Flávia Sukekava

Root-Coverage Procedures for the Treatment of Localized Recession-Type Defects: A Cochrane Systematic Review

BACKGROUND The purpose of this review is to evaluate the effectiveness of different root-coverage procedures in the treatment of recession-type defects. METHODS The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for entries up to October 2008. There were no restrictions regarding publication status or the language of publication. Only clinical randomized controlled trials (RCTs) with a duration > or = 6 months that evaluated recession areas (Miller Class I or II > or = 3 mm) that were treated by means of periodontal plastic surgery procedures were included. RESULTS Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significantly greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTGs) compared to guided tissue regeneration (GTR) with bioabsorbable membranes (GTR bms). A significantly greater gain in keratinized tissue was found for enamel matrix protein compared to a coronally advanced flap (0.40 mm) and for SCTGs compared to GTR bms plus bone substitutes. Limited data exist on the changes of esthetic conditions as related to the opinions and preferences of patients for specific procedures. CONCLUSIONS SCTGs, coronally advanced flaps alone or associated with other biomaterial, and GTR may be used as root-coverage procedures for the treatment of localized recession-type defects. In cases where root coverage and gain in keratinized tissue are expected, the use of SCTGs seems to be more adequate.

Success and survival rates of narrow diameter implants made of titanium–zirconium alloy in the posterior region of the jaws – results from a 1‐year follow‐up

OBJECTIVE The aim of the present prospective clinical study was to evaluate and to compare the success and survival rates of narrow diameter implants made of titanium-zirconium alloy and commercially pure titanium. MATERIALS AND METHODS Forty-two healthy adult patients scheduled for implant-supported single restorations were included in the study. In each patient, a titanium-zirconium alloy (Test group) or a commercially pure titanium (Control group) narrow diameter implants was installed in the posterior regions of the jaws. After 8 weeks of healing, all metal-ceramic single crowns were adapted to the implants and the patients enrolled in a plaque control program. The survival and success rates of the implants and the success rate of the implant-supported prosthesis were evaluated following 1 year of loading. Furthermore, mobility (M), suppuration (S), clinical probing depth (CPD), and bleeding on probing (BoP) were measured around the implants at 6 weeks of healing (T1) and 12 months after loading (T2). RESULTS In T2, survival and success rates for both groups were 95.2%. The corresponding value for the success rate of the implant-supported prosthesis was 100% in both groups. The average CPD was the following: 2.29 (±0.52) and 2.59 (±0.52) (P < 0.05) in the Test and Control groups, respectively, at T1; and 3.0 mm (±0.74) and 3.07 mm (±0.90) (P > 0.05) in the Test and Control groups, respectively, at T2. There was no statistically significant difference between groups concerning about S, M, and BoP at T1 and T2 (P > 0.05). CONCLUSION The present study suggests that, in a short-term follow-up, narrow diameter implants made of either titanium-zirconium alloy or commercially pure titanium may be used to support single crowns in the posterior portions of the jaws.

Long-term outcomes from implants installed by using split-crest technique in posterior maxillae: 10 years of follow-up.

OBJECTIVE The aim of the present 10-year retrospective study was to evaluate the success and survival rates of narrow diameter implants (NDIs) placed in combination with a split-crest technique. MATERIALS AND METHODS Twenty-one healthy individuals who received prosthetic rehabilitation supported by narrow diameter implants (NDIs) installed in atrophic maxillary posterior areas immediately after split-crest procedure were included in the study. Six to eight weeks after implant placement, the prosthetic rehabilitations were delivered. Periapical radiographs were taken at the 6-month and 10-year time interval after implant loading to assess bone marginal level around the implants. In addition, survival and success indexes were also obtained at these time intervals. RESULTS Forty NDIs were placed in 21 patients. At the end of the 10-year follow-up period, seven patients had dropped out, two implants were lost, and nine prostheses presented some type of deficiency (ceramic fracture or retaining screw fracture). At the 10-year time interval, the implant survival rate was 97% and the success rate was 95%. The marginal bone loss at the 6-month and 10-year time intervals was, respectively, 0.47 (SD 0.91) mm and 1.93 (SD 0.93) mm. CONCLUSION Narrow diameter implants installed immediately after split-crest procedure may successfully support prosthetic rehabilitations after long-time intervals.

