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PURPOSE: To clinically evaluate oral implant restorations placed by undergraduate students in the dental clinical curriculum at KU Leuven (Belgium) in terms of function and esthetics. MATERIALS AND METHODS: A retrospective observational cohort study was designed. The esthetic and functional evaluations of implant-supported restorations placed in the framework of the undergraduate implant dentistry clinical training program using White/Pink Esthetic Score (WES/PES) and visual analog scale (VAS) scoring was performed. Furthermore, complications were registered based retrospectively on the patient's medical file. The following research questions were stipulated: (1) How well do implant-supported restorations placed by undergraduate students perform esthetically? and (2) Which complications occurred and how were these managed? RESULTS: Between August 2008 and July 2014 (6 academic terms), 251 implants (Brånemark System Mk III, Nobel Biocare) were placed in 113 patients by 155 students (> 40% of all students enrolled in the training program). Of these implants, 228 were restored in 101 patients by 118 students with varying restoration types. Esthetic scoring of the restorations in 83 of these patients revealed a satisfying mean WES of 8.14 ± 2.09 (out of 10) and PES of 9.56 ± 3.14 (out of 14). Complications were registered in 18.9% of the cases. DISCUSSION: Clinical training in implant dentistry for undergraduates contributes to the development of advanced skills in the dental student's Master education. Overall, patients were satisfied with their implant-supported restorations. Implant and restoration success rates and complication incidence were confirmed by long-term data in the oral implant literature. ispartof: INTERNATIONAL JOURNAL OF PROSTHODONTICS vol:34 issue:4 pages:433-440 ispartof: location:United States status: published

AIM: The aim of this retrospective radiographic study in Flemish children was to examine the bone level and bone loss around deciduous molars and factors influencing this. MATERIALS AND METHODS: Two thousand eight hundred ninety six digital intra-oral radiographs of children younger than 18 years old were screened for eligibility. The distance from the cementoenamel junction to the alveolar bone crest was measured, and tooth surfaces were screened for local risk factors that are presumably related to changes in the bone level. A distance >2 mm was defined as bone loss based on previous literature. All measurements were performed by two examiners. RESULTS: One thousand four hundred ninety one radiographs of 796 patients (mean age 6.46 ± 2.38 years) were included. The distance between the cementoenamel junction and the alveolar bone crest ranged from 0.07 to 2.88 mm, and the mean distance was 0.93 ± 0.37 mm. This distance was positively correlated with age (p

Aim The aim of the study was to evaluate whether the use of a xenograft is not inferior to the use of xenograft and autogenous bone chips in treating dehiscences at implant placement. Materials and methods After implant placement, leaving a dehiscence, control sites were treated using a composite graft (autogenous bone chips and xenograft) and at the test sites 100% xenograft was used. Both sites were covered with a resorbable collagen membrane. Dehiscences were measured clinically at implant placement and at re-entry. CBCT was taken immediately after implant placement and after 4 months. Results In total, 28 GBR procedures were performed in 14 patients. On average, the change in vertical defect height was 2.07 mm (46.7%-test group) and 2.28 mm (50.9%-control group) (p > .05). The horizontal defect width at the implant shoulder change on average 1.85 mm (40.5%-test group) and 1.75 mm (40.9%-control group) (p > .05). On average, a loss in augmentation thickness of 0.45 mm (68.9%-test group) and 0.64 mm (55.5% control group) between implant placement and augmentation and abutment surgery was obtained at the implant shoulder. Conclusion Both treatment modalities seem to work to a certain extent. At implant shoulder level, the augmentation thickness seems to be disappeared after the healing phase. (NCT03946020).

OBJECTIVES: The aim of this study was to describe the histological and clinical outcome of "dentin block" (a mixture of autologous particulate dentin, leukocyte- and platelet-rich fibrin (L-PRF), and liquid fibrinogen) in alveolar ridge preservation. MATERIAL AND METHODS: Ten extraction sockets were grafted with "dentin block," a mixture of particulate autologous dentin with chopped leukocyte-platelet-rich fibrin (L-PRF) membranes at a 1:1 ratio, and liquid fibrinogen as a binder. Two grafted sites were followed at 4 and 5 months, and 6 sites at 6 months. Biopsies were taken from the core of the grafted site for histologic and histo-morphometric analysis. RESULTS: All patients completed the study without any adverse event. The vertical and horizontal dimensions of the alveolar ridge were preserved or even increased after 4, 5, or 6 months and remained stable after 6 months of the implant placement. The histological examination revealed a median relative percentage of bone, dentin, and connective tissue of 57.0, 0.9, and 39.3%, respectively. A comparison of samples at different time points (4, 5, and 6 months) showed a progressive increase in the proportion of bone with a decrease in the proportion of dentin. The bone was compact with normal osteocytes and moderate osteoblastic activity. In 4 out of 10 samples, no dentin was observed; in the other samples, it represented 1-5% (with geometric fragments). CONCLUSIONS: Dentin block showed to be a suitable bone substitute in an alveolar ridges preservation model. CLINICAL RELEVANCE: The promising results of dentin block as a bone substitute in alveolar ridge preservation could have an important clinical impact considering this biomaterial brings together the regenerative potential of three autologous products with excellent biological and clinical behavior, low risk of adverse effects, and feasible acquisition. ispartof: CLINICAL ORAL INVESTIGATIONS vol:24 issue:3 pages:1151-1160 ispartof: location:Germany status: published

STATEMENT OF PROBLEM: Implant-based prosthetic solutions can be time consuming. If implants can be loaded immediately, treatment time can be reduced. PURPOSE: The purpose of this prospective randomized controlled trial was to monitor the survival rate of Ankylos implants, comparing conventional with immediate loading by using abutments with the SynCone concept for screw-retained removable prostheses in the edentulous maxilla. MATERIAL AND METHODS: A total of 90 implants were placed in 15 study participants. The participants were randomly assigned to the immediate or conventional loading treatment group. Radiographic and clinical parameters were recorded at the time of permanent prosthesis installment and at 1- and 2-year follow-up examinations, and participants' satisfaction was measured by using questionnaires before and after prosthesis installation. A linear mixed model was used to measure differences. RESULTS: One implant in the conventional group was lost during abutment placement; hence, 89 implants could be followed for 2 years. Approximately 90% of these implants showed no bone loss or even bone gain at 1 and 2 years follow-up. Mean values for the immediate group were, respectively, 0.09 ±0.35 mm and 0.13 ±0.38 mm and 0.01 ±0.41 mm and -0.06 ±0.32 mm for the conventional method. No significant differences (P=.053) were found in bone level alterations between the groups. For all participants, the mean number of surfaces (4 per implant) with bleeding on probing (BoP) and plaque were 0.76 ±0.81 and 0.16 ±0.42 at 1 year follow-up and 0.44 ±0.66 and 0.02 ±0.15, respectively, at the second-year follow-up. The mean pocket probing depths were 2.05 ±0.54 mm at 1 year and 2.18 ±0.64 mm at 2 years. For both groups, a significant rise in satisfaction and quality of life was observed (P≤.001) at 1 and 2 years compared with pretreatment. CONCLUSIONS: Ankylos implants placed in the edentulous maxilla, immediately or conventionally loaded by a detachable prosthesis, showed favorable bone-level preservation after 2 years of follow-up. No significant differences could be found between the immediate and conventional groups. A significant increase in quality of life was observed for both loading modes. ispartof: JOURNAL OF PROSTHETIC DENTISTRY vol:121 issue:2 pages:258-264 ispartof: location:United States status: published

