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Literature update July - August 2010

Clinical Oral Implants Research

Vol. 21 No. 7 (July 2010)

Vol. 21 No. 8 (August 2010)

Degidi M, Nardi D, Piattelli A. A comparison between immediate loading and immediate restoration in cases of partial posterior mandibular edentulism: a 3.year randomized clinical trial.  Clin Oral Implants Res 2010;21(7):682-687.

Either immediate loading or immediate restoration was performed in 50  patients with partial posterior mandibular edentulism (25 patients per group). A total  of 100 implants were placed in healed sites. The prostheses in the restoration group were placed out of occlusal contact, and both groups received definitive restorations in occlusion after 6 months. Marginal bone loss was evaluated after 6, 12, 24 and 36 months. Mobility was detected in two implants, one in each group. Mean marginal bone loss after 3 years was 0.987 ± 0.375 mm and 0.947 ± 0.323 mm in the immediate restoration and immediate loading groups, respectively; there was no significant difference between the groups. Immediate rehabilitation was therefore predictable with both procedures.


Mardas N, Chadha V, Donos N. Alveolar ridge preservation with guided bone regeneration and a synthetic bone substitute or a bovine-derived xenograft:  a randomized, controlled, clinical trial. Clin Oral Implants Res 2010;21(7):688-698.

Following single tooth extraction in 27 patients, sockets were grafted with either Straumann BoneCeramic (SBC; test) or Bio-Oss (control), both covered with a collagen barrier membrane; complete soft tissue coverage was not achieved. The residual ridge was  evaluated and biopsies were taken after 8 months. Reduction of the bucco-lingual alveolar ridge dimensions was significantly less in the test group (1.1 ± 1 mm versus 2.1 ± 1 mm), while mesio-distal bone height was equally preserved in both groups. No differences in buccal and palatal bone width were observed between the groups. Histology showed new bone formation in the apical part of the biopsies, while dense fibrous connective tissue was observed in the coronal part.

Chang M, Wennström JL. Bone alterations at implant-supported FDPs in relation to inter-unit distances: a 5-year radiographic study. Clin Oral Implants Res 2010;21(7):735-740.

A total of 43 patients with 48 fixed prostheses supported by 130 implants were enrolled in a supportive care program, with radiography performed at prosthesis placement and after 1 and 5 years. Mean bone loss after 5 years was 0.1 mm, 0.4 mm and 0.2 mm at the tooth, implant and mid-proximal bone crest, respectively, and mean mid-longitudinal bone loss at implant/implant units was 0.5 mm at the implants and 0.3 mm mid-proximally. Change in BIC was found to be a significant predictor for 5-year mid-proximal bone level change at implant/implant units, but no significant associations were observed at tooth/implant units.


Passeri G, Cacchioli A, Ravanetti F, Galli C, Elezi E, Macaluso GM. Adhesion pattern and growth of primary human osteoblastic cells on five commercially available titanium implant surfaces. Clin Oral Implants Res 2010;21(7):756-765.

Human primary osteoblastic cells were cultured  on five titanium surfaces: polished; machined; sandblasted/acid-etched; sandblasted/acid-etched and modified with H2O2 rinse; and, titanium plasma-sprayed. Cell growth was measured after 3,  7 and 9 days and the production of osteocalcin and osteoprotegerin was evaluated. Cell shape and anchorage was affected by surface topography, with large lamellipodia observed on the polished and machined surfaces and thin filopodia on both sandblasted/acid-etched surfaces. Cell proliferation was greater on the rough surfaces and focal adhesions were stronger on both sandblasted/acid-etched surfaces. Osteoprotegerin increased on all surfaces over time, but osteocalcin production was highest on the sandblastzed/acid-etched/H2O2 rinse surface.


Simonis P, Dufour T, Tenebaum H. Long-term implant survival and success: a 10-16-year follow-up of non-submerged dental implants. Clin Oral Implants Res 2010;21(7):772-777.n

A total of 55 patients (from an original 76) who received 131 implants between 1990 and 1997 were available for a 10-16-year clinical and radiographic examination and a questionnaire on satisfaction. Cumulative implant survival up to 16 years was 82.94%, and the biological and technical complication rates were 16.94% and 31.09%, respectively. Most implant losses and biological complications were concentrated in a relatively small number of patients. Patients with a history of periodontitis were noted to have lower implant survival and were more prone to biological complications.

Leung KCM, McGrath CPJ. Willingness to pay for implant therapy: a study of patient preference. Clin Oral Implants Res 2010;21(8):789-793.

Subjects attending a dental hospital were presented with two hypothetical clinical scenarios, i.e. missing one anterior or posterior tooth. Clinical procedures, outcomes and potential complications of various treatment options were then explained, as well as the consequences of no treatment. The subjects were then asked to bid how much they would be prepared to pay for tooth replacement, with a starting bid of HK $20,000, decreasing in HK $1000 increments until the subject chose the opposite option or the bid reached HK $0. Implant treatment for the replacement of anterior or posterior teeth was chosen by 94% and 84% of subjects. And the mean willingness-to-pay amounts were HK $11,000 and HK $10,000, respectively. Female subjects, those with no missing teeth or restorative need, and those with higher levels of education were willing to pay greater amounts, and these were considered independent predictors.

Tran BLT, Chen ST, Caiafa A, Davies HMS, Darby IB. Transmucosal healing around peri-implant defects: crestal and subcrestal placement in dogs. Clin Oral Implants Res 2010;21(8):794-803.

In the mandibular premolar regions of three dogs, 23  implants were placed 3 months after tooth removal. Five were control implants, placed at crestal bone level, and 18 were test implants placed with surgically created peri-implant defects at either the crestal bone  level (nine implants) or 2 mm below the crestal bone level (nine implants). After 3 months of healing, greater BIC was observed in the coronal region for all implants, but the healing response was incomplete for  the test implants after 1 month, compared to the control implants. Histometric measurements for the test implants were more coronal or closer to the implant margin compared to the control implants, and the degree of osseointegration was similar for both test implant groups.


Payer M, Heschl A, Wimmer G, Wegscheider W, Kirmeier R, Lorenzoni M. Immediate provisional restoration of screw-type implants in the posterior mandible: results after 5 years of clinical function. Clin Oral Implants Res 2010;21(8):815-821.

