Colgajo de reposición coronal, con y sin injerto de tejido conectivo, para tratar recesiones gingivales / Coronally repositioned flap with and without connective tissue graft to treat gingival recession

Introducción: Las recesiones gingivales son afecciones de las encías, que son muy frecuentes y podrían provocar repercusiones estéticas, hipersensibilidad dentinaria y tener más tendencia a la formación de lesiones cervicales. Es necesario recubrir la superficie radicular mediante técnicas regenerativas periodontales. Objetivo: Comparar la cantidad de recubrimiento radicular, la profundidad al sondaje y el nivel de inserción clínica, empleando las técnicas de colgajo de reposición coronal, con y sin injerto de tejido conectivo, en pacientes con recesiones gingivales Miller I y II. Métodos: Se incluyeron un total de 16 pacientes con recesiones gingivales Miller clase I y II, de los cuales se seleccionaron 50 piezas dentarias tratadas quirúrgicamente para cubrir las recesiones. Se utilizaron las técnicas de colgajo de reposición coronal, con y sin injerto de tejido conectivo. Las mediciones clínicas fueron comparadas al inicio y a los tres meses posoperatorios. Resultados: Al tercer mes poscirugía los resultados del recubrimiento radicular, profundidad al sondaje y el nivel de inserción clínica para la técnica colgajo de reposición coronal con injerto de tejido conectivo, fueron 0,96 ± 1,33; 0,87 ± 0,63; 1,83 ± 1,7 y para la técnica colgajo de reposición coronal fueron 1,44 ± 1,19; 1,04 ± 0,52; 2,48 ± 1,48, respectivamente. Al comparar el recubrimiento radicular intergrupo no se encontraron diferencias significativas (p = 0,11). Sin embargo, al comparar la profundidad al sondaje intergrupo (p = 0,04), el nivel de inserción clínica intergrupo (p = 0,001) y todas las mediciones clínicas intragrupo (p = 0,001), se encontraron diferencias significativas. Conclusiones: La técnica de colgajo de reposición coronal, con y sin injerto de tejido conectivo, demostró diferencias significativas en la profundidad al sondaje y el nivel de inserción clínica en recesiones gingivales Miller I y II. No se alcanzaron diferencias significativas para el recubrimiento radicular en ambas técnicas a los 3 meses de seguimiento(AU)

Introduction: Gingival recession is a very common gum condition which may result in aesthetic alterations and dentin hypersensitivity, and increase the probability of cervical lesions. It is necessary to cover the root surface using periodontal regeneration techniques. Objective: Compare the amount of root coverage, probing depth and clinical insertion level, using coronally repositioned flap techniques with and without connective tissue graft in patients with Miller I and II gingival recessions. Methods: A total 16 patients with Miller class I and II gingival recessions were included in the study, from whom 50 teeth were selected which had been treated surgically to cover the recessions. The techniques used were coronally repositioned flap with and without connective tissue graft. Clinical measurements were compared at the start of the postoperative period and three months later. Results: Three months after surgery, root coverage, probing depth and clinical insertion level were 0.96 ± 1.33; 0.87 ± 0.63; 1.83 ± 1.7, respectively, for coronally repositioned flap with connective tissue graft, and 1.44 ± 1.19; 1.04 ± 0.52; 2.48 ± 1.48, respectively, for coronally repositioned flap. Root coverage intergroup comparison did not find any significant differences (p = 0.11). However, intergroup comparison of probing depth (p = 0.04) and clinical insertion level (p = 0.001), and all the intragroup clinical measurements (p = 0.001) did find significant differences. Conclusions: Coronally repositioned flap technique with and without connective tissue graft showed significant differences in terms of probing depth and clinical insertion level in Miller I and II gingival recessions. At three months' follow-up, no root coverage significant differences were observed for either technique(AU)

Outcome measurements following palatal soft tissue graft harvesting: A review.

