ARCOI presentation - Rome, march 2014

Dal lungotevere ai grandi laghi Un percorso di crescita professionale e umana

Dr. Nicola Alberto Valente

Roma 17 marzo 2014

UOC Chirurgia Odontostomatologica e Riabilitazione Implanto-Protesica !• Frequentatore da gennaio 2008 • Tutor da gennaio 2010

Los Angeles USC 2009

• Certificate of advanced graduate studies in Periodontology

!• Master of Science in

Oral Sciences

MS in Oral Science

• Research Design • Scientific Writing • Evidence Based Dentistry • Biostatistics • Advanced Statistical Concepts • Hard Tissue Engineering • Dynamics of Bone • …

Certificate in Periodontology

• 40 fully documented cases • 5 gingivectomy and/or gingivoplasty • 15 gingival or apically repositioned flap • 10 clinical crown lenghtening • 15 periodontal surgical ossous recontouring • 10 bone replacement grafts • 5 guided tissue regenerations • 5 lateral sliding flaps or free gingival graft • 5 subepithelial connective tissue grafts • 8 distal or proximal wedge procedures • 2 provisional splinting, extracoronal or intracoronal • 125 subgingival scaling and root planing • 5 localized delivery of chemotherapeutics agents • 2 root amputation or hemisection • 20 periodontal maintenance • 10 periodontal maintenance (supervision of hygienist) • 7 surgical placement of implant body • 3 sinus graft/ramus graft/chin graft

• 3 in-service exams • Comprehensive qualifying examination • Oral examination • Recertification every 6 years

Certificate in Periodontology• Advanced periodontics clinic • Hospital practice periodontics • Supervised teaching in periodontics


• Critical analysis of literature in Periodontics (Journal Club)


• Critical analysis of literature in Periodontics (Journal Club)• Seminars in periodontal biology


• Critical analysis of literature in Periodontics (Journal Club)• Seminars in periodontal biology• Postgraduate treatment planning (Perio/Pros)


• Critical analysis of literature in Periodontics (Journal Club)• Seminars in periodontal biology• Postgraduate treatment planning (Perio/Pros)• […]

PER 603 Unit C3. The Periodontal Tissues in DiseaseJanuary 21, 2014

Connective Tissue Regeneration and Mucogingival Surgery

Dr. Nicola Alberto Valente Supervisor: Dr. Joseph J Zambon

Outline• Introduction • Basic Concepts of Guided Tissue Regeneration

(GTR) • Current Concepts of GTR • Intrabony Defect • GTR and Furcation Therapy • Membranes • Enamel Matrix Derivative (Emdogain) • Connective Tissue Graft and GTR • Alternatives to the Use of Connective Tissue Graft • Implant and GTR

• 1. *Aukhil I, Iglhaut J. Periodontal ligament cell kinetics following experimental regenerative procedures. J Clin Periodontol. 1988 Jul;15(6):374-82. (Nicola)

• 2. *Jepsen S, Eberhard J, Herrera D, Needleman I. A systematic review of guided tissue regeneration for periodontal furcation defects. What is the effect of guided tissue regeneration compared with surgical debridement in the treatment of furcation defects? J Clin Periodontol. 2002;29 Suppl 3:103-16; discussion 160-2. Review. (Nicola)

• 3. *Wang HL, Greenwell H, Fiorellini J, Giannobile W, Offenbacher S, Salkin L, Townsend C, Sheridan P, Genco RJ; Research, Science and Therapy Committee. Periodontal regeneration (position paper) . J Periodontol. 2005 Sep;76(9):1601-22. (Nicola)

• 4. Hannu Larjava, Yi Yang, Edward Putnins, Jyrki Heino, Lari Häkkinen. Biological agents and cell therapies in periodontal regeneration Endodontic Topics 2012 26(1): 18-40 (Hania)

• 5. Carreira AC, Lojudice FH, Halcsik E, Navarro RD, Sogayar MC, Granjeiro JMBone Morphogenetic Proteins: Facts, Challenges, and Future Perspectives. J Dent Res. 2014 Jan 3. [Epub ahead of print] (Hania)

• 6. Lee CH, Hajibendeh J, Takahiro S, Fan A, Shang P, Mao J. 3D Printed Multiphase Scaffolds for Regeneration of Periodontium Complex. Tissue Eng Part A. 2013 Dec 2. [Epub ahead of print] (Hania)

