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Implantable cardioverter-defibrillators (ICD) are increasingly being used among the pediatric population for indications of both primary and secondary prevention. There is limited long-term data on the outcomes of pediatric patients following ICD implantation. The aim of this study was to investigate the characteristics of this population, burden of appropriate and inappropriate shock and complication rate in a large tertiary pediatric medical center. Included were children under the age of 18 years who underwent ICD implantation and had clinical follow up at our center. Data were retrospectively collected between study period 2005–2020. Primary outcome was the incidence of ICD shock appropriate and inappropriate. Secondary outcome was defining our patient population characteristics. Our cohort included 51 patients who underwent ICD implantation. Mean age at implantation was 10.9 ± 4.7 years and average follow-up time was 67 months. Diagnoses of implanted patients were: 28 (55%) patients with syndromes with risk for sudden death, cardiomyopathy in 14 patients (27%) and congenital heart disease (CHD) in 9 patients (18%). Forty-two (82%) patients had an ICD implanted for secondary prevention after experiencing a life-threatening arrhythmia and 9 (18%) for primary prevention. An endocardial system was implanted in 39 (76%) patients and an epicardial systems in 12 (24%) patients. A total of 20 (39%) patients received appropriate shocks for ventricular fibrillation(VF). 5 patients received inappropriate shocks, 4 due to sinus tachycardia and 1 due to rapidly conducted atrial fibrillation. Those who received an inappropriate shock had a significantly shorter ICD-programmed VF detection cycle length compared to those who did not receive an inappropriate shock (320 ms versus 270 ms, p = 0.062). This single center study demonstrates a high rate of appropriate ICD shocks (39%) and a low rate of inappropriate ICD shocks. Accurate programming of ICD devices in the pediatric population is paramount to avoid inappropriate ICD shocks. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine publication bias associated with a failure to report research results of studies that were initially posted on the ClinicalTrials.gov registry and to examine factors associated with this phenomenon. Methods: A search was conducted in the ClinicalTrials.gov registry using six dental-related topics. Corresponding publications for trials completed between 2016 and 2019 were then searched using PUBMED, EMBASE and Google Scholar. For studies lacking matching publications, we emailed the primary investigator and received some additional data. For included studies, we recorded additional variables: industry funding, site setting (academic, private research facilities or private practice), design (single or multi-center), geographical location and commencement date vis a vis registration and publication dates. Results: A total of 744 entries were found, of which 7 duplicates were removed; an additional 67 entries just recently completed were removed. An additional 7 studies were in different fields and thus removed. Thus, 663 trials were included; of these, only 337 studies (50.8%) were published. The mean registration to publication interval was 29.01 ± 25.7 months, ranging from +142 to −34 months (post factum registration). Less than 1/3 of the studies were posted prior to commencement, of which much smaller proportions were published (37.3%). Studies that were posted after commencement (n = 462) had a much higher publication rate (56.7%), p < 0.001. Multi-center studies and those conducted in commercial facilities had much higher, though non-significant, publication rates (56.5% and 58.3%, respectively). Conclusions: With only half of the studies registered being published, a major source for publication bias is imminent. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether a surgeons' position affects the axial angulation of dental implants placed freehand. Method and materials: Implants' axial angulation was assessed on digital panoramic radiographs. An occlusal line was plotted based on the neighboring teeth/crowns. The mesial angle between the long axis of the implant and the occlusal line was measured. In addition, post-hoc ideal implant-positioning planning was done on the panoramic digital image, and the angle of the intersection between the long axis of the actual and posthoc ideal implant was measured. Student t test for unpaired observations and the Kolmogorov-Smirnov nonparametric tests were utilized to compare the ipsi- and contralateral sides and between clinicians. Results: Seventy-seven patients (149 implants) were eligible for the study. Implants had slight mesial inclination (mean 97.7 ± 8.7 degrees) which was similar for both the ipsi- (98.2 ± 8.4 degrees) and contralateral sides (97.2 ± 9.1 degrees), P = .491. For the post-hoc planning versus actual placement comparison, the overall median (interquartile range) of implant angular deviation was minimal (-0.25 degrees [-2.98, +3.47]). This was true for both the ipsilateral (-0.5 degrees [-2.9, +2.9]) and contralateral (-0.2 [-4.2, +5.4]) sides, P = .55. For the actual versus post-hoc planning, most observations clustered around the midline (zero to minimal deviation), while for the implant to occlusal plane angle, a tendency towards slight mesial angulation was observed. Conclusions: Dental implants placed freehand by experienced clinicians have only slight axial de viation as measured from post-hoc optimal position. Implants placed in ipsilateral and contralateral sides and by leftand right-dominant-hand clinicians had similar angulations. [ABSTRACT FROM AUTHOR]

Purpose: To describe the postoperative complications following lateral wall sinus augmentation using (poly L-lactideco-e-caprolactone; PLCL) and natural polysaccharides polymers-coated bovine bone (PBB). The secondary aims were to examine histologic findings and to propose complication management alternatives. Materials and Methods: This retrospective study included 61 subjects who underwent 67 lateral wall sinus augmentation procedures using PBB in the standard protocol. In cases that presented complications, treatment included additional antibiotic therapy, implant removal, or sinus reentry and total removal of the grafting material. In three cases, biopsy specimens were taken from the sinuses, and histologic analyses were performed. Results: The prevalence of postoperative complications was 32.8% (22 of 67 cases) in 18 of the patients (29.5%). The most prevalent symptoms were persistent pain (68.2%), swelling (63.6%), and oroantral fistula (54.5%). Radiographic signs appeared in 45.5% of the complications. A total of 24 implants failed; thus, an overall 80.3% survival rate was established at 19 months. The vast majority of complications (86.4%) were treated eventually with reentry surgery and revealed that the sinus was full with granulation tissue surrounding pieces of a nonossified rubber-like material. In cases where implants were placed, nonosseointegrated implants were surrounded by soft tissue. The sinus was cleaned thoroughly; the graft material remnants were removed together with inflamed parts of the sinus membrane, followed by chlorhexidine and saline lavages. In the biopsy specimens taken from the sinus cavity, there were no histologic features of new bone formation around the grafted material. Conclusion: Lateral wall maxillary sinus augmentation using PBB was associated with an acute sinus infection histologic appearance and with a 7-times-higher failure rate compared with previous reports. This serious adverse event suggests that PBB cannot be recommended for maxillary sinus augmentations. [ABSTRACT FROM AUTHOR]

Objectives: In the present pilot, multicenter, randomized, single- blinded, controlled study, surgical treatment with or without the administration of D-PLEX500 (a biodegradable prolonged release local doxycycline formulated with β-tricalcium phosphate bone graft) was accessed for the treatment of peri-implantitis. Method and materials: Subjects undergoing surgical treatment for intrabony peri-implantitis defects after flap elevation were randomly assigned, to adjunct D-PLEX500 placement group or to control group. Clinical and radiographic parameters were measured at 6 and 12 months. Results: Twenty-seven subjects (average age: 64.81 ± 7.61 years) were enrolled; 14 patients (18 implants) were randomized to the test group and 13 (14 implants) to the control group. There was no difference in plaque scores between the groups. There was no difference in the changes of mean periodontal probing depth between the test and control groups between baseline and the 6-month follow-up, whereas statistically significant difference was observed after 12 months' follow- up when analyzed for all sites averaged. There was a statistically significant difference in the changes of clinical attachment levels and radiographic bone levels between the groups between baseline and 12 months. These improvements were demonstrated when analyzed at both implant and subject levels. Only D-PLEX500 treatment led to improved bone levels at both time points. The improvement in bone levels was significant in the D-PLEX500 treatment group already after 6 months, and further improved over the 12-month follow-up. Implants were lost only in the control group (14%). Conclusions: D-PLEX500 sustained release local antibiotic formulated with bone filler showed promising results in enabling healing of peri-implantitis lesions. The antibacterial component of the bone graft material might create favorable conditions that enable implant surface decontamination and soft and hard tissue healing over a prolonged period. [ABSTRACT FROM AUTHOR]

