Mattia Pramstraller

Single flap approach with and without guided tissue regeneration and a hydroxyapatite biomaterial in the management of intraosseous periodontal defects

BACKGROUND The single flap approach (SFA) is a minimally invasive procedure designed for periodontal reconstructive procedures of intraosseous periodontal defects characterized by a dominant unilateral, buccal or oral, extension. This study evaluates the adjunctive effect of guided tissue regeneration (GTR) combined with a hydroxyapatite (HA) biomaterial in the management of intraosseous periodontal defects accessed with SFA compared to SFA alone. METHODS Twenty-four intraosseous defects (in 24 patients) were randomly allocated to treatment with SFA or SFA + HA/GTR. Clinical outcomes were assessed 6 months post-surgery. RESULTS Five sites in the SFA + HA/GTR group showed incomplete closure at week 2, which resolved spontaneously. There were no statistically significant or clinically meaningful differences in mean (+/-SD) clinical attachment gain (4.7 +/- 2.5 versus 4.4 +/- 1.5 mm), probing depth reduction (5.3 +/- 2.4 versus 5.3 +/- 1.5 mm), and gingival recession increase (0.4 +/- 1.4 versus 0.8 +/- 0.8 mm) between the SFA + HA/GTR and SFA groups. CONCLUSIONS SFA with and without HA/GTR seems to be a valuable minimally invasive approach in the treatment of deep intraosseous periodontal defects. Under the present experimental conditions, the additional HA/GTR protocol offers no significant adjunctive effect.

Ridge dimensions of the edentulous posterior maxilla: a retrospective analysis of a cohort of 127 patients using computerized tomography data

OBJECTIVES to evaluate the edentulous ridge dimensions of maxillary posterior sextants with a tridimensional radiographic technique. The influence of the presence/absence of teeth adjacent to the edentulous site on the dimensions of the edentulous ridge was also evaluated. MATERIAL AND METHODS computerized tomography (CT) scans of 127 patients (65 males and 62 females; mean age: 55.2 ± 10.1 years) with at least one missing tooth in the maxillary posterior sextants were analyzed. On CT cross sections, bone height (BH), bone width (BW) at 1, 3, and 7 mm from the most coronal point of the alveolar crest (BW(1 mm) , BW(3 mm) , and BW(7 mm) , respectively) and the relative vertical ridge position (rVRP) were assessed at the first premolar, second premolar, first molar and second molar edentulous sites. RESULTS the results of the study indicate that (i) the maxillary sinus was radiographically evident in about 50% of first premolar sites and 90-100% of second premolar and molar sites; (ii) BH showed a significant decrease from first premolar to molar sites; (iii) BW(1 mm) was higher at second molar site compared with the first and second premolar sites, BW(3 mm) and BW(7 mm) were higher at each molar site compared with each premolar site; (iv) the proportion of sites with BH ≥ 8mm and BWI mm ≥ 6mm was 28.3%, 18.4%, 8.0% and 18.2% [corrected] at first premolar, second premolar, first molar and second molar sites, respectively. The absence of teeth adjacent to the edentulous site negatively affected rVRP, but not BH and BW. CONCLUSIONS The results of the study indicate that at premolar and molar sites, [corrected] the dimensions of the alveolar crest may call for bone augmentation procedures for proper implant placement in a substantial amount of edentulous patients. When both mesial and distal tooth adjacent to the edentulous site are absent, the placement of implants of adequate dimensions may be more challenging due to a more apical position of the alveolar ridge compared with sites where both adjacent teeth are present.

Alveolar ridge dimensions in maxillary posterior sextants: a retrospective comparative study of dentate and edentulous sites using computerized tomography data

AIM To compare the alveolar ridge dimensions between edentulous sites and contralateral dentate sites of maxillary posterior sextants in the same individuals. MATERIALS AND METHODS Computerized tomography scans of 32 patients with one fully edentulous and one fully dentate maxillary posterior sextants were analyzed. RESULTS When compared with dentate sextants, edentulous sextants showed (i) a lower bone height (BH) at second premolar, first molar and second molar sites, which was associated with a more coronal position of the maxillary sinus floor at second premolar site; (ii) a more apical position of the ridge at second premolar and second molar sites; (iii) a lower bone width (BW)(1 mm) at first and second premolar sites, and a lower BW(3 mm) at all sites, (iv) a lower, although not significant, prevalence of premolar and molar sites with BH ≥8 mm and BW(1 mm) ≥6 mm. CONCLUSIONS The edentulous sextants in the posterior maxilla showed a reduced height and width of the ridge when compared with contralateral dentate sextants. The reduced vertical dimensions observed in edentulous sextants were variably associated with ridge resorption as well as sinus pneumatization.

