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Literature update November/December 2009

Australian Dental Journal Vol. 54 No. 4 (December 2009)

Smith LP, Ng M, Grubor D, Chandu A. Outcomes of dental implants placed  in a surgical training program.
Aust Dent J 2009;54(4):361-367.

All surgeries performed by trainees at the Royal Dental Hospital of Melbourne over a 6-year period were
retrospectively evaluated. A total of 127 patients were treated during this time; follow-up data were available
for 105, with a total of 236 implants. Implant survival was 94% and 92.8% after 1 and 5 years, respectively,
and was influenced by perioperative bone grafting. Implant survival was therefore found to be satisfactory.
Biomaterials Vol. 31 No. 3 (January 2010)

Miron RJ, Oates CJ, Molenberg A, Dard M, Hamilton DW.  The effect of enamel matrix proteins on the
spreading, proliferation and differentiation of  osteoblasts cultured on titanium surfaces.

To evaluate the effect of EMD on osteoblasts on titanium surfaces, smooth and rough-surface (SLA) titanium
disks were coated with EMD or left uncoated and rat osteoblasts were cultured on the disks for up to 4
weeks. Cell spreading and proliferation were significantly increased from 3 to 7 days with the EMD-coated
disks, and alkaline phosphatase activity was significantly increased on EMD-coated surfaces. Levels of
mRNA encoding bone sialoprotein and osteocalcin  were increased 6-fold. EMD therefore enhanced
proliferation and differentiation of osteoblasts, regardless of titanium surface topography.
Clinical Implant Dentistry and Related Research Vol. 11 No. 4 (December 2009)

Degidi M, Iezzi G, Perrotti V, Piattelli A. Comparative analysis of immediate functional loading and immediate
nonfunctional loading to traditional healing periods: a 5-year follow-up of 550 dental implants.
Clin Implant
Dent Relat Res 2009;11(4):257-266.

A total of 550 implants were placed in 155 patients and received either immediate non-functional loading
without occlusal contact (82 patients, 264 implants) or loading via a one- or two-stage surgical procedure (73
patients, 286 implants) as control. The 5-year survival rate was 98.8% in the immediate group (three implant
failures) and 100% in the control group. The results suggest that good outcomes can be obtained with
shorter healing periods.
Elian N, Ehrlich B, Jalbout Z, Cho S-C, Froum S, Tarnow D. A restoratively driven ridge categorization as
determined by incorporating ideal  restorative positions on radiographic templates utilizing computed
tomography scan analysis.
Clin Implant Dent Relat Res 2009;11(4):272-278.

The intention of the study was to propose a restoratively driven ridge categorization (RDRC) for ridge
deformities based on ideal implant position. Measurements were taken from radiographic templates using
CT scan software and virtual placement of an implant. Five groups of edentulous ridges were apparent:
19.4% had simulated implants with  ≥ 2 mm of facial bone; 10.4% had  simulated implants surrounded by
bone, with < 2 mm facial plate thickness; 33.3% had dehiscences but no fenestrations; 6.3% had
fenestrations but no dehiscences; and 30.6% had both dehiscences and fenestrations. A high number of
cases in the maxillary anterior region would there require augmentation to achieve ideal implant restoration.
Cardemil C, Ristevski Z, Alsén B, Dahlin C. Influence of different operatory setups on implant survival rate: a
retrospective clinical study
Clin Implant Dent Relat Res 2009;11(4):288-291.

From 1985 to 2003 a total of 4000 implants were placed in 1,285 consecutively treated patients using either
the Brånemark System protocol (2,414 implants, 654 patients) or a simplified operatory protocol (1,586
implants, 631 patients). The results  showed no significant differences regarding complications or implant
survival, suggesting that implant survival is not adversely affected by a simplified operatory setup.
Jemt T. Cemented CeraOne and porcelain fused to TiAdapt abutment single-implant crown restorations: a
10-year comparative follow-up study.
Clin Implant Dent Relat Res 2009;11(4):303-310.

A total of 35 patients received 41 implants restored with either directly baked porcelain to custom-made
TiAdapt abutments (18 crowns in 15 patients) or cement crowns onto CeraOne abutments (23 crowns in 20
patients). The implant head was placed a mean 2.24  mm below the cemento-enamel junction of the
neighbouring tooth. The overall mean bone loss over 10 years was 0.26 mm and there were no significant
differences between the groups. In addition, bone loss was not significantly greater at implants placed more
apically in relation to the adjacent teeth. The few fistulas and/or loose abutment screws seen suggested that
some maintenance may be required.
Örtorp A, Jemt T. Early laser-welded titanium frameworks supported by implants in the edentulous mandible:
a 15-year comparative follow-up study.
Clin Implant Dent Relat Res 2009;11(4):311-322.

Retrospective data from 155 patients with abutment level implant prostheses with laser-welded titanium
frameworks or with gold alloy frameworks were assessed. Follow-up data over 15  years indicated that a
fixed prosthesis remained in the mandible of all patients at the end of the study period. Overall implant
survival was 98.7% and overall prosthesis survival was 91.7% (89.2% and 100% for titanium and gold
frameworks, respectively). Mean bone loss after 15 years was 0.59 ± 0.56 mm and 0.98 ± 0.64 mm for the
titanium and gold groups, respectively. Titanium frame fractures were found in 15.5% of patients, and
framework fractures were more common in the early titanium group than in the gold alloy group.
Kohal R-J, Finke HC, Klaus G. Stability of prototype two-piece zirconia and titanium implants after artificial
aging: an in vitro pilot study.
Clin Implant Dent Relat Res 2009;11(4):323-329.