One‐year follow‐up of titanium/zirconium alloy X commercially pure titanium narrow‐diameter implants placed in the molar region of the mandible: a randomized controlled trial

OBJECTIVE To analyze marginal bone loss (MBL) and clinical parameters around narrow-diameter implants (NDIs - 3.3 mm) made of titanium/zirconium alloy (TiZr) in comparison with commercially pure titanium (cpTi) installed in the molar region of the mandible after 1 year in function. MATERIALS AND METHODS Ten patients participated in the study. A TiZr and a cpTi NDI were randomly installed in contralateral molar sites of the mandible of each patient in a split-mouth design. Eight weeks after healing, all metal-ceramic single crowns were adapted to the implants and patients were enrolled in a plaque control program. MBL at the mesial and distal aspects of the implants were evaluated by comparing periapical radiographs taken immediately after prosthesis installation (T1) and 1 year after loading (T2). Clinical probing depth, bleeding on probing, suppuration, visible plaque and implant mobility were evaluated to determine implant success and survival rates. RESULTS Mean MBL at the interproximal aspects of TiZr implant sites was 0.32 ± 0.27 mm, while at cpTi implant sites mean MBL was 0.35 ± 0.24 mm (P = 0.60). Both TiZr and cpTi NDIs presented 100% implant survival and success rates, with no significant differences in the clinical parameters studied (P > 0.05). CONCLUSION TiZr and cpTi NDIs presented similar outcomes after 1 year in function in the molar region of the mandible. The results suggest that TiZr and cpTi NDIs may be equally used to support single crowns in the posterior area of the mouth. However, further studies with longer follow-up periods are necessary to confirm these findings.

Early healing in alveolar sockets grafted with titanium granules. An experimental study in a dog model

The aim of the present study was to evaluate the effect of the placement of titanium granules in fresh extraction sockets on early bone formation. The mesial roots of the third maxillary premolars of five adult beagle dogs were removed. On one side of the maxilla (Test group) the fresh extraction socket was grafted with titanium granules, while the contra-lateral socket was left non-grafted (Control group). After 1 month of healing, the dogs were euthanized and biopsies were obtained. The healing tissues were described, and histometric measurements were performed to obtain the percentage area occupied by connective tissue, new mineralized bone, bone marrow, and biomaterial particles. After 1 month of healing the findings from the histological examination revealed the titanium graft to be well incorporated into the provisional connective tissue or newly formed woven bone. The histometric measurements showed, however, that less mineralized bone was formed in the Test group than in the Control group. The present study suggests that the use of titanium granules in fresh extraction sockets was conducive to new bone formation. The graft of titanium granules seems, however, to delay the early phase of the healing process.

Dynamics of soft tissue healing at implants and teeth: a study in a dog model

OBJECTIVE The aim of this study was to describe and to compare some characteristics of the soft tissue healing process around teeth and implants after flap surgery. MATERIAL AND METHODS Five adult beagle dogs had their third and fourth lower premolars extracted. After 3 months, four implants per dog were placed on the healed alveolar ridge and allowed to heal non-submerged during 3 months. After 3 months, four regions characterized by one implant and one adjacent tooth were identified in each dog. One region was randomly selected and soft tissue ressective flap surgery was performed at its buccal aspect. The remaining three regions were randomly treated in an identical manner, and the dogs were sacrificed to provide biopsies representing healing intervals of 1, 2, 4, and 12 weeks. The biopsies were prepared for histological and morphological analyses. RESULTS Morphometric and histometric analyses have shown that the gingival tissues surrounding teeth were completely healed after a 4-week interval. However, it took from 4 to 12 weeks for the peri-implant mucosa to heal completely. CONCLUSION The healing process around teeth and implants follows a similar sequence of events. Nevertheless, the complete process of healing and maturation of the peri-implant tissues takes longer than around teeth.