Search

PURPOSE: The purpose of this study was to evaluate radiographic bone levels adjacent to implants placed in fresh extraction sockets (ESs) and immediately loaded with a fixed full-arch provisional restoration compared to bone levels adjacent to implants placed in native bone (NB) under the same restorative conditions. MATERIALS AND METHODS: Patients with a hopeless maxillary and/or mandibular dentition had their remaining teeth extracted and 6 to 8 implants placed and restored within 72 hours. Radiographs were obtained at time 0, 3 to 6 months, and annually for 5 years. The radiographs were digitized, and the bone level changes were measured using a computer-assisted method. RESULTS: A total of 139 implants, 42 ES and 97 NB, placed in 17 patients were evaluated. The overall results indicated that for all implants (ES + NB), 0.60+/-0.71 mm of bone was lost after 6 months; 1.17 +/-0.59 mm of bone was lost after 18 months; 0.87+/-0.76 mm bone was lost after 36 months; and 1.35 +/-0.42 mm of bone was lost after 60 months. When stratifying for NB versus ES implants, it was found that for NB implants, 0.75+/- 0.21 mm of bone was lost after 6 months; 1.31 +/- 0.91 mm of bone was lost after 12 months; 1.07+/-0.21 mm of bone was lost after 36 months; and 1.45 +/- 0.49 mm of bone was lost after 54 months. For ES implants, 0.14 +/-0.33 mm of bone was lost after 6 months; 1.02 +/-0.27 mm of bone was lost after 12 months; 0.86+/-0.42 mm of bone was lost after 36 months; and 1.30 +/-0.48 mm of bone was lost after 54 months. CONCLUSION: The combination of ES and NB implants can be immediately loaded with a fixed full-arch prosthesis and remain stable for greater than 5 years. The bone loss adjacent to these implants is similar to that seen surrounding those placed and restored using traditional protocols. [ABSTRACT FROM AUTHOR]

The primary objective of this proof-of-principle study was to evaluate the outcome of vertical ridge augmentation in a standardized dog model by combining purified recombinant platelet-derived growth factor (rhPDGF-BB) and a block of deproteinized cancellous bovine bone. The secondary objective was to determine the value of a resorbable barrier membrane to improve the efficacy of the procedure. Six adult foxhounds were committed to bilateral surgical extraction of all four mandibular premolars. A vertical alveolar ridge defect was created at the time of the extractions. Three months later, the artificially created defects were grafted: Group A used a deproteinized bovine bone block in combination with a collagen barrier membrane, group B used a deproteinized bovine bone block infused with rhPDGF-BB only, and group C included a deproteinized bovine bone block infused with rhPDGF-BB, plus a collagen resorbable barrier membrane. After 4 months, the animals were sacrificed. Histologic examination of group B revealed a large amount of newly formed bone, and a large amount of bone-to-implant contact was visible in the areas of bone regeneration extending over the top of the implant cover screw. The results of this preclinical canine study provide proof-of-principle that rhPDGF-BB, used in combination with a deproteinized bovine block without placement of a barrier membrane, has the potential to regenerate significant amounts of new bone in severe mandibular ridge defects. In addition, the results seem to point to the importance of the periosteum as a source of osteoprogenitor cells in growth factor-mediated regenerative procedures. [ABSTRACT FROM AUTHOR]

Background: This study evaluated patients who had been treated with recombinant human bone morphogenetic protein-2 (rhBMP-2) loaded in an absorbable collagen sponge (ACS) in human extraction sites or in sites that required alveolar ridge augmentation. An earlier report on the same patients revealed that after 4 months, implantation of rhBMP-2/ACS was safe, as determined by clinical, radiographic, systemic, and immunological analyses. In this longer-term follow-up, eligible patients were restored with endosseous dental implants in the area treated with rhBMP-2/ACS and bone biopsy samples were taken for histological analysis of the treated human bone tissue. The primary objective was to monitor the long-term safety of patients treated with rhBMP-2/ACS. Another objective was to evaluate the dental implants placed in the sites treated with rhBMP-2. Methods: Patient safety was evaluated by clinical examinations, periapical radiographs, and occurrence of adverse experiences. Dental implants were evaluated by radiographic and clinical examination. All 12 patients have been followed for 3 years. Results: Two years following surgical implantation of rhBMP-2/ACS, no serious or unexpected adverse experiences occurred. The adverse experiences that did occur were mostly benign and compatible with the dental implant surgeries performed in these patients. No adverse experiences were deemed as related to the rhBMP-2/ACS. Furthermore, no safety concerns in the local area of rhBMP-2/ACS placement were noted, based on oral wound examinations. In the 10 patients (6 extraction socket patients and 4 augmentation patients) who received endosseous implants, all implants were clinically stable at all assessments and all 10 patients have been functionally restored. Histological evaluation of the human bone core biopsies revealed normal bone tissue formation identical to the surrounding native bone. Three-year follow-up clinical examinations revealed that all implants had stable marginal bone levels and healthy peri-implant tissues. Conclusions: These 3-year results demonstrate that rhBMP-2/ACS can be used safely in human patients. Human bone biopsies reveal normal bone formation in areas treated with rhBMP-2/ACS. Endosseous implants placed in these areas were all stable with no radiographic or clinical complications. The results from this study suggest that rhBMP-2/ACS (0.43 mg/ml) can be safely used in tooth extraction sites and in local ridge augmentation procedures and that endosseous dental implants placed in bony areas treated with rhBMP-2/ACS are stable and can be functionally restored without complication. [ABSTRACT FROM AUTHOR]

