Journal Club- October 2024
Does Periodontitis Increase the Risk for Future Cardiovascular Events? Long-Term Follow-Up of the PAROKRANK Study. Norhammar A, Näsman P, Buhlin K, de Faire U, Ferrannini G, Gustafsson A, Kjellström B, Kvist T, Jäghagen EL, Lindahl B, Nygren Å, Näslund U, Svenungsson E, Klinge B, Rydén L; PAROKRANK Study Group. J Clin Periodontol. 2024 Sep 11. doi: 10.1111/jcpe.14064. Epub ahead of print. PMID: 39261983.
The impact of collagen membrane fixation protocols on volume stability in horizontal ridge augmentation in the aesthetic area: A retrospective study. Zhang S, Wang Y, Wang Q, Li J, Wang F, Li Z, Cui J, Zhang J Clin Implant Dent Relat Res. 2024 Sep 30. doi: 10.1111/cid.13393. Epub ahead of print. PMID: 39350569.
Change in clinical parameters after subgingival instrumentation for the treatment of periodontitis and timing of periodontal re-evaluation: A systematic review and meta-analysis. Holtzman, P., et al. Journal of clinical periodontology, 10.1111/jcpe.13985. 5 May. 2024, doi:10.1111/jcpe.13985.
Assessment of bone defect morphology for the adjunctive use of bone grafting combined with enamel matrix derivative: A 3-year cohort study. Matsuura, Takanori et al. Journal of Periodontology vol. 95,9 (2024): 809-820. doi:10.1002/JPER.23-0538.
A multi-centre randomized controlled trial comparing connective tissue graft with collagen matrix to increase soft tissue thickness at the buccal aspect of single implants: 3-Year results. Surdiacourt L, Christiaens V, De Bruyckere T, De Buyser S, Eghbali A, Vervaeke S, Younes F, Cosyn J. J Clin Periodontol. 2024 Mar 14. doi: 10.1111/jcpe.13975. Epub ahead of print. PMID: 38485651.
Ten-Year Follow-Up of Oral Implants in Bone With Limited Bucco-Oral Dimensions: A Prospective Case Series. Alami M, Ntovas N, Penne G, Teughels W, Quirynen M, Castro A, Temmerman A. J Clin Periodontol. 2024 Sep 25. doi: 10.1111/jcpe.14063. Epub ahead of print. PMID: 39322233.
Histological and immunohistochemical soft-tissue response to cylindrical and concave abutments: Multicenter randomized clinical trial. Camacho-Alonso F, Bernabeu-Mira JC, Sánchez J, et al. J Periodontol. 2024; 1-11. https://doi.org/10.1002/JPER.24-0250.
Effect of suturing in root coverage via coronally advanced flaps: A systematic review. Ariceta A, Chambrone L, Stuhr S, Couso-Queiruga E. Clin Adv Periodontics. 2024; 1-12. https://doi.org/10.1002/cap.10312.
Preloading peri-implant crestal bone loss: A retrospective study of incidence and related factors. Vilela N, Gurgel BCV, Bruzos C, Duarte WR, da Silva HDP, Pannuti CM, Duarte PM. J Periodontol. 2024 Jun 26. doi: 10.1002/JPER.24-0028. Epub ahead of print. PMID: 38923568.
Alveolar ridge preservation versus early implant placement in single non-molar sites: A systematic review and meta-analysis. Atieh MA, Shah M, Hakam A, AlAli F, Aboushakra I, Alsabeeha NHM. Clin Oral Implants Res. 2024 Jun 8. doi: 10.1111/clr.14314. Epub ahead of print. PMID: 38850092.
Effects of hard- and/or soft-tissue grafting with early implant placement: Histomorphometric outcomes of an exploratory study in canines. Lim, Hyun-Chang, et al. Clin Oral Impl Res. 2024;00:1–11. DOI: 10.1111/clr.14320.
Enhanced periodontal tissue healing via vascular endothelial growth factor expression following low-level erbium-doped: yttrium, aluminum, and garnet laser irradiation: In vitro and in vivo studies. Takemura S, Mizutani K, Mikami R, Nakagawa K, Hakariya M, Sakaniwa E, Saito N, Kominato H, Kido D, Takeda K, Aoki A, Iwata T. J Periodontol. 2024 Sep;95(9):853-866. doi: 10.1002/JPER.23-0458. Epub 2023 Nov 27. PMID: 38009257.
Maxillary sinus membrane perforation rate utilizing osseodensification-mediated transcrestal sinus floor elevation: A multicenter clinical study. Mazor Z, Gaspar J, Silva R, Pohl S, Gandhi Y, Huwais S, Bergamo ETP, Bonfante EA, Neiva R. Clin Implant Dent Relat Res. 2024 Aug 26. doi: 10.1111/cid.13368. Epub ahead of print. PMID: 39187444.
The efficacy of reconstructive therapy in the surgical management of peri-implantitis: A 3-year follow-up of a randomized clinical trial. Renvert, S., Giovannoli, J.-L., & Rinke, S. (2024). Journal of Clinical Periodontology, 51(10), 1267–1276. https://doi.org/10.1111/jcpe.14049.
Clinical efficacy of two vertical soft tissue augmentation techniques for peri-implant crestal bone level stability:A randomized clinical trial Puisys A., Vindasiute-Narbute E., Razukevicius D., Akhondi S., Gallucci G., Pedrinaci I. Clin Implant Dent Relat Res. 2024 Aug 11. doi: 10.1111/cid.13365. Online ahead of print.
Influence of repeated implant-abutment manipulation on the prevalence of peri-implant diseases in complete arch restorations. A retrospective analysis. Krebs M, Greilich L, Weigl P, Hess P, Dahmer I, Begić A. Clin Implant Dent Relat Res. 2024; 1-10. doi:10.1111/cid.13381.