Objective: To identify, quantify, and characterize leukocyte populations in PI and periodontitis using flow cytometry. Methods: Fresh biopsies from human PI and periodontitis lesions were processed to a single-cell suspension. The immune cell types were identified using flow cytometry. Results: Twenty-one biopsies were obtained and analyzed corresponding to fourteen PI and seven periodontitis samples. Participants' average age was 63.95 ± 14.77 years without a significant difference between PI and periodontitis patients, the female/male ratio was 8/12, and mean PD was 8.5 ± 2.17. High similarity was found between periodontitis and PI in the main immune cell types. Out of the leukocytes, the PMN proportion was 40% in PI and 33% in periodontitis. T-cells 22% in PI and 18% in periodontitis. Similar proportions of B-cells 10% and macrophages 6% were found in PI and periodontitis. Dendritic and NK cells were found in low proportions (~ 1%) in PI and periodontitis. T-cell sub-analysis showed that CD4-positive were more prevalent than CD8-positive in both diseases (CD4/CD8 ratio of 1.2). Conclusion: With the use of flow cytometry analysis, the leukocyte populations in human peri-implantitis and periodontitis were classified. In PI and periodontitis, we identified similar proportions of specific (CD4/CD8) and innate (dendritic and NK) immune cells. These results corroborate previous histological studies. Clinical relevance: Flow cytometry analysis can be used to identify and quantify immune cells in PI and periodontitis, including sub-classification of T cells (CD4/8) as well as detection of cells that require multiple markers for identification (such as dendritic cells). [ABSTRACT FROM AUTHOR]

The aim of this article was to compare baseline residual ridge height using Cone-beam Computed Tomography (CBCT) and panoramic radiographs. A secondary aim was to examine the magnitude of vertical bone gain 6 months after trans-crestal sinus augmentation and compare it between operators. Thirty patients, who underwent trans-crestal sinus augmentation simultaneously with dental implant placement, were included in this retrospective analysis. Surgeries were done by 2 experienced surgeons (EM and EG) using the same surgical protocol and materials. Preoperative residual ridge height was measured on panoramic and CBCT images. The final bone height and the magnitude of the vertical augmentation were measured on panoramic X ray taken 6 months after surgery. Mean residual ridge height measured preoperatively using CBCT was 6.07 ± 1.38 mm, whereas these same measurements on the panoramic radiographs yielded similar results (6.08 ± 1.43 mm), which were statistically insignificant (P =.535). Postoperative healing was uneventful in all cases. All 30 implants were successfully osseointegrated at 6 months. The mean overall final bone height was 12.87 ± 1.39 mm (12.61 ± 1.21 and 13.39 ± 1.63 mm for operators EM and EG, respectively; P =.19). Likewise, mean postoperative bone height gain was 6.78 ± 1.57 mm, which was 6.68 ± 1.32 and 6.99 ± 2.06 mm for operators EM and EG, respectively (P =.66). A moderate positive correlation was found between residual bone height and final bone height (r = 0.43, P =.002). A moderate negative correlation was found between residual bone height and augmented bone height (r = −0.53, P =.002). Sinus augmentation performed trans-crestally produce consistent results with minimal interoperator differences between experienced clinicians. Both CBCT and panoramic radiographs produced similar assessment of the preoperative residual bone height. [ABSTRACT FROM AUTHOR]

Background: Previous studies focused on the influence of buccal mucosa thickness on peri‐implant bone loss and inflammation, with inconclusive results. We observed substantially thicker palatal mucosal tissues at peri‐implantitis sites. Therefore, we hypothesize that thick palatal peri‐implant mucosa may be associated with deeper pockets and disease severity. Purpose: To compare the thickness of the palatal tissue between natural teeth and implants in periodontal health and disease. Methods: Adult, non‐smoker, healthy patients who visited our department for periodontal examination or treatment with restored implants in the posterior maxilla were recruited. Probing depth (PD), plaque index (PI), gingival index (GI) and radiographic measurements were recorded around implant and the contralateral tooth. Palatal tissue thickness was measured using a 30G needle that was inserted perpendicular into the mucosa at the bottom of the periodontal/peri‐implant pocket and 3 mm coronally. Differences in the palatal tissue thickness between teeth and implants (in the same patient) was performed using t‐test; as well as between peri‐implantitis and non‐peri‐implantitis sites (among patients). Results: Sixty patients were included. Thirty‐four implants were diagnosed with peri‐implantitis and 26 healthy/mucositis implants with corresponding 24 healthy/gingivitis teeth and 36 teeth with attachment loss. Mean PD was higher around implants (4.47 ± 1.57 mm) than teeth (3.61 ± 1.23 mm, p = 0.001). The thickness of implants' palatal mucosa was higher than in teeth, at the base of the pocket and 3 mm coronally (4.58 ± 1.38 mm vs. 3.01 ± 1.11, p = 0.000; 3.58 ± 2.15 vs. 1.89 ± 1.11, p = 0.000, respectively). Mean palatal tissue thickness was 4.32 ± 2.35 mm for the peri‐implantitis group while only 2.61 ± 1.39 in healthy implants, 3 mm coronal to the base of the pocket (p = 0.001). Palatal thickness at peri‐implantitis sites was higher (4.32 ± 2.35) compared to periodontitis sites (2.23 ± 0.93), p = 0.000. Implant sites with palatal mucosa >4 mm (n = 32) had deeper mean pockets (5.58 ± 1.98) compared with thinner (≤4 mm) sites (n = 28) (4.48 ± 1.18, p = 0.018). Conclusion: Thicker palatal tissue around implants is associated with deeper palatal pockets. Thick palatal tissue was found around implants diagnosed with peri‐implantitis. [ABSTRACT FROM AUTHOR]

Objective: A randomized trial to assess clinical and radiographic outcomes of short versus standard dental implants placed with concomitant vertical bone augmentation. Method and Materials: Patients requiring dental implants were randomized to receive either 6-mm implants (experimental) or 10-mm implants with vertical augmentation (control). Custom load-bearing healing abutments were connected to allow for indirect resonance frequency analysis measurements. Standardized radiographs were taken at implant placement (baseline), and at 3 and 12 months. Implants were restored at 3 to 6 months, and final measurements were taken at 12 months. Results: Fifty patients with 25 implants per group were included. Five implants failed, four experimental and one control (84% and 96% cumulative survival rate, respectively). Short implants required significantly less surgical time (51.6 ± 23 versus 68.5 ± 35 minutes, P = .05). Implant stability quotients at baseline (67.9 ± 8.3 experimental and 70.8 ± 7.6 control, P = .215) and 12 weeks (70.17 ± 7.4 and 72.03 ± 5.9, respectively, P = .513) were similar and unchanged. Positive correlation was found between the two measurement methods (r2 = .6, P = .025). One-year average marginal bone loss was slightly lower for the experimental group (0.6 ± 0.16 mm) compared to the control group (0.86 ± 0.19 mm); however, this was not statistically significant (P = .287). Conclusion: Short dental im plants may offer an alternative for implant placement in an atrophic jaw; however, they are associated with reduced firstyear survival rate. Short dental implants should be used judiciously in light of this potential predicament, and alternatives assessed. [ABSTRACT FROM AUTHOR]

