International Journal of Periodontics & Restorative Dentistry, 04/2002

This study measured bone height under a fixed detachable cantilever restoration supported by five or six endosseous implants in 60 consecutively treated patients. Panoramic films were made at surgery and 1, 2, 3, and 4 years postrestoration. A computer-enhanced method was used to measure mandibular height 5, 10, 15, and 20 mm distal to the last implant, which was used as a length standard to correct for variation in film magnification. Implant restoration resulted in a significant growth of the mandible (baseline: 7.25 ± 0.25 mm, 4 years: 8.18 ± 0.18 mm; P = .05). The growth in dimension appears to occur during the first year of function.

Young, systemically healthy subjects may suffer from early-onset forms of periodontitis characterized by the presence of localized deep vertical bony defects. The aim of this study was to compare the healing response after guided tissue regeneration (GTR) treatment of similar intrabony defects in patients affected by early-onset and chronic adult periodontitis. Twenty systemically healthy, nonsmoking subjects were enrolled in the study; 10 were affected by early-onset periodontitis (EOP) and 10 by chronic adult periodontitis (CAP). In each subject, only one deep vertical bony defect (intrabony component > 4 mm, probing attachment level ¡Ý 8 mm) was treated according to the principles of GTR therapy with titanium-reinforced e-PTFE membranes. At the time of the surgery and at the 1-year follow-up, a microbiologic test for the identification of the main periodontopathogens was performed in each of the treated sites. There was no statistically significant difference at 1 year in the amount of clinical attachment gain (P = .4), reduction of probing pocket depth (P = .3), or increase in gingival recession (P = 1.0) between EOP and CAP patients. The 1-year microbiologic results demonstrated the complete disappearance of the putative periodontopathogens fromYoung, systemically healthy subjects may suffer from early-onset forms of periodontitis characterized by the presence of localized deep vertical bony defects. The aim of this study was to compare the healing response after guided tissue regeneration (GTR) treatment of similar intrabony defects in patients affected by early-onset and chronic adult periodontitis. Twenty systemically healthy, nonsmoking subjects were enrolled in the study; 10 were affected by early-onset periodontitis (EOP) and 10 by chronic adult periodontitis (CAP). In each subject, only one deep vertical bony defect (intrabony component > 4 mm, probing attachment level ¡Ý 8 mm) was treated according to the principles of GTR therapy with titanium-reinforced e-PTFE membranes. At the time of the surgery and at the 1-year follow-up, a microbiologic test for the identification of the main periodontopathogens was performed in each of the treated sites. There was no statistically significant difference at 1 year in the amount of clinical attachment gain (P = .4), reduction of probing pocket depth (P = .3), or increase in gingival recession (P = 1.0) between EOP and CAP patients. The 1-year microbiologic results demonstrated the complete disappearance of the putative periodontopathogens from all surgically treated sites in both patient groups. The results of the study demonstrated that deep intrabony defects in patients with EOP can be successfully treated by means of GTR procedures and that the suppression of periodontopathogens under threshold values can be maintained for at least 1 year, provided that the patient is enrolled in a maintenance program consisting of recalls for professional tooth cleaning and reinforcement of self-performed oral hygiene measures at 1-month intervals. (Int J Periodontics Restorative Dent all surgically treated sites in both patient groups. The results of the study demonstrated that deep intrabony defects in patients with EOP can be successfully treated by means of GTR procedures and that the suppression of periodontopathogens under threshold values can be maintained for at least 1 year, provided that the patient is enrolled in a maintenance program consisting of recalls for professional tooth cleaning and reinforcement of self-performed oral hygiene measures at 1-month intervals.

Alveolar ridge defects resulting from tooth extraction, trauma, or periodontal disease often require surgical correction prior to prosthodontic reconstruction. Whether implants or conventional fixed prostheses are planned, without careful consideration and proper treatment planning, hard and/or soft tissue defects may lead to functional, structural, or esthetic compromises in the final prosthesis. This article reviews the etiology and treatment of alveolar ridge defects and introduces a therapeutically oriented classification system of such defects (horizontal, vertical, and combination-HVC-classification). In addition, a decision-making guide for approaching each defect type will be discussed, and clinical examples of treated cases will be presented.

A growing number of clinical studies show that early (2 months) and immediate loading protocols may be predictable. However, they are based on clinical stability only. The aim of this case report was to document the osseointegration status of two Osseotite implants after 2 months of healing in soft bone corresponding to type IV and subjected to two distinct mechanical environments. A completely edentulous patient received a total of 11 Osseotite implants in the mandible. Six were immediately loaded to support a provisional fixed partial denture, and five were left submerged. After 2 months, two submerged and one immediately loaded implants were retrieved and processed for histologic analysis. All immediately loaded implants were clinically stable. One histologic section per implant was obtained. All implants achieved osseointegration. The bone-implant contact was 38.9% for the submerged implant and 64.2% for the immediately loaded one. In the marrow space, both implants were covered by thin, neoformed bone trabeculae. Osseointegration can be achieved after 2 months by Osseotite implants placed in soft bone in the mandible either when immediately loaded and splinted into a provisional denture retained on six implants, or when submerged and unloaded.

