Maxillary Anterior Area Research Articles

Digital analysis of the correlation between gingival thickness and alveolar bone thickness in the maxillary anterior teeth region

Objective: To measure the labial gingival thickness and bone lamella thickness in the maxillary anterior area using digital method, and to analyze the correlation between the two, so as to provide a reference for esthetic restoration and implantation treatment of the upper anterior area. Methods: Fifty-seven patients [23 males, 34 females, (25.8±4.5) years old] who planned to receive posterior dental implant restoration were recruited randomly with the inclusion and exclusion criteria in Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University from May 2020 to October 2020. The 3Shape software was used to perform oral scanning, and cone beam CT (CBCT) was taken for each patient. The image data was fitted and registered by the 3Shape software. The gingival thickness at 2 mm below the gingival margin, bone thickness and gingival thickness at 2 and, 4 mm below the crest of the labial alveolar crest in maxillary central incisors, lateral incisors and canines, were measured. Results: The gingival thickness at 2 mm below the gingival margin of maxillary central incisors, lateral incisors and canines was (1.42±0.21), (1.19±0.17) and (1.23±0.20) mm respectively (F=12.47, P<0.001). The gingival thickness at 2 mm below gingival margin and 4 mm below crest of residual ridge in the male patients were (1.31±0.21) and (0.67±0.22) mm, and those in the female patients were (1.26±0.22) and (0.58±0.19) mm respectively, and there were statistically significant differences in the gingival thickness between the "2 mm below gingival margin" group and the "4 mm below crest of residual ridge" group (t=2.01 and 3.97, P<0.05). There was a positive correlation between gingival thickness and alveolar bone thickness at 2 mm and 4 mm below the crest of residual ridge in maxillary anterior region, and the correlation coefficients (r) were 0.387 and 0.344 respectively (P<0.05). Conclusions: Gingival thickness of maxillary anterior area is related to the tooth position and gender. The gingival thickness of men is greater than that of women.The gingival thickness at 2 and 4 mm below the crest of the alveolar crest is positively correlated with the thickness of the alveolar bone.

Tomographic sagittal root position in relation to maxillary anterior bone housing in a Brazilian population.

PurposeThis cross-sectional study evaluated and categorized the tomographic sagittal root position (SRP) of the maxillary anterior teeth in a Brazilian population.Materials and MethodsCone-beam computed tomographic scans of 420 maxillary anterior teeth of 70 patients (35 men and 35 women, mean age 25.2±5.9 years) were evaluated. The SRP was classified as class I, II, III, or IV. In class I, the root is positioned against the buccal cortical plate; in class II, the root is centered in the middle of the alveolar housing; in class III, the root is positioned against the palatal cortical plate; and in class IV, at least two-thirds of the root engage both the buccal and palatal cortical plates.ResultsIn total, 274 teeth (65.2%) were class I, 39 (9.3%) were class II, 3 (0.7%) were class III, and 104 (24.8%) were class IV. The frequency distribution over the teeth groups was different from the overall analysis. Important differences were found in the frequencies of classes I, II, and IV compared to other populations. Sex was not associated with the SRP classes (P=0.307). Age distribution was significantly different over the classes (P=0.004).ConclusionThe findings of this study on the distribution of SRP classes among the Brazilian population compared to other populations demonstrate that the SRP should be analyzed on a case-by-case basis for an accurate treatment plan in the maxillary anterior area.

Esthetic treatment of anterior implants: A case report

Aesthetic implant treatment in the maxillary anterior area can be challenging, especially in case of insufficient bone volume. In this clinical report, a guided bone regeneration procedure using the combination of xenograft and allograft with non-resorbable membrane was applied in the atrophic edentulous alveolar crest to reconstruct a proper implant bed. Moreover, Prosthetic tissue molding was performed to improve success and optimize aesthetics. This article provides information rele- vant to treatment plans, surgical procedures, and prosthetic management in aesthetically important areas.

