Juvenile paradental cyst : presentation of a rare case involving second molar

The aim of this article was to describe a rare case of paradental cyst of the permanent mandibular second molar. A 14-year-old girl was referred to Oral Surgery Department, Dental Clinic, IRCSS Fondazione Ca\u2019 Granda, University of Milan, Italy, for the evaluation of the deep probing located on the buccal aspect of her erupted mandibular left second molar. Clinical signs of inflammation were absent and the mucosa around the second molar appeared clinically normal. Pulp tests for the second molar were positive. The evaluation of the panoramic radiograph did not revealed radiolucency. The Cone-beam tomography showed a well-defined semilunar-shaped radiolucency demarcated by a fine radiopaque line. The cyst was enucleated. The histopathologic analisys revealed the presence of hyperplastic, non-keratinized squamous epithelium with heavy, dense inflammatory cell infiltrate in the epitelium and connective tissue wall. This analysis associated with macroscopic, clinical and radiografic examination confirmed the diagnosis of paradental cyst. A clinic-pathologic correlation, incorporating the surgical, radiographic and histologic findings, is required to obtain the final diagnosis of paradental cyst. Today, the treatment of choice is simple enucleation and thorough curettage of the cyst without extraction of the involved tooth, but if CT demonstrates erosions in the buccal or lingual cortices, marsupialization should be the treatment of choic

Influence of Timing on the Horizontal Stability of Connective Tissue Grafts for Buccal Soft Tissue Augmentation at Single Implants : a Prospective Controlled Pilot Study

Purpose: The timing for soft tissue augmentation during implant therapy is still debated. Therefore, the present study clinically evaluated whether immediate versus delayed soft tissue augmentation procedures had an impact on the stability of peri-implant mucosal thickness (PMT). Materials and Methods: Patients requiring a single implant posterior to the canines in association with soft tissue augmentation procedures at the buccal aspect of single implants using a connective tissue graft (CTG) were enrolled. Patients were randomly allocated to 2 different timing protocols: simultaneous implant and CTG placement (test group) or implant placement and then CTG placement after 3 months (control group). PMT was measured clinically at the mid-buccal aspect of the implant site by bone sounding with an endodontic K-file using customized acrylic stents. PMT measurements were recorded before and after implant placement and at 1, 2, 3, 4, 6, 9, and 12 months after implant insertion. Parametric statistical tests were used to compare PMT between the test and control groups at each study period and to evaluate changes in PMT over time. The level of significance was set at a P value less than .05. Results: Fourteen implants placed in 14 patients were available for statistical comparison. At 12 months, the difference in PMT between the test and control groups was 0.12 \ub1 0.51 mm. This difference was not statistically significant (P = .54). A significant increase in PMT was observed from baseline to 12 months after implantation in the test (P = .004) and control (P < .001) groups. Conclusions: The present study indicated that changes in PMT after CTG placement were not influenced by the timing of soft tissue augmentation and remained stable up to 1 year after implant insertion

Hard and soft tissue augmentation in implant surgery: a case report

Correct pre- and postimplant hard and soft tissue management is prerequisite to achieving optimal esthetic and functional outcomes after implant-prosthesis treatment. Various different methods for preimplant hard tissue augmentation in alveolus maxillary atrophy are described. In some cases, non-resorbable titanium-reinforced membranes are employed for vertical augmentation of the edentulous crest. Also well documented is soft tissue management through mucus-gingival surgery techniques that increase the thickness of peri-implant keratinized gingiva, enhancing soft tissue esthetic and health. These methods also include the use of epithelial-connectival grafts collected from the palate. Here we present a clinical case of severe bone vertical resorption in edentulous areas treated with two vertical ridge augmentations by means of non-resorbable membranes in the retromandibular area and deferred insertion of six implants. Peri-implant plastic surgery techniques to improve the quantity of keratinized mucosa during the second surgery phase are also discussed. Combination of the two techniques resulted in harmonic tissue architecture and adequate presence of keratinized gingiva

Computer aided flapless surgery for implant prosthodontic rehabilitation of edentulous patients : a clinical case report

Background The current guidelines for oral implantology aim to minimize surgical and prosthetic timing procedures and patient discomfort while preserving at the same time both quality and quantity of hard and soft tissues. A new surgical protocol, based on the concept of computer-aided flapless implant placement, has been recently presented, which complies to the above-mentioned purposes. Case report Implant position is pre-operatorily virtually planned through three-dimensional planning software based on functional and aesthetic demands related to the final prosthesis. The development of modern CT scan associated with CAD/CAM technology let the clinicians to transfer the virtual plan into the surgical environment. Surgical guides obtained with a rapid prototyping process allow the surgeon to perform a flapless surgery and an ideal implant placement in the planned position. Following this procedure, the present case-report shows an implant prosthodontic rehabilitation of an upper edentulous jaw, obtained using a computer-aided template-guided flapless implant placement followed by immediate loading. Computer-aided flapless implant surgery seems to provide several advantages to the clinicians, however a minimum safety distance from the limiting anatomical structures of at least 2 mm is recommended

