Long-term outcomes of osteotome sinus floor elevation without bone grafts
Comparison Between Dexamethasone and Ibuprofen for Postoperative Pain Prevention
Assessment of Marginal Peri-Implant Bone-Level Short-Length Implants Compared with Standard Implants
A Possible Link Between Rheumatoid Arthritis and Periodontitis
Influences of Obesity on Periodontitis Progression is Conditional on Interleukin-1
Guided Tissue Regeneration Involving Piercing-Induced Lingual Recession
Saving an Integrating Implant Involved with Endodontic Implant Pathology Using Surgical Treatment
The Correlation Between Immediate Implant Insertion Torque and Implant Stability Quotient
Biomechanical, Biologic, and Clinical Outcomes of Undersized Implant Surgical Preparation
Two-Year Evaluation of a Sloped Marginal Contour Implant System Placed in Healed Sites
Does Obstructive Sleep Apnea Increase the Risk for Periodontal Disease
Topic: Osteotome sinus lift
Title: Long-term outcomes of osteotome sinus floor elevation without bone grafts: a clinical retrospective study of 4–9 years
Author: Mi-si S. Yi-wen S. et al
Source: Clinical Oral Implants Research Volume 27, Issue 11 November 2016 Pages 1392–1400
Rating: Good
Study Type: Retrospective study
Keywords: osteotome, sinus lift, bone gain, implants
Purpose: To evaluate the long-term results of dental implant with
osteotome sinus lifts (OSL) without bone grafts and to examine potential
influential factors of endo-sinus bone remodeling and bone gain.
Material and Methods: Clinical and radiographic data of 96 implants in 80 patients were collected after 4–9 years follow-up. Implant failures, implant marginal bone loss (MBL), and endo-sinus bone remodeling on the radiographs were evaluated. Statistical models were used to assess the implant survival and investigate the potential influence factors of implant survival and endo-sinus bone gain (ESBG).
Results: Nine implants in seven patients failed, giving the 9-year survival rates of 90.6%. The mean MBL between implant placement and the 4-9 year follow-up visit was 0.46 ± 0.88 and 0.50 ± 1.69 mm, respectively. The average ESBG on radiographs was 2.95 ± 1.25 and 2.16 ± 1.13 mm at the 4- and 9-year follow-up. The final ESBG was found to be positively correlated to implant protrusion length after surgery without any other factors related. The implant survival rate was significantly lower in severe atrophic site with residual crestal bone height <5 mm.
(a) Radiographs taken immediately after surgery. (b) Radiographs taken before restoration at 4 months after surgery. (c) Radiographs taken at the 15-month follow-up visit. Double lamina dura around implant apex was detected. (d) Radiographs taken at the 52-month follow-up visit. The final endo-sinus bone gain was 3.65 mm.
Conclusion: Sinus lifts without bone grafting can be considered a predictable treatment modality in the long run as per this study’s suggestion. However there must be caution when the initial bone height of the edentulous site is lower than 5 mm. Final endo-sinus bone height was found to be positively correlated to implant protrusion length measured on radiographs immediately after implant installation.
Topic: Vestibuloplasty
Title: Long-term outcomes after vestibuloplasty with porcine collagen matrix (Mucograft) versus the free gingival graft: a comparative prospective clinical trial
Author: Mi-si S. Yi-wen S. et al
Source: Clinical Oral Implants Research Volume 27, Issue 11 November 2016 Pages e125-132
Rating: Good
Study Type: Prospective clinical study
Keywords: mucograft, allograft, vestibuloplasty
Background:
Porcine collagen matrices are proclaimed being a sufficient alternative to
autologous free gingival grafts (FGG) in terms of augmenting the keratinized
mucosa. The collagen matrix Mucograft already showed a comparable clinical
performance in the early healing phase, similar histological appearance, and
even a more natural appearance of augmented regions.
Purpose: To evaluate the predictability for long-term stability for >6 months for vestibuloplasties completed by a porcine collagen matrix.
Material and methods: The study included 48 patients with atrophic edentulous or partially edentulous lower jaw situations that had undergone an implant treatment. Control group: vestibuloplasty was either performed with two FGGs from the palate (n = 21 patients) or with Mucograft (n = 27 patients). Surgery time was recorded from the first incision to the last suture. Follow-up examinations were performed at the following time points: 10, 30, 90, and 180 days and 1, 2, 3, 4, and 5 years after surgery. The width of keratinized mucosa was measured at the buccal aspect of each implant, and augmented sites were evaluated in terms of their clinical appearances.
