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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

Various studies have described the biological properties of the Leucocyte- and Platelet Rich Fibrin (L-PRF) such as the antimicrobial effect against wound bacteria, but less is known about the effect against periodontal pathogens. The aim of this study was to evaluate the antibacterial properties of the L-PRF membrane and L-PRF exudate against the main periopathogens cultured on agar plates and in planktonic solution. This study demonstrated the antibacterial effect of the L-PRF membrane against P. intermedia, F. nucleatum, and A. actinomycetemcomitans, but especially against P. gingivalis. The L-PRF exudate also showed a strong inhibition against P. gingivalis on agar plates. No inhibition could be observed for the other bacterial strains. Moreover, L-PRF exudate decreased the number of viable P.gingivalis in a planktonic solution in a dose-dependent way. However, A. actinomycetemcomitans showed an increased growth in planktonic solution when in contact with the L-PRF exudate.

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

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

Osteotome sinus floor elevation (OSFE) is a technique aimed at simplifying implant placement in the posterior atrophic maxilla. The necessity of bone grafting under the elevated sinus membrane has been widely debated. The aim was to compare the evolution over 5 years of implant stability in sites grafted or left ungrafted.A total of 12 patients (9 female and 3 male) presenting ≤ 4 mm initial bone height (IBH) in the posterior maxillary sites were recruited. Implants (n = 37) were placed using OSFE. According to the randomisation, the sinuses received either bone graft (n = 20, control group) or no graft (n = 17, test group). Patients received both these treatments when both sinuses fulfilled the inclusion criteria. Control assessments were performed 1 week, 10 weeks, 12 weeks, and then 1 year, 3 years and 5 years after the implant placement. Periapical radiographs were taken and the implant stability quotient (ISQ) was measured at different time points.At implant surgery, the mean ISQ was 58.9 ± 11.2 for the test group and 53.8 ± 10.2 for the control group; it plummeted 10 weeks after the implant placement and rose thereafter. Five years after the implant placement, the mean ISQ reached 80.8 ± 4.2 for the control group, and 79.7 ± 4.3 for the test group. The difference between the groups was not significant. The IBH significantly affected implant stability at implant insertion and 5 years after the implant insertion, but not at the other time points.The implants performed using OSFE in ungrafted sites were as stable as the implants placed in grafted sites.

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

BACKGROUND: Cerebrospinal fluid (CSF) leakage represents an important and sometimes challenging complication in both cranial and spinal surgery. Current available options for dural closure pose inherent problems regarding safety, efficacy, immunogenicity, cost, and invasiveness. In this article, the use of leukocyte- and platelet-rich fibrin (L-PRF) derived from the patient's own blood is proposed to facilitate dural closure. We aim to describe the safety, feasibility, and applicability of L-PRF membranes and plugs in cranial and spinal neurosurgery. METHODS: A retrospective study reviewing clinical and surgical characteristics was conducted in 47 patients in whom the use of L-PRF was attempted to reinforce dural closure at a single institution during 1 year. Procedures included skull base, posterior fossa, and spinal revision surgeries. RESULTS: L-PRF membranes and/or plugs were used in 44 surgeries. The preparation of L-PRF failed in three cases. L-PRF membranes were used as onlay grafts to augment sealing or sutured into a defect. No short-term complications related to the use of L-PRF were recorded. Postoperative CSF leakage was present in two endoscopic transsphenoidal pituitary surgeries and in one spinal CSF leak repair. CONCLUSION: L-PRF is safe, inexpensive, and completely autologous and can be rapidly and non-invasively harvested to aid in dural closure. Theoretical advantages include a regenerative bioactive potential, which could lead to improved wound healing and reduced infection rates. These findings warrant larger prospective studies to determine the potential role of L-PRF in neurosurgery. ispartof: ACTA NEUROCHIRURGICA vol:160 issue:8 pages:1497-1503 ispartof: location:Austria 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.

Aim The objective of this proof-of-concept study was to investigate the effects of a new guided bone regeneration technique with a tissue engineering approach. Materials and methods This single cohort observational study evaluated the outcome of the leucocyte- and platelet-rich fibrin (L-PRF) Block for horizontal bone augmentation in the maxilla. The L-PRF Block is prepared by mixing a particulated biomaterial with chopped L-PRF membranes at a 50:50 ratio and adding liquid fibrinogen to glue all together. Horizontal augmentation was assessed linearly and volumetrically immediately after surgery and 5-8 months later by matching consecutive cone beam computed tomography (CBCTs). Results Ten patients (mean age of 50.7 years [±17.2]) representing 15 sites with horizontal alveolar deficiencies were included. Superimposition of pre-operative and posthealing CBCT scans showed an average linear horizontal bone gain of 4.6 mm (±2.3), 5.3 mm (±1.2) and 4.4 mm (±2.3), measured at 2, 6 and 10 mm from the alveolar crest, respectively. The volumetric gain was 1.05 cm3 (±0.7) on average. The resorption rate after 5-8 months was 15.6% (±6.7) on average. Conclusions L-PRF Block may be a suitable technique to augment deficient alveolar ridges.

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.

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

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.