Artificial aging and long-term load tests were performed on two-piece zirconia implants with zirconia crowns
(group 1), zirconia implants with Empress 2 crowns (group 2) or titanium implants with porcelain-fused-to-
metal crowns (group 3); 16 specimens were used in each group. Fracture occurred in one sample of group
1, six of group 3 and none of group 2. Fracture strength values with and without artificial load were 45-377 N 
and 270-393 N, respectively, in group 1, 240-314 N and 235-321 N, respectively, in group 2 and 45-582 N
and 474-765 N, respectively, in group 3. The biomechanical stability for all groups appeared to be borderline
for clinical use, and the zirconia implant groups showed implant head fractures at relatively low loads,
suggesting that the clinical use may be questionable.
Gualini F, Gualini G, Cominelli R, Lekholm U.  Outcome of Brånemark Novum implant treatment in
edentulous mandibles: a retrospective 5-year follow-up study
Clin Implant Dent Relat Res 2009;11(4):330-

Clinical, radiographic and resonance frequency data over 5 years were assessed for 15 patients. The 5-year
cumulative survival rate was 91% for implants and  87% for bridge reconstructions. Changes in implant
stability and marginal bone height were small, and signs of inflammation were absent from 87% of mucosal
quadrants. All patients were satisfied with the functional outcome but  two patients were not completely
satisfied with the esthetics of the bridgework.
Bornstein MM, Hart CN, Halbritter SA, Morton D, Buser D. Early loading of nonsubmerged titanium implants
with a chemically modified sand-blasted and acid-etched  surface: 6-month results of a prospective case
series study in the posterior mandible focusing on peri-implant crestal bone changes and implant stability
quotient (ISQ) values.
Clin Implant Dent Relat Res 2009;11(4):338-347.

Forty partially edentulous patients received a total of 56 implants, which were functionally loaded after 3
weeks. Clinical, radiological and implant stability parameters were recorded after 4, 7, 12 and 26 weeks. Two
implants were considered ‘spinners’ at 3 weeks, so were left unloaded for longer, but no implants failed to
integrate. Clinical and radiographic findings were favorable for all implants at 6 months, and ISQ values
steadily increased over the evaluation period from a mean of 74.33 at implant placement to a mean of 83.32
at 26 weeks. The 6-month survival and success rate was 100%.
Clinical Oral Implants Research Vol. 20 No. 11 (November 2009)

Vroom MG, Sipos P, de Lange GL, Gründemann LJMM, Timmermann MF, Loos BG, van der Velden U.
Effect of surface topography of  screw-shaped titanium implants in humans on clinical and radiographic
parameters: a 12-year prospective study.
Clin Oral Implants Res 2009;20(11):1231-1239.

A total of 80 implants were placed in 20 edentulous patients (two turned surface and two TiOblast surface
per patient) with severely resorbed mandibles  to support a bar-retained overdenture. Clinical and
radiographic evaluations were performed for up to  12 years. One turned implant was replaced due to
insufficient osseointegration, and abutment fracture occurred at one implant at 9 years, so the implant was
kept as a sleeper. No implants were lost up to 12 years, and there were no significant differences in clinical
parameters between the turned and TiOblast implants. In addition, the marginal bone loss was not
significantly difference between the turned and TiOblast surfaces.
Gahlert M, Röhling S, Wieland M, Sprecher CM, Kniha H, Milz S. Osseointegration of zirconia and titanium
dental implants: a histological and histomorphometrical study in the maxilla of pigs.
Clin Oral Implants Res

Acid-etched zirconia implants and sandblasted and acid-etched titanium implants of the same shape and
surface topography were placed in the maxillae of 15 pigs. Mean peri-implant bone density after 4, 8 and 12
weeks was 42.3 ± 14.5%, 52.6 ± 5.7% and 54.6 ± 11.5%, respectively,  for zirconia implants and 29 ±10%,
44.1 ±18% and 51.6 ± 8.6%, respectively, for titanium implants. BIC ranged from 27.1% to 51.1% for zirconia
implants and from 23.5% to 58.5% for titanium implants. There were no significant differences between the
two groups.
Romeo E, Tomasi C, Finini I, Casentini P, Lops D.  Implant-supported fixed cantilever prosthesis in partially
edentulous jaws: a cohort prospective study.
Clin Oral Implants Res 2009;20(11):1278-1285.

A total of 45 patients treated over a 12-year period with 116 implants supporting 59 cantilever prostheses
were evaluated for complications and marginal bone  loss. Bone loss exceeding the limit for success was
observed at 11 implants during the follow-up period; two of these showed peri-implant infection. The mean
observation time was 8.2 years, the implant survival and success rates were 100% and 90.5%, respectively,
and the prosthesis survival and success rates were 100% and 57.7%, respectively. The position or length of
the cantilever, location of the bridge or opposing dentition therefore did not influence the prognosis of
implant-supported FPDs or marginal bone loss.
Ellis JS, Burawi G, Walls A, Thomason JM.  Patient satisfaction with two designs of implant supported
removable overdentures: ball attachment and magnets. Clin Oral Implants Res 2009;20(11):1293-1298.
Patients were given a patient satisfaction questionnaire before receiving two implants in the interforaminal
region of the mandible supporting a removable overdenture with either  ball or magnetic attachments for
removable overdentures. After three months, another patient satisfaction questionnaire was given and the
attachments were changed to the alternative design and a third questionnaire was given after a further 3
months. There was a significant improvement in satisfaction from baseline with both attachment methods,
but general satisfaction, ability to chew and stability were significantly greater for ball attachments. General
satisfaction was also greater with ball attachments versus magnetic attachments.
Clinical Oral Implants Research Vol. 20 No. 12 (December 2009)

Cordaro L, Torsello F, Roccuzzo M. Clinical outcome of submerged vs. non-submerged implants placed in
fresh extraction sockets.
Clin Oral Implants Res 2009;20(12):1307-1313.

