This case report describes a simple method for augmenting tissue at prospective palatal connectiv... more This case report describes a simple method for augmenting tissue at prospective palatal connective tissue donor sites. The patient was referred for treatment of facial marginal tissue recession on the maxillary left canine. Clinical examination indicated that the palatal mucosa was thin and did not provide an adequate volume of soft tissue for donor harvesting, precluding the use of a palatal connective tissue graft for treatment of the recession defect. Sterile lyophilized bovine collagen sponge was therefore surgically inserted between a full-thickness palatal flap and bone at the prospective donor site. Eight weeks postoperative, the augmented palatal donor area showed a significant clinical increase in thickness and volume and served as a connective tissue donor source in the treatment of the facial marginal tissue recession. Histologic analysis of the donor tissue demonstrated normal structure, fibrous connective tissue, and abundant collagen. Clinical examination 6 months following surgery showed complete root coverage, with tissue texture, volume, and color similar to those of the adjacent soft tissue. Healing of the donor site was uneventful. This case report demonstrates that sterile lyophilized collagen sponge material may be used to augment palatal donor connective tissue and can subsequently be used as a donor source for soft tissue grafting.
This article reports on a case of root resorption following a clinically successful root coverage... more This article reports on a case of root resorption following a clinically successful root coverage procedure with a subepithelial connective tissue graft on a maxillary lateral incisor. Two years after the graft procedure was performed, the tooth was extracted in conjunction with the buccal attachment apparatus. Histologic examination of the specimen revealed signs of active resorption of the dentinal surface and bone formation in the deepest portion of the resorption cavity. Possible causative factors of the root resorption process are discussed.
The unpredictability of current surgical procedures for papilla reconstruction has been a matter ... more The unpredictability of current surgical procedures for papilla reconstruction has been a matter of concern for both periodontists and patients. This case report presents a complete papilla reconstruction in a 20-year-old woman using an interposed subepithelial connective tissue graft. The results show that this technique can be successfully used in treating the loss of papillae and achieving long-term stability. The objective of this report is to describe the surgical technique and comment on the factors that may have influenced the final result.
Introduction: Defects caused by root resorption are often associated with a variety of idiopathic... more Introduction: Defects caused by root resorption are often associated with a variety of idiopathic, external resorptions or perforations located at the mid‐third of the root surface. These defects can lead to gingival inflammation, breakdown of periodontal fibers, bone resorption, and damage to the periodontal apparatus. Treatment protocols that preclude tooth extraction are important adjuncts toward an ultimate goal of tooth/root preservation. Although a number of materials have been proposed to repair root resorption defects, only a few have been effective in the long‐term management of subgingival defects.Case Presentation: This case report presents long‐term follow‐up of a subgingival, external root resorption lesion that was successfully treated with mineral trioxide aggregate (MTA) and a coronally advanced flap. At 30 months, the results revealed gain in clinical attachment, reduction in probing depth, additional bone formation, and, ultimately, preservation of the gingival margin and esthetic appearance of the tooth.Conclusion: The use of MTA appears to be a viable and effective material to treat subgingival root resorption defects while also preserving the function and esthetics of the natural dentition.
The purpose of this study is to describe a modification in the apically repositioned flap techniq... more The purpose of this study is to describe a modification in the apically repositioned flap technique. Unlike the original technique, this technique preserves the marginal gingiva thus avoiding the risk of recession. It is recommended in cases where an increase in attached gingiva is desired. This study reports on the results of 54 single buccal areas consecutively treated in 38 healthy patients. The increase in the amount of attached gingiva, the impact on marginal tissue recession, and the impact on probing depth were analyzed. All 54 areas were evaluated at 8 weeks; 21 areas were analyzed for 24 weeks; and 19 areas for a period of 72 weeks. The final measurements were compared to baseline values. The analysis of variance of measurement (ANOVA) shows a significant increase of keratinized and attached gingiva (P <0.001). There was no statistical change in marginal tissue recession (P = 0.370) or probing depth. The results of this study demonstrate that this modification of the apically repositioned flap is effective and efficient for increasing the height of attached gingiva. This surgical procedure produces minor surgical trauma and does not require palatal donor tissue or membrane placement. It is simpler since it is less time‐consuming, requires no suturing, and results in an ideal color match of tissue. J Periodontol 1999;70:1110‐1117.