BACKGROUND: Free gingival graft (FGG) and connective tissue graft (CTG) are two of the most commonly techniques performed in periodontal and peri-implant plastic surgery. Although several outcome measurements have been proposed for evaluation of palatal wound healing and patient morbidity, a comprehensive review about these variables is lacking. The objective of this review is to present comprehensive information about outcome measurements related to postoperative palatal wound healing and postoperative patient-reported morbidity after FGG or CTG procedures. MATERIAL AND METHODS: An electronic search of English language dental literature in the Medline database via PubMed access was conducted from May 1994 to May 2020 following the PRISMA guidelines. Electronic search strategy complemented by hand search of impacting related dental journals, and the reference list of all included studies were used to complete data collection considering only clinical trials. Finally, inclusion criteria were applied to identify articles after full-text evaluation. RESULTS: A total of 111 articles were identified. After the exclusion of 34 articles based on title and abstract evaluation, 77 articles were full text screened. Following, 46 articles were excluded since they evaluated other surgical areas. Finally, 31 studies were selected and included for final evaluation. Outcome measurements were classified in variables collected by indexes and systems assessed professionally and patient-centered measurements. Visually-assessed measurements include indexes, photographs, bleeding and use of laboratory-aided measurements. Patients-centered outcomes comprise pain, discomfort and quality-of life, among others. CONCLUSIONS: The most commonly used outcome measurements related to postoperative palatal wound healing are hydrogen peroxide test, tissue color match, visual inspection, and bleeding evaluation. Pain perception, analgesic consumption, discomfort sensation, burning sensation, and changes in feeling habits are the most commonly used outcome measurements related to postoperative patient-reported morbidity. Key words:Morbidity, patient comfort, periodontics, tissue harvesting, wound healing.

Prevención de complicaciones y reducción de riesgos en implantología oral considerando los factores humanos y la conciencia de la situación / Prevention of complications and risk reduction in oral implantology considering human factors and situation awareness

En los últimos años, se ha incrementado el porcentaje de colocación de implantes dentales y, con ello, también la mayor presencia de eventos adversos, por lo que las complicaciones no son infrecuentes. La gran mayoría de recomendaciones para la reducción de complicaciones asociadas con la colocación de implantes dentales están analizadas desde el punto de vista de sus causas directas, juzgando la técnica o al individuo, pero no al sistema en conjunto, cuando este constituye la etiología real de las complicaciones. Recientemente, se ha empezado a considerar más importante la inclusión de los factores humanos y la conciencia de la situación en la comprensión de las complicaciones en implantología oral. Esto ha permitido analizar de manera global tanto al individuo como a su entorno, y aportar soluciones basadas en la prevención. Sin embargo, el conocimiento y la utilización de estos aspectos en implantología oral están aún en vías de popularización, por lo que el objetivo del presente artículo es difundir el enfoque de los factores humanos y la conciencia de la situación en la prevención de complicaciones y en la reducción de riesgos en los procedimientos de colocación de implantes dentales. (AU)

In recent years, the percentage of dental implant placement has increased, and the presence of adverse events and complications are not uncommon. The vast majority of recommendations for reducing complications associated with dental implant placement are analyzed from the point of view of their direct causes, evaluating the technique and/or the individual, but not the system as a whole, being this the actual etiology of complications. The inclusion of human factors and situation awareness has recently gained increasing importance in oral implantology complications and has allowed global analysis of both the individual and the environment, providing solutions based on prevention. However, knowledge and use of these aspects in oral implantology are still in the process of popularization, and therefore, the objective of this article was to describe the human factors involved and situation awareness for preventing complications and reducing the risks associated with dental implant placement procedures. (AU)

Periodontal phenotype: A review of historical and current classifications evaluating different methods and characteristics.