Results: The groups showed similar healing with increased peri-implant keratinized mucosa after surgery (FGG: 13.06 mm ± 2.26 mm and Mucograft: 12.96 mm ± 2.86 mm) with maximum follow-up was 5 years (5 patients per group). After 180 days, the width of keratinized mucosa had decreased to 67.08 ± 13.85% in the FGG group and 58.88 ± 14.62% in the Mucograft group with no statistically significant difference. The total loss of the width of keratinized mucosa after 5 years was significant between the FGG (40.65%) and the Mucograft group (52.89%). The Mucograft group had significantly shorter operation times than the FGG group. Augmented soft tissues had a comparable clinical appearance to adjacent native gingiva in the CM group. FGGs could still be defined after 5 years.
Conclusions: The FGG and Mucograft are both suitable for the regeneration of the peri-implant keratinized mucosa with a sufficient long-term stability. With the Mucograft, tissue harvesting procedures are invalid, surgery time can be reduced, and regenerated tissues have a more esthetic appearance.
Topic: Oral health literacy
Authors: Holtzman JS, Atchison KA, Mark D. Macek MD, Markovic D
Title: Oral Health Literacy and Measures of Periodontal Disease
Source: Journal of Periodontology January 2017, Vol. 88, No. 1: 78-88. doi: 10.1902/jop.2016.160203
Type: Cross-sectional study
Rating: fair
Keywords: Diabetes mellitus, health, health education, smoking
Purpose:
To assess the associations of health literacy (HL) and oral health literacy
(OHL) measures with the clinical periodontal measures number of teeth, bleeding
score, plaque score, and periodontal severity after accounting for
sociodemographic factors, smoking, and diabetes.
Methods: 325 new patients at a dental school clinic were used in this study. An OHL survey was used along with full mouth radiographs taken by an oral radiology technician and clinical exam done by dental students. Age, sex, smoking status and diabetic status were obtained. Evaluations included the relationship between each HL measure versus number of teeth, bleeding score, plaque score, and periodontal severity with linear and ordinal logistic regression models before and after adjusting for covariates. Rapid estimate of adult literacy in medicine and dentistry (REALMD-20), the short test of functional health literacy in adults (TOFHLA), and the newest vital sign (NVS) were all used to assess HL. The comprehensive measure of oral health knowledge (CMOHK) was also used.
Results: Among HL measures, NVS demonstrated a significant relationship with number of teeth and the TOFHLA showed a significant association with plaque score. The REALMD-20 showed participants who performed in the highest quartile had nearly 2 additional teeth, over 5.5% fewer bleeding sites, and nearly 9% fewer teeth with plaque after adjustment for demographic variables, smoking, and diabetes. Participants who scored in the highest quartile of CMOHK had nearly 9% less plaque.
Discussion: The sample was generally healthy and educated but poor and uninsured (study weakness). Two OHL instruments (REALMD-20 and CMOHK) provided statistical associations with clinical measures of periodontal health at a level that could be considered of moderate clinical relevancy. Findings suggest dentists may wish to assess familiarity of their patients with dental terminology and knowledge of periodontal disease to provide education on oral hygiene, smoking, and diabetes.
Topic: Postoperative pain
Authors: Bahammam MA, Kayal RA, Alasmari DS, Attia MS, Bahammam LA, Hassan MH, Alzoman HA, Almas K, Steffens JP
Title: Comparison Between Dexamethasone and Ibuprofen for Postoperative Pain Prevention and Control After Surgical Implant Placement: A Double-Masked, Parallel-Group, Placebo-Controlled Randomized Clinical Trial
Source: Journal of Periodontology January 2017, Vol. 88, No. 1: 69-77. doi: 10.1902/jop.2016.160353
Type: Randomized clinical trial
Rating: Good
Keywords: Dental implants, dexamethasone, double-blind method, ibuprofen, pain, pain measurement
Purpose: To compare the efficacy of dexamethasone and ibuprofen medication protocols for pain prevention and control after implant surgery.
Methods: This was a prospective, double-masked, parallelgroup, placebo-controlled randomized clinical trial that involved patients (71 males and 46 females, aged 18 to 65 years) who presented for placement of a single implant. Some exclusion criteria included need for extraction during procedure and need for bone graft or sinus lift during placement. All implants were placed by 6 residents under local anesthesia only (2% lidocaine with epi 1:100k). A state-trait anxiety inventory and Modified dental anxiety scale was done 1 hour before surgery to assess the correlation between pain scores and self-reported stress and anxiety. Amoxicillin (500 mg t.i.d. for 5 days) or clindamycin (300 mg q.i.d. for 5 days) was provided. Patient age/sex, incision size (mm), anesthetic used, and duration of operation were all recorded. Participants were randomly assigned to the following groups: Group 1- received 600 mg of ibuprofen 1 hour before surgery and another 600 mg 6 hours after the first dose; Group 2- received 4 mg dexamethasone 1 hour before surgery and another 4 mg 6 hours after the first dose; Group 3- received placebo 1 hour before surgery and another dose 6 hours after the first. Rescue medication consisting of 1,000 mg of acetaminophen was issued to each patient to take if necessary. Pain diaries were completed every hour for the first 8 hours after surgery and 3 times daily for the next 7 days. Visual analog scale (VAS), the 101-point numeric rate scale (NRS-101), and the 4-point verbal rating scale (VRS-4) were used to assess pain.