In 30 patients, implants were placed immediately post-extraction with either a submerged or non-submerged
protocol. Submerged implants were exposed after 8 weeks and provisional restorations were placed on all
implants after 12 weeks, with the definitive restoration placed after a further 12 weeks. The mean height of
keratinized tissue was significantly reduced at submerged implants compared to transmucosal implants, but
other outcomes were similar.
Lee D-W, Huh J-K, Park K-H, Chai J-K, Kim C-K, Moon I-S. Comparison of interproximal soft tissue height
for single implants and contra-lateral natural teeth.
Clin Oral Implants Res 2009;20(12):1320-1325.

The distance from the tip of the papilla to the crestal bone was evaluated for single-tooth implants in the
premolar/molar position and the contralateral teeth in 25 patients. Interproximal soft tissue dimensions were
not significantly different between implant restorations and the contralateral teeth for mesial and distal sides.
Zhou W, Han C, Li D, Li Y, Song Y, Zhao Y.  Endodontic treatment of teeth induces retrograde peri-
Clin Oral Implants Res 2009;20(12):1326-1332.

A total of 128 implants were placed adjacent to teeth that had received endodontic treatment at least 1 week
previously in 128 patients. The distance from implant to adjacent tooth was measured radiographically and
implant stability was recorded. The mean time between endodontic treatment and implant placement was
12.15 ± 10.1 weeks and the mean distance from implant to adjacent tooth was 2.99 ± 1.4 mm. The incidence
of retrograde peri-implantitis was  7.8% and was found to be related to distance and time. Implants with
retrograde peri-implantitis showed lower stability, but the difference was not significant.
De Boever AL, Quirynen M, Coucke W, Theuniers G, De Boever JA.  Clinical and radiographic study of
implant treatment outcome in periodontally susceptible and non-susceptible patients: a prospective long-term
Clin Oral Implants Res 2009;20(12):1341-1350.

A total of 513 TPS or SLA implants were placed in  health partially edentulous patients (non-susceptible
(NSP) patients; 110) or patients with chronic or generalized periodontitis (CAP and GAP; 68 and 16 patients,
respectively) and followed up for a mean of 48.1 ± 25.9 months. After 140 months, implant survival was 98%
and 96% in the NSP and CAP groups, respectively, but was significantly lower in the GAP group (80% after
100 months). Implant survival was also slightly lower with TPS versus SLA implants. Bone loss per year was
also greater in the GAP group and was significantly associated with bleeding on probing, age, inflammation,
plaque and probing depth. Smoking also had a significant adverse influence on implant survival.
Schätzle M, Männchen R, Zwahlen M, Lang NP.  Survival and failure rates of orthodontic temporary
anchorage devices: a systematic review.
Clin Oral Implants Res 2009;20(12):1351-1359.

An electronic literature search was conducted to identify clinical data on orthodontic temporary anchorage
devices with a follow-up time of at least 12 weeks. A total of 390 titles and 71 abstracts were identified, from
which34 studies were examined and 27 included in the analysis. Failure rates for Onplants, palatal implants,
miniscrews and miniplates were 17.2%, 10.5%, 16.4% and 7.3%, respectively. The clinical failure rate for
palatal implants and miniplates was 1.92-fold lower  than for Onplants and miniscrews. Survival rates for
miniplates and palatal implants were comparable. These devices therefore provide reliable absolute
orthodontic anchorage and should be the temporary anchorage devices of choice.
Zhou W, Han C, Li Y, Li D, Song Y, Zhao Y.  Is the osseointegration of immediately and delayed loaded
implants the same? – comparison of  the implant stability during a 3-month healing period in a prospective
Clin Oral Implants Res 2009;20(12):1360-1366.

Implant stability, as determined by resonance frequency analysis (RFA) was measured in 25 immediately
loaded implants in 12 patients and 79 delayed loaded implants in 47 patients over 12 weeks. One implant
was lost in the immediate loading group, but none were lost in the delayed loading group. Mean ISQ was
75.86 ± 3.60 and 72.88 ± 5.39 in the immediate and delayed groups, respectively. The lowest RFA values
were at 4 weeks in the delayed group and 2 weeks in the immediate group. Differences in osseointegration
between immediately and delayed loaded implants were therefore noted.
Kourkouta S, Dedi KD, Paquette DW, Mol A. Interproximal tissue dimensions in relation to adjacent implants
in the anterior maxilla: clinical observations and patient aesthetic evaluation.
Clin Oral Implants Res

The study evaluated 15 patients who had two or more adjacent implants in the anterior maxilla. Mean
distance from papilla tip to bone crest was 4.2 mm, mean loss of papilla height was 1.8 mm and median
proximal biologic width at inter-implant sites was 7 mm. The most coronal BIC at neighbouring tooth sites
was 4.6 mm apical to the bone crest and the tip of  the papilla was 2 mm more apical between adjacent
implants than at implant-tooth sites, and the contact point between adjacent implant restorations was 1 mm
more apically than at implant-tooth sites. Median missing papilla height was 1 mm for immediate
provisionalization and 2 mm for removable temporaries. Patient satisfaction with the papillae was 87.5%. The
location of the tip of the papilla appears to be determined by the apico-coronal  proximal biologic width
Felice P, Marchetti C, Iezzi G, Piattelli A, Worthington H, Pellegrino G, Esposito M.  Vertical ridge
augmentation of the atrophic posterior mandible with interpositional bloc grafts: bone from the iliac crest vs.
bovine anorganic bone. Clinical and histological results up to one year after loading from a randomized-
controlled clinical trial.
Clin Oral Implants Res 2009;20(12):1386-1393.

