Implant failure can be divided into early (prior to prosthetic treatment) or late (after prosthetic rehabilitation). Early failure is generally due to interference in the healing process after implant placement. Implants undergoing early failure will show progressive bone loss on radiographs during the healing period (4 to 6 weeks). In the present case report, early progressive bone loss was seen at 6 weeks, after placement of a non-submerged single piece mini implant. Clinical examination revealed peri-implant bleeding on probing and pocket and grade-1 mobility. Treatment protocol included mechanical debridement (plastic curettes), chemical detoxification with supersaturated solution of citric acid, antibiotics and guided bone regeneration therapy using the collagen membrane as guided bone regeneration barrier in combination with bioactive glass as bone grafting material. The 6 month postoperative examination showed complete resolution of the osseous defect, thus suggesting that this technique may hold promise in the treatment of implants undergoing early failure.
Various etiological factors are associated with gingival recession which may be anatomical, physiologic, or pathologic factors. Several root coverage procedures have been described to manage the gingival recession. However, it has been found that root coverage procedures in Miller's Class III and IV gingival recession have a poor prognosis with current techniques. A newer predictable technique, pedicled buccal fat pad (PBFP) has been introduced in cases of severe gingival recession. The buccal fat pad (BFP) is a specialized capsulated fat tissue that has the property of maintaining its volume and structure over a long period of time. It can also serve as a well vascularized, readily obtainable local flap for reconstructive purposes and increasing the dimensions of keratinized mucosa. The aim of this case report is to establish a new technique for root coverage using pedicled BFP in Miller Class IV recession on the maxillary right first molar.
The aim of the our study was to assess the efficacy of autogenous tooth root as block bone graft in reconstructing the vertical and horizontal dimensions at periodontally hopeless extraction sites both clinically and radiographically. Methods: A total of 13 patients having a tooth with periodontally hopeless prognosis indicated for extraction were included in the study. Following atraumatic extraction the tooth was processed to create a decoronated cementum free dentin block which was used to augment the extraction socket. Results: The augmentation of periodontally hopeless socket with tooth block autograft resulted in gain of clinical ridge width of 5.9mm radiographically, apico-coronal defect depth reduced upto 8.2 mm (p 0.001) and gain in ridge width of 5.8 mm post-operatively after 6 months (p 0.001). Conclusion: The present study demonstrated the effectiveness of using tooth root as a block graft for ridge augmentation in the periodontally hopeless extraction site making it suitable for implant placement in future.
Introduction
Numerous techniques have been reported in the literature for the reconstruction of gingival recession defects. The purpose of this case series was to evaluate clinically and radiographically the efficacy of sticky bone with i‐PRF‐coated collagen membrane in the treatment of gingival recession.
Case Series
Sixteen patients exhibiting isolated Miller's Class I or II recession in the maxillary esthetic zone were treated using sticky bone (i‐PRF + freeze‐dried bone allograft) with i‐PRF‐coated collagen membrane using the coronally advanced flap. Clinical parameters including probing depth (PD), width of keratinized gingiva (WKG), gingival thickness (GT), and recession depth (RD) were recorded at baseline and 6 months post‐surgery. The radiographic (ST‐CBCT) measurements computed were labial plate thickness (OT1, OT3, and OT5) and GT (GT1, GT3, and GT5) at baseline and 6 months post‐treatment. Twelve out of sixteen treated cases achieved complete root coverage. An increase in GT was observed in all the cases.
Conclusions
Within the limitations of this case series, sticky bone with i‐PRF‐coated collagen membrane showed promising results in the treatment of isolated maxillary Miller's Class I or II gingival recession and serves as an altered approach for root coverage procedure. However, histological analysis and larger sample size are needed to establish definitive proof of soft and hard tissue regeneration.
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