Optimizing esthetic zone periodontal regeneration in a 1-2-wall infrabony defect using recombinant human platelet-derived growth factor BB and ß-tricalcium phosphate: A case report.

OBJECTIVE: Periodontitis is an inflammatory condition induced by subgingival bacterial dysbiosis, resulting in inflammatory-mediated destruction of tooth-supporting structures, potentially leading to the formation of infrabony defects. This case report describes the treatment of a patient who presented with a combination 1-2-wall defect on tooth 21. To maintain the residual periodontal attachment and minimize esthetic consequences, a regenerative approach was performed using recombinant human platelet-derived growth factor-BB (rh-PDGF-BB) and ß-tricalcium phosphate (ß-TCP). MATERIALS AND METHODS: At the time of postscaling/root planing reevaluation, a 34-year-old Asian male initially diagnosed with molar/incisor pattern stage III grade C periodontitis exhibited a 6-mm residual probing depth on the mesiopalatal aspect of tooth 21. Periodontal regenerative surgery was performed using rh-PDGF-BB with ß-TCP, without the use of a membrane. RESULTS: At the 1-year follow-up, a significant reduction in probing depth and radiographic evidence of bone fill were observed. Additionally, re-entry surgery for implant placement at site tooth 23 confirmed bone fill in the defect on tooth 21. CONCLUSION: These results demonstrate the efficacy of rh-PDGF-BB with ß-TCP in enhancing periodontal regeneration and support its use as a treatment option when treating poorly contained infrabony defects in the esthetic zone.

Immediate single-tooth replacement with acellular dermal matrix allogeneic bone and ossifying collagen scaffold: A case series.

The pursuit of predictable implant success in the aesthetic zone continues as technology develops. Creating stable marginal bone and an optimal peri-implant mucosal environment is the foundation for a long-term healthy and aesthetic implant treatment outcome. Tissue stability is dependent on multiple factors, including the regenerative materials used to create the peri-implant supporting tissues and maintain the tissue volume. The present study aims to describe a technique that combines a flapless approach to extract hopeless teeth in the aesthetic zone and implant insertion using an acellular dermal matrix placed to contain the coronal aspect of an innovative ossifying collagen scaffold designed to promote neoformation of vital native bone. This technique combines a minimally invasive approach with the application of a novel biomaterial that offers stable augmentation of the gingival thickness as well as bone fill in the facial gap, the space between the implant and the buccal plate, to ensure predictable aesthetic results. A collection of cases are presented to demonstrate the surgical technique and the situation over a follow-up period of 22 months. Pre- and post-treatment CBCT imaging were utilised to quantify the stability or changes noted in the alveolar bone, and pre-and post-treatment intraoral scanning were used for the same purpose in the peri-implant phenotype. This case series presents stable and aesthetic clinical outcomes evaluated through digital assessment.

Three-dimensional printing of the human lung pleural cavity model for PDT malignant mesothelioma.

OBJECTIVE: The primary aim was to investigate emerging 3D printing and optical acquisition technologies to refine and enhance photodynamic therapy (PDT) dosimetry in the management of malignant pleural mesothelioma (MPM). MATERIALS AND METHODS: A rigorous digital reconstruction of the pleural lung cavity was conducted utilizing 3D printing and optical scanning methodologies. These reconstructions were systematically assessed against CT-derived data to ascertain their accuracy in representing critical anatomic features and post-resection topographical variations. RESULTS: The resulting reconstructions excelled in their anatomical precision, proving instrumental translation for precise dosimetry calculations for PDT. Validation against CT data confirmed the utility of these models not only for enhancing therapeutic planning but also as critical tools for educational and calibration purposes. CONCLUSION: The research outlined a successful protocol for the precise calculation of light distribution within the complex environment of the pleural cavity, marking a substantive advance in the application of PDT for MPM. This work holds significant promise for individualizing patient care, minimizing collateral radiation exposure, and improving the overall efficiency of MPM treatments.

A novel investigational preclinical model to assess fluence rate for dental oral craniofacial tissues.