Clinical investigation of mucosal thicness stability after soft tissue grafting around implants : a 3 year retrospective study

To assess the long-term stability of gingival grafts placed around dental implants at the time of second surgery uncovering and to further investigate the association between mucosal thickness (MTh) by demographic variables and clinical investigation. MATERIALS AND METHODS: Fourteen patients with submerged dental implants covered by inadequate keratinized mucosa were studied. The subjects underwent a periimplant plastic surgery (PPS) at the second-stage dental implant surgery and free gingival autograft orsubepithelial connective tissue graft were used according to the patients' clinical situation. Clinical measurement of MTh was assessed by bone sounding with a periodontal probe using customized acrylic stents andthe values were recorded at baseline (day of graft) and at 0.5, 1.5, 4, 12, 24 and 36 months after grafting. RESULTS: At 12 months postoperatively, the mean MTh was 2.89 mm, with a mean additional increase of 1.75 mm when compared with baseline (P=0.0001). No statistically significant differences in MTh were found between the 12- and the 36-month observations (P=0.09). In addition, at 36 months, a thin mucosa was associated with a greater increase in the MTh compared with a thick mucosa (2.14 and 0.64 mm, respectively, P=0.006). Similarly, the mandibular sites were associated with a greater increase in the MTh in comparison with the maxillary sites (2.17 and 0.81 mm, respectively; P=0.02). CONCLUSIONS: Within the limitations of this investigation, the data suggest that PPS at the second-stage dental implant surgery could results in additional increases in MTh, especially when it is performed in areas where the mucosa is of a thin biotype

La gestione di un caso complesso implantare : dall’analisi preoperatoria alla realizzazione della protesi definitiva

Una programmazione pre-chirurgica scorretta e una gestione del sito implantare altrettanto poco curata possono portare a inconvenienti quali risultati finali poco predicibili dal punto di vista funzionale e anche estetico. In questi casi sempre pi\uf9 frequentemente ci si trova di fronte alla gestione di casi complessi in cui ci si deve confrontare con impianti di diverse tipologie posizionati in tempi diversi. Nell\u2019ambito del trattamento implanto-protesico, queste situazioni, ancor pi\uf9 di altre, richiedono la corretta gestione dell\u2019intero piano di trattamento, cercando di ovviare agli inconvenienti affinch\ue9 si ottenga un risultato estetico e funzionale ottimale, soprattutto nelle zone ad alta esigenza estetica. La presenza di problemi a livello dei tessuti peri-implantari spesso provocano una serie di deficit dei tessuti duri e molli, che devono essere risolti attraverso delle manovre di rigenerativa tissutale e aumento dei tessuti molli. Diverse sono le metodiche descritte in letteratura inerenti le procedure di incremento dei tessuti duri pre-implantari in caso di atrofie alveolo mascellari1,2. In alcuni casi tali procedure prevedono l\u2019utilizzo di membrane non-riassorbibili rinforzate in titanio per l\u2019aumento verticale della cresta edentula. Anche la gestione dei tessuti molli \ue8 ben documentata in letteratura; infatti, mediante l\u2019utilizzo di tecniche di chirurgia muco-gengivale \ue8 possibile incrementare lo spessore di gengiva cheratinizzata peri-implantare migliorando l\u2019estetica e la salute dei tessuti molli. Tali metodiche comprendono anche l\u2019utilizzo di innesti epitelio-connettivali prelevati dal palato3,4. Il caso clinico preso in esame descrive l\u2019analisi, la programmazione e l\u2019esecuzione di un piano di trattamento complesso. Dall\u2019iniziale situazione implanto-protesica presente sono stati eseguiti sia interventi di rigenerativa ossea tramite GBR in zona retro-mascellare e l\u2019inserimento dilazionato di 3 impianti, che interventi con tecniche di chirurgia plastica periimplantare per l\u2019aumento della quantit\ue0 di mucosa cheratinizzata durante la seconda fase chirurgica sia nei nuovi siti implantari che nei vecchi. L\u2019unione delle due tecniche ha permesso l\u2019ottenimento di un\u2019architettura tissutale armonica e di un\u2019adeguata presenza di gengiva cheratinizzata e la risoluzione in modo soddisfacente della riabilitazione implanto-protesicaAn incorrect pre-surgery programmation and a wrong management of the implant site could cause many disadvantages like unpredictable aesthetic and functional final results. In this cases increasingly we have to manage complex situations in which different kind of implant are inserted in different time. This situation, in an implantprosthetic treatment, need the right management of the whole treatment plane, trying to avoid drawbacks, with the aim to obtain the best functional and aesthetic result, overall in the aesthetic area. Presence of peri-implant tissue problems, often could cause some deficit of hard and soft tissues that need regenerative techniques to eliminate these defect. There are some different kind of techniques described in literature to improve hard tissues1,2. Some of these provide the use of non-resorbable reinforced titanium membranes to facilitate the vertical growing of the edentulous ridge. The management of soft tissues is also well described in literature. With the use of mucous gum surgery techniques, is possible to improve the thickness of the keratinized gingiva, improving the health and the aesthetic of soft tissues. These techniques also include the use of epithelial connective tissue graft taken from the palate3,4. This clinical case describes the analysis, programming and execution of a complex treatment plan. From the initial implant-prosthetic situation, both bone regenerative responses with GBR in the back jaw area, insertion of 3 implants and peri-implant plastic surgery, to increase the quality of the keratinized mucosa, were performed, both in the new and old implant site. The union of the two techniques allowed us to obtain a tissue harmonic architecture and an appropriate presence of keratinized gingiva with the good resolution of the implant-prosthetic rehabilitation