Aim: To assess the horizontal and vertical dimensional changes of the alveolar ridge when using a collagen matrix in combination with collagen embedded xenogenic bone substitute, in comparison with natural healing after tooth extraction. Methods: Patients that required extraction in non‐molars areas were included. Test group‐15 sockets were treated with deproteinized bovine bone mineral containing 10% collagen (DBBM‐C), covered by a procaine collagen membrane (CMXs). Control group‐15 sockets left for spontaneous healing. We used a custom‐made acrylic stent as a reference for alveolar ridge measurements. Six‐month postoperative, a single implant was placed in the experimental site. A core biopsy was taken from the site, using a trephine bur. Histomorphometric analysis assessed bone area, connective tissue, bone marrow, and residual bone graft. Results: Six months later, horizontal ridge width at −3 mm showed a significant (p < 0.05) reduction in both groups albeit smaller in the test group 1.19 ± 1.55 mm, compared with the control 2.27 ± 1.52 (p = 0.087). At −5 mm sub‐crestally, statistically non‐significant reduction was noted in both groups, 1.61 ± 1.53 and 1.96 ± 1.52 mm for the test and control groups, respectively (p = 0.542). Vertical changes were smaller in the test group (0.14 ± 1.84 mm) compared with control (0.98 ± 1.49 mm). Keratinized tissue (KT) width was 7.3 ± 2.13 and 7.5 ± 3.49 mm in the test and control groups, respectively. Newly formed bone occupied 33.79 ± 17.37% and 51.14 ± 23.04% in the test and control groups, respectively, (p = 0.11). Connective tissue volume was 33.74 ± 13.81% and 30.12 ± 18.32% in the test and control groups, respectively (p = 0.65). Bone marrow occupied 19.57 ± 10.26% and 18.74 ± 17.15% in the test and control groups, respectively (p = 0.91). Residual graft occupied 12.9 ± 9.88% in the test group. Conclusion: Alveolar ridge preservation using DBBM‐C resulted in reductions of the vertical and horizontal dimensions albeit not reaching statistical significance. The larger than anticipated standard deviation and smaller inter‐group differences might account for this phenomenon. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine osseous changes following lateral bone augmentation using a novel scaffold (OV) alone and compare it to combination therapy using freeze-dried bone allograft (FDBA) and resorbable collagen membrane (FDBA/CM).Methods: Thirty patients completed this 9-months prospective two-center cohort clinical trial. Before surgery and 9-months re-entry, linear measurements were performed, and impressions taken. Cone-beam computed tomography (CBCT) were done at baseline and 9 months. DICOM slice data were converted into volumetric images using 3D Slicer. Following 3D volumetric image construction, pre- and post-op Standard Triangle Language files were superimposed and volumetric data were extracted for a 10-mm region of interest. Linear measurements were compared similarly.Results: Baseline clinical parameters were similar in both groups (4.22 and 4.53 mm for OV and FDBA/CM at -2 mm, respectively). Following treatment, vertical distance from the stent had changed minimally (-0.36 and -0.12 mm, respectively). Similarly, lateral bone gain ranged from 0 to 0.4 mm, for both groups. To the contrary, the CBCT measurements showed a significantly greater increase in horizontal width in the control at -2 mm (0.95 ± 0.2 mm) compared with -0.62 mm for the OV (P = 0.000). Similar changes were observed at -5 mm (0.63 and -0.41 mm, respectively, P = 0.01). Sites volume had increased from 266 ± 149 mm3 to 360 ± 138 mm3 (P = 0.001) for FDBA/CM with negligible changes for OV (from 334 to 335 mm3 , P = 0.952). these between-group changes being statistically significant (P = 0.023).Conclusion: FDBA/CM yielded better albeit moderate increase in the volume of the edentulous ridge, while OV scaffolds failed to produce similar results. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to assess the clinical accuracy of a novel open-lattice-frame implant positioning system by evaluating the deviation between planned and actual implant positions on pre- and postoperative cone beam computed tomography (CBCT) images of patients treated with dental implants. Secondary aims were to record surgical time from first incision to end of implant surgery and start of suturing, and to record patient and surgeon satisfaction from the implant surgical procedure. Pre- and postoperative CBCT of 10 patients receiving 18 dental implants were used to generate implant angular deviations and implant shoulder and apex deviations. Mean angular deviation was 2.96 ± 1.31 degrees (range 0.75 to 5.60 degrees). Mean shoulder and apex deviations were 1.07 ± 0.49 mm (range 0.38 to 1.85 mm) and 1.35 ± 0.57 mm (range 0.52 to 2.19 mm), respectively. Mean time from first incision to start of suturing was 24 ± 7 minutes. Patient satisfaction ranged between 8 and 10, and surgeon satisfaction regarding the procedure ranged between 9 and 10, on a scale of 1 to 10. The open-lattice-frame implant positioning system provided adequate accuracy, and may aid in improving patient-related and surgeon-related outcomes by improving surgical accuracy and shortening surgical treatment duration. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare periapical radiographs (PA) and panoramic radiographs (PAN) in the measurement of proximal bone height around implants. Method and Materials: Patients files that contained digital PAN and PA together with information on implant lengths and diameters were selected for this study. For each radiograph, the implant size served as reference for calibration. Proximal radiographic bone levels and the linear distance between the bone crest and implant shoulder were measured twice by one examiner. Paired t test was used to assess intra-examiner variability and differences between the two radiographic methods. Correlation was then assessed using Pearson correlation coefficient test. Significance level was determined at 5%. Results: For the PAN measurements, the median mesial distances from bone crest to implant shoulder were 0.53 and 0.56 mm (first and second sets, P = .53). Likewise, for distal measurements these readings were 0.92 and 0.86 mm respectively (P = .66). For PA measurements, the corresponding measurements were 0.33 and 0.44 mm (P = .48) and 0.99 and 0.99 mm (P = .42), respectively. When PAN and PA measurements were compared, no statistically significant differences were detected between the two radiographic modalities. A very high positive correlation (r > 0.91) was attained for the PAN - PA measurements (P < .0001). Conclusion: PAN are potentially as reliable and reproducible as PA for the assessment of proximal bone height around dental implants. [ABSTRACT FROM AUTHOR]

Objective: Dental restorations may be plaque retentive. The aim of this study was to evaluate the long-term association between proximal restorations and the incidence and progression of periodontal disease in well-maintained patients. Method and Materials: Probing pocket depths (PPD), bleeding on probing (BOP), and radiographic status of proximal restorations were retrospectively retrieved from files of patients attending a specialist periodontal office. Ill-fitting margins were recorded. The association between these parameters was evaluated at baseline examination (T0), after cause-related therapy (T1) and after ≥ 10 years from T0 (T2), during which supportive periodontal therapy (SPT) was administered, using descriptive statistics, ANOVA-Bonferroni, and chi-square analyses. Results: 1,301 teeth were examined. Mean PPD in unrestored surfaces was 3.7 ± 1.7 mm, 3.1 ± 1.3 mm, and 2.8 ± 1 mm at T0, T1, and T2, respectively. Deeper pockets were found in restored surfaces at those time points with PPD values of 4.4 ± 1 .8 mm, 3.6 ± 1.4 mm, and 3.2 ± 1.1 mm, respectively (P < .001). Higher PPD values were found in restored surfaces exhibiting inadequate restorations when compared to restored surfaces with adequate restorations at all time points. These values were 4.9 ± 1.9 mm, 4.1 ± 1.5 mm, and 4 ± 1.7 mm vs 4.3 ± 1.8 mm, 3 .6 ± 1.4 mm, and 3.1 ±1.1 mm, respectively ( P < .001). Conclusion: The present study confirmed that restorations might be detrimental to periodontal health. A significant association between the presence of proximal restorations and the incidence of periodontal disease was observed. This association was more pronounced for inadequate restorations while becoming less significant over time in patients receiving routine SPT. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate changes in sinus dimensions immediately postoperatively and 1 year later using a composite of bovine-derived xenograft and autogenous bone for lateral bone augmentation of the maxillary sinus. Materials and Methods: Patients who underwent lateral wall sinus augmentation procedures without concomitant implant placement were considered for this retrospective analysis if they had three consecutive panoramic radiographs: pretreatment (T0), immediately after lateral wall sinus augmentation (T1), and approximately 1 year postoperatively (T2). Eighteen subjects aged 47 to 69 years were included. The surgical protocol included grafting with a composite of bovine-derived xenograft and autogenous bone (9:1 ratio). Digital panoramic radiographs were transferred into measurement software, and the following measurements were performed: (1) vertical distance from the alveolar crest to the height of the augmented material, (2) sagittal area of the grafted area, and (3) vertical distance from the alveolar crest to the roof of the maxillary sinus. All measurements were performed by one examiner. Double measurements were performed in nine patients at T2, and the calculated Cronbach's alpha statistic was very high (.9658 to .9882). Results: The mean overall sinus sagittal area was 1,330 ± 481 mm² prior to the grafting procedure, when it decreased to 858.2 ± 436 mm² (range, 380.7 to 2,134 mm²) immediately postoperatively (P = .0035) and remained stable at 1 year (mean, 882.2 ± 384 mm², P > .05). Similarly, the overall area of the grafted material at the time of surgery was 468.3 ± 208 mm² and was only slightly reduced at 1 year (422.2 ± 193 mm²). The midsagittal graft height at T1 (mean, 20.67 ± 4.5 mm) was insignificantly and minimally reduced at 1 year (mean, 19.35 ± 4.9 mm). Conclusion: The linear dimensions of composite bone-derived xenograft/autogenous bone grafts following lateral wall sinus augmentation exhibited minimal changes during the 8- to 12-month healing period. [ABSTRACT FROM AUTHOR]

Background: Peri-implant disease following successful integration of an endosseous implant is the result of an imbalance between bacterial load and host defense, which may affect not only the peri-implant mucosa but also involve the supporting bone. Objectives: The aim of this study was to evaluate the adjunctive effect of a dental water jet rinse mixed with chlorhexidine gel to the nonsurgical treatment for peri-implantitis. Method and Materials: A prospective randomized interventional cohort study was conducted. Forty consecutive patients presenting with peri-implantitis were recruited and randomly assigned into two treatment groups. Initially all patients received scaling/surface debridement and oral hygiene instruction. Patients in the study group received a water jet device containing chlorhexidine gel (Silonite®) for home use twice daily while the control group performed the recommended oral hygiene measures with no water jet usage. Three months following baseline visit, patients were reevaluated clinically and radiographically. Results: In total, 39 patients completed the study and were available for final examination. Three months following baseline visit the test group exhibited greater mean probing depth reduction (0.75 mm vs 0.27 mm; P = .029) as well as greater reduction in the number of sites presenting with bleeding on probing (2.26 vs 0.45 sites; P = .011). No significant change in bone level was observed at 3 months (mean bone gain was 0.18 mm). Conclusions: Water jet mixed with chlorhexidine gel might supplement the response to nonsurgical treatment for peri-implantitis lesions. Further, larger-cohort studies are warranted. [ABSTRACT FROM AUTHOR]

