Time analysis of alveolar ridge preservation using a combination of mineralized boneâ plug and denseâ polytetrafluoroethylene membrane: A histomorphometric study

BackgroundThe objective of this study was to histologically evaluate and compare vital bone formation, residual graft particles, and fraction of connective tissue (CT)/other tissues between three different time points at 2â month intervals after alveolar ridge preservation with a cancellous allograft and denseâ polytetrafluoroethylene (dâ PTFE) membrane.MethodsRidge preservation with a cancellous allograft and dâ PTFE membrane was performed at 49 extraction sockets (one per patient). Volunteers were assigned to implant placement at three different time points of 2, 4, and 6 months, at which time core biopsies were obtained. Histomorphometric analysis was performed to determine the percentages of vital bone, residual graft particles, and connective tissue/other nonâ bone components, and subjected to statistical analyses.ResultsThere was a statistically significant difference in the amount of vital bone at every time point from 28.31% to 40.87% to 64.11% (at 2â , 4â , and 6â month groups, respectively) (P < 0.05). The percentage of residual graft particles ranged from 44.57% to 36.16% to 14.86%, showing statistical significance from 4 to 6 months (21.29%, P < 0.001), and 2 to 6 months (29.71%, P < 0.001), while there were no significant differences for the amount of CT/other tissue among the different time points.ConclusionsThis study provided the first histologic comparison of alveolar ridge preservation using a cancellous allograft and dâ PTFE membrane at three different time points. Extraction sockets that healed for 6 months produced the highest amount of vital bone in combination with the least percentage of residual graft particles, while similar results were observed for the fraction of CT/other tissues between the three time points.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154387/1/jper10405.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154387/2/jper10405_am.pd

Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting

Palatal-tissue harvesting is a routinely performed procedure in periodontal and peri-implant plastic surgery. Over the years, several surgical approaches have been attempted with the aim of obtaining autogenous soft-tissue grafts while minimizing patient morbidity, which is considered the most common drawback of palatal harvesting. At the same time, treatment errors during the procedure may increase not only postoperative discomfort or pain but also the risk of developing other complications, such as injury to the greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, and inadequate graft size or quality. This chapter described treatment errors and complications of palatal harvesting techniques, together with approaches for reducing patient morbidity and accelerating donor site wound healing. The role of biologic agents, photobiomodulation therapy, local and systemic factors, and genes implicated in palatal wound healing are also discussed

Comparison of three different types of implantâ supported fixed dental prostheses: A longâ term retrospective study of clinical outcomes and costâ effectiveness

ObjectiveTo study the performance of 2â 3 posterior boneâ level dental implants constructed with either three nonâ splinted crowns (NSC), three splinted crowns (SC), or a 3â unit implantâ supported bridge over two implants (ISB).Material and methodsPatients treated with three metalâ ceramic NSC, SC, or an ISB were included in the present retrospective study. Implant survival and success rate as well as all biological and technical complications were collected. The cost associated with each of the treatment options was evaluated in the comparative analysis.ResultsOne hundred and fortyâ five patients (40 NSC, 52 SC, and 53 in the ISB) receiving 382 boneâ level implants (120 NSC, 106 ISB, and 156 SC) were included (mean followâ up of 76.2 months). Lack of success was observed in 33.8% of the total patient sample, being lower in the ISB group. Implant survival rates were 92.5% in the NSC, 100% in the ISB, and 88.5% in the SC, with significant difference noted between the ISB and SC (p = 0.01). Overall, 9.9% of the total implants were found to have periâ implantitis (PI), with 16.7% in the SC, 7.5% in the NSC, and 2.8% in the ISB. Patients presenting prosthodontic complications were significantly higher in NSC (32.5%) than ISB (13.2%) and SC (15.4%). The total cost of the ISB group was significantly lower when compared to the NSC and SC groups (p < 0.001).ConclusionsAn 3â unit implantâ supported bridge restoring 2 implants seems to present the most ideal longâ term therapeutic solution, among the investigated approaches in this study, in rehabilitating a 3â unit edentulous area.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149366/1/clr13415.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149366/2/clr13415_am.pd

Guided tissue regeneration combined with bone allograft in infrabony defects: Clinical outcomes and assessment of prognostic factors

BackgroundClinical data on the outcomes of guided tissue regeneration (GTR) is scarce. The aim of this retrospective cohort study was to evaluate the outcomes after GTR, their stability and the survival of the treated teeth with periodontal infrabony defects.MethodsInfrabony defects treated with GTR using a bioabsorbable membrane and a bone graft substitute with at least 1- year follow- up were included. Survival and regression analyses were conducted to evaluate the outcomes, their stability, and the retention of the teeth. The effect of recorded variables on clinical attachment gain (CAL) and tooth survival were assessed via Cox proportional- hazards models and multivariate generalized linear models.ResultsOne hundred seventy- five treated defects were selected from a total of 641 charts. The average follow- up was 5.75 ± 4.6 years. At baseline, the mean CAL was 9.56 ± 1.93 mm with a mean pocket depth (PD) of 8.41 ± 1.42 mm. At the 1- year post- surgical recall, 3.55 ± 1.85 mm of CAL gain and 3.87 ± 1.87 mm PD reduction were observed (P < 0.05). The 5- and 10- year survival rates of the treated teeth were 85.0% and 72.7%, respectively. Baseline PD, smoking, and membrane exposure were significantly related to CAL gain, whereas baseline CAL, age, frequency in maintenance visits significantly affected tooth survival.ConclusionWithin the limitations of this study, data suggests GTR is a good option for the treatment of infrabony defects because it can improve both tooth retention rate and overall clinical outcomes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/156006/1/jper10462.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/156006/2/jper10462_am.pd

