Assessment of soft and hard tissue dimensions following different treatment approaches of ligature-induced peri-implantitis defects

Post-extraction volumetric analysis of alveolar ridge contour using subepithelial connective tissue graft in esthetic zone: a randomized controlled clinical trial

OBJECTIVES

The aim of this randomized clinical trial was to assess the alveolar ridge contour after soft tissue augmentation using subepithelial connective tissue graft (SCTG) buccal to fresh extraction sockets in patients with thin buccal bone, versus minimally-traumatic extraction followed by spontaneous healing solely.

MATERIALS AND METHODS

Forty non-restorable maxillary teeth in the esthetic zone were randomly assigned into two groups: minimally-traumatic extraction with SCTG (test) and minimally-traumatic extraction followed by spontaneous healing (control). The outcomes assessed included linear volumetric change of buccal soft tissue contour, vertical tissue loss, gingival thickness (GT), and interdental papilla (IDP) height after 6 months.

RESULTS

The SCTG group showed a significant improvement (P < 0.001) in all outcomes after 6 months. The SCTG group showed a statistically significant (P < 0.001) gain in the buccal soft tissue volumetric change compared to the control group. The SCTG group showed a statistically significant increase in GT (P < 0.001) and IDP height (P < 0.05) after 6 months compared to the control group.

CONCLUSIONS

The use of SCTG buccal to extraction sockets in the anterior maxilla might be considered as a predictable approach for preserving the alveolar ridge contour.

CLINICAL RELEVANCE

SCTG buccal to extraction sockets might counteract post-extraction hard and soft tissue alterations in the esthetic zone.

Clinical considerations in the surgical management of peri-implantitis lesions in the esthetic zone

OBJECTIVE

The treatment of peri-implantitis is commonly associated to soft tissue changes as part of disease resolution. These changes may alter harmony in the esthetic area, and thus may negatively affect patient satisfaction. This technical note presents the key features that may lead to an unsatisfactory esthetic outcome when managing peri-implantitis in the anterior zone.

CLINICAL SIGNIFICANCE

It is essential to consider four pivotal elements in securing therapeutic success through the resolution of inflammation while maintaining esthetics: (1) patient-related factors, including patient willingness to treat and the smile line; (2) implant-related factors that influence implant position; (3) site-related factors related to defect configuration; and (4) prosthetic-related factors referred to the prosthetic emergence profile and the type of prosthesis. A comprehensive examination must be carried out preoperatively to assess the impact of the surgical treatment upon the esthetic outcomes.

CONCLUSION

The clinician must be aware of the key features that condition the esthetic outcome when managing peri-implantitis.

Volumetric tissue changes following combined surgical therapy of peri-implantitis: A 2-year follow-up analysis. A prospective case series

AIM

To assess volumetric tissue changes following combined surgical therapy of peri-implantitis over a follow-up period of 24 months.

MATERIALS AND METHODS

A total of 20 patients (n = 28 implants) were diagnosed with peri-implantitis and underwent access flap surgery, implantoplasty, and augmentative therapy at intrabony components (ie, combined therapy) using a natural bone mineral and a native collagen membrane. The peri-implant region of interest (ROI) was intraorally scanned pre-operatively (S0), and after 12 (S3) and 24 (S4) months. Digital files were superimposed for the assessment of volumetric changes between the referred time points. The change in thickness was assessed at a standardized ROI, segmented into two equidistant sections (ie, marginal and apical).

RESULTS

Peri-implant tissues exhibited a nonsignificant mean thickness loss of 0.16 (95% CI: -4 to 0.06) and 0.17 mm (95% CI: -0.05 to 0.4) at S3 and S4, respectively. S0-S3 dimensional thickness changes at marginal and apical areas were -0.24 (95% CI: -0.48 to 0.002) and -0.19 mm (95% CI: -0.36 to -0.2), respectively. Dimensional changes from S0 to S4 amounted to -0.22 mm (95% CI: -0.46 to 0.02) and -0.07 mm (95% CI: -0.09 to 0.2), respectively. The thickness changes at marginal and apical ROIs were significant from S0 to S3. Clinical parameters (ie, plaque index, bleeding on probing, and probing depth) significantly improved over the 24-month follow-up period. Linear regression analyses revealed no significant association between baseline bone loss (%), width of keratinized mucosa, and mucosal recession scores and thickness changes.

CONCLUSIONS

Peri-implant tissues revealed minor volumetric changes at 12 and 24 months after combined surgical therapy.

A customized subepithelial connective tissue graft for interdental papilla reconstruction and soft tissue augmentation

OBJECTIVE

Due to the minimal blood supply and other reasons, stable reconstruction of interdental papilla is difficult. This article presented three cases, which describe a customized subepithelial connective tissue graft aiming to overcome the clinical challenge, with the combination of tunneling technique.

CLINICAL CONSIDERATIONS

An original customized subepithelial connective tissue graft combined with tunnel technique aimed to reconstruct interdental papilla (IP). The subepithelial connective tissue graft was partially spilt to create a bowtie-like shape, with four lateral wings and a main body. The four wings were tightly wrapped around the adjacent abutments, and the body part was used to reconstruct the IP.

CONCLUSIONS

With the customized subepithelial connective tissue graft, a favorable outcome has been preliminarily confirmed in these cases. Facing patients with a lack of gingival papilla and soft tissue fullness, the customized subepithelial connective tissue graft may be a good choice.

CLINICAL SIGNIFICANCE

This study provides a new method to reconstruct IP. The customized subepithelial connective tissue graft may be a good choice when a lack of gingival papilla and soft tissue fullness occurs, which will be of great benefit to meet the aesthetic needs of patients.

Principles of Combined Surgical Therapy for the Management of Peri-Implantitis

FOCUSED CLINICAL QUESTION

The purpose of this technical note is to present the principles for combined therapy as well as to illustrate the step-by-step approach of this procedure to efficiently manage peri-implantitis.

SUMMARY

Peri-implantitis is the primary threat that compromises the longevity of dental implants. This entity is regarded as a biofilm-mediated inflammatory condition. As such, the arrestment of disease is conditioned by the elimination of the etiological factor and the clinical resolution of inflammation by eliminating pathogenic pockets. It was suggested that the therapy of peri-implantitis relies upon defect configuration. In this sense, defect configuration is, in part, conditioned by the dimensions of the alveolar bone and implant position. In the clinical basis, it is frequent to identify combined defects exhibiting area(s) where reconstructive therapy is inefficient due to uncontained defect morphology. These situations represent clinical indications for combined therapy.

CONCLUSIONS

This therapeutic modality is based on the combination of reconstructive therapy in the infraosseous defect component and surface modification for the area of the implant within the supracrestal component or outside the reparative potential.