Biologic Interfaces in Esthetic Dentistry. Part I: The Perio/restorative Interface
Biologic Interfaces in Esthetic Dentistry. Part I: The Perio/restorative Interface
Biologic Interfaces in Esthetic Dentistry. Part I: The Perio/restorative Interface
net/publication/51472861
Article in European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The · June 2011
Source: PubMed
CITATION READS
1 829
2 authors:
All content following this page was uploaded by Arndt Happe on 17 March 2015.
* This article is Part I of a two-part review on biological interfaces in esthetic dentistry that took place
at the European Association of Esthetic Dentistry (EAED) Active Members Meeting in October 2010
in Tremezzo, Italy. Please see Part II (Eur J Esthet Dent 2011;6:226–251) for discussion of the peri-
implant/restorative interface.
206
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
KÖRNER/HAPPE
207
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME
VOLUME66
••NUMBER
NUMBER21
••SUMMER
SPRING 2011
scientific session
esthetic dentistry. The meeting aims to shape and size of teeth to improve the
be a thorough and well-structured dis- smile, which in turn should fit perfectly
cussion that will generate conclusions. in the general esthetic appearance of
For this reason the discussion will be the patient. However when there is the
founded on presented essays address- need to use prosthetic therapy, espe-
ing specific issues divided in two parts cially in periodontally susceptible pa-
as follows: tients, many questions arise.
Part I: the perio/restorative interface Surgical and prosthetic crown length
Part II: the peri-implant /restorative modifications, surgical and orthodontic
interface. leveling of gingival margins, improving
quality and quantity of attached gingiva,
At this point, it is more than appropri- periodontal plastic surgery procedures
ate for the Scientific Chairman of this such as root coverage, ridge augmen-
meeting to extend genuine gratitude to tation, recapture of papilla height are all
the two essayists, Dr Gerd Körner and problems which the clinician is confront-
Dr Arndt Happe and to the two mod- ed with, every day. Hard and soft tis-
erators, Dr Giano Ricci and Prof. Jörg sues need to be mastered in the proper
Strub for their willingness to invest their way. Stability of the gingival margins,
hard work and time toward the success absence of pocket depth, functionality
of such a demanding workshop. Also, and esthetic long-term results are key-
a warm invitation is extended to all the words for the sophisticated operator.
Life and Active Members of the Acad- Location of the prosthetic finish line
emy to respond to this opportunity by is a fundamental aspect of the esthetic
actively participating in the workshop, outcome. A good long-term result will
as proposed in the guidelines. depend on many different considera-
tions, such as tooth position, periodon-
tal biotype, susceptibility to periodontal
Moderator’s introduction disease, control of inflammation, and
good oral physiotherapy. In order to
by Dr Giano Ricci maintain marginal soft tissue stability, all
of these parameters must be kept under
The times when people wanted just to control along with proper prosthetic ma-
save the natural dentition without con- nipulation. It is imperative not to violate
cern for esthetics have long gone. To- the biologic width. The influence of the
day’s periodontal treatment requires type of restorative material, provided it
great consideration for good esthetic is precise, smooth, polished and doesn’t
results at the end of therapy. In most allow plaque accumulation, has yet to
cases, to completely solve the function- be scientifically demonstrated.
al and esthetic problems of periodontal In patients who have undergone peri-
disease or periodontal therapy, there is odontal surgery for treatment of the at-
the need to utilize a combined surgical tachment apparatus, for periodontal
and prosthetic approach, especially plastic surgery or for crown lengthen-
when it is necessary to recapture the ing procedures, it is mandatory to wait
208
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
KÖRNER/HAPPE
a long period of time, much longer than ural tooth surface.” This statement by
usually believed especially in esthetic Wunderlich and Cafesse (1985)1 will
cases. This precaution is fundamental stay true even in the future. Ideally no
in order to allow proper maturation of the restoration should approach the gingival
tissues, which present a wide range of apparatus. However, as case demands
patient-related responses. often dictate violating this ideal, the in-
The most demanding esthetic chal- tention of this article is to clarify different
lenge is the recapture of papilla height factors influencing the relationships be-
both around natural teeth or implants. tween the periodontal surroundings and
Different surgical techniques have the restorative situation on the interface.