OBJECTIVE: Photodynamic Therapy (PDT) and Photobiomodulation (PBM) are recognized for their potential in treating head and neck conditions. The heterogeneity of human tissue optical properties presents a challenge for effective dosimetry. The porcine mandible cadaver serves as an excellent model and has several similarities to human tissues of the dental oral craniofacial complex. This study aims to validate a novel modeling system that will help refine PDT and PBM dosimetry for the head and neck region. METHODS AND MATERIALS: Light transmission was analyzed through several tissue combinations at distances of 2 mm to 10 mm. Maximum light fluence rates (mW/cm2) were compared across tissue types to reveal the effects of tissue heterogeneity. RESULTS: The study revealed that light fluence is affected by tissue composition, with dentin/enamel showing reduced transmission and soft tissue regions exhibiting elevated values. The porcine model has proven to be efficient in mimicking human tissue responses to light, enabling the potential to optimize future protocols. CONCLUSION: The porcine mandible cadaver is a novel model to understand the complex interactions between light and tissue. This study provides a foundation for future investigations into dosimetry optimization for PDT and PBM.

Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement: A randomized clinical trial on patient-reported outcome measures.

OBJECTIVES: To compare patient-reported outcome measures and additional surgical outcomes after sinus floor elevation (SFE) with osseodensification (OD) versus lateral window (LW), both with simultaneous implant placement. MATERIALS AND METHODS: Twenty participants requiring single-implant rehabilitation with residual bone height (RBH) ≤4 mm were enrolled. Pain experience, quality of life (QoL) via the Oral Health Impact Profile-14 (OHIP-14), analgesics intake, and other symptoms were self-reported for a week on a daily basis. Surgery duration, complications, and implant stability quotient at baseline (ISQ T0 ) and after 6 months (ISQ T6 ) were registered. Participants were followed up for 1 year. RESULTS: From Day 0 (day of surgery) to Day 3, pain experience was significantly lower (p < 0.05) in the OD group. OHIP-14 score was significantly lower (p < 0.05) in the OD group on all postoperative days, except on Day 5. Average analgesics intake was significantly lower (p < 0.001) in the OD group. Surgery mean duration was significantly higher (p < 0.001) in LW compared to OD (71.1 ± 10.4 vs. 32.9 ± 5.3 min). After osseointegration period, all implants were successfully restored with screw-retained crowns. CONCLUSIONS: Within the limitations of this study, it can be concluded that OD and LW techniques were similarly effective in SFE with simultaneous implant placement when RBH ≤ 4 mm. However, OD significantly outperformed LW in pain experience, impact on self-perceived QoL, surgery duration, postoperative edema, and analgesics intake.

Immediate single-tooth replacement with acellular dermal matrix allogeneic bone on sloped platform-switching implants: A case series.

Achieving predictable success with implants in the aesthetic zone is essential for clinicians. Promoting marginal bone and stability of the gingival environment is key to obtaining a predictable aesthetic outcome. The present study aimed to describe a technique that combines a flapless approach to immediate extraction and placement of sloped implants, using an acellular dermal matrix to contain the coronal aspect of a deproteinised bovine bone mineral graft. This minimally invasive technique results in stable augmentation of soft tissue thickness to ensure predictable aesthetic results. A collection of case reports with a follow-up period of up to 45 months is presented to demonstrate the surgical technique. Clinical presentation showed relative stability of the soft tissue margins during the evaluation period.

Effects of different antidepressant classes on dental implant failure: A retrospective clinical study.

BACKGROUND: Previous studies have suggested an association between taking antidepressants and dental implant failure. This study aimed to investigate the association of different antidepressant classes with dental implant failure. METHODS: This retrospective study included patients that received dental implants at the University of Florida from 2011 to 2016. The variables of implant failure, antidepressant use and classes (selective serotonin reuptake inhibitors [SSRI], serotonin-norepinephrine reuptake inhibitors [SNRI], tricyclic antidepressants [TCA], atypical antidepressants [AA], and monoamine oxidase inhibitors [MAOI]), age, sex, smoking, mild systemic diseases, and implant location were obtained from patients' records. Odds ratio (OR) and confidence interval (CI) of implant failure in patients taking different antidepressant classes, in relationship to non-antidepressant users, were estimated, and the influence of multiple variables on implant failure were investigated. RESULTS: A total of 771 patients and 1,820 implants were evaluated. The statistically significant predictors for implant failure included smoking (OR = 5.221), use of antidepressants (OR = 4.285), posterior maxilla location (OR = 2.911), mild systemic disease (OR = 2.648), and age (OR = 1.037) (P <0.05). The frequency of implant failure was 33.3% in TCA users, 31.3% in SNRI users, 6.3% in SSRI users, 5.2% in Atypical antidepressant users, and 3.9% in non-users. Significant associations were observed between the use of SNRI (OR: 11.07; 95% CI: 3.265 to 33.82) and TCA (OR: 12.16; 95% CI: 1.503 to 71.58) and implant failure (P <0.05). CONCLUSIONS: Users of antidepressants were at higher risk of implant failure than non-users. Patients taking SNRI and TCA were at the highest risk of implant loss, when compared with non-users. Conclusions about TCA, however, are based on a limited number of cases.

