Literature update Octorber 2009
Clinical Oral Implants Research Vol. 20 No. 10 (October 2009)
Cosyn J, De Rouck T. Aesthetic outcome of single-tooth implant restorations following early implant
placement and guided bone regeneration: crown and soft tissue dimensions compared with contralateral
teeth. Clin Oral Implants Res 2009;20(10):1063-1069.
This study evaluated 27 patients, eaach with a single-tooth gap treated with an implant-supported restoration,
where the implant was placed 6-8 weeks after tooth extraction. The length of the implant-supported crowns
was comparable to contralateral teeth and the mid-facial tissues were similar after 21 months. Although there
was significant papilla loss, patients’ appreciation of the esthetics was favorable in 88% of cases. Favorable
esthetics were therefore achieved.
Dierens M, Collaert B, Deschepper E, Browaeys H, Klinge B, De Bruyn H. Patient-centered outcome of
immediately loaded implants in the rehabilitation of fully edentulous jaws. Clin Oral Implants Res
A questionnaire (visual analog scale; VAS) was used to evaluate patient-centered outcomes after 1 week
and 3, 6 and 12 months in 50 patients treated with implants. The median score for general satisfaction
increased from 40.25 at baseline to 98.25 after 12 months. Significant improvements in perceived esthetics,
overall comfort and eating comfort were observed after 1 week and again after placement of the final
prosthesis (3 or 6 months for the mandible and maxilla, respectively). One-stage surgery and immediate
loading were rated as very important prior to treatment. Significant improvements in satisfaction were
Zwahlen RA, Cheung LK, Zheng L-W, Chow RLK, Li T, Schuknecht B, Grätz KW, Weber FE. Comparison of
two resorbable membrane systems in bone regeneration after removal of wisdom teeth: a randomized-
controlled clinical pilot study. Clin Oral Implants Res 2009;20(10):1084-1091.
In 15 patients, impacted wisdom teeth were removed and the site treated with Inion biodegradable
membrane or Bio-Gide resorbable membrane. Assessments were made for up to 6 months and histological
and histomorphometric analyses were performed. Bone tissue density was 17.0% with Bio-Gide, with 3.8%
of old bone density and 9.8% of newly formed bone; corresponding values for Inion were 13.5% for bone
tissue density, with 9.5% of old bone density and 7.5% of newly formed bone. Both membranes showed
significant reductions in the area of the defect and significant increases in the CT density, but there were no
significant difference between the two treatments. Barrier function and analogous bone regeneration was
therefore similar with both membranes.
Matarasso S, Salvi GE, Siciliano VI, Cafiero C, Blasi A, Lang NP. Dimensional ridge alterations following
immediate implant placement in molar extraction sites: a six-month prospective cohort study with surgical re-
entry. Clin Oral Implants Res 2009;20(10):1092-1098.
Immediate transmucosal implants were placed in molar extraction sites in 12 patients, with peri-implant
defects treated according to GBR principles. Implant survival after 6 months was 100%, and there were
significant changes in the vertical and horizontal distance of alveolar bony walls to the bottom of the defect
and the implant surface between baseline and re-entry. All defects from the socket walls to the implant
surface were healed, and the thickness of the buccal wall and the newly formed bone was significantly
greater at sites with an initial thickness of 2 mm compared to an initial thickness of 1 mm.
Çehreli MC, Kökat AM, Comert A, Akkocaoğlu M, Tekdemir I, Akça K. Implant stability and bone density:
assessment of correlation in fresh cadavers using conventional and osteotome implant sockets. Clin Oral
Implants Res 2009;20(10):1163-1169.
Bone density was assessed in eight human femoral heads and stents were prepared for implant placement
in the collum, caput and trochanter sections using a conventional or an osteotome technique. Cutting torque
and implant stability were measured. The conventional group showed similar cutting torque measurements,
but cutting torques were different in the osteotome group. Cutting torque and ISQ tended to be higher in the
collum region, and these sites also showed higher bone density. There was a significant correlation between
cutting torque and bone density in the trochanter region in the osteotome group, but no other correlations
Schrott AR, Jumenez M, Hwang J-W, Fiorellini JP, Weber H-P. Five-year evaluation of the influence of
keratinized mucosa on peri-implant soft-tissue health and stability around implants supporting full-arch
mandibular fixed prostheses. Clin Oral Implants Res 2009;20(10):1170-1177.
