Péter Windisch

Clinical and histologic evaluation of granular Beta-tricalcium phosphate for the treatment of human intrabony periodontal defects: a report on five cases.

BACKGROUND The aim of the study is to clinically and histologically evaluate the healing of advanced intrabony defects treated with open flap debridement and the adjunct implantation of granular beta tricalcium phosphate (beta-TCP). METHODS Five patients, each displaying advanced combined 1- and 2-wall intrabony defects around teeth scheduled for extraction or root resection, were recruited. Approximately 6 months after surgery, the teeth or roots were removed together with a portion of their surrounding soft and hard tissues and processed for histologic evaluation. RESULTS The mean probing depth (PD) was reduced from 10.8 +/- 2.3 mm presurgically to 4.6 +/- 2.1 mm, whereas a mean clinical attachment level (CAL) gain of 5.0 +/- 0.7 mm was observed. The increase in gingival recession was 1.2 +/- 3.2 mm. The histologic evaluation indicated the formation of new cellular cementum with inserting collagen fibers to a varying extent (mean: 1.9 +/- 0.7 mm; range: 1.2 to 3.03 mm) coronal to the most apical extent of the root instrumentation. The mean new bone formation was 1.0 +/- 0.7 mm (range: 0.0 to 1.9 mm). In most specimens, beta-TCP particles were embedded in the connective tissue, whereas the formation of a mineralized bone-like or cementum-like tissue around the particles was only occasionally observed. CONCLUSION The present data indicates that treatment of intrabony periodontal defects with this beta-TCP may result in substantial clinical improvements such as PD reduction and CAL gain, but this beta-TCP does not seem to enhance the regeneration of cementum, periodontal ligament, and bone.

Clinical and Histologic Evaluation of a Granular Bovine Bone Biomaterial Used as an Adjunct to GTR With a Bioresorbable Bovine Pericardium Collagen Membrane in the Treatment of Intrabony Defects

BACKGROUND The aim of the present study is to evaluate the clinical and histologic healing of deep intrabony defects treated with guided tissue regeneration (GTR) with a collagen membrane from bovine pericardium and implantation of granular bovine bone biomaterial. METHODS Thirty patients with one deep, combined 1- and 2-wall intrabony defect exhibiting a probing depth ≥6 mm and an associated intrabony defect ≥3 mm were treated with GTR with a bioresorbable collagen membrane from bovine pericardium and adjunct implantation of a granular bovine bone biomaterial. The clinical results were evaluated 1 and 3 years after surgery. In addition, five teeth fulfilling the inclusion criteria but scheduled for extraction because of advanced periodontitis or restorative considerations were treated similarly and then extracted along with a portion of their surrounding periodontal tissues for histologic evaluation 6 months after surgery. RESULTS Healing was uneventful in all patients. Significant clinical improvements were observed at 1 and 3 years postoperatively (P <0.01; probing depth averaged 4.4 ± 1.6 and 4.7 ± 1.4 mm and clinical attachment level gain was 3.9 ± 1.4 and 3.5 ± 1.3 mm, respectively). The histologic evaluation revealed formation of new cellular cementum and new periodontal ligament in four of the five cases. In general, the xenograft particles seemed to be mostly embedded in connective tissue without any evidence of new bone formation. CONCLUSION GTR treatment of intrabony defects with the collagen membrane from bovine pericardium and adjunct implantation of the new bovine bone biomaterial may result in significant clinical improvements that can be maintained over a period of 3 years, and regeneration of cementum and periodontal ligament, but without bone formation.

Treatment of multiple adjacent Miller Class I and II gingival recessions with collagen matrix and the modified coronally advanced tunnel technique

OBJECTIVE To clinically evaluate the treatment of Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique combined with a newly developed bioresorbable collagen matrix of porcine origin. METHOD AND MATERIALS Eight healthy patients exhibiting at least three multiple Miller Class I and II multiple adjacent gingival recessions (a total of 42 recessions) were consecutively treated by means of the modified coronally advanced tunnel technique and collagen matrix. The following clinical parameters were assessed at baseline and 12 months postoperatively: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), probing depth (PD), recession depth (RD), recession width (RW), keratinized tissue thickness (KTT), and keratinized tissue width (KTW). The primary outcome variable was complete root coverage. RESULTS Neither allergic reactions nor soft tissue irritations or matrix exfoliations occurred. Postoperative pain and discomfort were reported to be low, and patient acceptance was generally high. At 12 months, complete root coverage was obtained in 2 out of the 8 patients and 30 of the 42 recessions (71%). CONCLUSION Within their limits, the present results indicate that treatment of Miller Class I and II multiple adjacent gingival recessions by means of the modified coronally advanced tunnel technique and collagen matrix may result in statistically and clinically significant complete root coverage. Further studies are warranted to evaluate the performance of collagen matrix compared with connective tissue grafts and other soft tissue grafts.