been proposed but the results seem
questionable and very technically sen-
sitive. It is in this area that surgical and Essay 1: Esthetics and
prosthetic procedures may be really
stability of the marginal
complementary and must act together
interface as influenced
to obtain the ultimate result. This will
be accomplished and maintained in
by its location and the
the long term only if the oral hygiene of restorative material
the patient is excellent and a strict pro-
tocol of supportive periodontal therapy 1.1 The periodontal soft tissue
is followed. The tooth is secured in the alveolar
The planned discussion regarding bone by a combination of connective
most of the above issues will be found- tissue and epithelial attachment.2 Con-
ed on presented essays addressing the nective tissue attaches to a tooth in two
specific items as follows: distinct areas: below the alveolar crest
esthetics and stability of the marginal and above the alveolar crest. With this,
interface as influenced by its loca- maxillary gingival fiber bundles pro-
tion and the restorative material vide additional attachment to secure
long-term stability of marginal surgi- the tooth in the alveolus, but they also
cal intervention: crown lengthening, serve to immobilize the gingival tis-
guided tissue regeneration and soft sues in relation to the supra-alveolar
tissue grafting portion of the root cementum. This tis-
predictability and long-term stability sue immobility, along with resistance
of reconstructing the interproximal to bacterial and mechanical challeng-
papilla in abutment teeth and in pon- es, contributes to the maintenance of
tic areas. a permucosal seal. The outer part of
this seal is constituted by three types
of epithelium.
The essays The junctional epithelium attaches
to the tooth and occupies the area be-
“There is no doubt that at present no tween the most coronal attachment of
man-made restorative can match the the supra-alveolar connective tissue and
biologic acceptance of a hygienic nat- the base of the gingival crevice. The thin,
209
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
scientific session
210
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
KÖRNER/HAPPE
cilitate subgingival plaque accumulation Considering that there has been an in-
with resultant inflammatory alterations in creasing demand for esthetic restorations
the adjacent gingiva.12–15 All investiga- in recent years, the type of restorative
tions are supporting the landmark study material and the subgingival microflora
by Valderhaug 198016 regarding the features after the placement of well-fin-
negative impact of subgingival restor ished subgingival restorations were of
ation margins followed by 40% showing interest for Paolantonio et al.15 In a short-
supragingival exposure already after term clinical and microbiological investi-
1 year. At the 10-year examination, as gation over a 1-year observation period,
many as 71% of the restorations had be- amalgam, glass-ionomer cement, and
come supragingivally positioned due to composite resin subgingival restorations
unesthetic recession of the soft tissue did not significantly effect the clinical pa-
margin. rameters recorded. However, composite
Stetler and Bissada17 could demon- resin restorations may have some nega-
strate that teeth with subgingival resto- tive effects on the quantity and the quality
ration margins and a narrow (< 2 mm) of the subgingival plaque. Compared to
band of keratinized gingiva in the apico– other investigations26-29 the effects were
coronal direction showed more pro- not as detrimental to gingival health. The
nounced clinical signs of inflammation dissimilarity was explained by the small
than restored teeth with a wide gingival number of subjects highly motivated
zone. But there was no difference in loss towards oral hygiene and by the accu-
of probing attachment. However, if sub- rate contouring, finishing, and polishing
gingivally placed restorations facilitate of subgingival restorations.30-31 These
plaque accumulation and the adjacent findings are supported by a review from
so-called “gingival biotype”18–19 is “thin- Quirynen and Bollen32 explaining the in-
scalloped,” there may be a potential risk fluence of surface roughness and sur-
for the development of soft tissue reces- face-free energy on supra- and subgin-
sion. This conclusion can be drawn from gival plaque formation in man.
findings in an animal model20 and from Rough surfaces will promote plaque
clinical observation.21 formation and maturation, high-energy
surfaces are known to collect more
1.4 Influence of material plaque. Although both variables in-
teract with each other, the influence of
Subgingival restoration margins neither surface roughness overrules that of the
prevent recurrence of decay,22–23 nor surface free energy. In accordance to
do they stop the onset of gingivitis, peri- these findings, different investigations
odontal attachment loss, or gingival re- are ranking several materials in respect
cession.23-24 Nevertheless there is a ten- to plaque accumulation and biocompat-
dency to hide them, in the sulcus or even ibility:33-39,122
subgingivally, out of esthetic and func- glass-ceramics
tional reasons.25 In those situations, den- zirconium oxide
tal restoration materials are coming into titanium
intimate contact with the adjacent tissues. dental porcelain
211
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
scientific session
Fig 1.1 Situation after periodontal treatment, Fig 1.2 Minimally invasive preparation after ad-
before restorative correction. hesive filling of cervical erosions with composite.