Background: The rate of progression of periodontal disease is dependent on the complex regulatory interactions between bacteria and the immune modulators of the host response. The purpose of this investigation was to determine if recombinant human interleukin-11 (rhIL-11), known to downregulate several inflammatory modulators, has the ability in subcutaneous administration to reduce the rate and/or extent of periodontal attachment loss and radiographic bone loss in a ligature-induced periodontal disease beagle dog model. Methods: Twenty 18-month-old female beagle dogs were brought to optimal periodontal health over a 2-week period. Periodontal disease was induced by placing 2.0 silk ligatures around the mandibular first molar and premolar teeth. The dogs were divided into 3 treatment groups and one control group. The 3 treatment groups received subcutaneous injections of either 15, 30, or 80 microg/kg of rhIL-11 in saline buffer twice a week. The placebo group received buffer only subcutaneously twice a week. The gingival health of each animal was measured by recording the presence or absence of gingival inflammation, plaque, and bleeding upon probing. Attachment levels and bone height were also measured. Treatment administration and clinical and radiographic evaluations were performed in a masked fashion. Results: At week 8, the placebo group had 3.89 mm of attachment loss and 73.8% radiographic bone remaining. The 15 microg/kg group had 1.99 mm attachment loss and 89.5% bone remaining; the 30 microg/kg group had 0.84 mm attachment loss and 92.5% bone remaining; and the 80 microg/kg group had 1.05 mm attachment loss and 85.5% bone remaining. All 3 treatment groups lost significantly less attachment and retained significantly more bone than did the placebo group. Conclusions: The study indicates that subcutaneous injections of rhIL-11 were able to slow the progression of attachment and radiographic alveolar bone loss in a ligature-induced beagle dog model. [ABSTRACT FROM AUTHOR]

Background: The rehabilitation of the oral cavity with dental implants has become a predictable treatment modality. However, there have been only a few direct comparisons evaluating the submerged and nonsubmerged placement techniques. The purpose of this study was to characterize radiographic peri-implant bone changes following the insertion of submerged and nonsubmerged implants in the beagle dog. Methods: At the end of the extraction healing phase, 19 submerged and 19 nonsubmerged implants were randomly placed in a split-mouth study design and observed over an 18-week period. For submerged implants, a second stage surgery and transmucosal abutment attachment was performed at week 12. Standardized dental radiographs taken at baseline, week 12, and week 18 were used to measure peri-implant bone changes. The radiographs were analyzed with a simple computer assisted method. Results: A total of 43 standardized radiographs were exposed to evaluate the 38 implants. During the study period, all submerged and nonsubmerged implants demonstrated peri-implant bone loss. At baseline, both submerged and nonsubmerged implants had similar bone levels (P > or = 0.05). When the mean peri-implant bone levels for submerged and nonsubmerged implants were compared from baseline to week 12, nonsubmerged implants had a significantly greater amount and rate of bone resorption than submerged implants (P < or = 0.05). Following week 12, the initially submerged implant had a significantly higher rate and amount of peri-implant bone loss than the nonsubmerged implants (P < or = 0.05). However, by the end of the study period, week 18, both submerged and nonsubmerged implants had comparable bone levels (P > or = 0.05). Conclusions: The study indicates that, although the temporal patterns of peri-implant bone resorption differed, there were no differences between submerged and nonsubmerged implants in the overall amount and rate of peri-implant bone loss. [ABSTRACT FROM AUTHOR]

A single-blind investigation was designed to study the effects of piroxicam in preventing gingival inflammation and plaque formation in beagle dogs. Twelve 1-year-old beagles were brought to optimum oral hygiene and gingival health. Thereafter, they were fed a moist plaque-promoting diet and were divided into three groups. The first group received daily administration of 1.0 ml placebo gel (methylcellulose) painted on the teeth. The second group received 1.0 ml of gel containing 2 mg/ml piroxicam and the third group received 1.0 ml liquid containing 2 mg/ml of piroxicam. Placebo and test solutions were applied daily, and dogs were examined biweekly for evaluation of plaque accumulation, gingival inflammation, bleeding upon gentle probing and tooth staining. Data were analyzed using the Krushkal-Wallis test. Over the treatment period, plaque accumulation was substantial in all three groups and was not significantly different between the three groups. By week 2, the gingival index in the piroxicam-treated dogs was significantly lower than that of the placebo-treated group and remained so throughout the study, with the exception of wk 6 and 12 in the topical gel-treated group. Mean percent bleeding sites were also significantly less in the piroxicam-treated groups than in the control dogs. Staining of the teeth increased for all groups over the 16-wk treatment period. These data indicate that piroxicam can significantly inhibit the development of gingival inflammation in beagle dogs. [ABSTRACT FROM AUTHOR]

Background: Edentulous sites with limited horizontal tooth-implant distance pose a challenge to clinicians. This case report describes root amputation of an adjacent compromised molar to maintain an optimal tooth-implant distance METHODS AND RESULTS: A 41-year-old female was referred for extraction and implant placement to replace her left, maxillary second premolar (#13), which had been diagnosed with a vertical root fracture. Extraction and ridge preservation of #13 was completed without complication. The 4-month postsurgical clinical examination revealed a narrow mesial-distal distance (5.69 mm) of the edentulous space (#13), which was influenced by the degree of divergence of the mesial buccal root of tooth #14. Cone-beam computed tomography (CBCT) analysis verified a periapical lesion on the mesial-buccal root of tooth #14. The amputation of the endodontically compromised mesial-buccal root of #14 was treatment planned to provide space and facilitate placement of a standard diameter implant without compromising the implant or adjacent teeth. Crestal bone levels were verified and maintained at the 1 year postoperative follow-up., Conclusion: The findings of the case report demonstrate how root amputation of a compromised molar is an alternative solution for managing spatial limitations in contemporary implant dentistry. More studies are required to assess the reliability and long-term success of this approach., Key Points: Why is this case new information? There is insufficient evidence on the long-term efficacy of narrow-diameter implants. Clinical treatment guidelines are not sufficiently available. This paper presents an alternative approach to managing a specific scenario where mesial-distance distance is limited using root amputation of an adjacent compromised tooth. What are the keys to successful management of this case? Comprehensive diagnosis and stringent case selection Multidisciplinary treatment planning Evidence-based decision making What are the primary limitations to success in this case? Very specific clinical application; adjacent compromised tooth Long-term follow up is required., (© 2023 American Academy of Periodontology.)

