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Periodontic Surgery Articles
The Pontic-Shield: Partial Extraction Therapy for Implant Dentistry

The Pontic-Shield: Partial Extraction Therapy for Implant Dentistry
Augmentive ridge preservation techniques aim to manage the postextraction ridge. The partial extraction of teeth may better preserve the ridge form by maintaining the bundle bone-periodontal tissues and preserve the ridge beneath dentures or fixed prostheses. The socket-shield technique entails preparing a tooth root section simultaneous to immediate implant placement and has demonstrated histologic and clinical results contributory to esthetic implant treatment. A retrospective 10-patient case series treating 14 partial extraction sites demonstrates how a modification of the socket-shield technique can successfully develop pontic sites and preserve the ridge.

Author(s): Howard Gluckman, BDS, MChD;Maurice Salama, DMD;Jonathan Du Toit, BChD, Dipl Implantol, Dipl Oral Surg, MSc Dent
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The Socket-Shield Technique to Support the Buccofacial Tissues at Immediate Implant Placement

The Socket-Shield Technique to Support the Buccofacial Tissues at Immediate Implant Placement
Tooth loss and subsequent ridge collapse continue to burden restorative implant treatment. Careful management of the post-extraction tissues is needed to preserve the alveolar ridge. In-lieu of surgical augmentation to correct a ridge defect, the socket-shield technique offers a promising solution. As the root submergence technique retains the periodontal attachment and maintains the alveolar ridge for pontic site development, this case report demonstrates the hypothesis that retention of a prepared tooth root section as a socket-shield prevents the recession of tissues buccofacial to an immediately placed implant. The socket-shield technique is a highly promising addition to clinical implant dentistry and this case report is among the first to demonstrate the procedure in clinical practice with a 1-year follow up.

Author(s): Howard Gluckman, BDS, MChD;Maurice Salama, DMD;Jonathan Du Toit, BChD
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Ridge Preservation with Modified “Socket-Shield” Technique: A Methodological Case Series

Ridge Preservation with Modified “Socket-Shield” Technique: A Methodological Case Series
After tooth extraction, the alveolar bone undergoes a remodeling process, which leads to horizontal and vertical bone loss. These resorption processes complicate dental rehabilitation, particularly in connection with implants. Various methods of guided bone regeneration (GBR) have been described to retain the original dimension of the bone after extraction. Most procedures use filler materials and membranes to support the buccal plate and soft tissue, to stabilize the coagulum and to prevent epithelial ingrowth.

Author(s): Markus Glocker, Dr. Med. dent ; Thomas Attin; Patrick R. Schmidlin
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Post-Traumatic Treatment of Maxillary Incisors by Immediate Dentoalveolar Restoration with Long-Term Follow-Up

Post-Traumatic Treatment of Maxillary Incisors by Immediate Dentoalveolar Restoration with Long-Term Follow-Up
Replacing both missing maxillary interior teeth is particularly challenging, especially in compromised sockets. The case report describes the management of an 18-year-old female patient, who suffered avulsion of both maxillary central incisors at 7 years of age. The multidisciplinary implant technique, called Immediate Dentoalveolar Restoration (IDR), included extraction of the injured teeth and a single procedure for immediate implant placement and restoration of the compromised sockets after root fracture and peri-apical lesion development were detected during orthodontic treatment. Successful esthetic and functional outcomes and reestablishment of the alveolar process after bone reconstruction were observed during the 3-year follow-up period. The predictable esthetic outcomes and soft and hard tissue stability that can be achieved following IDR are demonstrated.

Author(s): José Carlos Martins da Rosa, DDS, MS;Ariadene Cristina Pertile de Oliveira Rosa, DDS, MSc; Carlos Eduardo Francishone, DDS, MSc, PhD; Mauricio de Almeida Cardoso, DDS, MSc, PhD; Ana Carolina Alonso, DDS; Leopoldino Capelozza Filho, DDS, MSc, PhD
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Guidelines for the Diagnosis and Treatment of Peri-Implant Disease

Guidelines for the Diagnosis and Treatment of Peri-Implant Disease
Although some risk factors of peri-implant disease are well defined, the lack of efficient and predictable approaches to treat peri-implantitis has created difficulty in the management of those complications. The aim of this review was the evaluate the reliability of the diagnosis methods and to provide a set of guidelines to treat peri-implant disease. A search of PubMed and a hand search of articles related to peri-implant diseases were conducted up to August 2013. A summary of the current methods for the diagnosis of peri-implantitis, its potential risk factors, and a flow chart to guide the clinical management of these conditions are presented.