AIM: To evaluate dimensional changes in the alveolar ridge and bone structure after tooth extraction when L-PRF or A-PRF+ was used in comparison to unassisted socket healing. MATERIALS AND METHODS: Twenty patients in need of at least three tooth extractions in the aesthetic zone were included. L-PRF, A-PRF+ or control was randomly assigned, leaving one empty socket/edentulous site between conditions. CBCT scans were obtained immediately after tooth extraction and after 3 months of healing. Horizontal and vertical dimensional changes of the ridge and socket fill were calculated. Histological and micro-CT analysis of bone biopsies were used to evaluate post-surgical bone structural healing. RESULTS: Mean horizontal and vertical changes at 1-mm below the crest (buccal and palatal side) were similar for the three sites (p > 0.05). For the socket fill, L-PRF (85.2%) and A-PRF+ (83.8%) showed superior values than the control (67.9%). The histological and radiological analysis reported more newly formed bone for the PRF groups, without any significant differences between both. CONCLUSIONS: PRF matrices failed to reduce the dimensional changes after multiple tooth extractions in the premaxilla. After 3-month healing, both PRF matrices showed radiographically a significant superiority for the socket fill. Histologically, they seemed to accelerate new bone formation. ispartof: JOURNAL OF CLINICAL PERIODONTOLOGY vol:48 issue:7 pages:984-995 ispartof: location:United States status: published

OBJECTIVES: The task of this working group was to update the knowledge about the use of drugs and biologicals affecting healing of soft tissue and bone during implant treatment or procedures associated with it. Moreover, the impact of titanium particles and biocorrosion on complications and implant survival has been analysed. MATERIALS AND METHODS: The literature in the areas of interest (platelet concentrates, antiresorptive drugs as well as implant-host interaction) was screened using systematic reviews for the former two areas, whereas a narrative critical review was performed for the latter topic. Two manuscripts on platelet concentrates, one manuscript on antiresorptive drugs and one manuscript on the effects of biocorrosion, were presented for group analysis with subsequent discussion in the plenum and final consensus approval. RESULTS: Results and conclusions of the individual reviews of the three topics are presented in the respective papers. Conclusions of the group on strengths and weaknesses of available evidence as well as consensus statements and directions for further research are provided in this study. The following papers were subject to group discussions and formed the basis for the consensus statements: Stähli A, Strauss FJ, Gruber R. () The use of platelet-rich-plasma to enhance the outcomes of implant-related therapies: a systematic review Strauss FJ, Stähli A, Gruber R. (2018) The use of platelet-rich-fibrin to enhance the outcomes of implant-related therapies: a systematic review Mombelli A, Hashim D, Cionca N. () What is the impact of titanium particles and bio-corrosion on implant survival and complications? A critical review Stavropoulos A, Bertl K, Pietschmann P, Pandis N, Morten Schiødt, Klinge B. () The effect of antiresorptive drugs on implant therapy: a systematic review. ispartof: CLINICAL ORAL IMPLANTS RESEARCH vol:29 pages:93-99 ispartof: location:SWITZERLAND, Pfaffikon status: published

The impact of osteoporosis on implant treatment is still a matter of debate in the scientific community, as it may possibly lead to higher failure rates. As long-term controlled trials are missing, the aim of this study was to verify the long-term outcome of implants placed in patients with systemic osteoporosis. Postmenopausal women in need of implants underwent bone mineral density measurements in hip and spine, using dual X-ray absorptiometry scans. Based on T-scores, they were divided into 2 groups: group O (osteoporosis group) with a T-score ≤-2 or group C (control group) with a T-score of ≥-1. Implants were placed in a 2-stage manner and loaded 4 to 8 wk after abutment surgery. Six months after loading and thereafter yearly, clinical and radiographical parameters were assessed. In total, 148 implants were placed in 48 patients (mean age: 67 y [range, 59-83]). Sixty-three implants were placed in 20 patients (group O) and 85 implants in 28 patients (group C). After 5 y, 117 implants (38 in group O and 79 in the group C) in 37 patients were assessed. Cumulative survival rate on an implant level was 96.5% (group O: 91.5%; group C: 100.0% [ P < 0.05]) and 95.7% (group O: 89.2%; group C: 100.0% [ P > 0.05]) on a patient level. The overall marginal bone-level alterations, after 5 y of loading, were -0.09 ± 0.78 mm (group O: -0.15 ± 0.50 mm; group C: -0.06 ± 0.89 mm) on an implant level and -0.09 ± 0.54 mm (group O: -0.18 ± 0.43 mm; group C: 0.06 ± 0.58 mm) on a patient level ( P > 0.05). Oral implant therapy in osteoporotic patients is a reliable treatment option with comparable osseointegration rates, implant survival, and marginal bone-level alterations after 5 y of functional loading (ClinicalTrials.gov NCT00745121). ispartof: JOURNAL OF DENTAL RESEARCH vol:98 issue:1 pages:84-90 ispartof: location:United States status: published

BACKGROUND: This study aims to evaluate the use of the leukocyte- and platelet-rich fibrin (L-PRF) membranes in increasing the width of the keratinized mucosa (KM) around implants. MATERIAL AND METHODS: Eight patients in need for bilateral widening of the KM around implants in the lower jaw were recruited for a spit-mouth randomized controlled trial. At the control site, a free gingival graft (FGG) was used, whereas at the other side (test), L-PRF membranes were applied. The primary outcome was the increase in width of KM around the implants. As secondary outcomes, the postoperative pain and surgical time were assessed. The follow-up period was 6 weeks. RESULTS: A significant increase in the total bucco-lingual width of KM in both groups was observed, with 1.3 mm ± 0.9 extra gain (P

The aim of this study was to conduct a systematic review to compare the survival rates between short implants (length 10 mm) versus standard-length implants (≥ 10 mm) inserted in grafted bone. As secondary outcomes, marginal bone loss and survival rates of the implant supported prostheses were also analysed.Randomised controlled trials (RCT) that compared both techniques were searched on three electronic databases till June 2016, a manual search was performed on the bibliography of the collected articles, and the authors were contacted for additional references. The estimates of the interventions were expressed in relative risk (RR), mean implant survival rates and mean differences in marginal bone.Eight RCTs were included in this study. From a total of 458 short implants, 15 failed (mean survival rates = 96.7%), While from 488 regular implants, 13 failed (mean survival rates = 97.3%). The technique did not significantly affect: the implant failure rate (P 0.05), with RR of 1.34 (95% CI 0.67-2.87), the mean differences of marginal bone loss (P = 0.18; MD - 0.04 mm [- 0.10; 0.02] 95% CI), at loading or prosthesis failures rates (RR:0.98; 95% CI 0.40-2.41). The mean differences of marginal bone at 1 year follow-up (post loading) presented significant marginal changes in the short implant group (P = 0.002; MD - 0.10 mm [- 0.16; - 0.03] 95% CI) although a significant high heterogeneity was found between groups.This systematic review suggests no difference between both techniques in the treatment of atrophic arches. However, more long-term RCTs are needed to evaluate the predictability at the long run.The use of short implants might be considered an alternative treatment, since it usually requires fewer surgical phases and tends to be a more affordable option.