Background: Studies on risk factors affecting tooth retention after endodontic treatment in dental school settings are limited. Understanding these factors is crucial for preserving teeth. The aim of this retrospective study was to evaluate patient- and tooth-level risk factors associated with the survival of endodontically treated teeth., Methods: Electronic health records of patients who underwent endodontic treatment at the School of Dental Medicine at the University of Pennsylvania from 2017 through 2020 were analyzed. Patient-level factors included age, sex, American Society of Anesthesiologists Physical Status Classification, smoking history, diabetes status, and amoxicillin allergy. Tooth-level factors included position, presence of restorations, and periodontal conditions with preprosthetic treatments., Results: The results of this study indicate that the patient-level factors significantly associated with tooth retention included age, sex, American Society of Anesthesiologists Physical Classification Status, and amoxicillin allergy. Tooth-level factors such as core buildup, full-coverage crown, healthy periodontium, and scaling and root planing were also associated with higher survival rates. Mandibular premolars had higher survival rates than mandibular molars., Conclusions: This investigation revealed that the tooth retention rate of endodontically treated teeth was 96.2% after initial root canal treatment, 92.4% for nonsurgical re-treatment, and 97.8% for surgical re-treatment., Practical Implications: The tooth retention of the endodontic treatment was associated with healthy periodontium, tooth structure, tooth position, tooth restoration, and the patient's overall health., Competing Interests: Disclosure None of the authors reported any disclosures., (Copyright © 2024 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Minimally invasive nonsurgical treatment (MINST) aims to remove an etiology with minimal damage to the healthy periodontium and provide the ideal healing environment. This case series introduces the novel protocol of laser-assisted MINST (LAMINST), combining minimally invasive surgery with a dental laser. A total of 25 patients (32 teeth) with advanced periodontal disease were enrolled and received periodontal treatment by following the LAMINST protocol. Probing depth (PD), recession, clinical attachment level (CAL), bleeding on probing (BOP), plaque presence, and site mobility were evaluated preoperatively and at 6 months. Based on the periodontal evaluations, all cases were diagnosed as stage III grade C periodontitis. Six months after LAMINST, the average PD reduction was 4.44 mm and CAL improved by 4.38 mm. Baseline mobility scores of 1 (6 teeth), 2 (9 teeth), and 3 (3 teeth) decreased to 1 (5 teeth) or 0 (13 teeth). The initial prognoses of 5 (hopeless; 15 teeth), 4 (questionable; 13 teeth), and 3 (poor; 4 teeth), improved to 4 (5 teeth), 3 (12 teeth), 2 (fair; 13 teeth), and 1 (good; 2 teeth). The number of BOP sites reduced from 179 to 12, and the number of plaque sites reduced from 173 to 9. All clinical parameters were improved after LAMINST. The application of LAMINST may overcome the traditional limitations of nonsurgical treatment, such as poor accessibility.

Aim: The aim of the present study was to evaluate soft and hard tissue alterations around implants with a modified marginal portion placed in a healed, sloped ridge over 3 years of follow-up., Material and Methods: 65 patients with a single recipient implant site in an alveolar ridge with a lingual-buccal sloped configuration were recruited. Implants with a modified geometry in the marginal portion were installed in such a way that the sloped part of the device was located at the buccal and most apical position of the osteotomy preparation. Crowns were placed 21 weeks after implant placement. Radiologic examinations were performed at implant installation and at 1 and 3 years of follow-up. Bleeding on probing (BoP), probing pocket depth (PPD), and clinical attachment level (CAL; from the crown margin) were recorded at the insertion of the prosthesis and after 1 and 3 years., Results: 57 patients with 57 implant-supported restorations attended the 3 years follow-up examination. The radiographic analysis revealed a mean marginal bone loss of 0.57 mm during the 3 years period. While the average bone loss between 1 and 3 years amounted to 0.30 mm, approximately 50% of the implants showed no bone loss during this period. The results from the clinical examinations showed a CAL gain of 0.11 ± 0.85 mm between baseline and 3 years of follow-up. About 65% of the implants showed no loss of attachment between 1 and 3 years. BoP and PPD ≥5 mm were identified at <10% of implants at the 3 years examination., Conclusion: Hard and soft tissues formed around dental implants that were designed to match the morphology of an alveolar ridge with a lingual-buccal sloped configuration remained stable over 3 years., (© 2022 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

This retrospective study evaluated the long-term stability of teeth that were orthodontically treated with forced eruption for restorative purposes. A total of 25 participants with a total of 36 orthodontically extruded teeth were included in the study. The measured clinical parameters included (1) pre- and posttreatment radiographs, (2) activation time, (3) retention time, (4) total treatment time, (5) additional treatment required to restore the teeth, and (6) pre- and postsurgical complications. The results show a 96.0% survival rate for force-erupted teeth, with a 4.0% failure rate due to nonrestorable caries. When more than 1.0 mm of extrusion was completed, there was a statistically significantly higher chance that the tooth required additional surgeries (P < .05). Complications during treatment were higher in clinicians without orthodontic training (43.0%) vs clinicians with orthodontic training (10.0%). Forced eruption for prosthetic treatment and implant site development is a viable treatment option and is successful in the long-term.