Alveolar Ridge Expansion: Comparison of Osseodensification and Conventional Osteotome Techniques.

OBJECTIVE: The aim of this in vivo study is to compare the osseointegration of endosteal implants placed in atrophic mandibular alveolar ridges with alveolar ridge expansion surgical protocol via an experimental osseodensification drilling versus conventional osteotome technique. METHODS: Twelve endosteal implants, 4 mm × 13 mm, were placed in porcine models in horizontally atrophic mandibular ridges subsequent to prior extraction of premolars. Implants were placed with osseodensification drilling technique as the experimental group (n = 6) and osteotome site preparation as the control group (n = 6). After 4 weeks of healing, samples were retrieved and stained with Stevenel's Blue and Van Gieson's Picro Fuschin for histologic evaluation. Quantitative analysis via bone-to-implant contact (BIC%) and bone area fraction occupancy (BAFO%) were obtained as mean values with corresponding 95% confidence interval. A significant omnibus test, post-hoc comparison of the 2 drilling techniques' mean values was accomplished using a pooled estimate of the standard error with P-value set at 0.05. RESULTS: The mean BIC% value was approximately 62.5% in the osseodensification group, and 31.4% in the regular instrumentation group. Statistical analysis showed a significant effect of the drilling technique (P = 0.018). There was no statistical difference in BAFO as a function of drilling technique (P = 0.198). CONCLUSION: The combined osseodensification drilling-alveolar ridge expansion technique showed increased evidence of osseointegration and implant primary stability from a histologic and biomechanical standpoint, respectively. Future studies will focus on expanding the sample size as well as the timeline of the study to allow investigation of long-term prognosis of this novel technique.

Regeneration of the cementum and periodontal ligament using local BDNF delivery in class II furcation defects.

Periodontal furcation defects are usually addressed by the placement of a physical barrier which may limit the regenerative potential of periodontal wounds. This study morphometrically quantified the regenerative effect of brain-derived neurotrophic factor (BDNF) in furcation defects in a non-human primate model. Grade II furcation defects (with and without induced inflammation prior to surgery) were created on the first and second molars of eight non-human primates. Defects were treated with open flap debridement and subsequently filled with either: Group A; BDNF (500 µg mL-1 ) in high-molecular weight-hyaluronic acid (HMW-HA), Group B; BDNF (50 µg mL-1 ) in HMW-HA, Group C; HMW-HA acid only, Group D; unfilled defect, or Group E; BDNF (500 µg mL-1 ) in saline. Periodontal wound healing was observed every 2 weeks by computed-tomography. At 11 weeks all animals were sacrificed and maxillary and mandibular block biopsies were referred for nondecalcified histology. Linear measurements of new cementum (cellular and acellular) and periodontal ligament (PDL) formation were performed. Computerized-tomography reconstruction and software quantification demonstrated successful bone fill for all groups. However, histometric assessment demonstrated significantly higher level of total periodontal regeneration for the 500 µg mL-1 BDNF HMW-HA relative to all other groups. No significant differences in cementogenesis were observed among groups. Significantly higher acellular cementum formation was observed for sites where inflammation was not induced prior to surgical procedures. While all groups experienced similar bone fill and cementogenesis, the 500 µg mL-1 BDNF HMW-HA appeared to most effectively repair PDL (minimum increase of ∼22% relative to all groups; over 200% relative to unfilled defects). © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1611-1617, 2018.

Biomechanical and histologic basis of osseodensification drilling for endosteal implant placement in low density bone. An experimental study in sheep.