• 7. *Prichard JP. The diagnosis and management of vertical bony defects. J Periodontol 1983;54:29-35. (Gabriela)

• 8. *Aichelmann-Reidy ME, Reynolds MA. Predictability of clinical outcomes following regenerative therapy in intrabony defects. J Periodontol. 2008 Mar;79(3):387-93. (Gabriela)

• 9. *Stavropoulos A, Karring T. Guided tissue regeneration combined with a deproteinized bovine bone mineral (Bio-Oss) in the treatment of intrabony periodontal defects: 6-year results from a randomized-controlled clinical trial. J Clin Periodontol. 2010 Feb;37(2):200-10. (Gabriela)

• 10. *Anderegg C, Martin S, Gray J, Mellonig J, Gher M. Clinical evaluation of the use of decalcified freeze-dried bone allograft with guided tissue regeneration in the treatment of molar furcation invasions. J Periodontol 1991;62:264-268. (Reham)

• 11. *Pontoriero R, Lindhe J. Guided tissue regeneration in the treatment of degree II furcations in maxillary molars. J Clin Periodontol. 1995 Oct;22(10):756-63. (Reham)

• 12. *Pontoriero R, Lindhe J Guided tissue regeneration in the treatment of degree III furcation defects in maxillary molars. J Clin Periodontol. 1995 Oct;22(10):810-2. (Reham)

• 13. *Pradeep AR, Pai S, Garg G, Devi P, Shetty SK. A randomized clinical trial of autologous platelet-rich plasma in the treatment of mandibular degree II furcation defects. J Clin Periodontol. 2009 Jul;36(7):581-8. (Wael)

• 14. *Yukna C.N. and Yukna RA: Multi-center evaluation of bioabsorbable collagen membrane for guided tissue regeneration in human class II furcation. J. Periodontol 1996; 67: 650-657. (Ammar)

• 15. *Lindfors LT, Tervonen EA, Sándor GK, Ylikontiola LP. Guided bone regeneration using a titanium-reinforced ePTFE membrane and particulate autogenous bone: the effect of smoking and membrane exposure. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jun;109(6):825-30. Epub 2010 Apr 9. (Ammar)

• 16. Bottino MC, Thomas V, Schmidt G, Vohra YK, Chu TM, Kowolik MJ, Janowski GM. Recent advances in the development of GTR/GBR membranes for periodontal regeneration--a materials perspective. Dent Mater. 2012 Jul;28(7):703-21 (Ammar)

• 17. *Donos N, Glavind L, Karring T, Sculean A. Clinical evaluation of an enamel matrix derivative in the treatment of mandibular degree II furcation involvement: a 36-month case series. Int J Periodontics Restorative Dent. 2003 Oct;23(5):507-12. (Wael)

• 18. *Sculean A, Windisch P, Szendröi-Kiss D, Horváth A, Rosta P, Becker J, Gera I, Schwarz F. Clinical and histologic evaluation of an enamel matrix derivative combined with a biphasic calcium phosphate for the treatment of human intrabony periodontal defects. J Periodontol. 2008 Oct;79(10):1991-9. (Wael)

• 19. *Nickles K, Ratka-Krüger P, Neukranz E, Raetzke P, Eickholz P. Ten-year results after connective tissue grafts and guided tissue regeneration for root coverage. J Periodontol. 2010 Jun;81(6):827-36. (Amal)

• 20. Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, Montebugnoli L. Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions. A comparative short and long term controlled randomized clinical trial. J Clin Periodontol. 2013 Dec 30. doi: 10.1111/jcpe.12224. [Epub ahead of print] (Amal)

• 21. Kahn S, Rodrigues WJ, Barceleiro Mde O. Periodontal Plastic Microsurgery in the Treatment of Deep Gingival Recession after Orthodontic Movement Case Rep Dent. 2013;2013:851413. doi: 10.1155/2013/851413. Epub 2013 Nov 7. (Amal)

• 22. Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes. J Clin Periodontol. 2013 Oct 4. doi: 10.1111/jcpe.12178. [Epub ahead of print] (Hytham)