Topic: periodontitis and cardiovascular
Authors: Norhammar A, Näsman P, Buhlin K, de Faire U, Ferrannini G, Gustafsson A, Kjellström B, Kvist T, Jäghagen EL, Lindahl B, Nygren Å, Näslund U, Svenungsson E, Klinge B, Rydén L; PAROKRANK Study Group.
Title: Does Periodontitis Increase the Risk for Future Cardiovascular Events? Long-Term Follow-Up of the PAROKRANK Study.
Source: J Clin Periodontol. 2024 Sep 11
DOI: 10.1111/jcpe.14064
Reviewer: Amber Kreko
Type: clinical study
Keywords: cardiovascular disease, long-term follow up, myocardial infarction, periodontitis, prognosis
Purpose: A previous study was done that found an association between periodontitis and the first myocardial infarction. This follow up study was done to test whether those with periodontitis have an increased risk of cardiovascular events.
Material and methods: The study included 1587 participants. Participants were divided into those with a first MI and controls with no cardiovascular events. Participants had dental examinations with panoramic radiographs and were grouped into healthy, mild to moderate periodontitis, and severe periodontitis. They were followed for an average of 9.9 years and a composite cardiovascular event was investigated.
Results: There were 174 (19%) cardiovascular events in the 602 participants with periodontitis with a mortality of 10% and 187 (29%) events in the 985 periodontally healthy participants with a 5% mortality. After adjusting for age, diabetes, and smoking, participants with periodontitis had an increased likelihood for a future event and a hazard risk of 1.26.
Conclusions: Those with periodontitis had more cardiovascular events supporting a direct relation between periodontitis and cardiovascular risk.
Topic: horizontal ridge augmentation
Authors: A retrospective study. Zhang S, Wang Y, Wang Q, Li J, Wang F, Li Z, Cui J, Zhang
Title: The impact of collagen membrane fixation protocols on volume stability in horizontal ridge augmentation in the aesthetic area: A retrospective study
Source: J Clin Implant Dent Relat Res. 2024 Sep 30
DOI: 10.1111/cid.13393
Reviewer: Amber Kreko
Type: clinical study
Keywords: absorbable sutures, aesthetic area, guided bone regeneration, horizontal ridge augmentation, resorbable collagen membrane, titanium pins, volume stability
Purpose: This retrospective study evaluated volume stability of different membrane fixation protocols in horizontal ridge augmentation in the aesthetic area. Membrane without fixation, fixation with absorbable sutures, fixation with titanium pins, and fixation with both pins and absorbable sutures were evaluated.
Material and methods: This study included 48 patients with a total of 65 implants in the aesthetic zone. Implants (Straumann) were placed and GBR procedures were done when a labial dehiscence of less than 50% of the implant length was present. Cortical perforations were done and autogenous bone chips were placed covering the exposed implant threads. Bio-Oss mixed with autologous blood was placed in defect. A collagen membrane (Bio-Gide) was used to cover the bone grafts. Patients were divided into 4 groups: Group 1 – membrane without fixation, Group 2 – membrane fixed with 4-0 absorbable sutures using horizontal internal mattress sutures, Group 3 – membrane fixed with several titanium pins, Group 4 – membrane fixed with pins and absorbable sutures. Primary closure was achieved. CBCTs were taken immediately after surgery and 6 months post-surgery. Measurements were taken at different heights on the implants with H0 at the implant shoulder and H5 at 5mm apical to the implant shoulder.
Results: Horizontal bone thickness was less after 6 months of bone healing regardless of the collagen membrane fixation used. There was higher bone loss in group 1 than in the other groups showing that membrane fixation reduces horizontal bone loss. It was found that group 4 had less bone loss than group 2 and 3 demonstrating that a combination of pins and sutures could have higher volume stability.
Conclusions: GBR with membrane fixation demonstrated superior volume stability. No differences were found when comparing pins to sutures. However, when used it in combination there was higher volume stability.
Topic: Periodontal Re-evaluation
Authors: Holtzman, P, et al.
Title: Change in clinical parameters after subgingival instrumentation for the treatment of periodontitis and timing of periodontal re-evaluation: A systematic review and meta-analysis
Source: Journal of Clinical Periodontology, 10.1111/jcpe.13985. 5 May. 2024
DOI:10.1111/jcpe.13985
Type: Review
Reviewer: Tam Vu
Keywords: probing depth, clinical attachment level, subgingival instrumentation, re-evaluation
Purpose: To assess clinical parameters after subgingival instrumentation when treating periodontitis and determine the best timing for periodontal re-evaluation in periodontitis patients treated with subgingival instrumentation.
Material and methods: An electronic database search was done for articles up to December 1, 2022. The review focused on patients with periodontitis that needed mechanical subgingival instrumentation and compared re-evaluation after 1-2 months and after 3-4 or 5-6 months from treatment. The primary outcome measured was probing depth (PD), and the secondary outcome measured were clinical attachment level (CAL), change in bleeding upon probing (BOP), change in gingival index (GI), and change in pocket closure (%).
Results: Twenty-nine studies were included in this review. Six hundred thirty-three patients underwent treatment: step 1 (supragingival plaque control) and step 2 (subgingival instrumentation). Non-surgical mechanical instrumentation included both quadrant-wise and full-mouth and also power-driven and manual instrumentation.