A total of 40 implants were placed in 24 patients to replace mandibular molars and premolars, and were immediately provisionalized after placement. Bone levels and implant survival/success were assessed after 12, 24, 36, 48 and 60 months. Significant bone loss was observed in the first year after final restoration, but no further significant increase occurred between 12  and 60 months. Two implants were lost, giving an implant survival rate of 95%; the corresponding implant success rate  was 92.5% (two failures plus one implant with excessive bone loss). Careful patient selection appeared to be a key criterion for success.

Koizumi H, Sur J, Seki K, Nakajima K, Sano T, Okano T.  Effects of dose reduction on multi-detector computed tomographic images in evaluating the maxilla and mandible for pre-implant surgical planning: a cadaveric study. Clin Oral Implants Res 2010;21(8):830-834.

Micro-detector CT with variable tube currents of 80, 40, 20 and 10 mA was used to evaluate the maxillae and mandibles in six cadaver specimens. Multi-planar images were created and assessed by five oral radiologists for visibility of various anatomical landmarks, and the quality of the images was compared to the 80 mA images. The results indicated that anatomical landmarks could be visualized on 40 mA images to almost the same quality as 80 mA images, and 20 mA images were acceptable for diagnostic purposes, but with substantial deterioration of image quality. Significant dose reduction is therefore possible for pre-surgical implant planning with CT.


Widmann G, Zangeri A, Keiler M, Stoffner R, Bale R, Puelacher W.  Flapless implant surgery in the edentulous jaw based on three fixed intraoral reference points and image-guided surgical templates: accuracy in human cadavers. Clin Oral Implants Res 2010;21(8):835-841.

Implant planning was performed on the basis of CT  scans of edentulous cadaver specimens. Surgical templates were fabricated, and the registration mouthpiece and surgical template were supported via three fixed reference points. Implants were inserted through the guide sleeves and the accuracy was evaluated via post-surgical CT. A total of 51 implants were placed in five maxillary and three mandibular edentulous specimens. Mean (± SE) total and lateral error was 1.1 ± 0.6 mm and 0.7 ± 0.5 mm, respectively, at the implant base, and 1.2 ± 0.7 mm and 0.9 ± 0.7 mm at the implant tip and the mean angular error was 2.8° ± 2.2°. Similar accuracy to tooth-supported surgical templates or surgical navigation was therefore found.

von See C, Gellrich N-C, Jachmann U, Laschke MW, Bormann K-H, Rücker M. Bone augmentation after soft-tissue expansion using hydrogel expanders: effects on microcirculation and osseointegration. Clin Oral Implants Res 2010;21(8):842-847.

Bone grafts from eight isogenic rats and were implanted in eight rats without tissue expansion and eight rats after tissue expansion. Hydrogel expanders were inserted subperiostally in the tissue expansion group at the augmentation sites. Microcirculation was monitored  for 19 days and histological  samples were evaluated. Microvessel density was significantly higher in the  region above the augmentation material in the tissue expansion group over the whole study, but physiological microcirculation was observed in both groups. Osseointegration of the graft was observed in the tissue expansion group, while connective and granulation tissue was observed in the group without tissue expansion. Hydrogel expanders may therefore increase the probability of success in bone augmentation.


Northdurft F, Pospiech P. Prefabricated zirconium dioxide implant abutments for single-tooth replacement in the posterior region: evaluation of peri-implant tissues and superstructures 12 months after function. Clin Oral Implants Res 2010;21(8):857-865.

A total of 24 patients received 40 implants, which  were subsequently restored with all-ceramic Y-TZP abutments and all-ceramic crowns. Clinical parameters and mesial and distal bone levels were evaluated after 12 months, and implant stability was measured. Sulcus fluid flow rate and modified sulcus bleeding index indicated stable and healthy soft tissues, and probing pocket depth was generally low. Proximal bone defects were reduced from -1.1 mm to -1 mm. No implant or crown losses were recorded, but chipping of the veneering ceramic was observed in four cases. No mechanical failure of the all-ceramic abutments therefore occurred.

Klinger A, Asad R, Shapira L, Zubery Y.  In vivo degradation of collagen membranes exposed to the oral cavity. Clin Oral Implants Res 2010;21(8):873-876.

Collagen membranes of three different types (ribose cross-linked, glutaraldehyde cross-linked or non-cross-linked) were placed over the buccal mucosa in the premolar and molar region in 20 subjects. A periodontal dressing was placed over the membrane, which was removed after 10 days to assess membrane integrity. Discomfort, pain or dislodging of the pack led eight subjects to withdraw from the study. Marked differences in membrane integrity between the three types were observed. The results indicated that the ribose cross-linked membrane appeared to be more resistant to degradation.


European Journal of Oral implantology

Vol. 3 No. 2 (June 2010)

Esposito M, Grusovin MG, Loli V, Coulthard P, Worthington HV.  Does antibiotic prophylaxis at implant placement decrease early implant failures? A Cochrane systematic review.  Eur J Oral Implantol 2010,3(2):101-110.

The authors performed a literature search for randomized controlled trials comparing the outcomes of prophylactic regimens versus no antibiotics in implant placement. Four trials were identified; three compared 2 g amoxicillin preoperatively versus placebo (927 patients) and one compared 1 g amoxicillin preoperatively plus 500 mg four times daily versus no antibiotics (80 patients). Significantly more patients experienced implant failures in the groups not receiving antibiotics, but other outcomes were not statistically significantly different. Some evidence therefore  suggests that prophylactic amoxicillin may reduce implant failures in ordinary conditions.

Cannizarro G, Torchio C, Felice P, Leone M, Esposito M. Immediate occlusal versus non-occlusal loading of single zirconia implants. A muticentre pragmatic randomised clinical trial.  Eur J Oral Implantol 2010,3(2):111-120.

A total of 40 edentulous patients each received a single zirconia implant loaded immediately either occlusally or non-occlusally. There were five early implant  failures (three occlusally loaded and two non-occlusally loaded) and three complications were noted. Peri-implant bone was gradually lost in both groups up to 1 year (0.9 mm and 0.7 mm in the occlusal and non-occlusal loading groups, respectively). An association was also noted between immediate post-extraction implants and implant failures.

 Alissa R, Esposito M, Horner K, Oliver R. The influence of platelet-rich plasma on the healing of extraction sockets. An explorative randomised clinical trial. Eur J Oral Implantol 2010,3(2):121-134.

