Combining Techniques to Treat Isolated Deep Recession-Type Defects: A Case Report with Long-Term Stability.

INTRODUCTION: The purpose of this case report was to show the clinical long-term stability of a successful two-step root coverage procedure. A combination of two single techniques was used to treat an isolated deep-wide defect. Case Presentation. A 28-year-old female patient was referred in order to treat a single recession defect at #22. Due to her fear of dental procedures and a poor economic situation, the team developed an alternative solution. They used a modified apically repositioned flap (MARF) to increase the donor area and then a laterally positioned flap (LPF) to treat the root defect. Clinical evaluation at the three-year follow-up revealed complete resolution of the defect, a gain in clinical attachment, excellent esthetic results, and minor morbidity to the patient. CONCLUSION: The combination of the MARF and the LPF procedures was able to successfully treat a single deep recession defect with some advantages over traditional techniques such as simplicity, ideal color match of tissues, and the absence of palatal donor tissue.

The Modified Apically Repositioned Flap Technique and Its Potential to Create Attached Gingiva in Areas with No Keratinized Tissue: A Long-Term (1 to 11 Years) Retrospective Case Series Study.

The modified apically repositioned flap (MARF) technique has been previously published as a successful method to increase the zone of attached gingiva with numerous advantages, such as simplicity, predictability, and long-term stability. However, this technique has only been used in areas with at least 0.5 mm of attached gingiva, presurgically. In the current study, the MARF technique was utilized in 21 sites (teeth) with no attached gingiva and only mucosa comprising the marginal tissue. The long-term follow-up results over the course of 1 to 11 years (average follow-up: 3.2 years) show a statistically significant increase of 3.6 ± 0.8 mm for keratinized tissue and of 2.21 ± 0.83 mm for attached gingiva, and no increases in probing depths or marginal tissue recession. These results indicate that the MARF procedure has generated keratinized tissue and attached gingiva in areas with a presurgical absence of these tissues.

Rieger Syndrome: Rehabilitation With Dental Implants.

INTRODUCTION: Axenfeld-Rieger syndrome (ARS), also known as Rieger syndrome, is a rare autosomal dominant condition defined by craniofacial, ocular, dental, periumbilical, and systemic anomalies. CASE PRESENTATION: This case report describes in detail a multidisciplinary approach to successfully restore the oral function and esthetics of a 22-year-old patient diagnosed with ARS. The patient's clinical evaluation revealed that the area corresponding with teeth #13, #12, #11, #21, #22, and #23 was occupied by four malformed and/or deciduous teeth. The four anterior teeth were extracted, and socket preservation was performed using bovine-derived porous bone mineral. Six months after extractions, two implants were placed in the location of the lateral incisors and additional bone graft was performed. Two months after the initial healing, a temporary fixed partial was delivered and 9 months after implant placement the implants were restored with a porcelain-fused-to-metal fixed partial denture. CONCLUSIONS: The use of implant-supported fixed partial dentures to restore missing teeth in patients with ARS provides biological and mechanical advantages over conventional, fixed, or removable prosthodontics. Further evaluation is needed to determine the longevity and long-term prognosis of dental implants in patients with ARS.

Papilla reconstruction: Interdisciplinary consideration for clinical success.

One of the most difficult achievements in the periodontal therapy is the reconstruction of interdental papilla that has been lost by periodontal disease. The poor esthetic appearance caused by the "black triangle," especially in the maxillary anterior region has been a concern for both patients and professionals. However, when the papilla destruction is followed by loss of contact point, the use of different specialties is usually necessary to restore the interproximal embrasure. This clinical case report describes an interdisciplinary (periodontic-orthodontic-restorative) approach for the treatment of a patient with severe case of papilla destruction in an esthetic zone. The patient's esthetic expectations for the anterior maxilla were met through phase I treatment, including the surgical reconstruction of the papillary complex and the orthodontic movement to restore the contact point. However, after the initial treatment was successfully concluded, the long-term stability of the result was compromised as the intercommunication among the specialists was not coordinated. CLINICAL SIGNIFICANCE: The treatment plan that involves interdisciplinary teamwork should be followed by an understanding about the principles of the specialties as well the intercommunication among specialists.

The Modified Apically Repositioned Flap Technique: A Long-Term (4 to 16 Years) Retrospective Study.

Attached gingiva is desirable for the maintenance of gingival health. Although many methods are used to increase the zone of attached gingiva, the modified apically repositioned flap (MARF) technique has the advantages of simplicity and predictability. The short-term follow-up of the MARF technique demonstrated an increase in keratinized tissue and attached gingiva. This study evaluated long-term results of the MARF technique as used to increase the apicocoronal dimensions of keratinized tissue and attached gingiva in 28 sites (25 patients; average follow-up of 9 years). There was a statistically significant increase in keratinized tissue and attached gingiva with no increase in probing depths or gingival recession. These results suggest that the MARF procedure predictably generates keratinized tissue and attached gingiva with long-term stability.

