Combination Therapy for Reconstructive Periodontal Treatment in the Lower Anterior Area: Clinical Evaluation of a Case Series

Abstract

Clinically, periodontal regeneration may be achieved by the application of barrier membranes, grafts, wound-healing modifiers, and their combinations. Combination therapy refers to the simultaneous application of various periodontal reconstructive treatment alternatives to obtain additive effects. This approach may lead to assemblage of different regenerative principles, such as conductivity and inductivity, space provision and wound stability, matrix development and cell differentiation. The application of autogenous connective tissue grafts during periodontal regenerative treatment with enamel matrix proteins derivative (EMD) has been previously reported. The present case series present a modified approach for treatment of severe periodontally involved lower incisors presenting with thin gingival biotype, gingival recession, minimal attached and keratinized gingiva width and muscle and/or frenum pull. In all cases a combination therapy consisting of a single buccal access flap, root conditioning, EMD application on the denuded root surfaces and a free connective tissue graft was performed. Clinical and radiographic outcomes were consistently satisfactory, leading to probing depth reduction, clinical attachment gain, minimal gingival recession, increased attached and keratinizing gingival width, elimination of frenum and/or muscle pull together with radiographic bone fill of the defects. It may be concluded that the present combination therapy for reconstructive periodontal treatment in the lower anterior area is a valuable alternative for indicated cases.

O Uso De Derivados De Matriz De Esmalte Na Regeneração Periodontal: Uma Revisão De Literatura

“…A terapia combinada refere-se à utilização simultânea de várias abordagens de tratamento destinadas à reconstrução de tecidos periodontais, visando a obtenção de efeitos aditivos. Essa abordagem pode resultar na incorporação de diversos princípios regenerativos.O uso de retalho posicionado coronalmente, por exemplo, quando combinado com enxerto de tecido conjuntivo, pode ser potencializado pelo uso das proteínas derivadas de esmalte, gerando assim um novo estímulo aos tecidos, ativando processos e mecanismos essenciais para a regeneração periodontal, incluindo a formação de cemento, ligamento periodontal e osso alveolar, possibilitando uma nova inserção e ganho de nível clinico de inserção (Mcguire et al, 2016;Miron et al, 2016;Beitlitum, 2018).…”

“…Além disso, esses derivados de matriz de esmalte apontam benefícios significativos para tecidos moles e duros, devido aos estudos que vêm destacando um ganho clinico significativo de inserção, redução da doença periodontal e ganho ósseo radiográfico (Sousa, 2014). Dessa forma, devemos lançar mão de uma terapia combinada que consiste na utilização simultânea de várias abordagens de tratamento destinadas à reconstrução de tecidos periodontais, visando a obtenção de efeitos aditivos, essa abordagem pode resultar na incorporação de diversos princípios regenerativos Beitlitum, 2018).…”

Evaluation of the Marginal Location and Periodontal Health in Crowns and Bridges – A Patient Preference Based Study

“…3 The interplay between periodontology and restorative dentistry is present at many fronts, including location of restorative margins, crown contours, and response of the gingival tissues to restorative preparations. 4 The detrimental effects of management may occur in restorative rehabilitation, majorly due to inadequate teeth preparation, choosing inappropriate margin geometry and location. 5 There are different types of margin geometry and locations to be followed based on location of teeth, teeth height, crown root ratio, vitality of the teeth, amount of remaining tooth substance and aesthetic requirements.…”