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Background: To calculate the prevalence of dehiscences and fenestrations and measure the buccal alveolar bone width overlying healthy mandibular incisors and canines., Methods: Cone beam computerized tomographies (CBCTs) from patients aged 18 to 30 years were selected from a private database. The thickness of buccal bone in the sagittal scan was measured perpendicular to the long axis of 6 teeth at two locations: at the crest level and at the mid-root level. A single calibrated examiner performed all measurements. Descriptive and inferential statistics were performed., Results: A total of 100 CBCTs (600 teeth) were selected for the analysis. The overall prevalence of dehiscences and fenestrations was 89.16% and 5.16%, respectively. Dehiscences and fenestrations were shown to have a mean length of 6.78±1.90 mm and 4.89±1.74 mm, respectively. This result was similar between young and old subjects as well as between men and women. Bone width at the crest level was significantly thinner in women (0.71±0.13 mm), whereas men were found to have a statistically significant thicker bone at the mid-root level of tooth #33. Comparisons of bone width at the mid-root level among the 6 analyzed teeth showed no statistical difference., Conclusions: A high prevalence of dehiscences and sites with thin buccal bone were identified in correspondence of the lower anterior teeth by means of CBCT analysis.

Purpose: To compare 100% deproteinised bovine bone matrix (DBBM) grafts (test group) with 100% autogenous bone (AB) grafts (control group) for lateral maxillary sinus floor elevation in a parallel group, superiority, randomised controlled trial., Materials and Methods: Patients with 1 to 3 mm of residual bone height below the maxillary sinus were randomised for sinus floor elevation with DBBM and AB grafts and simultaneous implant placement. Randomisation was computer generated with allocation concealment by sealed envelopes and the radiographic examiner was blinded to group assignment. The abutment connection was performed 8 months after surgery and insertion of the provisional prostheses was performed 9 months after surgery. Outcome variables were implant failures, prosthetic failures, complications, chair time, postoperative pain and radiographic bone level 6 months after loading., Results: Forty patients were randomised: 20 (32 implants) to the DBBM group and 20 (27 implants) to the AB group. One patient from the AB group dropped out. Two implant failures occurred in the DBBM group and no implant failure occurred in the AB group (P = 0.4872). All of the planned prostheses could be delivered. One complication occurred in the DBBM group and 2 in the AB group (P = 0.6050). Chair time was shorter for the DBBM group, with a difference of 27.3 minutes (P = 0.0428). Pain difference measured with a visual analogue scale for 6 days post-surgery was 0.2 in favour of the DBBM group (P = 0.6838). The difference in vertical bone height was 0.0 mm (95% CI -1.1, 1.1; P = 0.9703) and the difference in marginal bone level was 0.3 in favour of AB (95% CI -0.3, 0.9; P = 0.3220)., Conclusions: No differences apart from chair time were observed when comparing DBBM and AB grafts with simultaneous implant placement in sinus elevation.

Purpose: The aim of this survey is to assess the different radiographic interpretations of simulated dental implant cases among a group of specialists in oral surgery., Material and Methods: A total of 76 active members of the Italian Society of Oral Surgery and Implantology were recruited for the study. The participants in the study were requested to assign scores to radiographic images of 12 simulated cases of dental implants: a baseline and follow-up image for cases with different bone loss (0, 1 or 5 mm), implant length (8 or 12 mm) and years of follow-up (1 or 5 years)., Results: In total, 63 active members agreed to participate in the survey. The inter-rater agreement was 0.86 (CI 95% 0.74; 0.95). In cases where the bone loss was absent (0 mm) no difference was detected at 1 or 5 years of follow-up. In contrast, when bone loss was present (1 or 5 mm) the longer follow-up (5 years) revealed the highest score. The lowest score was attributed to 5 mm of bone loss and 1 year of follow-up. Moreover, a significant difference between the short (8 mm) and the long (12 mm) implant was observed (score difference 0.45; CI 95% 0.28; 0.63)., Conclusions: This investigation suggests that subjective evaluation of radiographs on simulated implants by skilled clinicians is rather uniform, and bone loss, follow-up and implant length are factors considered in the perception of implant success.

