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1.
Clin Oral Implants Res ; 32(3): 349-358, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33420729

RESUMEN

OBJECTIVES: To introduce an esthetic index for assessing the outcomes of peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability. MATERIALS AND METHODS: Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables. RESULTS: Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability) and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters. CONCLUSION: The IDES showed persistent judgment among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.


Asunto(s)
Implantes Dentales de Diente Único , Implantes Dentales , Teorema de Bayes , Odontólogos , Estética Dental , Humanos , Reproducibilidad de los Resultados , Resultado del Tratamiento
2.
Artículo en Inglés | MEDLINE | ID: mdl-33151183

RESUMEN

When it comes to complete root coverage of exposed root surfaces, several limiting factors have been suggested. Although tooth malposition and papillae dimension are capable of influencing root coverage, they have not received sufficient emphasis in the literature. Therefore, the aim of the present commentary is to discuss the impact of tooth malposition and papillae dimension on root-coverage outcomes. This commentary combines evidence from the literature with the authors' experience. Limited evidence is available in the literature regarding the influence of tooth malposition on root-coverage outcomes. Severe buccal displacement and tooth extrusion and/or rotation may limit the amount of achievable root coverage, and the cementoenamel junction should no longer be considered the landmark for root coverage in these cases. The relationship between papillae dimension and root coverage has been tested in different clinical conditions and by applying different root-coverage approaches, thereby resulting in contradictory outcomes. The clinical experience of the authors suggests that having wider papillae is advantageous for coronally advanced flap and tunnel flap preparations and connective tissue graft stabilization. Although scientific evidence and the authors' clinical experience suggest that papillae dimension can play a major role in determining the surgical management of soft tissues and the amount of achievable root coverage, further studies are necessary to evaluate to which extent papillae dimensions contribute to treatment outcomes.


Asunto(s)
Recesión Gingival , Tejido Conectivo , Encía , Humanos , Cuello del Diente , Raíz del Diente/cirugía , Resultado del Tratamiento
3.
J Periodontol ; 2020 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-33152103

RESUMEN

The new classification of periodontal diseases recognizes the key role of the interdental clinical attachment for defining the periodontal status and the extent of disease severity. Regenerating interdental clinical attachment not only improves the prognosis of the tooth, but it also lessens the severity of the disease condition. This manuscript provides a state-of-the-art review on surgical reconstructive approaches for treating papillary deficiency associated with soft and hard tissue interproximal defects. Combination therapy of papilla preservation, connective tissue grafting, and coronally advanced flaps may result in regeneration of the intrabony defect coupled with root coverage. Future research highlighted in this review may have the potential especially in combination approaches to repair challenging interproximal soft and hard tissue deficiencies.

4.
J Periodontol ; 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32946124

RESUMEN

BACKGROUND: Patient-reported outcomes have received a great deal of interest in periodontal plastic procedures. However, their evaluation has mainly been short-term. Thus, the aim of this study was to evaluate the impact of soft tissue grafting procedures conducted over a decade ago on the willingness of a patients to undergo the surgery again. METHODS: Subjects that received an autogenous soft tissue graft over 10 years ago were screened and invited for a survey. Their response was only analyzed if they were able to correctly identify the sites of the surgical procedures. Dichotomous questions and visual analogue scales (VASs) were used to assess self-reported pain, willingness to retreat and satisfaction. RESULTS: Fifty-two patients were included in the analyses. Higher pain was reported for mandibular sites, and treated areas including ≥ 3 teeth (P < 0.01). Willingness to retreatment was 84.6% and it was negatively associated with self-reported pain measures, the arch location (mandible), and number of treated sites (≥3 teeth) (P < 0.01). Mean satisfaction rate was 86.9 ± 13.65 (VAS) and showed a positive correlation with willingness to retreat (P < 0.01). Having a complete root coverage at the recall visit was also significantly associated with higher patient satisfaction scores (P < 0.01). CONCLUSIONS: Patient experience of previous autogenous soft tissue grafting has an influence on their decision to undergo future treatment. Willingness to retreat was negatively affected by mandibular sites, larger treated areas and the perceived pain, while presenting with complete root coverage was significantly associated with patient satisfaction.