This study evaluated 386 mandibular implants in 73 patients for up to 60 months. Width of keratinized
mucosa and clinical parameters were recorded. Five-year data were available from 58 patients with 307
implants. Lingual sites showed significantly higher plaque accumulation and a tendency to bleeding, while a
keratinized mucosa width of < 2 mm resulted in larger soft tissue recession at buccal sites. Keratinized
mucosa width had no influence on bleeding or plaque accumulation at buccal sites.
Chang C-S, lee T-M, Chang C-H, Liu J-K. The effect of microrough surface treatment on miniscrews used as
orthodontic anchors. Clin Oral Implants Res 2009;20(10):1178-1184.
A total of 144 miniscrews with three different surfaces (machined, sandblasted and acid-etched or
sandblasted and alkaline-etched) were placed in the tibiae of 24 rabbits. Orthodontic forces were applied to
two of each set of three implants; the center implant acted as a control. There were no differences in removal
torque between loaded and unloaded implants, but there was a significant increase in removal torque for
sandblasted and acid-etched implants after 4 weeks and for sandblasted and alkaline-etched implants after 8
weeks. BIC in both sandblasted groups was higher than in the machined group after 12 weeks, and there
was a moderate correlation with removal torque.
Implant Dentistry Vol. 18 No. 5 (October 2009)
Rodriguez-Tizcareño MH, Bravo-Flores C. Anatomically guided implant site preparation technique at molar
sites. Implant Dent 2009;18(5):393-401.
A technique for guided implant site preparation, consisting of progressive preparation of the site is described
for molar teeth. The natural root anatomy and geometry of the tooth to be extracted is used for reference, so
that the implants can be placed in a favorable position regarding occlusal and biomechanical aspects.
Rios HF, Avila G, Galindo P, Bratu E, Wang H-L. The influence of remaining alveolar bone upon lateral
window sinus augmentation implant survival. Implant Dent 2009;18(5):402-412.
The correlation between remaining alveolar bone crest and implant survival in grafted areas was evaluated
by means of a literature search. From a total of 156 publications, 18 met the selection criteria. The results
indicated average implant survival rates of 96% with residual bone < 5 mm and 99% with residual bone > 4
mm. Implant survival therefore appears to be higher with increased residual bone, but further studies are
International Journal of Oral and Maxillofacial Implants Vol. 24 No. 5 (September/October 2009)
Sailer I, Sailer T, Stawarczyk B, Jung RE, Hämmerle CHF. In vitro study of the influence of the type of
connection on the fracture load of zirconia abutments with internal and external implant-abutment
connections. Int J Oral Maxillofac Implants 2009;24(5):850-858.
Four groups of implant-abutment connections with different types of connection were evaluated: CARES
abutments or Zirabut synOcta abutments on Straumann implants; Procera abutments on Brånemark or
replace implants. The abutments were either restored with glass-ceramic crowns or left unrestored and static
loading was performed until failure. Bending moments were significantly higher for two-piece internal
connection abutments than one-piece internal connection or external connection abutments, but there were
no significant differences between the restored and unrestored groups. Internal connection abutments were
significantly weaker than the other groups. The implant-abutment connection therefore has a significant
influence on the strength of zirconia abutments.
Agliardi EL, Francetti L, Romeo D, Del Fabbro M. Immediate rehabilitation of the edentulous maxilla:
preliminary results of a single-cohort prospective study. Int J Oral Maxillofac Implants 2009;24(5):887-895.
In each of 20 patients, four tilted implants engaging the sinus wall and two axial implants in the anterior
region were placed, and a full-arch maxillary provisional prosthesis was delivered within 4 hours; a definitive
restoration was placed after 4-6 months. After a mean follow-up of 27.2 months, there were no implant
failures and all prostheses remained stable and in function. Mean marginal bone loss after 1 year was 0.8
mm and 0.9 mm for axial and tilted implants, respectively, and patient satisfaction increased over time, while
plaque and bleeding scores decreased.
Degidi M, Piattelli A, Shibli JA, Perrotti V, Iezzi G. Bone formation around immediately loaded and
submerged dental implants with a modified sandblasted and acid-etched surface after 4 and 8 weeks: a
human histologic and histomorphometric analysis. Int J Oral Maxillofac Implants 2009;24(5):896-901.
