Root coverage and papilla reconstruction using autogenous osseous and connective tissue grafts.

Previous studies have reported that the distance from the interdental crest of bone to the apical portion of the contact of the two approximating teeth must be 5 mm or less to support a stable interdental papilla. The reconstruction of a stable, long-term papilla for esthetic purposes must therefore consider interdental bone reconstruction. Autogenous osseous graft material was harvested from the tuberosity and augmented with a subperiosteal connective tissue graft for papilla reconstruction between the maxillary central incisors. Flap design, osseous graft fixation with a screw, connective tissue placement, wound closure, and suturing techniques are presented. To enhance the final result, porcelain veneers were bonded to the approximating central incisors. This case report demonstrates a surgical procedure that has not been reported to date for papilla reconstruction to enhance periodontal esthetics.

[Current periodontal therapy].

Current periodontal therapy consists of a multitude of categories for study and concern. Therapy for Disease, Esthetics and Implant obligates the clinician to truly become a scientist, therapist and artist to fulfill these categories of therapy. Excellent technical skills must be combined with sound biologic knowledge for a successful, predictable and lasting outcome.

Surgical crown lengthening of the maxillary anterior dentition: aesthetic considerations.

Recent patient interest in aesthetic treatment has resulted in the development of advanced surgical and restorative procedures that are capable of conservatively addressing such objectives. While numerous materials and techniques have been developed accordingly, each must respect specific biological criteria in order to be successful. This article demonstrates the implementation of surgical periodontal plastic and restorative procedures that facilitate the full-mouth rehabilitation of a patient who presented with excessive wear of the natural dentition. The procedure described is specific for the maxillary anterior.

Clinical success in regeneration: report of a case.

Occasionally in clinical periodontics we are confronted with exceptional examples of the potential for healing. This is the report of one such instance in a young patient with a history of juvenile periodontitis and significant localized bone loss. Following relatively simple treatment, marked bone fill of a periodontal defect was observed over the course of 1 year. The factors which contributed to the remarkable healing response are considered, and the techniques used during therapy are presented.

Strip gingival autograft used to correct mucogingival problems around implants.

This case report describes the use of a strip gingival autograft to transplant narrow strips of keratinized gingiva around dental implants. Replacement of unattached, nonkeratinized mucosa with keratinized gingiva resulted in firmly attached gingiva and an improved seal around implants that was healthier and more resistant to inflammation. The strip gingival autograft technique is a simple surgery that results in less discomfort for the patient and provides predictable results.

The strip gingival autograft technique.

In keeping with the concept of rapid epithelialization of close wound edges, the strip technique was developed to maximize the area of gingival grafting with less trauma to the donor site or the recipient site. An incision is made and a partial-thickness flap is reflected so that stable periosteum is left. The apical mucosal border of the recipient site is sutured to the periosteum. Donor tissues are obtained in 2-mm-wide strips, transferred to the recipient site, and sutured. Dry foil and surgical packing are used to stabilize and protect the site during healing. The donor site is rapidly epithelialized (within 10 days) and produces minimal patient discomfort.

Surgical techniques for reconstructive periodontics.

The careful selection of the "graftable" case and the attention to details in the surgical technique increase the predictability of results in reconstructive periodontal therapy. When choosing a surgical technique for reconstructive periodontal therapy, the clinician must carefully consider the following: 1. Flap and incision design to best avoid exposure and contamination of the graft material. 2. Thorough debridement of the osseous lesion for intimate graft contact with the osseous walls. 3. Careful and complete planing of the root surface to the apical end of the vertical osseous lesion. 4. Suturing technique to prevent contamination of the graft material and to obtain a seal between the flap and the root surface. 5. Careful hygiene methods postsurgically to prevent infections during the healing process.

Comparative clinical study of porous hydroxyapatite and decalcified freeze-dried bone in human periodontal defects.

Interproximal bony defects were treated with either porous hydroxyapatite (PHA) or decalcified freeze-dried bone allograft (DFDB) implants at two different clinical centers. Twelve paired defects in 12 patients were treated at each center. Six months post-surgically the defects were measured to assess changes from the presurgical status. No statistically significant differences were found between the groups in changes in gingival fluid, bleeding index, plaque index, or tooth mobility. The porous hydroxyapatite implant produced greater reduction in pocket depth (P = 0.03) and more gain in clinical attachment level (P = 0.001) and defect fill (P = 0.001) when compared with DFDB grafted sites. This study indicates that more clinical resolution of interproximal periodontal defects in humans can be obtained with the use of PHA than with the use of DFDB.

The use of a porous hydroxylapatite implant in periodontal defects. II. Treatment of Class II furcation lesions in lower molars.

Twenty-three human subjects with two Class II furcation involvements in lower molars were treated with initial therapy following which presurgical measurements of pocket depth, gingival recession and attachment level were made. Periodontal flaps were used to expose the furcation defects, and one defect was implanted with porous hydroxylapatite while the other served as an unimplanted control. At the time of surgery, bone defects were measured obliquely and horizontally using a specially designed device to ensure reproducible probe angulation. Six months later the presurgical measurements were repeated, and reentry surgical procedures were carried out to measure the changes in the bone defects. Areas implanted with porous hydroxylapatite showed a statistically significant reduction in pocket depth and a statistically significant improvement in attachment level and fill of bone defects when compared with control defects. There was statistically less gingival recession in the implanted areas compared with the control sites. Control sites at six months showed no significant change in pocket depth, an increased loss of attachment and worsening of the bone defects.

Flap technique for periodontal bone implants. Papilla preservation technique.

A new flap design for placement of implants into osseous defects has been described. The flap design can be used in anterior and posterior areas of human subjects. Photographs of representative cases are presented. Wound healing always occurred by primary intention and without evidence of immediate graft exfoliation. Interdental soft tissue craters did not develop, making it easier for patients to maintain optimal oral hygiene. This type of flap design can also be used without grafts in order to improve postoperative soft tissue contour.

The interdental space.

There is a close relationship between the contact, contour, and shape of the teeth that creates the interproximal space with the help of the interdental gingiva. The interdental gingiva, composed of the facial and lingual papillae and the col, is a unique area anatomically and histologically. The high incidence of caries and periodontal disease in the interproximal area is partially the result of this histologic and anatomic make-up and the great accumulation of bacterial plaque. In restorative dentistry, it is important to recreate an interproximal area that will minimize a long facial-lingual col area, provide adequate space for interdental gingiva, minimize food impaction and retention, and allow for ease in plaque removal by the patient.