Different bone anchorages for Morse taper implants with different lengths in maxilla anterior: An in silico analysis

This study aimed to evaluate the stress distribution in bone tissue, in Morse tapper implants and components supporting a single crown in the maxillary anterior area, under different bone anchorages (conventional, bicortical and bicortical with nasal floor elevation) and implant lengths (8.5 mm, 10 mm and 11.5 mm) using 3D finite element analyses. Three 3D models including element #11 were simulated using software InVesalius, Rhinoceros 3D and SolidWorks. Bone block models were reconstructed from computed tomography and simulated the placement of one implant of 4 mm of diameter and lengths above mentioned, supporting cemented zirconia crown. The 3D models were processed by the finite element FEMAP and NeiNastran software, using a load of 178N were applied at 0º, 30º and 60º, considering the implant long axis. Results were visualized as the von Mises stress, maximum principal stress and microstrain maps. Bicortical bone anchorages showed lower stress and microstrain bone tissue when compared to conventional bone anchorage. However, no differences were observed between bicortical and nasal floor elevation. Regarding implants and components, the stress distribution was similar between models with little stress relief in the apical region of the implants for implants with conventional anchorage. The conclusion drawn from this study is that non-axial loading showed worse biomechanical behavior for bone tissue and implants/components. The bicortical techniques (bicortical and nasal floor elevation) should be preferred during the implant placement to reduce the stress and microstrain in the bone tissue.

The Sausage Technique using Collagen Membrane without Autogenous Bone Graft: A Case Report

Various techniques have been introduced for the guided bone regeneration procedure. Among these, the sausage technique using a natural collagen membrane has many advantages. This report describes two cases wherein the sausage technique was employed in the maxillary anterior area using deproteinized bovine bone mineral (DBBM) and native bilayer collagen membrane (NBCM) without autogenous bone graf t. In both cases, sufficient horizontal bone regeneration for implant placement was achieved. In addition, the bone and implant conditions were maintained without any complications maintained for more than 15 months. Within the limitations of this report, the sausage technique using NBCM with DBBM was able to achieve satisfactory horizontal alveolar bone augmentation for implant placement in the maxillary anterior area.

COMPARISON BETWEEN STRONTIUM RANELATE AND METAL SUBSTITUTED HYDROXYAPATITE AS GRAFTING MATERIALS IN TREATMENT OF PERI-IMPLANT BONY DEFECTS WITH IMMEDIATE IMPLANTS (CLINICAL AND EXPERIMENTAL STUDY)

Objective:The aim of this study is to compare between both of strontium ranelate and metallic substitute of hydroxyapatite as grafting materials in the treatment of peri-implant bony defects with immediate placement of dental implant in type I extraction sites within maxillary esthetic zone among clinical and experimental levels. This assessment was based on clinical, radiographic and histological studies. Subjects and Methods: The present study was carried on two types of population among both experimental levels on experimental white albinus rabbits and on clinical level among human patients for replacement of non-restorable maxillaryanterior and/or premolar teeth within esthetic zone by immediate implant. A written informed consent was obtained from all patients before their participation in this study.Patients were classified into two groups: the first one was with five patients with non-restorable maxillary anterior or premolar tooth that was treated by an immediately placed implant in conjunction with metallic substituted hydroxyapatite while the second one was treated by an immediately placed implant in conjunction with strontium ranelate as grafting material.The second sample population of study was carried out among ten male white (newzland) experimental rabbits with average body weight between 2.5 and 3 KG and within suitable environmental conditions in Medical Experimental Research Center (MERC) in faculty of medicine, Mansoura University. All rabbits sample was also divided equally and randomly in two groups with five rabbits within each one by the same criteria as mentioned where the first group was composed of five rabbits that received dental implant within intentionally made defect in tibia by trephine bur in conjunction with metallic substituted hydroxyl apatite as grafting material within gap between implant and defect and the second group was with the same criteria and procedures with strontium ranelategafting material within the defect. Pre-oparative photographs and cone beam computed topography (CBCT) were taken for study sample population. Within clinical patients, immediately paced dental implant have been placed in anterior esthetic zone with bone grafting around dental implant according to each group, Immediate CBCT and implant stability measurements has been taken after surgery followed by six months follow-up period to evaluate marginal bone loss, bone density, papillary esthetic score, implant stability and probing depth around dental implants. While within experimental animals trephine bur was used to intentionally create the bony defect that will simulate defect around immediate dental implant with grafting material around according to each group with six months follow-up to evaluate marginal bone loss, implant stability,bone density and for histological examination around implant within grafted area. All data were collected and statistically analyzed. Results:Generally among both clinical and experimental levels within both of clinical patients and experimental rabbits, metal substituted hydroxyl apatite (MSHAP) showed better results with significant difference than that presented in other group that has received Strontium ranelate (Sr) as a grafting material to fill the bony marginal gap around immediate dental implant during six months follow-up study period. Results presented high difference of significance between two groups in experimental and clinical levels in concern with both implant stability, marginal bone loss and even in bone quality and denisty when measured after six months follow-up. On the other hand there was no significant difference in concern with soft tissue response after six months in relation with peri-implant probing depth and MSHAP showed slight better results than that of Sr in records of papillary esthetic scores among clinical patients. Histological results showed better response of surrounding bony tissues towards MSHAP than that of Sr with more affinity of osteoblasts and osteocytes to the site of the grafted area. Conclusions:Metallic substituted hydroxyl-apatite (MSHAP) with its additive magnetic molecules within hydroxyapatite structure has better bony response from surrounding bony tissues than that provided by Strontium Ranelate (Sr) according to bone filling and preservation with less marginal loss, more affinity of new osteoblasts and mature osteocytes, long term implant stability after grafting and better bone density and quality at the grafted area around immediate dental implants in anterior maxillary area.

