior single-tooth implant restorations.

Abstract: The application of implant dentistry to the treatment of partial edentulism has necessitated the development of new components and techniques. This article reviews the various systems and techniques used to fabricate successful anterior single-tooth implant restorations. Placement techniques for nonsegmented, screw-retained abutments; segmented, screw-retained abutments; and segmented, cement-retained abutments are illustrated.

Strip gingival autograft used to correct mucogingival problems around implants.

Abstract: This case report describes the use of a strip gingival autograft to transplant narrow strips of keratinized gingiva around dental implants. Replacement of unattached, nonkeratinized mucosa with keratinized gingiva resulted in firmly attached gingiva and an improved seal around implants that was healthier and more resistant to inflammation. The strip gingival autograft technique is a simple surgery that results in less discomfort for the patient and provides predictable results.

An 11-year reevaluation of resin-bonded fixed partial dentures.

Abstract: Clinical success of resin-bonded fixed partial dentures is primarily dependent on their long-term retention. Retention rates of resin-bonded prostheses placed in 66 patients treated by three dentists in private practice were evaluated in the present study. Seventy-seven resin-bonded fixed partial dentures were followed over a period of 1 year to 11 years. Thirty (39%) became dislodged, but nine were successfully rebonded; thus there were 21 failures (27%). Prosthesis location and operator expertise minimally influenced the longevity of these restorations, but the luting agents tested in this sample had a profound impact on retention. Debonding rates were excessive for some materials tested, whereas other agents proved to be predictable. Modifications in preparation design that enhanced resistance form were also likely contributors to improved retention rates.

Treatment of the failing implant: case reports.

Abstract: Three case reports of treatment of the failing implant are presented. The implants were immobile but had lost a significant amount of osseous support. The cause of failure was determined to be a combination of bacterial and occlusal traumatogenic insult. The defects were debrided and the implant surface was detoxified with tetracycline. Decalcified freeze-dried bone allograft was implanted in the osseous defects and covered with expanded polytetrafluoroethylene material in accordance with principles of guided tissue regeneration. The barrier membrane was removed 6 to 8 weeks after placement. Eight months to 1 year posttreatment, all sites demonstrated a substantial reduction in probing depth, a gain in clinical attachment, and bone fill of the defects adjacent to the implant.

Postoperative healing complications associated with Gore-Tex Periodontal Material. Part II. Effect of complications on regeneration.

Abstract: The gain in open probing attachment level as a result of a guided tissue regeneration procedure with Gore-Tex Periodontal Material was measured in 62 sites. The incidence of complications was evaluated. When sites with a complication were compared to those without the complication, there was no statistically different gain or loss of newly regenerated tissue. However, the occurrence of sloughing of the gingival flap decreased the amount of gain in open probing attachment level. Analysis of the data also revealed that the combined use of allografts and a delay in the removal of the Gore-Tex Periodontal Material had a synergistic positive effect on the gain in open probing attachment level. No association between these treatment variables and the incidence of the complications was found.

Initial study of guided tissue regeneration in Class II furcation defects after use of a biodegradable barrier.

Abstract: This study evaluated guided tissue regeneration in Class II furcation defects after use of a polylactic acid biodegradable barrier in nine patients with mandibular molar defects. Following an initial hygienic phase, surgical flaps were elevated, and the sites were scaled and root planed. Defect perimeter was measured, and a customized barrier (600 to 750 mm thick) that adhered directly to tooth and bone was applied. At baseline, sites were measured for probing depth (6.2 +/- 0.5 mm), gingival margin location (-0.6 +/- 0.6 mm), and attachment level both vertically (6.9 +/- 0.7 mm) and horizontally (5.3 +/- 0.5 mm). Clinically, barriers fragmented and became displaced in 3 to 6 weeks. Substantial granulation tissue was sometimes present between barrier and root surfaces. Six months postsurgery, gingival margin location was close to the presurgical level (-0.4 +/- 0.8 mm). There was clinically and statistically significant improvement in all other parameters: a mean reduction of 3.1 mm in probing depth, a gain of 3.3 mm in vertical attachment level, and a gain of 3.0 mm in horizontal attachment level. These results suggested favorable regenerative outcomes.

