1/82. Guided bone regeneration using titanium grids: report of 10 cases.In order to ensure an adequate space where new bone can be formed in guided bone regeneration (GBR), most surgeons fill bone defects with biomaterials. In this work we evaluated new bone regeneration in 10 patients using only a blood clot protected with titanium grids and non-resorbable membranes, without any filling material. A manual measurement of the size of the bone defect, using a plastic probe, was performed at 2 surgical steps. After 5 months of treatment, a biopsy was taken from each patient, fixed and embedded in PMMA, examined microradiographically and morphologically to evaluate the newly-formed bone. Our results showed a good repair of the defects by bone regeneration (about 85% overall), high mineral density of new bone around the implants after 5 months, and steady state deposition processes. These results in GBR, without filling material, appear very promising for implantology and reconstructive odontostomatology practice.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/82. Tomodensitometric and histologic evaluation of the combined use of a collagen membrane and a hydroxyapatite spacer for guided bone regeneration: a clinical report.In this report, the problems of insufficient bone and soft tissue after extraction of maxillary incisors were addressed concurrently prior to endosseous implant placement, by combining the use of a diphenylphosphorylazide-cross-linked Type I collagen membrane and a resorbable space-making biomaterial composed of 200-micron porous hydroxyapatite granules blended in Type I collagen and chondroitin-4-sulfate. Upon flap reflection 8 months postsurgery, the horizontal deficiencies were almost completely resolved, membranes completely resorbed and the defects filled with hard, bonelike tissue, with a few superficial hydroxyapatite granules. Histologic evaluation of the bone biopsies obtained at the implantation sites revealed dense, well-reconstructed alveolar bone with a few traces of hydroxyapatite granules that had been completely resorbed. Tomodensitometric evaluation indicated that bone regeneration ranged from 14% to 58%, with an average bone gain of 29.77%. Four nonsubmerged ITI titanium implants placed in the augmented bone have been in function for more than 5 years, with no clinical or radiographic signs of hard or soft tissue breakdown. Bacterial sampling at dental sites with periodontitis 1 month prior to periodontal therapy and at implant sites for up to 30 months demonstrated rapid colonization of implant surfaces by periodontopathogens without causing any detrimental effect to implant integration.- - - - - - - - - - ranking = 6keywords = membrane (Clic here for more details about this article) |
3/82. Spacemaking metal structures for nonresorbable membranes in guided bone regeneration around implants. Two case reports.This article presents a surgical technique to promote bone regeneration and enlargement of localized alveolar ridge defects in the mandible. The purpose of this study was to investigate the use of spacemaking gold frames used in combination with expanded polytetrafluoroethylene Gore-Tex augmentation membranes (WL Gore) on two patients to create and maintain adequate space for the regeneration of bone. The membrane was sutured under the frame and the assembly was bent and adapted over the residual bony defect to create a dome and prevent the expanded polytetrafluoroethylene barrier membranes from collapsing into the defects. The framed membranes have also been positioned over dehisced implants. After a healing period of 12 months, a second-stage surgery procedure was performed to remove the gold frames and expanded polytetrafluoroethylene membranes and to connect the healing abutments. The gain of bone dimension was assessed by standardized measurements. On both patients the spaces created by the framed membranes were completely filled with newly regenerated bone. Biopsies from the treated sites revealed new bone formation.- - - - - - - - - - ranking = 10keywords = membrane (Clic here for more details about this article) |
4/82. Periodontal and peri-implant bone regeneration: clinical and histologic observations.The principle of guided tissue regeneration by barrier membranes to restore lost periodontal tissue around natural teeth has also been used around osseointegrated implants in an attempt to restore alveolar ridge defects. While most periodontal procedures in the literature describe root coverage by mucogingival surgery, which achieves healing through soft tissue attachment, regeneration of denuded root surfaces is performed by guided tissue regeneration using expanded polytetrafluoroethylene barrier membranes and demineralized freeze-dried bone allografts as inductive/conductive materials. In this study the technique is applied in two partially exposed cylindrical hydroxyapatite-coated implants in extraction sites in one patient. Surgical reentry in both sites is presented, with histologic examination revealing new bone formation on the exposed root surface and the hydroxyapatite-coated implants.- - - - - - - - - - ranking = 2keywords = membrane (Clic here for more details about this article) |
5/82. bone regeneration around an osseointegrated implant. A simultaneous approach in a fenestrated defect: a case report.The use of a barrier membrane, with or without osseous allograft, has been shown to establish regeneration of osseous tissue around dental implants. Following three episodes of persistent symptomatic failed apicoectomy and subsequent tooth extraction, an osseointegrated implant was placed in a wide fenestrated defect. Demineralized freeze-dried bone allograft was covered by an occlusive expanded polytetrafluorethylene membrane. The reentry procedure revealed complete bone fill that followed the texture of the augmentation material beyond the previous buccal bony envelope.- - - - - - - - - - ranking = 2keywords = membrane (Clic here for more details about this article) |
6/82. Cemental tear treated with guided tissue regeneration: a case report 3 years after initial treatment.Cemental tear is a rare but probably underdiagnosed condition that may be a factor in rapid periodontal breakdown. The present case report describes the regenerative treatment of a periodontal lesion around a mandibular canine in a 50-year-old woman. The preoperative radiograph revealed a small cemental tear within an intrabony lesion. The three-wall bony lesion was treated with a barrier membrane and followed for 3 years. periodontal pocket reduction was 5.5 mm, and attachment gain amounted to 3.5 to 4.5 mm Standardized radiographs showed remarkable, 1.6-mm bone fill of the intrabony lesion. Also, a band of keratinized tissue had formed.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