Effectiveness of the socket shield technique in dental implant: A systematic review.

Dental implant therapy is a common clinical treatment for missing teeth. However, the esthetic result is not as satisfactory as expected in some cases, especially in the anterior maxillary area. Poor esthetic results are caused by inadequate preparation of the hard and soft tissues in this area before treatment. The socket shield technique may be an alternative for a desirable esthetic outcome in dental implant treatments. In the present systematic review, PubMed-Medline, Google Scholar, and ScienceDirect were searched for clinical studies published from January 2000 to December 2018. Twenty studies were included, comprising one randomized controlled trial, two cohort studies, 14 clinical human case reports, and three retrospective case series. In total, 288 patients treated with the socket shield technique with immediate implant placement and follow-up between 3-60 months after placement were included. A quality assessment showed that 12 of the 20 included studies were of good quality. Twenty-six of the 274 (9.5%) cases developed complications or adverse effects related to the socket shield technique. Most studies reported implant survival without the complications (90.5%); most of the cases that were followed up for more than 12 months after implant placement achieved a good esthetic appearance. The failure rate was low without the complications, although there were some failures due to failed implant osseointegration, socket shield mobility and infection, socket shield exposure, socket shield migration, and apical root resorption. The socket shield technique can be used in dental implant treatment, but it remains difficult to predict the long-term success of this technique until high-quality evidence becomes available.

Non-Hodgkin Lymphoma Mimicking Endodontic Lesion: A Case Report with 3-dimensional Analysis, Segmentation, and Printing

Non-Hodgkin lymphoma (NHL) of the oral cavity can present with pain, swelling and radiolucent lesion mimicking endodontic diseases. This article reports on a case of diffuse large B-cell lymphoma initially diagnosed and treated as periodontal disease and then endodontic disease in the maxillary anterior and premolar area of a 40-year old female. A cone beam computed tomography (CBCT) image of the lesion was taken. The lesion was segmented using Mimics software (Materialise NV, Lueven, Belgium). Three-dimensional models of the tumor were printed. During the surgical phase teeth #4, 6, and 7 were extracted and biopsy samples were obtained. Histopathologic examination showed invasive sheets of large, atypical, basophilic cells strongly and diffusely positive for CD20. Three-dimensional analysis, segmentation, and printing of radiolucent lesions of the jaws assists with differential diagnosis and efficient treatment. Oral health professionals can play a crucial role in the early detection and diagnosis of oral NHL, thereby preventing extensive loss of function and esthetics, and even saving lives.

Comparison of the Effects Caused by Three Different Mandibular Advancement Devices on the Periodontal Ligaments and Teeth for the Treatment of Osa: A Finite Element Model Study