This study was undertaken to measure physical properties of materials used for direct core buildups, including high-copper amalgam, visible light-cured resin composite, autocured titanium-containing composite, polyacid-modified composite, resin-modified glass-ionomer, and silver cermet cement. Compressive strength, diametral tensile strength, and flexural strength of six core materials of various material classes were measured for each material as a function of time up to 3 months at different storage conditions, using a standard specification test designed for the materials. Three different storage conditions (dry, humid, wet) at 37°C were chosen. Materials were manipulated according to manufacturers' instructions for use as cores. Mean compressive, diametral tensile, and flexural strengths with associated standard deviations were calculated for each material. Multiple comparison and Newman-Keuls tests discerned many differences among materials. All materials were found to meet the minimum specification requirements, except in terms of flexural strength for amalgam after 1 hour and the silver cermet at all time intervals.

Clinicians often encounter osseous defects that are best treated by conventional surgical techniques, including bone grafting and guided tissue regeneration, with a goal of establishing a new connective tissue attachment. On occasion, the recognition of an infrabony defect proximal to a tooth with a large diastema may present an opportunity to consider resolution by orthodontic tooth movement. Ideally, the tooth could be moved in the proximal direction until there was no further radiographic or clinical evidence of the predisposing defect. The authors decided to treat an advanced case of adult periodontitis, with extrusion and migration of a maxillary central incisor, using a multidisciplinary approach. Radiologically, a large infrabony defect was present on the mesial aspect of the incisor, with an initial probing depth of 9 mm. After the surgical periodontal therapy, the orthodontic movement started and the incisor was repositioned using an intrusive mechanism, also leading to the closure of the diastema. At the end of the treatment, there was a significant clinical decrease in the probing depth values, and radiographs showed a remarkable reduction of the infrabony defect volume.

A classification system for connective tissue graft incisions is proposed. It categorizes the design of the palatal incision into three classes. In addition to the basic classification, two subclasses are mentioned in this article. Additional descriptions are included to further define the incision design. The use of such a classification should assist future communication among clinicians and researchers. This article presents representative clinical cases to aid the clinician in applying the classification for incision design from the palatal site.

The purpose of this study was to histologically evaluate furcation defects in humans treated with an allograft-alloplast-tetracycline composite graft combined with an absorbable membrane for guided tissue regeneration (GTR). Three teeth with Class II furcation involvement on the buccal aspects were included in this study. A notch was placed in calculus during the procedure to serve as a reference point for histologic evaluation. The defects were then treated with an allograft- alloplast-tetracycline composite graft combined with an absorbable membrane for GTR. At 6 months postoperative, the teeth were extracted with conservative block sections and processed for histologic evaluation. Regeneration (new bone, cementum, and connective tissue attachment) coronal to a notch could be seen in one of the three defects treated. In the other two defects, a new connective tissue attachment was demonstrated (new connective tissue attachment into new cementum) in the notch placed in calculus. In this study, regeneration of a furcation defect in a human was documented with histology.

The purpose of this study was to investigate the effect of porous xenographic bone graft (Bio-Oss) with a collagen barrier membrane (Bio-Gide) on formation new cementum and new bone in experimental intrabony defects of dogs. The intrabony defects were treated by either guided tissue regeneration with the collagen membrane (control group) or the collagen membrane with the porous bone mineral graft (experimental group). After 8 weeks, the animals were sacrificed and the tissues were histologically examined. New cementum with inserting collagen fibers was observed on the exposed surfaces in both groups. The amount of new bone was significantly greater in the group using the bone graft with the membrane than in the control group. The use of the collagen barrier membrane in combination with the porous bone graft material may enhance new bone and cementum formation.

The purpose of this study was to evaluate the effect of early loading of Osseotite dual acid-etched commercially pure titanium dental implants in an established baboon model. Implant sites were prepared by removal of premolars and first molars at maxillary and mandibular sites in 10 adult female baboons (Papio anubis). The resultant edentulous ridges were allowed to heal for 6 weeks. Following the placement of 80 implants, 2- mm healing abutments were placed on each implant and protruded through the mucosa after flap closure. Each implant was functionally loaded with a single crown after either 1 month (n = 40) or 2 months (n = 40) of implant healing. All implants were removed in block section after 3 months of functional loading and prepared for histologic evaluation. Photographs of histologic slides were digitized for data collection. The amount of osseous tissue contact along the implant surface in the buccolingual plane was determined using image analysis. The fraction of direct bone-tissue contact along a standardized region of each implant perimeter was calculated and compared using analysis of variance. Implants loaded after 1 month of healing had a mean of 76.6% ± 14.4% bone contact, and implants loaded after 2 months of healing had a mean of 77.2% ± 12.2% bone contact. Statistically, the 1- and 2-month groups were similar (P = .81). No implant failures were observed in either treatment group. Reducing the surgical healing time from 2 months to 1 month did not statistically affect the amount of bone observed at the tissue-implant interface in baboons under functionally loaded conditions.