João Carnio

Mineral trioxide aggregate and subepithelial connective tissue graft for treatment of iatrogenic gingival recession: long-term results.

This study aimed to examine the combination of mineral trioxide aggregate (MTA) and subepithelial connective tissue grafts to treat esthetic deficiencies caused by iatrogenic tooth perforations. Three patients were treated, and clinical and histologic documentation was obtained. Connective tissue grafts were performed following standard techniques after application of MTA to seal the root perforations. Complete root coverage was obtained, significantly improving the esthetic outcomes. Histologic analysis showed the long junctional epithelium in intimate contact with the root surface. It appeared to form coronal to the perforation and extended apical to the MTA. Based on the limitations of this clinical and histologic observation, it can be concluded that MTA in conjunction with connective tissue grafts could be considered for treatment of esthetic deficiencies associated with iatrogenic tooth perforations.

Nonsurgical periodontal therapy to treat a case of severe periodontitis: A 12-year follow-up.

BACKGROUND AND OVERVIEW This case report describes the successful treatment of a severe chronic periodontitis case by nonsurgical therapy and a strict maintenance program over a 12-year period. CASE DESCRIPTION A 38-year-old man concerned about the protrusion of his maxillary incisors was referred for periodontal treatment. The teeth in the maxillary arch had generalized severe chronic periodontitis. Several treatment options were presented to the patient including the most aggressive, extraction of all maxillary teeth, and the most conservative, scaling and root planing. The patient opted to having the most conservative approach, even though the prognoses for the maxillary teeth were unfavorable. Therefore, he received nonsurgical therapy via scaling and root planing combined with systemic antibiotics before referral to an orthodontist to address the esthetic concerns. The maxillary dentition was treated with orthodontic therapy to retract and align the maxillary anterior segment. Periodontal maintenance (1-hour session), including subgingival instrumentation, was performed 4 times per year until the end of the 12-year follow-up period. The patient only missed 2 appointments in 12 years. Twelve years later, the results revealed that all but 1 maxillary tooth were maintained in a state of acceptable health, function, and esthetics. CONCLUSIONS AND PRACTICAL IMPLICATIONS Although most would agree with the initial poor prognosis of this patients case, nonsurgical periodontal therapy was utilized with a 3-month periodontal maintenance program and demonstrated long-term success. The outcome presented in this case report may only have been possible because of patient compliance, professional experience, skill, and supervision throughout the course of treatment.

Modified apically repositioned flap technique: a surgical approach to enhance donor sites prior to employing a laterally positioned flap.

The goal of this study was to evaluate the ability of the modified apically repositioned flap (MARF) technique to increase keratinized tissue at the donor site and to analyze if this procedure would enhance the indication for and predictability of the laterally positioned flap (LPF) without any consequences to the donor area. Thirty isolated defects with recession and/or lack of attached gingiva were treated in 30 healthy patients. All donor areas adjacent to these defects lacked ideal gingival conditions both in height and width. The MARF technique was used to increase these areas 8 weeks before the LPF was performed. Clinical evaluation was done at the donor and receptor areas after 18 months. The results showed that the donor area increased from 2.78 to 5.01 mm at 8 weeks and remained at 3.28 mm after the use of the LPF. The marginal tissue recession and probing depth remained clinically unchanged. In the receptor area, the recession decreased from 1.86 to 0.57 mm, and the keratinized and attached tissue increased from 0.71 to 3.57 mm and from 0.05 to 2.49 mm, respectively. The use of the MARF technique to enhance keratinized tissue at the donor area proved to be an efficient and predicable technique that also augmented LPF use without any consequences to the donor site.

Palatal Augmentation Technique: A Predictable Method to Increase the Palatal Connective Tissue at Donor Sites- A Consecutive Case Series.

The palatal masticatory mucosa between the canine and first molar is the main source of connective tissue graft (CTG) for use in periodontal plastic surgery. The purpose of this study was to evaluate the palatal augmentation technique (PAT) to increase the palatal connective tissue donor area using a collagen sponge inserted between the palatal flap and bone. The 26 patients enrolled in this study were referred for root coverage and ridge augmentation procedures. All patients lacked adequate donor palatal tissue thickness. The PAT uses a full-thickness flap and insertion of a sterile lyophilized bovine collagen sponge between the flap and bone. The palatal thickness was clinically assessed before and after collagen sponge insertion. A manual probe was inserted in the mucosal surface perpendicular to the long axis of each tooth approximately 6 mm from the gingival margin. Probing depth (PD) and recession (REC) were also recorded. Treatment with PAT resulted in a statistically significant increase in the palatal thickness. The overall mean increase was from 2.03 mm before surgery to 3.57 mm after surgery, with no major alterations in PD and REC. Healing proceeded uneventfully and occurred by primary intention. PAT appeared to be a predictable procedure to create connective tissue donor graft in deficient areas and had uneventful postoperative healing.

Use of the Modified Apically Repositioned Flap Technique to Create Attached Gingiva in Areas of No Keratinized Tissue: A Clinical and Histologic Evaluation

The complete absence of keratinized attached gingiva on the buccal surface of a tooth can make the area more susceptible to gingival recession. The modified apically repositioned flap (MARF) technique is an effective procedure to increase the dimensions of attached gingiva in areas that present with some existing keratinized tissue. The objective of this case report is to present long-term clinical and histologic evidence that the MARF technique can be used to create attached gingiva in areas that lack keratinized tissue.

The Modified Apically Repositioned Flap Technique: A Long-Term (4 to 16 Years) Retrospective Study

Attached gingiva is desirable for the maintenance of gingival health. Although many methods are used to increase the zone of attached gingiva, the modified apically repositioned flap (MARF) technique has the advantages of simplicity and predictability. The short-term follow-up of the MARF technique demonstrated an increase in keratinized tissue and attached gingiva. This study evaluated long-term results of the MARF technique as used to increase the apicocoronal dimensions of keratinized tissue and attached gingiva in 28 sites (25 patients; average follow-up of 9 years). There was a statistically significant increase in keratinized tissue and attached gingiva with no increase in probing depths or gingival recession. These results suggest that the MARF procedure predictably generates keratinized tissue and attached gingiva with long-term stability.