Clinical Advances in Periodontics最新文献

{"title":"The innovative double or triple dental abutment-implant: Case study with a 3-to-12-year follow-up.","authors":"Luciana Silva Colepícolo, Maria Auxiliadora Mourão Martinez, Andrea Augusto Rodrigues, Leonardo Silveira Baeta, Fernando Oliveira Costa","doi":"10.1002/cap.10300","DOIUrl":"https://doi.org/10.1002/cap.10300","url":null,"abstract":"<p><strong>Background: </strong>The aim of this case study is to present the rationality and scientific evidence of a new design for a double (DA) and triple (TA) dental abutment-implant with their specific new concept of biodynamic optimized peri-implant tissue (BOPiT).</p><p><strong>Methods: </strong>The innovative design of these abutments with a paraboloid geometry was based on BOPiT, simultaneously involving the principles of mechanobiology, biotensegrity, and mechanotransduction. Thus, 37 consecutive individuals/43 cases rehabilitated with single dental implant using the innovative DA (n = 28) and TA (n = 15) on 43 implants were included in this case study. The DA and TA support 2 or 3 dental crowns on a single implant, respectively. Clinic and radiographic examinations were presented at T1 (loading after 4 months) and T2 [final examination with an average follow-up time of 7.2 years (>3 to 12 years)].</p><p><strong>Results: </strong>At T2, mean scores for plaque index, peri-implant bleeding on probing, and peri-implant probing depth were low, depicting healthy peri-implant conditions. All radiographic images showed insignificant annual marginal bone loss (0.022 ± 0.05 mm) when compared to T1, reflecting great bone stability.</p><p><strong>Conclusion: </strong>DA and TA, based on the BOPiT concept, represent an advantageous, simple and non-invasive mechanism for the longevity and healthy regulation of the peri-implant tissues.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peri-implantitis as a rare local manifestation of actinomycosis: A case report.","authors":"Daniel Hawkins, Janina Golob Deeb","doi":"10.1002/cap.10295","DOIUrl":"https://doi.org/10.1002/cap.10295","url":null,"abstract":"<p><strong>Background: </strong>Actinomycosis can be caused by periapical endodontic infection, trauma, or surgical dental procedures. Due to its rare occurrence in a healthy adult patient, persistent actinomycotic osteomyelitis around implants presenting as severe peri-implantitis may be challenging to diagnose.</p><p><strong>Methods: </strong>A 26-year-old male patient with non-contributory medical history presented to the Oral and Maxillofacial Surgery Clinic in 2018 with pain and edema associated with endodontically treated maxillary premolar teeth with poor prognosis. Oral examination revealed fair oral hygiene, heavily restored dentition, multiple carious teeth, failing restorations, endodontic treatments in both maxillary quadrants, and normal periodontal examination.</p><p><strong>Results: </strong>Two years following extractions and restoration with implants, the patient returned with a bony sequestrum and fistula in the buccal gingiva adjacent to the implants. The patient reported shifting of implants and slight change in his occlusion. Clinical, radiographic, and endodontic examinations did not demonstrate a clear origin of the fistula. A periodontist was consulted regarding the possibility of peri-implantitis and tracing of the fistula suggested intraosseous involvement of the implant surface. Flap surgery, biopsy, culture, implant removal, and surgical debridement were performed. Histologic examination revealed colonies of actinomycotic organisms and confirmed likely diagnosis of actinomycosis. The patient was placed on a long course of penicillin VK.</p><p><strong>Conclusions: </strong>The occurrence of actinomycosis in a healthy adult patient is rare. This case report describes persistent actinomycosis presenting as osteomyelitis with severe peri-implantitis in a healthy patient, which may have been associated with a previously existing periapical endodontic infection.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlations of gingival biotype with clinical crown and periodontal parameters in maxillary and mandibular jaws","authors":"Nidhi Pradeep Gadge,&nbsp;Ruhee Chawla,&nbsp;Sunil Ronad,&nbsp;Shreya Vikas Bhole,&nbsp;Pawan Kumar,&nbsp;Puttaraj Tukaram Kattimani","doi":"10.1002/cap.10302","DOIUrl":"10.1002/cap.10302","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The gingival biotype (GB) influences treatment planning and clinical outcomes in several dental specialties. This study aimed to investigate the associations between the GB and various clinical crown and periodontal parameters, such as probing depth (PD), papillary height (PH), keratinized tissue width (KTW), crown width/crown length ratio (CW/CL), and gingival thickness (GT). The secondary objective was to evaluate the optimal cutoff values for all parameters to determine the GB in both the maxillary and mandibular anterior teeth.