International Journal of Periodontics & Restorative Dentistry, 05/2020

The purpose of this retrospective study was to evaluate bone level stability around 441 mandibular and 350 maxillary molar implants, placed using an immediate implant protocol, that had been in function from 2 to 17 years postrestoration (mean: 9.9 years). Independent radiographic measurements using the known distance between threads on the specific implant that was used indicated a mean bone loss of 0.27 ± 0.68 mm around maxillary implants and 0.27 ± 0.67 mm around mandibular implants. Maxillary implants showed a statistically significant (SS) difference in bone loss on the mesial (0.20 mm) compared to the distal side (0.34 mm). In the mandibular group, there was an SS difference in bone loss around implants with wide (≥ 5 mm) and regular ( 5 mm) diameters. There was also an SS difference in bone loss in patients 50 years and older (0.28 mm) compared to patients younger than 50 (0.18 mm). In both groups, there were no SS differences in bone loss between machined- and rough-surface implants, men and women, single and splinted implants, nonsmokers and light/heavy smokers, or in patients with a penicillin allergy who were prescribed azithromycin as an alternate prophylactic antibiotic. All SS differences found in variables evaluated in the study were 1.0 mm and therefore were considered clinically insignificant.

This in vivo study assessed calcium hydroxide's effect as a matrix carrier for recombinant human platelet-derived growth factor (rhPDGF) and enamel matrix protein (EMD) on pulp tissue healing following pulp capping. Intact premolar sites (n = 18) were included. Coronal access and pulpotomy were performed, and each tooth was exposed to the oral cavity for 1 hour before pulp capping was performed. Teeth were randomly assigned to one of the following pulp-capping groups (n = 6 each): Group 1 (CaOH2 only); Group 2 (CaOH2+EMD); and Group 3 (CaOH2+rhPDGF). Coronal access cavities were then sealed. Immediate preoperative, postoperative, and 4-month follow-up radiographs were taken. At 4 months, teeth were extracted atraumatically and histomorphometric and micro-CT analyses were performed. Group 1 showed formation of thin, uneven, highly porous dentin-like structure with tunnel defects (average thickness: 0.18 to 0.19 mm). Lack of continuity of the newly formed tissue and interrupted communication tunnels were seen between the pulpal space and pulp-capping material. Group 2 showed formation of highly dense, nonporous, even-thickness dentin-like structure obliterating multiple areas of the pulp space (average thickness: 0.9 to 0.94 mm). Abundant odontoblast lacunae were present in the pulp and structure. Group 3 showed formation of an inconsistent, uneven dentin-like structure that appeared highly porous (average thickness: 1.04 to 1.05 mm). It was without tunneling, and abundant odontoblastic lacunae were present. No statistically significant differences were found between Groups 2 and 3, but both were richer in newly formed dentin-like structure with more thickness than Group 1 (P .05). Addition of EMD to CaOH2 can result in multiple root canal calcifications, mostly in the coronal and apical thirds of the canals. The calcified tissue does not appear to resemble secondary dentin in form, shape, amount, or density. Addition of rhPDGF to CaOH2 may not cause root canal calcifications. The newly formed structure differs from secondary dentin in degree of mineralization, porosity, and density.

The goal of the present study was to evaluate human histologic healing of dental implants with a unique triangular neck design that is narrower than the implant body. Four patients in need of full-mouth reconstruction were recruited and received several implants to support a full-arch prosthesis. In each patient, two additional customized reduced-diameter implants were placed, designated to be harvested after 6 months of submerged healing. The eight harvested implants were all placed in healed edentulous maxillary or mandibular ridges. These implants were Ø 3.5 × 8 mm in size, and the final osteotomy drill allowed for the creation of a gap up to 0.2 mm in size between the coronal aspect of the triangular implant neck and the surrounding bone. At the end of the healing period, the implants were retrieved with the surrounding bone. Microcomputed tomography (μCT) was performed before processing the biopsy samples for undecalcified histologic exampination. Bone-to-implant contact (BIC) was measured from the μCT data and from buccolingual/buccopalatal and mesiodistal central histologic sections. All implant gaps were filled by mature remodeled bone. The mean BICs of the BL/BP and MD sections were 64.45% ± 6.86% and 65.39% ± 10.44%, respectively, with no statistically significant difference. The mean 360-degree 3D BIC measured all over the implant surface was 68.58% ± 3.76%. The difference between the BIC measured on the μCT and on the histologic sections was not statistically significant. The positive histologic results of the study confirmed the efficacy of this uniquely designed dental implant.

