International Journal of Periodontics & Restorative Dentistry, 05/2005

The aim of this report was to describe the bone tissue response to Brånemark oral implants retrieved from patients. The material consisted of consecutively received Brånemark threaded oral implants and related patient data provided by clinicians. The implant samples were processed into undecalcified sections for evaluation under the light microscope. The analysis demonstrated a lower percentage of bone-to-implant contact for the unloaded implants as compared to the loaded implants. When the threads were divided into four different regions, the loaded implants had a lower percentage of bone-contacting length at the thread top as compared to the other three regions.

The aim of the present clinical study was to evaluate the placement of transmucosal implants into fresh extraction sockets and their immediate restoration with temporary crowns. A series of 22 cases with a 12-month follow-up is presented. Twenty-two patients (15 women and 7 men; mean age 39 years) who needed a single tooth replaced because of vertical or horizontal root fracture, caries, endodontic lesions, or periodontal disease were treated with immediate postextraction implant placement. The implant was then restored with a screw-retained prosthetic restoration within 24 hours. Radiographic assessments were made at baseline and 12 months after implant placement. Clinical parameters, such as plaque score, mucositis score, probing attachment level, mucosal margin position, variation of gingival level, and variation of papilla position, were also measured at baseline and after 12 months of follow-up. At 12 months, no implants had failed. Radiographic examination revealed mean bone resorption of 0.5 mm at 12 months compared to baseline. The mean variation of gingival level, compared to the neighboring teeth, was -0.75 mm. Probing attachment levels were 0.79, 0.45, and 0.54 mm at proximal, buccal, and lingual sites, respectively. The values for the mucosal margin position were 2.9, 2.2, and 2.4 mm at proximal, buccal, and lingual sites, respectively. Regarding variation of papilla position, according to Jemt's index, 27 papillae presented with a score of 2 (61%) and 17 with a score of 3 (39%). An examination of oral hygiene and peri-implant soft tissue conditions at the 12-month follow-up visit revealed an overall frequency of plaque-carrying implant surfaces of 13%. Furthermore, mucositis (score 2) was not observed at any of the peri-implant units. Primary implant stability did not significantly increase over time. The immediate restoration of dental implants placed into fresh extraction sockets was shown to be a safe and predictable procedure. The success rate and radiographic and clinical results were comparable to those obtained following the standard protocol. Within the limits of the present investigation, immediate restoration of single-tooth implants placed in fresh extraction sockets can be considered a valuable option to replace a missing tooth. However, long-termclinical trials are needed to confirm the present results.

The goal of this study was to evaluate the incidence and severity of the complications that occur after connective tissue grafts are used. Five hundred consecutively treated patients, for whom connective tissue grafts were used for root coverage or gingival augmentation, were included in this study. Complications did occur, but the rates and intensities seemed clinically acceptable. There was no pain reported in 81.4% of the patients, no bleeding in 97.0% of the patients, no infection in 99.2% of the patients, and no swelling in 94.6% of the patients. None of the factors evaluated in this study were associated with a statistically significant increase in the rate or intensity of complications. These factors included: age, sex of patient, smoking status, purpose of the graft (ie, for root coverage or for gingival augmentation), size of the recipient area, and the location of the defect being treated. Based on the results of this study, the incidence and severity of complications seemed to be clinically acceptable.

The aim of this prospective multicenter controlled clinical study was to evaluate the efficacy of Emdogain (Biora), an enamel matrix derivative (EMD), when combined with surgical treatment of periodontal angular defects, as compared to surgery alone, for up to 24 months of follow-up. The study was performed at six Italian universities and 11 private practices. Patients with one-, two-, or three-wall angular defects were enrolled if intrabony defect depth (IBD) was 4 mm or more and probing pocket depth (PPD) was at least 6 mm. They were randomly allocated to either test or control groups. The test group was treated by the simplified papilla preservation (SPP) flap plus Emdogain after root conditioning with ethylenediaminetetraacetic acid. The control group was treated by SPP alone. Plaque Index, Gingival Index, PPD, and periodontal attachment level (PAL) at surgical sites were assessed at the presurgical examination (baseline). IBD was measured intraoperatively after debridement. IBD was also evaluated with a computeraided technique, from periapical radiographs. Plaque Index, Gingival Index, PPD, PAL, and IBD were assessed at 12 and 24 months postsurgery. Data were further divided in two subgroups according to baseline IBD (6 mm or less and more than 6 mm). The differences between each follow-up and baseline, and between groups at each follow-up, for the above parameters were evaluated by standard statistical methods. One hundred fifty-three patients were recruited, accounting for 195 intrabony defects: 83 patients (108 defects) and 70 patients (87 defects) were allocated to the test and control groups, respectively. All parameters were improved at both 12 and 24 months, compared to baseline in both groups. In the test group, IBD, PPD, and PAL at 12 months were significantly better than these parameters in the control group. The test subgroup with IBD of more than 6 mm at baseline displayed a better outcome when compared to the 6 mm or less IBD subgroup. No significant adverse events related to the use of Emdogain were reported. The use of EMD as an adjunct to periodontal surgery in the treatment of angular defects significantly enhanced the rate and degree of periodontal regeneration. The control group also displayed significant tissue regeneration, but at a slower rate compared to the Emdogain group. The surgical procedure itself, with its goal of maximum preservation of the regenerative potential of periodontal tissues, proved to be effective in the treatment of periodontal angular defects. Pockets with IBD greater than 6 mm showed major improvement when treated with Emdogain.

