Clinical evaluation of acellular allograft dermis for the treatment of human gingival recession.

BACKGROUND: Periodontal root coverage procedures to treat recession areas are indicated for unesthetic, exposed, and/or painful root surfaces. Many methods, most using autogenous soft tissue grafts, have been utilized, but with associated morbidity at the donor sites. An alternative donor material would reduce the morbidity and provide for sufficient available donor tissue. METHODS: An acellular allogeneic dermal connective tissue matrix (AD) and autogenous palatal connective tissue (CT) were compared as subepithelial grafts for the treatment of gingival recession. Twenty-two patients with similar isolated gingival recession of > or = 2 mm on 2 separate teeth were treated with the subepithelial graft technique. Exposed roots were hand root planed only and, by random allocation, either a fitted AD or fitted CT graft was secured in place and covered by coronally positioned flaps. RESULTS: Mann Whitney U test analysis found the following changes at 6 months for AD and CT, respectively, compared to presurgical conditions: root coverage of 1.7 +/- 1.2 (65.9%) and 2.2 +/- 1.1 mm (74.1%) (both P<0.01), increase in keratinized tissue (KT) of 1.2 +/- 1.3 and 1.6 +/- 1.9 (both P<0.01), and an increase in gingival thickness with both; 83.2% of expected root coverage was obtained with AD and 88.6% with CT (P= 0.43). There were no significant differences between treatments for any parameter. Global assessments by clinicians and patients suggested a more esthetic clinical result with AD. CONCLUSIONS: These results suggest that acellular allogeneic dermal matrix may be a useful substitute for autogenous connective tissue grafts in root coverage procedures.

A proposed radiographic index for assessment of the current status of osseointegration.

The longevity of an osseointegrated implant is directly affected by the maintenance of its osseous anchorage. Progressive marginal bone loss would be detrimental to its survival. This article proposes a new radiographic index for use in the radiographic assessment of peri-implant marginal bone levels. The index scores range from 0 to 6 and denote marginal bone loss in percentages relative to the implant body length measured from its coronal-most margin in an apical direction. The proposed index should be of significance in: (1) use of short implants (7 to 10 mm); (2) evaluation of implants functioning in areas of low bone density (types 3 and 4); (3) prognosis and treatment of ailing/failing implants; (4) follow-up of implants placed in extraction sites; and (5) correlation of crown-to-implant ratio with marginal bone loss.

Crown lengthening in the esthetic zone.

Crown lengthening in the esthetic zone is a prosthodontically designed and surgically executed procedure that must only be considered after careful restorative and surgical treatment planning, including a detailed smile analysis, clinical and radiographic evaluation of the quality of soft and hard tissues, and selection of the appropriate approach for each individual case. The presented techniques are modifications of the original conventional surgical approach, where longer healing periods may have been required and loss of papilla height or fullness is of concern. Recognition of the advantages and disadvantages of each technique should increase predictability and success in interdisciplinary smile enhancement therapy.

The semilunar flap technique for root coverage.

The semilunar flap technique may be considered as a simple, minimally invasive option for coronally repositioning the receded free gingival margin on the facial aspects of natural teeth and implants. Judicious case selection and careful application of the described procedure may enhance the final esthetic outcome using this approach. Work is currently in progress by the authors to provide long-term evidence-based results using this technique, with future considerations including the application of recent advances in microsurgical instrumentation to facilitate surgical tissue management.

Bone and bone substitutes.

Bone replacement grafts will play a continuing role in periodontal and other regenerative therapy. Several choices are available to the clinician including autogenous, allogeneic, xenogeneic and a variety of alloplastic materials. Except for fresh autogenous bone, bone replacement graft(s) do not provide the cellular elements necessary for osteogenesis nor can they reliably be considered truly osteoinductive, but instead are mostly osteoconductive, providing a scaffold for bone deposition. Currently, significant decrease in clinical probing depth and gain of clinical attachment have been reported following use of bone replacement grafts when compared to flap debridement surgery alone for periodontal osseous defects. Reported differences among bone replacement grafts (autogenous, allogeneic, xenogeneic, and alloplastic) occur with respect to histological outcomes. Overall, probing depth reduction, attachment level gain and degree of defect fill are similar for all bone replacement grafts.