Dr. Rick Newhart Updates

It’s that time  again

The OSHA courses to be held by the Blennerhassett Dental Society are coming up in November.  Dentists and hygienists should watch for mailings from the Blennerhassett Dental Society.

Gingiva for your implants

Yan et al. (IJPRD2006;26:287-292) compared the effectiveness of the autogenous Free Gingival Graft to the Acellular Dermal Graft in increasing keratinized gingiva around dental implants. Warrer’s monkey study (CORI1995;6:131-138) of 30 transmucosal implants demonstrated that ligated implants without keratinized mucosa demonstrated significantly more recession than those with keratinized mucosa.  Yan’s group placed an autogenous free gingival graft around a patient’s four maxillary implants and an ADM allograft on four mandibular implants and measured the changes in their 35 year-old patient at a 6-month time interval.   The acellular dermal matrix graft was sutured in the same manner at the free gingival graft.  The authors found that the ADM allograft demonstrated significantly more shrinkage than the autogenous graft and produced significantly less gingival tissue.  The authors concluded that both techniques were beneficial to increase the gingival health around the dental implants, but that the autogenous free gingival graft showed a much greater increase in gingival tissue.  Dr. Newhart frequently grafts dental implants with autogenous grafts and has had very good clinical results.

Pre-implant orthodontics

Lopez et al. (IJOPRD2005;25:239-245) present a case of orthodontic traction in a 34 year-old woman with a hopeless right central incisor.  The tooth presented with 6mm of gingival recession on the facial aspect of the tooth due to horizontal root resorption.  The authors extracted the coronal portion of the tooth while the apical one-third of the root remained.  This apical one-third of the root was then subject to forced orthodontic extrusion over a 30-day period prior to the placement of a dental implant two weeks after orthodontic movement.  The authors described complete regeneration of the gingival band from the orthodontic super eruption, which was stable for a 3-year follow-up period.  Orthodontic extrusion is beneficial in that it can achieve both bone and gingival margin displacement to correct an unfavorable esthetic outcome.  Mantzikos and Shamus (AJODO1999;115:583-591) state that bone modification by forced orthodontic extrusion is almost always preferable to surgical modification.  Dr. Newhart feels that careful management of the orthodontic patient prior to implant placement can significantly enhance implant esthetics.   

Are you too thin?

Carnio and Hellmon (IJPRD2005;25:257-263) present a new technique for thickening the donor site for a free gingival graft, followed up with clinical and histological evaluation.  Their 26 year-old male patient presented with gingival recession on the upper right  canine, which was 4mm deep and 5mm wide.  The palate donor site was only 1mm thick, which was too thin for a subepithelial connective tissue graft.  Subsequently, the authors performed a full thickness flap incision and inserted sterile lyophilized bovine collagen sponge on the palate and sutured the site.  After 8 weeks of healing, an increase in thickness to approximately 4mm was noted.  This tissue was then harvested for use in a subepthelial connective tissue graft, which subsequently obtained an excellent result for the palate.  The authors conclude that sterile lyophilized bovine collagen sponge is fully absorbed by 8 weeks and can be successfully used to thicken donor sites for use in subepithelial connective tissue grafts.  Dr. Newhart frequently performs subepithelial connective tissue grafts to obtain root coverage and feels this may be a beneficial technique.

Thank you for your continued referral of dental implant and periodontal patients!

Please visit our website at: thegumdr.com

Dr. Richard Newhart, Periodontist

Dental Implant Placement

1308 Market Street    

Parkersburg, WV 26101

(304) 422-4867

“That Christ may dwell in your hearts by faith; that ye, being rooted and grounded in love, may be able to comprehend with all saints what is the breadth, and length, and depth, and height; and to know the love of Christ, which passeth knowledge, that ye might be filled with all the fullness of God.”

Ephesians 3:17-19

Dr. Newhart’s periodontal update is a referenced literature and research review and newsletter. Dr. Newhart is not claiming to perform, endorse, or achieve the results of every surgical technique or procedure published in this newsletter. Dr. Newhart is a licensed periodontal specialist, who has significant post-doctoral implant and periodontal education & training.