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Background: Guided tissue regeneration (GTR) is a common treatment modality for correcting vertical or bony defects in furcations. Multiple materials are used in GTR with allografts and xenografts being the most widely used. Each material has distinctive properties affecting the regenerative potential. A new bone graft combination of xenogeneic/allogeneic may improve the outcome of GTR by providing space maintenance (Xenograft) and osteoinductive potential (Allograft). The aim of this case report is to evaluate the efficacy of the new combined xenogeneic/allogeneic material based on clinical and radiographic outcomes. Methods: A 34‐year‐old healthy male presented with vertical bone loss interproximally between #'s 9 and 10. Clinical exam revealed 8 mm probing depth without mobility. The radiographic exam revealed a wide and deep vertical bony defect of 30%–50% bone loss. The defect was treated using a layering technique with xenogeneic/allogeneic bone graft and collagen membrane. Results: The 6‐ and 12‐month follow‐ups revealed a significant reduction in probing depths and radiographic bone fill. Conclusions: GTR using a layering technique of xenogeneic/allogeneic bone graft and collagen membrane showed proper correction of a deep and wide vertical bony defect. The 12‐month follow‐up revealed healthy periodontium with normal probing depths and bone level. [ABSTRACT FROM AUTHOR]

Introduction: Alveolar bone deficiency is a common postextraction sequela that adversely affects implant placement. Therefore, ridge augmentation is often required to obtain proper bone quantity and quality for restoratively driven implant placement. This case series describes the successful horizontal and vertical alveolar ridge augmentation using custom‐fabricated allogeneic block bone grafts. Case Series: Two healthy partially edentulous patients presented to private practice seeking dental implant treatment. Initial clinical examination and cone‐beam computed tomography (CBCT) radiographic analysis showed moderate to large horizontal ridge defects. Treatment options were discussed for alveolar ridge augmentation and the patients elected to undergo the custom allogeneic block graft procedure to regenerate the atrophied alveolar ridges. The CBCT scan in conjunction with computer‐aided design/computer‐aided manufacturing (CAD/CAM) technology was used to fabricate customized allogeneic block grafts based on alveolar ridge topography. The custom allogeneic block graft allowed less surgical time and decreased postoperative morbidity. The grafted area was allowed 6 months of healing time. Follow‐up radiographs showed the stability of the graft followed by dental implant placement. The dental implants were functionally loaded, and successful implant esthetics and function achieved. Conclusion: Custom allogeneic block grafts could provide a promising innovative method for optimal ridge augmentation. Why are these cases new information?Less invasive procedure as an alternative conventional two‐stage block augmentation.More predictable outcome due to customized block graft. What are the keys to successful management of these cases?It is important determining the type of bone defect.Vertical and horizontal bone loss.Primary closure. What are the primary limitations to success in these cases?Limited data from prospective clinical trials documenting the effectiveness of custom allogeneic block grafts.Limited data are available to confirm accuracy of the CAD/CAM process.Passive flap closure is needed. [ABSTRACT FROM AUTHOR]

Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder of keratinization associated with palmoplantar keratoderma and severe periodontitis resulting in complete edentulism in late adolescence. The pathognomonic dental features of PLS are pathologic migration, hypermobility and exfoliation of the teeth without any signs of root resorption. It has been suggested that an effective way to treat PLS patients presenting early in the disease progression is extraction of the erupted primary dentition or hopeless permanent teeth followed by antibiotic coverage with periodontal therapy for the remaining teeth. Unfortunately, studies have shown that this regimen only temporarily delays the progression of periodontal disease and does not prevent further tooth loss and bone destruction in the long term. Post-tooth loss, atrophic ridges make conventional prosthodontic rehabilitation quite challenging and more recently, implant-supported prostheses have been considered as a viable alternative. In a PLS patient, implant placement is complicated by inadequate bone volume; thus, bone augmentation techniques or the use of short implants is often considered. When large volumes of bone are required, parietal calvarium bone can be used to predictably reconstruct severe defects. A PLS patient aged 21 years presented a chief complaint of ill-fitting conventional complete dentures. The patient had severely atrophic ridges, requiring significant bone augmentation for an implant-supported prosthesis. The present case is the first example of bone augmentation using autogenous calvarium parietal graft followed by endosseous implant placement and prosthetic restoration in a PLS patient. [ABSTRACT FROM AUTHOR]

