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This case report describes a simple method for augmenting tissue at prospective palatal connective tissue donor sites. The patient was referred for treatment of facial marginal tissue recession on the maxillary left canine. Clinical... more
This case report describes a simple method for augmenting tissue at prospective palatal connective tissue donor sites. The patient was referred for treatment of facial marginal tissue recession on the maxillary left canine. Clinical examination indicated that the palatal mucosa was thin and did not provide an adequate volume of soft tissue for donor harvesting, precluding the use of a palatal connective tissue graft for treatment of the recession defect. Sterile lyophilized bovine collagen sponge was therefore surgically inserted between a full-thickness palatal flap and bone at the prospective donor site. Eight weeks postoperative, the augmented palatal donor area showed a significant clinical increase in thickness and volume and served as a connective tissue donor source in the treatment of the facial marginal tissue recession. Histologic analysis of the donor tissue demonstrated normal structure, fibrous connective tissue, and abundant collagen. Clinical examination 6 months following surgery showed complete root coverage, with tissue texture, volume, and color similar to those of the adjacent soft tissue. Healing of the donor site was uneventful. This case report demonstrates that sterile lyophilized collagen sponge material may be used to augment palatal donor connective tissue and can subsequently be used as a donor source for soft tissue grafting.
Research Interests: Dentistry, Medicine, Humans, Collagen, Pubmed, and 8 moreAnimals, Male, Connective tissue, Cattle, Adult, Mouth mucosa, Soft Tissue, and Gingival Recession
This article reports on a case of root resorption following a clinically successful root coverage procedure with a subepithelial connective tissue graft on a maxillary lateral incisor. Two years after the graft procedure was performed,... more
This article reports on a case of root resorption following a clinically successful root coverage procedure with a subepithelial connective tissue graft on a maxillary lateral incisor. Two years after the graft procedure was performed, the tooth was extracted in conjunction with the buccal attachment apparatus. Histologic examination of the specimen revealed signs of active resorption of the dentinal surface and bone formation in the deepest portion of the resorption cavity. Possible causative factors of the root resorption process are discussed.
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The unpredictability of current surgical procedures for papilla reconstruction has been a matter of concern for both periodontists and patients. This case report presents a complete papilla reconstruction in a 20-year-old woman using an... more
The unpredictability of current surgical procedures for papilla reconstruction has been a matter of concern for both periodontists and patients. This case report presents a complete papilla reconstruction in a 20-year-old woman using an interposed subepithelial connective tissue graft. The results show that this technique can be successfully used in treating the loss of papillae and achieving long-term stability. The objective of this report is to describe the surgical technique and comment on the factors that may have influenced the final result.
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Introduction: Defects caused by root resorption are often associated with a variety of idiopathic, external resorptions or perforations located at the mid‐third of the root surface. These defects can lead to gingival inflammation,... more
Introduction: Defects caused by root resorption are often associated with a variety of idiopathic, external resorptions or perforations located at the mid‐third of the root surface. These defects can lead to gingival inflammation, breakdown of periodontal fibers, bone resorption, and damage to the periodontal apparatus. Treatment protocols that preclude tooth extraction are important adjuncts toward an ultimate goal of tooth/root preservation. Although a number of materials have been proposed to repair root resorption defects, only a few have been effective in the long‐term management of subgingival defects.Case Presentation: This case report presents long‐term follow‐up of a subgingival, external root resorption lesion that was successfully treated with mineral trioxide aggregate (MTA) and a coronally advanced flap. At 30 months, the results revealed gain in clinical attachment, reduction in probing depth, additional bone formation, and, ultimately, preservation of the gingival margin and esthetic appearance of the tooth.Conclusion: The use of MTA appears to be a viable and effective material to treat subgingival root resorption defects while also preserving the function and esthetics of the natural dentition.