Implant rehabilitation was performed with fixed prostheses in the posterior mandible of four patients; each
patient also received an extra distal implant, which was either immediately non-functionally loaded with a
provisional prosthesis or left submerged. BIC after 4 weeks was 65.6% for the immediately restored implant
and 54.7% for the submerged implant. After 8 weeks, the BIC was 76.2% and 62.3% for the immediately
loaded and submerged implant, respectively. Immediate provisionalization therefore did not interfere with
bone formation in early healing.
Aimetti M, Romano F, Griga FB, Godio L. Clinical and histologic healing of human extraction sockets filled
with calcium sulfate. Int J Oral Maxillofac Implants 2009;24(5):901-909.
Following maxillary single-tooth extraction, medical grade calcium sulphate hemihydrate was used to fill the
extraction socket in 22 patients; a further 18 control patients did not receive graft material. Implants were
placed after 3 months. Resorption of the buccal walls and reduction of bucco-palatal width was greater at
control sites, and living trabecular bone was observed at both test and control sites, although it was greater
at test sites, with a significantly greater increase in lamellar bone. Medical grade calcium sulphate
hemihydrate therefore accelerated bone healing and helped maintain the alveolar ridge.
Stein AE, McGlumphy EA, Johnston WM, Larsen PE. Effects of implant design and surface roughness on
crestal bone and soft tissue levels in the esthetic zone. Int J Oral Maxillofac Implants 2009;24(5):910-919.
Implants with a rough collar and implants with a smooth collar, either straight or stepped, were evaluated
radiographically over 5 years, and 3D models were created based on radiodensity. The mean marginal bone
loss was 0.19 ± 0.09 mm for rough collar implants and 0.36 ± 0.06 mm for smooth collar implants; bone level
change was significantly influenced by the position of the crestal bone relative to the implant at the time of
placement, and by implant location, length and implant group; stepped collar implants showed greater bone
loss than straight collar implants, and greater sub-crestal placement led to greater bone loss. Bone level is
therefore influenced by implant surface and design.
Crespi R, Capparè P, Gherlone E. Radiographic evaluation of marginal bone levels around platform-
switched and non-platform-switched implants used in an immediate loading protocol. Int J Oral Maxillofac
A total of 45 patients with one or two teeth scheduled for extraction received implants with either an external
hexagon abutment junction (34 implants) or platform-switched abutments (30 implants) in fresh extraction
sockets. The cumulative implant survival rate was 100% after 2 years, and there was no significant
difference in mean bone loss between the groups. Implant placement in fresh extraction sockets was
Chung WE, Rebenstein JE, Phillips KM, Raigrodski AJ. Outcomes assessment of patients treated with
osseointegrated dental implants at the University of Washington Graduate Prosthodontic Program, 1988 to
2000. Int J Oral Maxillofac Implants 2009;24(5):927-935.
Patients treated between 1988 and 2000 on the University of Washington Graduate Prosthodontic Program
were retrospectively reviewed and outcomes assessed by a variety of methods, including clinical review,
chart review and phone survey. Results were obtained from 69 patients with 103 prostheses on 273 implants
from an original total of 114 patients treated, and all patients had prostheses in function for at least 5 years.
Cumulative implant and prosthesis survival rates were 96.3% and 85.4%, respectively.
Peñarrocha M, Carrillo C, Uribe R, Garcia B. The nasopalatine canal as an anatomic buttress for implant
placement in the severely atrophic maxilla: a pilot study. Int J Oral Maxillofac Implants 2009;24(5):936-
In each of seven patients with severely resorbed edentulous maxillae, implants were placed to support a
prosthesis, with one implant placed in the nasopalatine canal. One of the implants in the nasopalatine canal
was lost, but all prostheses were stable after 12 months and patient satisfaction (e.g. with comfort and
stability, ability to speak, ease of cleaning, and esthetics), was good. Minor sensory alterations occurred in
five of the seven patients in the first 5 weeks, but all reported normal sensation at the final examination.
Nasopalatine canal implant placement may therefore be a useful and suitable treatment approach in
severely resorbed maxillae.