A total of 15 extraction sockets were treated with  PRP in 12 patients and 14 control sockets were left untreated in 11 patients. Pain was significantly greater in the control group for the first 3 days, and analgesic consumption was significantly higher for the first and second days. There were significant differences in favor of PRP treatment for presence of bad taste/bad smell in the mouth and food stagnation in the operation area. Two dry sockets and one inflamed alveolus occurred in  the control group, and soft tissue was significantly better in the PRP group. Significant differences favoring PRP were also detected radiographically for sockets with dense homogeneous trabecular pattern and trabecular pattern for bone volume, but there were no differences for trabecular separation, length, width of number. PRP may therefore have some benefits, but data are currently insufficient.

Esposito M, Cannizarro G, Bozzoli P, Checchi L, Ferri V, Landriani S, Leone M, Todisco M, Torchio C, Testori T, Galli F, Felice P.  Effectiveness of prophylactic antibiotics at placement of dental implants: a pragmatic multicentre placebo-controlled randomised clinical trial. Eur J Oral Implantol 2010,3(2):135-143.

Patients scheduled for implant surgery were randomized to received 2 g amoxicillin (252 patients) or identical placebo (254 patients) 1 h prior to implant placement and were evaluated 1 and 2 weeks and 4 months later. There were four prosthesis and seven  implant failures in the antibiotic group compared to 10 prosthesis and 13 implant failures in the placebo group. The number of complications was similar (11 in the antibiotic group, 13 in the placebo group). Differences were not significant but the risk of implant failure was increased without antibiotic prophylaxis.


Cairo F, Nieri M, Gori AM, Tonelli P, Branchi R, Castellani S, Abbate R, Pini-Prato GP. Markers of systemic inflammation in periodontal patients: chronic versus aggressive periodontitis. An explorative cross-sectional study. Eur J Oral Implantol 2010,3(2):147-153.

Blood samples from 45 systemically healthy patients with either chronic (21 patients) or aggressive (24 patients) periodontitis were evaluated for high-sensitivity CRP, cytokine and chemokine levels. No significant differences were found between the groups for periodontal parameters or inflammatory markers, indicating a similar inflammatory profile for chronic and aggressive periodontitis.

Puig CP. A retrospective study of edentulous patients rehabilitated according to the ‘all-on-four’ od the ‘all-on-six’ immediate function concept using  flapless computer-guided implant surgery. Eur J Oral Implantol 2010,3(2):155-163.

A total of 195 implants were placed and immediately loaded in 30 patients to support 25 maxillary (128 implants) and 17 mandibular (67 implants) full-arch prostheses via the ‘all-on-four’ or ‘all-on-six’ protocols; provisional prostheses were placed immediately with definitive prostheses after 6-12 months. Implant positioning and guided flapless implant placement was by means of Procera software. There were four implant failures in three patients (two each in the maxilla and mandible), three of which were successfully replaced. No definitive prostheses failed and no patients dropped out of the study, but three patients were surgically and antibiotically treated for apically infected implants. Both surgical protocols appeared to be viable and predictable, but may be sensitive to the clinician’s experience.


European Journal of Oral Sciences

Vol. 118 No. 4 (August 2010)

Taylor B, Tofler G, Morel-Kopp M-C, Carey H, Carter T, Elliott M, Dailey C, Villata L, Ward C, Woodward M, Schenck K.  The effect of initial treatment of periodontitis on systemic markers of inflammation and cardiovascular risk: a randomized controlled trial. Eur J Oral Sci 2010;118(4):350-356.

A total of 136 patients with chronic periodontitis were randomized to receive initial periodontal treatment (test) or no treatment (control) in a 3-month  study. Cardiovascular risk  factors and hematological, inflammatory and metabolic markers were measured at  the start and end of the study. Data were available for 51 test and 64 control patients, and the results showed a non-significant trend towards lower fibrinogen levels in the test group and a significant increase in hemoglobin and hematocrit after intervention. Systemic effects of periodontal treatment were therefore observed.

Meijndert L, van der Reijden WA, Raghoebar GM, Meijer HJA, Vissink A. Microbiota around teeth and dental implants in periodontally healthy, partially edentulous  patients: is pre-implant microbiological testing relevant? Eur J Oral Sci 2010;118(4):357-363.

Subgingival microbial samples from 93 patients requiring single tooth replacement were obtained before implant treatment and after 1 year. Threshold levels for periodontal breakdown were applied, and periodontal treatment was given to patients with levels of  pathogens above these thresholds. One or more marker pathogens were found in 49.5% of subjects at baseline, and periodontal treatment reduced the levels to below the thresholds in 78.3% of these patients. Marker pathogens were above the threshold level in 74.1% of patients after 1 year. The long-term effectiveness of reducing pathogen levels prior to implant treatment was therefore limited; pre-implant reduction did not predict post-implant  levels. Pre-implant microbiological testing may therefore not be relevant.


Implant Dentistry

Vol. 19 No. 3 (June 2010)

Sánchez-Ayala A, Lagravère MO, Gonçalves TMSV, Lucena SC, Barbosa CMR. Nutritional effects of implant therapy in edentulous patients – a systematic review. Implant Dent 2010;19(3):196-207.

Studies relating to the nutrient intake improvement of edentulous subjects rehabilitated with various treatments were reviewed. Despite an extensive literature search, only five articles met the selection criteria. Inadequate nutrient intake after treatment was found in  two of these, while a randomized controlled trial showed an improvement in nutrient intake after treatment and another found adequate nutritional intake both before and after treatment. No difference between conventional and implant treatment was found in these four studies, but the fifth study indicated a higher risk of malnutrition for those wearing conventional complete dentures.


Chow YC, Wang H-L.  Factors and techniques influencing peri-implant papillae.  Implant Dent 2010;19(3):208-219.

A literature search was performed for articles relating to esthetics in terms of inter-implant papillae. Factors that can influence the appearance of inter-implant papillae include crestal bone height, interproximal distance, gingival width and the width of keratinized tissue. Promotion of inter-implant papillae formation has also been successfully achieved using a number of techniques.


Acocella A, Bertolai R, Sacco R. Modified insertion technique for immediate implant placement into fresh extraction socket in the first maxillary molar sites: a 3-year prospective study. Implant Dent 2010;19(3):220-228.