The mean PD reduction for all pockets was 1.16 mm in the first 1-2 months after treatment, and 0.25 additional reduction between 1-2 and 3-4 months. The mean PD reduction within the first 3-4 months was 1.00 mm and additional 0.35 mm at 5-6 months. For initial shallow sites, the first 1-2 months had mean PD reduction of 1.89 mm and additional 0.36 mm at 3-4 months. For initial deep sites (≥6 mm), the mean PD reduction at 1-2 months was 3.4 mm, with additional 0.97 mm reduction at 3-4 months.
The mean CAL gain after 1-2 months was 0.94 mm, plus 0.26 mm after 3-4 months. For initial shallow pockets, mean gain of 1.45 mm after 1-2 months, and 0.23 mm after 3-4 months; and deep pockets saw mean gain of 2.44 mm after 1-2 months, plus 0.67 mm after 3-4 months.
The mean BOP reduction was 34.38% in all initial PD values at 1-2 months, with additional 3.61% at 3-4 months. The mean GI reduction was 0.91 at 1- 2 months, and additional 0.16 at 3-4 months.
Conclusion: The change in clinical parameters after subgingival instrumentation for treating periodontitis shows that majority of PD reduction for all sites take place within the first 2 months. There is also clinically significant PD reduction at 3-4 months after treatment that can decrease the number of sites needing additional treatment. Waiting 3-4 months or longer before re-evaluating for surgery may show improved clinical parameters, but better designed studies needed to confirm or reject this notion.
Topic: Enamel matrix derivate
Authors: Matsuura, Takanori et al
Title: Assessment of bone defect morphology for the adjunctive use of bone grafting combined with enamel matrix derivative: A 3-year cohort study
Source: Journal of periodontology vol. 95,9 (2024): 809-820
DOI:10.1002/JPER.23-0538
Type: Clinical
Reviewer: Tam Vu
Keywords: Enamel matrix derivate, autogenous, autologous bone graft, defect angle, intrabony defect
Purpose: to evaluate the features of intrabony defects, like defect angle and number of bony walls, in terms of additional benefits of enamel matrix derivative (EMD) with or without bone grafting.
Material and methods: Patients included in this study had probing depth (PD) ≥4 mm after initial therapy and presence of radiographic interproximal intrabony defects ≥3 mm. Clinical and radiographic examinations were performed and assessed PD, clinical attachment level (CAL), and radiographic bone defect depth (RBD) and defect angle (DA). The surgical procedure carried out through the minimally invasive surgical technique (MIST) or modified-MIST (M-MIST), the root surface and defect was debrided, the root surface was treated with EMD. EMD was applied to the defect and mixed with autogenous bone in select sites. Patients were on maintenance for every month for 6 months and then every 3 months. Monitored and examined (including radiographic) at baseline, 1 year, and 3 years.
Results: There were 177 patients with 282 sites that completed the 3-year follow up. The average measures were, PD of 6.02 mm, CAL of 7.12 mm, bleeding upon probing at 66.3% of site, RBD of 5.04 mm, defect angle of 35.69, and furcations at 16.7% of sites. EMD was used at all sites and adjunctive use of autogenous bone were grafted at 95 (33.7%) sites. PD (~3 mm) and CAL (~4.5 mm) was significantly improved from baseline to 1 and 3 year, but not significant between 1 and 3 year. RBD significantly improved from baseline to 1 year and 3 year, and also between 1 and 3 years. Inverse relationship between DA and RBD reduction in groups without bone graft, bone grafting was significantly associated with RBD reduction. However, bone grafting did not correlate to improvements in PD and CAL.
Conclusion: Since DA and RBD reduction are inversely related, it is suggested that bone graft may compensate for the negative effect, in which EMD and autogenous bone grafting significantly reduced intrabony defects when DA ≥40°, independent of the number of bony walls. When DA was <30°, there was no significant difference when using EMD with or without bone graft.
Topic:Implant-soft tissue
Authors: Surdiacourt L, Christiaens V, De Bruyckere T, De Buyser S, Eghbali A, Vervaeke S, Younes F, Cosyn J.
Title: A multi-centre randomized controlled trial comparing connective tissue graft with collagen matrix to increase soft tissue thickness at the buccal aspect of single implants: 3-Year results.
Source: J Clin Periodontol. 2024 Mar 14.
DOI: 10.1111/jcpe.13975.
Reviewer: Daeoo Lee
Type: RCT
Keywords: implant, soft tissue, thickness, buccal
Purpose: To analyze the difference between connective tissue graft (CTG) and collagen matrix (CMX) for increasing the buccal soft tissue thickness of a single implant site.
Material and methods: A total of 60 patients with Seibert Class I defect at a single tooth gap were recruited for the study. 30 patients were included in the test (CMX) group, and the other 30 patients were included in the control (CTG) group. After full-thickness flap was elevated, a single dental implant (Nobel Replace TiUnite, Nobel Biocare AB) was placed utilizing a surgical guide. Based on random selection, for the test group CMX was adapted to fit soft tissue defect, whereas for the control group, a CTG was harvested from the palate to fit soft tissue defect. To measure the changes in the soft tissue dimension, intra-oral scan was taken at pre-op (T1), immediate post-op (T1), 3-month post-op (T2), 1-year post-op (T3), and 3-year post-op (T4). Other outcomes, such as patients’ esthetic satisfaction, complications, marginal bone loss (MBL), PD, PI, BOP, implant health status, recession, and other parameters were also evaluated. Statistical analysis was performed.
Results: There was a significant difference between the groups at all time points in terms of buccal soft tissue profile (BSP). At T1, due to CMX graft being thicker than CTG, the estimated mean difference favored the test group. At later time points T2, T3, and T4, the estimated mean difference favored the control group (@T4, CTG=0.83mm and CMX=0.48mm). In terms of patients’ esthetic satisfaction, complication rate, PD, plaque index, bleeding and other parameters, the test group and control groups were comparable. However, in terms of MBL and midfacial recession the results favored the control group significatively at least in one time point.