International Journal of Periodontics and Restorative Dentistry Vol. 29 No. 5 (September/October 2009)
Coachman C, Salam M, Garber D, Calamita M, Salama H, Cabral G. Prosthetic gingival reconstruction in a
fixed partial restoration. Part 1: introduction to artificial gingival as an alternative therapy. Int J Periodontics
Restorative Dent 2009;29(5):471-477.
Limitations of hard and soft tissue healing in the esthetic zone may mean that artificial gingival (gingival-
coloured restorative materials) need to be used, together with extensive planning and CAD/CAM procedures
so that good esthetic outcomes can be achieved. The rational for considering the use of artificial gingival,
which can overcome certain limitations as a result of vertical and horizontal deficiencies.
Ackermann K-L. Extraction site management using a natural bone mineral containing collagen: rationale and
retrospective case study. Int J Periodontics Restorative Dent 2009;29(5):489-497.
A total of 62 patients with natural bone mineral grafted into 110 sockets were retrospectively analyzed.
Preservation of soft tissue volume and contour was observed, regardless of the original defect morphology.
This protocol can allow predictable preservation of the alveolar ridge contours and favourable healing.
An K-Y, Lee J-Y, Kim S-J, Choi J-I. Perception of maxillary anterior esthetics by dental professionals and
laypeople and survey of gingival topography in healthy young subjects. Int J Periodontics Restorative Dent
Gingival topography was evaluated in healthy individuals and the perceptions of lay people and dental
professionals ascertained regarding gingival marginal parameters and esthetics. Substantial differences in
the perceptions of esthetic components were observed, with normal gingival topographic features acting as
an intermediate between preferences in the two groups. Such differences may therefore influence the
decision-making process when treatment is considered regarding gingival levels in the esthetic zone.
International Journal of Prosthodontics Vol. 22 No. 5 (September/October 2009)
Alsabeeha NHM, Payne AGT, Swain MV. Attachment systems for mandibular two-implant overdentures: a
review of in vitro investigations on retention and wear fractures. Int J Prosthodont 2009;22(5):429-440.
A literature search was performed to investigate retentive force or wear of attachment systems for
mandibular two-implant overdentures; 15 articles met the inclusion criteria from an initial 193 articles
identified. Evidence showed that most attachment systems show a reduction in retentive force in vitro, and
wear seemed to be the main etiologic factor. Other factors influencing the retentive force have also been
identified, but adequate evidence is lacking. Further investigations are therefore necessary.
Baldi D, Menini M, Pera F, Ravera G, Pera P. Plaque accumulation on exposed titanium surfaces and peri-
implant tissue behavior. A preliminary 1-year clinical study. Int J Prosthodont 2009;22(5):447-455.
Ten sets of implants with a dual acid-etched (DAE) surface and a machined collar (control), or with a DAE
surface along the entire implant length (test) were placed in the posterior quadrants of eight patients. The
control implants received machined healing abutments and the test implants received DAE-surfaced healing
abutments. Significantly more plaque accumulated on the DEA surface and it was significantly more difficult
to remove than on the control implants. However, significantly less crestal bone resorption was observed at
the test implants after 12 months. No significant differences in bleeding on probing or histologic parameters
were found between the two groups.
Wittneben J-G, Wright RF, Weber H-P, Gallucci GO. A systematic review of the clinical performance of
CAD/CAM single-tooth restorations. Int J Prosthodont 2009;22(5):466-471.
A literature search on CAD/CAM restorations for single teeth was performed. The results from a total of
1,957 single-tooth restorations were subsequently reviewed. The mean exposure time was 7.9 years and
there were 170 implant failures, indicating a failure rate of 1.75% per year; the 5-year survival rate was
Journal of Clinical Periodontology Vol. 36 No. 10 (October 2009)
Staab B, Eick S, Knöfler G, Jentsch H. The influence of a probiotic milk drink on the development of
gingivitis: a pilot study. J Clin Periodontol 2009;36(10):850-856.
In 50 volunteers, a test group drank a probiotic drink once per day for 8 weeks while a control group did not;
mechanical plaque control was ceased for 96 h at the end of the evaluation period. Papilla bleeding,
interproximal plaque and plaque index were recorded at baseline, at the end of the study (8 weeks) and 96 h
later, and gingival crevicular fluid was also analyzed. There was no difference in papilla bleeding or plaque
index between the groups, but elastase activity and MMP-3 were significantly lower in the test group. In
addition, myeloperoxidase activity significantly increased in the control group but not in the test group.