Treatment effect of guided tissue regeneration on the horizontal and vertical components of furcation defects: A retrospective study

BackgroundIdentifying factors affecting the treatment outcomes of guided tissue regeneration (GTR) in furcation defects is imperative in order to obtain predictable regeneration outcomes. The aims of this study were to evaluate the clinical outcomes and survival of furcation- involved teeth treated with GTR, and potential factors affecting the results.MethodsFurcation defects treated with GTR using an allogeneic cancellous bone graft and covered by an absorbable membrane with at least 1- year follow- up were selected. All data relative to the clinical outcomes were recorded. Analyses were conducted to evaluate the immediate (1- year post- op) clinical outcomes and the long- term (the last assessment time) survival of the treated teeth. The effect of variables on the 1- year post- op clinical attachment level (CAL) changes and the tooth survival were assessed via multi- level regression analyses and Cox Proportional- Hazards Models.ResultsNinety- eight treated defects were selected. The average follow- up was 5.3 ± 4.3 years. At the 1- year post- surgical recall, 1.23 ± 1.48 mm CAL gain was observed (P < 0.05). The 5- and 10- year survival rates of the treated teeth were 86.5% and 74.3%, respectively. The vertical component of the defect and the location of the furcation were significantly related to the post- surgical 1- year CAL gain, whereas membrane exposure significantly affected tooth survival.ConclusionWithin the limitations of this study, data suggests GTR using allogeneic cancellous bone graft and absorbable collagen membrane to be a viable option for treating furcation- involved teeth if the defect morphology and the location of the defect are favorable.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162817/2/jper10520_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162817/1/jper10520.pd

Twenty-five years of recombinant human growth factors rhPDGF-BB and rhBMP-2 in oral hard and soft tissue regeneration.

Contemporary oral tissue engineering strategies involve recombinant human growth factor approaches to stimulate diverse cellular processes including cell differentiation, migration, recruitment, and proliferation at grafted areas. Recombinant human growth factor applications in oral hard and soft tissue regeneration have been progressively researched over the last 25 years. Growth factor-mediated surgical approaches aim to accelerate healing, tissue reconstruction, and patient recovery. Thus, regenerative approaches involving growth factors such as recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and recombinant human bone morphogenetic proteins (rhBMPs) have shown certain advantages over invasive traditional surgical approaches in severe hard and soft tissue defects. Several clinical studies assessed the outcomes of rhBMP-2 in diverse clinical applications for implant site development and bone augmentation. Current evidence regarding the clinical benefits of rhBMP-2 compared to conventional therapies is inconclusive. Nevertheless, it seems that rhBMP-2 can promote faster wound healing processes and enhance de novo bone formation, which may be particularly favorable in patients with compromised bone healing capacity or limited donor sites. rhPDGF-BB has been extensively applied for periodontal regenerative procedures and for the treatment of gingival recessions, showing consistent and positive outcomes. Nevertheless, current evidence regarding its benefits at implant and edentulous sites is limited. The present review explores and depicts the current applications, outcomes, and evidence-based clinical recommendations of rhPDGF-BB and rhBMPs for oral tissue regeneration

Aesthetic- And patient- related outcomes following root coverage procedures: A systematic review and network meta- analysis

BackgroundAim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self- reported morbidity (post- operative pain/discomfort).Material and MethodsA comprehensive literature search was performed. A mixed- modelling approach to network meta- analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient- reported satisfaction and post- operative pain/discomfort (visual analogue scale (VAS) of 100).ResultsTwenty- six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p = .005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p = .01) and CAF + Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p = .04)) were significantly associated with higher RES than CAF. No significant difference between CAF + CTG and TUN + CTG was detected (0.09 (95% CI [- 0.54, 0.72], p = .77)). Addition of CTG resulted in less natural tissue texture (- 0.21 (95% CI [- 0.34, - 0.08]), p = .003) and gingival colour (- 0.06 (95% CI [- 0.12, - 0.03], p = .03)) than CAF. CTG techniques were associated with increased morbidity.ConclusionsConnective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG- based techniques were also correlated with a greater patient satisfaction and morbidity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163404/2/jcpe13346.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163404/1/jcpe13346_am.pd

Do soft tissue augmentation techniques provide stable and favorable peri-implant conditions in the medium and long term? A systematic review