212
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
KÖRNER/HAPPE
Fig 1.3 Glass ceramic veneers for best biologic Fig 1.4 Clinical situation after cementation of
response and esthetic outcome. veneers 12 to 22.
6 months. This pattern of coronal dis- The best research data available is for
placement of the gingival margin was the coronally advanced flap (CAF) pro-
more pronounced in patients with “thick cedure. It is based on the coronal shift of
gingival biotype” and also appeared to the soft tissues on the exposed root sur-
be influenced by individual variations in face.52-53 This approach may be used
the healing response, not related to gen- alone or in combination with soft tissue
der or age. grafts,54 barrier membranes (BM),55
enamel matrix derivative (EMD),56 acel-
2.2 Root coverage lular dermal matrix (ADM),57 platelet
plasma (RPP),58 and living tissue-engi-
The treatment of gingival recession in neered human fibroblast-derived der-
the area of the perio-restorative inter- mal substitute (HF- DDS).59
face is a common requirement due to Cairo et al60 conducted a systemat-
patient–centered concerns including ic review where only randomized-con-
root sensitivity, difficulty in plaque con- trolled clinical trials (RCTs), including a
trol, increased potential for root caries, split-mouth model of at least 6 months
restorative failure, and compromised es- duration, were considered to measure
thetics.47 and compare clinically relevant out-
The ultimate goal of a root coverage comes for Miller Class I or II localized
procedure is the complete coverage gingival recession defects. Determining
of the recession defect with stable and complete root coverage (CRC) as the
good appearance related to adjacent primary outcome variable revealed the
soft tissues and minimal probing depth most decisive result: only two combina-
(PD).48-50 tions (CAF + CTG and CAF + EMD) pro-
A large variety of different procedures vided better results than CAF alone. And
may be indicated51-52 even though for no other therapy showed better results
some, very limited data are available. than CAF + CTG.
213
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
scientific session
214
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
KÖRNER/HAPPE
215
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
scientific session
Essay 3: Predictability
and long-term stability of
reconstructing the inter-
a
proximal papilla next to
restorative situations
Fig 2.7 Situation after conventional periodontal
treatment with persisting violation of biologic width
caused by the old unesthetic restoration. 3.1 Preserving and reconstructing
the interproximal papilla
The interproximal papilla first described
by Cohen in 195971 is the gingival por-
tion, which occupies the space between
two adjacent teeth or adequate clinical
restorations supported by natural teeth
and implants or pontic designs.
The interproximal papilla, playing a
critical role for esthetics and phonet-
ics, may accordingly appear in different
constellations. In any case the founda-
a tion for the structured support is the un-
derlying contour of the osseous crest.
Fig 2.8 Final preparation 6 months after surgery
(maxillary front left).
However the mere existence of the bio-
logic width4,6 with more or less constant
value of 2 mm supra-crestal gingival tis-
sue fails to explain by itself the 5 mm
height72,73 of the interdental papilla.
It became obvious that other key
factors, besides the bone level, may
be involved in the papillary presence/
absence like the presence of the adja-
cent tooth attachment and the volume
of the gingival embrasure.74,75 Follow-
ing Tarnow et al,73 the vertical height
a
from the base of the interproximal
Fig 2.9 Final situation 1 year later. contact to the bone crest is one deter-
mining factor in maintaining a papilla.
But there are other factors in a more
216
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
KÖRNER/HAPPE
Table 1 Tissue height needed from the contact point to the crestal bone level in order to maintain papillae
in different clinical situations. From Zetu and Wang.78
three-dimensional direction like form the needed dimensions among the pos-
and volume of the embrasure, size, sible abutment constellations (Table 1).
shape of the contact area, lateral bone The proper soft tissue management
dimension, root proximity, and biotype is directed to recreate the papillae.97-99
playing a major role.76,77 Hence, there Different techniques for papilla pres-
are different options for therapeutic im- ervation100–105 have been described
pact:78 for beneficial impact on papilla recon-
preserving and reconstructing the struction. Especially in regard to implant
interproximal bony support uncovering techniques in combination
proper soft tissue management with optional soft tissue grafting, a large
beneficial selection of abutment con- variety of techniques were introduced
stellations recently.106–110
restorative interproximal design. The predictability of all these tech-
niques remains to be determined.