Aim To analyse the effect of Leucocyte- and Platelet Rich Fibrin (L-PRF) on bone regeneration procedures and osseointegration. Materials and Methods An electronic and hand search was conducted in three databases (MEDLINE, EMBASE and Cochrane). Only randomised clinical trials, written in English where L-PRF was applied in bone regeneration and implant procedures, were selected. No follow-up restrictions were applied. Results A total of 14 articles were included and processed. Three subgroups were created depending on the application: sinus floor elevation (SFE), alveolar ridge preservation, and implant therapy. In SFE, for a lateral window as well as for the trans-alveolar technique, histologically faster bone healing was reported when L-PRF was added to most common xenografts. L-PRF alone improved the preservation of the alveolar width, resulting in less buccal bone resorption compared to natural healing. In implant therapy, better implant stability over time and less marginal bone loss were observed when L-PRF was applied. Meta-analyses could not be performed due to the heterogeneity of the data. Conclusions Despite the lack of strong evidence found in this systematic review, L-PRF might have a positive effect on bone regeneration and osseointegration. This article is protected by copyright. All rights reserved.

PURPOSE This systematic review verified the usefulness/limitations of static surgical guides during implant surgery in the edentulous maxilla. The PICO question was: "Does the use of digitally generated surgical guides vs conventional techniques affect the following outcomes: surgical complications, implant complications, prosthesis complications, implant survival, prosthesis survival, economics, patient satisfaction, and maintenance intervention?" MATERIALS AND METHODS The electronic searches retrieved 2,588 unique articles from which eventually 36 full-text articles were read for eligibility. Because no randomized controlled clinical trials could be found, the PICO question had to be reformulated, now only looking to the outcome of digitally generated surgical guides without comparison with conventional techniques. RESULTS Although long-term data are lacking, the outcome of implants placed with a static guide and of the prosthetic reconstruction seems similar to that expected from conventional techniques. The number of surgical complications with guided surgery is negligible. Guided flapless implant surgery offers slightly more comfort for the patient; however, the economic benefits are unclear. CONCLUSION Implant therapy via static surgical guides in the maxilla is predictable, with slightly more comfort for the patient but with only minor economic advantages.

OBJECTIVES: Examine the clinical and microbiological benefits of a dual-strain Lactobacillus reuteri probiotic on the non-surgical therapy of initial peri-implantitis. MATERIALS AND METHODS: This randomized, double-blind study targeted patients with initial peri-implantitis, that is peri-implantitis with a maximum mean probing pocket depth of 6 mm and maximum 3 mm bone loss compared with loading. A full-mouth prophylaxis was performed and the peri-implantitis sites were debrided. Subsequently, local application of the study drops was carried out at the peri-implantitis sites and the study lozenges were handed out. The patients in the probiotic group received drops and lozenges containing L. reuteri (ATCC PTA 5289 & DSM 17938), those in the control group received placebo products. At the implant level the measurements of interest were bleeding, probing pocket depth and plaque. Full-mouth bleeding and plaque scores were also recorded. Microbiological samples were taken from the tongue, saliva and subgingivally around the implants. RESULTS: All clinical parameters were significantly decreased after 12 and 24 weeks. At the implant level the only statistically significant difference was a greater decrease in plaque levels in the probiotic versus the control group (p = .002 at 24 weeks). At the full-mouth level, the only intergroup difference was the greater decrease in full-mouth bleeding on probing sites in the probiotic group compared with the control group (p

OBJECTIVES The aim of the present randomized, controlled clinical multicenter trial was to compare a polyethylene glycol (PEG) and a native collagen membrane (BG) for simultaneous guided bone regeneration at bony dehiscence-type defects around bone level titanium implants. MATERIAL AND METHODS The study enrolled 117 patients requiring implant treatment in the posterior maxilla or mandible with expected buccal bony dehiscence-type defects at the placed titanium implants. According to a parallel groups design, defects were filled with a synthetic bone filler and randomly assigned to either PEG or BG membrane. As primary parameter, the relative vertical bone fill was assessed at baseline and at re-entry after 6 months of healing. As secondary parameters, the marginal bone level (MBL) was assessed radiographically and soft tissue conditions were recorded up to 18 months postloading. RESULTS Both groups showed comparable vertical bone fill revealing a relative change in defect height of 59.7% (PEG) and 64.4% (BG). The absolute mean reduction in defect size was 2.5 mm in the PEG group and 3.2 mm in the BG group. Although both groups revealed a statistically significant mean defect reduction (p

STATEMENT OF PROBLEM: Implant-based prosthetic solutions can be time consuming. If implants can be placed successfully with a guide, surgery time can be reduced. PURPOSE: The purpose of this randomized controlled clinical trial was to assess implant outcomes, both clinical and radiological, comparing guided with nonguided implant placement after 3 years of follow-up. MATERIAL AND METHODS: A total of 314 implants were placed in 72 jaws (60 participants). The jaws were randomly assigned to 1 of the 6 treatment groups: Materialise Universal/mucosa (Mat Mu), Materialise Universal/bone (Mat Bo), Facilitate/mucosa (Fac Mu), Facilitate/bone (Fac Bo), freehand navigation (Freehand), and a pilot-drill template (Templ). Radiographic and clinical parameters (bone loss, pocket probing depth, bleeding on probing, and plaque scores) were recorded at the time of implant placement, prosthesis installment (baseline), and 1-year, 2-year, and 3-year follow-up. Analysis was performed using a linear mixed model, and correction for simultaneous hypothesis was made according to Sidak (α=.05). RESULTS: Three participants left the study before the 3-year follow-up; hence, 302 implants in 69 jaws were included in this study. None of the implants failed. The mean marginal bone loss after the third year of loading was 0.7 ±1.3 mm for the guided surgery group and 0.5 ±0.6 mm for the control group. No significant intergroup or follow-up period differences were observed (P>.05). In the guided surgery groups, the mean number of surfaces with bleeding on probing and plaque at 3-year follow-up was 1.7 ±1.5 and 1.7 ±1.7, respectively; for the control groups, this was 1.6 ±1.4 and 1.6 ±1.6, respectively. The mean pocket probing depth was 3.0 ±1.3 mm for the guided group and 2.6 ±1.0 mm for the control group. No significant differences were found (P>.1). CONCLUSIONS: Within the limitation of this study, no statistically significant differences could be found between the guided group and the control group at the 3-year follow-up. ispartof: JOURNAL OF PROSTHETIC DENTISTRY vol:121 issue:6 pages:904-910 ispartof: location:United States status: published

Aim To analyse the regenerative potential of leucocyte‐ and platelet‐rich fibrin (L‐PRF) during periodontal surgery. Materials and Methods An electronic and hand search were conducted in three databases. Only randomized clinical trials were selected and no follow‐up limitation was applied. Pocket depth (PD), clinical attachment level (CAL), bone fill, keratinized tissue width (KTW), recession reduction and root coverage (%) were considered as outcome. When possible, meta‐analysis was performed. Results Twenty‐four articles fulfilled the inclusion and exclusion criteria. Three subgroups were created: intra‐bony defects (IBDs), furcation defects and periodontal plastic surgery. Meta‐analysis was performed in all the subgroups. Significant PD reduction (1.1 ± 0.5 mm, p 0.05), CAL gain (0.2 ± 0.5 mm, p > 0.05), KTW (0.3 ± 0.4 mm, p > 0.05) and recession reduction (0.2 ± 0.3 mm, p > 0.05). Conclusions L‐PRF enhances periodontal wound healing.