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The purpose of this study is to describe a modification in the apically repositioned flap technique. Unlike the original technique, this technique preserves the marginal gingiva thus avoiding the risk of recession. It is recommended in... more
The purpose of this study is to describe a modification in the apically repositioned flap technique. Unlike the original technique, this technique preserves the marginal gingiva thus avoiding the risk of recession. It is recommended in cases where an increase in attached gingiva is desired. This study reports on the results of 54 single buccal areas consecutively treated in 38 healthy patients. The increase in the amount of attached gingiva, the impact on marginal tissue recession, and the impact on probing depth were analyzed. All 54 areas were evaluated at 8 weeks; 21 areas were analyzed for 24 weeks; and 19 areas for a period of 72 weeks. The final measurements were compared to baseline values. The analysis of variance of measurement (ANOVA) shows a significant increase of keratinized and attached gingiva (P <0.001). There was no statistical change in marginal tissue recession (P = 0.370) or probing depth. The results of this study demonstrate that this modification of the apically repositioned flap is effective and efficient for increasing the height of attached gingiva. This surgical procedure produces minor surgical trauma and does not require palatal donor tissue or membrane placement. It is simpler since it is less time‐consuming, requires no suturing, and results in an ideal color match of tissue. J Periodontol 1999;70:1110‐1117.
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Se presenta en este articulo un caso de reabsorcion radicular tras un procedimiento de recubrimiento con injerto de tejido conjuntivo subepitelial de la raiz de un incisivo lateral superior, con un resultado clinico satisfactorio. Tras 2... more
Se presenta en este articulo un caso de reabsorcion radicular tras un procedimiento de recubrimiento con injerto de tejido conjuntivo subepitelial de la raiz de un incisivo lateral superior, con un resultado clinico satisfactorio. Tras 2 anos de la intervencion, se extrajo el diente junto con su periodonto vestibular. En el examen histologico, la muestra presento signos de reabsorcion activa de la superficie dentinaria, asi como formacion de hueso en la parte mas profunda de la cavidad de reabsorcion. Se discuten los posibles factores causantes del proceso de reabsorcion radicular.
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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... more
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 signifi...
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IntroductionAxenfeld‐Rieger syndrome (ARS), also known as Rieger syndrome, is a rare autosomal dominant condition defined by craniofacial, ocular, dental, periumbilical, and systemic anomalies.Case PresentationThis case report describes... more
IntroductionAxenfeld‐Rieger syndrome (ARS), also known as Rieger syndrome, is a rare autosomal dominant condition defined by craniofacial, ocular, dental, periumbilical, and systemic anomalies.Case PresentationThis 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 de...
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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... more
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.
Research Interests: Dentistry, Medicine, Recession, Humans, Female, and 7 morePubmed, Allografts, Tooth Root, Gingiva, Adult, Gingival Recession, and General Dentistry
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Research Interests: Dentistry, Medicine, Humans, Female, Follow-up studies, and 4 moreGingiva, Adult, Gingival Recession, and Surgical Flaps
Background: This case series reports on the effectiveness of the modified apically repositioned flap (MARF) in increasing the apico‐coronal dimension of attached gingiva over multiple adjacent teeth.Methods: The MARF surgical technique... more
Background: This case series reports on the effectiveness of the modified apically repositioned flap (MARF) in increasing the apico‐coronal dimension of attached gingiva over multiple adjacent teeth.Methods: The MARF surgical technique consists of a single horizontal incision within keratinized tissue, elevation of a split‐thickness flap, and suturing of the flap to the periosteum in an apical position. The periosteum is left exposed so that the full perimeter of the wound is surrounded by keratinized tissue. The nature of this wound healing leads to the formation of new keratinized and attached tissue in the area where periosteum is left exposed. A total of 37 areas in 33 systemically healthy patients were analyzed after treatment with the MARF technique. The treatment areas consisted of a minimum of two and a maximum of five adjacent teeth with a minimum of 0.5 mm and a maximum of 2.0 mm of attached gingiva on each tooth.Results: Treatment with MARF resulted in a significant increase in the apico‐coronal dimension of the keratinized tissue and attached gingiva (P <0.05). The increase in keratinized tissue ranged from 2.20 to 4.28 mm, and the increase in attached gingiva ranged from 1.0 to 3.14 mm. Gingival recession decreased significantly in the treated areas, but the difference was of little clinical significance. Probing depths in the treated areas did not change significantly compared to baseline values.Conclusions: MARF is an effective technique in increasing the apico‐coronal dimension of the keratinized tissue and attached gingiva. MARF offers considerable advantages over other mucogingival surgery techniques: simplicity, limited chair time for the patient and the operator, low morbidity because of the absence of palatal donor tissue, and a predictable tissue color match.