Se presenta en este articulo un caso de reabsorcion radicular tras un procedimiento de recubrimie... more Se presenta en este articulo un caso de reabsorcion radicular tras un procedimiento de recubrimiento con injerto de tejido conjuntivo subepitelial de la raiz de un incisivo lateral superior, con un resultado clinico satisfactorio. Tras 2 anos de la intervencion, se extrajo el diente junto con su periodonto vestibular. En el examen histologico, la muestra presento signos de reabsorcion activa de la superficie dentinaria, asi como formacion de hueso en la parte mas profunda de la cavidad de reabsorcion. Se discuten los posibles factores causantes del proceso de reabsorcion radicular.
The International journal of periodontics & restorative dentistry
The palatal masticatory mucosa between the canine and first molar is the main source of connectiv... more The palatal masticatory mucosa between the canine and first molar is the main source of connective tissue graft (CTG) for use in periodontal plastic surgery. The purpose of this study was to evaluate the palatal augmentation technique (PAT) to increase the palatal connective tissue donor area using a collagen sponge inserted between the palatal flap and bone. The 26 patients enrolled in this study were referred for root coverage and ridge augmentation procedures. All patients lacked adequate donor palatal tissue thickness. The PAT uses a full-thickness flap and insertion of a sterile lyophilized bovine collagen sponge between the flap and bone. The palatal thickness was clinically assessed before and after collagen sponge insertion. A manual probe was inserted in the mucosal surface perpendicular to the long axis of each tooth approximately 6 mm from the gingival margin. Probing depth (PD) and recession (REC) were also recorded. Treatment with PAT resulted in a statistically signifi...
IntroductionAxenfeld‐Rieger syndrome (ARS), also known as Rieger syndrome, is a rare autosomal do... more IntroductionAxenfeld‐Rieger syndrome (ARS), also known as Rieger syndrome, is a rare autosomal dominant condition defined by craniofacial, ocular, dental, periumbilical, and systemic anomalies.Case PresentationThis case report describes in detail a multidisciplinary approach to successfully restore the oral function and esthetics of a 22‐year‐old patient diagnosed with ARS. The patient's clinical evaluation revealed that the area corresponding with teeth #13, #12, #11, #21, #22, and #23 was occupied by four malformed and/or deciduous teeth. The four anterior teeth were extracted, and socket preservation was performed using bovine‐derived porous bone mineral. Six months after extractions, two implants were placed in the location of the lateral incisors and additional bone graft was performed. Two months after the initial healing, a temporary fixed partial was delivered and 9 months after implant placement the implants were restored with a porcelain‐fused‐to‐metal fixed partial de...
Several clinical studies have documented success when using an acellular dermal matrix (ADM) to t... more Several clinical studies have documented success when using an acellular dermal matrix (ADM) to treat mucogingival defects; however, information concerning its long-term stability is limited. This article presents a case involving a patient with root recession treated with an ADM. Probing depth, marginal tissue recession, and the amount of keratinized and attached tissues were evaluated for 10 years post-treatment; the results showed long-term stability during the observation period.