Socket preservation techniques79-91 Since soft tissue collapse can occur
have been developed to preserve or re- following bone resorption, additional
construct the interproximal space even steps can be taken for the impact on
in combination with forced orthodontic interproximal tissue height. Immediate
extrusions92 while maintaining or re- tooth replacement using an ovate pon-
building the soft tissue surroundings. tic to support the papilla for a natural-
Different bone augmentation tech- appearing emergence profile,111 for
niques have been advocated for sup- example in combination with strategic
porting the papilla appearance includ- abutment selection (Table 1) can be an
ing but not limited to GBR,93 onlay advantage. Last but not least, there are
grafting,94 distraction osteogenesis95 different options for having synergetic
and combinations of soft and hard tis- impacts in terms of backing and rein-
sue grafting.96 The aim of reconstruct- forcing the interproximal papilla by a
ing the bony support is to match ideally longer term provisional restoration,112
217
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
scientific session
Fig 3.1 Periodontally compromised tooth 21 can Fig 3.2 Vertical correction of the defect via osseo
not be preserved. distraction.
Figs 3.3 and 3.4 Implant 21 uncovering in combination with root coverage of tooth 11 and 22 interprox
imally and labially at implant site by a connective tissue graft, before and after suturing.
218
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
KÖRNER/HAPPE
Fig 3.5 Final restoration: veneers of tooth 11 and Fig 3.6 Final restorative situation 1 year postop-
22 and zirconia-based ceramic restoration of im- eratively.
plant 21.
219
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
scientific session
220
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
KÖRNER/HAPPE
29. van Noort R, Davis LG. The 39. Kollar A, Huber S, Mericske 48. Miller PD Jr. A classification
surface finish of composite E, Mericske-Stern R. Zirco- of marginal tissue recession.
resin restorative materials. nia for teeth and implants: a Int J Periodontics Restora-
Br Dent J 1984 24;157:360– case series. Int J Periodon- tive Dent 1985;5:8–13.
364. tics Restorative Dent 2008; 49. Roccuzzo M, Bunino M,
30. Gorzo I, Newman HN, Stra- 28:479–487. Needleman I, Sanz M. Peri-
han JD. Amalgam restora- 40. Palomo F, Kopczyk RA. odontal plastic surgery for
tions, plaque removal and Rationale and methods for treatment of localized gingi-
periodontal health. J Clin crown lengthening. J Am val recessions: a systematic
Periodontol 1979;6:98–105. Dent Assoc 1978;96:257– review. J Clin Periodontol
31. Laurell L, Rylander H, Pet- 260. 2002;29:178–194; discus-
tersson B. The effect of 41. Carnevale G, Sterrantino SF, sion 195–196.
different levels of polishing Di Febo G. Soft and hard 50. Clauser C, Nieri M, Franc-
of amalgam restorations on tissue wound healing follow- eschi D, Pagliaro U, Pini-
the plaque retention and ing tooth preparation to the Prato G. Evidence-based
gingival inflammation. Swed alveolar crest. Int J Peri- mucogingival therapy. Part
Dent J 1983;7:45–53. odontics Restorative Dent 2: Ordinary and individual
32. Quirynen M, Bollen CM. 1983;3:36–53. patient data meta-analyses
The influence of surface 42. Oakley E, Rhyu IC, Karat- of surgical treatment of
roughness and surface- zas S, Gandini-Santiago L, recession using complete
free energy on supra- and Nevins M, Caton J. Forma- root coverage as the out-
subgingival plaque forma- tion of the biologic width come variable. J Periodontol
tion in man. A review of the following crown lengthening 2003;74:741–756.
literature. J Clin Periodontol in nonhuman primates. Int 51. Oates TW, Robinson M,
1995;22:1–14. Review. J Periodontics Restorative Gunsolley JC. Surgical
33. Weber H. Netoschil: Bio-kom- Dent 1999;19:529–541. therapies for the treatment
patibilität und Plaquewachs- 43. Brägger U, Hämmerle CH, of gingival recession. A
tum usw. Dtsch Zahnarztl Z Mombelli A, Bürgin W, Lang systematic review. Ann Peri-
1992;47:278–281. NP. Remodelling of peri- odontol 2003;8:303–320.