Bone blocks from the iliac crest or Bio-Oss blocks as inlays were used to treat 10 partially edentulous
patients with 5-7 mm residual crest height above the mandibular canal. Implants were placed after 4 months
Provisional prostheses were placed 4 months later  and definitive prostheses were placed after another 4
months. Patients were followed for up to 1 year after loading. There was more residual graft in the BIO-Oss
group 4 months after augmentation, but  there were no significant differences in failures or complications
between the groups. Two implants in the autogenous  bone group could not be placed because of graft
failure, and one implant and prosthesis failed in the Bio-Oss group. Significant peri-implant bone loss was
noted in both groups, but the difference between the groups was not significant.
do Nascimento C, Pedrazzi V, Miani PK, Moreira LD, de Albuquerque RF Jr.  Influence of repeated screw
tightening on bacterial leakage along  the implant-abutment interface.
Clin Oral Implants Res

To investigate bacterial penetration along the implant-abutment interface, abutment screws in 10 pre-
machined abutments were tightened to 32 Ncm, and  abutment screws in another 10 abutments were
tightened to 32 Ncm, loosened and then re-tightened to the same torque. All implant-abutment assemblies
were then immersed in medium inoculated with  S mutans and incubated for 14 days, after which
contamination of the internal chamber was evaluated. Microorganisms were detected at the internal surfaces
of both groups, but counts were much greater where the screws had been loosened and re-tightened,
indicating leakage at a higher intensity.
Clinical Oral Investigations Vol. 13 No. 4 (December 2009)

Schropp L, Stavropoulos Gotfredsen E, Wenzel A.  Calibration of radiographs by a reference metal ball
affects preoperative selection of implant size
Clin Oral Investig 2009;13(4):375-381.

Presurgical digital radiographs from 70 patients, recorded with a metal ball in the edentulous area, were
assessed by three observers to determine the appropriate implant size; reference marks were placed on the
image using computer software and an implant with proper dimensions was outlined with four reference
marks. Implant size was adjusted according to a standard calibration method and a reference ball calibration
method and implant size was selected from those available in a given system. In comparison with unadjusted
implant dimensions, implant size chosen changed in 42% and 58% in periapical radiographs. using the
standard or reference ball calibration, respectively, and in 24% when comparing the two calibration methods.
Implant size changed in 48% for panoramic radiographs. The results indicated that  the use of a reference
ball may be advantageous.
Beuer F, Edelhoff D, Gernet W, Sorensen JA. Three-year clinical prospective evaluation of zirconia-based
posterior fixed dental prostheses (FDPs).
Clin Oral Investig 2009;13(4):445-451.

A total of 21 FDPs made of zirconia substructures veneered with pressable glass ceramic, replacing second
premolar or first or second molar, in 19 patients were assessed, with recall every 12 months. Framework
fracture occurred in one maxillary FDP after 30 months and an FDP was removed after 38 months due to
loss of retention. Survival probability was 90.5% for all failure types and 95.2% for framework fractures after
40 months. The overpressing technique therefore proved to be reliable.
European Journal of Oral Implantology Vol. 2 No. 3 (October 2009)

Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P. The efficacy of vertical
and horizontal bone augmentation procedures for dental implants – a Cochrane systematic review
Eur J
Oral Implantol 2009;2(3):167-184.

Randomized controlled trials of different techniques for horizontal and vertical bone augmentation for implant
treatment were evaluated in a systematic review. Of 18 possible trials, 13 (10 with vertical augmentation and
three with horizontal augmentation) were selected for inclusion. The results  indicated no significant
differences between various horizontal augmentation  techniques and no significant differences between
various vertical augmentation techniques, with the exception of three trials that showed greater vertical bone
gain with osteodistraction and with bone substitutes compared to autogenous bone. Other results showed
more complications with vertical augmentation than with short implants. The authors emphasized that the
results were based on few trials with few patients and sometimes short follow-up times.
European Journal of Oral Sciences Vol. 117 No. 6 (December 2009)

Wolfart S, Harder S, Eschbacj S, Lehmann F, Kern M. Four-year clinical results of fixed dental prostheses
with zirconia substructures (Cercon): end abutments vs. cantilever design
Eur J Oral Sci 2009;117(6):741-

A total of 58 three-to-four-unit restorations made of Y-TZP ceramic frameworks were placed in 48 patients;
24 had an end abutment design and 34 had a cantilever design. The frameworks had a minimum connector
dimension of 3 x 3 mm and were cemented with glass-ionomer cement. Mean follow-up times were 48 ± 7
months and 50 ± 14 months for the end-abutment and cantilever prostheses, respectively. Three prostheses
were recorded as drop-outs, all in the cantilever group. Four-year survival rates were 96% and 92% for end-
abutment and cantilever FDPs, respectively, while the rates of technical complications were 13% and 12%,
respectively, and of biological complications were 21% and 15%, respectively; none of the differences were
International Journal of Oral and Maxillofacial Surgery Vol. 38 No. 11 (November 2009)

Pirker W, Kocher A.  Immediate, non-submerged, root-analogue zirconia implants placed into single-rooted
extraction sockets: 2-year follow-up of a clinical study.
Int J Oral Maxillofac Surg 2009;38(11):1127-1132.

Zirconia implants with two different surfaces (sandblasted only [six implants] or with additional micro-
retentions prior to laser scanning [12 implants]) were placed in 18 patients for single-tooth replacement 1-8
days after extraction, with restoration after 3-5 months. Time in function ranged from 1-33 months. All
sandblasted only implants were lost, but the overall  survival for the macro-retention implants was 92%.
Modifications to zirconia implants can therefore allow excellent osseointegration and primary stability.
International Journal of Prosthodontics Vol. 22 No. 6 (November/December 2009)

Sailer A, Gottner J, Känelb S, Hämmerle CHF. Randomized controlled trial of zirconia-ceramic and metal-
ceramic posterior fixed dental prostheses: a 3-year follow-up. Int J Prosthodont 2009;22(6):553-560.
In 59 patients, a total of 38 zirconia-ceramic and 38 metal-ceramic three-to-five unit FDPs were placed and
outcomes were evaluated after 6 months and 1 and 3 years. Six patients were lost to follow-up, so data were
available from 53 patients with 67 FDPs after a mean of 40.3 ± 2.8 months. FDP survival was 100% in both
groups and there were no significant differences in  technical or biological outcomes. Minor veneering
ceramic chipping was observed in 19.4% of metal-ceramic FDPs and 25% of zirconia-ceramic FDPs, and
extended fracturing occurred only in the latter group.
Schmitt J, Holst S, Wichmann M, Reich S, Göllner M, Hamel J. Zirconia posterior fixed partial dentures: a
prospective clinical 3-year follow-up.
Int J Prosthodont 2009;22(6):597-603.