A bone drilling concept, namely osseodensification, has been introduced for the placement of endosteal implants to increase primary stability through densification of the osteotomy walls. This study investigated the effect of osseodensification on the initial stability and early osseointegration of conical and parallel walled endosteal implants in low density bone. Five male sheep were used. Three implants were inserted in the ilium, bilaterally, totaling 30 implants (n=15 conical, and n=15 parallel). Each animal received 3 implants of each type, inserted into bone sites prepared as follows: (i) regular-drilling (R: 2mm pilot, 3.2mm, and 3.8mm twist drills), (ii) clockwise osseodensification (CW), and (iii) counterclockwise (CCW) osseodensification drilling with Densah Bur (Versah, Jackson, MI, USA): 2.0mm pilot, 2.8mm, and 3.8mm multi-fluted burs. Insertion torque as a function of implant type and drilling technique, revealed higher values for osseodensification relative to R-drilling, regardless of implant macrogeometry. A significantly higher bone-to-implant contact (BIC) for both osseodensification techniques (p<0.05) was observed compared to R-drilling. There was no statistical difference in BIC as a function of implant type (p=0.58), nor in bone-area-fraction occupancy (BAFO) as a function of drilling technique (p=0.22), but there were higher levels of BAFO for parallel than conic implants (p=0.001). Six weeks after surgery, new bone formation along with remodeling sites was observed for all groups. Bone chips in proximity with the implants were seldom observed in the R-drilling group, but commonly observed in the CW, and more frequently under the CCW osseodensification technique. In low-density bone, endosteal implants present higher insertion torque levels when placed in osseodensification drilling sites, with no osseointegration impairment compared to standard subtractive drilling methods.

Periodontal soft tissue non-root coverage procedures: a consensus report from the AAP Regeneration Workshop.

BACKGROUND: Soft tissue grafting for the purposes of increasing the width of keratinized tissue (KT) is an important aspect of periodontal treatment. A systematic review was analyzed, focusing on non-root coverage tissue grafts. The references were updated to reflect the current literature. METHODS: To formulate the consensus report, group members submitted any new literature related to the topic that met criteria fitting the systematic review, and this information was reviewed for inclusion in this report. A consensus report was developed to summarize the findings from the systematic review and to guide clinicians in their treatment decision-making process. RESULTS: Forty-six articles met the criteria for inclusion in the final analysis, and two articles were added that were used to formulate this consensus report. A list of eight clinically relevant questions was posed, and consensus statements were developed. CONCLUSIONS: The evidence suggests that a minimum amount of KT is not needed to prevent attachment loss (AL) when optimal plaque control is present. However, if plaque control is suboptimal, a minimum of 2 mm of KT is needed. The standard procedure to predictably gain KT is the autogenous gingival graft. There is limited evidence for alternative treatment options. However, additional research may offer promising results in certain clinical scenarios. CLINICAL RECOMMENDATIONS: Before patient treatment, the clinician should evaluate etiology, including the role of inflammation and various types of trauma that contribute to AL. The best outcome procedure (autograft) and alternative options should be reviewed with the patient during appropriate informed consent. Proper assessment of the outcome should be included during supportive periodontal care.

Periodontal Soft Tissue Non-Root Coverage Procedures: Practical Applications From the AAP Regeneration Workshop.

Focused Clinical Question: What are the indications and clinical applications for gingival augmentation procedures, and what factors guide the choice among treatment options in specific situations? Summary: Although there is still controversy regarding whether there needs to be a minimum amount of attached gingiva to maintain the stability of the gingival margin, prospective and retrospective studies have shown that, in the presence of suboptimal plaque control and clinical inflammation, attachment loss and gingival recession (GR) may result unless a minimum amount of keratinized tissue (KT) and attached gingiva are present. Treatment of mucogingival deformities requires gingival augmentation procedures that address both a functional and esthetic component for the patient. Although free gingival grafts (FGGs) are considered the gold standard for treatment of GR defects to obtain root coverage, augmentation of KT and attached gingiva may be accomplished by FGG or other autogenous grafting options, including the free connective tissue graft, the lateral pedicle graft, and the double papilla technique. In addition, the modified apically repositioned flap can be considered in some instances. Alternatives to autogenous graft tissue include acellular dermal matrix, extracellular matrix membrane, bilayer collagen matrix, and living cellular construct. Conclusions: Understanding the clinical importance of the presence of a minimum amount of attached gingiva in patients with suboptimal hygiene is an important first step in addressing the condition. Patient education to address plaque control and counseling to quit smoking in patients who are smokers help enhance the success of these mucogingival surgical procedures. An analysis of patient-specific factors will help with the appropriate choice of surgical procedures aimed at augmenting the dimension of KT/attached gingival tissue. Evidence supporting the treatment decisions described in this practical application is summarized in the companion papers from the American Academy of Periodontology Regeneration Workshop (Kim and Neiva, J Periodontol 2015;86(Suppl.):S56-S72; Scheyer et al., J Periodontol 2015;86(Suppl.):S73-S76).