Objectives To evaluate clinical, radiographic, microbiologic, and biomechanical parameters related to bone remodeling around implants with external hexagon (EH) and Morse-taper (MT) connections. Materials and Methods Twelve totally edentulous patients received four custom-made implants in the interforaminal region of the mandible. Two of those implants had the same macroscopic design, but different prosthetic connections. All patients received an immediate implant-supported prosthesis. Clinical parameters (periimplant probing pocket depth (PPD), modified gingival index (mGI), and mucosal thickness (MTh)) were evaluated at 12 months follow-up. The distance between the top of the implant and the first bone-to-implant contact (IT-FBIC) was evaluated on standardized digital peri-apical radiographs acquired at 1, 3, 6, and 12 months follow-up. Samples of the subgingival microbiota were collected 1, 3, and 6 months after implant loading and used for the quantification of Tanerella forsythia, Porphyromonas gingivalis, Aggragatibacter actinomycetemcomitans, Prevotella intermedia, and Fusobacterium nucleatum. Further, 36 computerized-tomography based finite element (FE) models were accomplished, simulating each patient under three loading conditions. Results The evaluated clinical parameters were equal for EH and MT implants. Mean IT-FBIC was significantly different between the tested connections (1.17 ± 0.44 mm for EH, and 0.17 ± 0.54 mm for MT, considering all evaluated time periods). No significant microbiological differences could be observed between tested connections. FE analysis showed a significantly higher peak of equivalent (EQV) strain (p = 0.005) for EH (mean 3,438.65 µe) compared to MT (mean 840.98 µe) connection. Conclusions Radiographic periimplant bone loss depends on the implant connection type. MT connections showed less periimplant bone loss, compared to EH connections.

Background and Purpose Osteoporosis is a major skeletal disease affecting millions of people worldwide. Recent studies claim that patients with osteoporosis do not have a higher risk of early implant failure compared to non-osteoporotic patients. The aim of this study was to assess the effect of skeletal osteoporosis and local bone density on initial dental implant stability. Materials and Methods Seventy-three patients were recruited and were assigned (based on a Dual-energy X-ray Absorptiometry scan) to either the osteoporosis (Opr), osteopenia (Opn), or control (C) group. Forty nine of the 73 patients received dental implants and had implant stability measured by means of resonance frequency analysis (RFA) at implant placement and at prosthetic abutment placement. On the computerized tomography scans, the cortical thickness and the bone density (Hounsfield Units) at the sites of implant placement were measured. Results At implant placement, primary stability was on average lower in group Opr (63.3 ± 10.3 ISQ) than in group Opn (65.3 ± 7.5 implant stability qutient (ISQ)), and group C (66.7 ± 8.7 ISQ). At abutment placement, a similar trend was observed: group Opr (66.4 ± 9.5 ISQ) scored lower than group Opn (70.7 ± 7.8 ISQ), while the highest average was for group C (72.2 ± 7.2 ISQ). The difference between groups Opr and C was significant. Implant length and diameter did not have a significant effect on implant stability as measured with RFA. A significant correlation was found between local bone density and implant stability for all regions of interest. Conclusions Implant stability seems to be influenced by both local and skeletal bone densities. The lower stability scores in patient with skeletal osteoporosis reinforce the recommendations that safe protocols and longer healing times could be recommended when treating those patients with dental implants.

AIM: To compare the clinical and microbiological performance of minimally and moderately rough implants in patients with a history of severe periodontitis. MATERIAL AND METHODS: Forty-eight minimally (Turned surface [Tur]) and moderately (TiUnite surface [TiU]) rough implants were placed in eighteen patients according to a split-mouth protocol. Marginal bone loss, probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BoP) were recorded, and microbial samples were analysed by means of quantitative PCR. RESULTS: The amount of bone loss over the 5-year period tended to be lower along Tur when compared with that of TiU surfaces (1.0 versus 1.7 mm, p = .06). Although the clinical outcomes tended to be better for Tur surfaces, there were no significant differences between both surfaces in mean PPD (Tur: 3.1 versus TiU: 4.2 mm, p = .09) or CAL (Tur: 0.5 versus TiU: 1.7 mm, p = .06). More bone loss and deeper pockets were recorded for partially than for fully edentulous patients. The cumulative survival rate at 5-year follow-up was 95.8% for Tur, and 100% for TiU surface implants. No significant differences were found between the surfaces in counts for key pathogens. CONCLUSION: In patients with a history of severe periodontitis minimally rough implants showed more favourable clinical parameters after 5 years of loading, when compared with moderately rough implants. ispartof: JOURNAL OF CLINICAL PERIODONTOLOGY vol:45 issue:6 pages:711-720 ispartof: location:United States status: published

Objective To examine the effect of tongue cleaning with a tongue scraper (TS) or toothbrush (TB) in patients with periodontitis. Background The tongue is a possible reservoir for bacterial (re)colonization of the periodontal tissues in patients with periodontitis. To date, it is not known what the influence of tongue cleaning is on the tongue coating of patients with periodontitis. Material and Methods Eighteen systemically healthy, untreated moderate to severe adult patients with periodontitis with some degree of tongue coating were randomly assigned to the use of a TS or TB for cleaning the tongue. Microbial load of the saliva and tongue dorsum, amount of tongue coating and patient perception about tongue cleaning were studied at baseline and 2 weeks later. Results Two weeks of tongue cleaning with either a TB or a TS, did not influence the microbiological counts, neither in the saliva, nor in the tongue coating, even though tongue coating was significantly less. The patients themselves experienced no differences in breath odour or taste sensation after 2 weeks of tongue cleaning; however, they felt that their tongue was cleaner at the end of the study compared to baseline. No differences could be detected between the uses of a TS vs a TB. Conclusion In patients with periodontitis, tongue cleaning does not influence the bacterial load in the saliva or on the tongue dorsum.