Purpose: Instead of original abutments, compatible abutments are often selected for financial reasons. The present study aimed to evaluate mechanical outcomes, microleakage, and marginal accuracy at the implant-abutment interface of original versus nonoriginal implant abutments., Study Selection: Search strategy encompassed literature from 1967 up to March 2017 to identify relevant studies meeting the inclusion criteria. The following electronic databases were consulted: PubMed database of the U.S. National Library of Medicine, Embase (Excerpta Medica dataBASE), and the Grey Literature Database (New York Academy of Medicine Grey Literature Report). Quality assessment of the full-text articles selected was performed. Abutments were classified in original (produced by the same implant manufacturer), nonoriginal certified (produced by a third-party milling center, certified by implant companies), and nonoriginal compatible (produced by a third-party milling center for similar connections)., Results: A total of 16 articles fulfilled inclusion criteria and quality assessment and were selected for the qualitative analysis. All of the included studies were in vitro research with high or moderate risk of bias and reported data from 653 implant abutments. Original and nonoriginal certified abutments showed better results in terms of mechanical outcomes, microleakage, and marginal accuracy compared to nonoriginal compatible abutments., Conclusions: Following the clear warnings coming from the present systematic review, clinical suggestions regarding the effect of a nonoriginal abutment can be drawn. However, in vivo, long-term, randomized controlled trials are needed to provide definitive clinical conclusion about the long-term clinical outcomes of original and nonoriginal abutments.

Background: Soft tissue stability is crucial to obtain and maintain optimal esthetic results., Purpose: This study aimed to investigate, over 5 years, the soft tissue response using a conical abutment together with the "one-abutment one-time" (OA-OT) protocol in the restoration of implants inserted in the anterior esthetic area., Material and Methods: From January 2011 to January 2012, all consecutive patients requiring an implant n the maxillary area between canines were enrolled. After submerged healing and osseointegration, a definitive abutment with a provisional crown was inserted. After 1 month, the definitive crown was delivered (Tdef). Analog impressions were taken before tooth extraction (T0), at implant insertion Timpl, and Tdef, and at 12 months (T1) and 60 months (T5). Casts were scanned and superimposed using a dedicated software. Differences in vertical height of soft tissue margins between the digitized model casts were calculated and paired sample t test was conducted to compare results. To detect the potential role of biotype, groups (thick vs. thin) were compared by analysis of variance with general linear model., Results: Twenty-five patients were enrolled. Three patients dropped out. At the 60-month, 22 patients (12 men and 10 women with mean age of 68.3 ± 11 years) concluded the study follow-up. Horizontal changes demonstrated gain of 1.06 mm at Timpl, 0.94 mm at Tdef, 0.92 mm at T1 and 0.97 mm at T5 compared to T0. Vertical changes demonstrated gain of 0.84 mm at Timpl, 0.11 mm at Tdef, 0.29 mm at T1 and 0.59 mm at T5 compared to T0. The analysis of variance showed a significant better performance of thick biotype in soft tissue horizontal width (P = .022). No statistical differences were noticed for vertical width (P = .111)., Conclusions: The use of a conical abutment together with the OA-OT approach allowed longitudinal stable soft tissue dimensions., (© 2018 Wiley Periodicals, Inc.)

The aim of this randomized, match-paired, triple-blinded, controlled clinical trial was to assess the 6-year radiographic changes around customized platform-switched abutments placed according to the one abutment-one time concept, with and without plasma of argon cleaning treatment. A total of 20 periodontally healthy patients received one maxillary implant between the premolars. Immediately before stage 2 surgery and abutment connection, patients were randomly assigned to the control (cleaning protocol by steam) or test group (plasma of argon treatment). Periapical standardized digital radiographs were taken at the time of crown connection (T₀) and at 12 (T₁), 24 (T₂), 48 (T₄), 60 (T₅), and 72 months (T₆) after the final restoration delivery. Primary outcome measures were the success rates of the implants and prostheses and the occurrence of any technical and biologic complications during the follow-up period. Secondary outcome measures were peri-implant marginal bone level changes, bleeding on probing, and plaque score. Two patients (one in test and one in control group) dropped out at the last follow-up. Neither implant nor prosthetic complications were detected in the analyzed patients of both groups during the 6-year follow-up examinations. Radiographic analysis revealed a statistically significant higher mean bone loss in the control group than in the test group at T₂ (0.4 ± 0.28 mm; P = .018), T₄ (0.52 ± 0.63 mm; P = .037), T₅ (0.61 ± 0.70 mm; P = .038), and T₆ (0.71 ± 0.66 mm; P = .011), but not at T₁ (P = .131). From baseline to the 6-year follow-up, intragroup comparisons showed an absence of statistically significant difference in the test group (P = .08). Conversely, significant differences were found in the control group (P = .01). All implants demonstrated successful periodontal parameters, with no significant differences between groups. The results of this present study indicate that contaminant and bacterial removal from abutments in two-stage implants using plasma of argon could represent a positive strategy to minimize peri-implant bone resorption and longitudinally stabilize esthetic outcomes.

Diabetes is a metabolic disorder caused by insulin resistance and/or deficiency and impairs bone quality and bone healing due to altered gene expression, reduced vascularization, and prolonged inflammation. No effective treatments for diabetic bone healing are currently available, and most existing treatments do not directly address the diabetic complications that impair bone healing. We recently demonstrated that sustained and localized delivery of salicylic acid (SA) via an SA-based polymer provides a low-cost approach to enhance diabetic bone regeneration. Herein, we report mechanistic studies that delve into the biological action and local pharmacokinetics of SA-releasing polymers shown to enhance diabetic bone regeneration. The results suggest that low SA concentrations were locally maintained at the bone defect site for more than 1 month. As a result of the sustained SA release, a significantly reduced inflammation was observed in diabetic animals, which in turn, yielded reduced osteoclast density and activity, as well as increased osteoblastogenesis. Based upon these results, localized and sustained SA delivery from the SA-based polymer effectively improved bone regeneration in diabetic animals by affecting both osteoclasts and osteoblasts, thereby providing a positive basis for clinical treatments. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2595-2603, 2016., (© 2016 Wiley Periodicals, Inc.)