5.
J Periodontol ; 2020 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-32729954

RESUMEN

BACKGROUND: The long-term outcomes of acellular dermal matrix (ADM) for the treatment of isolated gingival recessions has not yet been evaluated. Thus, the aim of this study was to observe the root coverage outcomes of coronally advanced flap with ADM over time, and compare them with their adjacent untreated sites. METHODS: Twelve patients (from 20) were available at the 9-year recall. Clinical parameters (recession depth, mean root coverage [mRC], keratinized tissue width [KTW], and gingival thickness) were evaluated and compared with the 1-year results, and the ADM-adjacent untreated sites (on mesial and distal) via mixed-modeling regression analyses. RESULTS: From 1 to 9 years, the ADM-treated isolated recessions showed a relapse from 77% to 62% mRC (P <0.05). A similar pattern toward apical shift of the gingival margin was noticed for the ADM-adjacent untreated sites without baseline recession. However, ADM-adjacent untreated sites which had presented with recession at baseline but were not treated showed a significantly more apical shift of the gingival margin (almost two-fold). A significant increase in KTW was noted for all sites. Baseline KTW ≥2 mm was a significant predictor for the stability of the gingival margin at the ADM-treated, and the ADM-adjacent sites with baseline recession. CONCLUSIONS: ADM-treated sites displayed recession relapse from 1 to 9 years. The untreated adjacent sites with a recession at baseline, showed a higher apical displacement of the gingival margin compared with the ADM-treated sites, and ADM-adjacent sites without a recession at baseline.

6.
Clin Oral Investig ; 24(9): 3181-3191, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32361892

RESUMEN

OBJECTIVE: To test the safety of a new volume-stable collagen matrix (VCMX) in combination with coronally advanced flap (CAF) for the treatment of single gingival recession. MATERIAL AND METHODS: Ten patients were treated for single RT1 gingival recession. Complete and mean root coverage, gingival thickness and keratinized tissue height, patient-reported outcome measures (PROMs), and safety were assessed up to 180 days. Descriptive statistics were used to analyze the clinical parameters. RESULTS: VCMX resulted to be safe with no serious adverse events in all patients. At 6 months, root coverage was 96.7% with 90% of defects exhibiting complete coverage. There was an increase in mean width of keratinized tissue (KT) (0.4 ± 0.8 mm) and in gingival thickness (GT) (0.4 ± 0.34 mm); however, the difference was not statistically significant compared to baseline parameters. Pain perception and pain-killer consumption were low and decreasing further at 7 days. Esthetic satisfaction for both patients and experts revealed excellent scores. CONCLUSIONS: VCMX is a safe and well-tolerated device for the treatment of single gingival recessions. In combination with CAF, it resulted in a high performance in terms of mean and complete root coverage, KT width, and GT increase. VCMX may reduce patient discomfort and post-operative morbidity. CLINICAL RELEVANCE: VCMX is a safe and stable substitute for the treatment of gingival recession in conjunction with coronally advanced technique.

7.
Artículo en Inglés | MEDLINE | ID: mdl-32231082

RESUMEN

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4-6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.


Asunto(s)
Implantes Dentales , Mucosa Bucal , Consenso , Egipto , Humanos
8.
Artículo en Inglés | MEDLINE | ID: mdl-32032405

RESUMEN

This case report aimed to describe a soft tissue approach to restore a buccal soft tissue dehiscence (BSTD) combined with the loss of peri-implant papillae and loss of periodontal attachment on the adjacent teeth. The first step of the proposed approach was the removal of the crown and abutment to leave the interproximal soft tissue to fill the space previously occupied by the crown. After 3 months, during which time the patient was wearing a provisional restoration (a temporary Maryland bridge), the implant site was treated as an edentulous area with a soft tissue augmentation procedure: the most substantial modification with respect to the original connective tissue platform technique was the use of the wide mesial and distal papillae of the implant, once de-epithelialized on the occlusal surface, as a "partial" connective platform to suture the connective grafts and submerge the implant. At the 4-month reevaluation visit, a minor soft tissue defect remained in both apico-coronal and buccolingual dimensions, and thus a second surgery was performed to obtain further soft tissue augmentation. A flapless punch procedure was used to expose the implant head, and after conditioning the augmented peri-implant soft tissue with a new provisional crown, the definitive restoration was delivered. Complete coverage of the BSTD was achieved, and both papillae entirely filled the interproximal spaces. The results were well maintained up to the 5-year follow-up visit.