Results: 117 patients completed the study. Patients treated with ibuprofen and those treated with dexamethasone reported less pain in the morning than the placebo group on days 1 to 4 via VAS (P <0.01), but on the afternoon of day 3 there were no significant differences. Notably, there were no statistically significant differences between ibuprofen and dexamethasone at any time point. From noon on day 4 onward, none of the participants in any group reported pain. All placebo patients required rescue medication. Time to first rescue medication was lower in the placebo group and use of recue medication was lower in the ibuprofen and dexamethasone group.
Discussion: Non-steroidal ibuprofen before and after surgery is as effective as steroidal dexamethasone for preventing and controlling postoperative pain and discomfort after implant placement surgery. Both protocols significantly reduced pain and discomfort for 4 days after surgery compared with patients treated with placebo. Also, both treatments reduced need for postoperative painkillers and increased
Topic: Short implants vs standard implants
Authors: Mendoza-Azpur G, Lau M, Valdivia E, Rojas J, Munoz H
Title: Assessment of Marginal Peri-Implant Bone-Level Short-Length Implants Compared with Standard Implants Supporting Single Crowns in a Controlled Clinical Trail: 12 Month Follow-up
Source: Int’l J Perio and Rest Dent V.36, No. 6, 2017. Pg 791-795.
Type: Controlled clinical trial
Rating: Fair
Keywords: short implant, single crowns
Purpose: To compare marginal bone level alteration through radiographic evaluation and clinical parameters between short and standard implants supporting single crowns.
Methods: 82 healthy and non-smoking patients (42M/40W, 30-60 y/o) were included in this study and were divided into two groups. Group one had implants placed ranging from 5.5 to 7 mm and Group two was for standard length implants 10 to 12 mm. Periapical analysis was performed using ImageJ computer software for establishing initial bone measurement and periapical bone loss. All radiographs were taken using standard radiographic protocols and measurements were taken at 6 and 12 months.
Results: No implants were lost in either group during the observation period. Standard length implants had SSD less bone loss. Bone loss did not exceed 0.53 mm in the short implant group. A SSD was found in the standard implant group showing greater gingival recession.
Conclusion:
Short implants are as reliable as standard length implants. Short implants
experience minimal peri-implant bone loss and therefore you do not need to treat
partially edentulous patients with splinted crowns.
Topic: Rheumatoid Arthritis and Periodontitis
Authors: Tang Q, Fu H, Qin B, Hu Z, Liu Y, Liang Y, Zhou L, Yang Z, Zhong R
Title: A Possible Link Between Rheumatoid Arthritis and Periodontitis: A Systematic Review and Meta-analysis
Source: Int’l J of Perio and Rest Dent. Vol. 37, No. 1, 2017. Pg 79-86.
Type: Systematic review and Meta-analysis
Rating: Good
Keywords: rheumatoid arthritis
Purpose: To
comprehensively evaluate the association between rheumatoid arthritis (RA) and
periodontitis.
Methods: A literature search was performed on PubMed and EMBASE. Studies were excluded if data was insufficient, they were reviews or abstracts, and there was no control group.
Results: 253 articles were found on initial search. After screening 43 articles remained. Eight case control studies were included in the study after further screening. Study size ranged from 104 to 151,569 participants. The prevalence of periodontitis in participants with RA in these studies ranged from 15.5-100% compared to 10-82.1% in control groups. All studies reported a higher prevalence of periodontitis in patients with RA than those without. Due to articles using different control groups they were separated into two groups: Group 1 was studies using healthy patients as controls (4) and Group 2 was the remaining. When healthy patients were compared to RA patients, the risk of periodontitis was increased significantly (OR = 4.68, 95% CI). For group two the OR was 1.28 with a 95% CI. There was no heterogeneity among the studies with respect to the association between RA and periodontist.
Conclusion: RA is significantly associated with increased overall risk of periodontitis. Knowledge about this may be important in reducing the risk of RA development by treating periodontitis.
Topic: Immediately Loaded vs Delayed loaded implants
Author: Al Amri M, Kellesarian S.
Title: Comparison of Peri-Implant Soft Tissue Parameters and Crestal Bone Loss Around Immediately Loaded and Delayed Loaded Implants in Smokers and Non-Smokers: 5-Year Follow-Up Results
Source: J. Periodontol. 2017; 88 (1): 3-9. doi: 10.1902/jop.2016.160427
Type: Longitudinal Study
Rating: Good
Keywords: Alveolar bone loss; dental implants; immediate dental implant loading; inflammation; periodontal index; smoking
Purpose:
To compare peri-implant soft tissue parameters and crestal bone loss (CBL)
around immediately loaded (IL) and delayed loaded (DL) implants in smokers and
non-smokers.