Several studies have been published focusing on the possibility to treat patients affected by periodontal defects by means of orthodontic treatment. The aim of this systematic review is to evaluate the efficacy of the orthodontic treatment applied to the therapy of infraosseous defects, gingival recessions, and furcation lesions. An electronic and a manual search were performed based on a PICO assessment worksheet. Both human and animal studies were selected for this review. The electronic search (from January 1966 to December 2009) and the hand search (from January 1988 to December 2009) were conducted by 3 independent reviewers. A total of 197 articles were found and only 29 were considered eligible for this review. In particular, 22 studies dealing with infrabony defects, 1 gingival recession, and 6 furcation defect treatments. Due to the weak evidence and the controversial and unclear results, it appears important to encourage the researchers to produce Randomized Controlled clinical Trials aimed to investigate the efficacy of the orthodontic treatment for the correction of periodontal defects., (Copyright © 2011 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.)

Background: The purpose of these clinical guidelines, commissioned by the Italian Society of Periodontology and compiled with the tools and instructions of the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration, was to determine, in terms of efficacy, complications, and patient opinions, the most appropriate surgical techniques for periodontal patients with infrabony defects > or = 3 mm., Methods: Results published in the literature concerning open flap debridement (OFD), guided tissue regeneration (GTR) using a bioabsorbable or non-resorbable membrane, regeneration of periodontal tissues using enamel matrix derivative (EMD), and bone or bone substitute grafts were searched (electronically and manually) and compared. The following variables were analyzed: number of teeth lost, variation in clinical attachment level (CAL gain), variation in probing depth (PD reduction), variation in gingival recession, variation in bony defect depth (bone gain), complications, and the functional and esthetic satisfaction of the patients. Literature searches were performed selecting randomized clinical trials (RCTs) and systematic reviews (SRs) of RCTs published through December 31, 2006 with > or = 1 year of follow-up. The full text of the selected SRs and RCTs were analyzed using checklists for qualitative evaluation according to the Scottish Intercollegiate Guidelines Network (SIGN) method., Results: For the drafting of these guidelines, it was decided to accept the results of two SRs that compared OFD versus GTR, OFD versus EMD, and GTR versus EMD. With regard to efficacy, GTR and EMD can yield better results than OFD in terms of CAL gain (1.22 mm [P value <0.0001] and 1.20 mm [P value <0.0001], respectively), reduction of PD (1.21 mm [P = 0.0004] and 0.77 mm [P = 0.0001], respectively), and bone gain (1.39 and 1.08 mm, respectively) after > or = 1 year of follow-up. The available data are insufficient for an evaluation of bone or bone substitute grafts. The data in the literature are also insufficient for answering questions about complications and patient opinions., Conclusions: The evidence reported in the literature indicates that it is advisable to treat infrabony defects > or = 3 mm by OFD, GTR, and EMD. Further studies on these topics should be encouraged. There is a need for well-conducted RCTs that report data on complications and patient opinions.