Asunto(s)
Implantes Dentales de Diente Único , Implantes Dentales , Tejido Conectivo , Coronas , Humanos , Corona del Diente
9.
Artículo en Inglés | MEDLINE | ID: mdl-31815982

RESUMEN

Soft tissue augmentation procedures are crucial to obtain a successful outcome in implant therapy. The aim of this case series was to describe the 1-year clinical outcomes of a porcine-derived acellular dermal matrix for buccal mucosal thickness augmentation at osseointegrated single implants with facial peri-implant soft tissue deficiencies. Ten patients were included and treated with a prosthetic and surgical approach that combined a coronally advanced flap and a dermal matrix. Results showed the possibility to obtain an increase in buccal soft tissue thickness of 1.2 ± 0.18 mm at single implant sites in the esthetic area.


Asunto(s)
Dermis Acelular , Implantes Dentales , Animales , Estudios de Seguimiento , Humanos , Mucosa Bucal , Colgajos Quirúrgicos , Porcinos , Resultado del Tratamiento
10.
J Periodontol ; 90(11): 1244-1251, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31177536

RESUMEN

BACKGROUND: Tooth location has been shown to play a significant role on root coverage outcomes. However, whether this has an impact on the outcomes of coronally advanced flap (CAF) for treating multiple adjacent gingival recessions (MAGRs) remains to be determined. The aim of this study was to investigate the impact of tooth location, flap design, and flap extension on the outcomes of MAGRs following CAF with or without a connective tissue graft (CTG). METHODS: A re-analysis of six previously published clinical trials evaluating the outcomes of CAF in the treatment of MAGRs was performed using mixed regression and logistics to assess the influence of potentially influential factors on the treatment outcomes. RESULTS: Six hundred and nine MAGRs in 166 patients were evaluated. The anterior maxilla (second sextant) was associated to the highest mean root coverage (mRC) and complete root coverage (CRC) outcome (P < 0.05). In addition, the maxillary teeth showed significantly greater mRC and CRC than teeth in the mandible (with the lower anterior [fifth sextant] showing the lowest outcomes) (P < 0.05). A higher mRC was observed for the anterior teeth compared with posterior dentition (P < 0.05). While CAF + CTG achieved better results than CAF alone, no differences were found when the flap was performed with or without vertical releasing incisions (P > 0.05). Lastly, teeth in the distal part of the flap showed lower mRC and CRC than teeth in the central or mesial position (P < 0.05). CONCLUSIONS: Tooth location was found to play a key role in determining the amount of root coverage achievable, with maxillary canines and incisors being associated with the highest outcomes compared with other sextants. Maxillary MAGRs showed greater mRC and CRC than mandibular MAGRs.


Asunto(s)
Recesión Gingival , Tejido Conectivo , Encía , Humanos , Colgajos Quirúrgicos , Raíz del Diente , Resultado del Tratamiento
11.
J Periodontol ; 90(10): 1116-1124, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31087334

RESUMEN

BACKGROUND: The incidence of a peri-implant soft tissue dehiscence/deficiency (PSTD) is not a rare finding. Despite multiple previous attempts aimed at correcting the PSTDs, a classification of these conditions has not yet been proposed. This lack in the literature may also lead to discrepancies in the reported treatment outcomes and thus misinform the clinician or the readers. The aim of the present article was therefore to present a classification of peri-implant PSTD at a single implant site. METHODS: Four classes of PSTDs were discussed based on the position of the gingival margin of the implant-supported crown in relation to the homologous natural tooth. In addition, the bucco-lingual position of the implant head was also taken into consideration. Each class was further subdivided based on the height of the anatomical papillae. RESULTS: Subsequently, for each respective category a surgical approach (including bilaminar techniques, the combined prosthetic-surgical approach or soft tissue augmentation with a submerged healing) was also suggested. CONCLUSION: This paper provides a new classification system for describing PSTDs at single implant sites, with the appropriate recommended treatment protocol.