Methods: 61 partially edentulous patients (51m, 10f, aged 30-53yrs) were included. There were 33 smokers (defined as 1 or more cigarettes a day for 12+ months) and 28 non-smokers. Thirty-one patients were treated with IL bone level implants in the posterior mandible (16 smokers and 15 non-smokers), while 30 patients (17 smokers, 13 non-smokers) were treated with DL bone level implants. Both groups received dental implants that ranged from 12 to 14mm in length, and 3.3 to 4.1mm in diameter. Loading was performed 2 days after surgery in the IL group and 3 months in the DL group. Standardized radiographs were taken to assess crestal bone loss. Peri-implant PI, BOP and PD >4mm were recorded.
Results: Mean scores of PI and PD >4mm were SS higher in smokers compared with non-smokers in patients with IL and DL dental implants. The mean score of BOP was SS higher in non-smokers compared with smokers in both groups. Total CBL was SS higher in smokers compared with non-smokers. There was NSSD in PI, BOP, PD >4mm, and total CBL among smokers with IL and DL implants. At 5 years, the survival and success rates of all IL and DL implants were 100%.
Discussion: This is the first study to report peri-implant soft tissue parameters and CBL around IL and DL implants in smokers compared with non-smokers. All participants received cleanings 2 times a year for the duration of the study, which could help to minimize the oral soft tissue inflammation. Some limitations of this study include the fact that smokers weren’t classified by quantity and frequency of smoking. Heavy smokers may demonstrate different results from the light smokers. This study concluded that tobacco smoking enhances peri-implant soft tissue inflammation and CBL around IL and DL implants. Loading protocol did not show a SS effect on the peri-implant hard and soft tissue status in healthy smokers and non-smokers.
Topic: Obesity
Author: Wilkins L., Kaye E.
Title: Influences of Obesity on Periodontitis Progression is Conditional on Interleukin-1 Inflammatory Genetic Variation
Source: J. Periodontol. 2017; 88(1): 59-68. doi: 10.1902/jop.2016.160408
Type: Longitudinal study
Rating: Good
Keywords: Cytokines; diagnosis; genetics; obesity; periodontitis
Purpose: To evaluate whether specific patterns of IL-1 gene variants, influence the previously reported association between obesity and subsequent periodontitis progression in longitudinal database.
Methods: The study population included 292 men (29-64 YO) from the Veterans Affairs Dental Longitudinal study. This database includes DNA, dental endpoints which were collected every 3 years over 27 years. Some of the key variables assessed included: 1) periodontitis; 2) BMI; 3) Age; 4) smoking; 5) glucose tolerance; 6) waist circumference to height (WHTR) ratio for central adiposity; 7) two previously reported versions of IL-1 genetic patterns associated with periodontitis severity and progression. Disease progression was determined using predefined criteria that used a combination of change in classification of disease severity based on alveolar bone loss and tooth loss during follow-up. Statistical analysis was completed
Results: There were 2 main variations of IL-1 that were assessed (V1 and V2). Neither IL-1 genotype version was associated with baseline values of BMI, WHTR or with baseline ABL >20%. IL-1 V1 genotype was significantly associated with progression without consideration of weight-related parameters. However, in patients classified as overweight or obese, IL-1 V1 genotype-positive individuals had two-fold increased risk of disease progression. Time to onset of disease progression within the study duration was analyzed for effects of obesity-related variables and IL-1 genetic variation. In participants with high baseline central adiposity (WHTR>0.5), those who were also IL-1 V2 genotype positive exhibited earlier signs of disease progression than those who were genotype V2 negative.
Discussion: This study supports the potential value of identifying heightened risk for periodontal disease progression, including obesity-related traits and IL-1 genetic variations to predict the highest proportion of men showing advanced disease. Both measures of central adiposity and specific patterns of IL-1 genetic variation were independent risk factors for periodontal disease progression. Significant interactions were observed between IL-1 genetic variations and obesity-related traits in the prediction of disease progression.
Topic: Soft tissue
Authors: Parra C, Jeong YN, Hawley CE.
Title: Guided Tissue Regeneration Involving Piercing-Induced Lingual Recession: A Case Report.
Source: Int J Periodontics Restorative Dent. 2016 Nov/Dec;36(6):869-875. doi: 10.11607/prd.2968.
Type: Case Report
Rating: Good
Purpose: to report an application of GTR to a lingual recession periodontitis defect complicated by physical trauma from a tongue-piercing device.