Conclusions: CTG is more effective than CMX in terms of improving BSP and resulted in less MBL.
Topic: Implant-buccal bone
Authors: Alami M, Ntovas N, Penne G, Teughels W, Quirynen M, Castro A, Temmerman A.
Title: Ten-Year Follow-Up of Oral Implants in Bone With Limited Bucco-Oral Dimensions: A Prospective Case Series.
Source: J Clin Periodontol. 2024 Sep 25.
DOI: 10.1111/jcpe.14063
Reviewer: Daeoo Lee
Type: Prospective case series
Keywords: buccal, bone, thickness, dimension, implant
Purpose: To assess implants placed in ridges with narrow bucco-oral width.
Material and methods: 28 patients with less than or equal to 4.5 mm in ridge width for implant sites (mainly for overdentures) were recruited for the study. All implant sites had less than 1mm of buccal bone thickness after placement. Marginal bone level (MBL) changes were evaluated using an intra-oral radiograph (2D) at the time of implant placement, at functional loading, at 1-, 2-, 3-, 5-, and 10-years post-op. At the 10-year post-op clinical parameters such as plaque scores (PS), bleeding scores (BS), bleeding on probing (BOP), pockets depth (PD), keratinized tissue width (KTW), and other parameters were gathered. Statistical analysis was performed.
Results: Total of 100 implant sites (28 patients) were analyzed initially. At the 10-year mark, due to death and health issues of the patients 75 implants (21 patients) were included in the final evaluation. Around the time of second stage healing abutment connection, MBL was located 0.65mm apical compared to baseline. Progressively the MBL deepened to 0.84mm, 0.79mm, 0.84mm, 0.91mm, 1.76mm, at 1, 2, 3, 5, and 10 years respectively. In terms of clinical findings, at 10 years post-op 72% of patient had BS greater than 50%; looking at implant level, 84% of implants in 72% of patients had bleeding on probing. Also, 16% of implants in 27% of patients had PD greater than 6mm. In terms of implant health status, 69% of implants in 83% of patients had peri-mucositis and 15% of implants in 27% of patients had peri-implantitis. In terms of soft tissue analysis sites with keratinized but non-attached tissue had significantly higher BOP score and Peri-mucositis, compared to sites with attached tissues. Overall, implants had 100% survival rate at 10-year mark.
Conclusions: Even when placed into narrow alveolar ridges, without having the standard 1 mm of buccal and lingual bone surrounding them, implants may survive for at least 10 years and exhibit minimum marginal bone loss.
Topic: Suturing techniques for coronally advanced flap
Authors: Ariceta A., Chambrone L., Stuhr S., Couso-Queiruga E.
Title: Effect of suturing in root coverage via coronally advanced flaps: A systematic review
Source: Clin Adv Periodontics. 2024;1–12.
DOI: 10.1002/cap.10312
Reviewer: Cyrus J Mansouri
Type: Systematic review
Keywords: esthetics, gingival recession, surgery, surgical flaps
Purpose: To analyze the literature to assess the influence of the suturing technique and material usage on mean percentage root coverage (%MRC) for single tooth gingival recession defects treated using the coronally advanced flap for root coverage.
Material and methods: A literature search was completed with PICOS question: “What is the influence of the suturing technique and material on the %MRC, following the treatment of single GRDs with no interproximal clinical attachment loss with the aim of root coverage via a CAF?” Population: Adult subjects in the presence of single/localized GRD categorized as RT1, or Miller class I and II that required root coverage procedure. Intervention: Root coverage procedure via single layered CAF. Comparison: Any possible comparison between suture techniques and materials. Outcomes: %MRC, any complications. Study design: Randomized clinical trials (RCTs).
Results: A total of 15 RCTs were included in the final review. The cumulative study population consisted of 253 patients with a total of 301 localized non-molar gingival recession defects). A total of 12 studies utilized sling sutures at the most coronal of the flap and single interrupted sutures at the vertical incisions. A total of 3 studies used single interrupted sutures only. Four studies used silk as a material, 3 of which also used a periodontal dressing. One study utilized expanded polytetrafluoroethylene (ePTFE), and 7 studies used polyglactin 910. Three studies used nylon alone. Diameter of suture material varied from 3-0 to 6-0. Incision designs varied by split-full-split, full-split, and partial-full thickness. Mean follow-up was 11.6 months. For studies using sling and single interrupted sutures, MRC was 70.2%. For the three studies using single interrupted sutures alone, MRC was 74.1%. MRC for studies using silk sutures was 68.3%, ePTFE only was 37%, polyglactin 910 was 76.6%, and nylon was 74.8%. The study using 3-0 suture diameter showed a MRC of 67.5%, 4-0 showed MRC 68.5%, 79.1% for 5-0, and 65.5% for 6-0. No studies reported any complications.
Conclusion: Mean root coverage did not differ significantly whether single interrupted sutures were used alone or in combination with sling sutures. Sites treated with polyglactin 910 or nylon sutures exhibited higher %MRC. The use of 5-0 suture diameter demonstrated the highest %MRC.
Topic: Healing abutment shape
Authors: Camacho-Alonso F., Mira Bernabeu JC., Sanchez J., Buendia AJ., Mercado-Diaz AM., Perez-Sayans M., Jardon-Perez A., Martin JMS., Montero J., Gomez-Polo C., Quispe-Lopez N., Penarrocha-Oltra D.
Title: Histological and immunohistochemical soft-tissue response to cylindrical and concave abutments: Multicenter randomized clinical trial
Source: J Periodontol. 2024;1–11.
