Semmelweis University of Medicine, Department of Periodontology, Budapest, Hungary


Advanced horizonto-vertical bony defects originated from periodontal disease present a challenge for clinicians. In our clinical case series the patients have undergone a combined surgical and prosthetic rehabilitation in order to achieve a stabile, functional and aesthetically acceptable solution. The secondary goal was to develop  healthy periodontal conditions around neighbouring teeth.

Materials and methods

20 patients were enrolled in the study   with  at least one advanced horizonto-vertical bony defect  and hopeless   prognosis.  Following a  cause-related periodontal treatment   the Gingival and Plaque Indices were  below  20%. After tooth removal an extraction site development was performed to maintain the horizontal and vertical dimension of the remaining alveolar ridge and if it was needed soft tissue augmentation was proceeded to widen the keratinized gingiva. Either conventional prosthetic restoration  or implant placement was embraced. If implant therapy was chosen then simultaneous hard and soft tissue augmentation was done during implant placement. After the healing phase the patients were prosthodonticly rehabilitated.   


10 patients were rehabilitated with conventional bridges. In 6 patients implant-borne single crowns and in 4 patients implant-borne bridges were placed. In implant cases ideal hard and soft tissue conditions were achieved. The periodontal status of the neighbouring teeth was improved, the PPD changed from 3,97mm to 2,55mm, the GR from 0,84mm to 2,13mm, the CAL from 4,78mm to 4,58mm.

Conclusion   Extraction site development after tooth removal helps to  maintain  the dimensions of the remaining alveolar ridge. With  implant therapy  an  ideal hard and soft tissue environment were created. In all patients the periodontal status of neighbouring teeth improved.     

Key words

Prosthetic rehabilitation, advanced periodontal breakdown, implant therapy, extraction site development

Treatment of multiple gingival recessions with a bioresorbable collagen matrix
B. Molnar1, S. Aroca2, T. Keglevich1, P. Windisch1, G. E. Salvi2, I. Gera1, A. Sculean2

1Semmelweis University Department of Periodontology
2University of Bern, Department of Periodontology

Objectives The aim of this prospective, randomized, controlled split-mouth clinical trial was to compare the treatment of Miller Class I and II multiple gingival recessions using the modified coronally advanced tunnel (MCAT) technique by means of either a bioresorbable collagen matrix or a connective tissue graft (CTG). Methods Seventeen subjects in good general health exhibiting multiple Miller Class I and II gingival recessions (i.e. at least 3 recessions per site) were included and treated. According to a computer-generated randomization schedule, recession sites were treated using the MCAT technique by means of either a bioresorbable collagen matrix (Mucograft®, Geistlich, Wolhusen, Switzerland) (test) or a CTG harvested from the palate (control). The following clinical parameters were assessed at baseline and at 1, 3, and 6 months postoperatively: recession depth and width, width and thickness of keratinized tissue, distance from the tip of the papilla to the contact point, papilla width, probing pocket depth. Results No allergic reactions, soft tissue irritations or matrix exfoliations occurred at test sites. Mean root coverage amounted to 1.2 ± 0.4 mm at test sites vs. 1.5 ± 0.6 mm at control sites . The mean increase in keratinized tissue width amounted to 0.2 ± 0.4 mm at test sites vs. 0.5 ± 0.6 mm at control sites. Complete root coverage was found in 52% of test sites vs. 72% of control sites. Duration of surgery and patient morbidity were statistically significantly lower in the test compared to the control group, respectively. Conclusions These outcomes indicate that: i) treatment of Miller Class I and II multiple gingival recessions using the MCAT technique combined with either Mucograft® or CTG may result in substantial mean root coverage, but lower complete root coverage with Mucograft® and ii) Mucograft® may represent a valuable alternative to the palatal connective tissue graft, resulting in lower patient morbidity and duration of surgery. The present study was supported by a grant from Geistlich, Wolhusen, Switzerland.