Inferior alveolar nerve repositioning in implant dentistry: a preliminary report.

Abstract: The surgical repositioning of the inferior alveolar nerve facilitates the placement of implants in the posterior mandible. The entire height of the posterior mandible is made available and enables implants to be anchored in two cortical plates, improving the primary fixation and increasing the area of the bone-implant interface. The posterior mandible can thus be predictably treated with implants in those cases where posterior support is considered important for occlusal stability and masticatory efficiency. The rapid and total recovery of sensation to the lip following nerve repositioning renders the procedure more acceptable to both the patient and the clinician.

Periodontal healing after guided tissue regeneration with Atrisorb barriers in beagle dogs.

Abstract: Periodontal healing after use of Atrisorb barrier material (polylactic acid) for guided tissue regeneration was studied in the premolar and molar teeth of six beagle dogs. Defects studied were surgically induced or were caused by naturally occurring periodontitis. Barriers fragmented and became displaced in 2 to 5 weeks after application. Granulation tissue was sometimes present between the barrier and root surface at 10 days to 4 weeks. Several sites were surgically reentered at 4 months, and new bone covered 60% to 100% of the formerly exposed furcations and root surfaces. Sites obtained for histologic evaluation 9 to 12 months after the baseline surgery showed new connective tissue attachment, cementum, and alveolar bone. Histomorphometric analyses quantitated these tissue changes, and new connective tissue attachment covered 72% of surgically exposed root surfaces and 77% of periodontitis-exposed root surfaces. It was concluded that new periodontal supporting tissues became reconstituted on root and furcation surfaces after use of the Atrisorb barrier material for GTR.

Fixed bonded prosthodontics: a 10-year follow-up report. Part I: Analytical overview.

Abstract: Developments in biomaterials in the field of adhesion have made possible a less invasive dentistry. Improvements in adhesive polymers along with the analysis of certain failures in resin-bonded prostheses have suggested the micropreparation of abutment teeth. A long-term study of resin-bonded prostheses and splints was undertaken. The success rate of this protocol is presented for a study period of 10 years (1984 to 1993). These results indicated that the resin-bonded prosthesis is a viable option in patients who are missing one or two teeth. Of 145 prostheses, 11 failed, resulting in an overall survival rate of 83% (Kaplan-Meier test). Furthermore, the study confirmed that, for splints, preparation is important to counter the major stresses related to tooth mobility in patients with periodontal disease.

Correction of a large periradicular lesion and mucosal defect using combined endodontic and periodontal therapy: a case report.

Abstract: The successful treatment of a large endodontically induced periradicular defect and soft tissue fenestration by combined endodontic and periodontal therapy is described. Endodontics was performed on the mandibular left central incisor, the apex was resected, and a retrograde amalgam was placed. The defect was thoroughly debrided and the exposed root surface was planed with curettes. Demineralized freeze-dried bone allograft and a nonresorbable membrane were placed over the defect and the exposed root surface. The membrane was removed in 6 months and there appeared to be bone regeneration with complete closure of the soft tissue fenestration. Endodontic therapy in combination with guided tissue regeneration and bone grafting may provide another modality of treatment for endodontically related hard and soft tissue defects.

Evidence-based periodontal treatment. I. A strategy for clinical decisions.

Abstract: This article is first in a series of reports describing an evidence-based approach for evaluating information associated with periodontal treatment. Two main differences distinguish this approach from the traditional one, which is based largely on clinical experience. The evidence-based approach requires that investigators emphasize the importance of unbiased data (evidence) and use specific rules of evidence to quantify their recommendations. Search, evaluate, and rank are the three steps used for gathering information from the literature. The information (evidence) can then be used to formulate new decision pathways, practice guidelines, and treatment recommendations.

Gingival recession and exposure of barrier membrane: effect on guided tissue regeneration of Class II furcation defects.