Probiotic drinks may therefore have a beneficial effect on gingival inflammation.
Sanz M, Lorenzo R, Aranda JJ, Martin C, Orsini M. Clinical evaluation of a new collagen matrix (Mucograft
prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a
randomized prospective clinical trial. J Clin Periodontol 2009;36(10):868-876.
A total of 20 patients with minimal keratinized tissue (≤ 1 mm) in at least one location were treated with either
connective tissue graft (CTG) or a new collagen matrix (CM). The mean width of keratinized tissue gained
after 6 months was 2.6 ± 0.9 mm and 2.5 ± 0.9 mm in the CTG and CM groups, respectively. A marked
contraction occurred in both groups, but periodontal parameters were not affected. Patient morbidity and
surgery time were both lower in the CM group. The collagen matrix was therefore as predictable as
connective tissue graft for increasing keratinized tissue width.
Milstein DMJ, Mathura KR, Lindeboom JAH, Ramsoekh D, Lindeboom R, Ince C. The temporal course of
mucoperiosteal flap revascularization at guided bone regeneration-treated implant sites: a pilot study. J Clin
Orthogonal polarization spectral imaging was used to assess capillary density during wound healing over 6
weeks in 10 patients. The greatest increase in capillary regeneration was in the first 2 weeks, reaching
baseline levels after 4-5 weeks. The most significant differences were between anaesthesia and immediately
post-surgery, between immediate post-surgery and week 1, and between week 1 and week 2. Orthoganal
polarization spectral imaging therefore allowed the monitoring and quantification of revascularization after
Journal of Dental Research Vol. 88 No. 8 (August 2009)
Orwoll ES, Chan BKS, Lambert LC, Marshall LM, Lewis C, Phipps KR. Sex steroids, periodontal health, and
tooth loss in older men. J Dent Res 2009;88(8):704-708.
A cohort of 1,210 older men was assessed for 3 years; periodontal parameters (attachment loss, pocket
depth, gingival bleeding, number of teeth) and sex steroids (serum testosterone and estradiol) were
measured. Severe periodontitis was found to be common at baseline (38%), with progression in 32% and
incident tooth loss in 22%. There was no relationship between sex steroid or sex hormone binding globulin
concentrations and baseline periodontal status, number of teeth, periodontitis progression or incident tooth
Journal of Dentistry Vol. 37 No. 10 (October 2009)
Faggion CM Jr, Schmitter M, Tu Y-K. Assessment of replication of research evidence from animals to
humans in studies on peri-implantitis therapy. J Dent 2009;37(19):737-747.
A literature search was performed to find animal studies on peri-implantitis treatment, followed by a second
search for human trials that repeated or replicated animal studies. A total of 23 animal and 30 human studies
were included in the analysis, from an initial total of 1199 studies. No comparable study procedures were
found between any human and animal studies, so it was not possible to determine the extent of replication.
The authors recommended that standardization should be used to minimize heterogeneity, and power
analysis and sample size calculations should be considered.
Journal of Oral Implantology Vol. 35 No. 4 (August 2009)
Lee CYS, Rohrer MD, Prasad HS, Stover JD, Suzuki JB. Sinus grafting with a natural fluorohydroxyapatite
for immediate load; study with histologic analysis and histomorphometry. J Oral Implantol 2009;35(4):164-
A total of 11 patients with implants placed in sinuses grafted with autogenous bone and natural
fluorohydroxyapatite, with the addition of PRP, were retrospectively analyzed. The patients received 37 HA-
coated implants 4-6 months after grafting; the implants were loaded between 72 h and 5 days after
placement, and definitive restorations were placed after 6 months. Implant survival after 12 months was
97.3%, and the extent of new vital bone ranged from 23-34%- Fluorohydroxyapatite in combination with
autogenous bone and PRP was therefore a suitable sinus grafting material and allows for the immediate
loading of implants.
Franco M, Rigo L, Viscione A, De Santis B, Tropina E, Brunelli G, Guidi R, Avantaggiato A, Carinci F. CaPO4
blasted implants inserted into iliac crest homologue frozen grafts. J Oral Implantol 2009;35(4):176-180.