Background: This case series reports on the effectiveness of the modified apically repositioned f... more Background: This case series reports on the effectiveness of the modified apically repositioned flap (MARF) in increasing the apico‐coronal dimension of attached gingiva over multiple adjacent teeth.Methods: The MARF surgical technique consists of a single horizontal incision within keratinized tissue, elevation of a split‐thickness flap, and suturing of the flap to the periosteum in an apical position. The periosteum is left exposed so that the full perimeter of the wound is surrounded by keratinized tissue. The nature of this wound healing leads to the formation of new keratinized and attached tissue in the area where periosteum is left exposed. A total of 37 areas in 33 systemically healthy patients were analyzed after treatment with the MARF technique. The treatment areas consisted of a minimum of two and a maximum of five adjacent teeth with a minimum of 0.5 mm and a maximum of 2.0 mm of attached gingiva on each tooth.Results: Treatment with MARF resulted in a significant increase in the apico‐coronal dimension of the keratinized tissue and attached gingiva (P <0.05). The increase in keratinized tissue ranged from 2.20 to 4.28 mm, and the increase in attached gingiva ranged from 1.0 to 3.14 mm. Gingival recession decreased significantly in the treated areas, but the difference was of little clinical significance. Probing depths in the treated areas did not change significantly compared to baseline values.Conclusions: MARF is an effective technique in increasing the apico‐coronal dimension of the keratinized tissue and attached gingiva. MARF offers considerable advantages over other mucogingival surgery techniques: simplicity, limited chair time for the patient and the operator, low morbidity because of the absence of palatal donor tissue, and a predictable tissue color match.
Introduction. The purpose of this case report was to show the clinical long-term stability of a s... more Introduction. The purpose of this case report was to show the clinical long-term stability of a successful two-step root coverage procedure. A combination of two single techniques was used to treat an isolated deep-wide defect. Case Presentation. A 28-year-old female patient was referred in order to treat a single recession defect at #22. Due to her fear of dental procedures and a poor economic situation, the team developed an alternative solution. They used a modified apically repositioned flap (MARF) to increase the donor area and then a laterally positioned flap (LPF) to treat the root defect. Clinical evaluation at the three-year follow-up revealed complete resolution of the defect, a gain in clinical attachment, excellent esthetic results, and minor morbidity to the patient. Conclusion. The combination of the MARF and the LPF procedures was able to successfully treat a single deep recession defect with some advantages over traditional techniques such as simplicity, ideal color ...
This case report describes a simple method for augmenting tissue at prospective palatal connectiv... more This case report describes a simple method for augmenting tissue at prospective palatal connective tissue donor sites. The patient was referred for treatment of facial marginal tissue recession on the maxillary left canine. Clinical examination indicated that the palatal mucosa was thin and did not provide an adequate volume of soft tissue for donor harvesting, precluding the use of a palatal connective tissue graft for treatment of the recession defect. Sterile lyophilized bovine collagen sponge was therefore surgically inserted between a full-thickness palatal flap and bone at the prospective donor site. Eight weeks postoperative, the augmented palatal donor area showed a significant clinical increase in thickness and volume and served as a connective tissue donor source in the treatment of the facial marginal tissue recession. Histologic analysis of the donor tissue demonstrated normal structure, fibrous connective tissue, and abundant collagen. Clinical examination 6 months following surgery showed complete root coverage, with tissue texture, volume, and color similar to those of the adjacent soft tissue. Healing of the donor site was uneventful. This case report demonstrates that sterile lyophilized collagen sponge material may be used to augment palatal donor connective tissue and can subsequently be used as a donor source for soft tissue grafting.
This article reports on a case of root resorption following a clinically successful root coverage... more This article reports on a case of root resorption following a clinically successful root coverage procedure with a subepithelial connective tissue graft on a maxillary lateral incisor. Two years after the graft procedure was performed, the tooth was extracted in conjunction with the buccal attachment apparatus. Histologic examination of the specimen revealed signs of active resorption of the dentinal surface and bone formation in the deepest portion of the resorption cavity. Possible causative factors of the root resorption process are discussed.
The unpredictability of current surgical procedures for papilla reconstruction has been a matter ... more The unpredictability of current surgical procedures for papilla reconstruction has been a matter of concern for both periodontists and patients. This case report presents a complete papilla reconstruction in a 20-year-old woman using an interposed subepithelial connective tissue graft. The results show that this technique can be successfully used in treating the loss of papillae and achieving long-term stability. The objective of this report is to describe the surgical technique and comment on the factors that may have influenced the final result.