To review the available literature on the medium- and long-term effects of soft tissue augmentation (STA) at implant sites and to explore the effects of the different approaches on clinical-, patient-reported, and health-related parameters. Materials and Methods A comprehensive electronic and manual search was performed to identify prospective clinical studies that assessed the medium- and long-term (≥36 months) outcomes following STA, including number of sites maintaining peri-implant health and number of sites developing peri-implant disease, incidence of complications, stability of the clinical, volumetric, and radiographic parameters, and patient-reported outcome measures (PROMs). Results Fifteen studies were included in the qualitative analysis. STA was performed with either a bilaminar- or an apically positioned flap (APF) approach, in combination with autogenous grafts (free gingival graft [FGG] and connective tissue graft [CTG]) or substitutes (acellular dermal matrix [ADM] and xenogeneic cross-linked collagen matrix [CCM]). An overall high survival rate was observed. Most of the augmented implant sites maintained peri-implant health in the medium and long term, with the incidence of peri-implant mucositis and peri-implantitis ranging from 0% to 50% and from 0% to 7.14%, respectively. The position of the soft tissue margin following APF + FGG and bilaminar approaches involving CTG or CCM was found to be stable over time. No substantial changes were reported for plaque score/index, bleeding on probing/bleeding index, and probing depth between early time points and following visits. CTG-based STA procedures resulted in a stable or increased dimension of keratinized mucosa width (KMW) and mucosal thickness (MT)/volumetric outcomes over time, when compared with early follow-ups. Most of the included studies described stable marginal bone levels at the grafted implant sites over time. No substantial changes for patient-reported outcomes and professionally assessed esthetic results were reported at different time points.Conclusions Implants that received STA showed overall high survival rate and relatively low incidence of peri-implantitis in the medium and long term. Augmented sites seem to maintain the level of soft tissue margin and marginal bone over time, while non-augmented implants may exhibit apical shift of the soft tissue margin. The overall favorable early outcomes obtained with STA are maintained in the medium and long term, with an increase in KMW and MT that may be expected over time at CTG-augmented sites

The influence of palatal harvesting technique on the donor site vascular injury: A splitâ mouth comparative cadaver study

BackgroundThe aim of this study was to evaluate the influence of two harvesting approaches on the donor site vascular injury.MethodsA splitâ mouth cadaver study was designed on 21 fresh donor heads. Every hemiâ palate was assigned to receive the trapâ door harvesting technique (TDT) or the epithelialized free gingival graft harvesting technique (FGGT). A soft tissue graft was harvested from each side for histology analyses. Betadine solution was used to inject the external carotid artery and a collagen sponge was positioned over the harvested area to compare the amount of â leakage.â ResultsThe mean leakage observed was 16.56 ± 3.01 µL in the FGGTâ harvested sites, and 69.21 ± 7.08 µL for the TDT group, a ratio of 4.18 (P < 0.01). Regression analyses demonstrated a trend for more leakage at thinner palatal sites for the FGGT group (P = 0.09), and a statistically significant correlation for the TDTâ harvest sites (P = 0.02). Additionally, a shallow palatal vault height (PVH) was associated with a higher leakage in both harvesting groups (P = 0.02). The histomorphometric analyses revealed that grafts harvested with TDT exhibited a significantly higher mean number of medium (ø = 0.1 to 0.5 mm, P = 0.03), and large vessels (ø â ¥ 0.5 mm, P = 0.02).ConclusionsWithin the limitations of the present research, the TDT resulted in a significantly higher leakage than the FGGT, which was also correlated with the histology analyses where a greater number of medium and large vessels were observed in the harvested grafts.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153658/1/jper10394.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153658/2/jper10394_am.pd

The influence of tooth location on the outcomes of multiple adjacent gingival recessions treated with coronally advanced flap: A multicenter reâ analysis study

BackgroundTooth location has been shown to play a significant role on root coverage outcomes. However, whether this has an impact on the outcomes of coronally advanced flap (CAF) for treating multiple adjacent gingival recessions (MAGRs) remains to be determined. The aim of this study was to investigate the impact of tooth location, flap design, and flap extension on the outcomes of MAGRs following CAF with or without a connective tissue graft (CTG).MethodsA reâ analysis of six previously published clinical trials evaluating the outcomes of CAF in the treatment of MAGRs was performed using mixed regression and logistics to assess the influence of potentially influential factors on the treatment outcomes.ResultsSix hundred and nine MAGRs in 166 patients were evaluated. The anterior maxilla (second sextant) was associated to the highest mean root coverage (mRC) and complete root coverage (CRC) outcome (P  0.05). Lastly, teeth in the distal part of the flap showed lower mRC and CRC than teeth in the central or mesial position (P < 0.05).ConclusionsTooth location was found to play a key role in determining the amount of root coverage achievable, with maxillary canines and incisors being associated with the highest outcomes compared with other sextants. Maxillary MAGRs showed greater mRC and CRC than mandibular MAGRs.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153060/1/jper10366_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153060/2/jper10366.pd