• 23. Rotenberg SA, Tatakis DN. Dimensional Changes During Early Healing Following a Subepithelial Connective Tissue Graft Procedure. J Periodontol. 2013 Nov 11. [Epub ahead of print] (Hytham)

• 24. Ahmedbeyli C, Dirikan İpçi S, Cakar G, Kuru BE, Yılmaz S. Clinical Evaluation of Coronally Advanced Flap With or Without Acellular Dermal Matrix Graft on Complete Defect Coverage for the Treatment of Multiple Gingival Recessions with Thin Tissue Biotype. J Clin Periodontol. 2013 Dec 4. doi: 10.1111/jcpe.12211. [Epub ahead of print] (Hytham)

• 25. *El Helow K, El Askary Ael S. Regenerative barriers in immediate implant placement: a literature review. Implant Dent. 2008 Sep;17(3):360-71. Review. (Sri)

• 26. *Benić GI, Jung RE, Siegenthaler DW, Hämmerle CH. Clinical and radiographic comparison of implants in regenerated or native bone: 5-year results. Clin Oral Implants Res. 2009 May;20(5):507-13. Epub 2009 Mar 3. (Sri)

• 27. *Jung RE, Windisch SI, Eggenschwiler AM, Thoma DS, Weber FE, Hämmerle CH. A randomized-controlled clinical trial evaluating clinical and radiological outcomes after 3 and 5 years of dental implants placed in bone regenerated by means of GBR techniques with or without the addition of BMP-2. Clin Oral Implants Res. 2009 Jul;20(7):660-6. Epub 2009 Mar 27.(Sri)

Postgraduate Treatment Planning And Case Presentation

PER914Nicola Alberto Valente DDS

PG Periodontics

11/12/13

HIPAA Declaration

• The informations presented are within the limits of HIPAA declaration

Personal Data

• Name: E.B.

• Age: 50 years old

• Gender: male

• Race: caucasian

• Marital status: single

• Occupation: real estate

Referral

• Referred from PG prosthodontics for:

• Second stage surgery on implants #12 and #13

• Periodontal evaluation for deep pockets

• Crown lengthening on #22, #28, #29

Chief Complaint

• “I want to have a smile like Julia Roberts”

Medical History

• Major illness:

• ASA:

• Hospitalization & Surgical History:

• Medications:

• Allergies:

None

I

None

None

No

Habits

• Smoking: 1 pack of cigarettes a day (trying to quit, he reports he haven’t been smoking for the last 2 months and just started smoking again)

• Alcohol consumption: once or twice per week

• Recreational drugs: 2 pot per week (1 per day reported in a 2009 medical assessment)

• Parafunctional habits: Clenching

Personality And Behavior

• Indifferent (House 1958)

• Apathetic, uninterested and lacks motivation. Pays no attention to instructions, not enough cooperative

Dental History• Amalgam fillings: #s 1, 3, 14, 19, 30

• Composite fillings: #s 18, 19., 20, 31

• Endodontic treatments: #18

• Missing teeth: #s 2, 4, 5, 12, 13, 15, 16, 17, 20, 32

• Fractured teeth: #s 3, 30

• 4 implants (#s 4, 5, 12, 13) placed in march 2012 and never loaded (2nd stage only on 4 and 5)

Periodontal History• Osseous recontouring + distal wedge #31 (11/10)

• Open flap debridement + osseous recontouring #18 and 19 (4/11)

• Open flap debridement + osseous recontouring #14 (6/11)

• No Perio maintenance reported in chart between last surgery and implants placement in march 2012

• No Perio maintenance reported in chart after implant placement

Physical Examination• No physical or mental disability was noticed

• Records at initial visit:

• Blood pressure: 147/90 mmHg

• Pulse: 73 bpm

• Weight: 200 lbs

• Height: 6’ 4’’

• BMI: 24.3 (Normal weight)

Clinical Examination• Extra-oral examination:

• No facial asymmetry

• No palpable lymph nodes

• TMJ:

• No deviation detected upon opening

• Asymptomatic TMJ and masticatory muscles

• Mouth opening within normal range

• Head and neck: no abnormalities or pathology observed

Clinical Examination

Intra-oral examination: Patient’s tongue, mucosa, floor of the mouth, hard and soft palate were examined and no pathology was found.