34. Wang JC, Lai CH, Listgarten odontal tissues adjacent to 52. Allen EP, Miller PD Jr. Coronal
MA. Porphyromonas gingi- sites treated according to positioning of existing gin-
valis, Prevotella intermedia the principles of guided tis- giva: short term results in the
and Bacteroides forsythus in sue regeneration (GTR). Clin treatment of shallow marginal
plaque subjacent to bridge Periodontol 1992;19:615– tissue recession. J Periodon-
pontics. J Clin Periodontol 624. tol 1989;60:316–319.
1998;25:330–333. 44. Herrero F, Scott JB, Maropis 53. Pini Prato G, Pagliaro U,
35. Scarano A, Piattelli M, PS, Yukna RA. Clinical com- Baldi C, Nieri M, Saletta D,
Caputi S, Favero GA, parison of desired versus Cairo F, Cortellini P. Coronal-
Piattelli A. Bacterial adhe- actual amount of surgical ly advanced flap procedure
sion on commercially crown lengthening. J Perio for root coverage. Flap with
pure titanium and zirco- dontol 1995;66:568–571. tension versus flap without
nium oxide disks: an in vivo 45. Pontoriero R, Carnevale G. tension: a randomized con-
human study. J Periodontol Surgical crown lengthening: trolled clinical study. J Peri-
2004;75:292–296. a 12-month clinical wound odontol 2000;71:188–201.
36. Krekeler G, Kappert H, Pelz healing study. J Periodontol 54. Wennström JL, Zucchelli G.
K, Graml B. Die Affinität der 2001;72:841–8. Increased gingival dimen-
Plaque zu verschiedenen 46. Deas DE, Moritz AJ, McDon- sions. A significant factor for
Werkstoffen. Schweiz nell HT, Powell CA, Mea- successful outcome of root
Monatsschr Zahnmed ley BL. Osseous surgery coverage procedures? A
1984;94:647–651. for crown lengthening: a 2-year prospective clinical
37. Krämer A, Weber H, 6-month clinical study. J Peri- study. J Clin Periodontol
Geis-Gerstorfer J. odontol 2004;75:1288–1294. 1996;23:770–777.
Plaqueansammlung 47. McGuire MK, Nunn M. 55. Pini Prato G, Tinti C, Vin-
an Implantat- und pro- Evaluation of human reces- cenzi G, Magnani C, Cortel-
thetischen Werkstoffen. Eine sion defects treated with lini P, Clauser C. Guided
klinische Studie. Z Zahnärztl coronally advanced flaps tissue regeneration versus
Implantol 1989:5:283–286. and either enamel matrix mucogingival surgery in the
38. Hahn R, Weiger R, Netuschil derivative or connective tis- treatment of human buccal
L, Brüch M. Microbial accu- sue. Part 1: Comparison of gingival recession. J Period-
mulation and vitality on dif- clinical parameters. J Peri- ontol 1992;63:919–928.
ferent restorative materials. odontol 2003;74:1110–1125.
Dent Mater 1993;9:312–316.
221
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
scientific session
222
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
KÖRNER/HAPPE
80. Becker BE, Becker W, Ricci 87. Pinho MN, Roriz VL, Novaes 95. McAllister BS, Gaffaney TE.
A, Geurs N. A prospective AB Jr, Taba M Jr, Grisi MF, Distraction osteogenesis for
clinical trial of endosseous de Souza SL, Palioto DB vertical bone augmentation
screw-shaped implants Titanium membranes in prior to oral implant recon-
placed at the time of tooth prevention of alveolar col- struction. Periodontol 2000
extraction without aug- lapse after tooth extraction. 2003;33:54–66.
mentation. J Periodontol Implant Dent 2006;15:53–61. 96. Nemcovsky CE, Artzi Z. Split
1998;69:920–926. 88. Fickl S, Zuhr O, Wachtel H, palatal flap. I. A surgical
81. Artzi Z, Tal H, Dayan D. Bolz W, Huerzeler MB. Hard approach for primary soft
Porous bovine bone mineral tissue alterations after sock- tissue healing in ridge aug-
in healing of human extrac- et preservation: an experi- mentation procedures: tech-
tion sockets. Part 1: histo- mental study in the beagle nique and clinical results. Int
morphometric evaluations dog. Clin Oral Implants Res J Periodontics Restorative
at 9 months. J Periodontol 2008;19:1111–1118. Dent 1999;19:175–181.
