3.8.23 John Mazz_ Flashcards
Compare narrow - and regular-diameter implants in the posterior region (de Souza study COIR)
de Souza COIR
22 pts - RCT split-mouth
Compared 3.3 vs. 4.1 mm diameter implants placed into the maxilla or mandible posterior regions.
Findings: NSSD in MBL between groups
Implant success = 95% for 3.3 and 100% for 4.1
Dr Wang says the implant platforms were “the same” (essentially 4.5), so that’s why there was no difference between groups.
Describe the Buccally Displaced Palatal (BDP) Flap
Testori IJPRD
10 patients - fully edentulous maxilla and shallow vestibule depth, and minimal buccal KT (< 2mm)
Aim: Investigate the effectiveness of Buccally Displaced Palatal (BDP) flap technique to augment soft tissue volume and AKM for the improvement of peri-implant parameters at 6 and 12mo.
Usually, when creating KT width - aim for at least 3mm, to account for 1mm disappearance. -Dr. wang
Surgical technique:
* Longitudinal palatal incision across length of maxilla.
* Depends on buccal AKM present
* Allows for 5-6mm of palatal AKM to be displaced buccally
* Three releasing incisions made (medial, buccal, distal) to the MGJ
* Perform apical deepening in the fornix area until correct depth is achieved
* Perform muscle release to expose periosteum that can be used to secure CTG
* Place healing abutments
* Perform CTG in cases that require increased soft tissue width on the buccal
* Add L-PRF membranes in areas of 2nd intention healing (around implants and across ridge crest)
* Suture using resorbable sutures and horizontal mattress design
* Initiate prosthesis fabrication at 2 months post-op
Results:
BDP flap technique achieved healthy peri-implant soft tissues after 1 year (low mPIs, shallow PPD, reduced mBI sites)
BDP provided substantial dimensional stability of vestibular soft tissues
BDP allows for the reestablishment of correct fornix depth favoring home-care hygiene success
How effective is Autogenous Tooth-derived Mineralized Dentin Matrix for Alveolar ridge preservation?
Isola IJPRD
14 patients, Split-mouth randomized groups
* DDM + FGG (test)
* Spontaneous healing + FGG (control)
Aim: To evaluate histologic and clinical healing outcomes of a surgical protocol that combined DDM and FGG for alveolar ridge preservation prior to implant placement.
Histology had SSD: Test group had 4% more % vital bone, compared to the control group. Dr. Wang says - this is very unusual because usually, the control group is the best % vital bone due to no foreign body reaction.
Describe the Regenerative Treatment of Advanced Peri-implantitis: Retrospective case series with 3-15 year followup.
Froum IJPRD
46 implants with advanced peri-implantitis in 38 patients were included.
According to Froum’s 2012 classification, Advanced Peri-implantitis = PD > 8mm, BOP +/- suppuration, radiographic bone loss >50% of implant length
Aim: Investigate the clinical parameter changes following treatment of advanced peri-implantitis lesions over 3-15 years
Surgical approach:
* Flap access with reverse bevel incision
* Mechanical debridement of inner flap to remove inflamed soft tissue
* Surface treatment: Mechanical debridement with titanium curettes and brushes; Chemical decontamination with minocycline, saline, glycine air abrasion, saline, 50% citric acid solution, sterile water.
* NOTE: photo showed super overfilled bone graft (“kitchen sink technique” - super overfill with BioOss)
* rhPDGF-BB application
* Bone grafting with 3:1 FDBA:DBBM
* Membrane coverage with Bio-Guide collagen membrane stabilized by tacks or resorbable sutures
* Subepithelial CT graft placed if KT< 2mm
* Amoxicillin Rx for 1wk post op
Findings:
Avg PD reduction: 6.7 ± 1.6mm
Soft tissue level: 0.9 ± 1.8mm
Sites with BOP: 46 –> 4 sites
Avg RB gain: 3.6 ± 2.4mm
Avg clinical bone gain: 6.8 ± 1.6mm
Implant survival: 100%
What study compared a CAF and CT graft with or without EMD for gingival recession treatment: Systematic Review & Meta-Analysis of RCT’s?
Carvelli IJPRD
9 studies included in the Systematic Review & Meta-Analysis
P: Patients with mid-buccal gingival recessions
I: CAF+CTG+EMD treatment
C: CAF+CTG treatment
O: Amount of root coverage (in
millimeters)
Only 9 studies included.