Chronic wounds (VLU: venous leg ulcer, DFU: diabetic foot ulcer, PU: pressure ulcer, or complex wounds) affect a significant proportion of the population. Despite appropriate standard wound care, such ulcers unfortunately may remain open for months or even years. The use of leukocyte- and platelet-rich fibrin (L-PRF) to cure skin ulcers is a simple and inexpensive method, widely used in some countries but unknown or neglected in most others. This auto-controlled prospective cohort study explored and quantified accurately for the first time the adjunctive benefits of topical applications of L-PRF in the management of such refractory ulcers in a diverse group of patients. Forty-four consecutive patients with VLUs (n = 28, 32 wounds: 17 ≤ 10 cm(2) and 15 > 10 cm(2)), DPUs (n = 9, 10 wounds), PUs (n = 5), or complex wounds (n = 2), all refractory to standard treatment for ≥3 months, received a weekly application of L-PRF membranes. L-PRF was prepared following the original L-PRF method developed more than 15 years ago (400g, 12 minutes) using the Intra-Spin L-PRF centrifuge/system and the XPression box kit (Intra-Lock, Boca Raton, FL, USA; the only CE/FDA cleared system for the preparation of L-PRF). Changes in wound area were recorded longitudinally via digital planimetry. Adverse events and pain levels were also registered. All wounds showed significant improvements after the L-PRF therapy. All VLUs ≤ 10 cm(2), all DFUs, as well as the two complex wounds showed full closure within a 3-month period. All wounds of patients with VLUs > 10 cm(2) who continued therapy (10 wounds) could be closed, whereas in the five patients who discontinued therapy improvement of wound size was observed. Two out of the five PUs were closed, with improvement in the remaining three patients who again interrupted therapy (surface evolution from 7.35 ± 4.31 cm(2) to 5.78 ± 3.81 cm(2)). No adverse events were observed. A topical application of L-PRF on chronic ulcers, recalcitrant to standard wound care, promotes healing and wound closure in all patients following the treatment. This new therapy is simple, safe and inexpensive, and should be considered a relevant therapeutic option for all refractory skin ulcers. ispartof: Platelets vol:29 issue:5 pages:1-8 ispartof: location:England 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.

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.

OBJECTIVES This prospective study analyzed the accuracy of implant placement with mucosa-supported stereolithographic guides, executed by inexperienced surgeons supervised by an experienced colleague. MATERIAL AND METHODS For the accuracy analysis, 75 OsseoSpeed implants™, placed in 17 fully edentulous jaws (16 patients) using a mucosa-supported stereolithographic guide (IMPLANT SAFE Guide, DENTSPLY Implants) and the Facilitate™ protocol, were included. DICOM images of the pre-surgical planning and the post-surgical CBCT were matched using the Mimics(®) software (Materialise Dental). These data were compared with the data (12 jaws, 52 implants) of an experienced surgeon (Vercruyssen et al. Journal of Clinical Periodontology 2014; doi:10.1111/jcpe.12231). RESULTS The global deviation at the coronal and apical point was 0.9 mm (SD 0.5) and 1.1 mm (SD 0.5), respectively. Depth deviations were 0.5 mm (SD 0.5) and 1.1 mm (SD 0.5), respectively, and the angular deviation was 2.8° (SD 1.5°). These deviations were statistically not inferior to the deviations of the experienced surgeon and also within the range of deviations reported by several systematic reviews. CONCLUSION Within the limitations of this study and for the above-mentioned surgical protocol, inexperience of the surgeon had no influence on the accuracy of implant placement in fully edentulous jaws, when all steps needed for the procedure are supervised by experienced dentists.

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.

Aim To assess the accuracy of guided surgery compared with mental navigation or the use of a pilot-drill template in fully edentulous patients. Material and methods Sixty consecutive patients (72 jaws), requiring four to six implants (maxilla or mandible), were randomly assigned to one of the following treatment modalities: Materialise Universal® mucosa, Materialise Universal® bone, Facilitate™ mucosa, Facilitate™ bone, mental navigation, or a pilot-drill template. Accuracy was assessed by matching the planning CT with a postoperative CBCT. Deviations were registered in a vertical (depth) and horizontal (lateral) plane. The latter further subdivided into BL (bucco-lingual) and MD (mesio-distal) deviations. Results The overall mean vertical deviation for the guided surgery groups was 0.9 mm ± 0.8 (range: 0.0–3.7) and 0.9 mm ± 0.6 (range: 0.0–2.9) in a horizontal direction. For the non-guided groups, this was 1.7 mm ± 1.3 (range: 0.0–6.4) and 2.1 mm ± 1.4 (range 0.0–8.5), respectively (P

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

Cleeren G, Quirynen M, Ozcelik O, Teughels W. Role of 3D animation inperiodontal patient education: a randomized controlled trial. J Clin Periodontol2014; 41: 38–45. doi: 10.1111/jcpe.12170.AbstractAim: This randomized controlled parallel trial investigates the effect of 3Danimation on the increase and recall of knowledge on periodontitis by patientswith periodontitis. The effects of a 3D animation (3D animation group) werecompared with narration and drawing (control group) for periodontal patienteducation.Material and Methods: A total of 68 periodontitis patients were stratified accord-ing to educational level and then randomly allocated to control or 3D animationgroups. All patients received: (1) a pre-test (baseline knowledge), (2) a patienteducation video (3D animation or control video), (3) a post-test (knowledgeimmediately after looking at the video), and (4) a follow-up test (knowledge recallafter 2 weeks). Each test contained 10 multiple-choice questions.Results: There was no significant difference in baseline knowledge. Patientsreceiving the 3D animations had significantly higher scores for both the post-testand the follow-up test, when compared with patients receiving sketch animations.Conclusion: 3D animations are more effective than real-time drawings for peri-odontal patient education in terms of knowledge recall. 3D animations may be apowerful tool for assisting in the information process.