Occlusal Analysis• Severe Class II

• Severe deep bite and over jet

• Anterior guidance: Anterior teeth

• Excursive movements: Right side: balancing side interference Left Side: no interference

• Working side contacts: Left and right group function

• Protrusive assessment: No interference

• Fremitus: No

• Plane of occlusion: Irregular

• Esthetic deficit: wear, overeruption and spacing of anterior teeth, missing upper premolars

Oral Hygiene

• Plaque control include brushing 2 times/day and no flossing

• Plaque score is 31,3% (O’Leary et al. 1972)

Periodontal Status• Gingiva pink with firm consistency and stippling

• Gingival architecture: intermediate (flat/scalloped)

• Slight recessions on upper canines and molars

• Adequate amount of keratinized gingiva

• Generalized horizontal bone loss, localized vertical on #1

• Widening of PDL on #8, over eruption of #8 and 9

• Good vestibular depth except for #4 and 5

Periodontal Examination

Maxillary arch

Periodontal charting

Mandibular arch

Diagnosis and Prognosis• Diagnosis

• Medical: I (ASA)

• Periodontal: Chronic generalized severe periodontitis (AAP)

• Etiology

• Primary: Plaque due to poor oral hygiene

• Secondary: Defective restorations Risk factors: smoke

• Prognosis (McGuire & Nunn 1996)

• Overall: Fair

• #1, 19, 30, 31: Poor

• Long term prognosis (Kwok & Caton 2007)

• Favorable

Treatment Objectives• Eradicate and change etiologic factors for periodontal disease

• Educate the patient on the causes and prevention of periodontal disease

• Improve oral hygiene and plaque control

• Reduce plaque and calculus to below disease threshold (SRP)

• Surgically reduce the deep periodontal pockets

• Re-establish esthetics and functions

• Schedule regular periodontal maintenance recalls for monitoring and preventive care

Treatment Plan

• 2nd stage implant #12 and 13 • Open flap debridement on 1st quadrant • Open flap debridement + osseous surgery on 3rd quadrant • Open flap debridement + osseous surgery on 4th quadrant • Crown lengthening on #20, 28 and 29

• OHI, education, motivation • Scaling and root planing, recontouring defective

restoration

Treatment Plan

• Increase VDO 1-2mm (PG Pros) • trial phase: composite restorations, temporary FPD

(implants) • Re-evaluation after 6-8 weeks • Final restorations: single crowns up to the canines,

veneers on #7-10, 23-26 • Restore implant #4, 5, 12, 13• Night guard • Maintenance every 3 months

Treatment Plan

Treatment progressCrown lengthening should allow to have a tooth structure above the bone crest of about 3.5-4mm taking into account the biological width which is 2.04mm (Gargiulo 1961) + 1.5 mm for the ferrule. Anyway, since a rebound of about 1-2mm is expected (Wagenberg 1989), 4-5mm of tooth structure above the crest is recommended.

Treatment progress3rd quadrant OFD + OS + crown lengthening #20

Treatment progress

3rd quadrant OFD + OS + crown lengthening #20

Treatment progress


Treatment progress


4 weeks after surgery

4th quadrant OFD + ORS + crown lengthening #28 and 29

Treatment progress

Treatment progress


Treatment progress


1 week after surgery

Caso I• Paziente: DD

• Età: 28

• Sesso: Maschio

• Razza: Ispanico

• Occupazione: Allentown Industries: Heritage Center (work program for people with disabilities)

• Riferito da: UB pediatric dentistry for periodontal disease

• Chief complaint: preoccupato della mobilità dei due centrali superiori (il flaring è cominciato circa 2 anni fa)

• Storia medica: Autismo - Ipertensione - Obesità

Diagnosi

Armitage GC. Periodontal diagnoses and classification of periodontal diseases. Periodontol 2000. 2004;34:9-21.

Parodontite Aggressiva Localizzata

Parodontite aggressiva localizzata

• Insorgenza circum-puberale

• Robusta risposta anticorpale sierica agli agenti infettivi: il sierotipo anticorpale dominante è IgG2.

• Presentazione localizzata a primi molari e incisivi

• Infiammazione gengivale, edema, sanguinamento, formazione di tasche.

Parameter on aggressive periodontitis. American Academy of Periodontology. J Periodontol. 2000 May;71(5 Suppl):867-9

• Caratteristiche primarie

• Eccetto per la presenza della patologia parodontale i pazienti sono altrimenti in buona salute.