OBJECTIVE: To review the historical and current periodontal phenotype classifications evaluating methods and characteristics. Moreover, to identify and classify the methods based on periodontal phenotype components. OVERVIEW: Several gingival morphology studies have been frequently associated with different terms used causing confusion among the readers. In 2017, the World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions recommended to adopt the term "periodontal phenotype". This term comprises two terms, gingival phenotype (gingival thickness and keratinized tissue width) and bone morphotype (buccal bone plate thickness). Furthermore, gingival morphology has been categorized on "thin-scalloped", "thick-scalloped" and "thick-flat" considering the periodontal biotype. However, by definition, the term phenotype is preferred over biotype. Periodontal phenotype can be evaluated through clinical or radiographic assessments and may be divided into invasive/non-invasive (for gingival thickness), static/functional (for keratinized tissue width), and bi/tridimensional (for buccal bone plate thickness) methods. CONCLUSIONS: "Thin-scalloped," "thick-scalloped," and "thick-flat" periodontal biotypes were identified. These three periodontal biotypes have been considered in the World Workshop but the term periodontal phenotype is recommended. Periodontal phenotype is the combination of the gingival phenotype and the bone morphotype. There are specific methods for periodontal phenotype evaluation. CLINICAL SIGNIFICANCE: The term periodontal phenotype is currently recommended for future investigations about gingival phenotype and bone morphotype. "Thin-scalloped," "thick-scalloped," and "thick-flat" periodontal phenotypes can be evaluated through specific methods for gingival thickness, keratinized tissue width, and buccal bone plate thickness evaluation.

[Prevention of complications and risk reduction in oral implantology considering human factors and situation awareness]. / Prevención de complicaciones y reducción de riesgos en implantología oral considerando los factores humanos y la conciencia de la situación.

In recent years, the percentage of dental implant placement has increased, and the presence of adverse events and complications are not uncommon. The vast majority of recommendations for reducing complications associated with dental implant placement are analyzed from the point of view of their direct causes, evaluating the technique and/or the individual, but not the system as a whole, being this the actual etiology of complications. The inclusion of human factors and situation awareness has recently gained increasing importance in oral implantology complications and has allowed global analysis of both the individual and the environment, providing solutions based on prevention. However, knowledge and use of these aspects in oral implantology are still in the process of popularization, and therefore, the objective of this article was to describe the human factors involved and situation awareness for preventing complications and reducing the risks associated with dental implant placement procedures.

Reliability of cephalograms derived of cone beam computed tomography versus lateral cephalograms to estimate cervical vertebrae maturity in a Peruvian population: A retrospective study.

OBJECTIVE: Cone beam computed tomography (CBCT) images can be useful for estimating cervical vertebrae maturity (CVM). The aim of this study was to evaluate the reliability of cephalograms derived from CBCT versus lateral cephalograms (LC) to estimate the CVM in a Peruvian population. MATERIAL AND METHODS: The sample evaluated consisted of 40 cephalograms derived from CBCT and 40 LC images from individuals aged 10-19 years. One trained and calibrated observer (Kappa scores≥0.90) interpreted the CBCT and LC images twice. Intra-observer reliability of each maturation stage on CBCT sagittal slices and LC images were analysed using the weighted kappa statistics (α=0.05). Comparison of CVM stages between CBCT slices and LC images were analysed by the Spearman rank correlation coefficient, p<0.05. RESULTS: The weighted kappa test showed almost perfect intra-observer agreement for the CVM stages using the CBCT sagittal slices (0.873). Considering the LC images, the weighted kappa test showed almost perfect intra-observer agreement too (0.937). In both intra-observer agreement, the difference was limited to one maturation stage of the CVM method. The first and second intra-observer agreement for the CVM stages between the CBCT sagittal slices and LC images were almost perfect (0.937 and 0.874). High correlation values at the first (0.975) and second (0.976) intra-observer agreement for the CVM stages between CBCT sagittal slices and LC images were also found. CONCLUSION: CBCT is a reliable method for CVM assessment and can be used as an alternative method for this purpose. The orthodontists might use the CBCT scans as a valuable tool for CVM method estimation.