Asunto(s)
Implantes Dentales de Diente Único , Coronas , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Estética Dental , Corona del Diente , Resultado del Tratamiento
12.
Clin Oral Implants Res ; 29 Suppl 16: 69-77, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30328189

RESUMEN

OBJECTIVES: The aim of Working Group 1 was to address the influence of different local (implant length, diameter, and design) and systemic (medications) factors on clinical, radiographic, and patient-reported outcomes in implant dentistry. Focused questions on (a) short posterior dental implants (≤6 mm), (b) narrow diameter implants, (c) implant design (tapered compared to a non-tapered implant design), and (d) medication-related dental implant failures were addressed. MATERIALS AND METHODS: Four systematic reviews were prepared in advance of the Consensus Conference and were discussed among the participants of Group 1. Consensus statements, clinical recommendations, and recommendations for future research were based on structured group discussions until consensus was reached among the entire expert Group 1. The statements were then presented and accepted following further discussion and modifications as required by the plenary. RESULTS: Short implants (≤6 mm) revealed a survival rate ranging from 86.7% to 100%, whereas standard implant survival rate ranged from 95% to 100% with a follow-up from 1 to 5 years. Short implants demonstrated a higher variability and a higher Risk Ratio [RR: 1.24 (95% CI: 0.63, 2.44, p = 0.54)] for failure compared to standard implants. Narrow diameter implants (NDI) have been classified into three categories: Category 1: Implants with a diameter of <2.5 mm ("Mini-implants"); Category 2: Implants with a diameter of 2.5 mm to <3.3 mm; Category 3: Implants with a diameter of 3.3 mm to 3.5 mm. Mean survival rates were 94.7 ± 5%, 97.3 ± 5% and 97.7 ± 2.3% for category 1, 2 and 3. Tapered versus non-tapered implants demonstrated only insignificant differences regarding clinical, radiographic, and patient-reported outcomes. The intake of certain selective serotonin reuptake inhibitors and proton pump inhibitors is associated with a statistically significant increased implant failure rate. The intake of bisphosphonates related to the treatment of osteoporosis was not associated with an increased implant failure rate. CONCLUSIONS: It is concluded that short implants (≤6 mm) are a valid option in situations of reduced bone height to avoid possible morbidity associated with augmentation procedures; however, they reveal a higher variability and lower predictability in survival rates. Narrow diameter implants with diameters of 2.5 mm and more demonstrated no difference in implant survival rates compared to standard diameter implants. In contrast, it is concluded that narrow diameter implants with diameters of less than 2.5 mm exhibited lower survival rates compared to standard diameter implants. It is further concluded that there are no differences between tapered versus non-tapered dental implants. Certain medications such as selective serotonin reuptake inhibitors and proton pump inhibitors showed an association with a higher implant failure rate.


Asunto(s)
Implantes Dentales , Diseño de Prótesis Dental , Medición de Resultados Informados por el Paciente , Consenso , Implantación Dental Endoósea , Fracaso de la Restauración Dental , Difosfonatos/efectos adversos , Humanos , Arcada Parcialmente Edéntula/rehabilitación , Osteoporosis/complicaciones , Osteoporosis/tratamiento farmacológico , Inhibidores de la Bomba de Protones/efectos adversos , Radiografía Dental , Inhibidores de la Captación de Serotonina/efectos adversos , Análisis de Supervivencia , Revisiones Sistemáticas como Asunto
13.
J Periodontol ; 89(12): 1428-1441, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29963707

RESUMEN

BACKGROUND: The efficacy of Coronally Advance Flap (CAF) has been extensively evaluated and several parameters influencing the results, such as interproximal attachment loss, recession defect size, papilla dimension, flap thickness, have also been identified. However, the influence of tooth location has not been systematically investigated yet. Therefore, the aim of this systematic review was to evaluate the influence of tooth location on the outcomes of CAF. METHODS: A literature search on PubMed, EMBASE, Cochrane libraries and hand-searched journal until September 2017 was performed to identify clinical studies reporting the outcome of CAF for localized gingival recessions (GRs) for each single tooth. RESULTS: Eighteen articles reporting 399 localized GRs treated with CAF were included in the present systematic review. Canines and incisors were related to a higher mRC and CRC than premolars and molars (odds ratio 1.63) (p < 0.05), while the right side showed a higher CRC than the left side (odds ratio 1.60) (p < 0.05). No differences were found between maxillary and mandibular dentition (p > 0.05). The addition of a graft such as Connective Tissue Graft (CTG) with or without Enamel Matrix Derivative (EMD) was shown to enhance the outcomes compared to CAF alone (p < 0.05). CRC was negatively affected by initial clinical attachment level (p < 0.05), but not from the initial recession depth (p > 0.05). CONCLUSIONS: Tooth location plays an important role on mRC and CRC following CAF. The addition of CTG or substitutes, especially with biological agents (EMD), enhance the clinical outcomes compared to CAF alone.


