Ilan Beitlitum

Clinical evaluation of particulate allogeneic with and without autogenous bone grafts and resorbable collagen membranes for bone augmentation of atrophic alveolar ridges

OBJECTIVES The evaluate the clinical outcome of bone augmentation with the use of particulate mineralized freeze-dried bone allograft (FDBA) with or without the addition of autogeneous bone chips, applied in a bi-layered (BL) technique, covered by a resorbable cross-linked collagen membrane. MATERIAL AND METHODS Fifty patients presenting with a vertical and/or lateral ridge deficiency of at least 3 mm were included: Group FDBA, N=27 patients, particulate FDBA was the only graft; and Group BL, N=23 patients, a BL bone grafting procedure where autogenous bone chips were the inner layer and FDBA the outer. Bone graft was covered with a ribose cross-linked collagen barrier membrane. Ridge dimensions were clinically or radiographically (computerized tomography scan) measured at the time of the bone augmentation procedure and at implant placement or uncovering and the maximum linear vertical or horizontal calcified tissue gain was calculated. Statistical analysis consisted of linear regression analysis, with maximum bone gain being the dependent variable. RESULTS In the FDBA group, mean vertical bone gain was 3.47 mm (SD 1.25) and the horizontal, 5 mm (SD 1.28), while in the BL values were 3.5 mm (SD 1.2) and 3.6 mm (SD 1.72), respectively. Addition of autogenous bone does not appear to statistically significantly enhance the results. Spontaneous membrane exposure occurred in 24% of the cases and was the only variant that significantly influenced results (P<0.001). CONCLUSIONS Large vertical and/or horizontal ridge deficiencies may be treated with FDBA and ribose cross-linked collagen barrier membranes with good clinical outcome. No added effect of the application of a layer of autogenous bone in these bone augmentation procedures could be demonstrated. Spontaneous membrane exposure was the only parameter to affect the degree of new calcified tissue formation.

The Diagnostic Efficacy of Cone-beam Computed Tomography in Endodontics: A Systematic Review and Analysis by a Hierarchical Model of Efficacy

INTRODUCTION The aim of this study was to evaluate the diagnostic efficacy of cone-beam computed tomographic (CBCT) imaging in endodontics based on a systematic search and analysis of the literature using an efficacy model. METHODS A systematic search of the literature was performed to identify studies evaluating the use of CBCT imaging in endodontics. The identified studies were subjected to strict inclusion criteria followed by an analysis using a hierarchical model of efficacy (model) designed for appraisal of the literature on the levels of efficacy of a diagnostic imaging modality. RESULTS Initially, 485 possible relevant articles were identified. After title and abstract screening and a full-text evaluation, 58 articles (12%) that met the inclusion criteria were analyzed and allocated to levels of efficacy. Most eligible articles (n = 52, 90%) evaluated technical characteristics or the accuracy of CBCT imaging, which was defined in this model as low levels of efficacy. Only 6 articles (10%) proclaimed to evaluate the efficacy of CBCT imaging to support the practitioners decision making; treatment planning; and, ultimately, the treatment outcome, which was defined as higher levels of efficacy. CONCLUSIONS The expected ultimate benefit of CBCT imaging to the endodontic patient as evaluated by its level of diagnostic efficacy is unclear and is mainly limited to its technical and diagnostic accuracy efficacies. Even for these low levels of efficacy, current knowledge is limited. Therefore, a cautious and rational approach is advised when considering CBCT imaging for endodontic purposes.

Treatment Alternatives for the Preservation of Vertically Root Fractured Teeth

When a vertical root fracture (VRF) is diagnosed in an endodontically treated tooth, in most cases, extraction of the VRF tooth or root is still the treatment of choice. However, in certain cases, modern endodontics provides new treatment alternatives to treat and maintain some VRF teeth. The dilemma of whether to extract a VRF tooth and replace it with an implant or to adopt a more conservative treatment planning of an additional endodontic treatment aimed to preserve the natural tooth is complex and requires a multifactorial clinical decision-making process. This process should encapsulate endodontic, prosthetic, periodontal, and esthetic considerations as well as take into account patient values. Treatment options for VRF teeth vary from a simple root amputation in multirooted teeth to a complex surgical management in order to retain a fractured tooth.

Evaluation of a topical herbal patch for soft tissue wound healing: an animal study.