DOI: 10.1002/JPER.24-0250
Reviewer: Cyrus J Mansouri
Type: Randomized clinical trial
Keywords: dental implant-abutment design, dental implants, histology, immunohistochemistry, multicenter study, oral surgical procedures, randomized controlled trial
Purpose: To assess the influence of abutment shape (cylindrical vs concave) on peri-implant soft tissue via histological and immunohistochemical analyses.
Material and methods: Partially edentulous patients were recruited in need of 2 implants in the posterior mandible or maxilla. A minimum of 3 mm vertical supracrestal soft tissue thickness and 2 mm keratinized mucosa width (KMW) was required around the abutment. Two study groups were established – Cylindrical group with 3-mm high straight abutments and concave group with 3-mm high slim abutments, with a split-mouth model in each patient. The same implant surface and connection was used in both groups. After adequate pre-operative and intraoperative procedures, implants were placed equicrestal with at least 35 Ncm torque. Implants were Galimplant IPX (bone level with internal conical connection) 4, 4.5, or 5 mm in diameter and 8-14 mm in length. Study sites were randomized and healing abutments were placed and torqued to 30 Ncm. After 12 weeks of healing, a tissue punch was used to remove a 1.1-1.7 mm collar of the peri-implant soft tissue, dissected, removed with the healing abutment, and placed in 10% formalin. Abutments were removed and studied by field emission scanning electron microscope (FESEM) to determine percentage of submucosal abutment covered by biofilm. Peri-implant soft tissue was sectioned into 6 equal portions: Vertical peri-implant soft tissue height and collagen fiber orientation were measured in portion 1. Intensity and composition of the inflammatory exudate and vascular proliferation were measured in portions 2-6. A 4-micron section was obtained from all portions to assess histologically and immunohistochemically. Finally, implant success was determined according to Misch 2008.
Results: Mean peri-implant soft tissue height was significantly greater for concave abutments compared to cylindrical (3.57 mm vs 2.95 mm). Extension of the barrier epithelium was also significantly greater for concave abutments than cylindrical (2.46 mm vs 1.89 mm). Extension of the supracrestal connective tissue was greater for concave vs cylindrical abutments, but. Not reaching statistical significance (1.11 vs 1.03 mm). The percentage of fibers oriented perpendicular to the abutment was significantly greater in the concave abutments compared to the cylindrical (23.76% vs 15.68%). In both abutments, the inflammatory infiltrate and vascular proliferation was greatest in the lower portion of the barrier epithelium and supracrestal connective tissue. Inflammatory intensity and vascular proliferation were significantly lower in the peri-implant soft tissue surrounding concave abutments compared to cylindrical (1.05 vs 1.97). After analyzing abutment surfaces, the concave abutment showed a greater surface covered by soft tissue remnants than the cylindrical.
Conclusion: Concave abutments presented significantly greater peri-implant tissue height, linked to an extended barrier epithelium, compared to cylindrical abutments in thick tissue phenotype. This enhances soft tissue sealing, promoting a greater percentage of transversely oriented collagen fibers. The concave design also reduced chronic inflammatory exudate with T and B cells, minimizing risk of chronic inflammation.
Topic: Pre-loading Crestal Bone Loss
Authors: Vilela N, Gurgel BCV, Bruzos C, Duarte WR, da Silva HDP, Pannuti CM, Duarte PM.
Title: Preloading peri-implant crestal bone loss: A retrospective study of incidence and related factors.
Source: J Periodontol. 2024 Jun 26. doi: 10.1002/JPER.24-0028. Online ahead of print
DOI: 10.1002/JPER.24-0028.
Type: Retrospective Study
Reviewer: Veronica Xia
Keywords: pre-loading crestal bone loss, incidence, factors
Purpose: The purpose of this study was to determine the incidence of pre-loading crestal bone loss (PLCBL), the time between implant placement and uncovery or abutment/prosthesis placement, and to note the factors associated with PLCBL.
Materials and Methods: Patient and implant related information was collected, and inclusion/exclusion criteria were applied. Radiographs were used to quantify interproximal bone loss at two time points: implant placement and uncovery or abutment/prosthesis placement.
Evidence of PLCBL was noted if there was >/=0.5mm of bone loss, and classified as severe PLCBL with >/=1.5mm bone loss.
Results: 746 implants were included in the study, with 24.4% having PLCBL >/=0.5mm and 10.5% with severe PLCBL. Average PLCBL at mesial and distal sites were 1.2mm and 1.3mm respectively. Patient evaluation revealed that there was no significant difference in age between patients with/without PLCBL.
Patients with diabetes, taking antidepressant/blood thinners, and had amoxicillin allergies were more likely to have PLCBL >/=0.5mm. Maxillary located, Zimmer implants, tapered, two-stage, regular diameter, platform-abutment connection, and supracrestal position implants also more commonly showed PLCBL >/=0.5mm. This was seen to a lesser degree in Straumann, tissue-level, parallel, wide diameter, and equicrestal implants.
Factor | Odds Ratio of PLCBL >/=0.5mm |
Zimmer | 2.83 |
Regular diameter | 2.2 |
Bone-level connection | 3.7 |
Two-stage | 2.05 |
Supracrestal implant placement | 3.49 |
Subcrestal implant placement | 1.68 |
Similarly, diabetic patients, amoxicillin allergies, anti-depressant consumption, in addition to male gender, history of periodontitis, and consumption of anti-inflammatory medications showed increased presentation of PLCBL >/=1.5mm. Furthermore, anterior implants, tapered, two-stages, regular diameter, supracrestal, Zimmer implants more commonly has PLCBL >/=1.5mm. Less association with severe PLCBL was found with Straumann, tissue-level, wide-diameter, parallel, equicrestal, and sites of previous grafting/augmentation (OR 0.49)—protective factor.