Background and Objective: To the best of our knowledge, the healing time for toothbrush-induced gingival abrasions in humans has not yet been explored. The aim of this study was to evaluate the time needed to heal for toothbrush-induced abrasions of the keratinized mucosa of the palate. Material and Methods: In patients without, with mild periodontitis or with periodontitis, gingival abrasion lesions were induced at the keratinized mucosa of the palate by brushing up to 2 minutes. Healing as observed clinically was followed via calibrated digital photographs of the lesion after staining, every 24 hours until the lesion had resolved. In patients without or with only mild periodontitis, the healing time of lesions caused by 30 seconds and 1 minute of brushing was also recorded. Results: Thirty-one participants (11 without or with mild periodontitis, 20 with periodontitis) met the inclusion criteria. In patients without or with mild periodontitis, the lesions induced by brushing for 2 minutes diminished by 48.7% of their original surface area within 24 hours. In patients with periodontitis the respective outcome was 45.4% (P =.87). Abrasions caused by 2 minutes of brushing needed more than 24 hours to heal completely. When decreasing the time exposed to trauma, fewer lesions were visible at baseline and the time needed to heal decreased. The subgroup of smokers was too small to evaluate any effect. Conclusion: The longer the exposure time of the keratinized mucosa of the palate to trauma, the more lesions were visible, the larger the abrasions were and the more time they needed to heal completely. More studies are needed to investigate the role of smoking, gingival biotype and to link these findings with gingival recessions.

A classification for peri-implant diseases and conditions was presented. Focused questions on the characteristics of peri-implant health, peri-implant mucositis, peri-implantitis, and soft- and hard-tissue deficiencies were addressed. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri-implant health can exist around implants with reduced bone support. The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis. Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long-term health of the peri-implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day-to-day clinical practice and in epidemiological or disease-surveillance studies for peri-implant health, peri-implant mucositis, and peri-implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant-supported prosthesis. ispartof: JOURNAL OF CLINICAL PERIODONTOLOGY vol:45 issue:20 pages:S286-291 ispartof: location:IL, Chicago status: published

PubMedID: 26427036 Aim To evaluate the adjunctive effects of a Streptococcus oralis KJ3, Streptococcus uberis KJ2 and Streptococcus rattus JH145 containing probiotic tablet after scaling and root planing (SRP). Materials and Methods Forty-eight periodontitis patients were included in this double-blind, placebo-controlled clinical trial. After root planing, patients used either a placebo or a probiotic tablet twice a day for 12 weeks. The pocket probing depth (primary outcome measure), bleeding on probing and relative attachment levels were measured at baseline, 12 and 24 weeks. At baseline, 4, 8, 12 and 24 weeks, microbiological sampling was performed and plaque and gingival indices were recorded. Results The primary and secondary outcome measures were significantly (p < 0.05) improved at the 12- and the 24-week evaluation in both groups. However, no significant inter-group differences could be detected at any time point, except from the % of sites with plaque that were significantly lower in the probiotic group than in the control group at the 24-week evaluation. In addition, at the 12-week time point, the salivary Prevotella intermedia counts were significantly lower in the probiotic group. Conclusions No differences were detected when comparing the adjunctive use of a placebo or the investigated streptococci containing probiotic tablet after SRP. ClinicalTrials.gov Identifier: NCT02403960. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The aim of this study was to investigate the plaque inhibitory effect of a new 0.03 % chlorhexidine digluconate (CHX) and 0.05 % cetylpyridinium chloride (CPC) mouthrinse formulation and to explore patients’ experience and side effects after its use. This short-term, randomized, double blind, parallel, clinical trial enrolled 150 periodontally healthy patients. These volunteers were randomly allocated to one of following mouthrinse groups (n = 50/group): 0.12 % CHX + 0.05 % CPC (Perio-Aid® Treatment alcohol-free), 0.03 % CHX + 0.05 % CPC new test formulation or to the placebo group. Clinical parameters (plaque, gingival, and stain indexes) and microbiological samples were taken at baseline, before supragingival cleaning, and after 4 days of undisturbed plaque growth, rinsing twice/day with one of the mouthrinses. Plaque reduction was similar for the 0.12 % CHX (−0.52 ± 0.55) and 0.03 % CHX (−0.47 ± 0.49) groups. Both showed significant reductions in plaque accumulation compared to the placebo (p

Objectives Fractures of distal bar extensions, supporting a mandibular overdenture, do occur with significant functional and economic consequences for the patient. This study therefore aims to evaluate the effect of different bar cross-sectional shapes and surfaces, bar extension lengths and the placement of a support rib under the distal bar extension on fracture resistance. Materials and methods The 2nd moment area and static strength were calculated for 11 frequently used bar designs using finite element analysis (FEA). For two specific designs (Ackermann round O 1.8 mm and Dolder-Y macro, the former with and without a support rib) additional physical static and fatigue strength tests were included. Results The FEA static strength data corresponded well to the 2nd moment area (a similar ranking when maximum allowed force was considered). The application of a rib support (Ackermann O 1.8 mm) and limitations of the bar extension length (6 mm for the Ackermann O 1.8 mm, 8 mm for the Dolder-Y macro) allowed the bars to exceed 5 × 10 6 cycles of 120 and 250 N, respectively, before fracture. The region of highest stresses in FEA corresponded well with the locations of the fractures observed in static- and fatigue-testing. Conclusions With some simple guidelines/modifications, the number of bar extension fractures can be reduced significantly. Clinical significance This study focusses on distal bar extensions which improve the positioning of an implant supported overdenture. By combining laboratory testing and finite element simulations we aim to: (1) explain why fractures occur (dependent on physical characteristics of the bar), and (2) give clinical guidelines on how to prevent such fractures.

BACKGROUND AND AIMS: The scope of this working group was to review: (1) the effect of professional mechanical plaque removal (PMPR) on secondary prevention of periodontitis; (2) the occurrence of gingival recessions and non-carious cervical lesions (NCCL) secondary to traumatic tooth brushing; (3) the management of hypersensitivity, through professionally and self administered agents and (4) the management of oral malodour, through mechanical and/or chemical agents. RESULTS AND CONCLUSIONS: Patients undergoing supportive periodontal therapy including PMPR showed mean tooth loss rates of 0.15 ± 0.14 teeth/year for 5-year follow-up and 0.09 ± 0.08 teeth/year (corresponding to a mean number of teeth lost ranging between 1.1 and 1.3) for 12-14 year follow-up. There is no direct evidence to confirm tooth brushing as the sole factor causing gingival recession or NCCLs. Similarly, there is no conclusive evidence from intervention studies regarding the impact of manual versus powered toothbrushes on development of gingival recession or NCCLs, or on the treatment of gingival recessions. Local and patient-related factors can be highly relevant in the development and progression of these lesions. Two modes of action are used in the treatment of dentine hypersensitivity: dentine tubule occlusion and/or modification or blocking of pulpal nerve response. Dentifrices containing arginine, calcium sodium phosphosilicate, stannous fluoride and strontium have shown an effect on pain reduction. Similarly, professionally applied prophylaxis pastes containing arginine and calcium sodium phosphosilicate have shown efficacy. There is currently evidence from short-term studies that tongue cleaning has an effect in reducing intra-oral halitosis caused by tongue coating. Similarly, mouthrinses and dentifrices with active ingredients based on Chlorhexidine, Cetylpyridinium chloride and Zinc combinations have a significant beneficial effect. ispartof: Journal of Clinical Periodontology vol:42 issue:S16 pages:S214-S220 ispartof: location:SPAIN status: published