A retrospective analysis of 76 CaPO4 blasted (also know as resorbable blast media) implants placed in 16
patients was performed. The mean follow-up time was 23 months, and the implant survival rate was 98.7%
(one implant lost). Certain variables were associated with improved outcomes in terms of peri-implant crestal
bone resorption; longer implant length and a removable prosthesis were associated with significantly
reduced crestal bone loss.
Elo JA, Herford AS, Boyne PJ. Implant success in distracted bone versus autogenous bone-grafted sites. J
Oral Implantol 2009;35(4):181-184.
In 82 patients requiring alveolar augmentation for the placement of dental implants, autogenous grafts (65
patients) or distraction osteogenesis (17 patients) were used. Subsequently, 184 implants were placed. The
implant success rate was 97% and 98% for implants in autogenous bone or distracted bone, respectively.
The success rates were therefore not significantly different between the groups.
Kanawati A, Richards MW, Becker JJ, Monaco NE. Measurement of clinicians’ ability to hand torque dental
implant components. J Oral Implantol 2009;35(4):185-188.
Relative torque ability using finger drivers was assessed in 50 subjects, who were asked to torque a new
healing abutment on a firmly secured resin implant in a typodont. The maximum torque achieved ranged
from 11-38 Ncm and the average maximum torque was 28 Ncm (28 Ncm for male dentists, 24 Ncm for male
students and 19 Ncm for female students); differences between the groups were not significant. The extent
of hand torque achieved with a finger driver was therefore variable, and should therefore be calibrated
regularly. In addition, implant manufacturers should define maximum torque more precisely.
Rismanchian M, Bajoghli F, Mostajeran Z, Fazel A, Eshkevari P. Effect of implants on maximum bite force in
edentulous patients. J Oral Implantol 2009;35(4):196-200.
Bite force was measured in three groups of 45-65-year-old patients (total of 785 patients) were assessed:
those with conventional dentures for up to 6 months (group 1), those with conventional dentures for over 10
years (group 2), and those with maxillary dentures opposing mandibular implant-supported dentures (group
3). Mean maximal bite force was 5.65 ± 1.46 kgf, 7.01 ± 2.1 kgf and 12.22 ± 27 kgf for groups 1, 2 and 3,
respectively. Bite force was significantly greater in patients with overdentures, possibly reflecting the
importance of implants in conferring patient satisfaction via chewing ability.
Journal of Oral Rehabilitation Vol. 36 No. 10 (October 2009)
Piao CM, Lee JE, Koak JY, Kim SK, Rhyu IC, Han CH, Herr Y, Heo SJ. Marginal bone loss around three
different implant systems: radiographic evaluation after 1 year. J Oral Rehabil 2009;36(10):748-754.
Implants of three different types (rough surface, rough/smooth surface hybrid, or rough surface with
microthreads; 45 of each) were placed in 54 patients. After 1 year, marginal bone loss around the rough
surface with microthread implants was significantly lower (0.42 ± 0.27 mm) than around the rough surface
(0.81 ± 0.27 mm) or the hybrid surface (0.89 ± 0.41 mm) implants. Implants with a rough surface and
microthreads therefore maintained marginal bone better under functional loading.
Kahraman S, Bal BT, Asar NV, Turkyilmaz I, Tözüm TF. Clinical study on the insertion torque and wireless
resonance frequency analysis in the assessment of torque capacity and stability of self-tapping dental
implants. J Oral Rehabil 2009;36(10):755-761.
A total of 42 implants were placed in 13 patients and insertion torque and implant stability was recorded, with
secondary stability measured after 6 months. Mean insertion torque was 33 ± 11 Ncm, and mean primary
and secondary implant stability (in ISQ units) was 66 ± 12 and 71.9 ± 6, respectively; there was a significant
correlation between insertion torque and implant stability. Stability was significantly higher in the mandible
than the maxilla, but there were no other significant differences.
Journal of Periodontology Vol. 80 No. 9 (September 2009)
Haas AN, Rösing CK, Oppermann RV, Albandar JM, Susin C. Association among menopause, hormone
replacement therapy, and periodontal attachment loss in southern Brazilian women. J Periodontol
A total of 328 pre- and post-menopausal women were analyzed and categorized according to hormone
replacement therapy (HRT) and prevalence of periodontitis. Post-menopausal women not using HRT
showed a significantly greater prevalence and risk of periodontitis than pre-menopausal women, but there
were no significant differences between post-menopausal women using HRT and pre-menopausal women.