Each of 68 patients scheduled for extraction of a first maxillary molar immediately received an implant in the fresh extraction socket. Regenerative therapy was simultaneously performed, if necessary. Single crowns were placed after 3 months. After 3 years, there were three implant failures, giving a cumulative survival rate of 97.96%. Immediate implant placement in the maxillary first molar position, with appropriate regenerative material, is therefore a valid treatment option.

Bilhan H, Mumcu E, Erol S, Kutay Ö.  Influence of platform-switching on marginal bone levels for implants with mandibular overdentures: a retrospective clinical study. Implant Dent 2010;19(3):250-258.

A total of 51 patients with 126 implants supporting mandibular overdentures appeared for routine recall visits after 6, 12, 24 and 36 months and were included in the study group. Mean marginal bone level change was assessed from successive radiographs. Significantly lower bone loss was observed for platform-switched implants after 36 months, although rates of mesial and distal bone loss differed at 6, 12 and 24 months.

International Journal of Oral and Maxillofacial Implants

Vol. 25 No. 3 (May/June 2010)

Baixe S, Fauxpoint G, Arntz Y, Etienne O. Microgap between zirconia abutments and titanium implants. Int J Oral Maxillofac Implants 2010;25(3):455-460.

For each of four different systems (Procera zirconia, Cercon Balance Anterior, ZirDesign and Straumann Cares ceramic) assemblies (five per system) were embedded in epoxy, cut along the long axes, polished and examined by scanning electron microscopy for microgaps. Mean marginal microgap was 0.89 ± 1.67 μm, and significant differences were observed between the systems (Cercon 0.38 ± 0.28 μm, ZirDesign 0.55 ± 0.23 μm, Procera 1.83 ± 3.21 μm, Straumann Cares 0.90 ± 0.59 μm). The microgap quickly decreased from the outer region to the inner in all systems. The mean microgap for flat connection systems was greater than that for internal conical connection systems. 


Hudieb M, Wakabayashi N, Suzuki T, Kasugai S.  Morphologic classification and stress analysis of the mandibular bone in the premolar region for implant placement.  Int J Oral Maxillofac Implants 2010;25(3):482-490.

Scans of the premolar region were performed for 102 patients with missing mandibular premolars and were classified into nine groups according to bone morphology and alveolar crest. Finite element models were then constructed, with implants and superstructures, and 200 N loads applied 30° buccal from the vertical axis. Maximum compressive stresses were observed in the lingual cervical regions, but no influence of bone morphology on stress distribution was observed, but maximum stress and strain was affected by the alveolar contour; microstrain over 4,000 was only seen when the alveolar crest was lingual in relation to the body of the mandible. The alveolar crest contour therefore plays a role in maintaining peri-implant bone levels.

Waasdorp J, Reynolds MA.  Allogeneic bone onlay grafts for alveolar ridge augmentation: a systematic review. Int J Oral Maxillofac Implants 2010;25(3):525-531.

A literature search was performed for clinical studies using allogeneic bone grafts for alveolar bone augmentation. From an initial 35 publications identified, nine were included in the review (six case series, one prospective multicenter case series and two case reports). High graft incorporation and implant survival were found in observational studies, but most articles involved selected defects in the anterior region with < 3 years follow-up. Clinical evidence therefore differed in terms of defects, treatment and therapeutic endpoints. The potential for allogeneic block grafts was shown, but there is insufficient evidence to establish treatment efficacy.

Valderrama P, Jones AA, Wilson TG Jr, Higginbottom F, Schoolfield JD, Jung RE, Noujeim M, Cochran DL. Bone changes around early loaded chemically modified sandblasted and acid-etched surface implants with and without a machined collar: a radiographic and resonance frequency analysis in the canine mandible. Int J Oral Maxillofac Implants 2010;25(3):548-557.

A total of 72 implants, 36 with a 2.8 mm machined collar and 36 without a machined collar, were placed in six dogs. Implant stability (by resonance frequency analysis) was measured weekly for 3 weeks, and the implants were loaded after 21 days. Periapical radiographs were taken at 3 weeks and 3, 6, 9 and 12 months. Implant stability increased by 5 ISQs for implants with a machined collar and by 7 ISQs for implants without a machined collar from implant placement to week 3. After 12 months, a mean bone loss of 1.0 mm was observed for the machined collar implants,  compared to mean bone gain of 0.11 mm for implants without a machined collar. Coronal bone apposition was  attributed to the properties of the chemically modified implant surface.


Degidi M, Daprile G, Piattelli A. Determination of primary stability: a comparison of the surgeon’s perception and objective measurements. Int J Oral Maxillofac Implants 2010;25(3):558-561.

A total of 514 implants were placed in 152 patients. The surgeon was asked to indicate the probable ISQ value after placement for all implants and the probable insertion torque for 483 implants. The actual values were measured and classified into low, medium and high groups. Mean perceived and actual RFA values were 72.2 ± 9.8 and 73.5 ± 10.2, respectively, and the perceived and actual insertion torque values were 39.1 ± 20.1 Ncm and 39.9 ± 20.7 Ncm, respectively. Good primary stability was obtained but was generally underestimated, especially in the presence of low of medium ISQ and torque values. However, the accuracy of prediction is not enough to prevent mistakes, so more systematic use of objective measurements is encouraged.

van Kesteren CJ, Schoolfield J, West J, Oates T. A prospective randomized clinical study of changes in soft tissue position following immediate and delayed implant placement.  Int J Oral Maxillofac Implants 2010;25(3):562-570.

In 24 patients, implants were either placed immediately or ridge preservation was performed with implant placement 3 months later. Soft tissue, vertical and ridge width measurements were performed after 6 months. Minimal recession of mid-buccal tissue margins was found after 6 months, with no differences between the groups. There was a significant decrease in interproximal soft tissue height, with no significant differences between the groups, but ridge width reduction was greater at the immediate implant sites. No significant relationship could be seen between tissue  biotype and tissue changes. No differences in soft tissue changes were therefore noted between immediate and delayed implants.

Fickl S, Zuhr O, Stein JM, Hürzeler MB.  Peri-implant bone level around implants with platform-switched abutments. Int J Oral Maxillofac Implants 2010;25(3):577-581.

