Presentation PDF - Canadian Academy of Periodontology

Presentation PDF - Canadian Academy of Periodontology

CAP LITERARY REVIEW COMPETITION 2016
SOPHIE TOUPIN, DMD
R1 PARODONTIE UNIVERSITÉ LAVAL
INTERDENTAL PAPILLA MANAGEMENT
A REVIEW OF THE LITERATURE
OUTLINE
INTERDENTAL PAPILLA MANAGEMENT
• Factors
• Classifications
• Preservation Techniques
• Reconstruction Techniques
• Non-Surgical Techniques
INTERDENTAL PAPILLA LOSS
• Anatomical factors
• Periodontal diseases
Rouck, 2009
• Trauma
• Dental treatments
• Prosthetic
• Orthodontic
• Periodontal
DISTANCE
CONTACT POINT TO CREST OF BONE
Lindhe, 2015
Adapted from Tarnow et al. J Periodontol 1992; 63: 995-6
MINIMAL DISTANCES
100% PAPILLA PRESENT
Funato, 2007
DISTANCES
(MM)
MESIO-DISTAL
APICO-CORONAL
SALAMA 1998
TARNOW 2000
SALAMA 1998
CHOQUET 2001
TOOTH-TOOTH
1,0
≤5
TOOTH-IMPLANT
1,5
≤4,5
IMPLANT-IMPLANT
3,0
≤3,5
OTHER ANATOMICAL FACTORS
• Alveolar bone morphotypes (Becker 1997)
• Tooth shape
(Weisgold 1997)
• Gingival biotype
• Root position
(Olson and Lindhe 1991)
(Miller and Allen 1996, Cho 2006)
Becker et al. J Clin Periodontol 1997;24:727-31
CLASSIFICATIONS
Jemt
1997
Nordland and Tarnow
1998
2
0
3
1
4
Jemt, Int J Periodont Rest Dent 1997;17:327-33
Nordland and Tarnow, J Periodontol 1998;69:1124-6
PAPILLA PRESERVATION
TECHNIQUES
• Papilla Preservation Technique
• Modified Papilla Preservation Technique (MPP)
• Simplified Papilla Preservation Flap (SPPF)
• Papilla Amplification Flap (PAF)
• Minimally Invasive Surgery Approach (MIS) and Technique (MIST)
• Modified Minimally Invasive Surgery Technique (m-MIST)
PAPILLA PRESERVATION
TECHNIQUE
• Anterior or posterior region
• Sulcular incisions around the teeth, no incision through the papilla
• Palatal or lingual semi-lunar incision
Takei et al, J Periodontol 1985;56:204–210.
MODIFIED PAPILLA PRESERVATION
TECHNIQUE (MPPT)
•
Horizontal incision at the base of
the papilla
•
Elevation of the papilla towards
the palatal aspect
•
Technically demanding in cases
with narrow interproximal spaces
Cortellini et al, J Periodontol 1995;66:261–266.
SIMPLIFIED PAPILLA PRESERVATION FLAP
(SPPF)
• For narrow spaces or posterior teeth
• Oblique incision from the gingival margin to the mid-interproximal portion of the papilla
• Bucco lingual horizontal incision at the base of the papilla
Cortellini et al, Int J Periodontics Restorative Dent 1999;19:589–599.
PAPILLA AMPLIFICATION FLAP
(PAF)
• Narrow spaces or malposition
• Min 4 mm buccal keratinized tissue
•
Submarginal highly scalloped incision on buccal
• Split-thickness of interdental tissue
Zucchelli et al, Int J Periodontics Restorative Dent 2005;25:483–493.
MINIMALLY INVASIVE SURGERY
APPROACH
(MIS)
• Maximum soft tissue preservation
• 2 intrasulcular incisions
• 1 horizontal incision placed 2 to 3 mm from crest of the papilla
• Using magnification (3.5X) and light source, fiber optic light probe
Harrel S, J Periodontol 1999;70: 1547-1557.
MODIFIED MINIMALLY INVASIVE
SURGERY TECHNIQUE (M-MIST)
• Intrasulcular and horizontal incisions
• No incision or flap on palatal side
• Microblades, mini curettes, microscope
(X4 to X16)
Cortellini & Tonetti, J Clin Periodontol 2009; 36: 157–163.
PAPILLA RECONSTRUCTION
TECHNIQUES
• Beagle (1992)
• Han et Takei
• Azzi et al
(1996)
(1998)
• Nemkovksy (2001)
• Carnio
(2004)
• Nordland et Sandhu (2008)
SURGICAL RECONSTRUCTION
OF THE INTERDENTAL PAPILLA
•
1 case report
•
Partial palatal thickness flap elevated to the labial
•
Elongated papilla folded upon itself (similar to the roll
technique for ridge augmentation)
•
Creation of a pyramidal form
4 years
Beagle JR, Int J Periodontics Restorative Dent 1992;12: 144–151.