Orthodontic extrusion (OE) is an orthodontic tooth movement in a coronal direction to modify the tooth position and/or induce changes on the surrounding bone and soft tissue with a therapeutic purpose. Evidence emanating from clinical reports and case series studies indicates that OE is a predictable treatment option to manage a variety of clinical situations. Common indications include traction of impacted teeth, exposure of teeth presenting structural damage to facilitate restorative therapy, treatment of periodontal bony and papillary defects, and implant site development. Unfortunately, there is a paucity of established protocols and guidelines for its application in clinical practice. Controversy exists in regard to the definition of rapid and slow OE, use of circumferential supracrestal fiberotomy, and tooth stabilization protocols during and upon completion of orthodontic movement. This article provides a concise perspective on the topic of OE by discussing key biologic principles and technical aspects that are translated into guidelines for the management of different clinical scenarios.

This study aimed to determine the prevalence and diversity of archaea and select bacteria in the subgingival biofilm of patients with peri-implantitis in comparison to patients with unaffected implants and patients with periodontitis. Samples of subgingival biofilm from oral sites were collected for DNA extraction (n = 139). A 16S rRNA gene–based polymerase chain reaction assay was used to determine the presence of archaea and select bacteria. Seven samples were selected for direct sequencing. Archaea were detected in 10% of samples from peri-implantitis sites, but not in samples from the unaffected dental implant. Archaea were present in 53% and 64% of samples from mild and moderate/ advanced periodontitis sites, respectively. The main representative of the Archaea domain found in biofilm from periodontitis and peri-implantitis sites was Methanobrevibacter oralis. The present results revealed that archaea are present in diseased but not healthy implants. It was also found that archaea were more abundant in periodontitis than in peri-implantitis sites. Hence, the potential role of archaea in peri-implantitis and periodontitis should be taken into consideration.

The aim of this retrospective study was to evaluate clinical and radiographic outcomes of guided bone regeneration (GBR) procedures in the rehabilitation of partially edentulous atrophic arches. A total of 58 patients were included with a follow-up of 3 to 7 years after loading. Data seem to indicate that GBR with nonresorbable membranes can be a good clinical choice and suggest that it could be used to vertically reconstruct no more than 6 mm of bone in the posterior mandible. However, this technique remains difficult and requires expert surgeons.

The aim of this study was to investigate which factors play a major role in the healing of Class II mandibular furcation defects treated with different surgical techniques. Twenty-five systemically healthy subjects with periodontitis stage III grade B and Class II buccal mandibular furcation involvement received one of the following open flap debridement approaches: Group 1 (n = 10), no further treatment; Group 2 (n = 10), piezoelectric contouring of the furcation roof; Group 3 (n = 9), piezoelectric contouring of the furcation roof and bone grafting; Group 4 (n = 10), piezoelectric contouring of the furcation roof and bone grafting with coronally positioned flap. Clinical and radiologic variables—bleeding on probing, probing depth (PPD), vertical and horizontal bone level (CAL and PH), gingival recession, root trunk length, radicular separation, and furcation perimeter (FP)—were evaluated at baseline and 180 days and 1 year after surgery. All clinical parameters were statistically analyzed. Surgical techniques caused clinical (CAL, PPD, PH) and radiographic (FP) improvements. Regenerative techniques and the coronally positioned flap yielded a major radiographic reduction of furcation areas. All therapies resulted in significant horizontal and vertical PPD reduction and CAL gain.

The aim of this case series was to describe the successful treatment of excessive gingival display (EGD) using a lip repositioning technique (LRT) and botulinum toxin injections (BTIs) for long-term stability. Eight patients diagnosed with EGD were enrolled. A partial-thickness horizontal incision was made from the right first molar to the left first molar along the mucogingival line, leaving the midline frenum intact. The next day, all patients received BTIs. Mean reductions in gingival display between baseline and 3, 6, 12, 18, 24, and 36 months after surgery were considered. BTIs prevent movement of the upper lip during the healing phase of the LRT, improving the results and offering long-term outcomes with a follow-up period of 3 years.

