Restorative Alveolar Interface Management Combined With Tunnel Technique and Connective Tissue Graft: A Conservative Approach for Root Fracture Treatment.

INTRODUCTION: The infringement of supracrestal tissue attachment by subgingival restorative margins, extensive caries, and root fractures, can compromise the periodontal health, resulting in inflammation and loss of periodontal supporting tissues. This report describes a case of a root fracture on the upper left central incisor that was successfully treated using a conservative approach, by applying the restorative alveolar interface (RAI) management combined with tunnel technique and a subepithelial connective tissue graft (SCTG). CASE PRESENTATION: A 24-year-old male patient presented with a provisional single-unit fixed prosthesis on his upper left central incisor, in function for 4 years, with the chief complaint of prosthesis discoloration. After clinical and radiographic examination, a diagnosis of root fracture was established. Following the removal of the provisional prosthesis, a full-thickness flap was elevated creating a tunnel. The elimination of the fracture line/angle, root recontouring, and planning was then performed with the aid of a conical long diamond bur and periodontal curets. Additionally, an SCTG was placed buccally into the tunnel. The final zirconia layered with E-max crown was placed 6 months after surgery. At 12- and 24-month follow-up, the periodontal tissues presented healthy aspect, no bleeding on probing, and a 4-mm probing depth. CONCLUSIONS: Surgical repositioning of the restorative margin can be an alternative and conservative treatment approach to compromised teeth with subgingival fracture line/angle. However, case selection should be carefully considered and restorability assessed as limitations might apply.

Multidisciplinary Treatment for Peri-Implantitis: A 24-Month Follow-Up Case Report.

INTRODUCTION: Although osseointegrated implants are a highly predictable and effective alternative in the rehabilitation of partially or totally edentulous patients, the prevalence of implant biologic complications has been rising. This report describes a case of peri-implantitis involving multiple maxillary implants that was successfully treated by combining the removal of two implants, surgical debridement associated with implantoplasty of the remaining implants, and prosthetic design changes. CASE PRESENTATION: A 50-year-old female patient with a fixed full-arch implant-supported maxillary prosthesis presented with chief complaints of halitosis and difficulty in maintaining proper oral hygiene. Based on clinical and radiographic findings, a diagnosis of peri-implantitis was established. Two implants were removed because of advanced peri-implant bone loss and inadequate prosthetic positioning. The remaining implants were treated with access surgery, removal of granulation tissue, and implantoplasty of the exposed implant threads. Three months after surgery, an O-ring-retained bar overdenture was delivered. At 6, 12, and 24 months after treatment completion, peri-implant probing depths (PDs) were reduced significantly. None of the implants exhibited residual PDs >4 mm, bleeding on probing, or suppuration. Moreover, peri-implant bone levels remained stable over time. CONCLUSION: Surgical therapy combined with implantoplasty of the exposed threads and prosthetic design changes can be used successfully for treating peri-implantitis.