AIM: The purpose of this study is to compare the stress effects developed on the periodontal ligaments and teeth by three different types of mandibular advancement devices (MADs) using a finite element method (FEM) analysis. Introduction: Obstructive sleep apnea (OSA) is a disease with a high prevalence and, in recent years, the use of MADs as an alternative or support treatment to the continuous positive airway pressure (CPAP) has spread. Their use finds relative contraindications in the case of partial edentulism and severe periodontal disease. Given the widespread of periodontal problems, it is essential to know the effects that these devices cause on the periodontal ligament of the teeth. Materials and methods: Starting from the computed tomography (CT) scan of a patient’s skull, 3D reconstructions of the maxilla and mandible were implemented. Three different MADs were prepared for the patient, then 3D scanned, and lastly, coupled with the 3D models of the jaws. The devices have two different mechanics: One has a front reverse connecting rod (OrthoapneaTM), and two have lateral propulsion (SomnodentTM and HerbstTM). A FEM analysis was performed to calculate the stress applied on periodontal ligaments, on every single tooth and the displacement vectors that are generated by applying an advancement force on the mandible. Results: HerbstTM and SomnodentTM devices present very similar stress values, mainly concentrated on lateral teeth, but in general, the forces are very mild and distributed. The maximum stresses values are 3.27 kPa on periodontal ligaments and 287 kPa on teeth for SomnodentTM and 3.56 kPa on periodontal ligaments and 302 kPa on teeth for HerbstTM. OrthoapneaTM has, instead, higher and concentrated stress values, especially in the anterior maxillary and mandibular area with 4.26 kPa and 600 kPa as maximum stress values, respectively, on periodontal ligaments and teeth. Conclusions: From the results, it is concluded that devices with a bilateral mechanism generate less and more distributed stress than an anterior connecting rod mechanism. Therefore, they may be advisable to patients with compromised periodontal conditions in the anterior area.

RARE OCCURRENCE OF LOBULAR CAPILLARY HAEMANGIOMA IN MAXILLARY POSTERIOR SEGMENT INVOLVING THE ALVEOLAR MUCOSA

&#x0D; &#x0D; &#x0D; Pyogenic granuloma (PG) is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury or hormonal factors. PG is predominantly seen in the second decade of life in young adult females. PGs generally are soft, painless, and deep red to reddish-purple in colour. It shows a striking predilection for the maxillary anterior area. Also, the majority of PGs are found on the marginal gingiva with only 15% of the tumours on the alveolar part. There are two kinds of PG namely lobular capillary hemangioma (LCH type) and non-LCH type, which manifest as distinct entities and differ in many aspects. Although excisional surgery is the treatment of choice for it, some other treatment protocols such as the use of Nd:YAG laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection ofethanol or corticosteroid and sodium tetradecylsulfatesclerotherapy have been proposed. We hereby present a rare case report of lobular capillary hemangioma occurring in the maxillary posterior region. Also, contrary to its site specificity, it involved the attached gingiva and alveolar mucosa, thereby presenting a diagnostic dilemma. The various differences between the LCH and Non-LCH type PG are also discussed emphasising their different pathways of evolution.&#x0D; &#x0D; &#x0D; &#x0D;

Aesthetic aspects of adjacent maxillary single-crown implants—influence of zirconia and titanium as implant materials

The purpose of this retrospective survey was to assess the esthetic aspects of adjacent zirconia and titanium implants in the anterior maxillary area. A total of 40 patients and 109 adjacent implants (17 patients with 47 titanium implants and 23 patients with 62 zirconia implants) was included. The primary aim of this survey was to assess the papillary fill (Jemt score). Additionally, further esthetic aspects were assessed. Papillae were fully present (Jemt score 3) around 39.1% of adjacent zirconia implants and 17.4% of adjacent titanium implants (p<0.01). The papilla deficit was significantly higher 1.64 mm (SD 1.35) around titanium compared to zirconia implants 0.92 mm (SD 0.94, p<0.01). The evaluation of the soft tissue recessions revealed no differences between implant materials, whereas titanium implants presented more visible implant shadows (p<0.01). Zirconia implants had more implants with papillae that filled the entire proximal space compared to titanium implants. Furthermore, titanium implants had a greater frequency of visible implant shadowing than the zirconia implants. Esthetic rules such as the interdental contact area and golden percentage rules did not differ significantly between the titanium and zirconia implants.

COMPARATIVE STUDY BETWEEN TWO DIFFERENT TYPES OF ATTACHMENTS RETAINED IMPLANT MANDIBULAR OVER DENTUREON ON THE ANTERIOR MAXILLARY BONE RESORPTION