PAPILLA RECONSTRUCTION WITH A
SEMILUNAR INCISION
• Intrasulcular incisions mesial and distal adjacent teeth
• Semilunar incision between mesial line angles and
coronal displacement
• Connective tissue graft from palate placed into pouch
Han TJ, Takei HH, Periodontol 2000 1996;11:65–68.
RECONSTRUCTION WITH CTG FROM
TUBEROSITY AREA
• Buccal and palatal envelope split-thickness flap
• Intrasulcular incisions
• Buccal incision accross interdental papilla
• Incisions similar to a distal wedge (connective tissue
graft)
Azzi et al, Int J Periodontics Restorative Dent 1998;18:467–473.
PAPILLA AUGMENTATION PROCEDURE (PAP)
Jemt
2
0
3
1
• Intrasulcular incisions and coronal mobilisation papilla
• Graft (wedge) placed into tunnel
• Better succeses with larger interproximal spaces
Nemkovksy CE. Int J Periodontics Restorative Dent 2001;21:553–559.
RECONSTRUCTION USING AN INTERPOSED
SUBEPITHELIAL CONNECTIVE TISSUE
GRAFT
• Semilunar incision 2 mm coronal to mucogingival junction
• Connective tissue graft in split-thickness envelope flap
• Result after 4 years (3 procedures at 8 weeks interval)
• Repeated procedures might be necessary
Carnio J, Int J Periodontics Restorative Dent 2004;24:31–37
MICROSURGICAL TECHNIQUE
AUGMENTATION INTERDENTAL PAPILLA
• Microsurgical customized instruments
• Tunnelling surgical approach (no vertical release)
• Graft shaped to desired papilla height
• 3 years follow-up
Nordland WP. Sandhu HS. Int J Periodontics Restorative Dent 2008;28:543–549.
SURGICAL CHALLENGE
• Reconstruction techniques : limited predictibility (Blatz 1999, Prato 2004)
• Interproximal bone reconstruction is challenging
• Long-term studies needed
NON-SURGICAL TREATMENTS
Correction of traumatic habit or oral hygiene techniques
Repeated curettage (Shapiro 1985)
Biological engineering (McGuire and Sheyer 2007)
Prosthodontics / operative dentistry
Orthodontics
BIOLOGICAL ENGINEERING
EXPANDED AUTOLOGOUS FIBROBLAST
INJECTIONS
• Randomized Double-Blind Placebo-Controlled Study (20 patients)
• Autologous fibroblast injection at 7 and 14 days after initial injection
• Increase papilla height from baseline (2 months)
• No statistical difference at 4 months
McGuire MK Sheyer ET, J Periodontol 2007;78:4-17.
PROSTHETIC SOLUTIONS
OPERATIVE DENTISTRY
Courtesy of Dr. D. Lalande
• Longer proximal surfaces
• Reduce distance between contact point and bone crest
• Pink porcelain or composite
Challenge : reduce the interdental space without
compromising the periodontal health
ORTHODONTIC TREATMENTS
• Mesial repositioning roots
• Diastema closure
• Interproximal reduction
• Orthodontic extrusion
Sharma AA. Park JH. Esthet Restor Dent 22:18–30, 2010
PATHOLOGIC MIGRATION
COMBINATION PERIO, PROSTH AND
ORTHO
• 6 case reports
• Migration of incisors in chronic advanced
periodontitis
• Modified papilla preservation technique
• Orthodontic treatment a few days after surgery
• Intrusion (0,5-1 mm/month)
• Resin-bonded splint fixed retention
Cardoropoli D. Re S. J Periodontol 2005;76:655-661.
SUMMARY
• Preventing loss of papilla
• Identify the cause
• Reconstructive techniques : limited predictibility
• Long-term studies needed
• Multidisciplinary team
QUESTIONS
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ILLUSTRATION SOURCES
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Dental floss : http://dingo.care2.com/pictures/greenliving/1171/1170716.large.jpg
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Suturing : https://encryptedtbn3.gstatic.com/images?q=tbn:ANd9GcSSHJPIsoK3zuhMygRVNPPtaS7yjb2AEO82fQ61kogirv
Lg5apo6A
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C/C :
http://static1.squarespace.com/static/53b89073e4b0665887b3b14a/t/53ba47ede4b036664116ac
6d/1404717039184/10268708_482402211889411_9043600289946724093_n.jpg?format=1500w