Generation of site-appropriate tissue by a living cellular sheet in the treatment of mucogingival defects.

BACKGROUND: Generation of site-appropriate tissue in the oral cavity includes the restoration of the correct anatomic type, amount, and distribution of the tissue. This study is a post hoc analysis of data collected during previously published results from two randomized clinical trials of a living cellular sheet (LCS; allogenic cultured keratinocytes and fibroblasts in bovine collagen) versus a free gingival graft (FGG), evaluating their ability to augment keratinized tissue or gingiva. METHODS: Post hoc histologic and clinical (photographic) comparisons of the outcomes of treatment were performed on histologic and photographic data gathered in the two randomized clinical trials. RESULTS: Histologic findings showed that LCS-treated sites resembled gingiva rather than alveolar mucosa. Photographic analysis indicated that LCS treatment resulted in more site-appropriate tissue than FGG in terms of tissue color, with adjacent untreated tissue, absence of scar formation or keloid-like appearance, and mucogingival junction alignment. CONCLUSION: Treatment of mucogingival defects with LCS resulted in the generation of tissue that is more site appropriate than tissue transplanted from the palate.

Intraoral grafting of tissue-engineered human oral mucosa.

PURPOSE: The primary objective of this study was to evaluate the safety of a tissue-engineered human ex vivo-produced oral mucosa equivalent (EVPOME) in intraoral grafting procedures. The secondary objective was to assess the efficacy of the grafted EVPOME in producing a keratinized mucosal surface epithelium. MATERIALS AND METHODS: Five patients who met the inclusion criteria of having one mucogingival defect or a lack of keratinized gingiva on a nonmolar tooth, along with radiographic evidence of sufficient interdental bone height, were recruited as subjects to increase the width of keratinized gingiva at the defect site. A punch biopsy specimen of the hard palate was taken to acquire oral keratinocytes, which were expanded, seeded, and cultured on an acellular dermal matrix for fabrication of an EVPOME. EVPOME grafts were applied directly over an intact periosteal bed and secured in place. At baseline (biopsy specimen retrieval) and at 7, 14, 30, 90, and 180 days postsurgery, Plaque Index and Gingival Index were recorded for each subject. In addition, probing depths, keratinized gingival width, and keratinized gingival thickness were recorded at baseline, 30, 90, and 180 days. RESULTS: No complications or adverse reactions to EVPOME were observed in any subjects during the study. The mean gain in keratinized gingival width was 3 mm (range, 3 to 4 mm). The mean gain in keratinized gingival thickness was 1 mm (range, 1 to 2 mm). No significant changes in probing depths were observed. CONCLUSION: Based on these findings, it can be concluded that EVPOME is safe for intraoral use and has the ability to augment keratinized tissue around teeth. Future clinical trials are needed to further explore this potential.

Influence of lateral window dimensions on vital bone formation following maxillary sinus augmentation.

PURPOSE: The aim of this study was to evaluate the influence that lateral window dimensions may have on maxillary sinus augmentation outcomes. MATERIALS AND METHODS: Patients requiring maxillary sinus augmentation by a lateral window approach and delayed implant placement were recruited in this study. Approximate window dimensions (AWD) were calculated in mm2 at the time of the surgical intervention. In all cases, a mixture of cortical and cancellous allograft particles was used as the sole grafting material. Patients were followed for 6 months. At the time of implant placement, bone core biopsies were harvested. Transversal circular samples were histomorphometrically analyzed. Proportions of vital bone (VB), remaining allograft particles (RA), and nonmineralized tissue (NMT) were quantified. Analysis of correlation of AWD with %VB, %RA, and %NMT was performed using a statistical model. RESULTS: A total of 24 maxillary sinus augmentation procedures were performed in 21 patients. One patient developed an infection after grafting and was excluded. Histomorphometric analysis showed that mean %VB was 21.69% ± 16.30%, %RA was 23.51% ± 16.33%, and %NMT was 55.08% ± 8.52%. A strong negative correlation was observed between AWD and %VB (r = -0.621; P = .0007), a marked positive correlation was found between AWD and %RA (r = 0.565; P = .002), and a minimal positive correlation, without statistical significance, was found between AWD and %NMT (r = 0.076; P = .365). CONCLUSIONS: The results of this study suggest that AWD may have an important influence on the maturation and consolidation of a mixture of cortical and cancellous allograft in the maxillary sinus.