Purpose: One of the major factors governing implant success is the quantity and density of the host bone. The aim of this work was to determine whether mandibular bone texture and cortical width measurements on plain radiographs could be associated with implant failure and/or marginal bone loss. Materials and Methods: A statistical model was built to predict implant failure; it incorporated several radiographic features of cortical and cancellous bone texture, cortical width, and patient smoking habits. Cortical width measurements and texture measurements of cortical and cancellous bone were made on the panoramic radiographs of 460 subjects. These were used to predict implant failure and marginal bone loss after 5 years. Receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) were used to determine the diagnostic accuracy of the variables in predicting implant failure and marginal bone loss. Additionally, for 91 of 460 subjects with periapical radiographs, marginal bone levels around implants were measured over a 5-year period. Results: Of the 460 patients assessed for implant failure, 29 had failed implants (93.7% success rate). The ROC curve built from this model had a sensitivity of 62.1% and specificity of 67.5%. The AUC from the model was 0.690 (95% confidence interval [CI] 0.597 to 0.783). A model was also built to predict marginal bone loss. The ROC curve had 78.6% sensitivity and 74.6% specificity (AUC = 0.880, 95% CI = 0.810 to 0.953). Mandibular cortical width was not a significant predictor of either implant failure or bone loss. Conclusion: In a retrospective analysis 5 years after implant placement, features of cancellous and cortical bone of the mandible were significant in predicting implant failure and marginal bone loss in a sample of 460 patients.

Subgingival debridement is the part of nonsurgical therapy which aims to remove the biofilm without intentionally removing the cementum or subgingival calculus. The objective of this review was to describe the end point of this therapy, the different methods used and how often it should be carried out. The literature shows that several methods are currently available for subgingival debridement, namely hand instrumentation, (ultra)sonic instrumentation, laser, photodynamic therapy and air-polishing. None of these methods seems superior to any other regarding clinical benefits or microbiological differences. However, less treatment discomfort is reported using laser, photodynamic therapy or air-polishing compared with hand- and/or (ultra)sonic instrumentation. Subgingival debridement can be carried out when, during supportive periodontal therapy, pockets of 5 mm or deeper are detected. ispartof: Periodontology 2000 vol:75 issue:1 pages:189-204 ispartof: location:Denmark status: published

Aim To investigate the influence of various surgical techniques for sinus augmentation on the volumetric changes of graft, membrane and the post-operative discomfort. Materials and Methods Eighteen patients in need of bilateral sinus floor elevation (SFE) were assigned to lateral SFE, transcrestal SFE and intralift procedures. CBCT images taken at baseline, 1 week and 6 weeks were analysed for volumetric changes in graft and Schneiderian membrane. Questionnaires were used to analyse post-op discomfort. Results The overall average graft volume obtained after 1 week was 1.87 cm3 (range 0.12–4.72 cm3). Volumes decreased after 6 weeks to an overall mean volume of 1.33 cm3 (range 0.10–4.29 cm3 – average decrease of 27.6%). After 6 weeks, the amount of graft volume decreased in every treatment option, ranging from −23.13% for the tSFE, over −24.55% for the lSFE, to −33.71% for the IL. Although all treatment options correspond in an increase in Schneiderian membrane volume, no statistically significant correlation between this increase and loss of graft volume could be obtained for all treatments (p = 0.97). Conclusion All SFE techniques provided sufficient graft volume for implant treatment. All techniques provoke a partially transient swelling of the Schneiderian membrane. All techniques resulted in a decrease in graft volume after 6 weeks; however, no significant differences were obtained between treatments. Furthermore, no statistical significant correlation between the post-operative swelling of the Schneiderian membrane and reduction in graft volume at 6 weeks could be obtained.

Introduction and aim Buccal bone thickness is considered to be an important factor during implant surgery. Its resorption might have an effect on the soft tissue stability and eventually on implant survival. This study aimed to investigate the resorption of the buccal bone over the first 12 months after implant loading. Materials and methods Twenty-four subjects (47 implants) were included. The buccal bone thickness was measured during implant surgery at several distances from the implant shoulder using a specifically designed device which allows buccal bone thickness measurements without the elevation of a muco-periostal flap. These measurements were repeated after 12 months of loading. Sixteen implants were placed flapless and 31 with the elevation of a flap. Of the latter, 19 were placed following a one-stage protocol and 12 following a two-stage protocol. Results The mean reduction in buccal bone thickness, when all groups pooled, was 0.26, 0.36, 0.35 and 0.27 mm at the shoulder and 2, 4 and 6 mm apically. Implants with initial bone thickness

Background Osteoporosis has been called a potential risk factor for bone healing around implants. Aim The aim of this multicentre study was to verify the clinical performance of fluoridated implants in the maxilla of subjects with diagnosed systemic primary osteoporosis/osteopenia. Material and Methods Postmenopausal women in need of 2–8 splinted implants in maxilla underwent bone mineral density measurements in the hip and spine, using dual-energy X-ray absorptiometry scans. Based on their T-scores, they were divided into two study groups: Group O (osteoporosis/osteopenia group) subjects had a T-score ≤−2, Group C (control group) had a T-score of ≥−1, and subjects with a T-score −2 were excluded. Implants were placed with a two-stage procedure and loaded 4–8 weeks after abutment surgery. At 6 months and 1 year after functional loading, clinical parameters (including peri-apical radiographs) were assessed. Results One hundred and forty-eight implants were placed in 48 subjects (mean age: 67 years (range [59–83]). Sixty-three implants were placed in 20 osteoporosis subjects (Group O, mean age: 69 years; range [59–83]), and 85 were placed in control subjects (Group C, mean age: 65 years; range [60–74]). The cumulative survival rate, on an implant level, was 99.3% (Group O: 98.4%; Group C: 100.0%). The cumulative survival rate, on a subject level, was 97.9% (Group O: 94.7%; Group C: 100.0%). Marginal bone level (MBL) alterations from functional loading to the 1-year follow-up visit were measured on an implant level and a subject level. The overall MBL alteration on an implant level was −0.01 ± 0.51 mm (Group O: −0.11 ± 0.49 mm; Group C: 0.05 ± 0.52 mm). The overall MBL alteration on a subject level was −0.04 ± 0.27 mm (Group O: −0.17 ± 0.30 mm; Group C: 0.04 ± 0.23 mm). Conclusion Within the limitations of this prospective, non-randomized, controlled, multicentre study, it can be concluded that oral implant therapy in patients suffering from osteoporosis/osteopenia is a reliable treatment option with comparable integration rates as in healthy patients. Long-term follow of the study groups is necessary to compare marginal bone alterations and treatment outcomes.