Posterior three- and four-unit FDPs were placed in 30 patients; frameworks were manufactured using
CAD/CAM. Clinical parameters were evaluated 12, 24 and 36 months after cementation. After a mean of
34.2 months, data were available from 27 patients. FDP survival rate was 100%, and the cumulative success
rate was 96.3% due to a major chip in one of the  FDPs. Periodontal parameters were not significantly
different between test and control teeth, but the plaque index was significantly higher for distal control teeth
at 12 and 24 months.
Karl M, Graef F, Taylor TD, Heckmann SM.  Stability of screw-retained implant-supported fixed dental
prostheses bonded to gold cylinders.
Int J Prosthodont 2009;22(6):604-606.

The stability of screw-retained implant-supported FDPs bonded to gold cylinders after load cycling was
assessed. Five different loading or bonding conditions were evaluated: loading, no loading, moment loading,
humidity and silicoating. There were no significant differences between the groups. Sufficient bonding
stability can therefore be achieved, despite limited transferability into clinical practice.
Journal of Clinical Periodontology Vol. 36 No. 11 (November 2009)

Eghbali A, De Rouck T, De Bruyn H, Cosyn J.  The gingival biotype assessed by experienced and
inexperienced clinicians.
J Clin Periodontol 2009;36(11):958-963.

Three gingival biotypes have been identified (thin-scalloped, thick-flat  or thick-scalloped), and these were
assessed by 15 clinicians (five restorative dentists, five periodontists and five students) in 100 periodontally
healthy subjects. Gingival biotype was correctly assessed in approximately half of the patients regardless of
the clinician’s experience; the thick-flat biotype was most easily recognized but almost half of the thin-
scalloped cases were misidentified. Visual inspection alone may therefore not be adequate for the
identification of gingival biotype.
Nickles K, Ratka-Krüger P, Neukranz E, Raetzke P, Eickholz P. Open flap debridement and guided tissue
regeneration after 10 years in infrabony defects.
J Clin Periodontol 2009;36(11):976-983.

A total of 44 infrabony defects in 16 patients were  randomly treated with either open flap debridement of
guided tissue regeneration. Clinical parameters were evaluated at baseline, 12 and 120 months. After 10
years, 15 patients (41 defects) were available for evaluation, and both groups showed significant attachment
gain from baseline after 12 and 120 months, although attachment changes between 12 and 120 months was
Journal of Clinical Periodontology Vol. 36 No. 12 (December 2009)

Van Assche N, Van Essche M, Pauwels M, Teughels W, Quirynen M. Do periodontopathogens disappear
after full-mouth tooth extraction?
J Clin Periodontol 2009;36(12):1043-1047.

Microbial samples were obtained from nine patients  with severe aggressive periodontitis before and 6
months after full-mouth tooth extraction. Extraction  of natural teeth resulted in a 3-log reduction of  P
gingivalis and T forsythia and lesser reductions of A actinomycetemcomitans and P intermedia, although the
detection frequencies in saliva and on the tongue remained unchanged.
Van der Weijden F, Dell’Acqua F, Slot DE. Alveolar bone dimensional changes of post-extraction sockets in
humans: a systematic review.
J Clin Periodontol 2009;36(12):1048-1058.

A literature search was conducted for data concerning changes in alveolar ridge dimensions following tooth
extraction. Of 1244 Pubmed abstracts and 106 Cochrane papers, 12 met the inclusion criteria. Mean
alveolar ridge width reduction was 3.87 mm, mean mid-buccal height loss was 1.67 mm and the mean
crestal height loss was 1.53 mm. Loss in width was therefore greater than loss in height, both clinically and
Vignoletti F, de Sanctis M, Berglundh T, Abrahamsson I, Sanz M. Early healing of implants placed into fresh
extraction sockets: an experimental study  in the beagle dog. III: soft tissue findings
J Clin Periodontol

A total of 64 implants were placed in the third and fourth lower premolars of 16 dogs to evaluate soft tissue
healing after 1, 2, 4 and 8 weeks. Junctional epithelium and underlying loose connective tissue was seen
after 1 week, and signs of epithelial proliferation and organized connective tissue were seen after 2 weeks.
The epithelium was more mature after 4 and 8 weeks, and was in close contact with the implant or abutment
surface. After 8 weeks, soft tissue dimensions were around 5 mm (approximately 3-3.5 mm epithelium and 1-
1.5 mm connective tissue).
Journal of Oral and Maxillofacial Surgery Vol. 67 No. 11 (November 2009)

Del Fabbro M, Boggian C, Taschieri S.  Immediate implant placement into fresh extraction sockets with
chronic periapical pathologic features combined with plasma rich in growth factors: preliminary results of
single-cohort study.
J Oral Maxillofacial Surg 2009;67(11):2476-2484.

In 30 partially edentulous patients, 61 implants were immediately placed combined with PRGF in extraction
sockets; the implant surface was bioactivated with PRGF prior to placement. The prosthesis was placed after
3-4 months and the patients were evaluated after 1 year in function. The mean follow-up time was 18.5
months. There was one implant failure after 2 months as a result of infection, but there were no additional
complications. Implant success after 1 year was 98.4% and the mean peri-implant bone loss after 1 year was
0.41 ± 0.22 mm. All prostheses were successful and patients were satisfied with chewing function, phonetics
and esthetics.
Cuesta-Gil Caicoya SO, Riba-García F, Ruiz BD, Cuéllar CN, Vila CN.  Oral rehabilitation with
osseointegrated implants in oncologic patients. J Oral Maxillofacial Surg 2009;67(11):2485-2496.
Results from 111 oncologic patients who received a total of 706 implants were presented. Osseointegration
success rate was 92.9% and the success rate was 85%. Failures were particularly seen in irradiated patients
and patients who received lateral osseomyocutaneous trapezial pedicled flap reconstruction.
Journal of Oral and Maxillofacial Surgery Vol. 67 No. 11 Suppl (November 2009)

Interdisciplinary Advances in Implant Dentistry
Kan JYK, Rungcharassaeng K, Morimoto T, Lozada J. Facial gingival tissue stability after connective tissue
graft with single immediate tooth replacement in the esthetic zone: consecutive case report
J Oral
Maxillofacial Surg 2009;67(11 Suppl):40-48.