A total of 89 implants were placed in 36 patients in  two different groups: 75 wide diameter implants placed subcrestally with regular diameter cover screws (platform-switched) or 14 regular diameter implants placed at crestal level with regular diameter cover screws. Radiographs were taken at prosthesis placement and after 1 year. Significantly less bone loss was observed at the platform-switched implants at both prosthesis placement and after 1 year, therefore suggesting that this configuration can limit crestal bone remodeling.

Weinländer M, Piehslinger E, Krennmair G. Removable implant-prosthodontic anchorage of the edentulous mandible: five-year results of different prosthetic anchorage concepts.  Int J Oral Maxillofac Implants 2010;25(3):589-597.

Different bar retention designs were evaluated in 76 patients: 39 patients received an overdenture with an ovoid bar supported on two implants (design 1) or multiple ovoid bars on four implants (design 2), and 27 patients received a rigid implant-supported prosthesis with a milled bar. Implant survival, peri-implant parameters and prosthodontic maintenance were assessed over 5 years. Implant survival was 100% and there was no difference in peri-implant parameters between the groups. Prosthodontic maintenance was not significantly different between the  overdenture groups, but was significantly lower for the group with rigid prostheses and milled bars. High patient satisfaction was noted for all designs.

Lambert F, Lecloux G, Rompen E.  One-step approach for implant placement and subantral bone regeneration using bovine hydroxyapatite: a 2- to 6-year follow-up study.  Int J Oral Maxillofac Implants 2010;25(3):598-606.

Patients previously treated with sinus floor elevation and simultaneous implant placement were retrospectively selected for follow-up evaluation. Sinus elevation was performed using a lateral window technique with bovine HA, with immediate placement of non-submerged implants. A total of 50 subantral bone augmentations were performed in 40 patients, and 102  implants were placed. Two implants were lost before loading, but none were lost after definitive restoration; implant and prosthodontic survival were therefore 98% and 100%, respectively, after 2 to 6  years. Subantral bone regeneration with bovine HA is therefore safe and effective.

Prosper L, Crespi R, Valenti E, Capparé P, Gherlone E. Five-year follow-up of wide-diameter implants placed in fresh molar extraction sockets in the mandible: immediate versus delayed loading. Int J Oral Maxillofac Implants 2010;25(3):607-612.

Wide-diameter implants were placed immediately after tooth extraction and loaded either immediately (60 implants) or after 3 months (60 implants) in 71 patients. Radiographs were taken at baseline and after 1, 2, 3, 4 and 5 years. Four implants were lost (two in each group), giving an implant survival rate of 96.67% after 5 years. No significant radiographic or clinical differences were found between the groups.

Garcia-Bellosta S, Bravo M, Subirá C, Echeverría JJ. Retrospective study of the  long-term survival of 980 implants placed in a periodontal practice. Int J Oral Maxillofac Implants 2010;25(3):613-619.

Clinical records of 323 patients with 980 implants were retrospectively  reviewed; 71.1% of implants were placed in patients undergoing periodontal maintenance  care and 38.8% were placed in smokers. The cumulative implant survival rate was 96.2%, and most implant failures occurred before implant loading. The risk of failure was not increased with periodontitis or smoking, but the risk of failure was increased in individuals with many implants and with implants placed in sinus elevation. Implant placement is therefore reliable long-term, even in smokers or patients with periodontitis.

International Journal of Periodontics and Restorative Dentistry

Vol.30 No. 3 (May/June 2010)

Kan JYK, Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival biotype assessment in the esthetic zone: visual versus direct measurement. Int J Periodontics Restorative Dent 2010;30(3):237-243.

The gingival biotype of an anterior maxillary failing tooth in 48 patients was assessed by three different methods: visual, periodontal probing or direct measurement; for direct measurements,  ≤ 1.0 mm was considered thin and > 1.0 mm was considered thick. Mean gingival thickness was 1.06 ± 0.27 mm, and thick and thin biotypes were evenly distributed. There was a significant difference between visual assessment and assessment with a periodontal probe or direct measurement, but there was no significant difference between periodontal probing and direct measurement. Periodontal probing for assessment of gingival biotype is therefore adequately reliable, but visual assessment alone is not.

Rasperini G, Canullo L, Dellavia C, Pellegrini G, Simion M. Socket grafting in the posterior maxilla reduces the need for sinus augmentation. Int J Periodontics Restorative Dent 2010;30(3):265-273.

In 14 patients, 16 extraction sockets were either grafted (six patients) or left untreated (eight patients). Ridge alterations were evaluated at baseline and after 3 and 6 months, and histological analysis was performed at 3, 6 and 9 months, and implant placement, with or without sinus augmentation, was decided at 6 months. Sinus augmentation for implant placement was performed in three of eight control patients but only one of six patients in the test group. Alveolar ridge augmentation therefore increases the likelihood of placing implants without sinus augmentation.


Bersani E, Coppede AR, de Paula Pinto Prata HH. Immediate loading of implants placed in fresh extraction sockets in the molar area with flapless and graft procedures: a case series. Int J Periodontics Restorative Dent 2010;30(3):291-299.

A total of 23 implants were placed to replace single teeth in the molar regions of 20 patients, with no flap reflection or grafting. There were nom implant losses or signs of significant bone resorption or soft tissue complications. This treatment method may therefore be a suitable alternative for the replacement of failing molars.


Tymstra N, Meijer HJA, Stellingsma K, Raghoebar GM, Vissink A.  Treatment outcome and patient satisfaction with two adjacent implant-supported restorations in the esthetic zone.  Int J Periodontics Restorative Dent 2010;30(3):307-316.

Ten patients with two adjacent implants in the anterior maxilla, and who previously received augmentation with autogenous bone, were included in this study. Clinical and esthetic parameters were evaluated. No implants were lost. Bone crest level between the implants was significantly more apical than that between an implant and the adjacent tooth, and complete filling of the interproximal space was observed was observed in only one patient, but the papilla between implant and neighboring tooth was seen in seven patients. The esthetic outcome of the implant-supported was rated as ‘acceptable’ in all cases by the patients, but clinicians rated six as ‘acceptable’ and four as ‘unacceptable’. Esthetic results were therefore difficult to achieve.


International Journal of Prosthodontics

Vol. 23 No. 3 (May/June 2010)

Andreiotelli M, Att W, Strub J-R.  Prosthodontic complications with implant overdentures: a systematic literature review. Int J Prosthodont 2010;23(3):195-203.