The use of immediate placement and loading protocols in implant dentistry has increased during the past several years. However, limited information related to the response of the osseous architecture has been reported. The purpose of this study was to evaluate the fate of the buccal alveolar plate with cone beam computed tomography (CBCT) following lingualized placement of implants into fresh extraction sockets using a flapless surgical approach and immediate nonocclusal loading. A total of 14 patients who required extraction of a single maxillary incisor were selected for this study. CBCT was performed preextraction, at the time of implant placement, and 6 months following implant surgery. The results of this study indicate that resorption of the buccal alveolar plate was not significant. It was therefore concluded that with strict patient selection and appropriate technique, predictable healing can be achieved with lingualized implant placement into fresh extraction sockets and immediate loading.

Aim: The aim of this study was to evaluate soft and hard tissue alterations around implants placed in healed, sloped ridge sites., Materials and Methods: In this prospective multi-center study, 65 patients between 20 and 74 years of age and with a need for a single tooth replacement were included. All patients presented with a recipient implant site demonstrating a lingual-buccal bone height discrepancy of 2.0-5.0 mm and with a neighboring tooth on its mesial aspect. Implant placement (OsseoSpeed™ Profile implants; Astra Tech AB, Mölndal, Sweden) was performed using a non-submerged installation procedure. The implants were placed in such a way that the sloped part of the device was located at the buccal and most apical position of the osteotomy preparation. As the buccal rim of the implant was positioned at the crestal bone level, the lingual rim became situated either below or at the level of the lingual bone crest. Clinical assessments of bone levels at the buccal and lingual aspects of the implant were carried out immediately after implant installation and at a surgical re-entry procedure performed 16 weeks later. Crowns were placed at 21 weeks after implant placement. Radiographs were obtained immediately after implant placement, at 16 and 21 weeks and at the 1-year re-examination. Clinical assessment of probing pocket depth and clinical attachment levels were carried out at 21 weeks and at 1 year of follow-up., Results: The alterations of the bone levels that occurred between implant placement and the 16-week surgical re-entry were -0.02 mm (lingual) and -0.30 mm (buccal). The average change in interproximal bone levels between implant placement and the 1-year re-examination was 0.54 mm. Clinical attachment level changes between the 21 week and the 1-year examinations varied between 0.1 mm gain and 0.1 mm loss., Conclusion: Implant placement in an alveolar ridge with a sloped marginal configuration resulted in minor remodeling with preserved discrepancies between buccal and lingual bone levels., (© 2012 John Wiley & Sons A/S.)

The dental community's interest in early loading of endosseous implants provides the stimulation to test the ability of modified implant designs as well as surgical techniques to enhance the establishment and maintenance of implant stability. This preclinical canine study examined this potential by implementing several implant design and surgical technique modifications to an existing tapered implant system. The design and site preparation changes were intended to induce different compression states on the native bone, hypothetically affecting the primary stability and the rate and extent of osseointegration. The outcomes of the modifications were evaluated using resonance frequency analysis, radiographic analysis, light microscopy, and histomorphometric measurements. Three compression scenarios were tested, with each demonstrating excellent clinical, radiographic, and histologic results throughout the evaluation period. However, the scenario intended to induce a moderate degree of compression provided the best overall results, supporting its use in early loading protocols.

Background: The question of the importance of keratinized mucosa around dental implants for the prevention of peri-implant disease could not be answered in the relevant literature so far., Objective: To investigate the influence of peri-implant keratinized mucosa on long-term peri-implant soft-tissue health and stability over a period of 5 years., Material and Methods: A total of 386 mandibular dental implants were placed in 73 completely edentulous patients, and subsequently restored with fixed full-arch prostheses. At prosthesis delivery (baseline) and after 3, 6, 12, 18, 24, 36, 48 and 60 months, modified plaque index (mPlI), modified sulcus bleeding index (mBI), distance between implant shoulder and mucosal margin (DIM) and width of peri-implant keratinized mucosa (KM) were recorded. Statistical analysis included multivariate logistic regression, multivariate ordinal logistic regression, generalized estimating equations and Bonferroni's correction., Results: Fifty-eight patients with 307 implants completed the 5-year study. Statistically significantly higher plaque accumulation on lingual sites (mean mPlI 0.67, SD 0.85), bleeding tendencies on lingual sites (mean mBI 0.22, SD 0.53) and larger soft-tissue recession on buccal sites (mean DIM -0.69 mm, SD 1.11 mm) were found when the width of KM was <2 mm, compared to sites with>or=2 mm of KM (mean mPlI 0.40, SD 0.68, P=0.001; mean mBI 0.13, SD 0.41, P<0.01; mean DIM -0.08 mm, SD 0.86 mm, P<0.001). The width of keratinized mucosa had no effect on bleeding tendency or plaque accumulation on buccal sites (P>0.05)., Conclusion: In patients exercising good oral hygiene and receiving regular implant maintenance therapy, implants with a reduced width of <2 mm of peri-implant keratinized mucosa were more prone to lingual plaque accumulation and bleeding as well as buccal soft-tissue recession over a period of 5 years.

Untreated periodontal disease leads to tooth loss through destruction of the attachment apparatus and tooth-supporting structures. The goals of periodontal therapy include not only the arrest of periodontal disease progression,but also the regeneration of structures lost to disease where appropriate. Conventional surgical approaches (e.g., flap debridement) continue to offer time-tested and reliable methods to access root surfaces,reduce periodontal pockets, and attain improved periodontal form/architecture. However, these techniques offer only limited potential towards recovering tissues destroyed during earlier disease phases. Recently, surgical procedures aimed at greater and more predictable regeneration of periodontal tissues and functional attachment close to their original level have been developed, analyzed, and employed in clinical practice. This paper provides a review of the current understanding of the mechanisms, cells, and factors required for regeneration of the periodontium and of procedures used to restore periodontal tissues around natural teeth. Targeted audiences for this paper are periodontists and/or researchers with an interest in improving the predictability of regenerative procedures. This paper replaces the version published in 1993.