Author(s): Miguel Padial-Molina, DDS, PhD; Fernando Suarez, DDS; Hector F. Rios, DDS, PhD; Pablo Galindo-Moreno, DDS, PhD; Hom-Lay Wong, DDS, MSD, PhD
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Biologic Width Adjacent to Loaded Implant with Machined and Rough Collars in the Dog

Biologic Width Adjacent to Loaded Implant with Machined and Rough Collars in the Dog
Dental implant surface technology has evolved from a relatively smooth machined implant surface for osseointegration to more roughened osteoconductive surfaces. Recent studies suggest that peri-implant soft tissue inflammation with progressive bone loss (ie peri-implantitis) is becoming a prevalent condition. One possibility that could explain sucha a finding is that more bacterial plaque forms on the roughened implant and abutment surfaces, which may result in the peri-implant inflammation if the soft tissues. This study compared 36 tissue-level implants with a machined transmucosal collar to 36 implants with a relatively roughened transmucosal surface in the dog. The results demonstrated that the connective tissue contact was similar between the two implant types but that the junctional epithelium and biologic width dimensions were greater around the implants with the machined collars...

Author(s): David L. Cochran, DDS, PhD; Marcel Obrecht, SDIS; Klaus Weber, PhD, MDV, MS; Michel Dard, DDS, PhD; Dieter Bosshardt, PhD; Frank L. Higginbottom, DDS; Thomas G. Wilson Jr., DDS; Archie A. Jones, DDS
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Restoration of Optimal Esthetics in Complex Clinical Situations

Restoration of Optimal Esthetics in Complex Clinical Situations
Patients often neglect or delay dental care for an extended time because of their negative experiences with and fear of dental treatments. This neglect may result in the advance of periodontitis with severe bone loss, a substantial number of missing teeth, and problems with the remaining teeth. Pre-existing malocculsion can aggravate this condition. This case report demonstrates an interdisciplinary strategic approach, in combination with the use of biologically grounded, clinically proven, and viable techniques and technologies to restore optimal esthetics and function in such complex cases.

Author(s): Tomohiro Ishikawa, DDS;Xavier Vela-Nebot, MD, DDS; Kenji Kida, DDS; Hidetada Moroi, DMD; Hajime Kitajima, DDS; Takahiro Ogawa, DDS, PhD
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Surgical Crown Lengthening in a Population With Human Immunodeficiency Virus: A Retrospective Analysis

Surgical Crown Lengthening in a Population With Human Immunodeficiency Virus: A Retrospective Analysis
This report investigates the outcome of CLS procedures performed at an urban dental school in a population of individuals with HIV. Specifically, this retrospective clinical analysis evaluates the healing response after crown lengthening surgery (CLS). Of the 21 patients with HIV examined after CLS, none had postoperative complications, such as delayed healing, infection, or prolonged bleeding. Variations in viral load, CD4 cell count, smoking, platelets, and neutrophils did not impact surgical healing. In addition, variations in medication regimens (highly active anti-retroviral therapy; on pro-tease inhibitors; no medications had an impact. The results of this retrospective analysis show the absence of postoperative complications after CLS in this population with HIV. Additional investigation into this area will help health care practitioners increase the range of surgical services provided to this group of patients.

Author(s): Monish Bhola, DDS, MSD;Shilpa Kolhatkar, Suzanne A. Mason, Ana Janic, Shaziya Haque and James R. Winkler
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Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis

Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis
The purpose of this study was to determine the relationship between patients with a history of periodontitis and development of cement-related peri-implant disease. Seventy-seven patients with 129 implants for this retrospective analysis were selected from completed implant cases that were scheduled for regular maintenance or had experienced mechanical or biological complications between years 2006 and 2011 in private practice. Implants with extracoronal residual cement and implants without cement remnants were analyzed.