Vertical Marginal Discrepancy of Retrievable Cement/Screw-retained Design and Cement-retained Implant-supported Single Metal Copings.

AIM: To compare the vertical marginal discrepancy of retrievable cement/screw-retained design (RCSRD) and cement-retained (CR) implant-supported single metal copings cemented on implant abutments. MATERIALS AND METHODS: Single metal copings were fabricated for 20 4.5 × 10 mm titanium dental implants. Two groups of 10 implants each were randomly allocated. One group received RCSRD metal copings and the other group received CR metal copings. Both types of restorations were fabricated on solid abutments with 5.5 mm of diameter. The copings were cemented with resin cement. After the cementation procedure, cement excess was carefully removed in both groups. Inspections of coping-abutment vertical marginal discrepancy were measured using scanning electronic microscopy (SEM) under 800× magnification. The independent sample Student's t test was used to detect differences between groups (p < 0.05). RESULTS: The RCSRD implant-supported metal coping group (57.80 ± 2.34 µm) showed statistically better vertical marginal discrepancy than the CR implant-supported metal coping group (64.40 ± 2.23 µm) (p = 0.001). CONCLUSION: The RCSRD implant-supported metal copings offer less vertical marginal discrepancy than the CR copings group. This new technique would decrease the marginal discrepancy with less bacterial filtration and biomechanical problems. CLINICAL SIGNIFICANCE: Retrievable cement/screw-retained design is another alternative technique for dental implant rehabilitation that combines the advantages of CR and SR prostheses. The hybrid design offers less vertical marginal discrepancy for better control of bacterial filtration and biomechanical problems.

Fracture Resistance of Cement-retained, Screw-retained, and Combined Cement- and Screw-retained Metal-ceramic Implant-supported Molar Restorations.

AIM: To compare fracture resistance between the cement-retained (CR), screw-retained (SR), and combined cement- and screw-retained (CCSR) metal-ceramic (MC) implant-supported molar restorations and the fracture mode after vertical loading simulation. MATERIALS AND METHODS: Thirty MC molar restorations were fabricated on thirty tilted dental implants that were repositioned using prefabricated or universal castable long abutments (UCLA) with 15° of angulation divided into three groups of ten specimens each. Group C: CR, group S: SR, and group CS: cement- and screw-retained. The crowns in group CS were adhesively bonded extraorally, and composite resin was used to fill the screw access holes (SAHs) in groups S and CS. Subsequently, all the specimens were tested for fracture resistance. A scanning electron microscope (SEM) evaluation of the fracture mode was also performed. Mean values of fracture loads were calculated and compared in Newtons (N) using one-way ANOVA and Tukey post hoc test (p < 0.05) for each group. RESULTS: Mean fracture load values were 2718.00 ± 266.25 N for group C, 2125.10 ± 293.82 N for group S, and 2508.00 ± 153.59 N for group CS. Significant differences were found between group S and the other groups on fracture load values. However, no significant differences were found between groups C and CS (p = 0.154). The failures were at MC framework interfaces on mesiolingual cusps. CONCLUSIONS: Cement and CCSR MC molar restorations showed comparable fracture resistance using abutments with 15° of angulation. However, SR design showed significantly the lowest values of resistance. Screw access hole did not significantly affect the fracture resistance of cemented MC molar restorations. All the specimens exhibited mixed adhesive fractures at the mesiolingual cusps. CLINICAL SIGNIFICANCE: Combined cement- and screw-retained restorations (CCSRRs) incorporate the simplicity of the cement method and the retrievability of the screw method, offering good resistance, allowing the removal of the excess of cement before clinical placement of the restoration, and providing another alternative for dental implant rehabilitation.

Techniques for retrievability and for registering screw access holes in cement-retained implant-supported prostheses: A scoping review of the literature.