Innesto di tessuto molle nel sito postestrattivo mediante l'utilizzo della tecnica CPT, Clot Preservation Technique

La letteratura descrive diverse tecniche di preservazione dell\u2019alveolo post-estrattivo in caso di inserimento dilazionato degli impianti. Diversi autori, indicano l\u2019utilizzo di biomateriali come una delle tecniche per la preservazione della cresta alveolare (1-3). Quando la quantit\ue0 di osso residuo non \ue8 sufficiente per avere una buona guarigione, un\u2019alternativa pu\uf2 essere l\u2019utilizzo di un innesto epitelio-connettivale. Sono tre le ragioni per cui si pu\uf2 scegliere un innesto libero. Primo: nel caso in cui si renda necessario ottenere un\u2019adeguata quantit\ue0 di tessuti molli a favorire eventuali manovre di ricostruzione ossea con l\u2019utilizzo di biomateriale e membrane. Secondo: l\u2019innesto tissutale permette una corretta protezione del coagulo a favore di una buona guarigione dell\u2019alveolo post-estrattivo. Terzo: impedisce il collasso dei tessuti molli proteggendo il coagulo nella sua funzione riparatrice. In questo case report viene analizzata la guarigione di un alveolo post-estrattivo trattato solo con un innesto epi- telio-connettivale. Su un paziente di 30 anni \ue8 stato utilizzato un innesto epitelio-connettivale dopo l\u2019estrazione per motivi parodontali di un elemento dentale in area estetica. Dopo 2 mesi dall\u2019estrazione e dal posizionamento dell\u2019in nesto libero, \ue8 stato inserito un impianto endosseo. Successivamente al periodo di osteointegrazione, sono state eseguite prima la protesi provvisoria e poi la protesi in ceramica integrale. Il successo clinico ottenuto al momento dell\u2019inserimento dell\u2019impianto, con l\u2019ottima guarigione dei tessuti duri e molli pre-implantari, ha permesso una chirurgia rigenerativa pi\uf9 semplice. Nonostante i limiti rappresentati dalla presentazione di un singolo case report, il risultato clinico finale \ue8 soddisfacente. Lo sviluppo di studi pi\uf9 approfonditi potr\ue0 permettere una maggiore ripetibilit\ue0 e predicibilit\ue0 dei risultati

Histologic and radiographic comparison of bone scraper and trephine bur for autologous bone harvesting in maxillary sinus augmentation

Purpose: The aims of this study were to investigate the best two of five common methods of collecting autologous bone (preliminary study [PS]) and to test clinically the effects of autografts harvested using a trephine bur or bone scraper for sinus augmentation surgery (main study [MS]). Materials and Methods: In the PS, five autograft samples from five patients (n = 25) were harvested with a bone scraper, round bur, piezoelectric device, implant bur, and trephine bur and were processed for histomorphometric analysis. In the MS, sinus augmentation was performed on 20 patients using bovine-derived bone substitute and autograft collected with a trephine bur (group A, n = 10) or collected with a bone scraper (group B, n = 10). Narrow implants were also placed. At 6 months, changes in graft volume were evaluated with cone beam computed tomography. The amounts of regenerated bone, residual graft, and osseointegration of the implants were assessed histologically. Results: In the PS, the trephine bur and bone scraper harvested bone chips that were medium to large and more vital than those obtained with the other tools. In the MS, no significant differences were seen between groups in terms of the amount of residual biomaterial, regenerated bone, change in graft volume, and osseointegration. Conclusion: Biologic differences between these two bone particulates may not influence regeneration and implant osseointegration in sinus augmentation when mixed with xenograft bone