Background: Peri-implant disease following successful integration of an endosseous implant is the result of an imbalance between bacterial load and host defense, which may affect not only the peri-implant mucosa but also involve the supporting bone. Objectives: The aim of this study was to evaluate the adjunctive effect of a dental water jet rinse mixed with chlorhexidine gel to the nonsurgical treatment for peri-implantitis. Method and Materials: A prospective randomized interventional cohort study was conducted. Forty consecutive patients presenting with peri-implantitis were recruited and randomly assigned into two treatment groups. Initially all patients received scaling/surface debridement and oral hygiene instruction. Patients in the study group received a water jet device containing chlorhexidine gel (Silonite®) for home use twice daily while the control group performed the recommended oral hygiene measures with no water jet usage. Three months following baseline visit, patients were reevaluated clinically and radiographically. Results: In total, 39 patients completed the study and were available for final examination. Three months following baseline visit the test group exhibited greater mean probing depth reduction (0.75 mm vs 0.27 mm; P = .029) as well as greater reduction in the number of sites presenting with bleeding on probing (2.26 vs 0.45 sites; P = .011). No significant change in bone level was observed at 3 months (mean bone gain was 0.18 mm). Conclusions: Water jet mixed with chlorhexidine gel might supplement the response to nonsurgical treatment for peri-implantitis lesions. Further, larger-cohort studies are warranted. [ABSTRACT FROM AUTHOR]

Background: Chlorhexidine (CHX) is a broad‐spectrum antimicrobial agent commonly used in medicine. Application of (CHX) during abutment connection reduced the bacterial load at the implant–abutment interface. We hypothesize this treatment may consequently reduce peri‐implant soft tissue inflammation and marginal bone loss. Purpose To evaluate the effect of a single application of CHX gel inside the dental implant internal hexagon on peri‐implant tissue. Methods: Forty patients were recruited to this randomized, double‐blinded, clinical trial. At the time of implant installation, a 4‐mm healing abutment was connected to the implant. In the test group, chlorhexidine gel 1% was applied inside the implant hex, whereas control implants did not receive any gel. Clinical and radiographic measurements included soft tissue recession (REC), plaque index (PI), gingival index (GI), plaque index (PI), keratinized mucosa width (KM), probing depth (PD), and a peri‐apical parallel x‐ray. Peri‐implant crevicular fluid (PICF) was collected for cytokine analysis. t‐Test was used to compare changes from baseline to 3 months. Mann–Whitney U test and t test were used to compare test and control groups. Results: Twenty patients in the test group and 17 in the control group completed the study. One implant in the control group failed to osteointegrate. There were no significant differences between the control and test groups for REC changes, bone loss, and PD. GI was significantly lower in the test group after 1 week (1.79 ± 0.24 vs 0.75 ± 0.18, respectively) and 3 months (1.18 ± 0.21 vs 0.25 ± 0.12, respectively) although PI was equal. At 3 months, interleukin 1‐β (IL1‐β) was higher in the control group (p < 0.01) and a positive correlation was found between GI and IL1‐β (rs = 0.60424, p = 0.00032). Conclusions: Application of chlorhexidine gel reduced inflammation and IL1‐β levels in the peri‐implant soft tissue. [ABSTRACT FROM AUTHOR]

Purpose: To compare linear measurements made on cone beam computed tomography (CBCT) images to direct measurements in ex vivo porcine mandibles. Materials and Methods: Six cross-sectional planes were defined by gutta-percha-filled cavities in seven mandibles. The mandibles were scanned in a CBCT apparatus and later sectioned, using a band saw, through the gutta-percha markers. Next, four direct (DIR) linear measurements were performed for each section with a handheld digital caliper, using the gutta-percha markers as reference points. The corresponding radiographic (RAD) cross sections were then measured using dedicated software. A total of 168 sites were measured. Differences between RAD and DIR measurements [Δ(RAD - DIR)] were calculated for each pair individually. Results: Mean Δ(RAD - DIR) was -0.17 ± 0.53 mm (range, -1.42 to 1.09 mm). CBCT overestimated direct measurements at 36% of the sites; 8% of sites (95% confidence interval, 3.8% to 12.2%) showed errors between +0.5 and +1 mm, and 1.8% (95% confidence interval, -0.2% to 3.9%) showed errors greater than +1 mm. Conclusions: Good correlation was found between CBCT and direct measurements. However, the significant percentage of sites with overestimation of at least 0.5 mm indicates a need for safety margins to be maintained when CBCT is used to plan surgical interventions such as dental implant therapy. [ABSTRACT FROM AUTHOR]

The treatment of an infected socket with a severe facial dehiscence/ fenestration defect presents a therapeutic dilemma to the dental team. Both implant-supported restoration and fixed partial denture are viable options to restore function and occlusion, each with its benefits and disadvantages. In the present case report, a multi-stage regenerative approach was selected to enable implant-supported single crown. The first phase of the treatment after extraction of the maxillary central incisor was the stabilization of the blood clot with a collagen plug. Six weeks later, the surgical site was re-entered and the socket was grafted with biphasic calcium sulfate (BCS). Six months later, a dental implant was placed and a core biopsy taken. However, the central portion of the facial defect demonstrated only partial regeneration resulting in exposure of six implant threads. Freeze-dried bone allograft (FDBA) and a collagen membrane were utilized to augment the ridge and cover the exposed threads. The histology of the bone core showed a complete resorption of the grafted material with the presence of new woven bone throughout the specimen. Clinically, complete defect regeneration and augmentation of the alveolar ridge were attained after 4 months. Thus, the clinician should consider the pros and cons of this regenerative approach along with other more conservative treatment alternatives when dealing with similar cases. [ABSTRACT FROM AUTHOR]

The problem of failed implants cannot be overlooked. The purpose of this paper is to explore treatment alternatives for failed implants and their strengths and shortcomings. A comprehensive literature search was performed using PubMed and a manual search. Only five studies were identified that explored treatment in sites where implants had failed. In all five studies, the treatment alternative tested was the placement of a new implant in the failed site. The overall survival rate for such implants ranged from 71% to 92.3%. Four other alternatives are also discussed in light of data derived from other studies on the survival of various treatment strategies. These include: a continuation of the original plan using the remaining implants, modification of treatment to a tooth-supported fixed partial denture (FPD) or to a hybrid tooth-implant- supported FPD, or modification to a removable prosthesis. The selection of an appropriate alternative for failed implants is complex and involves biologic, mechanical, and psychologic considerations along with financial aspects. This should be a team decision with the patient's opinion included. [ABSTRACT FROM AUTHOR]

Objective: This randomized, single-controlled study was performed to validate in vivo the efficacy of single Fluorinex treatment by examining fluoride incorporation into enamel using electron microscopy. Method and Materials: Twenty healthy participants referred for routine dental treatment which also required extractions of at least two teeth as part of their treatment plan were included in this study. For each participant, one randomly selected tooth was extracted and sent for blind electron microscopic fluoride assay (control, C). Next, following a single Fluorinex treatment, the second (test, T) tooth was extracted and sent for the same assay. Intra-individual and intergroup fluoride content comparisons were performed, between control and test teeth. Results: Highly significant intra-individual and intergroup differences were found between the treated and untreated teeth. Fluoride atomic percent (at%) and weight percent (wt%) estimated least squares means of untreated group were found to be 0.56 and 0.48, and in the treated group 17.35 and 14.35. This increase in fluoride at% [16.78 ± 2.3 (SE)], was also significant statistically (P < .0001); likewise, the increase in fluoride wt % [13.86 ± 1.97 (SE)] was similarly significant (P < .0001). The system was well tolerated by the participants with minimal transitional mild side effects. Conclusion: In vivo fluoride application using the active Fluorinex system resulted in a significant increase of fluoride content in the enamel of adult permanent teeth compared to untreated internal controls. [ABSTRACT FROM AUTHOR]