STATEMENT OF PROBLEM: After implant rehabilitation, clinicians may need to remove a restoration because of technical and biological complications. For cement-retained implant-supported prostheses (ISPs), the retrievability process may damage the components of the prosthesis, the intaglio surface of the implant, or the abutment screw. To avoid that, the screw access hole (SAH) of the dental implant abutment (DIA) should be registered. Although several clinical reports and dental techniques have been proposed, a review of existing techniques is lacking. PURPOSE: The purpose of this scoping review was to evaluate the different techniques described for retrievability and for registering the SAH of cement-retained ISPs. MATERIAL AND METHODS: An electronic search of English language dental literature in the PubMed, Scopus, Google Scholar, and SciELO databases was conducted from 1980 to December 2017 with appropriate keywords and phrases. A hand search of relevant dental journals was also completed, and exclusion criteria were applied after full-text evaluation. RESULTS: The electronic and hand search revealed 325 articles. However, 252 publications were discarded after duplicates were removed. After reading the title and abstracts, 15 studies were excluded, and the full text of 64 publications was screened for inclusion and exclusion criteria. Forty studies were selected and included for final evaluation. The evaluation revealed 6 techniques for retrievability and 9 techniques for registering the position of the SAH, divided into 2-dimensional (2D) and 3-dimensional (3D) techniques. CONCLUSIONS: Cement-retained ISPs can be effectively retrieved by using interim cements and possibly by using a combined cement- and screw-retained design. Vacuum guides with guiding sleeves and computer-aided design and computer-aided manufacturing (CAD-CAM) guide templates are possible effective 3D techniques for registering the screw access channel (SAC) location and angulation.

Marginal Discrepancy of Cast Copings to Abutments with Three Different Luting Agents.

AIM: The purpose of this study was to evaluate the MD (marginal discrepancy) on the calcinable copings in abutments for cemented prostheses with three luting agents. METHODS: Sixty-four analogs of CeraOne-type abutments (NACONIH code, Titanium Fix Implant Sytem SP, Brazil) were divided into four groups (n = 16). The copings were cast and placed on the CeraOne abutment analogs and cemented with eugenol-free zinc oxide (EfZO) (n = 16), with glass ionomer (GI) (n = 16), and with zinc phosphate (ZP) (n = 16), and as a control group, there were CeraOne plastic copings (NACOC code, Titanium Fix Implant Sytem SP, Brazil) (n = 16) which were not cemented with any material. After 24 hours, the MD of the four groups was measured. MD was evaluated using a stereoscopic microscope (Leica EZ4 W, Leica Microsystems, Germany) with an increase of ×100. MD was measured at four predetermined and equidistant sites with respect to the marginal line of the cast adaptation. The measurement was made from the distance between the free edge of the cast cylinder and the margin of preparation of the titanium abutment, with a level of statistical significance of p < 0.05. RESULTS: Of the three fixing agents, the ZP was found to have the highest MD (53.59 ± 14.21 µm); however, the lowest MD (41.72 ± 9.10 µm) was found in the GI group. These differences are statistically significant at p < 0.001. CONCLUSIONS: In summary, according to our results, it was found that ZP cement showed the highest MD after cementation, followed by the glass ionomer, while EfZO showed the lowest MD.

Influencia de las perforaciones corticales en regeneración ósea guiada: Revisión de la literatura / The influence of cortical perforations on guided bone regeneration: A literature review