Clinical records of patients who underwent implant-supported rehabilitation according to the biologically oriented preparation technique (BOPT) principles were retrospectively analyzed. Records of 189 nonconsecutive patients who received 502 implants were reviewed. At the last follow-up visit (occurring on average 5.11 years after prosthesis delivery), 466 (92.8%) implants had a Gingival Index of 0, and 491 (97.8%) presented no bleeding on probing. Four hundred eighty-nine crowns on as many implants (97.4%) showed no sign of gingival recession. Technical complications occurred with 10 implants (2.0%) and 6 patients (3.2%). Biologic complications were detected with 14 implants (2.8%) and 6 patients (3.2%). When the BOPT approach is applied to rehabilitate patients using implant-supported prostheses, excellent medium-term results concerning soft tissue health may be achieved.

Preoperative planning and implant placement can be optimized using implant planning software followed by the creation of an individual surgical guide. Alongside clinical advantages of using guided surgery, a variability in the accuracy of implant position has been reported. This variability is even more substantial in fully edentulous patients and attributed to errors from intrinsic and extrinsic sources. The aim of this paper is to discuss the potential process errors and present two digital data registration protocols to be implemented in fully edentulous patients. The suggested protocols are aimed to improve accuracy of data acquisition, data superimposition on planning software, and therefore treatment outcome as well.

Horizontal and vertical reduction of the ridge has to be expected after tooth extraction. Immediate implant placement and provisionalization is a viable treatment option that can help to minimize those changes. Additionally, it can better meet a patient's expectations about the treatment, reducing time and invasiveness. The aim of this prospective study is to evaluate the stability of the hard and soft tissues surrounding single immediate implants placed in the esthetic zone, as well as evaluating patient satisfaction. A total of 16 implants were placed, and 15 could be evaluated at the 3-year follow-up. Radiographic and clinical data was recorded after this period. Some marginal bone level reduction was detected after 3 years but was not statistically significant. The soft tissues, measured at 3 points, showed stability and even better positions with respect to the day of the final restoration placement. Patient satisfaction was analyzed using the modified Oral Health Impact Profile questionnaire (OHIP-14), and high satisfaction values were reported. The implementation of a precise surgical and prosthetic protocol when an immediate implant is placed into a fresh extraction socket is likely to result in high survival and success rates combined with excellent patient satisfaction. After the 3-year follow-up, favorable results were present.

One standard approach for wound closure after ridge augmentation is coronal flap advancement. Coronal flap advancement results in displacement of the mucogingival junction and reduction of the vestibulum. In the maxilla, a buccal sliding palatal flap can be applied for primary wound closure after ridge augmentation. The dissected part of the palatal connective tissue is left exposed, thus eliminating or reducing the amount of the coronal flap advancement respectively and increasing the amount of keratinized gingiva. In combination with guided soft tissue augmentation, this flap design enables a three-dimensional peri-implant soft tissue augmentation.

This investigation was designed to evaluate the long-term effectiveness of human placental allograft in root coverage procedures in terms of clinical and esthetic outcomes. Thirteen patients with 28 maxillary or mandibular recession defects > 4 mm deep were reexamined at 6 months and 5 years postoperatively. Overall, mean percentage of root coverage decreased from 65.58% ± 16.45% to 49.75% ± 19.40% with a greater stability of the gingival margin in the mandible. At 5 years, 18 sites maintained at least 2 mm of keratinized tissue. Gingival color and texture blended well with adjacent soft tissue area in 78.6% of treated sites.

