Treating peri-implantitis using a combined regenerative/resective procedure: a case report.

The aim of this article is to describe a combined regenerative/resective procedure used in the treatment of peri-implantitis. The following case presented with excess-cement-induced peri-implantitis and the resulting combined circumferential and buccal dehiscence defect. Surgical therapy consisted of minimal resection of interproximal peaks of bone and subsequent guided bone regeneration. The 12-month clinical result was resolution of peri-implantitis (no pathologic probing depths, bleeding on probing, suppuration), radiographic evidence of bone fill of the defect, and some recession that was clinically acceptable to the patient.

A modified ridge Expansion technique in the maxilla.

Localized ridge expansion of a deficient edentulous maxillary alveolar ridge segment is a useful technique when the goal of surgery is to provide an increase in ridge width as a means of establishing an adequate alveolar crest capable of receiving endosseous implants. The purpose of this article is to describe several modifications to the original ridge-splitting technique for deficient maxillary ridges. These modifications include full-thickness flap reflection, elimination of vertical intraosseous incisions, and simultaneous incorporation of guided bone regeneration. The modifications help to decrease complications associated with the original ridge-splitting technique while increasing the predictability of ridge augmentation in the buccal-palatal dimension. A case is presented that demonstrates the efficacy of the modified technique.

Titanium mesh as an alternative to a membrane for ridge augmentation.

PURPOSE: The purpose of the present study was to determine the rate and extent of complications associated with using titanium mesh for bone regeneration and to identify which factors might be associated with postoperative complications, such as infection, soft tissue exposure, and graft failure. MATERIALS AND METHODS: A retrospective study design was used to analyze the treatment outcomes of 27 consecutive surgical sites in the maxilla and mandible that were treated with bone grafting in conjunction with fixation of titanium mesh. The primary study variable was whether the surgical sites treated with titanium mesh presented with any postoperative complications such as exposure of the titanium mesh and/or graft failure. A secondary study variable was whether treatment with bone grafting and fixation of titanium mesh provided the necessary bone augmentation required for subsequent dental implant placement. The predictor variables of maxillary versus mandibular surgical site and the type of bone graft material used were studied to determine whether any relationship exists between these variables and the aforementioned postoperative complications. RESULTS: A total of 27 consecutive sites in the maxilla and mandible that required substantial bone augmentation and were treated with titanium mesh were evaluated for 6 to 24 months after surgical treatment. Exposure of titanium mesh was seen in 7 (26%) of the 27 surgical sites evaluated. No significant difference in the exposure rate was seen between the maxilla and mandible or according to the type of graft material used. All 69 implants placed were in function, and the success rate was 100%. CONCLUSIONS: The findings from the present study indicate that substantial bone augmentation can be achieved using titanium mesh in conjunction with bone grafting. Furthermore, exposure of titanium mesh during healing does not necessarily compromise the final treatment outcome.

A liquid membrane as a barrier membrane for guided bone regeneration.

Membranes made of several different materials are available in the market, nonresorbable (e.g. ePTFE), resorbable (e.g. synthetic or collagen) and liguid applicable (e.g. Polyethylene glycol or Atrisorb). The purpose of the present study was to evaluate whether or not in situ application of Atrisorb could be used as a barrier membrane for guided bone regeneration. Ten patients with insufficient alveolar ridge width for implant placement participated in the study. Atrisorb in conjunction with various bone grafts was used to treat 10 different sites, 3 sites treated prior to implant placement and 7 sites in conjunction with implant placement. Augmented sites were allowed to heal for 3 to 7 months, with mean healing time of 4.7 months. Healing was uneventful with no major complications. Two sites experienced a flap dehiscence accompanied by barrier exposure during the initial healing period. Secondary healing was achieved soon after with no signs of infection, giving Atrisorb a barrier exposure rate of 20% for the present study, which corresponds to favorably to that of resorbable membranes. The liquid membrane has the potential of being a viable alternative to traditional resorbable membranes for use in GBR procedures.

Clinical and histologic assessment of lateral alveolar ridge augmentation using a synthetic long-term bioabsorbable membrane and an allograft.

BACKGROUND: Guided bone regeneration (GBR) is a widely used procedure for augmenting alveolar ridge width prior to placement of endosseous implants. Various graft materials and barrier membranes (non-resorbable and bioabsorbable) have been used in GBR. The aim of this study was to assess the performance of a new bioabsorbable, synthetic polyglycolic acid/trimethylene carbonate (PGA/TMC) barrier membrane with an increased absorption time in conjunction with a combination of assayed demineralized bone matrix and cortical cancellous chips uniformly dispersed in a thermoplastic biologic carrier. METHODS: At 72 potential implant sites in 38 subjects, ridge width at the crest and 4 mm apical to the crest was measured before and 6 months after a GBR procedure using the long-term (LT) PGA/TMC membrane and an allograft in a thermoplastic carrier. Before placement of endosseous implants, 48 biopsy specimens were obtained from the augmentation sites and analyzed histomorphometrically. RESULTS: The GBR procedure increased the mean ridge width at the crest from 2.4 to 5.2 mm. This 216% change from baseline was significant (P <0.001). The mean width 4 mm apical to the crest increased from 4.4 to 7.5 mm, a significant (P <0.001) 174% change. The histomorphometric analysis showed that the biopsy specimens consisted, on average, of 57% bone (36% graft material and 21% new bone) and 43% soft tissue and space. CONCLUSION: Our findings suggest that the LT PGA/TMC barrier membrane, used in conjunction with an allograft, provides lateral alveolar ridge augmentation comparable to that achieved with other materials without the necessity for bone-graft harvesting or a second procedure to remove the barrier membrane.

Introduction to the SES technique: a composite of surgical modifications which simplify the subepithelial connective tissue graft technique.

The subepithelial connective tissue graft has been a successful procedure when the primary goal of surgery is to obtain root coverage. A multitude of authors have described variations of the original technique that have the potential to decrease morbidity and increase the overall success of the procedure. This article describes the SES modifications, which consist of scooping horizontal incisions, elevating an envelope flap, and closing with a sling suture. Several cases demonstrate the potential of the SES technique to facilitate the connective tissue graft procedure.

Sinus elevation using a staged osteotome technique for site development prior to implant placement in sites with less than 5 mm of native bone: a case report.

Since the osteotome technique with simultaneous implant placement becomes less predictable when there is less than 5 mm of preexisting alveolar bone height beneath the sinus, a staged approach has been recommended for this situation. The purpose of the present article is to describe the osteotome technique as a site development method where the edentulous posterior maxilla radiographically showed less than 5 mm of bone between the alveolar crest and the sinus floor.

Associations between periodontal diseases and systemic diseases: a review of the inter-relationships and interactions with diabetes, respiratory diseases, cardiovascular diseases and osteoporosis.

The aim of this review article is to examine the associations between periodontal diseases and common systemic diseases, namely diabetes, respiratory diseases, cardiovascular diseases and osteoporosis. A substantial number of review articles have been published to elucidate the relationships between these diseases; however, none provide a complete overview on this topic from the aspects of definition, classification, clinical characteristics and manifestations, inter-relationships and interactions, proposed schematic mechanisms, clinical implications and management of periodontal patients with these systemic diseases. The aim of this article is to provide an overall understanding and general concepts of these issues in a concise and inter-related manner.