Human palatal and tuberosity mucosa as donor sites for ridge augmentation.

Since different clinical outcomes of periodontal bilaminar surgeries using the palate or the maxillary tuberosity as connective tissue (CT) donor sites have been observed, tissues grafted with CT from the palate or the tuberosity 1 year after surgical procedures for ridge augmentation were compared with nongrafted tissues by using morphologic and molecular methods. Collagen content and matrix metalloproteinases 1 and 2 expression were similar in tissues and cultured fibroblasts from the palate and tuberosity, although with interindividual differences. In contrast, differences in collagen cross-linking and maturation in the tuberosity fibroblasts were observed, suggesting a possible role in determining hyperplastic responses in some patients.

Save the natural tooth or place an implant? Three periodontal decisional criteria to perform a correct therapy.

To perform advanced periodontal therapy to save a natural tooth or to extract it and place an implant-which is best? Several considerations need to be made to make the proper decision. Endodontic conditions, proper reconstruction of a devitalized tooth, and the possibility of correct prosthetic treatment are all factors to be considered. From a strictly periodontal point of view, in the presence of a stable, vital, intact, periodontally involved, single-rooted tooth, a few fundamental criteria need to be considered to make the proper decision. These criteria will be discussed through analysis of therapy outcomes over a period of at least 10 years.

Long-term clinical observation of treatment of infrabony defects with enamel matrix derivative (Emdogain): surgical reentry.

A surgical protocol for the placement of Emdogain during new attachment procedures was published in this journal in 1999. Three cases with infrabony defects were treated, and significant periodontal attachment level gain, probing depth reduction, and bone fill were evident upon clinical probing and reentry procedures after 1 year. The patients were enrolled in a maintenance protocol with 3-month recall visits. After 7 years, the clinical parameters were stable, as was the radiographic evaluation. Surgical reentry after 7 years in two cases and 5 years in one case demonstrated the stability of the previous findings. These data show the long-term efficacy of enamel matrix derivative in new attachment procedures.

Crestal bone resorption 5 years after implant loading: clinical and radiologic results with a 2-stage implant system.

PURPOSE: The aim of the present study was to assess crestal bone resorption 5 years after loading by conducting a clinical and radiographic evaluation of 112 Frialit-2 implants consecutively placed in 51 patients from January 1994 through June 1994. MATERIALS AND METHODS: All implants were placed in the same private-practice clinic by the same surgeon. Clinical assessment included plaque score monitoring, bleeding on probing, probing depth, type of occlusion, and prosthetic adaptation. Intraoral radiographs were taken and compared using suitable software to accurately measure peri-implant bone resorption. RESULTS: The survival rate of the implants was 100%. Plaque was present on 47 (42%) implants. Bleeding on probing was detectable at 17 implants (15.5%). Probing depth was > 5 mm for 5 implants (4.5%). Crestal bone resorption was > 3 mm for 32 implants (28.6%); the average observed crestal bone resorption was 2.17+/-1.6 mm. DISCUSSION: The survival rate of the implants may be the result of the relatively short functional period as well as the strict and frequent clinical evaluations associated with oral hygiene procedures during the supportive periodontal therapy. CONCLUSION: The results suggest that with strict plaque control, and provided that the patient follows a regular program of supportive therapy, crestal bone resorption around a 2-stage implant system may be limited.

Comparison of infrabony defects treated with enamel matrix derivative versus guided tissue regeneration with a nonresorbable membrane.

AIM: The purpose of the present multicenter clinical trial was to compare the efficacy of two different procedures in the treatment of infrabony defects: guided tissue regeneration (GTR) with nonresorbable membranes and enamel matrix derivative (EMD). MATERIAL AND METHODS: Six centers participated in this study. Ninety-eight patients with an interproximal infrabony defect were selected. All patients were treated with an initial phase of scaling and root planing, and at the study's baseline the selected defects presented a value of probing depth (PD) > or =6 mm with an infrabony component > or =4 mm. Forty-nine patients were treated with GTR procedures (using ePTFE membranes (Gore-Tex W.L. Gore and Associates, Flagstaff, AZ, USA)) and forty-nine with EMDs (Emdogain (U Biora AB Malm, Sweden)). The efficacy of each treatment modality was investigated through covariance analysis. RESULTS: The patients were reevaluated at one year postop. Probing attachment level (PAL) gain and PD reduction were analyzed. In the Emdogain group the PAL before surgery (PAL 0) and the PD before surgery (PD 0) were respectively 9.9+/-1.4 and 8.5+/-1.6 mm. The PAL gain and the PD reduction at 1 year postsurgery were respectively 4.1+/-1.8 and 5.3+/-1.9 mm. The group of patients treated with membranes showed that PAL 0 and PD 0 were respectively 8.9+/-1.9 and 8.1+/-1.9. The PAL gain was 4.3+/-1.9 mm and the PD reduction was 5.6+/-1.5 mm. The mean PAL gain expressed by percentage (PAL gain/PAL 0) for the group treated with EMD was 41%, while it was 48% for the group treated with GTR. Results from our analysis suggest that there is no statistically significant difference between GTR and EMD treatments in terms of PAL gain, PD reduction and recession variation. Applying the regression model to a group of patients with a PAL 0 > or =8 mm, we observed a better clinical outcome in terms of PAL gain (difference of 0.3 mm) in patients treated with the GTR procedure compared to those treated with EMD. Covariance analysis showed a strong correlation in both groups of patients between PAL gain and full mouth bleeding score, and between PAL gain and defect morphology and depth.