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This cross-sectional study included 50 healthy individuals (26 men and 24 women) aged between 20 and 35 years. The GB was determined as a binary variable based on the transparency of a periodontal probe through the buccal gingival margin (TRAN). The clinical crown and periodontal parameters, such as PH, PD, KTW, GT (free gingival thickness [FGT] and attached gingival thickness [AGT]), and the CW/CL ratio were measured. The associations between different variables were evaluated by the chi-square test. Correlations between various clinical parameters and GB were assessed using point-biserial correlation analyses. Receiver operating characteristic (ROC) analysis and the Youden index were used to calculate the optimal cutoff values for the PH, PD, KTW, FGT, AGT, and CW/CL ratio to discriminate GB. The statistical significance level was set at &lt;i&gt;p&lt;/i&gt; &lt; 0.05.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The mean age of the males was 28.23 ± 2.81 years, while that of the females was 27.08 ± 2.85 years. Thick GB was present in 56% of individuals, and thin GB was present in 44% of individuals. Compared with females, males had a predilection for thick GB compared with females. According to the ROC analysis, the cutoff values to discriminate GB for mandibular anterior teeth were 3.4 mm for PH, 1.96 mm for PD, 4.21 mm for KTW, 0.98 mm for FGT, 0.43 mm for AGT, and 0.91 for the CW/CL ratio. Similarly, the cutoff values for discriminating the GB for maxillary anterior teeth were 4.02 mm for PH, 1.92 mm for PD, 3.89 mm for KTW, 1.02 mm for FGT, 0.42 mm for AGT, and 0.83 for the CW/CL ratio. PH, PD, and FGT showed strong positive correlations with GB, whereas KTW, AGT, and the CW/CL ratio showed weak positive correlation with GB.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Within the limitations of the present study, a significant association between all clinical crown and periodontal parameters with the GB has been confirmed. FGT for mandibular anterior teeth and PH for the mandibular anterior teeth have emerged as the mo","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"15 1","pages":"77-85"},"PeriodicalIF":0.9,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The wingspan suspension approach: A modified semilunar technique for multiple areas of recession.","authors":"Allison N Rascon, Bradley Lander, Joseph P Fiorellini, Rodrigo Neiva","doi":"10.1002/cap.10296","DOIUrl":"https://doi.org/10.1002/cap.10296","url":null,"abstract":"<p><strong>Background: </strong>Gingival recession can be considered an undesirable condition that results in the exposure of the root surface. There are many techniques that can be employed to address gingival recession; however, they frequently involve a second surgical site. Other approaches have been introduced in the past to address this concern, and this case study discusses the use of a modified technique to achieve root coverage.</p><p><strong>Methods: </strong>A patient presented to the periodontics clinic with concerns regarding gingival recession. A modification to the semilunar technique was employed to address the recession, whereas double sling sutures were utilized to maintain the coronal repositioning of the flap.</p><p><strong>Results: </strong>Maxillary central incisors initially presented with 2-3 mm of facial recession and root coverage was achieved by use of a modified surgical semilunar approach. No rebound noted over a 6-month period, newly established gingival margin deemed clinically stable.</p><p><strong>Conclusions: </strong>This case study provides an alternative to addressing gingival recession in the maxillary anterior region, when <3 mm of recession is noted. Avoidance of a second surgical procedure and/or donor site is of particular benefit, as well as maintenance of the blood supply.</p><p><strong>Key points: </strong>Why is this case new information? There is insufficient evidence on the use of a modified wingspan incision design Phenotype modification with elimination of a second surgical site is most ideal for the patient. What are the keys to successful management of this case? Comprehensive diagnosis and proper case selection Meticulous flap management and adequate release to allow for repositioning without tension Appropriate use ofsuture and suturing technique. What are the primary limitations to success in this case? Thin periodontal phenotype Poor oral hygiene and plaque accumulation postoperatively Loss to follow-up.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The distally anchored connective tissue graft platform for papilla enhancement: A case report.","authors":"Gonzalo Blasi, Lory Abrahamian, Alvaro Blasi","doi":"10.1002/cap.10299","DOIUrl":"https://doi.org/10.1002/cap.10299","url":null,"abstract":"<p><strong>Background: </strong>As the need for using dental implants to replace single missing teeth grows, so does the demand for greater esthetic results. However, achieving complete interproximal papillae fill in single-tooth implant restorations remains a challenge. The distally anchored connective tissue platform is a novel soft tissue augmentation technique that consists of harvesting an autogenous connective tissue graft from the palate, folding it, and positioning it at the level of the distal occlusal and buccal surfaces with the help of a distal sling suture to the adjacent distal tooth.</p><p><strong>Methods: </strong>This case report describes how a maxillary central incisor with compromised hard and soft tissues were replaced using a comprehensive treatment plan.</p><p><strong>Results: </strong>The clinical outcomes showed stable mucosal margin levels and complete papillae fill. The patient expressed satisfaction with the achieved results.