Objective The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) when compared to SRP alone in patients with untreated chronic periodontitis. Background Although chronic periodontitis is mostly treated without adjunctive systemic antibiotics, some recent meta-analyses have shown clinical benefit for some systemic antibiotics when used as an adjunct to SRP. However, there is a wide variety of systemic antibiotic regimens used today. It remains unclear if the selected type of systemic antibiotic influences the magnitude of clinical benefit. Material and Methods The MEDLINE-PubMed database was searched from their earliest records through May 16, 2013. Several journals were hand searched and some authors were contacted for additional information. Outcome measures analysed were mean bleeding on probing change, mean clinical attachment level gain and mean probing pocket depth reduction. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed. Results The search yielded 281 abstracts. Ultimately, 95 studies were selected, describing 43 studies meeting the eligibility criteria. Systemic antibiotics showed a significant (p

Aim To assess, in a randomized study, the implant (clinical and radiological) and patient outcomes of guided implant placement at 1-year follow-up, compared to conventional implant treatment. Material and Methods A total of 314 were placed in 59 patients, randomly assigned to one of the treatment groups. Radiographic and clinical parameters were recorded at the time of implant placement, prosthesis instalment (baseline) and at 1-year follow-up. Patient satisfaction was measured with the oral health-related quality of life instrument (OHIP-49). Results No implants were lost. The mean marginal bone loss after the first year of loading was 0.04 mm (SD 0.34) for the guided surgery and 0.01 mm (SD 0.38) for the control groups. In the guided surgery groups, the mean number of surfaces with BOP and plaque at 1-year follow-up was 1.41 (SD 1.25) and 1.10 (SD 1.22), for the control groups this was, respectively, 1.37 (SD 1.25) and 1.77 (SD 1.64). The mean pocket probing depth was 2.81 mm (SD 1.1) for the guided, and 2.50 mm (SD 0.94) for the control groups. For all treatment groups, a significant improvement in quality of life was observed at 1-year follow-up (p ≤ 0.01), no differences between groups were observed. Conclusion Within the limitations of this study, no difference could be found at 1-year follow-up between the implant and patient outcome variables of guided or conventional implant treatment.

The widespread use of oral implants in recent years has resulted in various types of complications. One of those complications is the periapical implant lesion. Different factors have been proposed to play a role in the development and emergence of a periapical implant lesion. To date, there is no consensus on the etiology and therefore periapical lesions around dental implants are considered to have a multifactorial etiology. The diagnosis of an implant periapical lesion should be based on both clinical and radiological findings. Additionally, in order to apply the best treatment strategy the evolution of the lesion should be taken into account. The treatment of this kind of lesion, however, is still empiric. Data, primarily from case reports, seem to indicate that the removal of all granulation tissue is a first step to arrest the progression of the bone destruction. The removal of the apical part of the implant seems a valuable treatment strategy.

Background and Purpose Osteoporosis is a disease affecting more than 300 million people worldwide and is responsible for numerous medical complications. This study aimed to investigate the relation between skeletal and maxillary bone density. Materials and Methods Seventy-three patients were recruited and divided between group A (osteoporosis), group B (healthy, control), and group C (osteopenia) on the basis of a dual-energy x-ray absorptiomery (DXA) scan. These patients also received a CT scan on which bone density measurements were performed at five sites: maxilla midline, retromolar tuberosities, incisor, premolars, and molar regions. Results The bone density was lower in osteoporotic patients compared with the control patients. The bone mineral density (BMD) of the tuberosities showed the strongest correlations with the BMD of the hip and the spine (respectively, r = 0.50 and r = 0.61). The midline region showed moderate correlations with the hip (r = 0.47) and the spine (r = 0.46). For potential implant sites, the correlations with the BMD of the hip and spine were, however, small to insignificant. Based on measurements of bone density of the maxilla, it was possible to predict if the patient was osteoporotic or not with a sensitivity of 65% and a specificity of 83%. Conclusions The maxillary bone density of subjects with osteoporosis is significantly lower than that of healthy patients. Moreover, there is a direct correlation between the density of the skeleton and the density of some sites of the maxilla. Using measurements of maxillary bone density in order to predict skeletal bone density might be a useful tool for the screening of osteoporosis.

AIM: To assess in a randomized study the patient-centred outcome of two guided surgery systems (mucosa or bone supported) compared to conventional implant placement, in fully edentulous patients. MATERIAL AND METHODS: Fifty-nine patients (72 jaws) with edentulous maxillas and/ or mandibles, were consecutively recruited and randomly assigned to one of the treatment groups. Outcome measures were the Dutch version of the McGill Pain Questionnaire (MPQ-DLV), the Health-related quality of life instrument (HRQOL), visual analogue scales (VAS), the duration of the procedure, and the analgesic doses taken each day. RESULTS: Three hundred and fourteen implants were placed successfully. No statistical differences could be shown between treatment groups on pain response (MPQ-DLV), treatment perception (VAS) or number or kind of pain killers. For the HRQOLI-instrument, a significant difference was found between the Materialise Mucosa and Materialise Bone group at day 1 (p = 0.02) and day 2 (p = 0.01). For the duration of the surgery, a statistical difference (p = 0.005) was found between the Materialise mucosa and the Mental group, in favour of the first. CONCLUSION: In this study little difference could be found in the patient outcome variables of the different treatment groups. However there was a tendency for patients treated with conventional flapped implant placement to experience the pain for a longer period of time. ispartof: Journal of Clinical Periodontology vol:41 issue:7 pages:724-732 ispartof: location:United States status: published

Despite etiological differences between aggressive and chronic periodontitis, the treatment concept for aggressive periodontitis is largely similar to that for chronic periodontitis. The goal of treatment is to create a clinical condition that is conducive to retaining as many teeth as possible for as long as possible. When a diagnosis has been made and risk factors have been identified, active treatment is commenced. The initial phase of active treatment consists of mechanical debridement, either alone or supplemented with antimicrobial drugs. Scaling and root planing has been shown to be effective in improving clinical indices, but does not always guarantee long-term stability. Antimicrobials can play a significant role in controlling aggressive periodontitis. Few studies have been published on this subject for localized aggressive periodontitis, but generalized aggressive periodontitis has been subject to more scrutiny. Studies have demonstrated that systemic antibiotics as an adjuvant to scaling and root planing are more effective in controlling disease compared with scaling and root planing alone or with supplemental application of local antibiotics or antiseptics. It has also become apparent that antibiotics ought to be administered with, or just after, mechanical debridement. Several studies have shown that regimens of amoxicillin combined with metronidazole or regimens of clindamycin are the most effective and are preferable to regimens containing doxycycline. Azithromycin has been shown to be a valid alternative to the regimen of amoxicillin plus metronidazole. A limited number of studies have been published on surgical treatment in patients with aggressive periodontitis, but the studies available show that the effect can be comparable with the effect on patients with chronic periodontitis, provided that proper oral hygiene is maintained, a strict maintenance program is followed and modifiable risk factors are controlled. Both access surgery and regenerative techniques have shown good results in patients with aggressive periodontitis. Once good periodontal health has been obtained, patients must be enrolled in a strict maintenance program that is directed toward controlling risk factors for disease recurrence and tooth loss. The most significant risk factors are noncompliance with regular maintenance care, smoking, high gingival bleeding index and poor plaque control. There is no evidence to suggest that daily use of antiseptic agents should be part of the supportive periodontal therapy for aggressive periodontitis. ispartof: Periodontology 2000 vol:65 issue:1 pages:107-33 ispartof: location:Denmark status: published