This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. It is intended to provide information for the dental profession and other interested parties. The purpose of this paper is to provide a general overview of oral reconstructive and corrective procedures used in periodontal therapy. It is not intended to be a comprehensive review of this subject.

Background: Bleeding indices are used as a screen for periodontal disease activity, a measure of disease prevalence, and a measure of effectiveness in clinical trials. Bleeding on probing (BOP) is widely interpreted as a sign of disease activity whereas its absence is interpreted as both a sign and predictor of health. Aspirin use has become increasingly common in the prevention of cerebrovascular and cardiovascular diseases. Because of its anti-platelet activity, aspirin is a non-disease factor that has the potential to affect the appearance of BOP. The hypothesis being tested is that short-term aspirin use in doses of 81 mg and 325 mg will increase the number of bleeding sites in a population with gingivitis., Methods: Fifty-four subjects were screened initially, those subjects with 20% to 30% whole mouth BOP were randomly assigned to one of three arms: placebo group, 81 mg aspirin group, or 325 mg aspirin group. Before and after exposure to the respective regimens, clinical parameters were measured on all the teeth: the plaque index was recorded at four sites per tooth, and probing depth and BOP were evaluated at six sites per tooth using an automated pressure-sensitive probe., Results: The data obtained in this clinical trial were analyzed utilizing a linear regression analysis to control for confounding variables. The primary measure of interest was BOP in patients clinically demonstrating naturally occurring gingivitis. The results of this study indicate that while controlling for age, gender, and plaque, "low dose" 81 mg and "regular dose" 325 mg of aspirin demonstrated a statistically significant 5.30 (P = 0.001) and 4.13 (P = 0.010) increase from baseline, respectively, in percent BOP., Conclusion: Failure to consider the effects of aspirin on BOP could impair proper diagnosis and treatment planning for clinicians and introduce a significant confounding variable in research situations.

Background: The absence or presence of bleeding on probing (BOP) is a sign of periodontal health or disease, but the presence of BOP is not an accurate predictor of disease progression. Aspirin is increasingly used in the prevention of cerebrovascular and cardiovascular diseases and is a non-disease factor that may modify bleeding indices given its antithrombolytic activity. The purpose of this double-blind placebo-controlled randomized clinical trial was to study the effect of short-term daily aspirin ingestion on the clinical parameter BOP., Methods: A total of 46 periodontally healthy subjects were included in this study: 16 received placebo, 15 low-dose aspirin (81 mg), and 15 regular dose (325 mg) aspirin. Clinical parameters assessed included plaque index, periodontal probing depth, and BOP using an automated pressure-sensitive probe. Measurements were recorded before and after 7-day exposure to placebo and aspirin regimens., Results: A statistically significant difference in BOP was found in patients with > or = 20% of bleeding sites during the visit prior to placebo or aspirin exposure (n = 11). The group treated with 325 mg aspirin exhibited a moderate yet statistically significant increase in BOP (12.4%) compared to the placebo group (there was no significant difference between the 81 mg aspirin group and placebo). The tendency to bleed was not statistically significant in the group which exhibited <20% (n = 35) of bleeding sites during the visit prior to exposure., Conclusion: Aspirin intake of 325 mg daily for 7 days moderately increased the appearance of bleeding on probing in a population that had > or = 20% BOP sites.

Background: Periodontitis is an inflammatory condition of tooth-supporting tissues that is usually treated by mechanical removal of plaque and microorganisms that adhere to teeth. This treatment, known as scaling and root planing, is not optimally effective. Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes such as probing depth reduction. This article reports on the efficacy and safety of locally administered microencapsulated minocycline., Methods: Seven hundred forty-eight (748) patients with moderate to advanced periodontitis were enrolled in a multi-center trial and randomized to 1 of 3 treatment arms: 1) scaling and root planing (SRP) alone; 2) SRP plus vehicle; or 3) SRP plus minocycline microspheres. The primary outcome measure was probing depth reduction at 9 months. Clinical assessments were performed at baseline and 1, 3, 6, and 9 months., Results: Minocycline microspheres plus scaling and root planing provided substantially more probing depth reduction than either SRP alone or SRP plus vehicle. The difference reached statistical significance after the first month and was maintained throughout the trial. The improved outcome was observed to be independent of patients' smoking status, age, gender, or baseline disease level. There was no difference in the incidence of adverse effects among treatment groups., Conclusions: Scaling and root planing plus minocycline microspheres is more effective than scaling and root planing alone in reducing probing depths in periodontitis patients.

Although dental implants have become an effective treatment modality for the replacement of missing teeth, their predictability relies on successful osseointegration during the healing period. The purpose of this pilot study was to evaluate the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on early bone formation within the perforations of dental implants in beagle dogs. Histologic sections were evaluated for the extent of new bone formation within a 1-mm diameter of through-and-through perforations. Data indicated that significantly more bone formation occurred with rhBMP-2-treated sites within the implant perforation (P < 0.01) compared to sites treated with the vehicle alone. This pilot study indicates that rhBMP-2 increases the rate and extent of bone formation in combination with dental implants.