</p><p><strong>Conclusions: </strong>The distally anchored connective tissue graft platform performed at the time of implant placement emerges as a viable and effective soft tissue augmentation technique that yields highly esthetic results.</p><p><strong>Key points: </strong>Why is this case new information? To the best of our knowledge, this is the first case report in the literature using the distally anchored connective tissue platform. What are the keys to successful management of this case? Adequate diagnosis and decision-making, resulting in a treatment plan focused on reconstructing both soft and hard tissues in a single-tooth implant within the esthetic area, yield favorable clinical, radiological, and patient-reported outcomes. What are the primary limitations to success in this case? The primary limitation of this study is its reliance on a single case report.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mucosal released-coronally advanced flap: A novel surgical approach-A case report.","authors":"Andrea Pilloni, Fabiola Dell'Olmo","doi":"10.1002/cap.10293","DOIUrl":"https://doi.org/10.1002/cap.10293","url":null,"abstract":"<p><strong>Background: </strong>The coronally advanced flap (CAF) can be a predictable surgical technique for the treatment of gingival recessions. However, the characteristics of the defect (e.g., limited amount of keratinized gingiva or flap tension, etc.) may limit the use of the CAF with a possible requirement of additional surgical interventions (i.e., the use of a tissue graft to be harvested from donor sites or connective tissue substitutes).</p><p><strong>Methods: </strong>A 28-year-old woman patient, with no history of periodontal disease, came for referral presenting receding gums as a chief complaint, poor esthetics, and dentinal hypersensitivity at the buccal surface of teeth 11, 12, and 13. Clinically, she presented a thick phenotype with gingival recession type, RT1, with detectable cemento-enamel junction (A‒) in the second quadrant. To reduce the need of harvesting soft tissue grafts, the amount of cutting of muscles and vessels from the inner portion of the flap and mitigate the postoperative discomfort associated with the CAF, a novel surgical approach is described here using an advanced flap that incorporates an external incision along the mucogingival junction.</p><p><strong>Results: </strong>The average root coverage achieved with the novel procedure presented in this case report was 95%, along with an increased amount of keratinized gingiva and minimal postoperative patient's discomfort.</p><p><strong>Conclusions: </strong>The mucosal released CAF is a promising technique in which the CAF technique alone may not be an indication.</p><p><strong>Key points: </strong>This technique has the following advantages: Reduce the need of harvesting soft tissue grafts. Reduce the amount of cutting of muscles and vessels from the inner portion of the flap. Minimal postoperative discomfort for the patient.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A clinical dilemma: Performing or avoiding root instrumentation in the treatment of the acute phase of endodontic-periodontal lesions? A case report.","authors":"Riccardo Pace, Riccardo Di Gianfilippo, Debora Franceschi, GiovanPaolo Pini Prato","doi":"10.1002/cap.10297","DOIUrl":"https://doi.org/10.1002/cap.10297","url":null,"abstract":"<p><strong>Background: </strong>This study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis.</p><p><strong>Methods: </strong>Clinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface.</p><p><strong>Results: </strong>At 6-month and 1-year follow-ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4-year follow-up period.</p><p><strong>Conclusions: </strong>The spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL.</p><p><strong>Key points: </strong>Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic-periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic-periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo-periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of intentional early dense-polytetrafluoroethylene membrane removal on vertical ridge augmentation.","authors":"Fabrizio Belleggia","doi":"10.1002/cap.10298","DOIUrl":"https://doi.org/10.1002/cap.10298","url":null,"abstract":"<p><strong>Background: </strong>Vertical ridge augmentation (VRA) requires long healing times for bone maturation. This case study deals with the intentional early removal of a titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membrane that allowed for treatment times reduction and improvement of bone quality.</p><p><strong>Methods: </strong>A TR-dPTFE membrane was used for VRA in the premolar region of the upper right maxilla. The defect was filled with a mix of particulate autogenous bone and porcine xenograft in a 1:1 ratio. After a 4-month uneventful healing period, the membrane was removed, and the thick keratinized palatal tissue was moved toward the buccal side via a pedicle flap. Implants insertion and healing abutments application were carried out 3 months later, when bone graft could have been revascularized and nourished by the periosteum.</p><p><strong>Results: </strong>The histologic evaluation of a bone sample harvested during implant bed preparation revealed a huge amount of mature newly formed bone even in the most coronal part. Two screw-retained crowns were delivered 2 months after implant insertion and the 3.5-year follow-up showed perfectly maintained hard and soft tissues.