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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... more
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 ...
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Resumen en: Introduction: The cross infection control in dental office has received great attention from professionals and one of the critical points is the bacterio...
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Based on data from the authors' three clinical trials that focused on the role exerted by various regenerative materials and techniques in preserving alveolar ridge dimensions following tooth extraction, there is evidence to support... more
Based on data from the authors' three clinical trials that focused on the role exerted by various regenerative materials and techniques in preserving alveolar ridge dimensions following tooth extraction, there is evidence to support the use of nonresorbable and resorbable membranes in combination with a closed-socket approach. There also is evidence to support a higher predictability of the results with resorbable membranes compared with nonresorbable membranes because the latter can become exposed to the oral environment during healing. A combination of bioactive glass and calcium sulfate using an open-socket approach is of marginal benefit in preserving alveolar ridge dimensions following tooth extraction. More research is necessary on combining osseous graft/guided bone regeneration using a closed-socket approach, on assessing the quality of bone present in the previous extraction socket following various preservation techniques, and on how effectively preserved/regenerated b...
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This article describes a surgical technique directed at increasing the dimensions of attached gingiva over multiple adjacent teeth. The described technique is a variation of the modified apically repositioned flap (MARF) technique... more
This article describes a surgical technique directed at increasing the dimensions of attached gingiva over multiple adjacent teeth. The described technique is a variation of the modified apically repositioned flap (MARF) technique previously proposed. The MARF technique uses one single horizontal incision within keratinized tissue, elevation of a split-thickness flap, and suturing of the flap to the periosteum in an apical position. Periosteum is left exposed in the area between the initial horizontal incision and the coronal margin of the flap. The full perimeter of the exposed periosteal area is completely surrounded by keratinized tissue. Therefore, keratinized epithelial cells migrate over the periosteum during wound healing, resulting in the formation of keratinized attached tissue in the area of the previously exposed periosteum. The advantages associated with this surgical technique include its simplicity: It employs one single horizontal incision, generates minimal morbidity...
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This article reports on a case of root resorption following a clinically successful root coverage procedure with a subepithelial connective tissue graft on a maxillary lateral incisor. Two years after the graft procedure was performed,... more
This article reports on a case of root resorption following a clinically successful root coverage procedure with a subepithelial connective tissue graft on a maxillary lateral incisor. Two years after the graft procedure was performed, the tooth was extracted in conjunction with the buccal attachment apparatus. Histologic examination of the specimen revealed signs of active resorption of the dentinal surface and bone formation in the deepest portion of the resorption cavity. Possible causative factors of the root resorption process are discussed.
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Research Interests: Materials Science, Dentistry, Biomedical Engineering, Medicine, Case Report, and 15 moreHumans, Female, Prosthetic Dentistry, Male, Connective tissue, Maxilla, Middle Aged, Gingiva, Adult, Incisor, Dental Plaque Index, Gingival Recession, Keratins, Surgical Flaps, and Reconstructive Surgical Procedures
Background: Osseointegration has been shown to occur around implants placed immediately after tooth extraction in humans. To date, such osseointegration has been achieved only with titanium plasma-sprayed (TPS) implants placed in... more
Background: Osseointegration has been shown to occur around implants placed immediately after tooth extraction in humans. To date, such osseointegration has been achieved only with titanium plasma-sprayed (TPS) implants placed in extraction sockets ...