Analysis of the influence of residual alveolar bone height on sinus augmentation outcomes.

INTRODUCTION: Maxillary sinus augmentation is a predictable implant site development technique for posterior atrophic maxillary ridges. However, graft consolidation requires adequate angiogenesis and migration of osteogenic cells from native bone. Therefore, the amount of residual bone height (RBH) may play a role in the rate of graft maturation. The purpose of this study was to analyze the influence of RBH in the histomorphometric outcomes of maxillary sinus augmentation procedures. MATERIAL AND METHODS: Patients in need of sinus augmentation were recruited for the study. Customized radiographic guides were fabricated and a cone-beam computerized tomography scan was obtained at baseline. Two examiners measured RBH on the scans at the locations marked by the radiographic guide. Sinus grafting was performed by a lateral window approach using a particulated mineralized allograft. Patients were followed up for 6 months. At the time of implant placement, bone core biopsies were harvested using the radiographic guide, which was converted into a surgical guide. Samples were histomorphometrically analyzed. Proportion of vital bone (%VB), remaining allograft particles (%RA), and non-mineralized tissue (%NMT) were quantified. Categorical analysis of correlation of RBH (<4 or ≥4 mm) with%VB and%RA was performed using a statistical model. RESULTS: Twenty-one patients underwent sinus augmentation for a total of 21 sinuses. One patient developed an infection after grafting and was excluded. Histomorphometric analysis revealed that mean%VB was 20.47 ± 18.25, mean %RA was 29.04 ± 24.94, and average %NMT was 50.47 ± 12.76. No significant correlation between RBH and %VB (r = 0.016; P = 0.951), and RBH and % (r = 0.009; P = 0.971) was found. Similarly, categorical analysis of correlation showed no statistical significance. CONCLUSION: These findings suggest that the remaining alveolar bone height does not appear to influence the maturation and consolidation of an allograft in the maxillary sinus.

Analysis of tissue neogenesis in extraction sockets treated with guided bone regeneration: clinical, histologic, and micro-CT results.

The aims of this article were to perform a detailed evaluation of the healing of extraction sockets covered with a resorbable collagen membrane 12 weeks following exodontia and to determine if this device had ossifying properties. Ten consecutive subjects in need of extraction of maxillary premolars were recruited. Each subject had a hopeless maxillary premolar extracted with minimal trauma. Sockets were then covered with a collagen barrier membrane alone. At 12 weeks, reentry surgery was performed, clinical measurements were repeated, and bone core biopsies were obtained prior to dental implant placement for histologic and microcomputed tomography (micro-CT) analysis. Study sites showed mean bone regeneration horizontally of 7.7 mm (buccopalatally) and 4.6 mm (mesiodistally). Vertical bone repair showed a mean gain of 10.9 mm. Subtraction radiography showed a mean apical shift of the crestal bone at the center of the socket of 2.1 mm (range, 0.7 to 4.3 mm). Micro-CT and histology revealed formation of well-mineralized tissue at 12 weeks, with a mean percentage of vital bone of 45.87% ± 12.35%. No signs of membrane ossification were observed. A detailed analysis of tissue neogenesis in extraction sites protected by this barrier membrane has demonstrated that adequate bone formation for implant placement occurs as early as 12 weeks following exodontia, with minimal changes in alveolar ridge dimensions. No evidence of membrane ossification was observed.

Living cellular construct for increasing the width of keratinized gingiva: results from a randomized, within-patient, controlled trial.