Use of the Modified Apically Repositioned Flap Technique to Create Attached Gingiva in Areas of No Keratinized Tissue: A Clinical and Histologic Evaluation.

The complete absence of keratinized attached gingiva on the buccal surface of a tooth can make the area more susceptible to gingival recession. The modified apically repositioned flap (MARF) technique is an effective procedure to increase the dimensions of attached gingiva in areas that present with some existing keratinized tissue. The objective of this case report is to present long-term clinical and histologic evidence that the MARF technique can be used to create attached gingiva in areas that lack keratinized tissue.

Palatal Augmentation Technique: A Predictable Method to Increase the Palatal Connective Tissue at Donor Sites- A Consecutive Case Series.

The palatal masticatory mucosa between the canine and first molar is the main source of connective tissue graft (CTG) for use in periodontal plastic surgery. The purpose of this study was to evaluate the palatal augmentation technique (PAT) to increase the palatal connective tissue donor area using a collagen sponge inserted between the palatal flap and bone. The 26 patients enrolled in this study were referred for root coverage and ridge augmentation procedures. All patients lacked adequate donor palatal tissue thickness. The PAT uses a full-thickness flap and insertion of a sterile lyophilized bovine collagen sponge between the flap and bone. The palatal thickness was clinically assessed before and after collagen sponge insertion. A manual probe was inserted in the mucosal surface perpendicular to the long axis of each tooth approximately 6 mm from the gingival margin. Probing depth (PD) and recession (REC) were also recorded. Treatment with PAT resulted in a statistically significant increase in the palatal thickness. The overall mean increase was from 2.03 mm before surgery to 3.57 mm after surgery, with no major alterations in PD and REC. Healing proceeded uneventfully and occurred by primary intention. PAT appeared to be a predictable procedure to create connective tissue donor graft in deficient areas and had uneventful postoperative healing.

Nonsurgical periodontal therapy to treat a case of severe periodontitis: A 12-year follow-up.

BACKGROUND AND OVERVIEW: This case report describes the successful treatment of a severe chronic periodontitis case by nonsurgical therapy and a strict maintenance program over a 12-year period. CASE DESCRIPTION: A 38-year-old man concerned about the protrusion of his maxillary incisors was referred for periodontal treatment. The teeth in the maxillary arch had generalized severe chronic periodontitis. Several treatment options were presented to the patient including the most aggressive, extraction of all maxillary teeth, and the most conservative, scaling and root planing. The patient opted to having the most conservative approach, even though the prognoses for the maxillary teeth were unfavorable. Therefore, he received nonsurgical therapy via scaling and root planing combined with systemic antibiotics before referral to an orthodontist to address the esthetic concerns. The maxillary dentition was treated with orthodontic therapy to retract and align the maxillary anterior segment. Periodontal maintenance (1-hour session), including subgingival instrumentation, was performed 4 times per year until the end of the 12-year follow-up period. The patient only missed 2 appointments in 12 years. Twelve years later, the results revealed that all but 1 maxillary tooth were maintained in a state of acceptable health, function, and esthetics. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Although most would agree with the initial poor prognosis of this patient's case, nonsurgical periodontal therapy was utilized with a 3-month periodontal maintenance program and demonstrated long-term success. The outcome presented in this case report may only have been possible because of patient compliance, professional experience, skill, and supervision throughout the course of treatment.

Surgical Techniques to Increase the Apicocoronal Dimension of the Attached Gingiva: A 1-Year Comparison Between the Free Gingival Graft and the Modified Apically Repositioned Flap.

The attached gingiva is a desirable anatomical element for the maintenance of gingival health. The free gingival graft (FGG) and the modified apically repositioned flap (MARF) are predictable surgical techniques often employed to increase the zone of attached gingiva. This randomized study compared the FGG and the MARF in increasing the zone of attached gingiva in contralateral sides of 15 patients 1 year posttreatment. There was an increase in keratinized tissue and attached gingiva in both groups. Gingival recession did not significantly change between pre- and posttreatment levels in either group. The MARF surgical time was approximately half as long as that of the FGG. The authors conclude that both techniques are viable; however, the main advantages of the MARF were decreased surgical time and less postoperative discomfort.

Modified apically repositioned flap technique: a surgical approach to enhance donor sites prior to employing a laterally positioned flap.