Discussion: Recession on the lingual aspect of mandibular incisors may occur in patients with history of tongue piercing and other factitious traumatic habits. Treatment of these areas is challenging due to the site specific anatomical features of the region. This case report presents a technique specific for mandibular lingual defect caused by tongue piercing. Clinical presentation: the mandibular right central incisor
exhibited 4.0 mm mid- lingual gingival recession and probing depths of 2.0 mm on the mesio-, mid-, and distolingual sides. The tooth had no attached gingiva and only 0.5 mm of keratinized marginal tissue. Grade I mobility on the tooth and a 1-mm diastema between it and the left central incisor. The recession defect was classified as Miller Class III.
Phase I (presurgical phase): inflammation control through OHI, full-mouth debridement, and occlusal adjustment.
Phase II (surgical phase): Intrasulcular incision was performed on the lingual sides. The inteproximal papilla was preserved. The buccal flap was not elevated. Full-thickness elevations were made past the mucogingival junction on the lingual side. The osseous defect and exposed root surfaces were fully debrided. EDTA gel 24% was applied for 2 minutes. After thorough rinsing with sterile saline, enamel matrix derivative (EMD) was applied on the root surface. Simultaneously, DFDBA was hydrated with saline and then mixed with EMD. The combined hydrated DFDBA and EMD were applied on the bony defect. A nonresorbable titanium-reinforced high-density polytetrafluoroethylene (dPTFE) membrane
(Cytoplast) was shaped appropriately and placed over the defect extending interproximally and 2 to 3 mm mesially, distally, and apically over sound alveolar bone. The flap was coronally advanced and sutured with ePTFE 5/0 and Vicryl 5/0 sutures.
Reentry surgery for membrane removal was performed at 8 weeks. The final follow-up was 18 months. At this point it was noticed: 1.0 mm residual recession, 4 mm of keratinized tissue with 2.0 mm of attached gingiva.
Conclusion: Evidence on the treatment of lingual recessions is limited, and several different approaches have been used to correct these deformities. Because of the relatively low occurrence of lingual recessions caused by tongue ring trauma, it is unlikely that any well-designed RCTs will ever be performed to determine the optimal treatment alternative for these unique periodontal defects.
Topic: Cosmetics
Authors: Sanchez IM, Gaud-Quintana S, Stern JK.
Title: Modified Lip Repositioning with Esthetic Crown Lengthening: A Combined Approach to Treating
Excessive Gingival Display.
Source: Int J Periodontics Restorative Dent. 2017 Jan/Feb;37(1):e130-e134. doi: 10.11607/prd.3124.
Type: Case Report
Rating: Fair
Purpose: To
describe a modified lip repositioning technique performed in conjunction with
esthetic crown lengthening to correct an excessive gingival display
Discussion: This study reports a case of excessive gingival display treated by a modified combined approach. A 25-year-old woman with a 4- to 8-mm gingival display when smiling caused by a combination of short clinical crowns induced by an altered passive eruption and hypermobility of the upper lip underwent a staged esthetic crown-lengthening procedure (stage 1) followed by a modified lip repositioning technique (stage 2), after 12 weeks of healing. Modified approach for treating the hypermobile lip: the surgical area was demarcated with two elliptical forms in the vestibule, a bilateral removal of a partial thickness strip of mucosa from the maxillary buccal vestibule without severing the muscle, leaving the midline frenum intact and suturing the lip mucosa to the mucogingival line. The parallel incision lines were approximated with interrupted stabilization sutures along the borders of the incision.
Conclusion: The narrower vestibule and increased tooth length resulted in a symmetric and pleasing gingival display when smiling that remained stable over time. With proper diagnosis and sequence of therapy, this technique can be used predictably to treat excessive gingival display and enhance smile esthetics.
Topic: Platform-Switched laser-microchannel implants
Authors: Nevins, Kerr, Rasperini, Pasquinelli, Shapoff
Title: A Prospective Clinical and Radiographic Assessment of Platform-Switched Laser-Microchannel Implants Placed in Limited Interimplant Spaces
Source:
Int J Periodontics
Restorative Dent 2017;36:33–38. doi: 10.11607/prd.3109
Type:
Multicenter clinical trial -
prospective clinical study
Rating: Good
Keywords: Platform-Switched, laser-microchannel, dental implants
Purpose: To investigate the hard and soft tissue result when implants are placed < 3 mm apart to emulate the interproximal space between teeth in the esthetic zone.
Materials and methods: n=18pt, DI=38 (22 maxilla, 16 mandible)
Patient treatment was performed in eight private periodontal practices. Each patient presented with a localized edentulous ridge site requiring two dental implants placed 2 to 3 mm apart. An assembly of laser-microchannel dental (BioHorizon) implant and healing abutment was placed. The interimplant distance was < 3 mm. A periapical radiograph was taken immediately after the surgery. Clinical photograph were taken 1 year post-restoration, evaluating intact interproximal papilla and preservation of crestal bone level. Radiograph were taken 1 year post-restoration, demonstrating interproximal bone level between two implants with limited interimplant space.