Factor | Odds Ratio of PLCBL >/=1.5mm |
Male | 1.85 |
Diabetic | 3.3 |
Penicillin allergy | 3.13 |
Anterior location | 2.08 |
Supracrestal implant placement | 3.77 |
Bone-level platform connection | 4.73 |
Conclusion:This study concluded that incidences for PLCBL >/=0.5 was 24.4% and for PLCBL >/=1.5mm was 10.5%. Factors such as male gender, penicillin allergy, diabetes, bone-level platform connection, supracrestal placement, anterior location were all associated with increased risk of PLCBL. Previously grafting at sites however, seemed to have a protective role in PLCBL.
Topic: Alveolar Ridge Preservation vs Early Implant
Authors: Atieh MA, Shah M, Hakam A, AlAli F, Aboushakra I, Alsabeeha NHM
Title: Alveolar ridge preservation versus early implant placement in single non-molar sites: A systematic review and meta-analysis.
Source: Clin Oral Implants Res. 2024 Jun 8.
DOI: 10.1111/clr.14314.
Reviewer: Veronica Xia
Type: Systematic Review
Keywords: alveolar ridge preservation, early implant placement, outcomes
Purpose: The purpose of this systematic review was to investigate the radiographic, clinical, and patient reported outcomes of alveolar ridge preservation (ARP) of non-molar teeth compared to early implant placement (EIP).
Material and methods: The following PICO (participant, intervention, comparison, outcome) outline was used:
P: >/=18 yo needing non-molar implant after extraction
I: early implant placement (after 4-8 weeks of spontaneous healing)
C: alveolar ridge preservation and late implant placement
O: primarily, midfacial tissue margin/thickness; in addition to soft tissue contour, ridge width/height, esthetics, need for additional augmentation, periodontal parameters, post-operative pain, implant failure
Electronic search was completed.
Results: 5 articles included in the quantitative analysis.
Outcome | Group favored (ARP vs EIP) |
Midfacial mucosal margin | ARP |
Mucosal thickness | No significant difference (NSSD) |
Ridge width | ARP |
Ridge height | NSSD |
Pink esthetic score | NSSD (favor EIP) |
White esthetic score | NSSD (favor ARP) |
Probing depth | NSSD |
Marginal bone level changes | ARP (less loss) |
Additional augmentation | NSSD (favor ARP—less augmentation needed) |
Post-op pain | NSSD |
Implant failure | NSSD |
Conclusion: Overall, there was no difference between ARP and EIP regarding, mucosal thickness, alveolar ridge height, soft tissue contour, white/pink esthetic scores, augmentation needs, probing depths, implant failure, or post-op pain. ARP did have improved outcomes with ridge width, midfacial mucosal margin, and marginal bone level. EIP showed improved outcomes with less probing depth and pink esthetic scores with no significant difference.
Topic: Grafting and early implant placement
Author: Lim, Hyun-Chang, et al.
Title: Effects of hard- and/or soft-tissue grafting with early implant placement: Histomorphometric outcomes of an exploratory study in canines
Source: Clin Oral Impl Res. 2024;00:1–11.
DOI: 10.1111/clr.14320
Reviewer: Ryan Higgins
Type: Animal study
Keywords: alveolar ridge augmentation, animal experimentation, dental implantation, tissue scaffold
Purpose: The objective of this study is to histomorphometrically determine the effects of hard-and/or soft-tissue augmentation by applying early implant placement protocol.
Materials and Methods: 10 dogs had the distal roots of maxillary second and third premolars extracted. At 1 month an early implant placement was performed in the distal roots, resulting in buccal dehiscence defects. Four treatment plans were then randomly assigned to each dog : 1) guided bone regeneration (GBR), (2) connective tissue grafting (CTG), (3) simultaneous GBR and CTG (GBR + CTG) and (4) no further treatment (control). Three reference lines used: at the implant shoulder (IS) level, at 1 mm above IS (IS+1) and at 1mm or 2mm below IS (IS-1 and IS-2 respectively. Implants underwent submerged healing with healing abutments. At time points of 4 and 16 weeks, tissue was harvested and histomorphometric analyses was performed. Synthetic bone substitute material (biphasic calcium phosphate; Osteon III, Genoss, Suwon, Korea) used with cross-linked collagen membrane (Collage membrane, Genoss), secured with tacks was used for the GBR. The CTG was 6-7mm by 5mm with thickness of 1.5mm harvested from hard palate.
Results: The group with the largest total tissue thickness at 4 weeks was GBR group, 2.14 mm at IS+1, 2.85 mm at IS, 3.13 mm at IS-1 and 3.72 mm at IS-2.
GBR + CTG were 1.62 mm at IS+1, 1.98 mm at IS, 2.88 mm at IS-1 and 3.22 mm at IS-2. The difference between GBR and GBR + CTG groups at 4 weeks were in favor of GBR.
The GBR + CTG group did have greater remodeling though from weeks 4 to 16. The group the largest total tissue thickness at 16 weeks was GBR +CTG group, 1.74 mm at IS+1 and 1.94 mm at IS. This group also had the most favorable level of margo mucosae and presence of mineralized tissue at the coronal level. The group with the next total tissue thickness was CTG alone 1.10 mm IS+1 and 1.37 mm at IS. When comparing the results of CTG alone vs. GBR alone at 16 weeks CTG demonstrated a larger thickness.
Conclusions: Simultaneous CTG and GBR resulted in the most-favorable tissue thickness when applying the early implant placement protocol.
Topic: Lasers and Endothelial Growth Factor
Author: Takemura, et al.