This study was conducted to evaluate and compare the effect of using two different types of attachments (Locator and ball); to retain implants mandibular over denture on the anterior maxillary bone resorption. Material and methods: Fourteen completely edentulous male patients with problematic existing mandibular dentures , received two implants in the canine region of the mandible. New maxillary complete dentures and mandibular overdentures were fabricated for all patients, following conventional clinical and laboratory techniques. Patients were divided randomly by closed envelops into two groups; Group I: Patients received implant retained overdenture by locator attachment, while Group II : patients received implant retained overdenture by ball attachment, four months after implant placement. Traced rotational tomograms were used for measurements of maxillary alveolar bone loss. The proportional value between bone areas and reference areas was expressed as a ratio R. Change in R for all patients were evaluated immediately before insertion overdenture (T0), and after two years (T2) later, and calculated for anterior maxillary area. Results: During the two years; the follow up period showed a significant decreasing change in R in the anterior maxillary area. group II (ball attachment) showed a significant change in R more anterior maxillary ridge resorption than group I (locator attachment) (P = 0.011). Conclusion : Within the limitation of this study and consideration of the small sample size, it could be concluded that; Ball attachments for implant retained mandibular overdentures are associated with more maxillary ridge resorption than locator attachments.

Esthetic and Physical Changes of Innovative Titanium Surface Properties Obtained with Laser Technology

Aim: The purpose of the study was the evaluation of the esthetic and physical changes produced on colored titanium Grade 5 (Ti6Al4V) laser treated surfaces to be used in implant dentistry for esthetic success. Materials and methods: Colored titanium surfaces were obtained with laser treatment. The physical and topographic properties were evaluated by stereo, light, and electron microscopy and profilometric analyses. L*a*b* colorimetric coordinates were measured by spectrometry, and the superficial chemical characteristics were evaluated by energy dispersive X-ray analysis. Results: Within the complete palette of titanium colors, pinks (P1-P2), incarnadine (I), and white (W) obtained by laser were selected. The topography, texture, hues, saturation, roughness, and porosity of the samples were compared with those of machined (M) and sand-blasted and etched (SBAE) control surfaces. P1, P2, and I, similar in hue and roughness (Ra ≅ 0.5 μm), had a microgroove spacing of 56 μm and a decreasing porosity. The W sample with a “checkerboard” texture and a light color (L* 96.31) was similar to the M samples (Ra = 0.32 μm), but different from SBAE (Ra = 1.41 μm, L* 65.47). Discussion: The aspects of hard and soft tissue could result in an esthetic failure of the dental implant by showing the dark color of the fixture or abutment. The two different pinks and incarnadine surfaces showed favorable esthetic and physical features to promote dental implant success even in the maxillary anterior area with gingival recession, asymmetry, and deficiency. Conclusion: Titanium colored laser surfaces represent a valid alternative to those currently traditionally obtained and interesting and potential perspectives in the management of dental implants’ esthetic failure.

Mapping of supernumerary elements in patients seeking orthodontic treatment

Introduction: Dimension, number and shape alterations are frequently observed dental anomalies. Objective: The aim of this study was to map the frequency, the preferred location and the most prevalent types of supernumerary teeth, in the studied population. In addition, to assess the interference that supernumeraryteeth may cause in the ectopic eruption of the normal dental series teeth. Methods: This is an observational retrospective study. Data collection was performed by evaluation of dental records of patients treated in an orthodontic clinic. Patients‘ radiographs, photographs and gypsum dental models were analyzed and datarecorded in protocol files, by previously trained undergraduate and postgraduate students. Records from 1984 to 2019 were evaluated, and evaluation lasted two months. Data were stored in Microsoft Office Excel (version 2016) for descriptive analysis. Results: From the 920 patients’ records analyzed, 2.7% presented atleast one supernumerary tooth, with preferred location on the anterior maxillary area and mandibular parapremolar area. The most prevalent type was the supplemental tooth, with normal eruption orientation and normal alveolar location. Conclusion: The supernumerary teeth of the studied population showedlittle interference in the ectopic eruption of the normal dental series. Most of the supernumerary teeth were impacted, and, approximately one third of the supernumerary teeth showed deviated eruptions.