Clinical and radiographic parameters were evaluated in 20 patients who received  immediate single-tooth
implants with connective tissue grafting. Thick and thin gingival biotypes were found in 8 and 12 patients,
respectively at baseline, but all patients displayed a thick biotype after a mean follow-up of 2.15 years. All
implants were in function and there were no differences in marginal mesial and distal bone level changes
and mean facial gingival level changes between those with initially thick or thin biotypes.
Blatz MB, Bergler M, Holst S, Block MS. Zirconia abutments for single-tooth implants – rationale and clinical
J Oral Maxillofacial Surg 2009;67(11 Suppl):74-81.

Ceramic abutments play an increasingly greater role in achieving esthetic success, but the material is not the
only determinant – abutment design and handling are also very important. The rationale for the use of
zirconia is explained, as are material properties and strategies for the successful implementation of zirconia
abutments in clinical practice.
Block MS, Mercante DE, Lirette D, Mohamed W, Ryser M, Castellon P. Prospective evaluation of immediate
and delayed provisional single tooth restorations.
J Oral Maxillofacial Surg 2009;67(11 Suppl):89-107.

In 76 patients, a maxillary tooth was removed and an implant placed and provisionalized immediately or after
4 months. Follow-up data were available for 55 patients – 21 were lost to follow-up due to implant loss (5),
labial bone loss (1), relocation (11), non-compliance (3) and medical problems (1). There were no significant
differences between the immediate and delayed groups for implant integration or crestal interdental bone
movement, but the facial gingival margin was significantly more apical in the immediate group. The facial
gingival margin should therefore be considered when considering immediate placement, and soft tissue
healing or an anatomic abutment may be required.
Journal of Oral and Maxillofacial Surgery Vol. 67 No. 12 (December 2009)

Manor Y, Oubaid S, Mardinger O, Chaushu G, Nissan J. Characteristics of early versus late implant failure: a
retrospective study
J Oral Maxillofacial Surg 2009;67(12):2649-2652.

A total of 194 patients who presented after dental implant failure (at least one implant failed and removed)
during a 6-year period were retrospectively evaluated. Features associated with early failure were minimal
bone loss and single crowns, and failures occurred more in women and at a younger age. Late failures were
associated with more failures, moderate to severe bone loss and posterior areas, and occurred more in men.
Li W, Chow J, Hui E, Lee PKM, Chow R. Retrospective study on immediate functional loading of edentulous
maxillas and mandibles with 690 implants, up to 71 months of follow-up.
J Oral Maxillofacial Surg

A total of 111 patients who received 690 implants for the immediate rehabilitation of 48 maxillas and 85
mandibles were retrospectively evaluated. The mean follow-up period was 29.5 months, and 97.4% were
followed up for at least 1 year. There were four failures in the maxilla and five in the mandible; the mean
failure time was 2.89 months. The overall cumulative survival rate was 98.7% and there was no difference
between survival in the maxilla or the mandible. Implant survival was not related to implant diameter, system,
configuration, abutment connection, or implant position.
Journal of Oral Implantology Vol. 35 No. 5 (October 2009)

Adibrab M, Shahabuei S, Sahabi M. Significance of the width of keratinized mucosa on the health status of
the supporting tissue around implants supporting overdentures. J Oral Implantol 2009;35(5):232-237.
Periodontal parameters were measured around 66 functioning implants. The results showed a negative
correlation between keratinized mucosa width and mucosal recession and periodontal attachment level.
Mean gingival and plaque index scores, and bleeding on probing were significantly higher for implants with a
narrow zone of keratinized mucosa (< 2 mm), and less mucosal recession and periodontal attachment loss
was associated with wider bands (≥ 2 mm).
Carinci F, Brunelli G, Danza M.  Platform switching and bone platform switching.  J Oral Implantol

Bone platform switching involves the use of an implant with a reverse conical neck. This retrospective study
evaluated 234 implants (40 conventional neck and 194 reverse conical neck) in 88 patients. There were no
differences in success rates or alveolar bone resorption between the two groups. There were also no
differences in other measured variables. Further larger studies are required.
Journal of Oral Rehabilitation Vol. 36 No. 11 (November 2009)

Kokubo Y, Sakurai S, Tsumita M, Ogawa T, Fukushima S. Clinical evaluation of Procera AllCeram crowns in
Japanese patients: results after 5 years.
J Oral Rehabil 2009;36(11):786-791.