Genetic determinants of periodontitis in the Hungarian population
Péter Stiedl1, Csilla Páska1, Gabriella Jobbágy-Óvári1, Dorina Hontvári1, Borbála Soós3, Bálint Molnár2, Gábor Nagy4, Gábor Varga1, István Gera2
1 Department of Oral Biology, Semmelweis University, Hungary
2 Department of Periodontology, Semmelweis University, Hungary
3 Department of Prosthodontics, Semmelweis University, Hungary
4 Department of Oral Diagnostics, Semmelweis University, Hungary

Objectives: Periodontitis is a complex multifactorial disease: genetic factors are evidenced in the aetiology besides pathogenic bacteria and various environmental factors. Its patophysiology is characterized by numerous biological pathways leading to the same phenomena. Depending on the ethnic population there are multiple genes and their polymorphisms, which are associated in the development of periodontitis. Our mission goal was to prove and investigate the incidence of 7 chosen single nucleotide polymorphisms (SNPs) (IL-1α -889A/G, IL-1β+3954C/T, IL-1β-511G/A, IL-10-1082T/C, TNFα-308A/G, TLR4-299A/G, TLR4-399C/T) in patients with several forms of periodontal disease in the Hungarian population.
Methods: DNA was isolated from buccal swabs from 259 healthy volunteers and patients with several clinical forms and gravity of periodontal disease. They were classified according to the clinical parameters into healthy control, gingivitis, chronic and aggressive periodontitis groups and the periodontitis groups were further stratified based on pocket depths into 4 groups (0-1 mm, 1-3.5mm, 3.5-5.5mm, and >5.5mm) The 7 SNPs were identified by Genotyping Realtime PCR using Taqman SNP Genotyping assays. Group wise differences were calculated by logistic regression and Chi2 probe.
Results: The rare A allele frequency at IL-1β-511G/A SNP increased at higher periodontal pocket depths OR=2.007 between control and 3.5-5.5mm groups (p=0.0097) OR=2.372 between control and >5.5mm groups (p=0.0024). The rare AA genotype frequencies were significantly different between control and 1-3.5mm, 3.5-5.5mm and >5.5mm groups, rising respectively from 19.1%, to 36.2%, 38.6% and 45.6%. Other SNPs did not exhibit significant differences at our sample numbers yet.
Conclusions: According to our results the IL-1β-511G/A polymophism may have a stronger association with periodontitis in the Hungarian population while other examined SNPs might have a relatively weak role or it necessitate larger sample numbers to achieve significance. The IL-1β-511G/A SNP may arise as a preliminary selective factor identifying patients with the risk of getting periodontitis.
Supported by the Hungarian Scientific Research Fund (OTKA 72385)

Effect of Er:YAG laser as adjunct to guided tissue regeneration



Objective: To evaluate the effect of the erbium:yttrium-aluminium-garnet laser (Er:YAG) on the healing of human intrabony defects treated with resorbable collagen barrier (BioGide) and demineralised bovine bone mineral (DBBM, BioOss).

Methods: Twenty-two periodontitis patients were included. Inclusion criteria were: presence of intrabony defect with minimum 3mm of depth following initial periodontal therapy; good oral hygiene (FMPS<25%); non-contributing medical history and signed informed consent. Plaque/bleeding score (FMPS/FMBS); pocket depth (PPD); gingival recession (REC) and attachment level (CAL) were measured at baseline and after twelve months. Following flap reflection, subjects were randomised in two groups. Root surface debridement and granulation tissue removal were carried out either with Er:YAG (KEY II, KaVo) at 160 mJ/pulse, 10 Hz and 15-20 degree between the chisel shaped tip and the root surface (test) or by ultrasonic and hand instruments (control). Defects were then filled with DBBM and covered by collagen membrane prior to flap closure. Postsurgical regime included amoxicillin (500mg, TID, 7 days) and chlorhexidine rinse (0.2%, BID, 2 weeks). Patients were entered in a supportive oral hygiene program.

Results: No significant differences were detected between test and control groups at baseline. Healing was uneventful in both groups. In the Er:YAG group mean PPD was reduced from 9.2±2.8 mm to 3.7±1.1 mm (p<0.001) and mean CAL changed from 11.7±2.9 mm to 7.5±1.8 mm (p<0.001). In the test group mean PPD was reduced from 8.5±2.6 mm to 3.4±1.0 mm (p<0.001) and mean CAL changed from 10.6±3.6 mm to 6.5±2.0 mm (p<0.001). None of the investigated parameters showed statistically significant intergroup differences.

Conclusion: Within their limits, the present findings indicate that both therapies led to significant PPD reduction and CAL gain. Consequently, Er:YAG may be a viable alternative, but may not provide additional benefit to conventional root surface instrumentation in regenerative periodontal surgery.