OBJECTIVE: The predictability and simplicity of the Summers' technique for sinus floor elevation encouraged many clinicians to consider this new approach. The impact of such intervention on the sinus mucosa has, however, not been explored extensively. This pilot study followed the response of the Schneiderian membrane, longitudinally, via cone-beam CT images. MATERIAL AND METHODS: Ten consecutive patients (five women, mean age 58.7 years) referred for implant therapy in the posterior part of the maxilla, in combination with a trans-alveolar sinus floor elevation (13 sinuses involved), were enrolled. CBCT images were taken prior to and at 1 week and 1 month after surgery. The changes in thickness of the Schneiderian membrane were scored at nine standardized points per sinus using reformatted cross-sectional images. RESULTS: One week after sinus floor elevation, the Schneiderian membrane showed a significant swelling of 9.2 mm in the middle (SD 0.3; P

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.

Objective: This retrospective analysis evaluated the long-term outcome of two implants supporting an overdenture in the mandible, as well as the significance of some confounding factors (smoking, implant length, bone quality). Material and methods: All mandibular overdenture cases (n=495) treated during the past 25 years in our centre (with ≥5 years loading of the implants) were included in this study. General information (medical history, implant data, report on surgery) was retrieved from the patient's file. A large number of patients (n=248) were willing to visit the clinic for an additional follow-up visit. For the others, information on implant survival was collected by phone (n=121), or contact was impossible (57 had died, three were hospitalized and 66 could not be reached). In the latter group, information was used, up to their last visit to the clinic. An implant was considered as surviving if it was still in function in the mouth, without clear adverse effects (pain, swelling, mobility). A failure was defined as early if it occurred within the window, insertion-final prosthesis placement; afterwards, it was considered as late. Results: Most of the inserted implants (Branemark type) were of the turned (machined) type (95.5%), the remainder was anodized (TiUnite). The anchoring system was either a bar (86.3%), ball attachments (11.7%) or magnets (1.6%), and only some patients changed from one to the other (0.4%). Kaplan–Meier analyses showed a survival rate of 95.5% after 20 years of loading. Factors that influenced the outcome included smoking (90% rate for smokers) and the surgical protocol (reduced survival rate for one-stage-placed implants). Implant length and bone quality had no impact. Conclusions: These results fully support the two-implant overdenture concept in the mandible even in the long run. To cite this article: Vercruyssen M, Marcelis K, Coucke W, Naert I, Quirynen M. Long-term, retrospective evaluation (implant and patient-centred outcome) of the two-implants-supported overdenture in the mandible. Part 1: survival rate. Clin. Oral Impl. Res. 21, 2010; 357–365. doi: 10.1111/j.1600-0501.2009.01849.x

Van Assche N, van Steenberghe D, Quirynen M, Jacobs R. Accuracy assessment of computer-assisted flapless implant placement in partial edentulism. J Clin Periodontol 2010; 37: 398–403. doi: 10.1111/j.1600-051X.2010.01535.x Abstract Aim: To assess the accuracy of implants placed flapless by a stereolithographic template in partially edentulous patients. Material and Methods: Eight patients, requiring two to four implants (maxilla or mandible), were consecutively recruited. Radiographical data were obtained by means of a cone beam or a multi-slice CT scan and imported in a software program. Implants (n=21) were planned in a virtual environment, leading to the manufacture of one stereolithographic template per patient to guide the implant placement in a one-stage flapless procedure. A postoperative cone beam CT was performed to calculate the difference between virtual implant (n=21) positions in the preoperative planning and postoperative situation. Results: A mean angular deviation of 2.7° (range 0.4–8, SD 1.9), with a mean deviation at the apex of 1.0 mm (range 0.2–3.0, SD 0.7), was observed. If one patient, a dropout because of non-conformity with the protocol, was excluded, the angular deviation was reduced to 2.2° (range 0.6–3.9, SD 1.1), and the apical deviation to 0.9 mm (range 0.2–1.8). Conclusion: Based on this limited patient population, a flapless implant installation appears to be a useful procedure even when based on accurate and reliable 3D CT-based image data and a dedicated implant planning software.

Objectives: To evaluate the implant survival rate, periodontal and radiographic parameters of non-submerged screw implants with two different surfaces (TPS and SLA) in periodontally non-susceptible patients (NSP) and in patients with chronic adult periodontitis (CAP) or with generalized aggressive periodontitis (GAP). Material and methods: In 110 healthy partially edentulous subjects, 68 patients with CAP and 16 patients with GAP, a total of 513 implants were installed and followed for on average 48.1 +/- 25.9 months. Only fixed partial dentures were used as suprastructures. All patients were offered a supportive periodontal maintenance program. Smoking habits, health impairment, plaque score, bleeding on probing (BOP), type of surface, bone score, bone loss on radiographs and the number of failed implants were noted. Results: Implant survival in the NSP and CAP group was 98% and 96% after 140 months (NS), but only 80% after 100 months in the GAP group (P=0.0026). The overall rate of implant loss was 4.7%, but 15.25% in the GAP group (6/16 patients). The average marginal bone loss for all implants was 0.12 +/- 0.71 mm on the mesial side and 0.11 +/- 0.68 mm on the distal side. Bone loss/year was 0.08 +/- 0.31 and 0.07 +/- 0.3 mm in the NSP group, but 0.17 +/- 0.2 and 0.17 +/- 0.19 mm in the GAP group. Only in the GAP group, was bone loss significantly related to BOP, age, inflammation, presence of plaque, probing depth. Implants with a TPS surface had a lower survival than implants with an SLA surface (93% vs. 97%; P=0.06), especially in the GAP group (80% vs. 83%; P=0.005). Smoking habits had a significant influence on implant survival only in the GAP group (P=0.07), declining in current smokers to 63%, and to 78% in former smokers. Overall, impaired general health had no significant influence (P=0.85). However, impaired health further reduced implant survival in the GAP group (survival: 71%). In a statistical model to predict the chance for implant failing, only periodontal classification (P=0.012) and implant surface type (P=0.027) were significant. Conclusion: Periodontally healthy patients and patients with CAP show no difference in peri-implant variables and implant survival rate, but patients with GAP have more peri-implant pathology, more marginal bone loss and a lower implant survival implant rate. SLA surface had a better prognosis than the TPS surface.