Background: Assigning a prognosis to a periodontal patient is one of the greatest challenges in clinical practice. Many different factors can affect the result of periodontal therapy. The purpose of this study was to evaluate the prognostic value of some clinical, genetic, and radiographic variables in predicting bone level variation in periodontal patients (aged 40 to 60) treated and maintained for 10 years., Methods: Sixty consecutive non-smoking patients (mean age 46.77 +/- 4.96) with moderate to severe chronic periodontitis were treated with scaling and root planing (SRP). Some patients also underwent additional surgical treatments. All patients were maintained in the same private practice for 10 years. At baseline (T0) and at least 10 years later (T2), the following clinical variables were evaluated: probing depth (PD), tooth mobility (TM), presence of prosthetic restorations (PR), and molar teeth (MT). In addition, radiographic measurements were taken of the mesial and distal distances from the cemento-enamel junction (CEJ) to the bottom of the defect (BD), to the bone crest (BC), and to the root apex (RA). At T2, a genetic test to determine the IL-1 genotype and genetic susceptibility for severe periodontal disease was performed for all 60 patients. Based on the results of this assay, the patients were categorized as IL-1 genotype positive (G+) or negative (G-). The differences between the bone levels measured at T0 and T2 (ABD), indicating the bone level variation, was used as the outcome variable. Different predictor variables were then tested using a 3-level statistical model (multilevel statistical analysis; patient, tooth, and site level). At the patient level these were: age, gender, and interaction between mean bone loss and the IL-1 genotype (mean CEJ-BD(T0) x IL-1 genotype). At the tooth level the variables were: TM(T0), PR(T0), MT(T0); and at the site level the evaluated factors were: the infrabony component of the defect (CEJ-BD(T0) - CEJ-BC(T0), PD(T0), bone level (CEJ-BD(T0)), and the residual supporting bone (BD-RA(T0))., Results: Among the considered predictor parameters, the following were significantly associated with the outcome variable: 1) mean CEJ-BD(T0) x IL-1 genotype (P = 0.0019); 2) TM(T0) (P < 0.0000); 3) CEJ-BD(T0) (P < 0.0000); 4) CEJ-BD(T0) - CEJ-BC(T0) (P < 0.0000); 5) PD(T0) (P = 0.0010). Deeper probing depths at a site and tooth mobility at baseline were associated with worst prognosis. Greater CEJ-BD(T0) distance and infrabony component at a site at baseline were associated with a better prognosis. The interaction between mean CEJ-BD measurement at baseline and IL-1 genotype was significantly associated both with a good or a poor prognosis. The other parameters evaluated - age, gender, presence of molars and prosthetic restorations, and residual supporting bone - were not significantly associated with bone level variation., Conclusions: Within the scope of this study design, many traditional prognostic factors were ineffective in predicting future bone level variation and therefore were of no prognostic value. Conversely, a few specific factors at each level emerged as valuable prognostic factors. At the patient level, the prognostic factor was initial mean bone level in conjunction with a positive IL-1 genotype. At the tooth level, the prognostic factor was tooth mobility. At the site level, the significant prognostic factors were initial bone level at a site, the infrabony component of a defect, and initial probing depth at a site. The use of these factors may be of value to clinicians as predictors of bone level variation when assigning a prognosis to a patient, a tooth, or a site.

Background: A difference in genetic susceptibility to plaque accumulation has been advocated to explain different responses to periodontal therapy. The purpose of this study is to assess the role of the interleukin-1 (IL-1) polymorphism on the rate of bone and tooth loss in non-smoking periodontally treated patients during maintenance., Methods: Sixty consecutive non-smoking patients (mean age 46.8 +/- 5.0) with moderate to severe periodontitis, treated and maintained for over 10 years were selected. At baseline (T0), radiographic evaluation (cemento-enamel junction [CEJ]-root apex, CEJ-bottom of defect mesial and distal, CEJ-bone crest mesial and distal, crown-root ratio) was performed. All patients received scaling and root planing; 36 patients then underwent surgical therapy. Subsequently, all patients were enrolled in a periodontal maintenance program with recall visits every 3.4 +/- 1.0 months for at least 10 years. At the latest recall visit (T2) the same radiographic measurements evaluated at baseline were taken and a DNA sample for IL-1 genetic susceptibility testing was collected and sent for analysis., Results: Twenty-three of the 60 patients (38.3%) were IL-1 genotype positive. A total of 52 teeth (3.3%) out of 1,566 were lost due to periodontitis between T0 and T2; 28 of 957 (2.9%) in the IL-1 genotype negative group and 24 of 609 (3.9%) in IL-1 genotype positive group. The mean variation in bone defect level (DeltaBD) averaged -0.04 mm in IL-1 genotype negative patients and 0.01 mm in IL-1 genotype positive patients. The mean variation in bone crest level (DeltaBC) averaged -0.24 mm in IL-1 genotype negative patients and -0.28 mm in IL-1 genotype positive patients. However, a few patients showed significant differences in response to therapy based on initial bone levels and genotype. IL-1 negative patients who showed minimal initial bone loss responded to the therapy better than the IL-1 positive patients. IL-1 positive patients with severe initial bone loss showed a better response to the therapy than IL-1 negative patients., Conclusions: On average, there were no significant differences related to IL-1 genotype in tooth loss after 10 years in a non-smoking, well-maintained periodontal population. On an individual patient basis, the IL-1 genotype, in combination with the initial bone level, seems useful at the beginning of therapy for predicting bone level variation.