• Rapida perdita di attacco e distruzione ossea.

• Aggregazione familiare

Zambon JJ. Actinobacillus actinomycetemcomitans in human periodontal disease. J Clin Periodontol. 1985 Jan;12(1):1-20

American Academy of Periodontology (1999). Consensus report: Aggressive Periodontitis". Ann. Periodontol.

Terapia• Scaling sopragingivale (familiarizzazione del paziente mentalmente disabile)

• SRP 1° e 2° quadrante con anestetico gel intrasulculare (Oraqix)

• SRP 3° e 4° quadrante con anestetico gel intrasulculare (Oraqix)

• Rivalutazione a 1 mese: nessun miglioramento significativo. Prescritta terapia sistemica con Amoxicillina+Metronidazolo 250mg+250mg TID per 10 giorni.

• Rivalutazione a 3 settimane dall’inizio della terapia sistemica, miglioramenti già visibili in termini di PD e BOP (sanguinamento non rilevato in nessun sito) OHI has been reinforced. Rivalutazione in un mese.

Zambon JJ, Christersson LA, Genco RJ. Diagnosis and treatment of localized juvenile periodontitis. J Am Dent Assoc. 1986 Aug;113(2):295-9.

Van Winkelhoff, A.J., et al.Metronidazole plus amoxycilin in the treatment of Actinobacillus actinomycetemcomitans associated periodontitis. J. Clin. Periodontol, 1989; 16: 128-31.

• Rivalutazione a 7 settimane da inizio tx sistemica: ulteriori miglioramenti, mutamento generalizzato delle tasche da profondità severe a range fisiologici e stabilizzazione delle mobilità (eccetto 1.1). Controllo domiciliare della placca da migliorare, prescritta CHX 0,12% BID per un mese. Rivalutazione in 5 settimane.

pre tx

post tx

• Rivalutazione dopo chx 0,12%: controllo della placca migliorato, nessun BOP residuo. Tessuti parodontali relativi a 1.1 sono ancora interessati da patologia parodontale (infiammazione, perdita ossea, tasca) dopo consultazione con protesista si decide per estrazione e realizzazione di PPR. Il paziente passa in fase di mantenimento con cadenza trimestrale.

Caso II• Paziente: AR

• Età: 65

• Sesso: Maschio

• Razza: Caucasico

• Occupazione: Insegnante in pensione

• Riferito da: Clinica pre-doc per cure parodontali

• Chief complaint: nessuno

• Storia medica: Broncopneumopatia cronica istruttiva - enfisema - disordine ossessivo compulsivo - ipertrofia prostatica

Diagnosi

Armitage GC. Periodontal diagnoses and classification of periodontal diseases. Periodontol 2000. 2004;34:9-21.

Parodontite Cronica Severa Generalizzata

Stambaugh RV, Dragoo M, Smith DM, Carasali L. The limits of subgingival scaling. Int J Periodontics Restorative Dent. 1981;1(5):30-41.

Kaldahl WB1, Kalkwarf KL, Patil KD, Dyer JK, Bates RE Jr. Evaluation of four modalities of periodontal therapy. Mean probing depth, probing attachment level and recession changes. J Periodontol. 1988 Dec;59(12):783-93.

Ramfjord SP, Nissle RR. The modified widman flap. J Periodontol. 1974 Aug;45(8):601-7.

1 mese post OFD

1 anno post OFD

Caso III• Paziente: LS

• Età: 45

• Sesso: Femmina

• Razza: Caucasica

• Occupazione: Receptionist in una palestra

• Riferito da: Clinica pre-doc per tasca profonda elemento 347

• Chief complaint: “sono consapevole e preoccupata dei miei problemi alle gengive”

• Storia medica: Nessuna patologia rilevante dichiarata

Takei HH, Han TJ, Carranza FA Jr, Kenney EB, Lekovic V. Flap technique for periodontal bone implants. Papilla preservation technique. J Periodontol. 1985 Apr;56(4):204-10.