Introduction: Defects caused by root resorption are often associated with a variety of idiopathic... more Introduction: Defects caused by root resorption are often associated with a variety of idiopathic, external resorptions or perforations located at the mid‐third of the root surface. These defects can lead to gingival inflammation, breakdown of periodontal fibers, bone resorption, and damage to the periodontal apparatus. Treatment protocols that preclude tooth extraction are important adjuncts toward an ultimate goal of tooth/root preservation. Although a number of materials have been proposed to repair root resorption defects, only a few have been effective in the long‐term management of subgingival defects.Case Presentation: This case report presents long‐term follow‐up of a subgingival, external root resorption lesion that was successfully treated with mineral trioxide aggregate (MTA) and a coronally advanced flap. At 30 months, the results revealed gain in clinical attachment, reduction in probing depth, additional bone formation, and, ultimately, preservation of the gingival margin and esthetic appearance of the tooth.Conclusion: The use of MTA appears to be a viable and effective material to treat subgingival root resorption defects while also preserving the function and esthetics of the natural dentition.
The purpose of this study is to describe a modification in the apically repositioned flap techniq... more The purpose of this study is to describe a modification in the apically repositioned flap technique. Unlike the original technique, this technique preserves the marginal gingiva thus avoiding the risk of recession. It is recommended in cases where an increase in attached gingiva is desired. This study reports on the results of 54 single buccal areas consecutively treated in 38 healthy patients. The increase in the amount of attached gingiva, the impact on marginal tissue recession, and the impact on probing depth were analyzed. All 54 areas were evaluated at 8 weeks; 21 areas were analyzed for 24 weeks; and 19 areas for a period of 72 weeks. The final measurements were compared to baseline values. The analysis of variance of measurement (ANOVA) shows a significant increase of keratinized and attached gingiva (P <0.001). There was no statistical change in marginal tissue recession (P = 0.370) or probing depth. The results of this study demonstrate that this modification of the apically repositioned flap is effective and efficient for increasing the height of attached gingiva. This surgical procedure produces minor surgical trauma and does not require palatal donor tissue or membrane placement. It is simpler since it is less time‐consuming, requires no suturing, and results in an ideal color match of tissue. J Periodontol 1999;70:1110‐1117.
Se presenta en este articulo un caso de reabsorcion radicular tras un procedimiento de recubrimie... more Se presenta en este articulo un caso de reabsorcion radicular tras un procedimiento de recubrimiento con injerto de tejido conjuntivo subepitelial de la raiz de un incisivo lateral superior, con un resultado clinico satisfactorio. Tras 2 anos de la intervencion, se extrajo el diente junto con su periodonto vestibular. En el examen histologico, la muestra presento signos de reabsorcion activa de la superficie dentinaria, asi como formacion de hueso en la parte mas profunda de la cavidad de reabsorcion. Se discuten los posibles factores causantes del proceso de reabsorcion radicular.
The International journal of periodontics & restorative dentistry
The palatal masticatory mucosa between the canine and first molar is the main source of connectiv... more The palatal masticatory mucosa between the canine and first molar is the main source of connective tissue graft (CTG) for use in periodontal plastic surgery. The purpose of this study was to evaluate the palatal augmentation technique (PAT) to increase the palatal connective tissue donor area using a collagen sponge inserted between the palatal flap and bone. The 26 patients enrolled in this study were referred for root coverage and ridge augmentation procedures. All patients lacked adequate donor palatal tissue thickness. The PAT uses a full-thickness flap and insertion of a sterile lyophilized bovine collagen sponge between the flap and bone. The palatal thickness was clinically assessed before and after collagen sponge insertion. A manual probe was inserted in the mucosal surface perpendicular to the long axis of each tooth approximately 6 mm from the gingival margin. Probing depth (PD) and recession (REC) were also recorded. Treatment with PAT resulted in a statistically signifi...
