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These case reports present a surgical technique to improve the clinical attachment level and cover the exposed root surface in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area. The tunnel wall approach combined previously described concepts and placed a CTG into a modified tunnel-type flap through a vertical releasing incision. The CTG acted both as a buccal soft tissue wall to stabilize the blood clot and as a space maintainer to coronally move the tissue. The decontaminated root surfaces were treated with enamel matrix derivative, and a bone filler material was placed from the bottom of the intrabony defect up to the cementoenamel junction to support the proximal soft tissue architecture. Healing of the four presented sites was uneventful. Clinical measurements up to 12 months showed significant probing depth reduction, clinical attachment gain, and coverage of the buccal recession in each case. Papilla improvement was reported in three cases. Radiographic examinations confirmed intrabony defect healing and the presence of embedded bone filler material in the soft tissue above the bone crest. The tunnel wall approach seems to be a valuable option to safely enhance the clinical attachment level and cover the exposed root in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area. [ABSTRACT FROM AUTHOR]

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Background: The aim was to identify and evaluate those surgical protocols reporting on positive clinical outcomes for treating periimplantitis with 12 or more months of follow-up. Method of surface decontamination (SDC) was evaluated for any correlation with outcomes. Results: A literature search was performed of all articles published in English between January 1, 2001 and April 30, 2015. Of the 639 identified, 26 satisfied the inclusion criteria. Outcomes reported on included reductions in bleeding on probing (BoP) and probing depth (PD), mean radiographic bone fill (RBF), and mean change in marginal soft tissue levels (MR±). Methods of SDC included mechanical debridement (MD) with and without saline use, MD plus laser or photodynamic therapy, MD with air powder abrasion, MD with chemotherapeutic implant surface decontamination, and combination approaches. The results suggested that various methods of SDC were effective. Heterogeneity of the studies made it impossible to determine correlations between clinical outcome and SDC method. Most studies over 12 months reporting better treatment outcomes employed a bone replacement. Additionally, studies where patients with periodontitis were treated before their peri-implantitis care also had better outcomes. Conclusion: The current review failed to reveal any correlation between any particular method for SDC or defect treatment protocol and positive clinical outcomes. Further comparative studies are warranted to determine the most appropriate approach for both of these topics. [ABSTRACT FROM AUTHOR]

Copyright of Implant Dentistry is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)