A literature search was performed for clinical studies with data regarding prosthetic complications with follow-up periods of at least 5 years. Only a limited number of randomized controlled trials were identified, and very few prospectively compared prosthetic complications for over 5 years. Predictable results were observed with implant-supported overdentures in terms of stability, retention and patient satisfaction, but lower implant survival and a higher prosthetic complication rate  is observed for maxillary  overdentures. Considerable information on complications can be found, but analysis is difficult due to variations in study design. Well designed longitudinal studies are therefore required.


Eliasson A, Narby B, Ekstrand K, Hirsch J, Johansson A, Wennerberg A. A 5-year prospective clinical study of submerged and nonsubmerged Paragon system implants in the edentulous mandible. Int J Prosthodont 2010;23(3):231-238.

This investigation included 29 patients who received 168 titanium plasma-sprayed implants supporting fixed mandibular prostheses; 24 patients were evaluated at the 5-year follow-up. The prostheses remained in function for all patients, and the implant survival rate was 99.4%; however, three implants fractured in one patient. Mean bone loss after 5 years was 0.42 ± 0.48 mm for non-submerged implants and 0.51 ± 0.33 m for submerged implants, but 19 implants (including the three fractured implants) exhibited annual bone loss > 0.2 mm after the first year, giving a success rate of 86.2%.

Journal of Clinical Periodontology

Vol. 37 No. 7 (July 2010)

Vol. 37 No. 8 (August 2010)

Benguigui C, Bongard V, Ruidavets J-B, Chamontin B, Sixou M, Ferrières J, Amar J. Metabolic syndrome, insulin resistance, and periodontitis: a cross-sectional study in a middle-aged French population.  J Clin Periodontol 2010;37(7):601-608.

A cross-sectional survey on cardiovascular risk factors included 276 subjects, 21 of whom were excluded due to edentulism or infectious risk. Periodontal parameters were recorded and periodontitis was classified as moderate or severe. Moderate or severe periodontitis was identified in 41% and 39% of subjects, respectively, and periodontitis was found to be associated with metabolic syndrome, most of its components, and the homeostasis model assessment of insulin resistance (HOMA) index. The association between HOMA index and severe periodontitis remained after adjusting for confounders, and HOMA was also associated with the number of periodontal sites with clinical attachment level ≥ 4 or 5 mm, or probing depth ≥ 4 mm, but there was no such relationship in patients who had never smoked.  

Han D-H, Lim S-Y, Sun B-C, Paek D, Kim H-D.  The association of metabolic syndrome with periodontal disease is confounded by age and smoking in a Korean population: the Shiwha-Banwol Environmental Health Study. J Clin Periodontol 2010;37(7):609-616.

A cross-sectional survey was performed for 1,046 subjects in the Shiwha-Banwol Environmental Health Study. Medical and dental examinations were performed, periodontitis was assessed and confounders (age, gender, smoking, drinking, monthly income, brushing frequency and physical activity) were evaluated. A strong association between metabolic syndrome and  periodontitis was found,  and the association was greater with more metabolic syndrome components and for subjects aged ≥ 65 years, males and smokers. The association was also found to be higher if the metabolic syndrome included high glucose and hypertension compared to other types of metabolic syndrome.


Ylöstalo P, Anttila S, Rajala U, Päivänsalo M, Keinänen-Kiukaanniemi S, Sakki T, Knuuttila M. Periodontal infection and subclinical atherosclerosis: the role  of high-density lipoprotein as a modifying factor.  J Clin Periodontol 2010;37(7):617-624.

Data from 60 dentate subjects in a diabetic study were analyzed and measurements of atherosclerosis were performed. There was no consistent association between the presence of periodontal pockets and subclinical atherosclerosis, but there was a strong association in subjects with low HDL and an opposing but less consistent association in subjects with high HDL. Product terms indicating potential HDL modification were significant for all total plaques, carotid artery plaques with cut-off values 1.2-1.4 and for intima-media thickness with cut-off values 1.1-1.2, but not for aortic plaques.


Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P.  Coronally advanced flap versus connective tissue graft in the treatment of multiple  gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol 2010;37(7):644-650.

In 13 patients, a total of 93 Miller class I, II and III gingival recessions were treated with coronally advanced flap (CAF) alone or combined with connective tissue graft (CTG) and assessed after 6 months and 1 and 5 years. After 6 months, there was no difference in the number of sites with complete root coverage between the groups, but the prevalence of complete root coverage was significantly greater in the CAF+CTG group after 5 years. Between 6 months and 5 years, the gingival margins showed an apical relapse in the CAF group but a coronal improvement in the CAF+CTG group.

Ronaldo B, Mattos CML, Dibart S. A clinical comparison of two flap designs for coronal advancement of the gingival margin: semilunar versus coronally advanced flap. J Clin Periodontol 2010;37(7):651-658.

In this investigation the semilunar coronally re-positioned flap (SLCRF) technique, one of the variants of the semilunar incision was evaluated versus coronally advanced flap (CAF) in 22 patients with 22 contralateral Miller class I gingival recessions. Clinical parameters were recorded at baseline and after 6 months. Coronal displacement of the gingival margin was effective  with both techniques, but significantly greater root coverage, frequency of complete root coverage and gain in clinical attachment level was found with CAF. Root coverage obtained immediately following SLCRF surgery was not maintained.

Thoma DS, Jung RE, Schneider D, Cochran DL, Ender A, Jones AA, Görlach C, Uebersax L, Graf-Hausner U, Hämmerle CHF. Soft tissue volume augmentation by the use of collagen-based matrices: a volumetric analysis. J Clin Periodontol 2010;37(7):659-666.

Soft tissue volume augmentation in dogs was performed with collagen matrix (CM) or subepithelial connective tissue graft (SCTG); controls were sham-operated. Impression casts were taken at baseline and after 28 and 84 days, and were scanned and analyzed. In the CM group, significant gains in volume were obtained in the CM and CSTG groups after 28 and 84 days compared to control, and there was no significant difference between CM and SCTG, indicating that  CM may be a suitable replacement for autogenous connective tissue.

Chambrone L, Chambrone D, Lima LA, Chambrone LA. Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies. J Clin Periodontol 2010;37(7):675-684.