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Implant-supported restorations in the upper anterior segment need to meet biological, functional, and esthetic requirements to be successful. Bone availability and soft-tissue characteristics in the area of implant placement are crucial... more
Implant-supported restorations in the upper anterior segment need to meet biological, functional, and esthetic requirements to be successful. Bone availability and soft-tissue characteristics in the area of implant placement are crucial for achieving maximum success. This article describes the steps involved in replacing a fractured upper central incisor with an implant-supported crown. Using surgical techniques involving extraction socket preservation/augmentation and connective tissue grafting, ideal positioning of the implant was possible and gingival contours were idealized. With this multiple step treatment, the final restoration met biological and functional requirements and its esthetic results were maximized.
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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... more
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.
Research Interests: Dentistry, Humans, Female, Allografts, Tooth Root, and 4 moreGingiva, Adult, Gingival Recession, and General Dentistry
This case series reports on the effectiveness of the modified apically repositioned flap (MARF) in increasing the apico-coronal dimension of attached gingiva over multiple adjacent teeth. The MARF surgical technique consists of a single... more
This case series reports on the effectiveness of the modified apically repositioned flap (MARF) in increasing the apico-coronal dimension of attached gingiva over multiple adjacent teeth. The MARF surgical technique consists of a single horizontal incision within keratinized tissue, elevation of a split-thickness flap, and suturing of the flap to the periosteum in an apical position. The periosteum is left exposed so that the full perimeter of the wound is surrounded by keratinized tissue. The nature of this wound healing leads to the formation of new keratinized and attached tissue in the area where periosteum is left exposed. A total of 37 areas in 33 systemically healthy patients were analyzed after treatment with the MARF technique. The treatment areas consisted of a minimum of two and a maximum of five adjacent teeth with a minimum of 0.5 mm and a maximum of 2.0 mm of attached gingiva on each tooth. Treatment with MARF resulted in a significant increase in the apico-coronal dimension of the keratinized tissue and attached gingiva (P <0.05). The increase in keratinized tissue ranged from 2.20 to 4.28 mm, and the increase in attached gingiva ranged from 1.0 to 3.14 mm. Gingival recession decreased significantly in the treated areas, but the difference was of little clinical significance. Probing depths in the treated areas did not change significantly compared to baseline values. MARF is an effective technique in increasing the apico-coronal dimension of the keratinized tissue and attached gingiva. MARF offers considerable advantages over other mucogingival surgery techniques: simplicity, limited chair time for the patient and the operator, low morbidity because of the absence of palatal donor tissue, and a predictable tissue color match.
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Este caso clinico describe un metodo simple para aumentar el tejido en las futuras localizaciones donantes de tejido conjuntivo del paladar. El paciente fue referido para tratamiento de la recesion del tejido marginal vestibular del... more
Este caso clinico describe un metodo simple para aumentar el tejido en las futuras localizaciones donantes de tejido conjuntivo del paladar. El paciente fue referido para tratamiento de la recesion del tejido marginal vestibular del canino superior izquierdo. El examen clinico senalo que la mucosa palatina era delgada, y que no proporcionaba un volumen adecuado de tejido blando para la toma, lo que impedia el uso de un injerto conjuntivo del paladar para el tratamiento del efecto de recesion. Por tanto, se inserto quirugicamente una esponja de colageno bovino liofilizado esteril entre un colgajo palatino de espesor completo y el hueso, en la futura localizacion donante. Tras 8 semanas de la intervencion, la zona del paladar donde se habia realizado el aumento mostraba un incremento clinicamente significativo del grosor y el volumen, y sirvio como fuente donante de tejido conjuntivo para el tratamiento de la recesion del tejido marginal vestibular. El examen clinico despues de 6 mese...