Aims: The aim of this paper was to analyse the aetiology and characteristics of 2000 patients who visited a multidisciplinary bad breath clinic in Leuven, Belgium and to correlate organoleptic ratings with portable device measurements. Materials and Methods: The characteristics and aetiology of breath malodour of two thousand consecutive patients who visited a halitosis consultation were explored by means of a standard questionnaire and a clinical examination, including organoleptic scores provided by a trained and calibrated judge, and a portable bad breath detector (Halimeter®). Results: Most patients came without referral and had complaints for several years (mean: 7 years, SD: 8 years). For 76% of the patients, an oral cause was found [tongue coating (43%), gingivitis/periodontitis (11%) or a combination of the two (18%)]. Pseudo-halitosis/halitophobia was diagnosed in 16% of the cases; and ear, nose and throat/extra-oral causes were found in 4% of the patients. Most patients had an organoleptic score

In the past few decades, more patients have been treated orthodontically, but no longitudinal study has compared orthodontic bands and brackets microbiologically and clinically.This longitudinal trial (split-mouth design) included 24 patients. Microbiology (sub- and supragingival), probing depth (PD), bleeding on probing (BOP), and gingival crevicular fluid flow (GCF) were assessed at baseline (band placement) and at weeks 18 (bracket bonding) 20, 24, and 36. A statistical comparison was made over time and among the banded, bonded, and control sites.The aerobe/anaerobe ratio of sub- and supragingival colony forming units decreased significantly (relatively more anaerobes) over the study period for the banded and bonded sites (P0.001). This decrease was accompanied by significant elevations in PD, BOP, and GCF. These changes occurred faster after bonding compared to banding. No significant changes were observed 18 weeks after banding with the exception of increased PD (P0.001). At week 36, all microbial and clinical variables at the bonded site had changed significantly in the negative direction (P0.001) compared to week 18. The control sites did not show any significant changes over time, indicating that the effects were localized.The placement of fixed orthodontic appliances had a significant impact on microbial and clinical variables. The changes occurred faster at the bonded sites compared to the banded sites, probably because wire insertion caused difficulties in approximal cleaning. Over the long term, banding did not lead to more adverse microbial and periodontal effects than bonding.

AIM: To compare undisturbed plaque formation on teeth bonded with different types of orthodontic brackets with non-bonded control teeth, via a de novo plaque growth experiment over a 7-day period. MATERIAL AND METHODS: A randomized controlled trial with split-mouth design was set up enroling 16 dental students. Within each subject sites with Speed(S) and GAC(G), brackets and control sites were followed. Clinical periodontal parameters were recorded at baseline, on days 3 and 7. Microbiological samples were taken from the brackets and the teeth on days 3 and 7. RESULTS: Both anaerobe and aerobe colony-forming units (CFU) were significantly higher in S-sites than in G-sites (p=0.0002, p=0.02). The shift from aerobic to anaerobic species was observed earlier in S-sites than in G-sites. The aerobe/anaerobe CFU ratio was significantly lower in S-sites than in G-sites (p=0.01). On day 3, the crevicular fluid flow was significantly higher in S-sites than in control sites (p=0.01). On day 7, S-sites and G-sites showed a significantly higher crevicular flow than control sites (both p

AIM: The study was set to evaluate the validity of subjective jaw bone quality assessment. MATERIALS AND METHODS: A total of 298 patients (198 females, mean age 56.4) were treated with oral implants at the Periodontology Department at the University Hospital of KUL. A total of 761 TiUnite implants have been installed. Subjective bone quality assessment was performed on radiographs and by the surgeon's tactile sensation and was compared with torque measurements. In a subset of patients, implant stability was also assessed by implant stability quotient and/or periotest values. RESULTS: Subjective assessment of bone quality was related to the PTV, ISQ and placement torque [in the crestal, the second and the apical third (N cm)], respectively; in grade 1: -5.3, 73.3 (4.2, 9.6, 15.2), and grade 3 or 4: -1.6, 55 (3.3, 5.5, 8.4). For the surgeon's tactile sensation, a good correlation was noted for the presence of a thick cortex: -4.6, 70.3 (4.2, 9.7, 15.1), or a thin one: -0.3, 65.9 (3.6, 6.9, 10.1). For dense trabecular bone, the values were -2.8, 69.4 (4.4, 9.7,14.8), while for poor trabecular bone, the values were-1.7, 66.4 (3.6, 6.4, 9.8). CONCLUSIONS: Subjective assessment of bone quality is related to PTV, ISQ and placement torque measurements at implant insertion. ispartof: Journal of clinical periodontology vol:34 issue:4 pages:359-366 ispartof: location:United States status: published

To evaluate clinical, radiographic, microbiologic, and biomechanical parameters related to bone remodeling around implants with external hexagon (EH) and Morse-taper (MT) connections.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.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 µε) compared to MT (mean 840.98 µε) connection.Radiographic periimplant bone loss depends on the implant connection type. MT connections showed less periimplant bone loss, compared to EH connections.

