Soft-Tissue Enhancement Combined With Biologically Oriented Preparation Technique to Correct Volumetric Bone Defects: A Clinical Case Report

Influence of Angulation in Cervical Prosthetic Emergences Relative to the Gingival Tissue of Teeth Treated under the Biologically Oriented Preparation Technique (BOPT)

Background: The objective of this study was to digitally evaluate the effect of the cervical emergence of restorations in terms of gingival tissue volume. Materials and methods: In this study, 31 upper front teeth (from canine to canine) were selected and prepared using the biologically oriented preparation technique (BOPT). Each tooth had undergone a change in its provisional process with different emergence profile angles: 30° and 60°. Each sample was digitalised (STL file) using an intraoral scanner. By using various pieces of manipulation software for STL files, a volumetric analysis protocol was carried out. Changes in gingival thickness and position were measured at the buccal and the lingual positions. Results: By increasing the angulation of the emergence profile to 60°, the gingival thickness increased by 0.255 ± 0.381 mm (p = 0.001; t-test) at buccal and by 0.038 ± 0.381 mm at lingual (p = 0.600; t-test). In relation to the gingival height, at buccal, there is an apical displacement of 0.262 ± 0.246 mm (p = 0.001; t-test), and at lingual, there is an apical displacement of 0.390 ± 0.279 mm (p = 0.001; t-test). It was shown that an increase in the provisional emergence profile angle significantly diminishes the gingival height while significantly increasing gingival thickness. The Pearson’s correlation coefficient, r = 0.636, was moderately high and significant (p = 0.001; Pearson). Conclusions: The soft tissue surrounding the BOPT restored tooth evolved according to the prosthetic emergence angle of the provisional restoration, enabling us to plan for an apico-coronal and bucco-lingual displacement of the gingival tissue prior to the definitive restoration.

Horizontal continuous and apical stretching sutures does not reduce FGG shrinkage: a split-mouth randomized controlled clinical trial

Purpose:

This study aimed to evaluate whether horizontal continuous and apical stretching sutures could reduce FGG shrinkage.

Materials and methods:

In this randomized controlled clinical trial ten patients (20 sites, seven females and three males) ranging from 18 to 53 years (average 39 years) with insufficient keratinized and attached gingiva received FGG in two quadrants of mandible (splitmouth design). Horizontal continuous and apical stretching sutures were used in test sites in addition to common suturing techniques. Clinical parameters including probing depth (PD), the width of keratinized and attached gingiva (KG, AG), the horizontal and vertical dimension of the graft (HD, VD), and graft area (GA) were recorded at baseline and 1, 3, and six months after the operation.

Results:

PD did not differ significantly for six months. The average change of other parameters in test and control sites respectively was as follows: KG increased 5.5 mm and 5.1 mm, AG increased 5.3 mm and 5.1 mm, HD shrinkage was 21.6% and 15.8%, VD shrinkage was 33.7% and 33.2%, GA shrinkage was 47.3% and 43.3%. There were no significant differences between test and control sites in clinical parameters six months after surgery.

Conclusion:

Application of horizontal continuous and apical stretching sutures does not reduce FGG shrinkage.

Volumetric variation of peri-implant soft tissues in convergent collar implants and crowns using the biologically oriented preparation technique (BOPT)

BACKGROUND

To evaluate the changes in the peri-implant soft tissues of convergent collar implants with biologically oriented preparation technique (BOPT) crowns, 10 months after loading.

MATERIAL AND METHODS

A pilot study was carried out from January 2016 to October 2017 involving 14 patients with one or two implants in the posterior mandibular sector. A total of 32 convergent collar implants were placed using a non-submerged protocol. Three months later the provisional cemented crowns were fitted using the BOPT approach with the finish line 1-1.5 mm below the gingival margin, simulating coronal emergence of a natural tooth. The soft tissue changes were measured with an intraoral scanner at two different timepoints: a) on the day of provisionalization, before prosthetic loading; and b) 10 months later without the provisional prosthesis. The STL files were superimposed and the soft tissue changes were recorded using a color scale with measurement of the volumetric changes in mm3.

RESULTS

A mean increase in peri-implant mucosal volume of 64.7 mm3 was observed in 29 implants. The zones with the greatest increase in soft tissue volume were the papillae of implants with adjacent teeth and the peri-implant buccal margin. Three implants showed a mean decrease in soft tissue volume of -25.1 mm3.

CONCLUSIONS

The fitting and design of crowns using the biologically oriented preparation technique (BOPT) over convergent collar implants affords a significant increase in peri-implant soft tissue volume both at the level of the papillae and in the buccal margin.

The Application of Three-Dimensional Printing Model and Platelet-Rich Fibrin Technology in Guided Tissue Regeneration Surgery for Severe Bone Defects

A 36-year-old male patient diagnosed with severe chronic periodontitis was treated with novel surgery for his maxillary right lateral incisor. Preoperatively, a 3D printer was used, based on CBCT datasets, to produce a photosensitive resin bony anatomy replica. The patient's blood was centrifuged to obtain advanced platelet-rich fibrin (A-PRF) and injected platelet-rich fibrin (I-PRF), then mixed with Bio-Oss and packed onto the 3D replica to form the ideal shape. The replica was positioned at the planned sites without changes. The A-PRF membrane was applied over the replica as well as a Bio-Gide collagen membrane. Fifteen months after the surgery, clinical and radiographic followup revealed greatly reduced pocket depths and significant 3D alveolar bone fill at the treatment site. Based on these short-term results, the initial 3D printing surgical temple assisted guided tissue regeneration method resulted in significant clinical and radiographic improvements; A-PRF/I-PRF should be considered an ideal biomaterial for regenerative periodontal therapy.