Abstract Aim This study evaluated the effects of a topical herbal patch (PerioPatch®) for gingival wound healing in a rat model. Materials and Methods A mid‐crestal incision was performed on each side of the edentulous anterior maxilla in 48, 6‐month‐old, Wistar rats. Full‐thickness flaps were raised, repositioned and sutured. Four experimental groups were established: herbal patch, placebo patch, no patch and no patch and no surgery. Patches were placed immediately after surgery and replaced every 12 h for the following 3 days. Half of the animals were killed after 5 and the remaining ones after 12 days. Tissue blocks were retrieved and processed for histological and immunohistochemical evaluation. Epithelial gap, collagen contents, amount of macrophages, cellular proliferation and vascular contents were evaluated in the central incision area. Statistical analysis consisted of two‐way anova. Results The herbal patch group presented the smallest epithelial gap at 12 days, the highest collagen content both at 5 and 12 days, a larger number of proliferating cells at day 5 and more numerous blood vessels at day 12. Macrophage number was similar in all groups. Conclusion Herbal patch improved wound healing in this animal model.

Combination Therapy for Reconstructive Periodontal Treatment in the Lower Anterior Area: Clinical Evaluation of a Case Series

Clinically, periodontal regeneration may be achieved by the application of barrier membranes, grafts, wound-healing modifiers, and their combinations. Combination therapy refers to the simultaneous application of various periodontal reconstructive treatment alternatives to obtain additive effects. This approach may lead to assemblage of different regenerative principles, such as conductivity and inductivity, space provision and wound stability, matrix development and cell differentiation. The application of autogenous connective tissue grafts during periodontal regenerative treatment with enamel matrix proteins derivative (EMD) has been previously reported. The present case series present a modified approach for treatment of severe periodontally involved lower incisors presenting with thin gingival biotype, gingival recession, minimal attached and keratinized gingiva width and muscle and/or frenum pull. In all cases a combination therapy consisting of a single buccal access flap, root conditioning, EMD application on the denuded root surfaces and a free connective tissue graft was performed. Clinical and radiographic outcomes were consistently satisfactory, leading to probing depth reduction, clinical attachment gain, minimal gingival recession, increased attached and keratinizing gingival width, elimination of frenum and/or muscle pull together with radiographic bone fill of the defects. It may be concluded that the present combination therapy for reconstructive periodontal treatment in the lower anterior area is a valuable alternative for indicated cases.

Lateral bone augmentation in narrow posterior mandibles, description of a novel approach, and analysis of results

BACKGROUND Combination of particulate grafts and collagen membranes is widely used for augmentation of bony defects for implant placement. Fixation of the barrier membrane may avoid complications due to unfavorable mechanical properties and poor stability leading to collapse of the augmented area. PURPOSE To evaluate a new simplified method for resorbable collagen membrane fixation in lateral bone augmentation procedures in narrow posterior mandibles. MATERIALS AND METHODS This retrospective study analyzed 16 procedures performed in 15 patients who followed lateral ridge augmentation procedures before implant placement in the posterior mandible. A particulate mineralized bone allograft was covered with a cross-linked resorbable collagen barrier membrane, which was fixated with a single, nonresorbable pin. Complications were registered and results analyzed on pre and post op measurements on computerized tomographic scans. Descriptive statistical analysis and ANOVA with repeated measures were performed. RESULTS No complications were recorded. Average bone gain was 3.3 mm at implant platform level and 4.29 mm at 3 mm apically, both, statistically significant. All sites had sufficient bone width allowing implant placement. Thirty-three implants placed in the augmented areas, integrated and survived for over a 2-year follow-up. CONCLUSION The simplified membrane fixation procedure enables large horizontal bone gain with minimal complications while allowing adequate implant placement.

Prevention and Management of Soft Tissue Complications in Endodontic Surgery

Operator-related factors such as preoperative planning of the surgical procedure, correct flap design, and soft tissue management, as well as patient-related factors such as the gingival biotype and the periodontal condition, may influence the risk of soft tissue complications following endodontic surgery. The clinician should be aware of possible anatomical pitfalls during flap procedure, such as adjacent neurovascular bundles. In order to avoid flap dryness and possible tissue necrosis and delayed healing, it is recommended to perform a short-duration surgery with a constant irrigation of the reflected tissues with saline. Different flap designs may be predisposed to different risks of complications. Intra-sulcular flaps are prone to gingival recession, submarginal and semilunar flaps are prone to scar formation, and a controversy exists whether papilla-based incision is prone to gingival recession and if papilla preservation incision may prevent gingival recession.