Results:
Radiographic:
After 1 year of loading, the interproximal bone appeared to be at the level of the implant abutment junction for most of the implants. No significant osseous dieback was seen around 31 implants, but 4 implants lost bone to the first thread and 1 implant to the second thread.
Clinical Observation: Healing proceeded uneventful. There was minimal clinical inflammation and no evidence of postoperative infection. No soft tissue recession was observed for any implants, but 3 cases did not have 100% interdental papillae.
Conclusion: the histologic findings of the preclinical investigation with the laser-micro-channel finish on the implant-abutment complex were well supported. Radiographic and photographic evidence provide an optimistic outlook for this system. Most cases demonstrated intact interdental papillae and no loss of bone apical to the collar of the implant.
12
Topic:
Root Coverage Procedures
Authors: Santoro G, Zucchelli G, Gherlone E.
Title: Combined Regenerative and Mucogingival Treatment of Deep Intrabony Defects Associated with Buccal Gingival Recession: Two Case Reports
Source: Int J Periodontics Restorative Dent. 2016 Nov/Dec;36(6):849-857.
Type: Case report
Rating: Fair
Keywords: root coverage and regenerative procedures, biomaterials
P: The case reports presented in this article describe a surgical approach for improving root coverage and regenerative parameters in deep intrabony defects associated with buccal gingival recession. A mandibular canine and a maxillary premolar were treated.
M&M: The surgical technique consisted of a connective tissue graft (CTG) that was placed and sutured at the inner surface of a coronally advanced envelope flap (CAF), thickening the buccal soft tissue wall of the most coronal extension of the intrabony defect and treated with biomaterials as scaffold. No palatal/lingual flap was elevated.
R: Two years after the surgery, clinically significant root coverage, increased buccal keratinized tissue height and thickness, some minor improvement in the position of the interdental papilla, and clinical attachment level gain were achieved. The radiographs showed bone fill of the intrabony components of the defects.
BL: This report encourages a novel application of CAF + CTG + biomaterials to improve both esthetic and regenerative parameters in deep intrabony defects associated with gingival recessions.
Topic: Endodontic implant pathology
Authors: Chung SH, Park YS, Bae KS, Baek SH, Kum KY, Lee W, Shon WJ.
Title: Saving an Integrating Implant Involved with Endodontic Implant Pathology Using Surgical Treatment.
Source: Int J Periodontics Restorative Dent. 2016 Nov/Dec;36(6):893-898.
Type: Case report
Rating: Good
Keywords: endodontic implant pathology, endodontic implantitis, periapical lesion
BG:
Endodontic implant pathology (EIP) refers to cases in which endodontic
infections cause infections in adjacent implants, and vice versa.
P: This case report demonstrates the successful resolution of two types of EIPs, implant endodontitis and endodontic implantitis, by endodontic intervention with surgical treatment.
In case 1: the patient complained of tooth discomfort after implant placement in the adjacent tooth. The tooth was sensitive to percussion and showed slight mobility with a negative reaction
to an electric pulp test. The symptoms persisted despite conventional root canal treatment, and surgical treatment of the symptomatic tooth and implant lesion was performed.
In case 2: the patient suffered from repeated infection around a newly installed implant. The adjacent devitalized tooth exhibited a periapical lesion that was contiguous with the implant. Conventional root canal treatment and retreatment did not successfully resolve the symptoms. Surgical root canal therapy was then performed with regenerative biomaterials as needed.
D: Neither case showed radiographic or clinical evidence of failure after 4 and 5 years of follow-up, respectively, after the surgery and the adjacent implants were successfully osseointegrated.
BL: Endodontic intervention combined with surgical treatment resolved both types of EIPs and led to tooth preservation and successful osseointegration of adjacent implants.
Topic: Torque vs ISQ
Authors: Levin, Barry P
Title: The Correlation Between Immediate Implant Insertion Torque and Implant Stability Quotient
Source: Int J Periodontics Restorative Dent 2016;36:833–840. doi: 10.11607/prd.2865
Type: retrospective study
Rating: Good
Keywords: Torque, Implant stability quotient, dental implants
Purpose: to investigate whether a correlation exists between immediate implant insertion torque value (ITV) and implant stability quotient (ISQ) in nonmolar sites.
Material and methods: A total of 59 implants (OsseoSpeed EV, ASTRA TECH Implant System, Dentsply) in 52 patients were placed into extraction sockets. ITV was recorded at surgery, and ISQ was recorded at surgery and at follow- up. Implants with higher ITV and/or ISQ were evaluated at 6 to 8 weeks. An additional 4 to 6 weeks was permitted for implants with lower initial stability values.