Recession Coverage Using Autogenous Grafts

Recreating natural pink esthetics around single or multiple recession defects require proper surgical planning and a careful choice of the grafting approach. The transplantation of free autogenous soft tissue grafts in combination with state-of-the-art surgical techniques for recession coverage still represents the gold standard in terms of long-term tissue stability. Donor site morbidity has to be considered prior to surgery; graft harvesting procedures should be well planned and executed to minimize postoperative patient complaints.

Functional characterization of collaterals in the human gingiva by laser speckle contrast imaging

The rate of blood flow between the various areas of the gingiva in resting position and under challenge is unknown. In this study, the LSCI method was used to map spatial and temporal changes in gingival blood flow after transient compression.

A proposed method for assessing the appropriate timing of early implant placements: a case report

An abstract is not required.

Analysis of blood supply in the hard palate and maxillary tuberosity—clinical implications for flap design and soft tissue graft harvesting (a human cadaver study)

ObjectivesThe aim of the present study is to provide a detailed macroscopic mapping of the palatal and tuberal blood supply applying anatomical methods and studying specific anastomoses to bridge the gap between basic structural and empirical clinical knowledge.Materials and methodsTen cadavers (three dentate, seven edentulous) have been prepared for this study in the Department of Anatomy, Semmelweis University, Budapest, Hungary, and in the Department of Anatomy of the Medical University of Graz. All cadavers were fixed with Thiel’s solution. For the macroscopic analysis of the blood vessels supplying the palatal mucosa, corrosion casting in four cadavers and latex milk injection in other six cadavers were performed.ResultsWe recorded major- and secondary branches of the greater palatine artery (GPA) and its relation to the palatine spine, different anastomoses with the nasopalatine artery (NPA), and lesser palatal artery (LPA) as well as with contralateral branches of the GPA. Penetrating intraosseous branches at the premolar-canine area were also detected. In edentulous patients, the GPA developed a curvy pathway in the premolar area. The blood supply around the maxillary tuberosity was also presented.ConclusionThe combination of different staining methods has shed light to findings with relevance to palatal blood supply, offering a powerful tool for the design and execution of surgical interventions involving the hard palate.Clinical relevanceThe present study provides clinicians with a good basis to understand the anatomical background of palatal and tuberal blood supply. This might enable clinicians to design optimized incision- and flap designs. As a result, the risk of intraoperative bleeding and postoperative wound healing complications related to impaired blood supply can be minimized.

Fogeltávolítást követően visszamaradt szöveti defektus ellátása. Három eset ismertetése

Absztrakt: Kiterjedt gyulladassal korulvett fog eltavolitasat kovetően gyakran jelentős lagy- es kemenyszoveti defektus marad vissza. Ezt tovabb sulyosbitja, ha a foghuzas utan a fogmedret – alveolust – magara hagyjuk. A szovetek igy meg jobban osszeesnek, es a terulet alkalmatlanna valik implantatum behelyezesere. Az esztetikai regioban hidpotlas sem hozza meg a vart eredmenyt. A bemutatasra kerulő esetekkel azt szeretnenk demonstralni, hogy fogeltavolitast kovetően elvegzett alveolusprezervacio lehetőve teszi implantatum behelyezeset, valamint megfelelő esztetikai eredmenyt biztosit meg frontalis teruleten is. CBCT-felveteleket keszitettunk a fogeltavolitast kovető alveolusprezervacio előtt es a beavatkozast kovető hatodik–nyolcadik honapban. Vertikalis es teruletmereseket vegeztunk, illetve osszehasonlitottuk pre- es posztoperativ ertekeiket. Az implantatum mindharom esetben beultethető volt, valamint jelentős buccalis csontnovekedest (4,24 mm, 6,22 mm, 9,57 mm) es teruletnovekedest (129%, 145%, 167%) ...Following tooth removal, three dimensional hard- and soft-tissue loss take place. Spontaneous healing makes the defect more severe and results in collapsing tissues. Implant placement is not feasible. In the aestethic zone even fixed partial dentures will not deliver the expected result. Our aim was to demonstrate that only ridge preservation enables implant placement and also provides excellent aestetic result even at frontal areas. CBCT was made before and 6-8 months after ridge preservation. Vertical and socket area measurements were carried out and compared in pre-, and postoperative images. Implant placement was feasible in all three cases; furthermore favourable buccal bone (4.24 mm, 6.22 mm, 9.57 mm) and area growth (129%, 145%, 167%) were measured. Ridge preservation provides appropriate therapy for complete reconstruction of tissues after tooth removal. Orv Hetil. 2017; 158(31): 1228-1234.

Volumetric difference evaluation of registered three-dimensional preoperative and postoperative CT volumes

A methodology is presented for registering three-dimensional preoperative and postoperative CT scan volumes and for evaluating their differences in selected areas of interest. The proposed method was applied to CT cone beam data from ten patients in order to assess the volume of augmented bone in the alveolar region. A 3D affine model was used to align the preoperative and postoperative data. The differences between the aligned sets were assessed through subtraction radiography. The volume of the differences was finally evaluated by defining regions of interest in each slice of the subtracted 3D data. Both quantitative and qualitative results were obtained after applying the method to all sets. The effectiveness of the volumetric assessment algorithm was verified by applying the algorithm to an object of known volume.