A literature search was performed for articles on  patients with periodontitis who underwent periodontal therapy and at least 5 years of maintenance care. From a total of 527 potential articles, 13 retrospective case series were included, eight and five of which were shown to of medium and low methodological quality, respectively. A total of 41,404 teeth were present  after periodontal therapy and 3,919 were lost during periodontal maintenance. Tooth loss due to periodontal reasons varied from 1.5% to 9.8% and no tooth loss varied from 36.0% to 88.5%. Age and smoking (patient-related factors), tooth type and location and initial tooth prognosis (tooth-related factors) were associated with tooth loss during periodontal maintenance. However, definitive conclusions could not be drawn due to the heterogeneity of the studies.


Pires ILO, Cota LOM, Oliveira OCB, Costa JE, Costa FO. Association between periodontal condition and use of tongue piercing: a case-control study. J Clin Periodontol 2010;37(8):712-718.

Oral health records of 60 patients with tongue piercings and 120 without tongue piercings were evaluated, including periodontal parameters and tooth fracture, and risk variables for gingival recession were identified. The presence and severity of gingival recession was much higher for those with tongue piercings than for those without, and the risk of gingival recession in the anterior lingual region was 11 times greater. Use of piercings, age, male gender and bleeding on probing were associated with gingival recession in the anterior lingual region.


Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 2010;37(8):728-738.

Recessions in 50 patients were treated with coronally advanced flap (CAF) combined with connective tissue graft (CTG) or de-epithelialized gingival graft (DGG). No significant differences in painkiller consumption, post-operative discomfort or bleeding were observed  between the groups, but consumption of painkillers increased with the height of the graft and with primary flap dehiscence/necrosis. A negative correlation was found between pain and residual thickness of soft tissue over the palatal bone, and the DGG group showed significantly greater buccal soft tissue thickness.


de Sanctis M, Vignoletti F, Discepoli N, Muñoz F, Sanz M. Immediate implants at fresh extraction sockets: an experimental study in the beagle dog comparing four different implant systems. Soft tissue findings. J Clin Periodontol 2010;37(8):769-776.

Immediately following tooth extraction, implants were placed in the distal sockets of the third and fourth premolars in eight dogs; four implant sites were used in each dog. After 6 weeks, the biological width consisted of junctional epithelium of 2 to 2.7 mm and connective tissue from 1 to 1.8 mm; the length of the junctional epithelium was longer than that observed  in healed-ridge models. No significant differences between any of the implant systems were found.

Journal of Dentistry

Vol. 38 Suppl. 1 (June 2010)

Vol. 38 No. 7 (July 2010)

Vol. 38 No. 8 (August 2010)

Javed F, Romanos GE. The role of primary stability for successful immediate loading of dental implants. A literature review. J Dent 2010;38(8):612-620.

A literature search was performed for articles relating  to primary stability in immediate loading of implants. The evidence suggested that good primary stability is a key criterion for immediate loading and is dependent on a number of factors, including bone density, bone quality, implant design and surface characteristics, and surgical technique. In certain situations, e.g. poor bone quality/quantity, multiple implants or augmentation procedures, further research on the influence of primary stability is required. 

 Journal of Oral and Maxillofacial Surgery

Vol. 68 No. 7 (July 2010)

Vol. 68 No. 8 (August 2010)

Uckan S, Deniz K, Dayangac  E, Araz K, Özdemir BH.  Early implant survival in posterior maxilla with or without β-tricalcium phosphate sinus floor graft. J Oral Maxillofac Surg 2010;68(7):1642-1645.

A total of 121 implants were placed in 70 maxillary sinuses in 62 patients with simultaneous sinus augmentation using β-tricalcium phosphate (test), and 136 implants were placed in the posterior maxillae of 65 patients without sinus augmentation (control). For mean follow-up times of 29.8 and 32.3 months for test and control, respectively, there was one implant failure in each group, giving implant survival rates of 99.17% and 99.26%, respectively. Implant survival was therefore similar for augmented and non-augmented sites.


Jang H-Y, Kim H-C, Lee S-C, Lee J-Y. Choice of graft material in relation to maxillary sinus width in internal sinus floor augmentation. J Oral Maxillofac Surg 2010;68(8):1859-1868.

Three different sinus floor elevation methods were used in 57 patients for the placement of 100 implants, and the distance of the grafts from the lateral and medial walls at the apex of the implant were evaluated using cone-beam CT. The mean buccolingual distance of the grafts was 12.1 ± 2.0 mm. Contact was made with the medial wall in 29.9% of cases where the distance was > 12.1 mm and complete contact was made in 95.7% of cases where the distance was < 12.1 mm. The buccolingual width at the apical end of the implant should therefore be measured, and autogenous bone with osteogenic potential should be used for grafting larger sinuses, or the median wall should be reflected in a lateral window technique.

Scarano A, Piattelli A, Assenza B, Quaranta A, Perrotti V, Piattelli M, Iezzi G. Porcine bone used in sinus augmentation procedures: a 5-year retrospective evaluation. J Oral Maxillofac Surg 2010;68(8):1869-1873.

Sinus augmentation with porcine bone was performed in 121 patients, and implants were placed 4-6 months after surgery. No major complications were noted during healing, with the exception of lack of regeneration at time of implant placement in two cases. Minor peri-implant bone resorption was noted. A total of 21 implants were lost, giving an implant survival rate of 92% after 5 years. Porcine bone can therefore be successful in sinus augmentation procedures.

Journal of Oral Implantology

Vol. 36 No. 3 (June 2010)

Develioglu H, Saraydin S, Kartal Ü, Taner L. Evaluation of the long-term results of rat cranial bone repair using a particular xenograft. J Oral Implantol 2010;36(3):167-173.

Parietal bone defects 6 mm in diameter were created  in rats and filled with a porous particle xenograft material, while defects in the contralateral side were used as control. Tissue samples and histological sections were assessed after 3, 6 and 12 months. Dense collagenous tissue was found in the control sites after 3 months, compared to a fibrous tissue layer surrounding graft particles at the test sites. No significant bone repair was found at subsequent time points. Evidence of resorption or enhanced bone formation were not apparent with the graft material, but biocompatibility and osteoconductivity were observed.

Potijanyakul P, Sattayasansakul W, Pongpanich S, Leepong N, Kintarak S.  Effects of enamel matrix derivative on bioactive glass in rat calvarium defects. J Oral Implantol 2010;36(3):195-204.