Aim This study envisaged to explain early marginal bone loss (first years of function) around implants in the posterior area of the mandible by the local bone quality (ratio cortical vs. cancellous bone). Material and methods Four hundred and twenty-three Brånemark MKIII® implants inserted in the posterior region of the mandible were examined, retrospectively, on intra-oral radiographs taken at abutment connection, and 1 and 3–4 years after loading. The quality of the bone was assessed on cone beam or multi-slice CTs. The bone quality was determined by the relative proportions of cortical and trabecular bone at the insertion site. Cortical bone was defined as a clearly white structure without a trabecular pattern. Trabecular bone was defined as the structure between the two cortical plates. The width of both structures was measured at 1, 3, 5, and 7 mm away from the crest of the alveolar bone and converted in to relative proportions. Other parameters (smoking, history of periodontitis, dehiscence, pre-tapping, submerged healing, etc.) were retrieved from the patients record. Results At abutment connection, the mesial and distal marginal bone level was located 0.7 (±0.7) and 0.8 (±0.7) mm apically to the implant–abutment junction. At 1 year and 3–4 years of loading implants placed in a mandible consisting of

To investigate dentist- as well as patient-centered outcomes of the implant-supported cone-anchored removable prosthesis in the edentulous maxilla over 5 years.Ten patients, edentulous in the maxilla, received six Ti implants after which they were delayed loaded through a cone-anchored removable prosthesis. Clinical parameters such as plaque and bleeding indices, PTV, implant success, marginal bone loss, device and prosthesis complications, and patient satisfaction (visual analogue scale) were collected at follow-up visits scheduled 1, 3, 6, 12, 24, 36, and 60 months postprosthesis delivery.After at least 5 years of follow-up (mean: 63.7 months), 53/59 implants were rated successful, while two of 59 failed and one implant was kept sleeping. Mean marginal bone loss from prosthesis delivery until 1, 3, and 5 years, respectively, was; 0.15 (SD: 0.87), 0.36 (SD: 1.07), and 0.60 mm (SD: 1.12). The mean Periotest® values at baseline and 5 years did not differ significantly. After 1 year, a significant improvement in patient satisfaction was recorded compared with the old denture, and this remained stable over the 5-year period.Cone-anchored removable dental prostheses retained by secondary splinted implants offer a safe alternative for patients with an edentulous maxilla in need of more comfort. Dentist- as well as patient-centered outcomes compete with reports using other prosthetic anchoring devices. Larger replica studies are encouraged to further validate this concept.

AIM The dimension of the alveolar bone reduces significantly after tooth loss. Clinicians consider a 1-2 mm buccal and lingual bone width mandatory around the implant at placement. This prospective study analysed the outcome of implants inserted in jaws with narrow (≤4.5 mm) buccal bone dimensions. MATERIAL AND METHODS Twenty-eight patients (mean age 63, 89% female) with a narrow alveolar crest (≤4.5 mm in width on CBCT) received 100 implants (3.5 mm) via a two-stage procedure. Intra-oral radiographs were taken at placement, functional loading and after 1, 2 and 3-years of follow-up. Peri-implant bone level alterations were recorded by two calibrated, periodontologists. RESULTS All implants integrated and the cumulative survival rate after 3 years was 100%. The implants were inserted 0.81 mm ± 0.83 subcrestal. At functional loading the bone was located 0.65 mm ± 0.6 apical of the implant shoulder. During 3 years of loading the amount of annual marginal bone loss was 0.17 ± 0.4, 0.05 ± 0.4 and - 0.06 ± 0.1 mm, respectively. CONCLUSION Based on these data and within the limitations of this study it became clear that implants, placed in sites with limited dimensions (≤4.5 mm width), showed minimal amounts of marginal bone loss during the first 3 years of functional loading.

OBJECTIVES: The beneficial effects of the one-stage, full-mouth disinfection remain controversial in the scientific literature. This might be due to the fact that an entire mouth disinfection with the use of antiseptics has been confused with a full-mouth scaling and root planing. This parallel, single blind RCT study aimed to compare several full-mouth treatment strategies with each other. MATERIAL AND METHODS: Seventy-one patients with moderate periodontitis were randomly allocated to one of the following treatment strategies: scaling and root planing, quadrant by quadrant, at two-week intervals (negative control, NC), full-mouth scaling and root planing within 2 consecutive days (FRP), or three one-stage, full-mouth disinfection (FM) protocols within 2 consecutive days applying antiseptics to all intra-oral niches for periopathogens using as antiseptics: chlorhexidine (FMCHX) for 2 months, amine fluoride/stannous fluoride for 2 months (FMF), or chlorhexidine for 2 months followed by amine fluoride/stannous fluoride for another 6 months (FMCHX+F). At baseline and after 2, 4, and 8 a series of periodontal parameters were recorded. RESULTS: All treatment strategies resulted in significant (p

The treatment of periodontitis/peri-implantitis involves the reduction/eradication of periopathogens. After therapy, beneficial and pathogenic species recolonize the subgingival area. The dynamics of recolonization and especially the role of the supragingival environment in this process are still not well-understood. This prospective, split-mouth study followed the early colonization of 'pristine' pockets created during implant surgery (16 partially edentulous patients), to record the time needed before a complex subgingival flora could be established with the supragingival area as the single source. Four subgingival plaque samples were taken from shallow and medium pockets around implants (test), and neighboring teeth (undisturbed microbiota as reference) 1, 2, and 4 wks after abutment connection. Checkerboard DNA-DNA hybridization and culture data revealed a complex microbiota (including several pathogenic species) in the pristine pockets within a wk, with a minimal increase in counts up to 4 wks. Analysis of these data demonstrated that, even with the supragingival environment as the single source for colonizing bacteria, a complex subgingival microbiota can develop within 1 wk. ispartof: Journal of Dental Research vol:84 issue:4 pages:340-4 ispartof: location:United States status: published