Abstract: The purpose of the present study was to evaluate the effect of barrier membrane exposure on the success of guided tissue regeneration in Class II furcation defects Twenty-six subjects with mandibular Class II furcation defects received initial periodontal therapy followed by guided tissue regeneration surgery The membrane was placed and the flaps were repositioned so that the membrane was totally submerged Membranes were removed 4 to 6 weeks later, at which time the extent of their exposure was recorded An overall improvement in all clinical parameters was observed for all subjects 1 year after surgery Half of the patients had experienced no membrane exposure, while the other 13 subjects had experienced mild to pronounced exposure; both groups showed similar improvement in all clinical and surgical parameters In light of the comparable results obtained in exposed sites, and the anatomic difficulties sometimes encountered in covering a membrane completely, in some of these cases the membrane may be left only partially submerged This approach will allow for tighter occlusal "seal" of the tooth-membrane interface and preservation of the keratinized gingiva

Bone augmentation at single-tooth implants using mandibular grafts: a one-stage surgical procedure.

Abstract: The surgical procedure of using a titanium implant in combination with a mandibular bone graft for a single-tooth reconstruction is presented. The donor bone was taken from the vestibular base, close to the symphysis of the mandible. Patients who were missing a maxillary incisor or canine tooth, and exhibiting a loss of supporting bone in the area, were found suitable for the technique.

Evaluation of the potential of a polylactic acid barrier for correction of periodontal defects in baboons: a clinical and histologic study.

Abstract: Created periodontal defects in baboons were treated with one of four possible treatment modes: (1) root preparation and Epi-Guide biodegradable polylactic acid barrier, (2) root preparation and Gore-Tex e-PTFE membrane, (3) root preparation only (no barrier), and (4) no root preparation and no barrier (control). Root preparation consisted of hand instrumentation and use of finishing burs. Measurements of gingival recession were recorded from color photographic slides taken weekly for 6 weeks following barrier placement. Block sections were removed from one animal 6 weeks after barrier placement and prepared for histologic evaluation. Significantly more gingival recession was observed at the Gore-Tex sites than at the Epi-Guide sites. There were no significant differences in gingival recession between the Epi-Guide sites and root preparation-only sites or control sites. Both types of barriers were histologically acceptable. At 6 weeks, the Epi-Guide material was present histologically in a partially resorbed state. There was a mild inflammatory reaction in the surrounding connective tissues.

The new In-Ceram Spinell system--a case report.

Abstract: The final color of all-ceramic restorations is mainly dependent on the light-transmission characteristics of the different components of the ceramic material. This article is a report on the improvement in light reflection and light transmission possible with the new In-Ceram Spinell crown system, which provides a natural-looking appearance.

Translating clinical outcomes to patient value: an evidence-based treatment approach.

Abstract: This is a summary report from An Evidence-Based Treatment Approach: Successful Regenerative Outcomes, Task Force 4, Translating Clinical Outcomes to Patient Value. It represents recommendations for translating the clinical benefits of regenerative therapies to value that the patient can understand and accept. A review of the evidence on translating clinical outcomes to patient value was presented to the task force for discussion. Then outcome criteria established by other task forces on clinical applications of regenerative therapy were used to evaluate the evidence. Published literature related to many different areas, such as clinician-patient communication, patient behavior, the role of other dental professionals, and organization of the practice and its processes, was included in this review. Outcomes charts and decision-making trees were developed to provide a framework for the recommendations of the task force. The ultimate objectives of this task force were to help the practitioner to clearly perceive the benefits that regeneration can provide to patients and to help the clinician to present the facts in a manner that will increase patients' acceptance of the recommended treatment.

Evidence-based periodontal treatment. II. Predictable regeneration treatment.

Abstract: Clinical experience, technical ability, and intuition are indispensable but are no longer sufficient as the sole clinical skills necessary to provide the best outcomes from periodontal and peri-implant regeneration treatment. This article describes a comprehensive and rigorous methodologic framework to assess the available evidence contained within the literature. This assessment tool is referred to as the evidence-based method. The methodology was used by a series of task forces convened to evaluate three common areas of clinical regenerative treatment. The major goals of these task forces were: (1) to increase the strength of the inference that practitioners can derive from the base of knowledge contained within the literature, (2) to develop algorithms to improve the predictability of regeneration treatment, and (3) to determine methods that can be used to predictably transfer the value of therapy to the patient.