Title: Enhanced periodontal tissue healing via vascular endothelial growth factor expression following low-level erbium-doped: yttrium, aluminum, and garnet laser irradiation: In vitro and in vivo studies.
Source: J Periodontol. 2024 Sep;95(9):853-866.
DOI: 10.1002/JPER.23-0458
Reviewer: Ryan Higgins
Type: In vitro and in vivo studies
Keywords: histology, laser therapy, periodontitis, wound healing
Purpose: The objective of the study is to investigate low-level erbium doped: yttrium, aluminum, and garnet (Er:YAG) laser irradiation on the effects of periodontal tissue healing, regeneration, and angiogenesis in vivo and in vitro.
Materials and Methods: Using mouse model intrabony defects were created in bilateral maxilla. The defects were treated with open flap debridement and Er:YAG laser, which included low-level laser irradiation (LLLI) to bone and blood clot surfaces (10Hz and 30mJ/pulse). The mRNA expression of vascular endothelial growth factor (VEGF) from surgical sites was quantified via PCR. LLLI was also performed on endothelial cells from human umbilical vein to evaluate the effects on angiogenesis. Cell proliferation, VEGF expression, and tube formation were assessed. Capsazepine (CPZ), a selective inhibitor of transient receptor potential vanilloid 1 (TRPV1), treatment was performed before LLLI for some assays. TRPV1 is expressed in vascular endothelial cells and plays an important role in cell proliferation and angiogenesis of endothelial cells.
Results: In vivo: When using Er:YAG laser with OFD there was no thermal damage to bone or root surfaces. LLLI resulted in accelerated hemostasis. VEGF expression and bone formation were significantly increased in the laser group compared to conventional treatment group. In the LLLI group in vitro, cell proliferation and VEGF expression were significantly increased compared to control. In vitro: Irradiation at 1.5 J/cm2 increased the temperatures of the dish surface from 22.7 ± 0.2◦C before irradiation to 25.2 ± 0.3◦C, with an average increase of 2.5 ± 0.2◦C. Tube formation assays showed significant promotion of angiogenesis in LLLI group. The total number of nodes, branches, and tubes significantly increased in the LLLI group 18 h after laser irradiation compared to control.
Conclusions: The results suggest that Er:YAG laser irradiation may promote periodontal tissue healing by enhancing angiogenetic effect of endothelial cells via TRPV1. Angiogenesis is improved via upregulation of VEGF secretion, proliferation, and tube formation of endothelial cells.
Topic: Maxillary sinus perforation
Authors: Mazor, Z et al.
Title: Maxillary sinus membrane perforation rate utilizing osseodensification-mediated transcrestal sinus floor elevation: A multicenter clinical study
Source: ClinImplantDentRelatRes.2024;1–9.
DOI: 10.1111/cid.13368
Reviewer: Nicolas Lobo
Type: Clinical study
Keywords: dental implants, membrane perforation, osseodensification, osseointegration, sinus floor elevation
Purpose: This study looked at how often the membrane gets damaged during transcrestal sinus floor elevation (TSFE) when using osseodensification (OD) burs. It also aimed to find out what factors might increase the risk of this happening.
Materials and Methods: This study was a multicenter, cross-sectional research on patients needing dental implants in the posterior maxillary edentulous spaces. The study included patients aged 18 or older with 2-6 mm of residual bone height (RBH) between the crest of the ridge and the sinus floor, excluding those over 80 or with specific health issues like sinus pathologies, uncontrolled diabetes, or smoking.
Preoperative evaluations involved medical history, clinical examination, and CBCT scans for surgical planning. The standardized surgical procedure involved local anesthesia, a mucoperiosteal flap, and the use of specialized drilling burs (Densah burs) for osteotomy and sinus membrane lifting. Depending on the RBH, the protocol varied in terms of osteotomy depth, bone grafting materials, and whether immediate or delayed implant placement occurred. Parameters studied included surgical complications, particularly sinus membrane perforations.
Results: In this study, 621 subjects with a mean age of 57.9 years underwent sinus lifting and implant surgery, with 670 sinus grafting sites and 621 implants placed in the posterior maxilla. The procedures were generally uneventful, with no major complications such as excessive bleeding or infections. Most grafts were done in molar (515 – 76.87%) and healed bone sites (498 – 74.33%), with an average RBH of 5.1 mm.
Sinus membrane perforations occurred in 49 sites (7.31%), confirmed by direct observation. Logistic regression analysis identified RBH as a significant risk factor for perforations, with RBH ≤3 mm (OR = 10.130) and RBH between 3 and 5 mm (OR = 3.726) posing higher risks. However, factors such as implant site (molar vs. premolar, healed vs. fresh socket) did not significantly affect perforation rates.
Conclusions: Using OD instrumentation for TSFE results in a low rate of membrane perforation. However, severe posterior maxillary atrophy was identified as a significant risk factor for increasing the likelihood of membrane perforation during the procedure.
Topic: Management of periimplantitis
Authors: Renvert, S et al.
Title: The efficacy of reconstructive therapy in the surgical management of peri-implantitis: A 3-year follow-up of a randomized clinical trial.
Source: J Clin Periodontol. 2024; 51:1267–1276.
DOI: 10.1111/jcpe.14049
Reviewer: Nicolas Lobo
Type: RCT
Keywords: bone augmentation, bone substitute, native bilayer collagen membrane, peri-implantitis, surgical treatment
Purpose: To find out if guided bone regeneration (GBR) can help heal bone loss in peri-implantitis better than open flap debridement (OFD) after 36 months.
Materials and Methods: The study involved participants referred for peri-implantitis treatment. Inclusion criteria required participants to be at least 18 years old, have peri-implantitis at a functional implant for at least one year, with specific probing pocket depth and radiographic defect measurements.
