Three- to 4-year follow-up of the reverse palatal pedicle graft for maxillary palatal recessions.

BACKGROUND: This study evaluates the long-term stability and clinical outcomes of the reverse palatal pedicle graft (RPPG) technique in treating maxillary molar palatal recessions over a 3 to 4-year follow-up period. METHODS: Three patients with palatal recession defects on maxillary molars were treated using the RPPG technique. Clinical parameters including recession depth, probing depth, and clinical attachment levels (CALs) were recorded at baseline, 2 months, and 3-4 years postoperatively. Healing outcomes, tissue perfusion, and soft tissue thickness were assessed through clinical examination, cone beam computed tomography (CBCT), and ultrasonography. RESULTS: All patients demonstrated significant CAL gain and partial root coverage. The RPPG technique resulted in significant improvements in attachment gain (41%-67%) and root coverage (44%-83%). In addition, a CBCT scan of one grafted site at a 4-year follow-up (Case 1) demonstrates a gain in soft tissue thickness and partial root coverage. Ultrasound imaging of another grafted site at a 4-year follow-up (Case 2) demonstrates a gain in soft tissue thickness and adequate graft perfusion. The outcomes suggest stable graft sites with some evidence of creeping attachment. CONCLUSION: The RPPG technique provides a viable option for treating maxillary molar palatal recessions, demonstrating promising long-term stability and clinical improvements. Further studies with larger sample sizes and frequent follow-ups are needed to better understand the dynamics of creeping attachment and refine clinical guidelines for palatal grafting. KEY POINTS: The reverse palatal pedicle graft (RPPG) is a surgical technique providing a viable solution for the treatment of maxillary molar palatal root coverage for a single recession site with 3-4 years of follow-up demonstrating a degree of predictability. Clinical indications for the application of the RPPG technique include severe palatal recession with little to no interproximal attachment loss (RT1 or RT2), palatal root sensitivity, and a sufficient amount of keratinized tissue on the palatal aspect of adjacent teeth. The main limitations of the application of the RPPG technique include its ability to treat only one isolated recession site, the inability for coronal advancement of the flap, and the quality and thickness of the autogenous graft being patient-dependent. PLAIN LANGUAGE SUMMARY: This study explores the reverse palatal pedicle graft (RPPG) technique, a method used to treat gum recession in the palate around the upper posterior teeth. The research followed three patients over a period of 3-4 years after they underwent the RPPG procedure. This technique involves using a piece of tissue from the roof of the mouth and repositioning it to cover the receded gum area. All patients showed significant improvement in gum attachment and coverage of the exposed roots. The grafts remained stable, and there was continued growth of the gum tissue, further covering the exposed roots over time. These promising results suggest that RPPG could be a reliable and effective option for treating severe gum recession on the roof of the mouth. However, further studies with larger patient groups are needed to confirm these findings and refine the technique.

The Modified Osseodensification Visco-Elastic (MOVE) Sinus Protocol: A Case Series to Illustrate the Combination of Osseodensification with Viscoelastic Bone Replacement Material.

INTRODUCTION: The Modified Osseodensification Visco-Elastic (MOVE) protocol combines two established techniques for sinus lifting: osseodensification drills to elevate the Schneiderian membrane, and the use of a viscoelastic putty to distribute forces on the membrane, a combination first described by Neiva et al. (2019). This case series elucidates the technique for combining these materials, and its possible benefits, which include reduced procedure time, less traumatic sinus elevation, and more versatility for unusual sinus anatomy, such as sloped sinus floors and immediate implant sites. CASE SERIES: The three cases, illustrating a single implant, adjacent implants, and an immediate implant, demonstrate various indications for using the MOVE protocol, documented with two- and three-dimensional radiography. The MOVE protocol is explained in detail with supplemental photos of the steps. CONCLUSION: Applying the MOVE protocol has the potential to allow for same-day implant placement in sites that previously required preoperative bone augmentation or lateral wall sinus access, thereby reducing the extent of surgical invasiveness associated with implant placement in the posterior maxilla.

The impact of a change in classification criteria on the prevalence of peri-implantitis: A cross-sectional analysis.

BACKGROUND: Peri-implantitis is a frequent finding but estimates of its prevalence vary widely. This may be due to the wide variety of disease definitions. In 2017 the World Workshop on Periodontal and Peri-implant Diseases and Conditions established new criteria for disease definitions. The aim of this study is to assess the potential impact of a new definition on the future reporting of peri-implant disease. METHODS: Data from a 2015 report of peri-implant prevalence were examined using the new diagnostic criteria. This cross-sectional study was performed on 95 patients with 220 implants who had their implants placed between 1998 and 2003. An examiner masked to the previous diagnosis examined the radiographs and patient data to make a diagnosis based on 3 mm of bone loss from the expected level of bone. This reanalysis was used to calculate the prevalence of peri-implant disease and generate new relative risk indicators. RESULTS: The mean follow-up time for the patients was 10.9 years. Using the 2017 criteria, peri-implant mucositis was found in 35.3% of the implants and 52.2% of the subjects, and peri-implantitis occurred in 8.7% of the implants and 15.2% of the subjects. This constituted a drop in peri-implantitis at both patient and implant level of nearly 50% from the prior analysis. Smoking at time of implant placement emerged as a new risk factor in this analysis that was not identified in the prior analysis. CONCLUSIONS: The new diagnostic criteria significantly reduce the reported prevalence of peri-implantitis and bring new risk factors into focus.