Background: Chlorhexidine (CHX) mouth rinse/spray can still be considered the gold standard in the chemical prevention of plaque formation and development of gingivitis. The product unfortunately has some side effects, such as extrinsic tooth staining, poor taste, taste disturbance, sensitivity changes in tongue, pain and irritation because of the alcohol content. These side effects led to the search of new formulations. Methods: In this double-blind, randomized, long-term, parallel study, 48 moderate periodontitis patients rinsed for 6 months (starting immediately after a “one-stage, full-mouth” disinfection) with one of the following products: CHX 0.2%+alcohol (Corsodyl®), CHX 0.05%+ cetyl pyridinium chloride (CPC) 0.05% and no alcohol (Perio-Aid Maintenance®, a new formulation), or the placebo of the latter. After 1, 3 and 6 months a series of clinical and microbiological parameters were recorded for the supra- and subgingival area as well as for saliva. Results: Although there was a significant treatment impact (mechanical debridement) in all groups, both CHX solutions further decreased both plaque and gingivitis indices (p

The safety, efficacy and acceptability of an oscillating/rotating powered toothbrush was assessed in patients rehabilitated with fixed prostheses on implants. One hundred consecutive patients (aged 18-80; mean 56.3; 51 females), who met the inclusion/exclusion criteria and who participated in a regular annual recall scheme, were enrolled. They were instructed on how to use the powered toothbrush, as well as on classical interdental plaque control. The electric toothbrush had to be used twice daily for 2 min. The following periodontal parameters were measured at baseline and at 3 months, 6 months and 12 months: presence/absence of gingival and/or mucosal ulceration/desquamation; sulcus bleeding index; probing pocket depth; periodontal pocket-bleeding index and gingival recession. At 3 months and at the end of the study, patients completed a questionnaire concerning the overall acceptability and convenience of the powered toothbrush, as compared with their habitual manual toothbrush. A total of 80 patients completed the study. No dropouts were related to the use of the powered toothbrush. All parameters improved over the course of the study. The mean overall pocket depth decreased from 3.3 mm at baseline to 3.0 mm at 12 months, while the mean decrease in recession was 0.1 mm at 12 months. During the 1-year observation, there was a slight gain in periodontal attachment level. Gingival ulcerations were not observed at any point in the study. High scores for convenience and comfort of the powered toothbrush were reported, and the majority (95%) said that they would continue to use it for habitual oral hygiene. It is concluded that the powered toothbrush investigated is effective, safe and comfortable for patients rehabilitated by means of oral implant-supported prostheses. ispartof: Clinical oral investigations vol:8 issue:4 pages:206-10 ispartof: location:Germany status: published

Although a two-stage procedure with symphyseal oral implants can lead to a long-term (15 years) 99% cumulative survival rate, a one-stage approach with immediate loading via prefabricated elements seems to offer a short-term acceptable outcome with significantly lower costs. A series of 50 consecutive patients, not eliminated for any systemic or smoking condition, received at the department of periodontology three implants in the symphyseal area, connected by a very rigid horse shoe-shaped titanium bar. A final screw retained prosthetic framework was placed on top of it at the department of prosthetic dentistry within 2 days after surgery (44) or after a delay, due to purely external factors, of up to 10 days (6). Forty-five patients were followed for 1 year. In one patient, all three implants failed and another four patients were lost to follow-up. The cumulative failure rates for implants and prostheses at 1 year were, respectively, 7.3% and 5%. The mean marginal bone loss at 1 year was 1.08 mm (SD: 1.62; range −5.68 to +2.55). This study shows that stable marginal bone levels can be maintained around immediately loaded implants in the lower jaw in an average patient population for at least 1 year. The survival rate is, however, lower than for a staged approach.

Adhesion of bacteria to epithelial cells might be influenced by the degree of cell differentiation, as observed in the multi-layering process of epithelial cells. In the present study, the adhesion of a large group of clinical Porphyromonas gingivalis strains (n=11) to in vitro cultured mono- and multi-layers of epithelial cells was examined and compared. The tissue samples originated from 6 patients with chronic adult periodontitis. Porphyromonas gingivalis bacteria adhered more to mono-layers as opposed to the more differentiated multi-layers. Differences between the clinical P. gingivalis strains, however, became obvious only on multi-layers. These partially differentiated cells may also better represent the individual subject variations. Mono-layer cultures, which are simpler to obtain, seem to be less precise. The importance of cell differentiation on bacterial adhesion needs more attention.

The purpose of this study was to evaluate over time the marginal bone level changes around implants installed to treat partial edentulism and to investigate the possible effect of several confounding variables. Consecutive intraoral radiographs taken with the paralleling technique were used. In all, 660 partially edentulous patients ever treated in the departments (248 males; 15-83 years of age) with 1655 implants, which were successfully integrated at abutment connection, were loaded by means of fixed partial prostheses. The observation period starting at abutment connection reached 16 years (mean 5.1). Implants were divided into three groups: 235 implants supported single-tooth crowns, 398 supported implant-tooth connected and 1022 free-standing fixed partial prostheses. Implants were placed in maxilla and mandible, both anteriorly and posteriorly. No significant difference in bone level evolution was predicted between the three groups of implants, either for posterior or for anterior sites. The estimated marginal bone loss for the first 6 months is 0.31 mm/year and after that 0.015 mm/year higher in the maxilla than in the mandible. More bone loss was predicted for the first 6 months when dehiscences existed, when a membrane or a bone graft were used, or when metal/ceramic prosthesis material was applied. Age and gender did not affect the change in bone level. The use of subsequently situated single-implant crowns to restore an edentulous space did not lead to more marginal bone loss than around splinted implants. Based on marginal bone height maintenance, the excellent prognosis of the presently used implants to support restorations in the treatment of partial edentulism was confirmed.