Purpose: One-piece dental implants are commonly used for the immediate restoration of missing teeth. In most cases, the clinician has to prepare the abutment intraorally to ensure a proper emergence profile and abutment angulation. However, this procedure might impair primary stability and thus potentially compromise osseointegration. The aim of this study was to determine the effect of abutment preparation on the primary stability of a one-piece implant system (UNO MIS). Materials and Methods: Implant stability was assessed by resonance frequency analysis with a novel custom-made external fixation device, validated previously, developed specifically for resonance frequency measurements of this implant. Thirty 3 × 13-mm implants were inserted in porcine jawbone with insertion torque of 15 Ncm (group A, 15 implants) or 30 Ncm (group B, 15 implants). Abutments were prepared by reducing the facial aspect of the implant abutment with a high-speed dental turbine (400,000 rpm) equipped with a medium-roughness diamond bur. Implant stability quotients (ISQs) were measured before and after abutment preparation. Results: Mean ISQs measured in group A and group B before abutment preparation were very similar (58.2 ± 1.4 and 57.4 ± 0.9, respectively; P > .05). Following abutment preparation, three implants in group A lost primary stability. The mean ISQ value in group A was reduced from 58.2 ± 1.4 to 54.9 ± 7.9 following abutment preparation (P < .05). The mean ISQ in group B was not affected by abutment preparation (57.4 ± 0.9 versus 57.3 ± 1.0; P > .05). Conclusions: Abutment preparation of a one-piece dental implant inserted with low insertion torque might impair implant primary stability. [ABSTRACT FROM AUTHOR]

Background: Peri-implantitis is a challenging condition to manage and is frequently treated using non-surgical debridement. The local delivery of antimicrobial agents has demonstrated benefit in mild to moderate cases of peri-implantitis. This study compared the safety and efficacy of chlorhexidine gluconate 2.5 mg chip (CHX chips) as an adjunctive treatment to subgingival debridement in patients afflicted with peri-implantitis.Methods: A multicenter, randomized, single-blind, two-arm, parallel Phase-3 study was conducted. Peri-implantitis patients with implant pocket depths (IPD) of 5-8 mm underwent subgingival implant surface debridement followed by repeated bi-weekly supragingival plaque removal and chlorhexidine chips application (ChxC group) for 12 weeks, or similar therapy but without application of ChxC (control group). All patients were followed for 24 weeks. Plaque and gingival indices were measured at every visit whereas IPD, recession, and bleeding on probing were assessed at 8, 12, 16, 24 week.Results: A total of 290 patients were included: 146 in the ChxC group and 144 in the control. At 24 weeks, a significant reduction in IPD (P = 0.01) was measured in the ChxC group (1.76 ± 1.13 mm) compared with the control group (1.54 ± 1.13 mm). IPD reduction of ≥2 mm was found in 59% and 47.2% of the implants in the ChxC and control groups, respectively (P = 0.03). Changes in gingival recession (0.29 ± 0.68 mm versus 0.15 ± 0.55 mm, P = 0.015) and relative attachment gain (1.47 ± 1.32 mm and 1.39 ± 1.27 mm, P = 0.0017) were significantly larger in the ChxC group. Patients in the ChxC group that were < 65 years exhibited significantly better responses (P < 0.02); likewise, non-smokers had similarly better response (P < 0.02). Both protocols were well tolerated, and no severe treatment-related adverse events were recorded throughout the study.Conclusions: Patients with peri-implantitis that were treated with an intensive treatment protocol of bi-weekly supragingival plaque removal and local application of chlorhexidine chips had greater mean IPD reduction and greater percentile of sites with IPD reduction of ≥2 mm as compared with bi-weekly supra-gingival plaque removal. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate implant and patient characteristics in a prospective clinical study involving immediate fixed restoration of delayed placement of dental implants. Materials and Methods: Patients diagnosed with generalized chronic periodontitis and previously treated were accepted into the study when they expressed a wish to receive immediate restoration of dental implants. Treatment planning and implant placement were computer assisted, using computerized tomography, planning software, and a surgical template. Patients received abutments and cemented provisional prostheses no later than 72 hours following implant surgery. Patients were followed at 2 and 4 weeks, and 3, 6, and 12 months. Results: Eighteen patients were accepted and completed the study, ages ranged from 34 to 69 years (mean 54.5 ± 8.5 years). Five patients (27.8%) were smokers (2.5 to 60 pack years). Fifty implants were placed, ranging between 1 to 8 implants per patient. Median implant length was 13 mm (range, 10 to 13 mm) and median implant diameter was 3.75 mm (range, 3.75 to 5 mm). Mean insertion torque was 43 NCm ± 6.2 SD (range 30 to 50 NCm). Mean implant stability quotient was 71 ± 11 (range 37 to 85). One implant in a patient who smoked and three implants in another patient who smoked failed for a total of four failed implants. At 12 months, the overall survival rate was 92% (100% and 73% among nonsmokers and smokers, respectively). Conclusions: The survival of immediately restored dental implants in periodontally treated patients is greater than 90%. Smokers with a past history of chronic periodontitis seem to have a lower implant survival rate. [ABSTRACT FROM AUTHOR]

Objective: To compare the current (t1) periodontal status of post-liver transplantation patients to their status 10 years earlier (t0). Method and Materials: Seventeen patients 45 to 71 years of age who were evaluated approximately 10 years previously were enrolled in the study. All subjects had undergone a liver transplantation 1 to 10 years prior to the initial examination (tO). Clinical and radiographic parameters were recorded for the Ramfjord Index teeth and compared between to and t1, including Plaque Index (PI), Gingival Index (Gl), probing depth (PD), clinical attachment level (CAL), and gingival overgrowth (GO). Bone loss was measured on digitized images of panoramic radiographs. Results: Mean PI, Gl, CAL, and GO were slightly lower at t1 than at tO; however, these differences were not statistically significant (P > .05, Student ftest for paired observations). The mean PD was reduced at t1 (2.43 ± 0.18 mm) compared with t0 (3.35 ± 0.22 mm), which was sta­tistically significant (P = .001, Student t test for paired observations). To the contrary, the mean radiographic bone loss at t1 was higher than at t0 (5.61 vs 4.48 mm, respectively), which was also statistically significant (P = .017). Tooth loss was observed in some of these patients, ranging from 0 to 4 during the 10 years of follow-up, which amounted to an annual rate of 0.24 teeth per patient. Conclusion: Post-liver transplantation patients maintained stable clinical periodontal parameters during a 10-year period; however, some radiographic bone loss occurred during this time. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the radiographic crestal bone level changes around immediately restored dental implants up to 5 years after insertion in patients with a history of periodontitis. Materials and Methods: Patients previously treated for chronic periodontitis who required a fixed full-arch restoration for the maxilla or mandible or a fixed partial restoration in the esthetic zone were treated. Implant surgery included extraction of hopeless teeth, debridement around remaining adjacent teeth, and implant insertion guided by a surgical stent. A prefabricated screw-retained provisional restoration was immediately placed on selected implants. Periapical radiographs were taken at implant placement, 6 and 12 months postsurgery, and annually thereafter. The distance between the alveolar crest and the implant shoulder was measured at the mesial and distal aspects of each implant. Bone changes (BC) and annual rate of bone change (Rate) were calculated for the first year and the following 4 years. Results: Total BC (mean ± standard deviation) from baseline to 5 years (BCt0-t5) was -1.41 ± 0.67 mm. First-year BC (BCt0-t1) was -1.14 ± 0.86 mm, and BC in years 2 to 5 (BCt1-t5) was -0.27 ± 0.69 mm. Ratet0-t1 was -0.98 ± 0.79 mm/year and ratet1-t5 was -0.06 ± 0.17 mm/year. Fifty-seven of 61 available implants met the criterion of cumulative bone loss of no more than 1.5 mm for the first year and 0.2 mm/year for the following years. Four implants (7%; 95% confidence interval: 0.4% to 13.6%) failed the criterion. Conclusions: Dental implants in patients with a history of periodontitis showed radiographic bone changes similar to previous reports in the literature. After the first year, immediately restored implants exhibited crestal bone loss rates similar to those seen for conventionally restored implants. [ABSTRACT FROM AUTHOR]