2000;71:1015–1023. 89. Fickl S, Zuhr O, Wachtel H, 97. Aubert H, Bertrand G,
82. Froum S, Cho SC, Rosen- Kebschull M, Hürzeler MB. Orlando S, Benguigui F,
berg E, Rohrer M, Tarnow Hard tissue alterations after Acocella G. [Deep rotated
D. Histological comparison socket preservation with connective tissue flap for
of healing extraction sock- additional buccal overbuild- the reconstruction of the
ets implanted with bioac- ing: a study in the beagle interdental papilla] Minerva
tive glass or demineralized dog. J Clin Periodontol Stomatol 1994;43:351–357.
freeze-dried bone allograft: 2009;36:898–904. 98. Azzi R, Etienne D, Carranza
a pilot study. J Periodontol 90. Araújo MG, Lindhe J. Ridge F. Surgical reconstruction of
2002;73:94–102. preservation with the use the interdental papilla. Int
83. Froum S, Cho SC, Elian of Bio-Oss collagen: A J Periodontics Restorative
N, Rosenberg E, Rohrer 6-month study in the dog. Dent 1998;18:466–473.
M, Tarnow D. Extraction Clin Oral Implants Res 99. Azzi R, Takei HH, Etienne D,
sockets and implantation 2009;20:433–440. Carranza FA. Root cover-
of hydroxyapatites with 91. Araújo MG, Liljenberg B, age and papilla reconstruc-
membrane barriers: a his- Lindhe J. Dynamics of Bio- tion using autogenous
tologic study. Implant Dent Oss Collagen incorporation osseous and connective
2004;13:153–164. in fresh extraction wounds: tissue grafts. Int J Peri-
84. Oakley E, Rhyu IC, Karat- an experimental study in the odontics Restorative Dent
zas S, Gandini-Santiago L, dog. Clin Oral Implants Res 2001;21:141–147.
Nevins M, Caton J. Healing 2010;21:55–64. 100. Takei HH, Han TJ, Carranza
of human extraction sockets 92. Salama H, Salama M. The FA Jr, Kenney EB, Lekovic V.
filled with Bio-Oss. Clin Oral role of orthodontic extru- Flap technique for periodon-
Implants Res 2003;14:137– sive remodeling in the tal bone implants. Papilla
143. enhancement of soft and preservation technique. J
85. Iasella JM, Greenwell H, hard tissue profiles prior Periodontol 1985;56:204–
Miller RL, Hill M, Drisko to implant placement: a 210.
C, Bohra AA, Scheetz JP. systematic approach to the 101. Murphy KG. Interproximal
Ridge preservation with management of extraction tissue maintenance in GTR
freeze-dried bone allograft site defects. Int J Peri- procedures: description of
and a collagen membrane odontics Restorative Dent a surgical technique and
compared to extrac- 1993;13:312–333. 1-year re-entry results. Int
tion alone for implant site 93. Wang HL, Al-Shammari KF. J Periodontics Restorative
development: a clinical and Guided tissue regenera- Dent 1996;16:463–477.
histologic study in humans. tion-based root coverage 102. Cortellini P, Pini Prato G.
J Periodontol 2003;74:990– utilizing collagen mem- Tonetti M. The modified
999. branes: technique and case papilla preservation. J Peri-
86. Nevins M, Camelo M, De reports. Quintessence Int odontol 1995;66:261.
Paoli S, Friedland B, Schenk 2002;33:715–721. 103. Cortellini P, Prato GP, Tonetti
RK, Parma-Benfenati S, 94. Cordaro L, Amadé DS, MS. The simplified papilla
Simion M, Tinti C, Wagen- Cordaro M. Clinical results preservation flap. A novel
berg B. A study of the fate of alveolar ridge augmenta- surgical approach for the
of the buccal wall of extrac- tion with mandibular block management of soft tissues
tion sockets of teeth with bone grafts in partially in regenerative procedures.
prominent roots. Int J Peri- edentulous patients prior Int J Periodontics Restora-
odontics Restorative Dent to implant placement. tive Dent 1999;19:589–599.
2006;26:19–29. Clin Oral Implants Res
2002;13:103–111.