Author(s): Tomas Linkevicius, DDS, Dip Pros, PhD;Algirdas Puisys; Egle Vindasiute; Laura Linkeviciene; Peteris Apse
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A Periodontal-Restorative Approach to Achieving an Esthetic Outcome in Worn Dentition

A Periodontal-Restorative Approach to Achieving an Esthetic Outcome in Worn Dentition
Esthetic dentistry demands more of clinicians than just simeple knowledge of tooth anatomy and the proper dimensions of teeth. Dentists must also know and understand the proper positions of the teeth in relation to the gingiva, the lips, and entire face. Esthetic measurements are not the only important factors. Other considerations need to include the patient's phonetics and function. A example of a situation where this knowledge and awareness is imperative is in the case of the worn dentition (eg, attrition, abrasion, etc). This article addresses a simple case of how a patients esthetics have been compromised as a result of erosion as well as parafunctional activity (toothbrush abrasion) and how the patient was eventually restored with an interdisciplinary approach between the restorative dentist and the periodontal surgeon.

Author(s): David Wong, DDS;Jerome Cha, DDS
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Combining Perio-Restorative Protocols to Maximize Function

Combining Perio-Restorative Protocols to Maximize Function
This article describes a team approach for periodontal and restorative treatment intended to produce a predictable, biologically sound outcome that preserves more supporting bone and restores carious and broken down teeth.

Author(s): Daniel J Melker, DDS;Lloyd M. Tucker, DMD, MSD; Howard M. Chasolen, DMD
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Periodontal Photo Essay

Periodontal Photo Essay
Dr. Daniel J. Melker presents a Periodontal Photo Essay. Question: Why do we barrel in furcations?

Author(s): Daniel J Melker, DDS
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Biologic Shaping

Biologic Shaping
Creating proper space for biologic width ensures that the new margin will not infringe upon the periodontal complex and reduces the likelihood for future inflammation.

Author(s): Daniel J Melker, DDS
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Coverage of Gingival Recession Defects Using Guided Tissue Regeneration With and Without Adjunctive Enamel Matrix Derivative in a Dog Model

Coverage of Gingival Recession Defects Using Guided Tissue Regeneration With and Without Adjunctive Enamel Matrix Derivative in a Dog Model
The results of the present investigation suggest that the adjunctive use of EMD with GTR promotes formation of new bone and cementum without root resorption in recession-type defects in dogs.

Author(s): Takahisa Fujita, DDS; Shigeki Yamamoto, DDS, PhD; Mikio Ota, DDS, PhD; Yoshihiro Shibukawa, DDS, PhD; Satoru Yamada, DDS, PhD
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Biologic Rationale of Esthetic Crown Lengthening Using Innovative Proportion Gauges

Biologic Rationale of Esthetic Crown Lengthening Using Innovative Proportion Gauges
Using a series of innovative measuring gauges, the ideal clinical crown length of a tooth as well as the proper occlusogingival placement of the interproximal papilla will be determined based on established, documented tooth proportion relationships.

Author(s): Paul Fletcher, DDS
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Peptide-Enhanced Bovine Xenograft to Treat Severe Defects

Peptide-Enhanced Bovine Xenograft to Treat Severe Defects
The following case studies highlight patients who presented with various severities of recession, and for whom periodontal plastic surgery was successfully completed without the use of the patient's palate as a donor site.

Author(s): David Wong, DDS;Steven Kendrick, DDS
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Periodontal Plastic Surgery - Predictable Root Coverage in the Mandibular Incisor Region

Periodontal Plastic Surgery - Predictable Root Coverage in the Mandibular Incisor Region
This article presents a detailed case report as well as other supporting cases demonstrating predictable root coverage utilizing a subepithelial connective tissue graft.

Author(s): David Wong, DDS
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Peri-Implant Tissue Response Following Connective Tissue and Bone Grafting in Conjunction with Immediate Single-Tooth Replacement in the Esthetic Zone

Peri-Implant Tissue Response Following Connective Tissue and Bone Grafting in Conjunction with Immediate Single-Tooth Replacement in the Esthetic Zone
The case series evaluated the peri-implant tissue response following extraction and immediate placement and restoration of an implant in conjunction with subepithelial connective tissue graft (SCTG) and bone grafting in the esthetic zone.

Author(s): Hirotaka Tsuda, DDS; Kitichai Rungcharassaeng, DDS, MS; Joseph Y. K. Kan, DDS, MS; Phillip Roe, DDS, MS; Jaime L. Lozada, DDS; Grenith Zimmerman, PhD
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Maximizing Esthetic Transformations Using a Closed Flap ErCr - YSGG Modality

Maximizing Esthetic Transformations Using a Closed Flap ErCr - YSGG Modality
The clinical study presented in this article demonstrates that, in selected cases, combining minimally invasive laser therapy with detailed restorative design and technique can satisfy the bioesthetic functional requirements.