Asunto(s)
Proteínas del Esmalte Dental , Recesión Gingival , Tejido Conectivo , Encía , Humanos , Colgajos Quirúrgicos , Raíz del Diente , Resultado del Tratamiento
14.
Eur J Oral Implantol ; 11(2): 215-224, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29806668

RESUMEN

PURPOSE: To report the 5-year clinical and aesthetic outcomes of a novel surgical-prosthetic approach for the treatment of buccal soft tissue dehiscence around single dental implants. MATERIALS AND METHODS: Twenty patients with buccal soft tissues dehiscence around single implants in the aesthetic area were treated by removing the implant-supported crown, reducing the implant abutment, coronally advanced flap in combination with connective tissue graft and final restoration. After the first year, patients were recalled three times a year until the final clinical re-evaluation performed 5 years after the final prosthetic crown. Complications, bleeding on probing (BoP), peri-implant probing depth (PPD), clinical attachment level (CAL), keratinized tissue height (KTH), soft tissue coverage and thickness (STT), patient satisfaction (VAS) and aesthetic assessment (PES/WES) were evaluated 5 years after the final restoration. RESULTS: Of the 20 patients enrolled in the study, 19 completed the study at 5 years. A total of 99.2% mean soft tissue dehiscence coverage, with 79% of complete dehiscence coverage, was achieved at 5 years. A statistically significant increase in buccal soft tissue thickness (0.3 mm 0.1-0.4 P < 0.001) and keratinized tissue height (0.5 mm 0.0-1.0; P < 0.001) at 5 years with respect to 1 year was demonstrated. The patient aesthetic evaluation showed high VAS scores with no statistical difference between 1 year and 5 years (8.75 ± 1.02 and 8.95 ± 0.91 respectively). A statistical significant PES/WES score improvement was observed between baseline and 5 years (9.48 ± 2.68; P < 0.001), but not between 1 and 5 years. CONCLUSIONS: Successful aesthetic and soft tissue dehiscence coverage outcomes were well maintained at 5 years. The strict regimen of post-surgical control visits and the emphasis placed on the control of the toothbrushing technique could be critical for the successful long-term maintenance of soft tissue dehiscence coverage results.


Asunto(s)
Coronas , Implantes Dentales de Diente Único , Encía/cirugía , Dehiscencia de la Herida Operatoria/cirugía , Adulto , Estudios de Cohortes , Humanos , Procedimientos Quirúrgicos Orales/métodos , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento
15.
Periodontol 2000 ; 77(1): 19-53, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29504166

RESUMEN

Treatment of buccal gingival recession is performed for esthetic concerns, root sensitivity, root caries and cervical abrasion resulting from incorrect toothbrushing. Over the years, clinicians and researchers have improved surgical techniques to achieve surrogate end points, such as complete root coverage, gingival recession reduction or keratinized tissue increase, ignoring the input from the patient regarding the true indications for treatment. In the past few years there has been an emphasis to include patient-centered outcomes in the evaluation of root-coverage procedures. The aim of this narrative review is to describe the professional objective assessment of the esthetic results after root-coverage procedures and the patient perception of outcome in terms of esthetics, postoperative morbidity and dentinal hypersensitivity resolution after the treatment of gingival recessions. The need to align professional (surrogate) end points with patient-centered outcomes (true end points) in the future is emphasized.


Asunto(s)
Estética Dental , Recesión Gingival/cirugía , Procedimientos Quirúrgicos Orales , Atención Dirigida al Paciente , Humanos
16.
Periodontol 2000 ; 77(1): 54-64, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29504173

RESUMEN

The primary indication for treatment of gingival recessions is esthetics. In the last decades, patients have become increasingly more demanding in the esthetic outcome expected. In order to obtain a successful final result, periodontal plastic surgery should provide not only complete root coverage but also perfect blending in terms of color and texture. In the literature, many techniques have been demonstrated to be effective in obtaining complete root coverage, and the selection of one surgical technique over another depends on several factors related to the anatomic characteristics of the defect. The purpose of this paper was to suggest a decision-making process which starts from the clinical observation of the defects and is structured in progressive nodes that will guide the clinician through the most suitable surgical technique to achieve the ideal esthetic outcome.