Purpose: Immediate loading and/or restoration of dental implants requires the assessment of implant stability, which is best performed by resonance frequency analysis (RFA) prior to loading. One-piece dental implants are usually used for immediate loading, but there is currently no available reliable method to assess the primary stability of one-piece dental implants. Therefore, this study sought to validate a novel device designed for RFA measurements of one-piece implants. Material and Methods: Thirty (3.75 × 13 mm) internal-hex implants (Seven, MIS) were divided into two groups; 15 were placed in an acrylic glass block and 15 were placed in fresh porcine jawbone using 30 N/cm2 of insertion torque. Implant stability quotient (ISQ) values were measured using the Osstell Mentor device; then, a new external fixation device was attached to the implant abutment with a 10-mm arm extending from the implant to an internal-hex ring at its proximal end. ISQ values were measured at the implant's internal hex and at the internal hex of the device, and the damping ratio was calculated. The measurements were repeated with 15 (3 × 13 mm) one-piece implants (UNO, MIS) attached to the same device. Results: The damping ratio between the implant and the proximal device was 23.6% ± 4% in acrylic glass (50.1 ± 1.7 ISQ and 38.2 ± 1.8 ISQ, respectively) and 23.1% ± 3% in porcine bone (74.9 ± 2.8 ISQ and 57.5 ± 0.5 ISQ, respectively). ISQ values determined by the device on one-piece and two-piece implants were similar (57.4 ± 0.9 and 57.5 ± 0.5, respectively). Conclusion: With the present validation of this external fixation device for the measurements of implant stability using RFA, it is now possible to measure primary stability of any one-piece implant system, obviating the need for custom-made Osstell adaptors. [ABSTRACT FROM AUTHOR]

Purpose: Preparation of a one-piece dental implant abutment is often needed to achieve a proper emergence profile for a definitive restoration. However, this procedure may compromise osseointegration through the production of heat. The aim of this study was to measure heat production during implant abutment preparation with different volumes of water irrigation using a one-piece implant system. Materials and Methods: Forty-five one-piece dental implants were used in this study. The implants were divided into three groups according to the water flow rate used during abutment preparation: 30 mL/min (G30), 15 mL/min (G15), and without water irrigation (GO). Thermocouples were positioned at the most coronal and most apical threads. The abutments were prepared using a high-speed dental handpiece. Preparation continued for 120 seconds or until the implant temperature reached 47 °C. Results: The time needed to reach 47 °C in the most coronal thread of group GO was 5.73 ± 1.16 seconds. After the preparation was stopped at 47 °C, the temperature continued to increase until reaching a maximum temperature. None of the implants in the water irrigation groups reached 47°C. The time needed to reach maximum temperature was significantly shorter for group GO than the groups with water irrigation. A strong positive correlation was found between coronal and apical recordings. Conclusion: Prosthetic preparation of one-piece dental implants without irrigation induced a rapid increase in temperature. Water irrigation reduced heat production during abutment preparation in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Purpose: Preparation of a one-piece dental implant abutment is often needed to achieve a proper emergence profile for a definitive restoration. However, this procedure may compromise osseointegration through the production of heat. The aim of this study was to measure heat production during implant abutment preparation with different volumes of water irrigation using a one-piece implant system. Materials and Methods: Forty-five one-piece dental implants were used in this study. The implants were divided into three groups according to the water flow rate used during abutment preparation: 30 mL/min (G30), 15 mL/min (G15), and without water irrigation (G0). Thermocouples were positioned at the most coronal and most apical threads. The abutments were prepared using a high-speed dental handpiece. Preparation continued for 120 seconds or until the implant temperature reached 47°C. Results: The time needed to reach 47°C in the most coronal thread of group G0 was 5.73 ± 1.16 seconds. After the preparation was stopped at 47°C, the temperature continued to increase until reaching a maximum temperature. None of the implants in the water irrigation groups reached 47°C. The time needed to reach maximum temperature was significantly shorter for group G0 than the groups with water irrigation. A strong positive correlation was found between coronal and apical recordings. Conclusion: Prosthetic preparation of one-piece dental implants without irrigation induced a rapid increase in temperature. Water irrigation reduced heat production during abutment preparation in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate implant angulations and alignments with neighboring teeth/implants and compare them to angulations and alignments measured with preinsertion surgical gauges. Materials and Methods: Two hundred implants placed freehand were included. For each site, two panoramic radiographs were obtained, one with a gauge and one with an implant. The mesiodistal angular relationships between gauge and subsequently placed implant, gauge and gauge (for neighboring implants), gauge and neighboring teeth, implant and neighboring teeth, and gauge and the inferior border of the mandible were measured. Results: The mean gauge-implant discrepancy was -0.72 degrees. The gauge to teeth angulation was -3.95 degrees, the implant-teeth angulation was -4.67 degrees, the gauge-gauge angulation was 0.49 degrees, and the angulation between the gauge and the inferior border of the mandible was 86.86 degrees. Maxillary implants were more divergent than mandibular implants (-9.89 degrees versus -2.14 degrees). Likewise, implants placed away from (opposite) the clinician's side had smaller gauge-implant discrepancies than those placed in the ipsilateral side (-0.94 degrees versus -1.66 degrees). Implant location (incisor, premolar, molar) also affected this angular relationship; implants placed in the anterior region diverged more (-3.96 degrees) than implants placed in premolar (-1.02 degrees) and molar regions (0.06 degrees). Implants that were placed adjacent to teeth had greater divergence than implants placed in an edentulous region (-1.66 degrees versus 0.09 degrees). Likewise, gauges placed in conjunction with shorter implants (10 mm or shorter) were more divergent than those placed in conjunction with longer implants (-8.29 degrees versus -3.259 degrees, respectively). Conclusion: Placement of dental implants, even without the use of a surgical guide, can result in adequate dental implant angular relationships. An implant's location (arch, side, or site) and the presence of adjacent teeth might affect these relationships. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate implant angulations and alignments with neighboring teeth/implants and compare them to angulations and alignments measured with preinsertion surgical gauges. Materials and Methods: Two hundred implants placed freehand were included. For each site, two panoramic radiographs were obtained, one with a gauge and one with an implant. The mesiodistal angular relationships between gauge and subsequently placed implant, gauge and gauge (for neighboring implants), gauge and neighboring teeth, implant and neighboring teeth, and gauge and the inferior border of the mandible were measured. Results: The mean gauge-implant discrepancy was -0.72 degrees. The gauge to teeth angulation was -3.95 degrees, the implant-teeth angulation was -4.67 degrees, the gauge-gauge angulation was 0.49 degrees, and the angulation between the gauge and the inferior border of the mandible was 86.86 degrees. Maxillary implants were more divergent than mandibular implants (-9.89 degrees versus -2.14 degrees). Likewise, implants placed away from (opposite) the clinician's side had smaller gauge-implant discrepancies than those placed in the ipsilateral side (-0.94 degrees versus -1.66 degrees). Implant location (incisor, premolar, molar) also affected this angular relationship; implants placed in the anterior region diverged more (-3.96 degrees) than implants placed in premolar (-1.02 degrees) and molar regions (0.06 degrees). Implants that were placed adjacent to teeth had greater divergence than implants placed in an edentulous region (-1.66 degrees versus 0.09 degrees). Likewise, gauges placed in conjunction with shorter implants (10 mm or shorter) were more divergent than those placed in conjunction with longer implants (-8.29 degrees versus -3.259 degrees, respectively). Conclusion: Placement of dental implants, even without the use of a surgical guide, can result in adequate dental implant angular relationships. An implant's location (arch, side, or site) and the presence of adjacent teeth might affect these relationships. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate and compare the effect of nonsurgical periodontal therapy in conjunction with 2 different antibacterial agents on clinical and immunological parameters in aggressive periodontitis (AgP) patients. Method and Materials: Thirty-one AgP patients underwent clinical examination that included plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). GCF (gingival crevicular fluid) samples were collected and assayed for PGE2, IL-1b, and TNFa. Nonsurgical periodontal therapy was performed. The patients received doxycycline (doxy group) or metronidazole plus amoxicillin (am-met group). After completion of the mechanical phase of therapy, patients were seen biweekly for oral hygiene reinforcement. After 12 weeks, clinical measurements and GCF sampling were repeated. Results: The combined mechanical and antimicrobial therapy resulted in overall improvement in all clinical parameters; mean PPD reduction of 0.74 ± 0.1 mm and mean CAL gain 0.86 ± 0.1 mm were both statistically significant (P = .0001). Marked reduction was observed for PGE2 and IL-1b, but not TNFa. There was no significant difference between the 2 groups at baseline or final examination, except for PGE2 at final examination: It was significantly lower for the doxy group (83.61 ± 5.8 ng) than for the am-met group (124.08 ± 15.8 ng), P = .0202. Conclusion: Both treatment protocols resulted in significant improvements in the clinical and immunological parameters. When combined mechanical and antimicrobial protocol is desired and microbial cultures are not available, the use of both antibiotic regimens is recommended; the treatment of choice should be based on compliance, allergies, and potential side effects. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate and compare the effect of nonsurgical periodontal therapy in conjunction with 2 different antibacterial agents on clinical and immunological parameters in aggressive periodontitis (AgP) patients. Method and Materials: Thirty-one AgP patients underwent clinical examination that included plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). GCF (gingival crevicular fluid) samples were collected and assayed for PGE2, IL-1β, and TNFα. Nonsurgical periodontal therapy was performed. The patients received doxycycline (doxy group) or metronidazole plus amoxicillin (am-met group). After completion of the mechanical phase of therapy, patients were seen biweekly for oral hygiene reinforcement. After 12 weeks, clinical measurements and GCF sampling were repeated. Results: The combined mechanical and antimicrobial therapy resulted in overall improvement in all clinical parameters; mean PPD reduction of 0.74 ± 0.1 mm and mean CAL gain 0.86 ± 0.1 mm were both statistically significant (P = .0001). Marked reduction was observed for PGE2 and IL-1β, but not TNFα. There was no significant difference between the 2 groups at baseline or final examination, except for PGE2 at final examination: It was significantly lower for the doxy group (83.61 ± 5.8 ng) than for the am-met group (124.08 ± 15.8 ng), P = .0202. Conclusion: Both treatment protocols resulted in significant improvements in the clinical and immunological parameters. When combined mechanical and antimicrobial protocol is desired and microbial cultures are not available, the use of both antibiotic regimens is recommended; the treatment of choice should be based on compliance, allergies, and potential side effects. [ABSTRACT FROM AUTHOR]