The goal of this study was to evaluate the ability of the modified apically repositioned flap (MARF) technique to increase keratinized tissue at the donor site and to analyze if this procedure would enhance the indication for and predictability of the laterally positioned flap (LPF) without any consequences to the donor area. Thirty isolated defects with recession and/or lack of attached gingiva were treated in 30 healthy patients. All donor areas adjacent to these defects lacked ideal gingival conditions both in height and width. The MARF technique was used to increase these areas 8 weeks before the LPF was performed. Clinical evaluation was done at the donor and receptor areas after 18 months. The results showed that the donor area increased from 2.78 to 5.01 mm at 8 weeks and remained at 3.28 mm after the use of the LPF. The marginal tissue recession and probing depth remained clinically unchanged. In the receptor area, the recession decreased from 1.86 to 0.57 mm, and the keratinized and attached tissue increased from 0.71 to 3.57 mm and from 0.05 to 2.49 mm, respectively. The use of the MARF technique to enhance keratinized tissue at the donor area proved to be an efficient and predicable technique that also augmented LPF use without any consequences to the donor site.

Mineral trioxide aggregate and subepithelial connective tissue graft for treatment of iatrogenic gingival recession: long-term results.

This study aimed to examine the combination of mineral trioxide aggregate (MTA) and subepithelial connective tissue grafts to treat esthetic deficiencies caused by iatrogenic tooth perforations. Three patients were treated, and clinical and histologic documentation was obtained. Connective tissue grafts were performed following standard techniques after application of MTA to seal the root perforations. Complete root coverage was obtained, significantly improving the esthetic outcomes. Histologic analysis showed the long junctional epithelium in intimate contact with the root surface. It appeared to form coronal to the perforation and extended apical to the MTA. Based on the limitations of this clinical and histologic observation, it can be concluded that MTA in conjunction with connective tissue grafts could be considered for treatment of esthetic deficiencies associated with iatrogenic tooth perforations.

Clinical long-term evaluation of acellular dermal matrix in the treatment of root recession: case report.

Several clinical studies have documented success when using an acellular dermal matrix (ADM) to treat mucogingival defects; however, information concerning its long-term stability is limited. This article presents a case involving a patient with root recession treated with an ADM. Probing depth, marginal tissue recession, and the amount of keratinized and attached tissues were evaluated for 10 years post-treatment; the results showed long-term stability during the observation period.

Evaluation of the level of microbial contamination and prevalence of gram-negative non-fermentative rods in dental unit waterlines

Introduction: The cross infection control in dental office has received great attention from professionals and one of the critical points is the bacteriological control of water used in dental unit. Objective: To perform a microbiological evaluation of the water used in dental units, the identification of Gram-negative non-fermentative rods (GNNR) and their ability to adhere to polystyrene, and the antimicrobial activity of disinfectants on the identified strains. Material and methods: The heterotrophic bacteria count and GNNR identification were performed on water samples collected from 25 dental units (air/water syringe and reservoir). The GNNR were assessed on their capability to adhere to polystyrene and on their antimicrobial activity to the following disinfectants: sodium hypochlorite (0.06%, 0.12%, 0.25%, and0.5%) and chlorhexidine (0.03%, 0.06%, and 0.12%). Results: 88% of the air/water syringe collected samples and 68% of the reservoir collected samples were out of the potability standards. The quantity of isolated bacteria from the reservoir was lower than from the air/water syringe in 88% of the dental units. Methylobacterium spp. was found in highest percentage (19.7%) during GNNR genus isolation. There was a weak adherence to polystyrene in 85.04% of the samples. Sodium hypochlorite at 0.25%, inactivated 100% of the GNNRs in 10 minutes, while the highest tested concentration of chlorhexidine (0.12%), inactivated 98.5% of the GNNRs. Conclusion: These results provide information on the contamination problem of dental unit waterlines (DUWL) and indicate a need for treatment of the water used in dental units. The disinfection of DUWL can be performed with sodium hypochlorite at 0.25% (half the concentration recommended in the literature). However, further studies are necessary regarding DUWL frequency disinfection.

Apresentação de modelo de ficha clínica periodontal / Presentation of a model of periodontal clinical record

Introdução: a ficha clínica é uma ferramenta essencial para a execução de qualquer procedimento periodontal. Sua finalidade é obter e registrar o maior número possível de informações sobre o estado de saúde geral e bucal do paciente, além de armazenar o registro de todos os procedimentos executados desde a consulta inicial até a conclusão do tratamento. Objetivo: o propósito desse trabalho é destacar a importância da ficha clínica periodontal e propor um modelo orientador a profissionais ou instituições na elaboração de suas próprias fichas clínicas. Conclusões: através da análise dos dados contidos nas fichas clínicas de diversas instituições do estudo dos principais artigos referentes ao assunto, foi criado um modelo de ficha clínica específico para a Periodontia.

Introduction: The clinic form is an essential tool for the execution of any periodontal procedure. Its finality is to obtain and record as much information as possible about the patient’s general and oral state of health, besides storing records of all executed procedures since initial appointment until the treatment conclusion. Objective: The purpose of this work is to emphasize the importance of the periodontal clinic form and propose a guidance model for professionals and institutions on the elaboration of their own clinical forms. Methods: Through the analysis of the data contained on clinical forms of several institutions and study of the main articles related to the subject it was created an specific model of clinical form for Periodontics.