Results: ITVs ranged from 20 to 50 Ncm with a mean of 28 Ncm. The range of ISQ values for 59 implants immediately placed into nonmolar sites was 51 to 80 with a mean of 68. All 59 implants osseointegrated and none were lost. Implant survival was 100% at the time of final restoration.
A non-significant
correlation coefficient of 0.06 could be found between the measurements at
either time point. The data suggests that there is no linear correlation between
ITV and ISQ in the measured population. In the subgroup with immediately
placed provisional crowns, there was a negative correlation between ITV and ISQ
at follow-up but it was not significant
Conclusion: The
present study failed to demonstrate a linear correlation between ITV and ISQ in
nonmolar, immediate implant placements with the selected implant system. The
findings of this study question the requirement of excessively high ITV and ISQ
for immediate temporization in the partially edentulous patient and as absolute
prerequisites for successful osseointegration after immediate implant placement.
Topic: Implants
Authors: Stocchero M, Toia M, Cecchinato D, Becktor JP, Coelho PG, Jimbo R.
Title: Biomechanical, Biologic, and Clinical Outcomes of Undersized Implant Surgical Preparation: A Systematic Review.
Source: Int J Oral Maxillofac Implants. 2016 Nov/Dec;31(6):1247-1263.
Type: Systematic Review
Rating: Good
Keywords: dental implant, primary stability, secondary stability, surgical protocol, systematic review, undersized steotomy
Purpose: To compile the current evidence on biomechanical, biologic, and clinical outcomes of undersized surgical preparation protocols in dental implant surgery.
Method: An electronic search using three different databases (PubMed, Web of Science, and Cochrane
Library) and a manual hand search were performed including in vitro, animal, and clinical studies published prior to October 2015. Studies in which an undersized drilling protocol was compared with a nonundersized drilling protocol were included.
Results: Of 1,655 titles, 29 studies met the inclusion criteria, including 14 biomechanical, 7 biologic, 6 biologic and biomechanical, and 2 clinical. Due to methodologic variation, meta-analysis was not performed. Several studies showed that implants inserted with an undersized drilling approach reached a significantly higher insertion torque value than conventional drilling in low-density substrates, while this effect is less evident if a thick cortical layer is present. Similar results in terms of bone-to-implant contact (BIC) were achieved in the longer term between implants inserted with undersized and nonundersized protocols. Results in the short term were inconclusive. Clinical studies did not show negative outcomes for undersized drilling, although clinical evidence was sparse. No data are available on marginal bone loss.
Conclusion: From the biomechanical standpoint, an undersized drilling protocol is effective in increasing insertion torque in low-density bone. Biologic response in long-term healing after undersized implant placement is comparable to that in the nonundersized surgical drilling protocol. Clinical studies indicate that performing an undersized drilling protocol on low-density bone is a safe procedure; however, more extensive studies are needed to confirm these data.
Topic: Implants
Authors: Lee PK, Siu AS.
Title: A Two-Year Evaluation of a Sloped Marginal Contour Implant System Placed in Healed Sites.
Source: Int J Oral Maxillofac Implants. 2016 Nov/Dec;31(6):1423-1428
Type: Clinical
Rating: Good
Keywords: dental implant, marginal bone, sloped marginal contour
Purpose: The purpose of this clinical trial was to evaluate the survival rate, bone remodeling, and soft
tissue health around sloped marginal contour implants when placed in healed sites posteriorly in the
mouth.
Method: Osseospeed TX Profile Implants were placed in healed sites at premolar and molar regions.
After a 3-month osseointegration period, definitive prostheses were connected. Clinical and radiographic
examinations were performed at implant placement and then 1, 3, 6, 12, and 24 months after implant
placement. An assessment of implant stability, peri-implant mucosa, level of attached gingivae, occlusion,
proximal contact, and marginal bone levels was performed at each respective visit.
Results: 14 patients were treated and restored with 18 single crowns. The cumulative survival rate was
100% after 2 years. The mean marginal bone remodeling was 0.04 ± 0.26 mm (n = 18). The attached
gingival change was +0.33 ± 0.35 mm.
Conclusion: The 24-month results indicate that the sloped marginal contour implant performed well in
posterior healed sites with a 100% survival rate and good marginal bone maintenance.
Topic: sleep apnea and perio
Authors: Gamsiz-Isik H, Kiyan E, Bingol Z, Baser U, Ademoglu E, Yalcin F
Title: Does Obstructive Sleep Apnea Increase the Risk for Periodontal Disease?