Over a 14-month period, 101 AllCeram crowns were placed in 57 patients and evaluated at baseline and
annually for up to 5 years. Of the 75 crowns that could be evaluated over the 5-year period, the cumulative
survival rate was 90.2%; six fractures were observed necessitating the removal of the crowns. According to
California Dental Association criteria, 98% of crowns were rated as satisfactory and the plaque and gingival
indices were comparable to those of control teeth.
Journal of Periodontology Vol. 80 No. 10 (October 2009)

Bhatavadekar N. Clinical decisions and the quality of evidence available for dental implants. J Periodontol

Clinical evidence is crucial in helping clinicians choose the appropriate implant system for their needs. This
article outlines the importance of looking beyond manufacturers’ claims, which may not be substantiated by
randomized controlled trials. The use of evidence-based portals may allow an evidence-based approach for
decision making, and standard reporting criteria may allow better comparisons across different implant
systems and studies.
Döri F, Kovács V, Arweiler NB, Huszár T, Gera I, Nikolidakis D, Sculean A. Effect of platelet-rich plasma on
the healing of intrabony defects treated with an anorganic bovine bone mineral: a pilot study.
J Periodontol

Anorganic bovine bone mineral (ABBM) alone or with PRP was used to treat intrabony defects in 30 patients
with advanced chronic periodontal disease, and clinical parameters were evaluated for 1 year. Clinical
attachment level (CAL), the primary variable, changed from 9.9 ± 1.7 mm to 5.3 ± 1.8 mm in the PRP +
ABBM group and from 9.6 ± 1..9 mm to 4.9 ± 1.5 mm in the ABBM group, and CAL gain ≥ 3 mm occurred in
80% of PRP + ABBM cases and in 87% of ABBM cases. There were no significant differences between the
two groups. The use of PRP therefore did not improve the results obtained with ABBM.
Crespi R, Capparè P, Gherlone E.  Dental implants placed in extraction sites grafted with different bone
substitutes: radiographic evaluation at 24 months
J Periodontol 2009;80(10):1616-1621.

A total of 45 fresh extraction sockets in 15 patients were filled with magnesium-enriched hydroxyapatite
(MHA), calcium sulphate (CS) or porcine bone (PB), and dental implants were placed 3 months later, with
temporary restoration after a further 3 months. Marginal bone levels were evaluated at baseline and 12 and
24 months after implant placement. After 2 years, no implants were lost and the mean bone loss values were
-0.21 ± 0.09 mm, -0.13 ± 0.09 mm and -0.16 ± 0.08 mm for the MHA, CS and PB groups, respectively. There
were no significant differences between the groups, indicating that implant placement was not affected by the
Bertl K, An N, Bruckmann C, Dard M, Andrukhov O, Matejka M, Rausch-Fan X. Effects of enamel matrix
derivative on proliferation/viability, migration, and expression of angiogenic factor and adhesion molecules in
endothelial cells in vitro.
J Periodontol 2009;80(10):1622-1630.

The effect of EMD on the proliferation and viability of human umbilical vein endothelial cells (HUVECs) was
measured and cell migration was observed. The results showed that 0.1  μg/ml EMD stimulated the
proliferation/viability of HUVECs, but larger doses were inhibitory. Concentrations from 0.1 to 50  μg/ml
promoted cell migration, but 100  μg/ml inhibited migration. EMD at 50  μg/ml resulted in the highest
expression of ICAM-1, E-selectin and ang-2 genes. EMD may therefore influence HUVECs, which can have
a role in periodontal regeneration.
Goda S, Kaneshita Y, Inoue H, Domae E, Ikeo T, Iida J, Domae N.  Enamel matrix derivative protein
stimulated wound healing vi phosphoinositide 3-kinase.
J Periodontol 2009;80(10):1631-1638.

MG-63 cells were scratched to remove the cells in a circular area, and the wells incubated with 25, 50 or 100
μM EMD with or without a phosphoinositide (PI) 3-kinase inhibitor. Migrated cells were counted and
activation of PI 3-kinase evaluated. EMD enhanced migration into wounds but did not affect proliferation. Akt
phosphorylation was enhanced. Migration into wounds was blocked by the addition of a PI 3-kinase inhibitor.
The results indicated that PI 3-kinase activation plays a major role in EMD-stimulated osteoblast migration.
Journal of Periodontology Vol. 80 No. 11 (November 2009)

Kotsovilis S, Fourmousis I, Karoussis IK, Bamia C. A systematic review and meta-analysis on the effect of
implant length on the survival of rough-surface dental implants
J Periodontol 2009;80(11):1700-1718.

A systematic literature and meta-analysis was conducted to find data on survival rates between short (≤ 8 or
< 10 mm) and conventional length (≥ 10 mm) implants. From 1,056 and 14,417 titles and abstracts identified
by electronic and manual searching, respectively, a total of 300 articles were examined, of which 37 were
included. The results showed no significant difference in survival rates between short and conventional
implants, indicating that the placement of short implants is no less efficacious.
Javed F, Romanos GE.  Impact of diabetes mellitus and glycemic control on the osseointegration of dental
implants: a systematic literature review.
J Periodontol 2009;80(11):1719-1730.

A literature search on articles evaluating the effect of diabetes or glycemic control on osseointegration was
performed. The search identified 33 studies, of which 15 were excluded. Data from the remaining studies
suggested that osseointegration can be adversely affected by poorly controlled diabetes but that
osseointegration can be successful with optimal glycemic control. Successful osseointegration can be aided
by antiseptic mouth rinses and maintenance of oral hygiene.
Xiong X, Elkind-Hirsch KE, Vastardis S,  Delarosa RL, Pridjian G, Beukens P.  Periodontal disease is
associated with gestational diabetes mellitus: a case-control study.
J Periodontol 2009;80(11):1742-1749.

Periodontal examinations were carried out in a cohort of 159 pregnant women (53 with gestational diabetes
mellitus and 106 without). The incidence of periodontitis was 77.4% and 57.5% in the women with and
without gestational diabetes mellitus, respectively. The odds ratio, after adjusting for several confounding
variables, was 2.6 (1.1 to 6.1). The results indicated an association between periodontal disease and
gestational diabetes mellitus.
Santana RB, de Mattos CML, Van Dyke T.  Efficacy of combined regenerative treatments in human
mandibular class I furcation defects.
J Periodontol 2009;80(11):1742-1749.

