Clinical blog

Gingival creep on implants

Gingival creep is a well-known and highly desirable effect of gingival augmentation procedures. Matter and Bell as early as the late seventies demonstrated this concept in what could be described as case series. At present, we do not definitely know what the predictive variables for this phenomenon are. It is strongly associated with: Tooth position in the arch Thickness of the soft tissues Level of plaque control The remaining question in the 21st century is whether this

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Apicectomy for GBR using Symbios

Rushing to label a tooth hopeless and proceeding to extract it can be a very costly affair for patients.  Teeth with large apical pathosis should have the apical pathology managed and preferably bone regenerated prior to proceeding on to bridgework or implant based replacement. Teeth can have a regenerative potential from the PDL stem cells but also from the ability to retain soft tissue flap in a more coronal position than if the tooth was

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Regenerative treatments for peri-implantitis

The holy grail for the management for peri-implantitis is bone regeneration and re-osteointegration. These are difficult to achieve reliably and in fact most histological studies indicate that true reintegration is unpredictable and difficult to achieve. From a practical clinical perspective, we aim to achieve a pocket depth reduction to manageable levels (ie less than or equal to 5mm), no bleeding on probing and no erythema or suppuration around an implant.  The German group lead by

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To link or not to link??

There are numerous clinical, logistic and financial advantages from linking teeth to implant restorations.  Tarnow et al 2009  presented a literature review to on the subject of linking teeth and they sited a high risk of intrusion of abutment teeth in cases of parafunction or when semi-rigid (ie fixed movable) connectors were used. Palmer et al 2005 demonstrated high success rates with minimal critical complications like bone loss or tooth intrusion when linking teeth and implants with telescopic crowns

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Worsening recession!!

Gum recession so what and who cares?? Relax and keep cleaning it and it will be fine! NOT TRUE ANY MORE!!!!These statements will soon be a thing of the past. Chambrone et al 2016 demonstrated with systematic review and a meta-analysis that about 80% of untreated recession defects worsened over 24 months moreover the number of recession defects also increased. The odds ratio of this happening is over 2 meaning it is likely to happen.This is problematic for

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Free gingival graft

​Free gingival grafts have high success rates in achieving:1-increase in keratinised tissue2-deepening of vestibule3-increasing biotype4- eliminating frenal attachmentsThey have limited efficacy when it comes to improving cosmetics or root coverage. If these two aims are the holygrail for mucogingival surgery, why do we still utilise free gingival grafts??The answer is in the nature of the free gingival graft procedure.  It is considerably less complex than other grafting procedures with a very low risk of graft

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