All types of recession defects: SSD.
Subanalyses:
Miller I and II - NSSD for adding EMD
Miller III and IV - SSD for adding EMD
Conclusion: This SR supports the additional benefit of EMD in the amount of root coverage achieved when using EMD+CAF+CTG compared to CAF+CTG alone.
poor quality studies - lots of heterogenicity, no blinding, only English studies included
What study looked at the combined periodontal and orthodontic treatment of severely compromised teeth in Stage IV periodontitis patients?
Aimetti IJPRD
Retrospective study - 40 Stage IV periodontitis patients.
Investigate clinical and radiographic effects of perio + ortho treatment in patients with advanced periodontitis and pathologically migrated teeth
Conclusions:
In conjunction with traditional periodontal therapy and maintenance, OTM is an effective adjunct to re-establish function and esthetics in Stage IV periodontitis patients.
OTM does not significantly improve periodontal parameters but allows for effective maintenance over long time spans.
OTM significantly improves patient satisfaction with esthetics and function following comprehensive periodontal therapy.
What study was a prospective RCT comparing the VISTA vs. Sulcular Tunnel accesses for root coverage?
Geisinger IJPRD
RCT - 9 patients with 29 recessions (either Miller I or II) with only 6 month followup. (Too short followup for soft tissue)
Aim: to compare clinical and patient-centered outcomes of Miller Class I and II gingival recession defects treated with acellular dermal matrix (ADM) grafts and either vestibular incision subperiosteal tunneling access (VISTA) or sulcular tunnel access (STA) techniques.
VISTA technique: (Dr Wang says it is more of a VISTA suturing technique, not a true VISTA):
* A vestibular incision extended to include all involved teeth in the treated surgical site.
* Simple interrupted sutures placed horizontally at the mucogingival junction to allow for coronal fixation of the flap.
* Acellular dermal matrix was inserted into the vestibular access and sutured at the mesial and distal ends of the overlying flap.
* The vestibular incision sutures and suspensory sutures bonded to the buccal aspects of the treated teeth to allow for coronal flap and graft advancement.
Sulcular tunnel access (STA) technique:
* Intrasulcular incisions (teeth to be treated and on one tooth beyond the affected teeth)
* Sharp and blunt dissection to create a continuous pouch. (c)
* Acellular dermal matrix (ADM) within the pouch sutures
* Coronal advancement with sling sutures
Findings:
Mean root coverage was 74.4% and 75.2% for VISTA and STA, respectively, at 6 months =
NSSD between the groups
What is the Periosteum Classification and Flap Advancement techniques around the Mental Foramen?
Urban IJPRD
Aim: Highlight anatomical considerations around the mental foramen and propose new tissue classification to inform surgical technique for buccal flap advancement.
Periosteum classifications:
* Class I : Native periosteum.
* Class II: Mildly fibrotic periosteum with presence of scar tissue
* Class III: Thick, fibrotic, “stone-like” periosteum with pronounced scarring and foreign substances embedded.
Techniques:
Class I: Easy. Periosteal scoring incision + periosteo-elastic technique (separation of elastic fibers)
* Periosteal scoring incision (PSI) made < 1mm deep apical to MGJ, extending from mesial to distal of the flap
* Debundling of subperiosteal elastic fibers by turning blade 45-90º to the incision and brushing
* Another PSI can be made 3mm coronal to the initial PSI if more release is necessary.
Class II:
* PSI made to variable depth based on scar tissue thickness
* Periosteoplasty may be required in areas of very thick fibrotic periosteum in areas away from the MF
* Debundling of subperiosteal elastic fibers achieved by turning blade 45-90º to the incision and brushing
* Another PSI can be made 3mm coronal to the initial PSI if more release is necessary.
* Elastic separation by stretching the flap coronally
Class III technique:
* Multiple PSI’s can be made to variable depth based on scar tissue thickness
* Periosteoplasty will be required to remove fibrotic periosteum with embedded foreign material
* PSI’s and excision of foreign material should only be done in areas >3mm coronal to the MF
* Debundling and release of elastic fibers can be achieved similarly to Class I and II flaps once sufficient PSI’s are completed and thick fibrous tissue and foreign bodies are removed.
Dr Urban uses 15 (not 15c) blades for this technique. 15 is wider and better for spreading the tissues.
