International Journal of Periodontics & Restorative Dentistry, 03/1997

Radiographic examinations in connection with implant installation are important means to diagnose changes in the bone tissue following implantation. During the healing and early remodeling phases, a slight reduction of the marginal bone height occurs in the first year after implantation, which is followed by an even smaller annual mean loss in bone height. Conventional radiographs, however, are of limited value for reliable assessment of subtle alveolar bone changes, although methods were developed to standardize the projection geometry of serial radiographs from implants to improve the accuracy in detecting changes of the peri-implant bone height. Newer radiographic diagnostic methods should not only comprise the possibility of metric assessment of bone height but also further information on changes in density. This report emphasizes the potential of digital subtraction radiography as a sensitive diagnostic tool in peri-implant diagnosis. Minute peri-implant density changes may occur in the healing phase after implant installation, after loading, and during the maintenance phase.

The objective of this study was to determine the predictability of endosseous implants placed in a maxillary sinus grafted with a mixture of bovine porous bone mineral and demineralized freeze-dried bone. Sixty implants were placed in 20 patients representing 28 sinuses using either a one- or two-stage technique. After an implant loading period of more than 2 years, the survival rate (eg, a clinically functioning implant without signs of mobility or infection) varied from 90% to 96%. No infections or other complications were encountered. The data suggest that this treatment regimen can result in a high rate of survival.

The purpose of the present study was (1) to examine smear layer formation following different root planing modalities, and (2) to evalute its removal and the exposure of collagen using an ethylenediaminetetraacetic acid gel preparation. Twenty-four periodontitis-affected human teeth were mechanically root planed. Twelve teeth were etched with an ethylene-diaminetetraacetic acid gel preparation. The surfaces were examined by a scanning electron microscope. The results showed that root planing resulted in a smear layer covering the root surfaces, irrespective of treatment modality. The smear layer could be efficiently removed with the ethylene-diaminetetraacetic acid gel preparation. During this process, collagen fibers were exposed to varying degree

The aim of this study was to determine the effect of subgingival scaling and root planing on healing of the distal surface of second molars following extraction of third molars. Twenty-eight patients with contralateral erupted third molars and pocket depths greater than or equal t o 3 mm on the distal surface of the second molars part icipated in this study. Measurements of supragingival bacterial plaque, bleeding on probing, pocket depth, and relative attachment level were performed at baselineand 2 months after treatment. Extraction of contralateral third molars was carried out simultaneously. The experimental site received thorough scaling and root planing of the distal surface of the second molar, while the control site received extraction alone. Experimental sites showed significant improvement in all clinical parameters assessed compared to the control sites. In conclusion, periodontal lesions on the distal of second molars can be significantly improved following scaling and root planing afte r extraction of third molars.

Connective tissue grafts have become an important part of periodontal reconstructive surgery. There are several techniques available to harvest a suitable connective tissue graft. In this study, two techniques for obtaining a connective tissue graft were compared. The techniques examined were the free gingival graft knife method and the parallel incisions method. The connective tissue grafts were used in a root coverage procedure: the connective tissue with partial thickness double pedicle graft technqiue. No statistically significant difference in the mean root coverage was detected when comparing the results produced by these graft harvesting techniques (98.3% to 98.7%). Root coverage of 100% was obtained in 84.2% of the cases treated with the free gingival graft knife method and in 93.3% of the cases treated with the parallel incisions method. Additionally, the parallel incisions method produced less patient discomfort, a smaller wound at 1 week postoperative, a more uniform graft, and was easier to use clinically. Based on this study, the parallel incision method meets more of the goals of an ideal technique for harvesting a connective tissue graft than the free gingival graft knife method.

The placement of endosseous implants in the atrophic posterior mandible has presented a challenge to the surgeon and restorative dentist. Traditional procedures eithe rrequire nerve transposition or utilization of implants placed at less than favorable angles. A technique is presented for the three-dimensional augmentation of the atrophic alveolar ridge utilizing microplate-enhanced guided bone regeneration technology. The applications of this technique in other intraoral and extraoral sites are currently under investigation by the authors.

The purpose of this study is to confirm histologically whether a new attachment can be obtained around a tooth by guided tissue regeneration using bioresorbable barrier. The test tooth was a maxillary molar with an intrabony pocket. At reentry 5 months after periodontal surgery, a hard, whitish, blood-free tissue was found to fill the original defect. Histologic analysis revealed presence of new bone, cementum, and periodontal ligament compatible with the expected histologic result of guided tissue regeneration techniques with barrier membrane.

Guided bone regeneration procedures were carried out around 1,503 implants, including 237 that were noted in a previous publication, using Gore-Tex membranes over deminerali zed freeze-dried bone allograft, freeze-dried bone allograft, an equal combination of htese, or demineralized freeze-dried bone allograft combined with equal parts of resorbable tricalcium phosphate. Comparison of findings at the time of clinical reentry and preoperative photographs and measurements yielded an overall success rate of 97.0% in the treatment of dehisced or fenestrated implants or fixtures placed in immediate extraction sockets. Success was defined as the presence of regenerated hard tissue covering all previously exposed implant surfaces (complete success) or as the presence of two threads or 2 mm or less of residual dehiscence (partial success).