The Reverse Palatal Pedicle Graft for Maxillary Molar Palatal Recessions: Two Case Reports.

INTRODUCTION: Historically, the treatment of palatal recession was thought to be extremely challenging if not impossible due to the anatomy of the palate. A novel technique is presented for treating gingival recession on maxillary molars utilizing a rotated subepithelial connective tissue pedicle graft. The technique is designed to maximize perfusion to the graft as compared to a free graft CASE PRESENTATIONS: The authors present two cases in which the technique was utilized to achieve attachment gain and root coverage. The cases were followed for at least 2 months. CONCLUSIONS: More than 5 mm of attachment was gained and 55% to 60% root coverage achieved over recession defects on maxillary first molars. The following case reports demonstrate that the Reverse Palatal Pedicle Graft (RPPG) technique was successful in improving root coverage over maxillary palatal recession defects.

Biofilm as a risk factor in implant treatment.

This article summarizes the microbiological findings at dental implants, drawing distinctions between the peri-implant microbiome and the periodontal microbiome, and summarizes what is known regarding biofilm as a risk factor for specific stages of implant treatment. Targeted microbial analysis is reviewed as well as the latest results from open-ended sequencing of the peri-implant flora. At this time there remains a lack of consensus for a specific microbial profile that is associated with peri-implantitis, suggesting that there may be other factors which influence the microbiome such as titanium surface dissolution. Therapeutic interventions to address the biofilm are presented at the preoperative, perioperative, and postoperative stages. Evidence supports that perioperative chlorhexidine reduces biofilm-related implant complications and failure. Regular maintenance for dental implants is also shown to reduce peri-implant mucositis and implant failure. Maintenance procedures should aim to disrupt the biofilm without damaging the titanium dioxide surface layer in an effort to prevent further oxidation. Evidence supports the use of glycine powder air polishing as a valuable adjunct to conventional therapies for use at implant maintenance visits. For the treatment of peri-implantitis, nonsurgical therapy has not been shown to be effective, and while surgical intervention is not always predictable, it has been shown to be superior to nonsurgical treatment for decontamination of the implant surface that is not covered by bone.

Restoration contour is a risk indicator for peri-implantitis: A cross-sectional radiographic analysis.

AIM: The purpose of this study was to determine whether restoration emergence angle was associated with peri-implantitis. MATERIALS AND METHODS: A data set consisting of 96 patients with 225 implants (mean follow-up: 10.9 years) was utilized. Implants were divided into bone-level and tissue-level groups, and radiographs were analysed to determine the restoration emergence angles, as well as restoration profiles (convex or concave). Peri-implantitis was diagnosed based on probing depth and radiographic bone loss. Associations between peri-implantitis and emergence angles/profiles were assessed using generalized estimating equations. RESULTS: Eighty-three patients with 168 implants met inclusion criteria. The prevalence of peri-implantitis was significantly greater in the bone-level group when the emergence angle was >30 degrees compared to an angle ≤30 degrees (31.3% versus 15.1%, p = .04). In the tissue-level group, no such correlation was found. For bone-level implants, when a convex profile was combined with an angle of >30 degrees, the prevalence of peri-implantitis was 37.8% with a statistically significant interaction between emergence angle and profile (p = .003). CONCLUSIONS: Emergence angle of >30 degrees is a significant risk indicator for peri-implantitis and convex profile creates an additional risk for bone-level implants, but not for tissue-level implants.

Prevalence and predictive factors for peri-implant disease and implant failure: a cross-sectional analysis.

BACKGROUND: Long-term studies worldwide indicate that peri-implant inflammation is a frequent finding and that the prevalence of peri-implantitis correlates with loading time. Implant loss, although less frequent, has serious oral health and economic consequences. An understanding of predictive factors for peri-implant disease and implant loss would help providers and patients make informed decisions. METHODS: A cross-sectional study was performed on 96 patients with 225 implants that were placed between 1998 and 2003. Implant placement data were collected from patient records, and patients presented for a clinical and radiographic follow-up examination. Implant status and periodontal status were determined, the data were analyzed to determine the prevalence of peri-implant disease or implant loss, and a predictive model was tested. RESULTS: The mean follow-up time for the patients was 10.9 years. The implant survival rate was 91.6%. Peri-implant mucositis was found in 33% of the implants and 48% of the patients, and peri-implantitis occurred in 16% of the implants and 26% of the patients. Individuals with peri-implantitis were twice as likely to report a problem with an implant as individuals with healthy implants. Peri-implantitis is associated with younger ages and diabetes at the time of placement and with periodontal status at the time of follow-up. Implant loss is associated with diabetes, immediate placement, and larger-diameter implants. CONCLUSIONS: One in four patients and one in six implants have peri-implantitis after 11 years. The data suggest that periodontal and diabetes status of the patient may be useful for predicting implant outcomes.

A technique for converting an existing denture into a cast metal-reinforced implant-retained overdenture.

Prosthesis fracture is a common complication associated with implant-retained overdentures. A new overdenture can be strengthened by incorporating a cast metal reinforcement during processing. The authors describe a technique for converting an existing conventional nonreinforced serviceable denture into an overdenture that includes a cast metal reinforcement and its attachments.