In some periodontal cases, biomechanical, esthetic, medical, or economic concerns make it difficult for clinicians to employ either traditional therapy or restoration with an implant-supported prosthesis. To avoid any compromise and ensure a good result in such cases, we chose a removable telescopic prosthesis on natural teeth. In this paper we present a new clinical and technical method for the telescopic prosthesis, and we show that this is a predictable, reliable solution that is easy to realize, inexpensive, and comfortable for patients.

A modified surgical approach to interproximal guided tissue regeneration procedures (GTR) was used when anatomic conditions at the defect-associated interdental area rendered papilla preservation techniques very difficult. The main goal of this study was to evaluate the effectiveness of the papilla amplification flap (PAF) in obtaining and maintaining primary soft tissue closure of the interdental space above nonresorbable, titanium-reinforced, expanded polytetrafluoroethylene (e-PTFE) membranes and to quantify the regenerative outcomes obtained using this procedure. Seventeen patients with one deep intrabony defect associated with a narrow interproximal space were selected for this case-series clinical study. The application of the PAF in combination with e-PTFE membranes resulted in clinically and statistically highly significant gains in clinical attachment levels (4.7 ± 1.4 mm) and reductions in probing pocket depth (6.3 ± 1.3 mm) after 1 year. Primary soft tissue closure of the interdental space was obtained in 100% of cases after completion of the surgery and maintained in 65% of cases during the initial healing period (6 weeks). Results from the present study indicate that the PAF can be considered a suitable soft tissue surgical approach for GTR treatment of intrabony defects when papilla preservation techniques are not recommended because of unfavorable local anatomic conditions interproximally.

The possibility of restorative inaccuracies increases with the number of impressions taken and subsequent models poured. Herein we describe a unique, splinted, dual-arch pick-up impression technique using abutment components instead of transfer copings. In our experience, this permits the fabrication of a definitive restoration as a result of a single impression.

To minimize the number of implant surgical procedures, a total of 72 singlestage, transgingival Frialoc implants (Friadent) were placed in the mandibles of 18 patients who required implant restoration. The patients' ability to undergo surgical implant treatment was restricted because of either poor general medical health or psychologic conditions. All implants were immediately loaded with a bar-retained overdenture. Only 4 of the 72 immediately loaded Frialoc implants (in one patient) failed over a control period of 29 months. The cumulative implant survival rate was 94.4%. Apart from an initial increase in bone resorption at two posterior implants supporting a cantilever bar (the cantilevers were removed 13 months after delivery of the prosthesis) and serious lip swelling in one patient, there were no further serious surgical, prosthetic, or general medical problems during the treatment period. The initial results of the study indicate that the single-stage Frialoc System allows fast prosthetic mandibular restorations. Because there is only one operation, the risk of local or general health complications in compromised patients is reduced.

This study was performed to evaluate the effect of deproteinized bovine porous bone mineral (BBM) and BBM-collagen (BBMC) used alone or in combination with a bilayer collagen membrane in guided periodontal regeneration. In 12 dogs, contralateral surgical circular fenestration defects 5 mm in diameter were produced at the midbuccal aspect of the alveolar bone in 24 maxillary canines. Bone, periodontal ligament, and cementum were completely removed. Experimental sites were filled with BBM or BBMC. Bilayered collagen membranes covered half the experimental sites (BBM+M and BBMC+M), and the other half were left uncovered. Control sites remained empty; half were covered with collagen membranes (cont+M) and the underlying space spontaneously filled with blood, and half were left uncovered (cont). Three months postsurgery, undecalcified sections were prepared. Measurements were made using a caliper on a projection microscope, and the surface area of new bone and BBM particles within the healed surgical defect was evaluated using the point-counting method. In the experimental defects, new cementumcovered 31% to 67% of the exposed dentin, with a significant difference between defects covered with membranes and defects that were not covered (P .05). New cementum in the control (unfilled) defects also differed significantly between covered and uncovered defects. New bone growth presented a pattern similar to the cementum. There was no statistical difference between defects treated with BBM and BBMC, within both covered and uncovered groups. There was less connective tissue in the covered defects than in the uncovered defects (P .05). The defects were filled with new bone, new connective tissue/bone marrow, and bovine bone particles. New bone area fraction was 23.4% to 25.2% in defects filled with BBMC and BBM, respectively (P = NS). Bone fraction area in membranecovered defects ranged from 34.4% to 36.8% in experimental defects (P = NS). All membrane-treated defects showed higher values for bone area fraction in comparison to the uncovered control defects. Particle area fraction ranged between 17.4% and 26.2%, with only BBMC and BBM+Mdefects showing a statistically significant difference (P .05). Defects filled with submembranous blood clot exhibited significantly more new cementumand bone regeneration than experimental defects filled with BBM or BBMC. Treatment of defects with BBM or BBMC showed similar influences on bone and cementum regeneration in fenestration periodontal defects. The presence or absence of bilayered collagen membranes was the predominant factor influencing bone and cementum regeneration.