HRT may therefore have a beneficial effect on periodontal health.
Wilson TG Jr. The positive relationship between excess cement and peri-implant disease: a prospective
clinical endoscopic study. J Periodontol 2009;80(9):1388-1392.
Residual excess cement has been associated with peri-implant disease. This relationship was evaluated in
39 patients exhibiting signs of peri-implant disease over a 5-year period; 42 such implants were evaluated.
Twelve of the patients had similar implants with no signs of inflammation, so these implants (20) were used
as controls. Excess cement was found at 34 of the test implants (81%) and none of the control implants. Of
33 test sites where cement was removed, 25 showed no signs of inflammation after 30 days.
Degidi M, Nardi D, Piattelli A. Immediate versus one-stage restoration of small-diameter implants for a single
missing maxillary lateral incisor. A 3-year randomized clinical trial. J Periodontol 2009;80(9):1393-1398.
Patients with a missing lateral incisor received 3.0 mm diameter implants that were restored either
immediately (30 patients) or using a one-stage protocol (30 patients). The definitive crown was placed after 6
months in both groups. Mean bone loss after 36 months was 0.85 ± 0.71 mm for the immediate loading
group and 0.75 ± 0.63 mm for the one-stage group, while the mean probing depths were 1.91 ± 0.59 mm and
2.29 ± 0.81 mm for the immediate and one-stage groups, respectively; there were no significant differences
between the groups. Implants with a diameter of 3.0 mm were therefore a suitable option in both groups.
Paolantonio M, D’Ercole S, Pilloni A, D’Archivio D, Lisanti L, Graziani F, Femminella B, Sammartino G,
Perillo L, Tetè S, Perfetti G, Spoto G, Piccolomini R, Perinetti G. Clinical, microbiologic, and biochemical
effects of subgingival administration of a xanthan-based chlorhexidine gel in the treatment of periodontitis: a
randomized multicenter trial. J Periodontol 2009;80(9):1479-1492.
In each of 98 patients, two sites that were positive for bleeding on probing in symmetric quadrants were
chosen and randomized to received scaling and root planing (SRP) or SRP plus a xanthan-based
chlorhexidine gel. Significantly greater improvements in probing depth and clinical attachment level were
found in the chlorhexidine-treated sites after 3 and 6 months, and similar findings were observed in deep (≥ 7
mm) pockets. There were no differences for total bacterial counts or alkaline phosphatase activity in the
gingival crevicular fluid at 6 months, but lower scores were seen in the chlorhexidine group at 3 months. The
adjunctive use of chlorhexidine gel therefore conferred a substantial benefit.
Gassmann G, Schwenk B, Entschladen F, Grimm W-D. Influence of enamel matrix derivative on primary
CD4+ T-helper lymphocyte migration, CD25 activation, and apoptosis. J Periodontol 2009;80(9):1524-
A CD4+ lymphocyte separation was obtained from peripheral blood from three volunteers, and the effect of
EMD on cell locomotion was evaluated using a 3D collagen matrix migration model (CMMM); direct cell
contact with EMD was assessed in a one-phase model and the indirect influence was assessed in a two-
phase model (one collagen phase with EMD and a second adjacent phase with T lymphocytes). Mean
locomoting cell percentage was decreased in the one-phase CMMM and dose-dependently increased in the
two-phase CMMM. Increased concentrations of EMD showed dose-dependent CD25 receptor expression
and increased apoptosis. CD4+ lymphocyte apoptosis may be a potential background for early wound
Mellonig JT, Valderrama P, Gregory HJ, Cochran DL. Clinical and histologic evaluation of non-surgical
periodontal therapy with enamel matrix derivative: a report of four cases. J Periodontol 2009;80(9):1534-
In four patients with chronic periodontitis scheduled to receive complete dentures, notches were placed on
the tooth root ≥ 1-2 mm from the apex of scaling and root planing, and EMD was placed in the pocket.