The primary endpoint was radiographic defect fill (RDF) at 36 months, measured with digital software. The study compared two treatments: a test group (TG) that received guided bone regeneration (GBR) using deproteinized bovine bone mineral (DBBM) and a control group (CG) that received open flap debridement (OFD). Post-surgical care included antibiotics, pain management, and chlorhexidine rinsing. Follow-up visits occurred regularly, and patient-reported outcomes (PROs) were collected at 24 and 36 months to evaluate satisfaction. Secondary outcomes included implant survival, probing pocket depth (PPD), bleeding on probing (BOP), and treatment success based on clinical parameters.
Results: 71 subjects were initially enrolled, with 66 completing the 1-year follow-up and 60 continuing in the 36-month follow-up. Two implants were lost in each group during the follow-up period, resulting in a 96.6% implant survival rate for both groups. At 36 months, GBR led to greater defect fill (2.13 mm in TG vs. 1.64 mm in CG), but the difference was not statistically significant. Both groups experienced reductions in PPD, suppuration, and BOP, with no significant differences between the groups in these clinical parameters. There were minor changes from 12 to 36 months in both groups, with no significant differences in outcomes between the two periods. The composite treatment success rate was higher in the TG (46.2%) compared to CG (20%), though this difference did not reach statistical significance (p = .053). PROs, including satisfaction, showed no significant difference between the groups, with satisfaction reaching 100% in TG and 92% in CG at 36 months.
Conclusions: At 36 months, both GBR and OFD treatments maintained the results achieved at 1 year in patients who received SPT. GBR led to greater RDF and a higher overall treatment success rate compared to OFD. However, there were no significant differences between the two groups in clinical parameters or PROs.
Topic: vertical soft tissue augmentation around implants
Authors: Puisys A, et al.
Title: Clinical efficacy of two vertical soft tissue augmentation techniques for peri-implant crestal bone level stability: A randomized clinical trial
Source: Clin Implant Dent Relat Res. 2024
DOI: 10.1111/cid.13365
Type: RCT
Reviewer: Mahya Sabour
Keywords: dental implant, soft tissue augmentation, vertical soft tissue height, bone remodeling, bone resorption
Purpose: to assess the efficacy of peri-implant soft tissue augmentation via acellular dermal matrix (ADM) grafting compared to the use of short healing abutments to expand the soft tissue through the tenting technique (TT).
Materials and Methods: 40 patients who were to receive single implants at posterior mandibular sites, in the presence of minimum 4mm of KT (2mm buccal and 2mm lingual) were randomly assigned to either ADM or TT treatment groups. Implants were placed equicrestally on the buccal aspect. The ADM group received cover screws (0mm height) and a porcine dermal collagen graft (Mucoderm) on top, while the TT group received 2mm healing abutments and was submerged with primary closure. Implants were uncovered after 2 months and 4mm healing abutments placed in both groups, followed by screw-retained crowns that were delivered 1 month after. Crestal bone level (CBL) changes, soft tissue height (STH) gain, PPD, BOP, and PI were assessed.
Results: CBL insignificantly decreased in both groups over the 1-year follow-up period, however the TT group was more efficient in preventing bone remodeling at the mesial of the implants. CBL remained above the implant platform in all cases.Both groups were comparably effective at increasing STH with an average increase of 1.6 +/- 0.5mm in the ADM group and 1.8 +/- 0.4mm in the TT group. A small but insignificant PPD increase was seen at the distal aspects in both groups while BOP and PI were low.
Conclusion: Both ADM graft and TT are effective in augmenting STH and maintaining crestal bone levels around implants. TT offers the added benefits of maintaining crestal bone stability at the mesial aspect, but also has higher risk of post-surgical complications.
Topic: Implant-abutment manipulation
Authors: Krebs M., et al.
Title: Influence of repeated implant-abutment manipulation on the prevalence of peri-implant diseases in complete arch restorations. A retrospective analysis.
Source: Clin Implant Dent Relat Res. 2024; 1-10
DOI: 10.1111/cid.13381
Type: Retrospective study
Reviewer: Mahya Sabour
Keywords: dental implants, one-abutment one-time, peri-implantitis
Purpose: to evaluates the effects of abutment manipulation by comparing one-abutment-one time (OAOT) vs. conventional multiple abutment replacements (AR) on peri-implant disease prevalence.
Materials and Methods: 27 patients that received 4 interforaminally and subcrestally placed implants with morse taper connections and immediate loading with a removable denture were selected. The test group received OAOT treatment, and a final denture was fabricated without abutment exchange after 1 year. The control group was treated with abutment replacements (up to 6 times) and implant level impressions after osseointegration.
Age, gender, mid-vestibular keratinized mucosa, BOP, implant related factors, and interproximal bone level measurements were assessed.
Results: 108 implants were placed with 11mm being the most common length, 55.6% OAOT and 66.7% AR groups. Majority of sites displayed keratinized mucosa width >/=2mm. BOP was seen in 5.6% of sites in the OAOT protocol and 77.8% of sites in the AR protocol. Healthy peri-implant tissues were seen in 94.4% of OAOT and 0% of the AR group patients, with a 5.6% and 88.9% diagnosis of peri-implantitis and 0% and 22.2% diagnosis of peri-implant mucositis respectively. Abutment replacement was a significant predictor of increased peri-implant disease prevalence. A significant difference was seen between the OAOT and AR groups in terms of radiographic bone loss, being 1.38mm higher in the AR group (after a mean time of 10.2 years).
Conclusion: The one-abutment one-time treatment concept leads to lower peri-implant disease prevalence.