Author(s): Hugh Flax, DDS, PC
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Alargamiento clínico coronal en la erupción pasiva alterada - aspectos diagnósticos y quirúrgicos para el logro estético y la estabilidad tisular

Alargamiento clínico coronal en la erupción pasiva alterada - aspectos diagnósticos y quirúrgicos para el logro estético y la estabilidad tisular
El siguiente articulo nos muestra de una manera completa cómo se llevan a cabo este tipo de decisiones fundamentadas en aspectos biológicos y estéticos.

Author(s): Alejandro James, DDS, MsD, FID; Tony Ponti, DDS; José L. Castellanos, DDS; Iñaki Gamborena, DMD, MSD, FID
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Clinical Realities - Papilla and Free Gingival Margin Preservation in Multiple-Tooth Extraction

Clinical Realities - Papilla and Free Gingival Margin Preservation in Multiple-Tooth Extraction
Bone atrophy is a natural response to tooth extraction, and anatomic and functional aberrations can be magnified when alveolar atrophy is accompanied by periodontitis, root fracture, radicular caries, apical processes, or endoperiodontal complications.

Author(s): Alejandro James, DDS, MsD, FID; Jose L. Castellanos, DDS
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Replacing the Natural Tooth System in the Esthetic Zone: Flapless Implant Placement and Simultaneos Restoration to Preserve Tissue Contours and Guarantee Esthetics

Replacing the Natural Tooth System in the Esthetic Zone: Flapless Implant Placement and Simultaneos Restoration to Preserve Tissue Contours and Guarantee Esthetics
Over the last decade, the number of cosmetic dental procedures performed in the general dental practice has increased steadily each year. Likewise, the use of dental implants as a tooth replacement options has become a more routine treatment alternative for patients missing teeth or requiring tooth removal.

Author(s): Paul S. Petrungaro, DDS
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Management of the Compromised Implant Site With Small-Diameter Implants

Management of the Compromised Implant Site With Small-Diameter Implants
The use of the ANEW titanium alloy implant for the treatment of compromised tooth-tooth spaces is a viable treatment option.

Author(s): Paul S. Petrungaro, DDS
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Unique Implant Technology for Immediate Provisional Restorations at Implant Placement

Unique Implant Technology for Immediate Provisional Restorations at Implant Placement
To achieve adequate bone regeneration and implant stability, external forces that cause micro- or macro movement to the bone graft and implants had to carefully eliminated.

Author(s): Paul S. Petrungaro, DDS
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Lip Repositioning for Reduction of Excessive Gingival Display: A Clinical Report

Lip Repositioning for Reduction of Excessive Gingival Display: A Clinical Report
This case report demonstrates the successful management of excessive gingival display with a lip-repositioning procedure.

Author(s): Ari Rosenblatt, DMD, DDS; Ziv Simon, DMD, MSc
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Healing of Gingival Recessions Using a Collagen Membrane with a Demineralized Xenograft

Healing of Gingival Recessions Using a Collagen Membrane with a Demineralized Xenograft
A Randomized Controlled Clinical Trial

Author(s): Daniele Cardaropoli, DDS
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Alveolar Ridge Preservation and Reconstruction

Alveolar Ridge Preservation and Reconstruction
Periodontal plastic surgery procedures designed to reconstruct deformed, partially edentulous residual ridges were introduced to the dental profession between 1971 and 1986. They have been revised and refined to their current state of development, where they now occupy a major place in the reconstructive armamentarium. Before these concepts were developed, it was generally believed that it was impossible to surgically reconstruct deformities in the partially edentulous ridge. Deformities were filled…

Author(s): Henry Salama, DMD;Jay S. Seibert
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The Aesthetic Smile: Diagnosis and Treatment

The Aesthetic Smile: Diagnosis and Treatment
Until recently, dentists' and the public's concept of dental aesthetics was necessarily limited to alterations of the teeth themselves. Dentists concerned themselves with changing the position, the shape and the color of the teeth -basically restoring missing units or enhancing those already present. For the most part the dentist was forced to accept the pre-existing relationship between the three components of the smile; the teeth, the gingival scaffold and the lips.

Author(s): Maurice Salama, DMD;David Garber, DMD
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