Asunto(s)
Toma de Decisiones , Estética Dental , Recesión Gingival/cirugía , Procedimientos Quirúrgicos Orales , Humanos
17.
Periodontol 2000 ; 77(1): 150-164, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29493024

RESUMEN

Criteria for successful implants, in the rehabilitation of a single missing tooth in the esthetic area, should be determined by composite outcomes, including functional and esthetic aspects of soft tissues and the reconstruction, as well as patient-reported outcomes. This paper focuses on current methods in esthetic assessment and patient-centered/reported outcomes in single-tooth implant rehabilitation in the esthetic area. The relationship between subjective, patient-based esthetic evaluations and objective, professional-based esthetic evaluations is reviewed. In spite of increasing interest in the assessment of 'success' in implant dentistry, it is not yet possible to provide evidence-based conclusions because of the lack of consensus on a universal implant-supported crown esthetic index. There is also a need to standardize reporting of patient-centered outcomes in partially edentulous patients treated with implants.


Asunto(s)
Implantes Dentales de Diente Único , Estética Dental , Resultado del Tratamiento , Humanos
18.
Periodontol 2000 ; 77(1): 111-122, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29493049

RESUMEN

Loss of dentition leads to functional and esthetic challenges that are determined by the anatomic features of the edentulous area. These features can complicate the prosthetic rehabilitation of such patients, especially in situations where optimal esthetic outcomes are desired. For these reasons, reconstructive plastic surgery procedures, aimed at restoring the alveolar ridge to its former dimensions, have become of great clinical interest. These reconstructive plastic surgery procedures frequently involve soft-tissue augmentation, performed to improve the quality and quantity of mucogingival tissue with the aim to achieve an ideal esthetic result. This review will focus on the description and expected outcomes of different surgical techniques for soft-tissue augmentation in edentulous areas, as described in the literature. Although more information from a larger number of studies and randomized controlled clinical trials is needed, it is possible to draw some conclusions, namely: pouch procedures are the first choice for soft-tissue augmentation, especially in high-demand esthetic areas; roll techniques are possible in shallow buccolingual soft-tissue augmentations; and onlay, inlay and combination grafts are less suitable for soft-tissue augmentation because of their poor esthetic results.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Estética Dental , Gingivoplastia/métodos , Arcada Edéntula/cirugía , Humanos
19.
Periodontol 2000 ; 77(1): 84-92, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29493814

RESUMEN

Crown lengthening is one of the most common surgical procedures in periodontal practice. Its indications include subgingival caries, crown or root fractures, altered passive eruption, cervical root resorption and short clinical abutment, and its aim is to re-establish the biologic width in a more apical position. While the procedure in posterior areas of the dentition has been thoroughly investigated, crown lengthening performed for esthetic reasons in the anterior areas is still a matter of debate and an evidence-based technique is not available. This paper provides accurate descriptions of the surgical and restorative phases of the esthetic crown-lengthening procedure by answering the following questions: what is the ideal surgical flap design? how much supporting bone should be removed? how should the position of the flap margin relate to the alveolar bone at surgical closure? and how should the healing phase be managed in relation to the timing and the position of the provisional restoration with respect to the gingival margin?


Asunto(s)
Alargamiento de Corona/métodos , Estética Dental , Alveolectomía/métodos , Alveoloplastia/métodos , Restauración Dental Provisional , Humanos , Colgajos Quirúrgicos , Cicatrización de Heridas/fisiología
20.
Periodontol 2000 ; 77(1): 256-272, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29473219

RESUMEN

Soft-tissue dehiscence at the facial aspect of an osteointegrated implant is a common complication which impacts on the final esthetic result. The etiology and ways of diagnosing this condition are still controversial. Many factors seem to influence the position of the peri-implant soft-tissue margin, and some of these have been studied more carefully than others. Various surgical and combination surgical-prosthetic approaches have been described to treat soft-tissue dehiscence, with the latter appearing to be more predictable. This paper focuses on the factors affecting peri-implant soft-tissue margins and describes the different treatment approaches, reported in the literature, to treat buccal soft-tissue dehiscence, with more focus on the prosthetic-surgical-prosthetic approach.


Asunto(s)
Implantes Dentales/efectos adversos , Estética Dental , Recesión Gingival/cirugía , Gingivoplastia/métodos , Dehiscencia de la Herida Operatoria/cirugía , Tejido Conectivo/trasplante , Humanos , Colgajos Quirúrgicos
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