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La naturaleza impredecible de los procedimietos quirurgicos actuales para la reconstruccion de la papila han sido objeto de interes tanto para los periodoncistas como para los pacientes. Este caso clinico presenta la reconstruccion... more
La naturaleza impredecible de los procedimietos quirurgicos actuales para la reconstruccion de la papila han sido objeto de interes tanto para los periodoncistas como para los pacientes. Este caso clinico presenta la reconstruccion completa de una papila en una mujer de 20 anos de edad, mediante la interposicion de un injerto de tejido conjuntivo subepitelial. Los resultados demuestran que esta tecnica puede ser empleada con exito para tratar la perdida de papilas y conseguir una estabilidad a largo plazo. El objetivo de este articulo es describir la tecnica quirurgica y comentar los factores que pueden haber influido en el resultado final.
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... more
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.
Research Interests: Dentistry, Humans, Female, Allografts, Tooth Root, and 4 moreGingiva, Adult, Gingival Recession, and General Dentistry
Implant-supported restorations in the upper anterior segment need to meet biological, functional, and esthetic requirements to be successful. Bone availability and soft-tissue characteristics in the area of implant placement are crucial... more
Implant-supported restorations in the upper anterior segment need to meet biological, functional, and esthetic requirements to be successful. Bone availability and soft-tissue characteristics in the area of implant placement are crucial for achieving maximum success. This article describes the steps involved in replacing a fractured upper central incisor with an implant-supported crown. Using surgical techniques involving extraction socket preservation/augmentation and connective tissue grafting, ideal positioning of the implant was possible and gingival contours were idealized. With this multiple step treatment, the final restoration met biological and functional requirements and its esthetic results were maximized.
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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... more
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.
Research Interests: Dentistry, Humans, Female, Allografts, Tooth Root, and 4 moreGingiva, Adult, Gingival Recession, and General Dentistry
Implant-supported restorations in the upper anterior segment need to meet biological, functional, and esthetic requirements to be successful. Bone availability and soft-tissue characteristics in the area of implant placement are crucial... more
Implant-supported restorations in the upper anterior segment need to meet biological, functional, and esthetic requirements to be successful. Bone availability and soft-tissue characteristics in the area of implant placement are crucial for achieving maximum success. This article describes the steps involved in replacing a fractured upper central incisor with an implant-supported crown. Using surgical techniques involving extraction socket preservation/augmentation and connective tissue grafting, ideal positioning of the implant was possible and gingival contours were idealized. With this multiple step treatment, the final restoration met biological and functional requirements and its esthetic results were maximized.
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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... more
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.
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É evidente que uma quantidade adequada de gengiva inserida ao redor dos dentes como forma de proteção ao periodonto marginal se torna essencial na promoção da saúde periodontal. Menos evidente, porém, é em relação à decisão profissional... more
É evidente que uma quantidade adequada de gengiva inserida ao redor dos dentes como forma de proteção ao periodonto marginal se torna essencial na promoção da saúde periodontal. Menos evidente, porém, é em relação à decisão profissional do que fazer diante da existência de uma faixa inadequada ou mesmo ausente de gengiva ceratinizada e inserida. Muita controvérsia existe a respeito da necessidade ou não de se aumentar a área de gengiva inserida, porém trabalhos de acompanhamento em longo prazo e recentes de analise do comportamento fisiológico gengival, mostraram a importância desta estrutura como forma de proteção e prevenção ao periodonto contra os efeitos dos hábitos diários, principalmente da alimentação e escovação, ou mesmo contra possíveis seqüelas causadas pelo tratamento profissional ao paciente. Vários procedimentos, que vão desde um simples, mas rigoroso controle de placa bacteriana a sofisticadas técnicas cirúrgicas, tem sido sugerido como forma de tratamento das áreas c...
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. A 38-year-old man concerned about the protrusion of his maxillary... more
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. 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),...