BACKGROUND: The standard of care for increasing keratinized gingiva adjacent to teeth that do not require root coverage is the free gingival graft (FGG). A pilot study indicated that the use of a living cellular construct (LCC) could be effective in this clinical scenario. METHODS: A pivotal, multicenter, randomized, within-patient, controlled, open-label trial was conducted (N = 96 patients). After removing the mucosa and keratinized gingiva from the test site, either an LCC or FGG was applied. The primary efficacy endpoint was the ability of the LCC to regenerate ≥2 mm keratinized gingiva at 6 months. Secondary measures were the same color and texture as the adjacent tissue, a 1-mm width of keratinized gingiva at 6 months, patient treatment preference, surgical site sensitivity at 1 week, and patient-reported pain after 3 days. Safety was assessed by reports of adverse events. RESULTS: At 6 months, the LCC regenerated ≥2 mm of keratinized gingiva in 95.3% of patients (81 of 85 patients; P <0.001 versus a 50% predefined standard). As expected, the FGG generated more keratinized gingiva than the LCC (4.57 ± 1.0 mm versus 3.2 ± 1.1 mm, respectively). The gingiva regenerated with the LCC matched the color and texture of the adjacent gingiva. All patients achieved ≥1 mm keratinized gingiva with the LCC treatment by 6 months, and more patients preferred treatment with the LCC than with the FGG. No difference in sensitivity or pain was noted between the treatments. The treatments were well tolerated, and reported adverse events were typical for this type of periodontal surgery. CONCLUSION: The use of an LCC may provide a safe and effective therapy for augmenting the zone of keratinized gingiva.

Clinical and histologic outcomes after the use of a novel allograft for maxillary sinus augmentation: a case series.

PURPOSE: To document the clinical and histologic outcomes of sinus augmentation using a novel allogenic bone substitute as a sole grafting material. MATERIALS: Patients in need of sinus augmentation before implant placement were recruited for this study. Sinus augmentation procedures were performed following a lateral approach, using a freeze-dried allograft as the only grafting material. Patients were followed up postoperatively for 6 months. Plaque score, wound healing, and patient discomfort were recorded at each follow-up visit. Implants were placed between 6 and 7 months after sinus augmentation and restored 6 months later. Bone core biopsy specimens were harvested at the time of implant placement and processed for histologic and histomorphometrical analysis. Vital bone, remaining allograft (RA) particles, and nonmineralized tissue percentages were assessed on each sample. Results were expressed as mean percentages with SD. RESULTS: Of the 23 sinus patients, 20 patients underwent sinus augmentation surgery. All patients had satisfactory postoperative healing in the absence of complications. A total of 39 implants were placed. One implant failed and was replaced 3 months later. Histologic analysis revealed the presence of well-organized lamellar bone, in direct contact with RA particles. Mean vital bone was 23.02 +/- 19.11%, mean RA was 22.25 +/- 20.30%, and average nonmineralized tissue was 54.73 +/- 13.51%. CONCLUSION: Clinical and histologic findings support the suitability of an allograft consisting of a combination of cortical and cancellous chips for sinus augmentation procedures.

The influence of the bucco-palatal distance on sinus augmentation outcomes.

BACKGROUND: Maxillary sinus augmentation is one of the most reliable implant site development options to increase vertical bone height. However, graft consolidation requires adequate angiogenesis and migration of cells involved in osteogenesis and bone remodeling. It is speculated that these biologic events are greatly determined by the dimensions of the maxillary sinus cavity. Hence, the purpose of this study is to assess the influence of the distance from the lateral to the medial wall of the maxillary sinus on the outcomes of sinus augmentation procedures. METHODS: A total of 25 patients in need of sinus augmentation were recruited for the study. After initial examination, customized radiographic and surgical guides were fabricated and a cone-beam computerized tomography scan was obtained per patient. The bucco-palatal distance (BPD) was measured at 8, 10, and 12 mm from the alveolar crest. Sinus grafting was performed by a lateral window approach using a particulated allograft material. Patients were followed-up for 6 months. At the time of implant placement, bone core biopsies were harvested using the radiographic-surgical guide. Sections of the bone cores at 8, 10, and 12 mm from the alveolar crest were histomorphometrically analyzed. The proportion of vital bone (%VB) was correlated with the BPD using a statistical model. RESULTS: Twenty-one patients underwent sinus augmentation for a total of 24 sinuses; however, the data analyzed contained only one sinus per patient. One sinus developed an infection after grafting, resulting in a 96% success rate for the sinus grafting procedure. Twenty sinuses were used in the final statistical analysis. Histomorphometric analysis revealed that mean %VB was 22.71 +/- 19.08, mean percent of remaining allograft was 23.39 +/- 20.85, and average percent of non-mineralized connective tissue was 53.90 +/- 13.23. Analysis of the correlation between %VB and BPD by linear regression, using the actual values of BPD showed a strong negative association (R(2) = 0.141; P <0.001). CONCLUSION: The findings suggest that the %VB formation after maxillary sinus augmentation is inversely proportional to the sinus BPD.