Background: Immediate implant placement (IIP) into fresh extraction socket is a favorable treatment option. If successfully managed, it reduces the overall treatment time, and increases patient's satisfaction. Surgical and restorative factors affect IIP success rates. In this systematic review we evaluate the effect of guided bone regeneration (GBR) at the time of IIP on crestal bone level (CBL) changes after at least 12-months of functional loading.Methods: Reviewers conducted an independent search of the National Center for Biotechnology Information PubMed, Medline, and the Cochrane Collaboration Library from 1966 to January 2017 following the inclusion criteria. A hand search of bibliographies of reviews and clinical trials related to IIP was also performed. This study looked into CBL changes around IIP primarily and further extracted the data to conduct three meta-analysis of "IIP using GBR versus IIP without GBR", "IIP using bone graft alone versus IIP using bone graft with membrane" and "IIP using GBR versus conventional implant placement" which were further subdivided to provide more detailed information for each. Four reviewers independently assessed the study data and methodologic quality using data extraction and assessment forms.Results: The electronic search identified 714 potential studies and the hand search retrieved 55 studies. Crestal bone level (CBL) changes were determined in three meta-analyses. The results revealed a mean difference in CBL changes of 0.175 ± 0.180 mm  in favor of IIP without GBR when compared with implant with GBR. However, IIP with bone graft and membrane showed better results when compared with IIP with bone graft alone [CBL changes of 0.532 ± 0.572 mm]. CBL preservation was noted in IIP with GBR versus conventional implant placement [CBL changes of - 0.001 ± 0.049 mm].Conclusions: Meta-analyses showed minimal difference in CBL around IIP with bone graft versus without bone graft and with IIP with GBR compared with conventional implant placement. However, IIP with bone graft and membrane reported better CBL preservation compared with IIP with bone graft alone. Nonetheless, these results should be interpreted with caution because of moderate heterogeneity between studies. [ABSTRACT FROM AUTHOR]

Introduction: Dermatomyositis is an uncommon inflammatory disease marked by muscle and joint weakness with skin rash. Dermatomyositis affects adults and children, with higher prevalence for females aged 40 to 60 years. Most common oral lesions include mucosal edema, erythema, and telangiectasia. Case Presentation: A 51‐year‐old white female with an unremarkable medical history presented for periodontal evaluation in 2010. She reported a 6‐month history of gingival inflammation and skin irritation on her hands and a rash on the center of her chest and forehead. Other complaints included fatigue, hot flashes, decreased appetite, and weight loss. Periodontal examination revealed generalized acute marginal erythema, with localized slight incipient bone loss. Oral hygiene was deemed good to fair. Oral hygiene instructions were reviewed and a prescription for chlorhexidine gluconate was given. The patient was then referred to an allergist and dermatologist where a diagnosis of dermatomyositis was made. After the initial diagnosis, localized scaling and root planing was performed using local anesthetic. The patient was managed medically using prednisone, mycophenolate mofetil, and methotrexate and a 3‐month periodontal maintenance recall interval. The patient remained stable over an 8‐year period. Conclusions: Dermatomyositis is an uncommon inflammatory disease that requires medical and dental teams for proper diagnosis and management. Although the condition is chronic in nature with no definitive cure, signs, and symptoms can be managed with steroids and immunosuppressants to delay progression of the disease and improve quality of life for the patient. [ABSTRACT FROM AUTHOR]

Introduction: Excessive gingival display (EGD) is an esthetic concern for patients with a gummy smile. With the increase in the esthetic expectations of patients, EGD could have an adverse emotional and psychosocial impact. The extent and etiology of gingival display dictate which treatment is indicated. For patients with EGD and a short or hypermobile upper lip, surgical lip repositioning (LRP) is a viable treatment alternative to other more invasive procedures such as orthognathic surgery. The procedure was first introduced in 1973 and resulted in reduced morbidity compared with orthognathic surgery while resulting in predictable improvement. LRP reduces gingival display by restricting the pull of elevator lip muscles and shortening the vestibule, thereby decreasing the range of motion of the lips and decreasing the amount of gingival display. Case Presentation: The current report evaluates the esthetic results of LRP surgery on identical 27‐year‐old twin sisters exhibiting severe vertical maxillary excess (VME) and hypermobile upper lip. Both patients were given the option of orthognathic surgery to correct their VME or LRP to reduce their gummy smile and improve esthetics. Both elected LRP to address their gummy smile and avoid higher morbidity and costs associated with orthognathic surgery. Conclusion: Both patients achieved acceptable esthetic results that were stable at 12 and 24 months. [ABSTRACT FROM AUTHOR]

Achieving natural esthetics around implants in the maxilla is generally a challenge for clinicians. This is primarily due to soft and hard tissues loss that occurs post tooth extraction. In an attempt to compensate for this loss, ridge augmentation is often required before or at the time of the implant placement. In the current paper, a modification of the roll technique is described to correct soft tissue defects around implants to improve esthetics. The main modifications involve the use of a papilla preservation technique and avoidance of using sutures for the pedicle part of the connective tissue graft (CTG). The results of these clinical cases were objectively evaluated using the white esthetic score (WES) and pink esthetic score (PES). The combined score for PES and WES ranged from 16 to 20 at final follow-up (24 months) compared to 14-18 at the time of initial restoration delivery with mean scores of 9.33±0.58 for PES and 8.33±1.53 for WES. The esthetic scores of the current case series were satisfactory and remained stable at 12 and 24 months follow-up, indicating a beneficial use of the modified rolled CTG technique for improving peri-implant soft tissues. [ABSTRACT FROM AUTHOR]