Management Of Perforating External Cervical Root Resorption

Introduction: External cervical resorption (ECR) is the loss of dental hard tissue as a result of odontoclastic action; it usually begins on the cervical region of the root surface of the teeth. The etiology and predisposing factors are not very clear. The aim of this case report is to show the management of maxillary right canine diagnosed with ECR. Case Report: A 54-year old female patient was referred to our clinic with the history of dentin hypersensitivity in maxillary right anterior area. Radiographic examination revealed a radiolucent lesion located on the cervical third of maxillary right canine. The tooth was clinically asymptomatic. The patient did not report any traumatic history. CBCT scans revealed the extent of the resorption cavity and confirmed the diagnosis of the lesion. Due to perforation of the resorption into the root canal space, the access cavity was opened and temporarily occluded with a gutta-percha point. Then the surgical repair of the resorptive defect was carried out without blocking the root canal with filling material. A mucoperiosteal flap was elevated to clean the granulamatous tissue. The lesion was apparent after complete degranulation of soft tissue. It was repaired with MTA-Angelus (Angelus, Londrina, PR, Brazil) , a glass ionomer and a composite resin. The flap was replaced and sutured. Once the ECR cavity was restored, then endodontic treatment was completed in the same appointment. The root canal was obturated with gutta percha and root canal sealer by cold lateral condensation. . Conclusion: In the 9-month follow-up examination, the tooth including ECR defect was completely asymptomatic and functional. Early detection is necessary for successful management and outcome of ECR. CBCT should be considered for the assessment and/or management of ECR.

Clinical and Radiographic Outcomes of Immediate Implant Placement With or Without Nanocrystalline Bone Grafting Material in The Facial Gap Distance: A Randomized Clinical Trial

Objectives: The aim of this study was to evaluate the clinical and radiographic outcomes of the simultaneous use of nanocrystalline bone grafting material placed in the facial gap distance around immediate dental implants placed in the anterior maxilla and its effect for minimizing the crestal bone loss. Material and methods: Adult patients were eligible for the study if they needed one immediate implant placement (IIP) replacing a tooth to be extracted within the maxillary anterior region. The patients included in the study were divided into two groups; patients in the first group received IIP without grafting material in the gap distance while patients in the second group received IIP simultaneously with nanocrystalline bone in the facial gap distance. Clinical and radiographic assessments were performed before IIP (baseline) and scheduled 4 and 12 months after implant placement. Clinical assessment included bleeding Index (BI) and probing depth (PD). Facial bone height measurements were performed using cone beam computed tomography (CBCT) to measure the crestal bone loss.Results: The means of BI and PD values at the 12 months follow up indicated healthy peri-implant soft tissues for both groups, however higher means of BI and PD were shown in IIP without grafting material when compared to IIP with nanocrystalline bone in the facial gap distance. There was no statistically significant difference in CBL between both groups (p=0.924).Conclusions: The short-term follow-up of 12 months of IIP in the maxillary anterior area revealed successful clinical outcomes as assessed by objective parameters. IIP with or without simultaneous nanocrystalline bone grafting material placed in the facial gap distance around the implants did not prevent crestal bone loss as assessed by CBCT.

Long-Term (15 to 20 Years) Outcomes of Papillae Preservation Flap Surgery in Esthetic Areas.

Several techniques have been proposed to maintain full papillary form and preserve soft tissue during periodontal surgical access. However, very little evidence of long-term results is available. The aim of the present paper is to report the 15- to 20-year follow-up outcomes of a case series study of papillae preservation flap surgery in esthetic areas. Twenty-two patients (10 women, 12 men; mean age: 41.3 years) with moderate to advanced generalized periodontitis were included in this study carried out in a private office from 1994 to 1996. In each patient, nonsurgical therapy with scaling and root planing was performed. Following this initial phase of therapy and the periodontal re-evalutaion, a papillae preservation flap surgery was performed in the anterior maxillary area in each subject. Full-mouth Plaque Index (FMPI), Gingival Index (GI), full-mouth Bleeding Score (FMBS), probing depth (PD), bleeding on probing (BOP), clinical attachment level (CAL), gingival recession (GR), and papilla height (PH) were assessed at the baseline and at each year of the follow-up. GI and BOP decreased with a statistical difference after surgery (P < .05) and remained low over the entire observation period. At the end of the follow-up period, PD and CAL decreased significantly (P < .05) compared to baseline (PD from 7.18 ± 0.91 mm to 2.98 ± 0.49 mm; CAL from 8.06 ± 1.2 mm to 4.01 ± 0.28 mm). Gingival recession and papilla height did not change significantly after surgery compared to baseline (GR from 0.88 ± 0.42 mm to 0.92 ± 0.36 mm; PH from 5.6 ± 1.1 mm to 4.2 ± 0.8 mm) and remained stable over the 15 to 20 years of the study (GR = 1.12 ± 0.36 mm; PH = 4.9 ± 0.9 mm) (P > .05). Results of the present long-term study show that the papillae preservation flap procedure may be applied successfully to the treatment of periodontal pockets in the maxillary anterior region.

