Reconstruction of Interimplant Papilla by Demineralized Freeze-dried Bone Allograft Block Fixed by Titanium Screw in Maxillary Esthetic Zone

AIM

To evaluate effectiveness of demineralized freeze-dried bone allograft (DFDBA) block fixed by titanium screw for reconstructing interimplant papilla in maxillary esthetic zone during one-stage early loading multiple implant procedure.

MATERIALS AND METHODS

A total of 20 implants were placed in 10 systemically healthy patients (2 implants per patient) for replacement of multiple teeth by early loading one-stage implants along with interimplant papilla reconstruction using DFDBA block fixed by titanium screw. At the baseline, 6 months, and at 1 year, clinical measurements (interimplant papillary height measurement, papilla contour) and radiographic measurements were recorded.

RESULTS

At 1 year, mean gain in interimplant vertical crestal bone was 1.7 mm, and complete reconstruction of the papilla was observed in 90% cases.

CONCLUSION

Demineralized freeze-dried bone allograft block fixed by titanium screw for reconstruction of interimplant papilla in maxillary esthetic zone during one-stage early loading multiple implant procedure is effective.

CLINICAL SIGNIFICANCE

Presence of interimplant papilla is of utmost importance for esthetically successful implant-supported restoration in the anterior region. This technique leads to reconstruction of interimplant papilla, thus providing esthetic appearance.

Evaluation of survival of 8 mm-length implants in posterior resorbed ridges: A pilot study

Context

Rehabilitation of jaws with reduced bone height is technically demanding and expensive. Short implants are emerging as an alternate in such cases.

Aim

This study aimed to evaluate the survival of implants of 8 mm in length (short implants), clinically and radiographically, in posterior resorbed ridges.

Materials and Methods

A total of 11 patients with single missing posterior tooth, having 9-10 mm of residual bone height determined using radiographs, were selected for the study. Twelve implants of 8 mm length were inserted in the resorbed alveolar ridges following standard operating procedure. A second-stage surgery was performed 4-6 months after implant placement for placement of gingival former. This was followed by placement of prosthesis. Twelve months after prosthesis placement, all the patients were examined clinically and radiographically.

Results

According to Albrektsson et al.'s criteria, all implants were successful with mean bone loss of 1.1 ± 0.32 mm mesially and 0.83 ± 0.35 mm distally with healthy gingival condition at 12-month follow-up.

Conclusion

Short implants (8 mm in length) can be a viable alternative in cases of atrophic alveolar ridges.

Alveolar Bone Housing- A Modified Wilkodontics Approach- A Case Report

Accelerated orthodontic treatment is the need of the hour in current scenario as the conventional orthodontics is time taking. Corticotomy assisted orthodontics have been used for years to reduce the treatment duration by reducing the resistance provided by alveolar bone housing. This case report describes the orthodontic treatment combined with the modification in conventional wilkodontic technique in a patient to accelerate tooth movement and shorten the treatment time with an anterior open bite and flared and spaced upper and lower incisors. Firstly plaque control was achieved with supra and subgingival scaling. A modified approach using periodontal access flap followed by vertical bone cuts in the cortical bone from the crest of the alveolar bone margin to 2mm-3mm below the apices of all the anterior teeth extending from upper left canine to upper right canine were performed. These vertical cuts were joined by horizontal cuts apically and flap repositioned. An MBT 0.018 inch appliance was bonded. Orthodontic therapy proceeded with frequent activation of the appliances to retract the incisors every two weeks. The total treatment time was four and half months with active period of two months and no adverse effects were observed at the end of active treatment. The modified decortication technique reduced the treatment time to a considerable extent. The interdental spacing closed and optimum overjet and overbite was achieved.

Comparative evaluation of the effectiveness of acellular dermal matrix allograft and subepithelial connective tissue to coronally advanced flap alone in the treatment of multiple gingival recessions: A clinical study

Background:

Obtaining predictable and esthetic root coverage has become an important part of periodontal therapy. Several techniques have been developed to achieve these goals with variable outcomes. The aim of this study was to appraise the effectiveness of acellular dermal matrix allograft (ADMA) and subepithelial connective tissue graft (SCTG) compared to coronally advanced flap (CAF) in the treatment of multiple gingival recessions.

Materials and Methods:

A total of 30 patients aged between 18 and 50 years, with multiple Miller's Class I and II recessions on labial or buccal surfaces of teeth were selected for this study. The patients were randomly assigned to CAF + ADMA, CAF + SCTG and CAF groups with 10 patients in each group. The clinical parameters assessed were probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), width of keratinized tissue, plaque index and papilla bleeding index at base line and 6 months after surgery.