Caso IV• Paziente: LA

• Età: 46

• Sesso: Femmina


• Occupazione: Insegnante di italiano e spagnolo

• Riferito da: Screening per valutazione parodontale

• Chief complaint: “I miei denti d’avanti si muovono”


Perdita di attacco interprossimale - coronale alla MGJ CAL interprossimale > CAL buccal

Miller class III copertura radicolare parziale

Miller, P.D. A classification of marginal tissue recession. Int J Perio Rest Dent 5: 9-13, 1985

Zucchelli G, Testori T, De Sanctis M. Clinical and anatomical factors limiting treatment outcomes of gingival recession: A new method to predetermine the line of root coverage. J Periodontol 2006;77:714-721.

3 settimane post-op

7 mesi post-op

Caso V• Paziente: PM

• Età: 36

• Sesso: Femmina


• Occupazione: Casalinga

• Riferito da: Clinica pre-doc per recessioni multiple

• Chief complaint: “Le mie gengive sono sensibili”


No perdita di attacco interprossimale - coronale alla MGJ Miller class I copertura radicolare totale

Miller, P.D. A classification of marginal tissue recession. Int J Perio Rest Dent 5: 9-13, 1985

Zuhr O, Rebele SF, Schneider D, Jung RE, Hürzeler MB. Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part I. Clinical and patient-centred outcomes. J Clin Periodontol. 2013 Oct 4. [Epub ahead of print]

Implant Center

Post-estrattivo in posizione 1.5 da dente deciduo ritenuto per

agenesia premolare

Dente deciduo ritenuto e agenesia premolare 1.5

Straumann Bone Level - SLA

4.1mm RC x 12mm

Kutkut A, Andreana S, Monaco E. Esthetic consideration for alveolar socket preservation prior to implant placement: description of a technique and 80-case series report. Gen Dent. 2012 Nov-Dec;60(6):e398-403..

1 settimana post-op

Barone A, Toti P, Piattelli A, Iezzi G, Derchi G, Covani U. Extraction socket healing in humans after ridge preservation techniques: comparison between flapless and flapped procedures in a randomized clinical trial. J Periodontol. 2014 Jan;85(1):14-23.

3 settimane post-op

3 mesi post-op

4 mesi post-op

16 mesi

Posizionamento implantare 3.5-3.6 con socket preservation 3.5 e espansione di cresta con osso di cadavere irradiato e

solfato di calcio

Referral

Extraction and socket preservation of #20 Ridge augmentation

Implant placement #19 and #20

Prima visita

6 mesi dopo socket preservation

ridge augmentation

Kutkut A, Andreana S. Medical-Grade Calcium Sulfate Hemihydrate in Clinical Implant Dentistry: A Review Journal of Long-Term Effects of Medical Implants, 20(4): 295–301 (2010)

• Rocky Mountain Tissue Bank Irradiated bone

• Dentogen Calcium Sulphate, 1g

• ACE conFORM Collagen Membrane 20mm x 30mm

• Cytoplast PTFE 3-0

2 settimane post-op

3 settimane post-op

Posizionamento impianti

Cornelini R, Cangini F, Covani U, Andreana S. Simultaneous implant placement and vertical ridge augmentation with a titanium-reinforced membrane: a case report. Int J Oral Maxillofac Implants. 2000 Nov-Dec;15(6):883-8.

• Straumann SLA BL RC 4.8mm x 10mm (#19)

• Straumann SLA BL RC 4.1mm x 10mm (#20)

• Alloss Cortico/Cancellous Particulate

• Dentogen Calcium Sulphate

• ACE conFORM Collagen Membrane 15mm x 20mm

• Cytoplast PTFE 3-0

2 weeks after

Controllo a 2 mesi

2nd stage

4 febbraio 2014

2nd stage

Posizionamento implantare 2.4-2.5 con espansione di cresta

con osso equino e solfato di calcio

follow up 1 settimana

2nd stage

2nd stage

2 settimane dopo

Osteonecrosi post-implantare da terapia bifosfonati IV pregressa

- Rigenerazione con rhPDGF e Solfato di Calcio

follow up a 9 mesi

Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, McAllister BS, Murphy KS, McClain PK, Nevins ML, Paquette DW, Han TJ, Reddy MS, Lavin PT, Genco RJ, Lynch SE. Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol. 2005 Dec; 76(12): 2205-15.

Grazie

navalente

[email protected]

ARCOI presentation - Rome, march 2014

Presentations & Public Speaking

Transcript of ARCOI presentation - Rome, march 2014