The aim of the present study was to describe nerve fibres around osseointegrated implants in humans.Twelve mechanically failed implants, retrieved from 10 patients were collected from three dental centres over a period of 5 years. After implant removal, decalcified semi-thin sections (0.5 μm) were stained with thionic methylene blue for light microscopic analysis. In addition, an ultrastructural analysis was performed on serial ultra-thin sections (0.06 μm) using transmission electron microscopy.Both myelinated and unmyelinated nerve fibres could be identified inside the Haversian canals of the osteonal bone near the implant threads. Myelinated fibres were also located at the woven bone around the implant. However, no differentiated nerve endings could be observed around the implants.This study shows the presence of nerve fibres in human peri-implant bone. Previous studies in animals showed that those fibres participate in the process of bone modelling and remodelling. Yet, the role of peri-implant bone innervation in the osseoperception phenomenon cannot be ruled out since the mechanism of mechanoreception in bone is not fully understood.

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.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.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%.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 the accuracy of guided surgery (mucosa and bone-supported) compared to mental navigation or the use of a surgical template, in fully edentulous jaws, in a randomized controlled study. Material and Methods Fifty-nine patients (72 jaws), requiring four to six implants (maxilla or mandible), were consecutively recruited and randomly assigned to one of the following treatment groups; guidance via Materialise Universal®/mucosa, Materialise Universal®/bone, Facilitate™/mucosa, Facilitate™/bone, or mental navigation or a pilot-drill template. The precision was assessed by matching the planning computed tomography (CT) with a post-operative cone beam CT. Results A significant lower mean deviation at the entry point (1.4 mm, range: 0.3–3.7), at the apex (1.6 mm, range: 0.2–3.7) and angular deviation (3.0°, range: 0.2–16°) was observed for the guiding systems when compared to mental navigation (2.7 mm, range: 0.3–8.3; 2.9 mm, range: 0.5–7.4 and 9.9°, range: 1.5–27.8) and to the surgical template group (3.0 mm, range: 0.6–6.6; 3.4 mm, range: 0.3–7.5 and 8.4°, range: 0.6–21.3°). Differences between bone and mucosa support or type of guidance were negligible. Jaw and implant location (posterior–anterior, left–right), however, had a significant influence on the accuracy when guided. Conclusion Based on these findings, guided implant placement appears to offer clear accuracy benefits.

Structured Abstract Objectives The aim of this prospective study was to monitor patients' microbiological and clinical periodontal parameters prior and up to 2 years after orthodontic treatment. Material and Methods Twenty-four adolescents were treated with brackets. Fourteen of them received bands on upper first molars for extra-oral force application before bonding brackets to the remaining teeth. Microbiology, periodontal probing depth, bleeding on probing (BOP), and gingival crevicular fluid (GCF) flow were assessed at baseline (T1), bracket removal (T2), and 2 years post-treatment (T3). A statistical comparison was made over time and between bands and brackets. Results A significant increase from T1 to T2 and a decrease from T2 to T3 in pathogenicity of plaque were noted. No significant difference was observed concerning supragingival colony-forming units (CFU) ratio (aerobe/anaerobe) between T3 and T1. However, the subgingival CFU ratio (aerobe/anaerobe) at T3 did significantly differ from the ratio at T1. Periodontal probing depth, BOP and GCF flow showed a significant increase between T1 and T2 and a reduction between T2 and T3, resulting in the absence of significant differences between T3 and T1, except for BOP at banded sites. Conclusion Placement of fixed appliances has an impact on periodontal parameters. The results showed that not all parameters were normalized at T3, indicating that the changes are only partially reversible.

Morning breath odor is an often-encountered complaint. This double-blind, crossover, randomized study aimed to examine the bad breath-inhibiting effect of 3 commercially available mouthrinses on morning halitosis during an experimental period of 12 days without mechanical plaque control.Twelve medical students with a healthy periodontium refrained from all means of mechanical plaque control during 3 experimental periods of 12 days (with intervening washout periods of at least 3 weeks). A professional oral cleaning preceded each period. During each experimental period, as the only oral hygiene measure allowed, the students rinsed twice a day with one of the following formulations in a randomized order: CHX-Alc (a 0.2% chlorhexidine [CHX] solution); CHX-NaF (CHX 0.12% plus sodium fluoride 0.05%); or CHX-CPC-Zn (CHX 0.05% plus cetylpyridinium chloride 0.05% plus zinc lactate 0.14%). After 12 days, morning breath was scored via volatile sulfur compound (VSC) level measurements of the mouth air and organoleptic ratings of the mouth air, the expired air, and a scraping of the tongue coating. At the 12-day visit, a questionnaire (subjective ratings) was completed and samples taken from both the tongue coating and the saliva for anaerobic and aerobic culturing and vitality staining. The de novo supragingival plaque formation was also recorded. All parameters were correlated with the baseline registrations.Although oral hygiene during the 3 experimental periods was limited to oral rinses, bad breath parameters systematically improved, with the exception of a slight increase in VSC levels while using CHX-Alc, a finding which was associated with the direct influence of the CHX on the sulfide monitor. The oral microbial load after the use of CHX-NaF remained unchanged, while for the CHX-Alc and CHX-CPC-Zn, significant reductions in both aerobic and anaerobic colony forming units (CFU)/ml were noticed in comparison with baseline data for both tongue coating and saliva samples. The composition of microflora, on the other hand, did not reveal significant changes. The supragingival plaque formation was inhibited, in descending order, by CHX-Alc, CHX-CPC-Zn, and CHX-NaF. The subjective scores for the rinses indicated a higher appreciation for CHX-CPC-Alc and CHX-NaF because of a better taste and fewer side effects.The results of this study demonstrate that morning halitosis can be successfully reduced via daily use of mouthrinses. CHX-Alc and CHX-CPC-Zn mouthrinses result in a significant reduction of the microbial load of tongue and saliva.