Explaining pain after lower third molar extraction by preoperative pain assessment.

PURPOSE To evaluate whether preoperative pain sensitivity testing and emotional perception of pain could explain the level of postoperative pain after lower third molar extraction. PATIENTS AND METHODS Twenty-three patients (16 women, 7 men) scheduled for lower third molar extraction were enrolled in the study. Patients preoperatively were submitted to a nociceptive stimulus by a cold pressor test (immersion of the hand into ice water). Preoperative pain tolerance (seconds), algosity and unpleasantness (visual analog scale), and dental anxiety (Modified Dental Anxiety Scale) were assessed. The duration of surgery was recorded (minutes). Postoperative pain ratings were taken by self-reported registrations on a 100-mm visual analog scale during the 6 days after surgery. Separate stepwise regression analyses were performed to evaluate the usefulness of preoperative scores in explaining the overall maximum postoperative pain level and postoperative pain rates at different intervals. RESULTS Preoperative unpleasantness related to the nociceptive stimulus was found to be the best predictor of maximum postoperative pain (adjusted R(2) = 0.39, P = .001). Demographic information (age) and preoperative (dental anxiety, pain tolerance, algosity) and intraoperative (duration of surgery) factors were not correlated with postoperative pain. CONCLUSIONS These results show that a simple preoperative test is useful to identify patients at risk of developing greater pain after third molar surgery. They are characterized by a higher level of reported pain or unpleasantness after exposure to a nociceptive stimulus. This test may be tailored to specific patient needs for postoperative treatment.

Ridge Dimensions of the Edentulous Mandible in Posterior Sextants: An Observational Study on Cone Beam Computed Tomography Radiographs.

Aims: To evaluate the ridge dimensions of posterior sextant in totally edentulous mandibles. Material and Methods: Cone beam computed tomography scans of 136 patients were retrospectively included for analysis. At sites corresponding to the second premolar (site a) and the mesial and distal root of first molar (sites b and c, respectively), bone height (BH) and bone width (BW) were measured. Results: BH significantly decreased from site a (11.20 ± 4.03 mm) to site c (10.28 ± 3.33 mm). Males showed a significantly higher BH compared with females at all sites (P < 0.001), No significant impact of age on BH was found. BW increased from coronal to apical at all sites. At all height levels, BW increased from mesial to distal (BWc > BWb > BWa). Conclusions: BH decreased from mesial to distal, whereas BW showed an increase. Sex showed a significant impact on BH, with males having on average a 2.8 mm greater height than females, but not on BW. Age did not significantly influence the dimensions of the residual bone crest.

A simplified soft tissue management for peri-implant bone augmentation

PURPOSE This case series illustrates a simplified soft tissue management, namely, the subperiosteal peri-implant augmented layer (SPAL), to increase hard and soft tissue dimensions at the most coronal portion of an implant. MATERIALS AND METHODS Twenty-seven implants in 16 patients presenting either a buccal bone dehiscence or a thin (< 1 mm) buccal cortical bone plate (BCBP) were consecutively treated. Briefly, a split-thickness flap (namely, the mucosal layer) was raised on the buccal aspect. Then, the periosteal layer was elevated from the bone crest. A full-thickness flap was elevated on the oral aspect. After implant site preparation, a xenograft was used to fill the space between the periosteal layer and the BCBP and/or exposed implant surface and, if present, to completely correct the bone dehiscence. The periosteal layer was sutured to the oral flap. The mucosal layer was coronally advanced and sutured to submerge both the graft and the implants. At 3 to 6 months, a re-entry procedure for implant exposure was performed. RESULTS Healing was uneventful, with no signs of infection in all cases. A wound dehiscence was observed in three implants in two patients at 2 weeks postsurgery. Out of 15 implants showing an initial bone dehiscence, 12 implants (80%) showed a complete resolution, with a subperiosteal tissue thickness (SPTT) at the time of re-entry of 3.1 ± 1.0 mm. Three implants presented a residual dehiscence of 1 mm (two implants) or 2 mm (one implant), with a SPTT of at least 2 mm. Out of 12 implants showing a thin BCBP at implant placement, 10 implants (90%) revealed a SPTT ≥ 2 at the time of re-entry. Two implants revealed a SPTT of 1 mm. CONCLUSION The SPAL technique represents a valuable simplified surgical approach associated with a low rate of complications in the treatment of peri-implant bone dehiscence and in the horizontal augmentation of peri-implant tissue thickness.