PURPOSE: There is little information available about radiographic bone changes around immediately restored implants in periodontally compromised patients. The aims of this study were to evaluate the effect of immediate restoration on radiographic bone changes and to compare radiographic changes between arches and between healed and extraction sites in periodontally susceptible patients. MATERIALS AND METHODS: Patients received periodontal treatment. 'All in one' implant surgery was then performed: Hopeless teeth were extracted, debridement around remaining adjacent teeth was performed, implants were inserted guided by a surgical stent, and a prefabricated screwed provisional restoration was immediately delivered on selected implants. Periapical radiographs using a parallelism appliance were taken at implant surgery and 6 and 12 months postsurgery. The distance between the alveolar crest and the implant shoulder was measured at the mesial and distal aspect of each implant. Bone changes were compared between immediately restored, submerged, and nonrestored implants; between arches; and between healed and extraction sites. RESULTS: Nineteen patients received 74 implants. Twelve implants in 4 patients failed within the first 6 months. Mean bone changes (+/- SE) between baseline and 12 months ranged between -1.19 +/- 0.19 mm and -1.88 +/- 0.3 mm. No difference was found between restored versus nonrestored sites or between maxillary and mandibular sites. Bone loss was slightly higher in healed sites. CONCLUSIONS: First-year bone changes around immediately restored dental implants in periodontally susceptible patients were slightly higher than most reports in the literature. This indicates a potential influence of periodontal disease on the success rate of dental implants. [ABSTRACT FROM AUTHOR]

Purpose: There is little information available about radiographic bone changes around immediately restored implants in periodontally compromised patients. The aims of this study were to evaluate the effect of immediate restoration on radiographic bone changes and to compare radiographic changes between arches and between healed and extraction sites in periodontally susceptible patients. Materials and Methods: Patients received periodontal treatment. "All in one" implant surgery was then performed: Hopeless teeth were extracted, debridement around remaining adjacent teeth was performed, implants were inserted guided by a surgical stent, and a prefabricated screwed provisional restoration was immediately delivered on selected implants. Periapical radiographs using a parallelism appliance were taken at implant surgery and 6 and 12 months postsurgery. The distance between the alveolar crest and the implant shoulder was measured at the mesial and distal aspect of each implant. Bone changes were compared between immediately restored, submerged, and nonrestored implants; between arches; and between healed and extraction sites. Results: Nineteen patients received 74 implants. Twelve implants in 4 patients failed within the first 6 months. Mean bone changes (± SE) between baseline and 12 months ranged between -1.19 ± 0.19 mm and -1.88 ± 0.3 mm. No difference was found between restored versus nonrestored sites or between maxillary and mandibular sites. Bone loss was slightly higher in healed sites. Conclusions: First-year bone changes around immediately restored dental implants in periodontally susceptible patients were slightly higher than most reports in the literature. This indicates a potential influence of periodontal disease on the success rate of dental implants. [ABSTRACT FROM AUTHOR]

PURPOSE: Immediate restoration of dental implants in patients with a history of periodontal disease was examined. The influence of insertion torque and implant stability quotient (ISQ) on the survival rate was compared in immediately restored, nonrestored, and submerged implants. MATERIALS AND METHODS: Patients received periodontal treatment after which 'all in one' implant surgery was performed: hopeless teeth were extracted, debridement around remaining adjacent teeth was performed, implants were inserted and, in some cases, a prefabricated screw-retained provisional restoration was immediately delivered. Insertion torque and ISQ were recorded at baseline and 6 and 12 months postsurgery. RESULTS: Nineteen patients were treated, and 74 implants were placed. Twelve implants, 10 of which were maxillary, failed in 4 patients. Survival rates were 100% in partial-arch restorations, 94% in the mandible, and 78% in the maxilla. The survival rate of restored implants was 65% in extraction sites versus 94% in healed, nonextraction sites. Implants exhibited a decrease in ISQ at 6 months followed by an increase at 12 months. There were no statistically significant differences in insertion torque or ISQ between failed and successful implants, restored and nonrestored implants, or extraction-site and nonextraction-site implants. Mandibular implants demonstrated higher insertion torque and higher ISQ at baseline and 6 and 12 months. CONCLUSIONS: Within the limits of this study, immediate restoration of dental implants in periodontally susceptible patients had a variable success rate. Several factors were shown to affect these results. [ABSTRACT FROM AUTHOR]

Purpose: Immediate restoration of dental implants in patients with a history of periodontal disease was examined. The influence of insertion torque and implant stability quotient (ISQ) on the survival rate was compared in immediately restored, nonrestored, and submerged implants. Materials and Methods: Patients received periodontal treatment after which "all in one" implant surgery was performed: hopeless teeth were extracted, debridement around remaining adjacent teeth was performed, implants were inserted and, in some cases, a prefabricated screw-retained provisional restoration was immediately delivered. Insertion torque and ISQ were recorded at baseline and 6 and 12 months postsurgery. Results: Nineteen patients were treated, and 74 implants were placed. Twelve implants, 10 of which were maxillary, failed in 4 patients. Survival rates were 100% in partial-arch restorations, 94% in the mandible, and 78% in the maxilla. The survival rate of restored implants was 65% in extraction sites versus 94% in healed, nonextraction sites. Implants exhibited a decrease in ISQ at 6 months followed by an increase at 12 months. There were no statistically significant differences in insertion torque or ISQ between failed and successful implants, restored and nonrestored implants, or extraction-site and nonextraction-site implants. Mandibular implants demonstrated higher insertion torque and higher ISQ at baseline and 6 and 12 months. Conclusions: Within the limits of this study, immediate restoration of dental implants in periodontally susceptible patients had a variable success rate. Several factors were shown to affect these results. [ABSTRACT FROM AUTHOR]

A case of 2 pregnancy tumors in the same individual and at the same site within 2 years, during 2 consecutive pregnancies, despite complete eradication of the first lesion, is described. A 27-year-old woman at 32 weeks gestation was referred for gingival swelling. Gingival enlargement was pronounced on her maxillary right side, and a hemangioma was present on the lip adjacent to this mass. Despite preventive periodontal treatment the lesion continued to grow, interfering with speech and mastication, and became painful; it was therefore removed surgically. Sixteen months later, during a subsequent pregnancy, the woman returned at 20 weeks gestation for treatment of a recurrent lesion at the same site, and the lesion was excised. The roles of female sex hormones, multiplicity of vascularity, and local irritants in the development of pregnancy tumors are examined. [ABSTRACT FROM AUTHOR]

A case of 2 pregnancy tumors In the same Individual and at the same site within 2 years, during 2 consecutive pregnancies, despite complete eradication of the first lesion, is described. A 27-year-old woman at 32 weeks gestation was referred for gingival swelling. Gingival enlargement was pronounced on her maxillary right side, and a hemangioma was present on the lip adjacent to this mass. Despite preventive periodontal treatment the lesion continued to grow, interfering with speech and mastication, and became painful; it was therefore removed surgically. Sixteen months later, during a subsequent pregnancy, the woman returned at 20 weeks gestation for treatment of a recurrent lesion at the same site, and the lesion was excised. The roles of female sex hormones, multiplicity of vascularity, and local irritants in the development of pregnancy tumors are examined. [ABSTRACT FROM AUTHOR]