IntroductionAxenfeld‐Rieger syndrome (ARS), also known as Rieger syndrome, is a rare autosomal do... more IntroductionAxenfeld‐Rieger syndrome (ARS), also known as Rieger syndrome, is a rare autosomal dominant condition defined by craniofacial, ocular, dental, periumbilical, and systemic anomalies.Case PresentationThis case report describes in detail a multidisciplinary approach to successfully restore the oral function and esthetics of a 22‐year‐old patient diagnosed with ARS. The patient's clinical evaluation revealed that the area corresponding with teeth #13, #12, #11, #21, #22, and #23 was occupied by four malformed and/or deciduous teeth. The four anterior teeth were extracted, and socket preservation was performed using bovine‐derived porous bone mineral. Six months after extractions, two implants were placed in the location of the lateral incisors and additional bone graft was performed. Two months after the initial healing, a temporary fixed partial was delivered and 9 months after implant placement the implants were restored with a porcelain‐fused‐to‐metal fixed partial de...
Several clinical studies have documented success when using an acellular dermal matrix (ADM) to t... more Several clinical studies have documented success when using an acellular dermal matrix (ADM) to treat mucogingival defects; however, information concerning its long-term stability is limited. This article presents a case involving a patient with root recession treated with an ADM. Probing depth, marginal tissue recession, and the amount of keratinized and attached tissues were evaluated for 10 years post-treatment; the results showed long-term stability during the observation period.
Background: This case series reports on the effectiveness of the modified apically repositioned f... more Background: This case series reports on the effectiveness of the modified apically repositioned flap (MARF) in increasing the apico‐coronal dimension of attached gingiva over multiple adjacent teeth.Methods: The MARF surgical technique consists of a single horizontal incision within keratinized tissue, elevation of a split‐thickness flap, and suturing of the flap to the periosteum in an apical position. The periosteum is left exposed so that the full perimeter of the wound is surrounded by keratinized tissue. The nature of this wound healing leads to the formation of new keratinized and attached tissue in the area where periosteum is left exposed. A total of 37 areas in 33 systemically healthy patients were analyzed after treatment with the MARF technique. The treatment areas consisted of a minimum of two and a maximum of five adjacent teeth with a minimum of 0.5 mm and a maximum of 2.0 mm of attached gingiva on each tooth.Results: Treatment with MARF resulted in a significant increase in the apico‐coronal dimension of the keratinized tissue and attached gingiva (P <0.05). The increase in keratinized tissue ranged from 2.20 to 4.28 mm, and the increase in attached gingiva ranged from 1.0 to 3.14 mm. Gingival recession decreased significantly in the treated areas, but the difference was of little clinical significance. Probing depths in the treated areas did not change significantly compared to baseline values.Conclusions: MARF is an effective technique in increasing the apico‐coronal dimension of the keratinized tissue and attached gingiva. MARF offers considerable advantages over other mucogingival surgery techniques: simplicity, limited chair time for the patient and the operator, low morbidity because of the absence of palatal donor tissue, and a predictable tissue color match.
Introduction. The purpose of this case report was to show the clinical long-term stability of a s... more Introduction. The purpose of this case report was to show the clinical long-term stability of a successful two-step root coverage procedure. A combination of two single techniques was used to treat an isolated deep-wide defect. Case Presentation. A 28-year-old female patient was referred in order to treat a single recession defect at #22. Due to her fear of dental procedures and a poor economic situation, the team developed an alternative solution. They used a modified apically repositioned flap (MARF) to increase the donor area and then a laterally positioned flap (LPF) to treat the root defect. Clinical evaluation at the three-year follow-up revealed complete resolution of the defect, a gain in clinical attachment, excellent esthetic results, and minor morbidity to the patient. Conclusion. The combination of the MARF and the LPF procedures was able to successfully treat a single deep recession defect with some advantages over traditional techniques such as simplicity, ideal color ...
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Papers by Joao Carnio