Fabio Mazzocco

Coronally Advanced Flap Combined With a Subepithelial Connective Tissue Graft Using Full- or Partial-Thickness Flap Reflection

BACKGROUND Although the use of a subepithelial connective tissue graft (SCTG) in conjunction with a coronally advanced flap (CAF) is a widely performed periodontal procedure, the creation of a partial-thickness flap can incur a risk of perforation or overthinning of the flap itself. Therefore, the aim of the present trial is to compare the efficacies of partial- and full-thickness flap reflections combined with an SCTG. METHODS Twenty patients with Miller Class I or II defects (52 teeth) were selected, and teeth with defects were randomly assigned to the test group (25 teeth) for a CAF and SCTG using a full-thickness flap reflection or to the control group (27 teeth) for a CAF associated with an SCTG and partial-thickness flap reflection. The probing depth (PD), gingival recession (GR), and width of the keratinized tissue (KT) were assessed at baseline and 6 months after surgery. RESULTS The mean root coverage was 97% in the test group (mean reduction in GR: 2.27 ± 1.15 mm) and 95% in the control group (mean reduction in GR: 1.68 ± 0.74 mm). The gain in KT was 0.46 ± 1.47 mm in the test group and 0.49 ± 1.3 mm in the control group, the PD ranged from 1.33 to 1.55 mm in the test group and from 1.31 to 1.64 mm in the control group; no statistically significant difference was found between the two groups for all of these parameters (P >0.05). CONCLUSIONS The elevation of a full- or partial-thickness flap did not appear to influence the amount of KT or the percentage of root coverage achieved post-surgically. More expanded studies are needed to confirm the present findings.

Three-Dimensional Volume Change of Grafted Bone in the Maxillary Sinus

PURPOSE The purpose of this study was to evaluate the three-dimensional radiographic changes of 100% anorganic bovine bone xenograft volume in a grafted maxillary sinus, based on a computerized analysis of cone-beam computed tomography (CBCT) scan. MATERIALS AND METHODS A maxillary sinus augmentation procedure done with a lateral approach using 100% anorganic bovine bone was performed in 20 patients. A CBCT scan of the grafted area was taken immediately after the procedure (T1) and 8 to 9 months later (T2). CBCT scan data were analyzed with image processing software to evaluate differences in the volume of grafted material between T1 and T2. Residual ridge height and width were also measured at T1. RESULTS The mean residual bone height and width at the implant sites was 4.40±0.87 mm and 7.9±2.22 mm, respectively. The mean graft volume was 1,432±539 mm³ and 1,287±498 mm³ at T1 and T2, respectively. A significant difference in graft volume was found between T1 and T2 data by paired t test (P=.01). The mean ratio between the volume at T2 and the volume at T1 was 0.90±0.12, meaning a graft volume contraction of 10%. CONCLUSION Within the limits of the present investigation, good stability of anorganic bovine bone graft volume up to 8 months after the grafting procedure was demonstrated. Three-dimensional computed tomographic volumetric assessment seems to be a promising approach to quantify long-term changes in the regenerated area.

Clinical Periodontal Response to Anterior All-Ceramic Crowns with Either Chamfer or Feather-edge Subgingival Tooth Preparations: Six-Month Results and Patient Perception.

Subgingival margins are often required for biologic, mechanical, or esthetic reasons. Several investigations have demonstrated that their use is associated with adverse periodontal reactions, such as inflammation or recession. The purpose of this prospective randomized clinical study was to determine if two different subgingival margin designs influence the periodontal parameters and patient perception. Deep chamfer and feather-edge preparations were compared on 58 patients with 6 months follow-up. Statistically significant differences were present for bleeding on probing, gingival recession, and patient satisfaction. Feather-edge preparation was associated with increased bleeding on probing and deep chamfer with increased recession; improved patient comfort was registered with chamfer margin design. Subgingival margins are technique sensitive, especially when feather-edge design is selected. This margin design may facilitate soft tissue stability but can expose the patient to an increased risk of gingival inflammation.

Human Histologic Evaluation of Root Coverage Obtained with Connective Tissue Graft Over a Compomer Restoration

This investigation was designed to evaluate the histologic healing pattern of two Miller Class III recession defects associated with noncarious cervical lesions (NCCLs) treated with a connective tissue graft (CTG) and coronally advance flap (CAF). One patient presenting with two teeth predetermined to be surgically extracted was enrolled and consented to treatment. One month after phase I treatment, a full-thickness flap was reflected and the NCCLs treated with a compomer restoration; at the same time, a CTG was harvested from the palate and positioned over the compomer restoration. The flap was then coronally repositioned. After 4 months of healing, an en bloc biopsy extraction of the two teeth was executed. The teeth were analyzed histologically to assess the periodontal wound healing. A long junctional epithelial attachment was noted throughout the major portion of the restored surface. Only minimal signs of connective adhesion and new bone formation could be seen in the apical portion of the restored area, without signs of root resorption or ankylosis. This report provides evidence that the presence of a compomer restoration allowed the formation of a long juctional epithelium after CTG and CAF treatment.