Background: Predictable regeneration of lost periodontal tissues in furcations is difficult to achieve. This paper investigates the efficacy of different treatment modalities for Class II molar furcations. Methods: Publications in English were searched using PubMed, Medline, and Cochrane Library databases combined with hand searching from January 1, 1966 to October 1, 2007. The search included randomized controlled human trials in molar Class II furcations with over 6 months of surgical reentry follow-up. Changes in vertical probing depths, vertical attachment levels, and vertical and horizontal bone levels were compared. Results: The search identified 801 articles of which 34 of 108 randomized clinical trials met the criteria. Thirteen trials had test and control arms allowing three meta-analyses: 1) five comparing non-resorbable versus resorbable membranes, 2) five comparing non-resorbable membranes versus open flap debridement and 3) three comparing resorbable membranes versus open flap debridement. There was significant improvement for resorbable versus non-resorbable membranes mainly in vertical bone fill (0.77 ± 0.33 mm; [95% CI; 0.13, 1.41]). Non-resorbable membranes showed significant improvement in vertical probing reduction (0.75 ± 0.31 mm; [95% CI; 0.14, 1.35]), attachment gain (1.41 ± 0.46 mm; [95% CI; 0.50, 2.31]), horizontal bone fill (1.16 ± 0.29 mm; [95% CI; 0.59, 1.73]), and vertical bone fill (0.58 ± 0.11 mm; [95% CI; 0.35, 0.80]) over open flap debridement. Resorbable membranes showed significant improvement in vertical probing reduction (0.73 ± 0.16 mm; [95% CI; 0.42, 1.05]), attachment gain (0.88 ± 0.16 mm; [95% CI; 0.55, 1.20]), horizontal bone fill (0.98 ± 0.12 mm; [95% CI; 0.74, 1.21]) and vertical bone fill (0.78 ± 0.19 mm; [95% CI; 0.42, 1.15]) over open flap debridement. Conclusions: Guided tissue regeneration with the use of resorbable membranes was superior to non-resorbable membranes in vertical bone fill. Both types of membranes were more effective than open flap debridement in reducing vertical probing depths and gaining vertical attachment levels and in gaining vertical and horizontal bone. J Periodontol 2011;82:413-428. [ABSTRACT FROM AUTHOR]

This article describes the biology and techniques of the sinus augmentation procedure. Most of the commonly used augmentation procedures aimed at restoring the atrophic posterior maxilla are presented through a series of clinical cases. This article also discusses the drawbacks and complications associated with sinus bone grafts along with pertinent literature supporting their validity and long-term success. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Key points Encountering a retained root tip post‐extraction and prior to implant placement is a possible clinical complication. There are numerous approaches for removing retained roots that may be traumatic or atraumatic. Regardless of the approach, careful treatment planning is important to minimize complications, reduce morbidity, and preserve bony structures. The aim of the current case study is to introduce a technique and digitally generated device used for identifying and atraumatically removing a retained root tip and simultaneously placing a stable dental implant.A 63‐year‐old female with a history of myocardial infarction, hypertension, and acute pancreatitis presented for implant placement at site #5. Clinical examination revealed adequate interocclusal, mesiodistal, and buccolingual dimensions for implant placement. Radiographic examination using cone beam computed tomography revealed that retained root #5 interfered with implant placement. Digital planning was used to extract the root tip with minimal trauma to maintain adequate bone for simultaneous implant placement with good primary stability.The follow‐ups at 1, 3, and 6 weeks and 4, 8, and 10 months revealed good bone preservation with an osseointegrated implant.Employment of digital planning to create a palatal window allowed excellent accuracy in removing the retained root while maintaining the bony foundation for a well osseointegrated dental implant. Pre‐planning using cone beam computed tomography scan merged with an intraoral digital scan is necessary for precise location of a retained root and correct implant placement with excellent primary stability. A digitally planned 3D surgical guide is a useful method for extracting retained roots during implant placement to minimize bone damage. Digital planning provides a precise and minimally invasive implant surgery. [ABSTRACT FROM AUTHOR]

Periodontal and endodontic diseases are inflammatory responses leading to periodontal and pulpal tissue loss. Regenerative therapies aim to restore the lost structures to vitality and function. Various materials and treatments methods have been used such as bone grafts, guided tissue regeneration, enamel matrix derivatives, growth and differentiation factors, and stem cells. Although the current materials and methods demonstrated adequate clinical results, true and complete biological tissue regeneration is not yet attainable. The current article reviews chronologically the materials and methods used in periodontal and endodontic regeneration highlighting their clinical success and shortcomings, and discussing future directions in regenerative therapy., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Post extraction sites may have residual ridge deformities with insufficient bone present for future implant placement. This presents a challenge to the clinician attempting to obtain optimum results. To predictably augment these areas and obtain aesthetically pleasing results, bone grafting may be required. Guided bone regeneration with an allograft material is a predictable means by which to solve this challenge. This article describes three case presentations utilizing on allograft material for bone regeneration prior to implant placement.