Combined regenerative therapy (bioabsorbable HA and tetracycline, guided tissue regeneration barrier and
coronally advanced flap) was performed to treat class  furcation lesions in 30 patients, while another 30
patients received treatment open flap debridement (OFD). Clinical parameters were evaluated at baseline
and after 12 months, and improvements were seen in both groups, but the results were significantly better for
combined regenerative therapy versus OFD. Significant positive correlations were found between baseline
and 12-month probing depth with both combined regenerative therapy and OFD, and  there was a positive
correlation between initial vertical attachment level (VAL) and probing depth reduction and gain in horizontal
attachment level (HAL) in the combine regenerative therapy group. In the OFD group, there was a positive
correlation between initial probing depth and gains in VAL and HAL and a negative correlation with
Stein JM, Fickl S, Yakta SS, Hoischen U, Ocklenburg C, Smeets R. Clinical evaluation of a biphasic calcium
phosphate calcium composite grafting material in the treatment of human periodontal intrabony defects: a
12-month randomized controlled clinical trial.
J Periodontol 2009;80(11):1774-1782.

In 45 patients, intrabony defects were treated with either biphasic calcium phosphate composite (BCC),
autogenous bone spongiosa (ABS) or open flap debridement (OFD), with clinical parameters measured at
baseline and 12 months. Significant reductions in probing depth and gains in clinical attachment level were
noted in all groups, although BCC and ABS produced significant additional gain in clinical attachment level
and BCC produced significant additional probing depth reduction. BCC therefore showed additional clinical
benefits over ABS and OFD.
Pieri F, Aldini NN, Fini M, Marchetti C, Corinaldesi G.  Immediate functional loading of dental implants
supporting a bar-retained maxillary overdenture: preliminary 12-month results.
J Periodontol

Each of 22 patients received four or five implants connected with a bar and loaded with a maxillary
overdenture within 48 hours. With the 1-year follow-up time there were three implant failures and excessive
marginal bone loss at two implants, giving survival and success rates of 97.1% and 95.2%, respectively. The
most common prosthetic implication was the need for relining (27.2%). Results from a questionnaire showed
a significant increase in comfort, function and esthetics, except for cleaning where there was a significant
decrease in satisfaction, indicating the difficulty in maintaining oral hygiene.
Journal of Prosthetic Dentistry Vol. 102 No. 5 (November 2009)

Boeckler AF, Lee H, Stadler A, Setz JM.  Prospective observation of CAD/CAM titanium ceramic single
crowns: A three-year follow up.
J Prosthet Dent 2009;102(5):290-297.

A total of 41 crowns with CAD/CAM milled titanium copings were fabricated for 21 patients and cemented
with zinc phosphate cement. Complications and periodontal parameters were recorded after 12, 24 and 36
months. The cumulative survival rate after 3 years was 94.9% and the success rate regarding mechanical
complications was 82.3%; there were no biological complications. The clinical outcomes were therefore
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology Vol. 108 No. 5 (November 2009)

Hassan KS.  Autogenous bone graft combined with polylactic polyglycolic acid polymer for treatment of
dehiscence around immediate dental implants.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Immediate implants for single tooth replacement were placed in 16 patients; one group received
augmentation with autogenous bone alone and the second group received autogenous bone and Fisiograft
(copolymer polylactic and polyglycolic acid). Bone fill, probing pocket depth and attachment level were all
significantly improved in both groups, but outcomes were slightly superior in the Fisiograft group. The results
indicate that Fisiograft may be suitable for the treatment of dehiscence defects around dental implants.
Quintessence International Vol. 40 No. 9 (October 2009)

Tao J, Han D. The effect of finish line curvature on marginal fit of all-ceramic CAD/CAM crowns and metal-
ceramic crowns.
Quintessence Int 2009;40(9):745-752.

Abutments with 1, 3 or 5 mm finish line curvature were prepared for maxillary incisors and five all-ceramic
CAD/CAM crowns and five metal-ceramic crowns were fabricated for each abutment. The marginal gaps
were then measured. The all-ceramic crowns showed similar mean labial, lingual, mesial and distal marginal
gaps for all curvatures. For the metal-ceramic crowns,  the labial and lingual gaps were significantly greater
than the mesial and distal gaps for 3 mm and 5 mm curvature. Abutment line curvature therefore had a
significant effect on the marginal fit of metal-ceramic crowns but not all-ceramic crowns.
Casarin RCV, Ribeiro E Del P, Ribeiro FV, Nociti FH, Jr, Sallum AW, Sallum EA, Casati MZ.  Influence of
anatomic features on the effectiveness of enamel matrix derivative proteins in the treatment of proximal class
II furcation involvements.
Quintessence Int 2009;40(9):753-761.

Clinical and periodontal parameters were evaluated before and 6 months after treatment in 18 proximal class
II furcation defects treated with open flap debridement, root conditioning and EMD. Defect depth correlated
with gingival margin position, probing depth and horizontal bone level; the latter two parameters also
correlated with furcation height. The number of vertical defect walls had a positive influence on vertical
clinical attachment level. The response to EMD therapy was therefore influenced by the furcation anatomy
and defect morphology. 
Quintessence International Vol. 40 No. 10 (November/December 2009)

Cabanilla LLL, Neely AL, Hernandez F. The relationship between periodontal diagnosis and prognosis and
the survival of prosthodontic abutments: a retrospective study.
Quintessence Int 2009;40(10):821-831.

A total of 70 patients with either fixed or removable partial dentures were retrospectively evaluated from
dental charts, which included periodontal diagnosis and prognosis, year of tooth loss, date of prosthesis
delivery, etc. Of 226 abutment teeth, 16 (7.1%) were lost; 88.6% of subjects lost no abutment teeth. The
cumulative 13.8-year survival rate was 66%, and  periodontal prognosis was found to be a significant
indicator of tooth loss. In addition, the risk of tooth loss was increased 3.05-fold with removable compared to
fixed partial dentures.

Nhan Tam Dental Clinic – Dental Implant And Cosmetic Restoration
Address: 807, 3/2 Street, Ward 7, Dist. 10, Ho Chi Minh City, Viet Nam - Tell: (+ 84) 8 3957 0229 –  (+84) 8 3957 5569 . Mobile (+84) 903.632701 (+84) 938.344970 
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