</p><p><strong>Conclusions: </strong>Intentional early removal of TR-dPTFE membrane after a 4-month healing time, with simultaneous soft tissue augmentation via a buccally reposioned pedicle flap, allowed graft revascularization from the periosteum, and resulted in optimal quantity and quality of the regenerated bone. This process shortened the overall treatment times, taking only 9 months from VRA to prosthetic loading. Both augmented hard and soft tissues allowed for crestal bone maintenance around implants.</p><p><strong>Key points: </strong>Titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membranes, due to their closed structure, do not allow the passage of cells and vessels from the periosteum, and revascularization from the residual bone alone is not enough for proper graft maturation and long-term crestal bone maintenance. Early removal of TR-dPTFE membrane allows graft revascularization from the periosteum, and results in optimal quantity and quality of the regenerated bone. Increasing the thickness of the soft tissues, increasing the width of the keratinized mucosa, and repositioning the mucogingival line, via a free gingival graft or a pedicle flap, should be performed simultaneously in the membrane removal phase to reduce the number of surgical interventions, decrease patient morbidity, and shorten the total treatment time.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 3-year follow-up of implant placement in proximity to canalis sinuosus: Case study.","authors":"Cássio Cardona Orth, Celso Orth, Celso Cardona Orth, Lisângela da Silva, Maria Helena Streb, Mike Dos Reis Bueno","doi":"10.1002/cap.10294","DOIUrl":"https://doi.org/10.1002/cap.10294","url":null,"abstract":"<p><strong>Background: </strong>While the nasal fossa and nasopalatine canal are recognized limitations for immediate implants in esthetic areas, the canalis sinuosus (CS) and its branches have been largely overlooked. Neglecting this anatomy can lead to sensory issues, pain, and implant failure underscores the necessity of meticulous pre-surgical assessment and planning to mitigate risks and ensure implant success. This case highlights the need for comprehensive pre-surgical evaluation and precise planning to minimize these complications and ensure successful implant outcomes in this scenario.</p><p><strong>Methods and results: </strong>A 41-year-old woman with a history of root perforation and external root resorption was referred for dental implant placement. Following clinical evaluation and computed tomography, the presence of an accessory canal of the CS was identified. After meticulous planning to avoid implant contact with this structure, ridge preservation was performed. After 6 months, the implant was successfully placed following guided osteotomy. The case demonstrates clinical and radiographic stability after 36 months of follow-up.</p><p><strong>Conclusion: </strong>The correct diagnosis and planning, within a multidisciplinary team, can lead to successful implant placement in a challenging site with an anatomical variation. This study, to our knowledge, represents the first to propose an alternative treatment approach in the presence of CS in an esthetic region.</p><p><strong>Key points: </strong>Why is this case new information? This case emphasizes the importance of thorough pre-surgical evaluation to mitigate potential complications related to the CS. It is the first, to our knowledge, to propose an alternative treatment approach in the presence of this anatomical variation in an esthetic region. What are the keys to successful management in this case? Comprehensive pre-surgical evaluation, precise planning with detailed CBCT assessment to identify the CS, careful consideration of its anatomy during surgical intervention, knowledge of the limitations of tissue reconstructions, and precise clinical strategies to minimize associated complications. What are the primary limitations to success in this case? The need to position the implant with a safety margin from the CS led to implant positioning resulting in fenestration of the buccal bone plate, preventing its reconstruction due to the bone envelope's design, resulting in a discrepant gingival margin compared to the contralateral tooth, which did not allow for further crown lengthening due to a rather short root.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digitally guided root removal and simultaneous implant placement: A case study","authors":"Roksolana Gala,&nbsp;Mohammed Al Sammarraie,&nbsp;Rocio Sanchez Padilla,&nbsp;Zheng Zhou,&nbsp;Anthony L. Neely,&nbsp;Bassam M. Kinaia","doi":"10.1002/cap.10292","DOIUrl":"10.1002/cap.10292","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The follow-ups at 1, 3, and 6 weeks and 4, 8, and 10 months revealed good bone preservation with an osseointegrated implant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key points</h3>\u0000 \u0000 <div>\u0000 <ul>\u0000 \u0000 <li>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.</li>\u0000 \u0000 <li>A digitally planned 3D surgical guide is a useful method for extracting retained roots during implant placement to minimize bone damage.</li>\u0000 \u0000 <li>Digital planning provides a precise and minimally invasive implant surgery.</li>\u0000 </ul>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":"15 1","pages":"69-76"},"PeriodicalIF":0.9,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}