Source: J Periodontol. 2016 Nov 18:1-8. DOI: 10.1902/jop.2016.160365
Type: case-control
Rating: fair
Keywords: Sleep apnea, obstructive; cytokines; gingival crevicular fluid; periodontal-systemic disease interactions; periodontitis
Background:
A possible association between periodontitis and obstructive sleep apnea (OSA)
has been suggested. OSA is a common disease characterized by recurrent
obstruction of the upper airway during sleep. Excessive daytime sleepiness,
snoring, witnessed apnea, insomnia, and lack of concentration are the most
common symptoms of OSA
Purpose: The aim of this study was to compare periodontitis prevalence between control and OSA patients by assessing clinical periodontal parameters and the levels of gingival crevicular fluid (GCF) interleukin-1 beta (IL-1β), tumor necrosis factor alpha (TNF-α), high-sensitive C-reactive protein (hs-CRP) and serum hs-CRP.
Methods: A case-control study was performed that included 163 individuals: 83 individuals (18 females; 65 males) with OSA and 80 non-OSA individuals (23 females; 57 males) as controls. The test group was classified according to OSA severity. Demographic features such as age, gender, BMI, and smoking status were homogenously matched between OSA patients and the controls to limit the effect of patient-related factors. Clinical periodontal measurements (PI, GI, CAL, PPD, BOP) were recorded, and gingival crevicular fluid (GCF) samples were collected. GCF hs-CRP, IL-lβ and TNF-α levels were analyzed using an enzyme-linked immunosorbent assay (ELISA) method. Serum hs-CRP was measured by latex-enhanced immunoturbidimetric assay.
Results: The prevalence of periodontitis in the OSA group (96.4%) was significantly higher than in the control group (75%), (p<0.001). Severe periodontitis prevalence was higher in the OSA group than in the control group. All periodontal clinical parameters and GCF IL-lβ concentrations were significantly higher in patients with OSA than in the controls (p=0.001). No significant differences were found between mild OSA group and severe/moderate OSA group. Additionally, there was no significant difference in GCF TNF-α and hs-CRP levels between the groups (p>0.05). The serum hs-CRP levels were significantly higher in OSA patients. A significant correlation was found between GCF IL-1β and all clinical parameters.
Discussion: In OSA, mouth breathing may cause drying of the oral cavity, and this symptom may lead to an increase of bacterial colonization in the oral cavity. Due to the sleepiness experienced by these patients and the subsequent reduction in their daily comfort, daily stress increases. Both a dry mouth and increased stress are risk factors for periodontal diseases.
Conclusion: The results demonstrated a higher prevalence of periodontitis and higher levels of GCF IL-1β and serum hs-CRP in OSA patients. However, there is still a need for randomized clinical trials testing oral care interventions.
Topic: fluvastatin and osteoclast activity
Authors: Pokhrel NK, Kim YG, Kim JY, Kim HH, Lee Y
Title: Fluvastatin Inhibits Osteoclast Differentiation and P. gingivalis lipopolysaccharide-Induced Alveolar Bone Erosion in Mice
Source: J Periodontol. 2016 Nov 18:1-14. DOI: 10.1902/jop.2016.160536
Type: in-vitro and in-vivo on mice
Rating: good
Keywords: fluvastatin, osteoclasts, cell differentiation, alveolar bone loss.
Background: Statins have been widely used to treat hypercholesterolemia. In addition to the inhibition of cholesterol synthesis, recent reports suggest bone anabolic property of statins. However, the direct effect of statins on osteoclastogenesis and bone resorption has not been thoroughly assessed.
Methods: The effect of fluvastatin on osteoclast differentiation was determined using in vitro culture of mouse bone marrow macrophages (BMMs) in the presence of macrophage colony-stimulating factor (M-CSF) and RANKL. The role of fluvastatin on bone erosion was examined in vivo in the P. gingivalis lipopolysaccharide (LPS)-induced alveolar bone loss model in mice; 28 seven-week old mice, test groups received intraperitoneal fluvastatin injections on day 1, 4, and 7. On days 4 and 7 they were injected with P. gingivalis LPS at the gingiva of lower left second molars. Sacrificed on day 10. Number of osteoclasts, eroded bone surface per bone surface and lacunar surface were recorded.
Results: Fluvastatin significantly inhibited both RANKL- and LPS-induced osteoclast differentiation in mouse BMMs. Fluvastatin also markedly reduced the expression of osteoclast differentiation marker genes (Acp5, Calcr, and Ctsk) as well as fusion markers (Atp6v0d2 and Dcstamp). These were accompanied by the decreased expression of transcription factors (c-Fos and NFATc1). Fluvastatin reduced the generation of reactive oxygen species (ROS) upon the addition of RANKL and LPS, suggesting an anti-oxidant role. Finally, the administration of fluvastatin in mice conspicuously reduced P. gingivalis LPS-induced osteoclastogenesis and alveolar bone erosion in vivo.
Conclusion: These results suggest that fluvastatin directly inhibited osteoclastogenesis and efficiently blocked bone erosion.
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