Patients were evaluated for up to 6 months, at which time reductions in probing depth and gains in clinical
attachment level were observed in three quarters of specimens. New cementum, bone, periodontal ligament
and connective tissue attachment were observed in three quarters of specimens, indicating that EMD may
be a useful adjunct to scaling and root planing.
Kwon H-J, Lee D-W, Park K-H, Kim C-K, Moon I-S. Influence of the tooth- and implant-side marginal bone
level on the interproximal papilla dimension in a single implant with a microthread, conical seal, and platform-
switched design. J Periodontol 2009;80(9):1541-1547.
Bone levels on tooth and implant sides on periapical radiography from 17 patients with single implants were
recorded, as were marginal bone levels and papilla dimensions. There was a positive correlation between
papilla dimension and bone level on both the tooth and implant sides, but only bone level on the tooth side
had a significant influence on the soft tissue dimension between a natural tooth and a microthreaded,
Journal of the American Dental Association Vol. 140 No. 10 (October 2009)
Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK, Sasser HC. Poor oral
hygiene as a risk factor for infective endocarditis-related bacteremia. J Am Dent Assoc 2009;140(10):1238-
Oral hygiene, gingivitis and periodontal status were assessed in 194 patients, who were in either a
toothbrushing or a single-tooth extraction group. The results indicated that gingival disease and oral hygiene
were significantly associated with infective endocarditis-related bacteremia after toothbrushing, and that
generalized bleeding after toothbrushing was associated with an 8-fold greater risk of developing
bacteremia. In contrast, disease status and oral hygiene after single-tooth extraction were not significantly
associated with bacteremia.
Sedghizadeh PP, Kumar SKS, Gorur A, Schaudinn C, Shuler CF, Costerton JW. Microbial biofilms in
osteomyelitis of the jaw secondary to bisphosphonate therapy. J Am Dent Assoc 2009;140(10):1259-1265.
In a university program, specimens from 20 patients with osteomyelitis of the jaw (OMJ) or osteonecrosis of
the jaw (ONJ), from a larger cohort of patients scheduled for surgical debridement or sequestrectomy, were
examined. Large surface areas of bone occluded with biofilms consisting of organisms in an extracellular
polymeric substance; diverse bacterial organisms were observed in ONJ, whereas actinomycetes
predominated in OMJ. Biofilms may therefore be a potential target therapy in OMJ and ONJ.
Griffin SO, Barker LK, Griffin PM, Cleveland JL, Kohn W. Oral health needs among adults in the United
States with chronic diseases. J Am Dent Assoc 2009;140(10):1266-1274.
Data from the NHANES study were used to calculate the prevalence of dental diseases, poor oral health and
missing teeth in adult patients with chronic diseases. The need for urgent dental treatment was twice as
likely in patients with rheumatoid arthritis, diabetes or a liver condition. Other factors associated with dental
disease included cardiovascular disease, emphysema, obesity and stroke. Some chronic diseases therefore
increase the risk of dental diseases and carry a high burden of unmet dental care.
Quintessence International Vol. 40 No. 6 (June 2009)
Buff LR, Bürklin T, Eickholz P, Monting JS, Ratka-Krüger P. Does harvesting connective tissue grafts from
the palate cause persistent sensory dysfunction? A pilot study. Quintessence Int 2009;40(6):479-489.
This study included 14 patients who had received at least one connective tissue graft. Neurosensory tests
were performed post-operatively at 5, 10 and 15 mm from the palatal tissue margin at canines, premolars
and first molars. Persistent numbness or rough palatal surface was noticed by two patients, but no
dysfunction was noted in the remaining 12 patients, but there was a significant difference between donor and
non-donor sites for measurements 5 and 10 mm from the palatal tissue margin. Sensory dysfunction can
therefore occur following connective tissue graft harvesting.
Quintessence International Vol. 40 No. 8 (September 2009)
Michaeli E, Weinberg I, Nahlieli O. Dental implants in the diabetic patient: systemic and rehabilitative
considerations. Quintessence Int 2009;40(8):639-645.
Implant treatment was previously considered to be a contraindication in patients with diabetes, but recent
studies have shown implant success rates comparable to those in studies with other patients. However,
some studies have indicated an increased risk for implant failure in diabetic patients. The available literature
is reviewed in this article, as well as the treatment considerations for dental rehabilitation of patients with