RESUMEN Objetivo: Evaluar la influencia de las perforaciones corticales en regeneración ósea guiada (ROG) mediante resultados de histomorfometría obtenidos de estudios humanos y animales. Revisión de la literatura actual: Se realizó una búsqueda electrónica de estudios en humanos y animales en bases de datos PubMed, Cochrane Library, SciELO y Google Scholar desde 1980 hasta mayo del 2017. Se utilizó la siguiente estrategia de búsqueda: ((decortication of bone) OR (bone decortication) OR (alveolar decortication) OR (decortication) OR (decortications) OR (cortical perforation of bone) OR (cortical bone perforation) OR (cortical perforation) OR (cortical perforations) OR (intramarrow penetration) OR (marrow penetration)) AND ((guided bone regeneration) OR (guided bone augmentation) OR (bone augmentation) OR (osseous repair) OR (graft integration)). Discusión y conclusión: Se identificaron 65 artículos y sólo se seleccionaron 8. Cuatro estudios en animales mostraron influencia estadísticamente significativa al realizar perforaciones corticales. En 3 estudios en animales y en un estudio en humanos esta diferencia no fue estadísticamente significativa. Sin embargo, al realizar perforaciones existió mayor número de vasos sanguíneos y mayor formación ósea sin reacciones inflamatorias resaltantes ni impactos negativos. Las perforaciones corticales muestran beneficios en etapas tempranas de cicatrización influyendo significativamente en la angiogénesis incrementando la cantidad de hueso neoformado.

ABSTRACT Objective: To evaluate the influence of cortical perforations on guided bone regeneration (ROG) by histomorphometry results obtained from human and animal studies. Review of current literature: An electronic search of trials in humans and animals with histomorphometric evaluations was carried out in the PubMed, Cochrane Library, SciELO and Google Scholar databases from 1980 to May 2017. The following search strategy was used: ((decortication of bone) OR (bone decortication) OR (alveolar decortication) OR (decortication) OR (decortications) OR (cortical perforation of bone) OR (cortical bone perforation) OR (cortical perforation) OR (cortical perforations) OR (intramarrow penetration) OR (marrow penetration)) AND ((guided bone regeneration) OR (guided bone augmentation) OR (bone augmentation) OR (osseous repair) OR (graft integration)). Discussion and conclusion: Sixty five articles were identified and only 8 were selected. Four studies in animals showed statistically significant influence when performing cortical perforations. In 3 studies in animals and in 1 human study this difference was not statistically significant. However, when drilling, a greater number of blood vessels and a greater bone formation without inflammatory reactions or negative impacts were recorded. Cortical perforations show benefits in early stages of healing, influencing significantly in the angiogenesis, increasing the amount of neoformed bone.

Perforaciones corticales, penetraciones intramedulares y decorticaciones en regeneración ósea guiada / Cortical perforations, intramedular penetrations and decortications in guided bone regeneration

Las perforaciones corticales, penetraciones intramedulares o decorticaciones se realizan a menudo como parte del procedimiento de regeneración ósea guiada (ROG). Su sustento biológico se basa en que mejorarían la angiogénesis y proporcionarían una vía hacia el hueso esponjoso rico en vasos sanguíneos. También se consideran como un "noxious stimuli" (estímulo nocivo) que iniciaría el fenómeno regional acelerado con una respuesta local exuberante facilitando la cicatrización ósea normal. Además, mejorarían la unión o enlace físico entre el injerto óseo y el lecho receptor asegurando estabilidad y fusión de los bloques óseos. Sin embargo, se nos presentan algunas interrogantes relacionadas a su fundamento, a los términos que las describen, a los tamaños, a su cantidad y disposición, al instrumental adecuado para realizarlas y al confort del paciente. (AU)

Cortical perforations, intramedullary penetrations or decortications are often performed as part of the guided bone regeneration (GBR) procedure. Their biological basis is that they would improve angiogenesis, providing a pathway to the medullar bone rich of blood vessels. In addition, cortical perforations would be consider as a "noxious stimuli" that initiate the accelerated regional phenomenon with an exuberant local response facilitating normal bone healing. Moreover, they would improve the physical bonding between the bone graft and the recipient bed ensuring stability and fusion of the bone blocks. However, there are some questions related to its foundation, terms to describe them, their sizes, quantity and disposition, the appropriate instruments to perform them and the comfort of the patient. (AU)