223
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
scientific session
104. Cortellini P, Tonetti MS. A 111. Spear F. The esthetic man- 118. den Hartog L, Slater JJ, Vis-
minimally invasive surgi- agement of dental midline sink A, Meijer HJ, Raghoe-
cal technique with an problems with restorative bar GM. Treatment outcome
enamel matrix derivative dentistry. Compend Contin of immediate, early and
in the regenerative treat- Educ Dent 1999;20:912– conventional single-tooth
ment of intra-bony defects: 914, 916, 918. implants in the aesthetic
a novel approach to limit 112. Oates TW, West J, Jones zone: a systematic review to
morbidity. J Clin Periodontol J, Kaiser D, Cochran DL. survival, bone level, soft-tis-
2007;34:87–93. Long-term changes in soft sue, aesthetics and patient
105. Cortellini P, Tonetti MS. tissue height on the facial satisfaction. J Clin Periodon-
Improved wound stability surface of dental implants. tol 2008;35:1073–1086.
with a modified minimally Implant Dent 2002;11:272– 119. Zuhr O, Rebele SF, Thalmair
invasive surgical technique 279. T, Fickl S, Hürzeler MB. A
in the regenerative treatment 113. Müterthies K, Körner G. Art modified suture technique
of isolated interdental intrab- Oral. Munich: Verlag Neuer for plastic periodontal
ony defects. J Clin Period- Merkur, 1996. and implant surgery – the
ontol 2009;36:157–163. 114. Jemt T, Lekholm U. Meas- double-crossed suture. Eur
106. Palacci P. Soft and hard tis- urements of buccal tissue J Estheth Dent 2009;4:338–
sue management. Esthetic volumes at single-implant 347.
implant dentistry. Chicago: restorations after local bone 120. Zuhr O, Fickl S, Wachtel
Quintessence Publishing, grafting in maxillas: a 3-year H, Bolz W, Hürzeler MB.
2001. clinical prospective study Covering of gingival reces-
107. Tinti C, Benfenati SP. The case series. Clin Implant sions with a modified micro
ramp mattress suture: a Dent Relat Res, 2003;5:63– surgical tunnel technique:
new suturing technique 70. case report. Int J Peri-
combined with a surgical 115. Kan JY, Rungcharassaeng odontics Restorative Dent
procedure to obtain papil- K, Umezu K, Kois JC. 2007;27:457–463.
lae between implants in the Dimensions of peri-implant 121. Burkhardt R, Lang NP. Cov-
buccal area. Int J Peri- mucosa: an evaluation of erage of localized gingival
odontics Restorative Dent maxillary anterior single recession: comparison of
2002;22:63–69. implants in humans. J Peri- micro- and macro- surgical
108. Misch CE, Al-Shammari odontol 2003;74:557–562. techniques. J Clin Periodon-
KF, Wang HL. Creation of 116. Grunder U. Stability of tol 2005;32:287–293.
interimplant papillae through the mucosal topogra- 122. Abrahamsson I, Berglundh
a split-finger technique. phy around single-tooth T, Glantz PO, Lindhe J. The
Implant Dent 2004;13:20– implants and adjacent teeth: mucosal attachment at dif-
27. 1-year results. Int J Peri- ferent abutments. An experi-
109. Nemcovsky CE. Interproxi- odontics Restorative Dent mental study in dogs. J Clin
mal papilla augmentation 2000;20:11–17. Periodontol 1998;25:721–
procedure: a novel surgi- 117. Belser U, Buser D, Higgin- 727.
cal approach and clinical bottom F. Consensus state- 123. Allegri MA, Landi L, Zuc-
evaluation of 10 consecutive ments and recommended chelli G. Non-carious
procedures. Int J Peri- clinical procedures regard- cervical lesions associated
odontics Restorative Dent ing esthetics in implant den- with multiple gingival reces-
2001;21:553–559. tistry. Int J Oral Maxillofac sions in the maxillary arch.
110. Happe A, Körner G, Nolte A. Implants 2004;19:73–74. A restorative-periodontal
The keyhole access expan- effort for esthetic success. A
sion technique for flapless 12-month case report. Eur J
implant stage-two surgery: Esthet Dent 2010;5:10–27.
technical note. Int J Peri-
odontics Restorative Dent
2010;30:97–101.
224
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
VOLUME 6 • NUMBER 2 • SUMMER 2011
View publication stats