Cases reported "Alveolar Bone Loss"

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1/283. 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.
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2/283. guided tissue regeneration in the management of severe periodontal-endodontic lesions.

    diagnosis of combined periodontal-endodontic lesions can prove difficult and frustrating. They are often characterised by extensive loss of periodontal attachment and alveolar bone, and their successful management depends on careful clinical evaluation, accurate diagnosis, and a structured approach to treatment planning for both the periodontic and endodontic components. Recent advances in regenerative periodontics have led to improved management of periodontal-endodontic lesions. This paper reviews the management of such lesions in light of these recent advances and illustrates this through reports of two patients who had severe periodontal involvement.
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3/283. 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.
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4/283. Tissue necrosis after subgingival irrigation with fluoride solution.

    Irrigation of periodontal pockets with fluoride solution after scaling and root planing is occasionally recommended to inhibit the growth of pathogenic bacteria in the periodontal pocket. At the same time, irrigation enables mechanical removal of loosely adhering plaque and debris. Due to its toxicity, fluoride solution deposited in the periodontium may lead to tissue damage. We report in this paper, a case of extensive periodontal tissue necrosis and permanent loss of alveolar bone after irrigation of periodontal pockets with stannous fluoride solution. The literature on the toxic effects of fluoride on the local tissues is briefly reviewed and arguments for a re-evaluation of the use of stannous fluoride for pocket irrigation are provided.
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5/283. 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.
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6/283. 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.
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7/283. 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.
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8/283. 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.
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9/283. Effective periodontal treatment in a patient with type IIA von Willebrand's disease: report of a case.

    von Willebrand's disease (vWD) is one of the most common hereditary hemorrhagic disorders. A mild to moderate deficiency of factor viii and von willebrand factor (vWf) often is associated with gingival bleeding. In this case report, the periodontal treatment of a patient with vWD is described. A 45-year-old woman with type IIA vWD was referred for periodontal therapy because of an episode of gingival hemorrhage and percussion pain of teeth #18 and #47. The periodontal findings included probing depths ranging from 2 to 6 mm, horizontal bone loss, and Class II furcation involvement of tooth #46. After consultation with a hematologist, apically positioned flap surgery and hemisection were performed on tooth #46 following completion of oral hygiene instruction, scaling and root planing, and endodontic therapy. The patient was given 500 units of factor viii including vWf multimer 30 minutes before surgery. After healing of the periodontal tissue, prosthodontic treatment was undertaken on the posterior mandibular sextants. At follow-up, the probing depths ranged from 2 to 3 mm, and gingival bleeding on probing was minimal. The patient's children all had vWD. They had mild to moderate periodontitis with probing depths ranging from 2 to 5 mm and gingival bleeding on probing. With the combined efforts of the periodontist and hematologist, effective periodontal treatment can be provided to patients with von Willebrand's disease.
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10/283. Use of crestal bone for augmentation of extremely knife-edged alveolar ridges prior to implant placement: report of 3 cases.

    A technique is presented for interforaminal lateral augmentation of mandibles with adequate bone height, but extremely knife-edged mandibular alveolar ridges (Class IV of Cawood and Howell's classification of residual ridges), in which the crestal portion of the knife-edged ridge is used as grafting material. Following an osteotomy and rotation of the grafts by 180 degrees, the grafts were fixed to the residual ridge below the osteotomy line by means of miniscrews. All grafts showed only mild resorption after a healing period of 3 months, and it was possible to place 4 implants in the now sufficiently wide host region.
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