Background: Aspartate aminotransferase (AST), an enzyme released from necrotic cells, has been identified in gingival crevicular fluid (GCF), and elevated levels are associated with periodontal tissue destruction. The aim of this study was to examine the relationship between elevated GCF levels of AST and periodontal disease progression., Methods: Over a 12-month period, 8 to 10 interproximal sites in 41 periodontitis subjects (PS) and 15 healthy subjects (HS) were monitored. Clinical measurements included relative attachment level (RAL), probing depth, and bleeding on probing (BOP). Semiquantitative levels of GCF AST (< 800 microIU, > or = 800 microIU, and > or = 1,200 microIU) were determined using a chairside assay. At the 6- and 12-month visits, scaling and root planing and prophylaxis were performed in the PS and HS, respectively. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated for 2 diagnostic criteria (AST > or = 800 microIU, AST > or = 1,200 microIU) utilizing 4 thresholds of disease progression as determined by 2 methods (absolute change in relative attachment level and cumulative sum [CUSUM])., Results: The percentage of sites exhibiting AST > or = 800 microIU, AST > or = 1,200 microIU, and BOP in the PS was significantly (P<0.02) lower at 6 and 12 months compared to baseline. The use of crevicular AST activity to monitor periodontal disease progression was associated with many false-positive results. Overall, low specificities, PPV, and odds ratios were demonstrated by the assay when using 2 diagnostic criteria and 4 thresholds of disease progression. The high NPV suggest that a negative AST test result was indicative of a periodontally stable site., Conclusions: These results demonstrate that elevated levels of AST were present at sites that did not subsequently exhibit disease progression. The high prevalence of AST-positive sites due to gingival inflammation diminished the test's ability to discriminate between progressive and stable, but inflamed, sites.

The purpose of this study was to estimate the quantity of dental implant literature available on MEDLINE for evidence-based clinical decision-making and to identify its location. A search strategy based on Medical Subject Headings for dental implants was developed to examine MEDLINE using the Ovid Web Gateway search engine. Sensitive and specific methodologic search filters identified 4 categories of information: etiology, diagnosis, therapy, and prognosis. The results were then subdivided by year to identify trends and sorted to identify the sources of publications. The searches identified 4,655 articles published in English between 1989 and 1999 on human dental implants on MEDLINE. The mean number of articles (+/- SD) per year ranged from 15 +/- 11 for specific searches to 107 +/- 50 for sensitive searches. The number of articles increased by 14% to 43% each year for the sensitive search. When subdivided by clinical category, the mean numbers of articles per year for sensitive and specific searches were, respectively: diagnosis 12 +/- 7.5 and 1.5 +/- 1.6, etiology 58 +/- 33 and 1.9 +/- 2.5, therapy 23 +/- 15 and 0.3 +/- 0.5, and prognosis 67 +/- 33 and 12 +/- 8.3. Four dental journals account for approximately half of these publications. These results provide 6 key central findings: (1) there appears to be a substantial literature of clinically relevant information on implants upon which to base clinical decisions; (2) the implant literature is significantly biased toward articles addressing prognosis; (3) to stay current, one would need to read between 1 and 2 articles per week 52 weeks per year, and this number increases significantly each year; (4) approximately 50% of the articles were published in 4 journals, whereas the remainder reside in approximately 97 other journals, making it difficult to stay current; (5) these trends reaffirm the need for lifelong learning; (6) these trends also suggest the need for computer-based clinical knowledge systems.

This study examined the healing of intrabony defects around 5 teeth treated with bioactive glass ceramic (PerioGlas). Healing was evaluated by clinical measurements, radiographic observation, and histologic analysis. The protocol included a presurgical phase of scaling and root planing therapy, with measurements obtained immediately prior to the surgical procedures and after 6 months of healing. Following therapy there was a mean of 2.7 mm of probing depth reduction, 2.2 mm of clinical attachment gain, and 0.5 mm of recession. The histologic analysis revealed healing by a long junctional epithelium with minimal new connective tissue attachment to the teeth, except in one case where the intrabony region demonstrated new cementum formation and new connective tissue attachment. Graft particles were found to be biocompatible, as evidenced by being embedded in a stroma of dense connective tissue with minimal inflammatory infiltrate. There was minimal new bone formation limited to the most apical borders of the defects. No signs of periodontal regeneration as defined by new cementum, periodontal ligament, and bone formation on a previously diseased root surface were observed. Although the clinical results are encouraging and radiographs evidenced radiopacities within the defects, histologic analysis revealed that as a periodontal grafting material, bioactive glass ceramic has only limited regenerative properties.

The efficacious placement of dental implants in diabetic patients remains controversial. Definitive guidelines with objective criteria, including the type of diabetes, age of onset, and level of long-term control, have not been determined. In addition, few relevant literature citations assess the survival rate of implants in diabetic patients. Therefore, it is the purpose of this study to assess the success and survival rates of dental implants in diabetic patients. In this retrospective analysis, 215 implants placed in 40 patients at 2 clinical centers were evaluated. Chart reviews and interviews provided medical and implant data. From the analysis, 31 failures occurred, for an overall success rate of 85.6%. Of these failures, 24 occurred within the first year of functional loading. The mean time of functional load was 4.05 +/- 2.6 years. When the success rate was analyzed by implant location, success rates for the maxilla and mandible were 85.5% and 85.7%, respectively. For the anterior and posterior regions, success rates were 83.5% and 85.6%, respectively. The lifetable analysis revealed a cumulative success rate of 85.7% after 6.5 years of function. Based on the data, the survival rate of dental implants in controlled diabetic patients is lower than that documented for the general population, but there is still a reasonable success rate. The increase in failure rate occurs during the first year following prosthetic loading.

At present, there are no diagnostic tools that permit early detection of peri-implantitis. The purpose of this cross-sectional study was to evaluate the correlation of aspartate aminotransferase (AST) levels with traditional periodontal clinical parameters around dental implants, since AST has been associated with destruction of cardiac, hepatic, and periodontal tissues. Twenty healthy volunteers with 59 implants were recruited from the Harvard School of Dental Medicine clinics. Clinical parameters evaluated included: AST level, probing depth (mm), Gingival Index (0, 1, 2, or 3), and bleeding on probing (0 or 1). Utilizing the site or implant as the unit of measure, the authors found a statistically significant association of increased AST activity with positive bleeding on probing, increased probing depth, and increased Gingival Index. No statistical correlations were found between clinical indices and increased AST levels when the results were examined on an individual patient basis. This cross-sectional study was able to demonstrate a statistical correlation between diseased clinical periodontal parameters and elevated AST levels.

