The use of a bioabsorbable barrier for regenerative management of marginal tissue recession. I. Report of 100 consecutively treated teeth.

BACKGROUND: Periodontal plastic surgical procedures aimed at coverage of exposed root surfaces have evolved into routine treatment modalities. The present study was designed to assess the effectiveness and the predictability of a bioabsorbable barrier in the treatment of human recession defects utilizing a single-step surgical procedure. METHODS: One hundred consecutive single and multiple adjacent Miller Class I, II, and III buccal recession defects in 41 patients were treated with a combination of a bioabsorbable barrier and coronally advanced flap technique. Clinical parameters were recorded immediately prior to surgery, at 3 months, and after a minimum of 6 months. RESULTS: A highly significant reduction in recession depth from a mean value of 3.2 +/- 0.9 mm preoperatively to 0.3 +/- 0.5 mm postoperatively, corresponding to a mean root coverage of 92. 7% +/- 14.1%, was obtained. Complete (100%) root coverage was obtained in 75% of the sites. Factors adversely affecting root coverage were membrane exposure postoperatively and preoperative recession depth > or =4 mm. In addition, inferior results were achieved at mandibular incisor and maxillary molar sites. Factors having no effect on root coverage included maxillary versus mandibular sites and single versus multiple adjacent sites. CONCLUSIONS: The use of guided tissue regeneration in periodontal plastic surgery is highly predictable, and highly esthetic root coverage can be gained without requiring a second surgical procedure or a second surgical site and is, therefore, an attractive alternative to conventional grafting techniques.

The single-incision palatal harvest technique: a strategy for esthetics and patient comfort.

The use of connective tissue grafts for root coverage and ridge augmentation is a proven, effective treatment modality. Complications associated with the palatal donor site can arise because of incomplete primary closure of the palatal wound or sloughing of the overlying tissue. This article presents a new technique for the atraumatic harvesting of connective tissue grafts from palatal donor sites. The main advantage of this single-incision technique is the primary closure of the palatal flap, resulting in less pain and sensitivity and fewer postoperative complications. A review of the technique and its indications, rationale, and limitations is presented.

The bilateral pedicle flap-tunnel technique: a new approach to cover connective tissue grafts.

A new surgical technique for the treatment of adjacent soft tissue marginal recession is presented. This technique combines the use of a tunnel procedure with double lateral pedicle flaps to cover a connective tissue graft. This approach combines the advantages of the tunnel technique with the increased blood supply and protection provided by pedicle flaps. Indications include adjacent Class I and II deep, wide recessions; however, the procedure may also be applied to mild Class III recessions. Two case reports are presented to illustrate this new technique.

The thickness of masticatory mucosa in the human hard palate and tuberosity as potential donor sites for ridge augmentation procedures.

The aim of the present investigation was to clinically determine the thickness of masticatory mucosa in the hard palate and tuberosity as potential donor sites for ridge augmentation procedures. In 31 periodontally healthy, fully dentate subjects the masticatory mucosa thickness was assessed by bone sounding with a periodontal probe. Eighteen standard measurement points were defined in the hard palate, located on 3 lines which ran at different distances parallel to the gingival margin. Six positions were designated on each of these 3 lines between the level of the canine and the second molar. In the tuberosity, 6 standard measurement points were defined, located on 2 lines running parallel to the gingival margin at 2 different distances from the distal aspect of the second molar. Three positions were designated on each line. The hard palate and tuberosity were anesthetized by a spray followed by carticain injection with an epinephrine vasoconstrictor of 1:100,000. Data were analyzed to determine differences in gender, between different positions, and between lines, using an analysis of variance and Wilcoxon test. The mucosa of the tuberosity was significantly thicker than in the hard palate region. Gender did not influence the thickness of masticatory mucosa, either in the hard palate or the tuberosity with the exception of the most distant line in the palate. The mucosa was thickest at the mid-distal position of the tuberosity. In the hard palate, mucosa thickness increased with greater distances from the marginal gingiva. The mucosa over the palatal root of the maxillary first molar was significantly thinner than at all other positions in the hard palate. This represents an anatomical barrier in graft harvesting. It was concluded that two different regions may be defined for soft tissue graft harvesting from an anatomic point of view: 1) In the canine-premolar region rather wide and shallow grafts may be harvested. This region extends distally to the first palatal molar root with a significantly thinner mucosa. 2) The tuberosity revealed a significantly more soft tissue thickness in comparison to the hard palate. This region allows the harvesting of deeper grafts, but graft size is limited by the width of keratinized tissue.

Use of guided tissue regeneration to treat a mucogingival defect associated with interdental bone loss: a case report.

Guided tissue regeneration was successfully used to treat a patient who had a mucogingival defect associated with interdental bone loss. The defect involved the mandibular left central incisor, which exhibited 6.0 to 7.0 mm of attachment loss on the facial, mesial, and distal aspects. A regenerative procedure consisting of critic acid demineralization and placement of a demineralized freeze-dried bone allograft and Gore-Tex membrane was performed. At 8 months, a gain of 4.5 to 5.0 mm, or 64% to 83%, in clinical attachment levels was demonstrated. Root coverage was 86%.

Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry.

The annual review of selected dental literature this year cites 384 published papers and reports. This year's review contains more editorial comment than reviews of years passed. New data on the biological responses to materials is emphasized in several sections. Observations on new compounds able to prevent plaque formation are presented. Clinically relevant advances in knowledge concerning the etching of different tooth structures are reported along with the effect of etching procedures on the dental pulp. Evaluation of periodontal diseases in all age groups is a topic. Limitations of current diagnostic techniques in periodontal disease, temporomandibular disorders, and implant therapy are included. There are new views on the use of dental amalgam. The future use of dental mercury is predicted. Interest in new ceramic systems is indicated as the demand for esthetics continues. Clinical information is emphasized over scientific information throughout this year's review.

Pedicle flaps, gingival grafts, and connective tissue grafts in aesthetic treatment of gingival recession.

Gingival recession leading to exposure of crown margins or extensive areas of the tooth root can cause significant aesthetic difficulties. Surgical innovations over the last decade have enabled the periodontist to correct such problems with greater predictability and improved aesthetics. The current surgical procedures for treatment of gingival recession are described and illustrated, and criteria for selection of the appropriate procedure are presented. The learning objective of this article is a review of the surgical procedures and an increased predictability in implementation.

Surgical crown lengthening for function and esthetics.

Clinical crown lengthening is a useful procedure to provide tooth length for proper restoration of a tooth without compromising the periodontium or the retentive qualities of the restoration. It is also useful for enhancing maxillary anterior esthetics. Crown lengthening may be as simple as a limited removal of soft tissue or as complex as orthodontic extrusion followed by flap with osseous surgery on a tooth requiring endodontic therapy. Total treatment could thus involve endodontic, orthodontic, periodontic, and restorative procedures. Careful evaluation, case selection, treatment planning, and surgical treatment following the principles outlined in this article can achieve results that meet the functional and esthetic challenges of current dental practice.

Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry.

The committee screened several hundred articles, citing 518 published papers. Some are present quality in research, others provide clinical interest, and some are identified as misleading. New techniques in pulp physiology and pathology are reported. Laser use and techniques in prevention, restorative dentistry, and materials use are reported. Epidemiology of selected diseases and the results of various formulations for treatment are cited. Diagnosis of craniomandibular dysfunction is well represented as well as references to literature reviews and other sophisticated scientific investigation. Research on adhesives is presented in respect to bonding agents for dentin and enamel. Several clinical studies are included, along with customary laboratory reports on several materials.