Background: The effect of different surgical techniques for ridge preservation on soft tissue parameters has seldom been investigated. The objective of this study was to compare the effect of two different ridge preservation techniques on soft and hard tissue dimensions.Methods: Thirty patients requiring tooth extraction were randomly allocated to either control group C (allograft covered with a non-crosslinked collagen membrane with primary closure) or experimental group E (allograft covered with cross-linked collagen membrane left exposed). Sites were surgically re-entered at 6 months. Soft and hard tissue measurements, cone beam computed tomography (CBCT), and cast measurements were taken at baseline and 6 months.Results: Twenty-eight patients were included in this analysis. When the two treatment groups were compared, the width of the buccal keratinized tissue in the E group showed an increase of 0.43 ± 0.42 mm compared to net loss of 1.57 ± 0.51 mm for the C (P = 0.006). Similarly, buccal tissue thickness has increased in the E group 0.46 ± 0.22 mm compared to a loss of 0.15 ± 0.23 mm in the C group (P = 0.068). Volumetric assessment of the changes in the alveolar ridge for the E group showed a slight decrease (68.3 ± 17 mm3) whereas the C group has experienced almost double this loss (107.5 ± 11 mm3; P = 0.07). Crestal width, measured on the CBCT scan, has shown significant reduction in the C group (4.18 ± 0.56 mm) compared to only 1.74 ± 0.4 mm in the E group (P = 0.003).Conclusion: Crosslinked collagen membrane with allograft placed intentionally non-submerged resulted in better preservation of the keratinized tissues (width and thickness) with similar and at times better osseous preservation following extraction. [ABSTRACT FROM AUTHOR]

Purpose: To compare dimensional changes and bone quality of two different grafting materials used for socket preservation. Materials and Methods: Thirty‐three patients requiring extraction were recruited and randomly assigned to receive: biphasic calcium sulfate/ hydroxyapatite (BCS/HA); bovine derived xenograft (BDX) or no grafting (Control). Ridge width (at −3 and −6 mm) and vertical distance from a stent were measured at the time of extraction/grafting. Measurements were repeated at reentry and core biopsies were harvested. Results: Baseline vertical distance for the BDX, C and BCS/HA groups were 7.45 ± 3.1, 7.69 ± 4.2, and 6.75 ± 3.5 mm, respectively (P = .830). Post‐op, C group had greater vertical loss (1.71 ± 0.4 mm) compared to BCS/HA (0.65 ± 0.5) and BDX (0.25 ± 0.2 mm), P = .059. Mean baseline width at −3 mm was 8.69 ± 1.1 mm, 8.31 ± 1.4 mm, and 9.0 ± 1.1 mm, respectively (P = .509). Post‐op, this width was reduced by 2.96 ± 0.3 mm (C), 1.56 ± 0.4 mm (BDX), and 0.5 ± 0.4 mm (BCS/HA), P = .001. Mean ridge width at −6 mm for the C (6.5 ± 1.7 mm) was significantly smaller than BCS/HA (7.95 ± 2.8 mm) and BDX (8.85 ± 1.9 mm), P = .043. Histologically, the BDX group had greater residual scaffold material and less vital bone compared to the BCS/HA group. Pain scores were relatively low for all groups. Conclusions: BCS/HA may be used for socket preservation with similar or better results compared to BDX. The significance of greater residual scaffold found in the BDX group is yet to be determined. [ABSTRACT FROM AUTHOR]

The purposes of the present study were to examine the frequency of cervical enamel projection in mandibular molars with class II furcation defects and to examine the response of these teeth to guided tissue regeneration procedures. Probing depth and vertical and horizontal periodontal attachment levels were recorded with a constant-force electronic periodontal probe. Following surgical exposure of the bifurcation and prior to membrane placement, the cervical enamel projection was examined and then graded clinically; photographs were taken to allow further examination of the bifurcation. An overall improvement in clinical parameters was observed in most sites. Cervical enamel projection was present in 82.1% of all molars examined. Grade II was the most prevalent (34.8%). Patients with any degree of cervical enamel projection demonstrated significantly higher mean probing depths at baseline than did patients without cervical enamel projection. Likewise, pretreatment probing attachment levels were higher in patients with some degree of cervical enamel projection. However, greater posttreatment horizontal and vertical attachment gains were observed in sites with a baseline cervical enamel projection. [ABSTRACT FROM AUTHOR]

Tooth rotation and periodontal breakdown has not been thoroughly studied due to lack of quantitative tools. The purpose of the present study was to examine this correlation, with respect to alveolar bone loss, from direct observation of 17 skulls. A photograph of the mandibular occlusal plane was taken from a fixed reference point, and the midcentral fossa and the extreme mesial and distal points of each tooth were marked on the photograph. A computer program established the arch form of each mandible from the midtooth landmarks. The angle between individual teeth and the arch (at any given point) was calculated. Bone loss, indicated by the distance of the bone crest from the cementoenamel junction, was measured at six reference points around each tooth with a caliper. A positive correlation, though weak, was found between increased tooth rotation and greater bone loss. Mean bone loss of teeth with rotation of 20 degrees and greater was 4.03 mm, while that of teeth with less than 20 degrees of rotation was 3.49 mm. [ABSTRACT FROM AUTHOR]

Various therapeutic techniques for the treatment of juvenile periodontitis are reported in the literature, with occasional contradictory results. One of the reasons for the contradictory results may be differences in patient selection and/or response to treatment. The following report describes the results of various treatment modalities, in different sites in the same individual, on localized juvenile periodontitis. [ABSTRACT FROM AUTHOR]

The treatment of a dilacerated maxillary incisor requires a multidisciplinary approach. Orthodontic, endodontic, and periodontal considerations are essential for successful treatment. A case that demonstrates the periodontal aspects of the treatment of this anomaly is presented. Treatment included (1) a conservative surgical technique for crown exposure that preserved a wide band of keratinized gingiva; (2) initial periodontal preparation before active orthodontic movement as well as a supplemental intensive maintenance program that continued throughout orthodontic treatment; and (3) a vestibular extension procedure designed to alleviate the shallow vestibular depth that can result in poor oral hygiene. Careful monitoring is essential to the long-term success of treatment. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to evaluate the effect of barrier membrane exposure on the success of guided tissue regeneration in Class II furcation defects. Twenty-six subjects with mandibular Class II furcation defects received initial periodontal therapy followed by guided tissue regeneration surgery. The membrane was placed and the flaps were repositioned so that the membrane was totally submerged. Membranes were removed 4 to 6 weeks later, at which time the extent of their exposure was recorded. An overall improvement in all clinical parameters was observed for all subjects 1 year after surgery. Half of the patients had experienced no membrane exposure, while the other 13 subjects had experienced mild to pronounced exposure; both groups showed similar improvement in all clinical and surgical parameters. In light of the comparable results obtained in exposed sites, and the anatomic difficulties sometimes encountered in covering a membrane completely, in some of these cases the membrane may be left only partially submerged. This approach will allow for tighter occlusal "seal" of the tooth-membrane interface and preservation of the keratinized gingiva. [ABSTRACT FROM AUTHOR]

The purpose of the present evidence-based critical review was to define goals and outcomes for regenerative therapy of Class II furcation defects and rank the efficacy of current regenerative procedures based on the available literature. Meta-analysis was employed to quantitate the mean overall expected changes and compare various techniques. The evidence presented in the literature was used to determine factors affecting regeneration of Class II furcation defects. These factors were used to establish decision-making trees to enhance success and highlight potential shortcomings of the technique. Guided tissue regeneration, used alone or in combination with bane replacement grafts, had the highest overall ranking. Mean reduction in probing depths and gains in vertical and horizontal attachment levels were all statistically significant at 6 months. Similar results were obtained in the 12-month studies. Compared to flap debridement. guided tissue regeneration resulted in greater reduction in probing depths and greater gains in vertical and horizontal attachment levels. Guided tissue regeneration provided almost identical results whether used with or without root conditioning, suggesting that root conditioning does not offer an adjunctive effect. A combination of guided tissue regeneration and bone replacement grafts yielded better results than did guided tissue regeneration alone in reducing probing depths and increasing vertical attachment levels. The decision-making trees derived from analysis of these results may assist the clinician in improving success and predictability of guided tissue regeneration procedures in Class II furcation defects [ABSTRACT FROM AUTHOR]