O emprego de matriz de colágeno suíno (mucograft) para recobrimento radicular / The porcine collagen matrix (Mucograft) used to root coverage. A case report

O enxerto de tecido conjuntivo subepitelial associado ao retalho reposicionado coronário é considerado, atualmente, a técnica padrão-ouro para recobrimento radicular na terapia mucogengival. No entanto, as dificuldades técnicas, o uso da área doadora palatal e o desconforto pós-operatório aumentaram os estudos por técnicas menos invasivas. O objetivo deste estudo foi avaliar, clínica e histologicamente, a eficácia da matriz de colágeno reabsorvível nos procedimentos de cobertura radicular, analisando a possibilidade de ser uma alternativa viável em substituição ao enxerto de tecido conjuntivo subepitelial.

Estudo comparativo entre o esfigmomanômetro e o aparelho digital de pulso na aferição da pressão arterial e da pulsação em pacientes submetidos a tratamento periodontal / Comparative study between sphygmomanometer and the wrist digital monitor in measurement of blood pressure and pulse rate in patients submitted to periodontal treatment

A aferição da pressão arterial (PA) é um importante indicador do estado de saúde atual do paciente e permite uma atuação mais consciente, segura e eficaz do clrurgião-dentista durante os procedimentos odontológicos. 0 uso dos aparelhos digitais tornaria esta medição mais prática e rápida, se comparados com o esfigmomanômetro, permitindo o monitoramento da PA e frequênoa do pulso (FP) durante a execução dos procedimentos, sem necessidade de que o operador interrompa os mesmos para tomada das medidas. 0 objetivo deste trabalho foi comprovar, através de análise estatística, a precisão das aferições realizadas com o aparelho digital de pulso, comparando-o com o esfigmomanômetro aneróide. Foram realizadas aferições em 45 pacientes da Clínica de Especialização em Periodontia da Universidade Estadual de Londrina. Os resultados demonstraram que não houve diferença estatística significativa entre as medidas obtidas e o tempo de manuseio entre os dois aparelhos. Estes dados confirmam a viabilidade do uso do aparelho digital de pulso na rotina da prática clínica periodontal.

Retalho reposicionado apical modificado e retalho posicionado coronário. Combinação de técnicas cirúrgicas para tratamento de recessão radicular / The modified apically repositioned flap and coronally positioned flap. Combined techniques for treatment of root

Este trabalho teve por objetivo relatar um caso clínico de recobrimento radicular realizado, a longo prazo, em um dente com sensibilidade exacerbada devida a uma recessão gengival Classe I de Miller. O retalho reposicionado apical modificado foi executado com o intuito de aumentar a quantidade de tecido ceratinizado apical ao defeito, previamente ao retalho posicionado coronário. Esta combinação de técnicas foi eficiente na resolução da sensibilidade radicular, proporcionado 100% de recobrimento com menor trauma cirúrgico, ausência de tecido doador palatal e com resultado estético ideal.

Aumento de gengiva inserida: enxerto livre epitelizado palatal x retalho reposicionado apical modificado / Increase the amount of attached gingiva: epitheliazed free palatal graft X modified apically repositioned flap. A case report

Este relato de caso clínico compara duas técnicas cirúrgicas, o tradicional enxerto livre epitelizado palatal com o retalho reposicionado apical modificado mais recentemente introduzido na literatura. Ambos, apesar de apresentarem diferenças clínicas, mostram-se eficientes quanto ao propósito de aumentar a dimensão ápico-coronal da gengiva inserida com resultados estáveis quatro anos após.

Aumento de coroa clinica com objetivo estético / Crown lengthening with esthetical purpose

Este artigo apresenta uma breve revisão sobre o sorriso gengival, sua etiologia e aspectos anatômicos. Também, fornece uma abordagem com foco no aspecto estético do procedimento de aumento da coroa clínica abrangendo suas indicações, contraindicações e técnica cirúrgica ilustrada por apresentação de caso clínico.

Técnica cirúrgica para criação de tecido conjuntivo doador palatal aumentando a previsibilidade no tratamento de recessões radiculares / Surgical technique for creation of palatal connective tissue donor by increasing predictability in the treatment of recession root

O propósito deste relato clínico é de apresentar o tratamento de recessões radiculares Classe I de Miller em um paciente jovem que relatava problema estético e sensibilidade exacerbada nos dentes 23 e 24, porém não apresentava tecido conjuntivo palatal suficiente para ser utilizado na cobertura radicular. Por meio de uma técnica recentemente introduzida na literatura, com a finalidade de criar tecido conjuntivo doador palatal, foi possível solucionar o problema com resultado satisfatório e estável a longo prazo.