European Association of Osseointegration, EAO 22nd Annual Scientific Meeting, Dublin, Ireland 17-19 October 2013

Aim To investigate the influence of the use L-PRF as a socket filling material and its ridge preservation properties. Materials and Methods Twenty-two patients in need of single bilateral and closely symmetrical tooth extractions in the maxilla or mandible were included in a split-mouth RCT. Treatments were randomly assigned (L-PRF socket filling versus natural healing). CBCT scans were obtained after tooth extraction and three months. Scans were evaluated by superimposition using the original DICOM data. Mean ridge width differences between timepoints were measured at three levels below the crest on both the buccal and lingual sides (crest −1 mm (primary outcome variable), −3 mm and −5 mm). Results Mean vertical height changes at the buccal were −1.5 mm (±1.3) for control sites and 0.5 mm (±2.3) for test sites (p

Introduction Universities are developing and implementing implant dentistry training to prepare dental professionals for the growing treatment needs. This study describes how implant dentistry is taught at the KU Leuven and focuses on implant-related clinical outcomes. Perspectives of participating undergraduate students are analysed with a view to improve oral implant dentistry training. Materials and methods Implant dentistry training at the KU Leuven consists of theoretical lectures, pre-clinical hands-on workshops and clinical (surgical/prosthetic) experience. Questionnaires were used to investigate the perceptions of students on the educational programme. Radiographs were taken at implant insertion, at healing abutment connection, at restoration/prosthesis insertion and after 1 and 2 years of functional loading. The marginal bone level was measured from the implant–abutment connection to the first visible bone-to-implant contact. Results One hundred and twelve implants were placed by 56 undergraduate students (61.5% of the total students) in 56 patients. After a follow-up time of 3 years, the cumulative implant survival rate, at implant level, was 97.1%. The mean marginal bone loss after 1 and 2 years in function was 0.35 mm and 0.39 mm, respectively. Eighty percentage of students were satisfied with the training, and they considered this sufficient preparation to perform implant placement under close supervision. Conclusions The clinical outcome of implant treatment performed by undergraduate students under close supervision is similar to that reported by experienced clinicians/research teams. Clinical, surgical as well as restorative experience in addition to theoretical and pre-clinical training seems beneficial when implementing implant dentistry in the undergraduate programmes.

Objectives This clinical trial explored the clinical and radiographic dimensional changes of the alveolar ridge in the first 4 months after tooth extraction in combination with the application of Leukocyte- and Platelet Rich Fibrin (L-PRF). Methods Eighteen single rooted maxillary and mandibular sockets were filled with L-PRF without soft tissue closure. Clinical measurements (bone sounding) were performed using a customized acrylic stent and radiographic measurements were accomplished using Cone Beam Computed Tomography (CBCT), immediately after tooth extraction and after 4 months. Results The clinical observations indicated a mean horizontal resorption of 1.18 ± 2.4 mm (p = 0.8) at the crest, 1.25 ± 2.0 mm (p = 0.57) and 0.83 ± 2.0 mm (p = 0.78) at 2 mm and 4 mm apical to the crest, respectively. The buccal plate demonstrated a mean vertical loss of 0.44 ± 3.5 mm (p = 0.9), the centre of the socket had a significant filling of 5.72 ± 3.6 mm (p = 0.0001) and the oral cortical plate had a mean vertical gain of 0.09 mm ± 1.57 mm (p = 0.9). The radiographic analysis demonstrated a mean vertical bone loss of 0.27 ± 2.5 mm (p = 0.9) on the buccal and of 0.03 ± 1.6 mm (p = 0.9) at the oral crest. The width of the alveolar ridge had a mean loss of 1.33 mm ± 1.43 mm. Conclusions Within the limitations of this pilot study, it can be concluded that L-PRF might show clinical benefits for ridge preservation.

Aim To assess the accuracy of static computer-guided implant placement. Material and methods Electronic and manual literature searches were conducted to collect information on the accuracy of static computer-guided implant placement and meta-regression analyses were performed to summarize and analyse the overall accuracy. The latter included a search for correlations between factors such as: support (teeth/mucosa/bone), number of templates, use of fixation pins, jaw, template production, guiding system, guided implant placement. Results Nineteen accuracy studies met the inclusion criteria. Meta analysis revealed a mean error of 0.99 mm (ranging from 0 to 6.5 mm) at the entry point and of 1.24 mm (ranging from 0 to 6.9 mm) at the apex. The mean angular deviation was 3.81° (ranging from 0 to 24.9°). Significant differences for all deviation parameters was found for implant-guided placement compared to placement without guidance. Number of templates used was significant, influencing the apical and angular deviation in favour for the single template. Study design and jaw location had no significant effect. Less deviation was found when more fixation pins were used (significant for entry). Conclusion Computer-guided implant placement can be accurate, but significant deviations have to be taken into account. Randomized studies are needed to analyse the impact of individual parameters in order to allow optimization of this technique. Moreover, a clear overview on indications and benefits would help the clinicians to find the right candidates.

Objective: The objective of this study is to systematically review the literature regarding the impact of mouthrinses on oral malodor and present evidence for the treatment effects of mouthrinses on oral malodor. Material and methods: PubMed-MEDLINE, the Cochrane-CENTRAL and EMBASE were searched through February 10, 2012 to identify appropriate studies. Volatile sulphur compound measurements, organoleptic measurements and tongue coating were selected as outcome variables. Search results: The independent screenings of 333 unique titles and paper abstracts revealed 12 publications (12 experiments) that met the eligibility criteria. Means and standard deviations were extracted. The results were separated into short-term (

This 3-year prospective randomized controlled trial compared the clinical, microbiological and biochemical outcome of minimally (Turned, Tur) and moderately rough (TiUnite®, TiU) implant surfaces in a split-mouth design.The study population included 14 subjects: nine fully edentulous and five partially edentulous subjects with a history of periodontitis. Implants (n = 78, 39 Tur and 39 TiU) were installed randomly in each patient. Peri-implant clinical parameters and intra-oral radiographs were recorded after 3 years of loading. Subgingival plaque and peri-implant crevicular fluid samples were collected and analysed using culture and quantitative polymerase chain reaction for the biofilm, and enzyme-linked immunosorbent assay for the concentration of osteoprotegerin and receptor activator of nuclear factor kappa-B ligand, respectivelyNo statistically significant differences in clinical, microbiological and biochemical parameters could be observed when comparing the Tur and TiU implant surfaces.After 3 years of loading, in periodontitis susceptible patients, the moderately rough, TiU implants demonstrated a similar clinical outcome compared with the smoother, turned implants. Longer follow-up and studies using different implant types are needed to confirm the statement that minimally and moderately rough implant surfaces perform similar, both from a clinical and from a microbiological point of view.