Results:

Statistical analysis using One-way ANOVA suggested that the root coverage obtained was greater in the ADMA + CAF (89.83 ± 15.29%), when compared to SCTG + CAF (87.73 ± 17.63%) and CAF (63.77 ± 27.12%) groups. The predictability for coverage of >90% was greater in CAF + ADMA (65%) when compared with SCTG + CAF (61.66%) and CAF (31.17%). Improvements in the clinical parameters from baseline were found in all the three groups treated.

Conclusion:

It was concluded that all three techniques could provide root coverage in Miller's class I and II gingival recessions; but greater % root coverage and predictability for coverage of >90% could be expected with CAF + ADMA and CAF + SCTG groups when compared with CAF alone.

The effectiveness of enamel matrix protein (Emdogain(®)) in combination with coronally advanced flap in the treatment of multiple marginal tissue recession: A clinical study

Background:

Gingival recession resulting in root exposure is a common problem faced by clinicians. This clinical study compared the results obtained by treating gingival recession using enamel matrix derivative (Emdogain gel^®) along with coronally positioned flap and coronally positioned flap alone.

Materials and Methods:

Twenty patients with a total of 46 gingival recession defects, each patient with a minimum of two recession defects, were included in the study. The test group, which consisted of 10 patients with 22 recession defects, was treated by enamel matrix derivatives (Emdogain gel) in combination with a coronally positioned flap, while the control group, which consisted of 10 patients with 24 gingival recession defects, was treated with 24% ethylenediaminetetraacetic acid (EDTA; Prefgel^®) in combination with coronally positioned flap.

Results:

Student's paired and unpaired t-test was used for statistical analysis. If the probability value (P) was less than 0.05, it was considered significant. Data from this study demonstrated that application of (EMD) Emdogain gel resulted in a statistically significant increase in root coverage, gain in the clinical attachment level (CAL), and probing pocket depth (PPD) reduction when compared with coronally advanced flap (CAF) alone, but there was no statistically significant difference in the width of keratinized gingiva (WKG) between the two groups.

Pathogenesis of periodontitis: role of cytokines in host response

There is no doubt that plaque bacteria are necessary to initiate disease and drive the chronic inflammatory response in the periodontal tissues. At the same time, there is strong evidence that destructive processes occurring as part of the host inflammatory response are responsible for the majority of the hard- and soft-tissue breakdown leading to the clinical signs of periodontitis. The characteristic clinical signs of chronic periodontitis occur mainly as a result of activation of host-derived immune and inflammatory defense mechanism. IL-1 and TNF induce expression of other mediators that amplify the inflammatory response, such as prostaglandins, and lead to production of lytic enzymes and stimulate the production of chemokines. Investigations on the soluble protein delivery of antagonists to IL-1 and TNF in animal models have shown promising results. Collectively, the clinical, radiographic, and biochemical findings of these experiments show that IL-1 and TNF-alpha antagonists block the progression of the inflammatory cell infiltrate towards the alveolar crest and the recruitment of osteoclasts, and prevent the periodontal lesions may destroy the soluble cytokine antagonists prior to their peak activity, which may necessitate more frequent administration of the active agents to the defects. Thus, gene transfer of TNF receptor antagonists and IL-1ra may offer a more efficient mode of delivery of disease controlling agents to the periodontal structures. Periodontal treatment through the ages has focused on the reduction of bacterial infection by mechanical removal of infectious agents (i.e., SRP). Attempts at elimination of infectious agents often do not represent a definitive therapy in periodontitis, necessitating the administration of more sophisticated biological treatment modalities. A thorough understanding of the host inflammatory response in periodontal pathogenesis presents the opportunity for exploiting new treatment strategies for periodontitis by means of host response modulation. The rationale behind this approach is to aid the host in its fight against infectious agents by supplementing the natural inherent defense mechanism or to modify its responses by changing the course of inflammatory systems. Therefore, pharmaceutical inhibition of host response pathways that mimic endogenous anti-inflammatory mechanisms may prove to be an effective strategy for treating periodontal diseases. This would require the development of polypharmaceutical approaches controlling all pathways associated with inflammation and tissue destruction. Current research has focused on the use of SDD as a treatment modality, and SDD is the only systemically used host modulatory drug approved by the United States Food and Drug Administration.