Ridge augmentation and implant placement on maxillary anterior area with deficient alveolar ridge : case report

Atrophic alveolar ridge of maxillary anterior area is commonly observed after the extraction of teeth in patients with severely compromised periodontal disease, causing difficulties with implant placement. Successful esthetics and functional implant rehabilitation rely on sufficient bone volume, adequate bone contours, and ideal implant positioning and angulation. The present case report categorized the ridge augmentation techniques using guided bone regeneration (GBR) on the maxillary anterior site by Seibert classification. Case I patient presented for implant placement in the position of tooth #11. The alveolar ridge was considered a Seibert classification I ridge defect. Simultaneous implant placement and GBR were performed. Eight months after implantation, clinical and radiological examinations were performed. Case III patient presented with discomfort due to mobility of the upper maxillary anterior site. Due to severe destruction of alveolar bone, teeth #11 and #12 were extracted. After three months, the alveolar ridge was considered a Seibert classification III ridge defect. A GBR procedure was performed; implantation was performed 6 months later. Approximately 1-year after implantation, clinical and radiological examinations were performed. During the whole treatment period, healing was uneventful without membrane exposure, severe swelling, or infection in all cases. Radiographic and clinical examinations revealed that atrophic hard tissues and buccal bone contour were restored to the acceptable levels for implant placement and esthetic restoration. In conclusion, severely resorbed alveolar ridge of the maxillary anterior area can be reconstructed with ridge augmentation using the GBR procedure so that dental implants could be successfully placed.

Evaluation of advanced-PRF with xenograft for obliteration of bone cavity in anterior maxillary region

Objective: was to evaluate the clinical outcomes of the use of Advanced-PRF with xenograft for obliteration of bone cavity in anterior maxillary region. Methods: this study included ten patients suffering from a cystic lesion in anterior maxillary area causing bony defect. Clinical examination was made to ensure the cases and to exclude any interfering maters. Radiographic examination was done preoperatively using digital panoramic x-ray and CT to ensure size will be of a critical size defect. Endodontic treatment for the corresponding teeth has been done before surgery. A-PRF has been prepared as soon before surgery to enucleate the lesion and apicectomy then xenograft block with A-PRF was put into the cavity. Follow up was done to evaluate clinical and radiographic progress. All reading was recorded and analyzed statistically. Results: The study showed an improvement in clinical features and bone density. Conclusion: The application graft with (A-PRF) is very effective in improving the healing process as well as decreasing the postoperative complication.

Soft tissue augmentation at immediate implants using a novel xenogeneic collagen matrix in conjunction with immediate provisional restorations: A prospective case series.

Collagen matrices used around immediate implants may reduce morbidity although there is limited evidence on their performance. To evaluate soft and hard tissue changes when combining immediate implants, hard and soft tissue grafting, and an immediate provisional restoration. In 12 patients, immediate implants were placed in the anterior maxillary and first premolar area together with a xenogeneic bone substitute. Then a xenogeneic collagen matrix was placed under the buccal mucosal margin with an immediate provisional restoration. Study casts and clinical measurements were taken before extraction (Baseline/BS) at 6 months (6M) and 12 months (1Y) after implant placement. Files from the scanned casts were matched to calculate the linear and volumetric changes at the buccal tissues. Cone Bean Computed Tomographies (CBCTs) were taken prior to extraction and at 6M. The superimposed DICOM files allowed for assessing hard tissue changes and the superimposition of DICOM and STL files allowed for evaluating of soft tissue thickness at BS and 6M. After 6 months, the horizontal tissue contours decreased 0.66 ± 0.57 mm, concomitant with a horizontal bone loss of 1.31 ± 1.32 mm, measured 1 mm below the most coronal aspect of the ridge. In contrast, the soft tissue thickness, 1 mm below the gingival margin, increased 0.75 ± 1.12 mm. At 1-year, tissue contours had decreased 1.01 ± 0.67 mm compared to BS reaching statistical significance. The mean volume loss after 1Y was 20.43 ± 11.70 mm3 while the mean mucosal margin recession was 0.86 ± 0.67 mm. These changes had a limited clinical impact as the PES Scores remained stable. The tested protocol resulted in a significant reduction of the tissue contours and osseous ridge dimensions that was partially compensated by a non-significant increase in soft tissue thickness.