Sinus augmentation has been shown to be an effective methodology to augment a deficient maxillary sinus. However, there are many techniques a clinician can choose from. Historically, lateral window or crestal osteotome approaches were the most frequently discussed techniques. In this paper, a sinus floor elevation technique with crestal window sinus elevation was proposed to treat cases of extremely atrophic maxillae (remaining bone height ≤ 2 mm). A crestal window is opened for the sinus membrane to be detached from the bony walls. After the proper elevation and membrane detachment, human particulated allografts were placed via the crestal access window to elevate the sinus membrane. Primary closure was then achieved, and after 6 to 9 months of healing, implant placement was performed. From the long-term clinical outcome that was obtained, the authors concluded that crestal window sinus elevation is a procedure with predictable outcomes for elevation of a maxillary sinus floor less than 2 mm thick, with an average elevation height of 11.73 mm.

The aim of this study was to compare the effect of an autogenous blood concentrate (L-PRF) with the effect of white porous titanium granules (WPTG) on buccal bone remodeling. These materials were used to graft the void between the implant and the buccal bone following immediate implant placement. Clinical measurements were made at two time points, and the mean buccal bone horizontal dimension at placement was 2.94 ± 0.59 mm for L-PRF and 3.49 ± 0.99 mm for WPTG. At reentry, the values were 1.19 ± 0.90 mm and 2.12 ± 0.87 mm, respectively. Overall, there was no difference observed in the performance of the two materials regarding buccal bone resorption.

Dental implants are intended to provide long-term reliable dental restorations. Limited data exist on the comparison between different implant surfaces. This study aims to clarify whether there is a difference between airborne particle– abraded and acid-etched (SLA implants) and only acid-etched surfaces (Osseotite) in healthy and periodontally compromised patients. After comprehensive evaluation of all 109 patients, including nonsurgical and surgical therapy for the treatment of periodontal disease, 109 implants were placed according to the manufacturer's guidelines. Each treatment site was examined radiographically 3 to 6 months after the final coronal restorations were placed. Patients were enrolled in the follow-up maintenance program, and radiologic evaluations were carried out at 5 and 10 years. Data recorded from 91 patients who completed the final 10-year follow-up were included in the analysis (SLA: n = 50; Osseotite: n = 41). At 10 years, the difference between bone-to-implant distances (DIBs) for SLA and Osseotite was significantly different (P = .001; 95% confidence interval: 0.55, 1.89 mm). Mean ± SD DIB for SLA implants was 2.1 ± 1.1 mm and 0.9 ± 2.1 mm for Osseotite implants. The overall survival rates of SLA and Osseotite implant surfaces were high during the observation period. History of previous periodontal disease plays an important role in the incidence of complications, regardless of the surface type.

The relationship between attachment loss and occlusal trauma has been debated for many years. When a patient presents with advanced periodontal disease, a decision has to be made on whether the teeth can be saved or extracted. In this treatment example, the decision process in therapeutic planning for a patient with stage IV periodontal disease is discussed. The main dilemma is whether the patient should receive a prosthodontic reconstruction supported by osseointegrated implants or by periodontally compromised natural teeth. It is assumed that implants do better than teeth over the long term based on firm documentation in the literature, but this article describes why a periodontal prosthesis is still a viable treatment option.

During a scaling and root planing procedure, a large, actively germinating seed was removed from a deep periodontal pocket. The histologic examination confirmed that it was a germinating tomato seed (Solanum lycopersicum). Since all seeds inside their fruits are in a quiescent stage, this seed was quiescent when the patient ate the tomato. Therefore, the germination occurred inside the periodontal pocket. This case led to a very interesting biologic finding: A periodontal pocket is not only a favorable environment for the development of periodontal microbiota, it is also an ecologic niche that can promote the germination and development of a plant seed.

In the article by Bhatavadekar et al (Long-Term Outcomes of Coronally Advanced Tunnel Flap [CATF] and the Envelope Flap [mCAF] Plus Subepithelial Connective Tissue Graft [SCTG] in the Treatment of Multiple Recession-Type Defects: A 6-Year Retrospective Analysis) in Volume 39, Number 5 (September/October), 2019, the number of incisors and canines that were included in the study and the baseline and 6-year probing depths were incorrectly reported in the Results text. The correct number of incisors and premolars are 34 and 22, respectively, and the correct baseline and 6-year probing depths are 1.67 ± 0.76 mm and 1.63 ± 0.68 mm, respectively, as reported in Tables 1 and 2. This has been corrected in the online version of the article. doi: 10.11607/prd.4026