Background/aims Recent studies reported significant additional clinical and microbiological improvements when severe adult periodontitis was treated by means of a "one-stage full-mouth" disinfection instead of a standard treatment strategy with consecutive root planings quadrant per quadrant. The one stage full-mouth disinfection procedure involves scaling and root planing of all pockets within 24 h in combination with an extensive application of chlorhexidine to all intra-oral niches such as periodontal pockets, tongue dorsum, tonsils (chairside, and at home for 2 months). This study aims to examine the relative importance of the use of chlorhexidine in the one stage full-mouth disinfection protocol. Methods Therefore, 3 groups of 12 patients each with advanced periodontitis were followed, both from a clinical and microbiological point of view, over a period of 8 months. The patients from the control group were scaled and root planed, quadrant per quadrant. at two-week intervals. The 2 other groups underwent a one stage full-mouth scaling and root planing (all pockets within 24 h) with (Fdis) or without (FRp=full-mouth root planing) the adjunctive use of chlorhexidine. At baseline and after 1, 2, 4 and 8 months, the following clinical parameters were recorded: plaque and gingivitis indices, probing depth, bleeding on probing and clinical attachment level. Microbiological samples were taken from different intra-oral niches (tongue, mucosa, saliva and pooled samples from single- and multi-rooted teeth). The samples were cultured on selective and non-selective media in order to evaluate the number of CFU/ml for the key-periodontopathogens. At baseline, an anonymous questionnaire was given to the patients to record the perception of each treatment (post operative pain, fever, swelling etc.). Results All 3 treatment strategies resulted in significant improvements for all clinical parameters, but the Fdis and FRp patients reacted always significantly more favourably than the control group, with an additional probing depth reduction of +/- 1.5 mm and an additional gain in attachment of +/- 2 mm (for pockets > or = 7 mm). Also from a microbiological point of view both the FRp and Fdis patients showed additional improvements when compared to the control group, as well in the reduction of spirochetes and motile organisms as in the number of CFU/ml of the key-pathogens, especially when the subgingival plaque samples were considered. The differences between FRp and Fdis patients were negligible. Conclusions These findings suggest that the benefits of a "one-stage full-mouth disinfection" in the treatment of patients suffering from severe adult periodontitis probably results from the full-mouth scaling and root planing within 24 h rather than the beneficial effect of chlorhexidine. The raise in body temperature the second day after the full-mouth scaling and root planing seems to indicate a Shwartzman reaction.

This study deals with 4971 implants (Brånemark system) installed in 1315 patients, either fully or partially edentulous, and followed from implant installation up to the last control. A predominance of female patients (61%) and a nearly equal number of upper and lower jaws characterised the study group. Patients were scheduled each 6-12 months for recall. The observation time varied from 0.5 to 15 years (mean 5.1). The whole cohort was split up into compromised (n = 59) and non-compromised (n = 1256) patients. The former are defined as grafted (autologous bone) and patients irradiated in the head and neck area. In the compromised patients 24 out of 59 patients (40.6%) showed failures, in whom 59 out of 310 (19%) implants failed. In the non-compromised patients, implant failures were observed in 11.6% of the patients, which corresponds to 5.9% of the installed implants, excluding iatrogenic failures. Failures were further divided chronologically into early (up to 1 year after abutment connection) and late failures. There were early implant failures in 12.5% of the compromised patients and in 3.4% of the others. Late implant failures occurred in 7.4 and 2% of the two patients groups, respectively. While gender did not affect the failure rate, implant lengths, corresponding to the available bone height did, since a 21.5% failure rate for the 7-mm implants contrasts with 4.1 and 3.8% for 13- and 15-mm implants, respectively. Early as well as annual late failures are more frequently found in the maxilla. Implant fractures only occurred in the fixed (both partial and full) prosthesis group but never surpassed the 0.2% annual level. Marginal bone loss, exceeding the third screw thread occurred in 1.8% of the implants at the last control. It appears that this type of implant configuration offers a high long-term predictability. Failures occur before, at or during the first year after abutment connection and in very short implants. Marginal bone as a whole is very stable over the years.

The present study compared 2 different methods (direct versus indirect evaluation) for the quantification of the adhesion of Porphyromonas gingivalis strains to in vitro cultured mono-layers of pocket epithelium.The indirect culture viability assay (calculation of colony forming units) was compared to a direct microscopic evaluation using a novel fluorescent stain. The fluorescent kit was found to stain both bacteria and epithelial cells and enabled a differentiation between dead and living cells.Comparing the visual to the culture data, a high and significant correlation was found (Pearson's correlation = 0.75; P0.001). The adhesion capacity was in general higher for dead epithelial cells than for living cells (P0.01). Although comparable numbers of bacteria of 2 P. gingivalis strains (Pg 4 and Pg 5) were applied, Pg 4 showed a significantly lower adhesion capacity. This intra-strain variability was observed by the culture assay (2.3 x 10(6) versus 7.8 x 10(6)+/-2.7 x 10(6); P0.01) and by the direct microscopy (P0.01) for both live and dead epithelial cells. A second goal was to see whether there was a difference in the amount of bacterial adherence to mono- and multi-layers of in vitro cultured epithelium. No significant differences were found for the 5 examined P. gingivalis strains. However, interstrain differences in adhesion capacity were evident for both tissues.This study highlights the reproducibility of a direct microscopic evaluation of bacterial adhesion to in vitro cultured epithelial cells, and suggests both intrastrain (P. gingivalis) and inter-cell (live versus dead) variation in adhesion capacity. Studies are needed to determine the extent to which P. gingivalis strain variation is reflected in variation of other strains in humans.