Osseointegrated implants as anchors for various prosthetic reconstructions have become a predictable treatment alternative. It was expected that implants required submucosal placement during the healing period for successful tissue integration. However, it has been demonstrated that healing and long-term health of implants could be achieved with equal predictability in a 1-stage, non-submerged approach. This prospective 5-year study not only calculates implant success by life table analysis, but also evaluates the correlation between observed bone level changes with clinical parameters as measured by suppuration, plaque indices, bleeding indices, probing depth, attachment level and mobility. A total of 112 ITI dental implants were inserted in different areas of the jaws. Clinical and radiographic parameters were evaluated annually for 5 years, whereas a portion of the study group for which 6-year evaluations were available were included in the life-table analysis. The overall success rate after 5 years in service was 99.1%, while after 6 years it was reduced to 95.5% due to the fracture of 3 implants in 1 patient. The mean crestal bone loss experienced during the first year was 0.6 mm followed by an annual yearly loss of approximately 0.05 mm. No significant differences could be found between the amount of bone loss measured at each of the yearly follow-up visits. This suggests that statistically the followed implants did not show any radiographically measurable bone loss following the initial period of bone loss associated with implant placement and osseointegration. Low levels of correlation between the individual and cumulative clinical parameters with radiographically measured bone loss suggests that these parameters are of limited clinical value in assessing and predicting future peri-implant bone loss.

Statement of Problem: Immediate loading of implants may be a predictable treatment alternative when cross-arch stabilization with a fixed provisional is observed., Purpose: This study investigated the effect of immediate masticatory loading on the stability of single-standing dental implants with 4 different surfaces., Material and Methods: A total of 40 solid screw implants (diameter 3.3 mm, length 8 mm) were placed in the mandibles of 4 beagle dogs. Test groups included 3 hydroxyapatite (HA) coatings of titanium plasma-sprayed (TPS) implants. Implants with TPS alone served as control. Gold crowns were inserted 2 days after implant placement and the dogs were immediately put on a hard food diet. Implants were followed for 6 months after loading. Clinical and radiographic assessments of implants were performed at time of crown insertion (baseline) and after 1, 3, and 6 months of loading. The Periotest instrument was used for mobility measurements and radiographs were obtained for evaluation of peri-implant radiolucency and measurement of crestal bone changes., Results: Of 40 implants, 39 displayed no discernible mobility, corresponding to successful clinical function. Peri-implant radiolucencies were absent for all but the 1 mobile implant. The reduction in crestal bone levels adjacent to the implants between baseline and 6 months was statistically significant (P <.0001). No statistically significant differences in crestal bone level changes over time were found between the various coatings demonstrating the absence of a treatment effect initiated by the surface coatings., Conclusion: In this study in beagle dogs, immediate masticatory loading of single-standing dental implants did not jeopardize tissue integration, provided the implants had excellent primary stability.

As patients become edentulous, dental implants have been one treatment alternative. Although studies indicate that dental implants inserted in healthy patients have been successful, their placement in the diabetic patient remains controversial. The purpose of this study utilizing histometric parameters compares the course of osseous healing around endosseous implants in normal non-diabetic and insulin controlled diabetic rats. Diabetes was induced by a single intraperitoneal injection of streptozotocin. Blood glucose was monitored by the glucose-oxidase method and controlled with daily insulin injections. Sterile custom fabricated commercially pure solid cylinder titanium implants, with a titanium plasma-sprayed surface were placed in the femora of each animal. The results indicate that insulin therapy was able to upregulate the formation of bone around implants inserted in the streptozotocin-induced diabetic rat model. However, histometric parameters utilized indicated that although the total quantity of bone formation was greater in the insulin controlled group, there was significantly less bone-to-implant contact in the insulin controlled diabetic group as compared to normal non-diabetic controls.

Wound healing has been shown to be altered in diabetes mellitus. The aim of this study was to identify the effects of streptozotocin-induced diabetes on osseointegration. Diabetes was induced in 40-day-old rats by intraperitoneal injection of 70 mg per kg streptozotocin. At 14 days postinjection, implants were placed in the femora of 10 diabetic and 10 age-matched normal rats. Animals were sacrificed at 28 and 56 days following implantation. Histometric results indicated that the quantity of bone formation was similar for diabetic and control animals (P > .05). However, less bone-implant contact was observed for diabetic compared to control animals at both 28 and 56 days (P < .0001). This study demonstrates that the process of osseointegration is affected by streptozotocin-induced diabetes.

Detection of periodontal disease progression occurs when a predetermined threshold of attachment loss is exceeded during longitudinal monitoring. The incidence of disease progression in a population may be dependent on the method and threshold utilized to identify significant changes in attachment level measurements. The aim of this study was to investigate the effect of utilizing different methods and thresholds on the incidence of disease progression in an untreated periodontitis population. The relationship between baseline clinical parameters and disease progression was also examined. A total of 411 interproximal sites in 46 individuals were monitored monthly over a 6-month period. Disease progression was determined by the cumulative sum (CUSUM) method and by the absolute change in relative attachment level between months 0 and 6 utilizing 3 different thresholds for attachment level change (0.58 mm, 1.16 mm, and 1.74 mm) based upon examiner repeatability using an automated probe. Utilizing the CUSUM method, 49 of 411 sites (11.9%) demonstrated attachment loss over the 6-month observation period. When attachment level changes > or = 0.58 mm, > or = 1.16 mm, and > or = 1.74 mm were used to identify disease progression, the percentage of sites exhibiting deterioration were 19.5%, 8.8%, and 2.9%, respectively. These results demonstrate that the apparent incidence of disease progression was dependent on the method and threshold utilized to detect progressive sites. When utilizing the CUSUM and 0.58 mm thresholds a significant (P < 0.05), but weak relationship (r = -0.26) was observed between baseline relative attachment level measurements and sites exhibiting disease progression. This finding suggests that sites with significant but relatively less attachment loss may be more likely to experience further breakdown compared to sites with a history of greater periodontal destruction.