7/82. Localized ridge maintenance using bone membrane.The immediate placement of a dental implant into a fresh extraction socket has been limited in many instances by the quantity of bone that remains after the extraction. This article presents two clinical cases that demonstrate successful regeneration of alveolar ridges in which there was extensive loss of the buccal plate of bone. This lack of alveolar process impeded the immediate placement of dental implants into fresh extraction sockets. The surgical technique performed in these cases was based on the principles of guided bone regeneration using a demineralized freeze-dried bone membrane. The bone membrane acted as an efficient barrier that excluded the nonosteogenic tissues. Bone formation took place for the placement of endosseous dental implants 8 months after the procedures were initiated. These human clinical cases confirm positive results of previous animal findings.- - - - - - - - - - ranking = 6keywords = membrane (Clic here for more details about this article) |
8/82. Treatment of peri-implantitis: longitudinal clinical and microbiological findings--a case report.Failing implants can be successfully treated by surgical procedures that use either bone fillers or membranes combined with an antimicrobial treatment. In this report, we present a case of failing implants with the corresponding treatment and results of 8 years of follow-up.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
9/82. Laser de-epithelialization for enhanced guided tissue regeneration. A paradigm shift?The rationale for laser de-epithelialization stems from the attempts to block the down-growth of epithelium into the healing periodontal wound after surgery and prevent formation of a long junctional epithelial attachment. This concept has seen numerous techniques for accomplishing the blockage of epithelium. The advent of GTR was an offshoot of this concept and led Gottlow et al [table: see text] to examine the effects of selectively blocking certain cell types from contacting the root surface during periodontal wound healing. The use of a CO2 laser to de-epithelialize the gingival flaps is an attempt to exclude this cell type from the healing wound and has been used with and without the benefit of GTR membranes. In a study on beagle dogs, the histologic results of using membranes and the laser procedure enhanced the wound healing and regeneration of new bone, cementum, and connective tissue attachment when compared with paired defects using the membranes alone. The results from the human studies and case reports combined with the animal studies indicate a positive benefit in wound healing because of the laser de-epithelialization technique. The use of an osseous graft in treatment of periodontal defects has been shown to stimulate new bone growth effectively and to regenerate new attachment. It has been speculated that the additional benefit of an osseous graft in GTR procedures is the organization of the blood clot at initial healing, which may tend to maintain the space needed for regeneration and to provide a matrix for the fibrin clot to retard epithelial down-growth. Studies comparing the results of osseous grafting with flap debridement always have shown that the amount of new bone formation and clinical new attachment favor the grafted sites versus paired nongrafted sites. The effects of removal of the pocket epithelium at the time of periodontal surgery have been studied by several authors, and these studies generally shown an incomplete removal of the sulcular epithelium by the inverse bevel incision. Epithelial excision was studied by Centty et al, who compared the removal of sulcular epithelium by the CO2 laser technique with conventional methods. Their results confirm that (1) a more complete removal of sulcular epithelium was obtained by laser than by knives, and (2) the technique effectively removes the oral and sulcular epithelium from a gingival flap without damaging the viability of the flap during wound healing. The technique as described in this article was used by israel et al to verify further the ability to maintain a viable gingival flap during multiple laser deepithelialization procedures in humans during the first 30 days of healing. [table: see text] The concept of laser de-epithelialization as an adjunct to regenerative periodontal procedures currently is being studied in a multicenter university setting using a parallel study in controlled clinical trials. The first of these reports was mentioned previously (Araujo et al, unpublished data) and shows the enhanced wound healing of periodontal defects through use of the laser de-epithelialization technique. The authors believe that this technique has shown significantly better results than those obtained through conventional osseous grafting alone and appears to be comparable to the results reported for GTR procedures with barrier membranes. This concept provides a paradigm shift from the conventional use of GTR therapy by acknowledging the difficulty in controlling epithelium during the early wound healing. It also allows a more comprehensive therapy for treating periodontal disease that addresses the generalized nature of the disease, with multiple lesions being treated concurrently in an economical manner. The patient presenting with generalized advanced periodontal disease could have several defects definitively treated in one quadrant using the laser deepithelialization technique without the need for multiple membrane therapy. (ABSTRACT TRUNCATE- - - - - - - - - - ranking = 5keywords = membrane (Clic here for more details about this article) |
10/82. Ridge preservation of dentition with severe periodontitis.Severe loss of alveolar bone height and width can occur following the removal of teeth with advanced periodontitis. This compromise of the alveolar bone can limit the options available for achieving an acceptable dental restoration. Two case reports are presented of alveolar ridge augmentation after tooth removal and before implant placement using bone grafting and a biodegradable membrane. The resultant alveolar ridges in both patients were adequate for the placement of dental implants.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
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