Two critical-sized calvarial defects 5 mm in diameter were created in each of 20 rats. In three groups, one defect was filled with bioactive glass alone and the contralateral defect was filled with bioactive glass and EMD and evaluated after 2, 4 and 8 weeks, while in a fourth group one defect was filled with EMD alone and the contralateral defect was left empty and evaluated after 8 weeks. Radiomorphometry showed no difference between bioactive glass alone or with EMD, but histology showed a greater percentage of new bone with the combination but the difference was not significant. The greatest new bone formation was with the combination at 8 weeks.

Journal of Oral Rehabilitation

Vol. 37 No. 7 (July 2010)

Vol. 37 No. 8 (August 2010)

Patel PM, Lynch CD, Sloan AJ, Gilmour ASM. Treatment planning for replacing missing teeth in UK general dental practice: current trends. J Oral Rehabil 2010;37(7):509-517.

A total of 500 questionnaires were sent to general dental practitioners in Wales to assess treatment for the replacement of missing teeth. The response rate  was 43.4% (217 questionnaires), most of whom were confident in providing removable partial dentures (acrylic (100%) or metal-based (99.5%)), cantilever resin-bonded bridges (94.4%) and conventional bridgework (98.6%). However, most were not confident in providing implants (81.4%) and many were not confident in providing  fixed resin-bonded bridges (21.1%). Some financial barriers were identified, particularly  due to treatment limitations by the NHS, and privately funded patients were more likely to be offered implant replacement for upper first molars or fixed bridges.

Ogawa T, Dhaliwal S, Naert I, Mine A, Kronstrom M, Sasaki K, Duyck J.  Impact of implant number, distribution and prosthesis material on loading of implants supporting fixed dentures.  J Oral Rehabil 2010;37(7):525-531.

Seven implants were placed in an edentulous composite mandible and prostheses (all-acrylic, fiber-reinforced acrylic or milled titanium framework) were placed with a 50N vertical load on the extension 10 mm distal from the most posterior implant. Axial forces and bending moments were measured with different numbers of supporting implants, different implant distribution conditions and different prosthesis materials. The maximum bending moments were observed on three implants and were significantly influenced by implant distribution (the largest bending moments resulted from the smallest distribution). Bending moments were also lower with the titanium prosthesis.

Lee SY, Piao CM, Koak JY, Kim SK, Kim YS, Ku Y, Rhyu IC, Han CH, Heo SJ.  A 3-year prospective radiographic evaluation of marginal bone  level around different implant systems.  J Oral Rehabil 2010;37(7):538-544.

Three different types of implants  (rough surface, hybrid smooth and rough surface, and rough surface with microthreads) were placed in 54 patients, with clinical and radiographic examinations performed at implant placement and after 1 and 3 years. A total of 135 implants were placed, of which 120 completed the study. After 3 years, mean bone loss was lower with the  rough surface/microthread implants (0.59 ± 0.30 mm) compared to rough (0.95 ±0.27 mm) and hybrid  surface (1.05 ± 0.34 mm) implants. The rough surface/microthread implants may therefore have a positive effect on maintenance of marginal bone level.

Al-Amleh B, Lyons K, Swain M.  Clinical trials in zirconia: a systematic review.  J Oral Rehabil 2010;37(8):641-652.

The manufacture of zirconia restorations is done by either soft or hard milling processes, each of which has advantages and disadvantages. This review found 17 clinical trials on zirconia-based restorations (13 on fixed partial dentures, two on single crowns and two on zirconia abutments). Six of the trials used hard-milled zirconia and 11 used soft-milled. Chipping of the veneering porcelain was common, while framework fracture only occurred with soft-milled zirconia. Zirconia appeared to be suitable for fixed partial dentures and single crowns, but further trials are required to determine the best manufacturing process.

Journal of Periodontology

Vol. 81 No. 6 (June 2010)

Vol. 81 No. 7 (July 2010)

Waasdorp JA, Evian CI, Mandracchia M.  Immediate placement of implants into infected sites: a systematic review of the literature. J Periodontol 2010;81(6):801-808.

Infected sites have been considered a contraindication  for implant placement, but data have shown similar success rates to implants placed in healthy sites. A literature review was therefore performed for studies where implants were immediately placed in infected sites. A total of 417 articles were identified, of which 12 met the inclusion criteria. Most studies were of sites with chronic periapical infection, but classification was vague and uncategorized in relation to outcome. High implant survival was observed in animal studies, although BIC may be impaired. High implant survival was also seen in clinical studies, but evidence was limited to small numbers of studies and patients. Thorough debridement of the site is required and guided bone regeneration is usually performed.

Bornstein MM, Wittneben J-G, Brägger U, Buser D. Early loading at 21 days of non-submerged titanium implants with a chemically modified sandblasted and acid-etched surface: 3-year results of a prospective study in the posterior mandible. J Periodontol 2010;81(6):809-818.

In 39 partially edentulous patients, 56 implants with  a chemically modified SLA surface were placed and loaded with provisional crowns after 21 days. Definitive restorations were placed after 6 months, and radiography and soft tissue analysis were performed for up to 36 months. There were no implant failures, but two implants were not osseointegrated after 21 days, so were subjected to a longer healing period. All implants showed favorable clinical and radiographic findings after 36 months, and the survival and success rate was 100%. Significantly lower probing depths and clinical attachment levels were observed compared to a historic control group. Implants with a chemically modified SLA surface can therefore achieve and maintain successful tissue integration over 3 years.

Anitua E, Orive G. Short implants in maxillae and mandibles: a retrospective study with 8 years of follow-up. J Periodontol 2010;81(6):819-826.

A total of 1,287 short implants (< 8.5 mm) were placed in 661 patients over an 8-year period, and implant survival and the influence of demographic and clinical factors, surgery-dependent factors and prosthetic variables were analyzed. Overall implant- and subject-based survival rates were 99.3% and 98.8%, respectively (nine implants were lost), after a mean follow-up of 47.9 ± 24.46 months. Because of the low failure rate, none of the variables analyzed were associated with implant failure. Placement of short implants can therefore be safe and predictable.


Nickles K, Ratke-Krüger P, Neukranz E, Raetzke P, Eickholz P.  Ten-year results after connective tissue grafts and guided tissue regeneration for root coverage. J Periodontol 2010;81(6):827-836.

A total of 38 Miller class I and II recessions in 15 patients were treated using either connective tissue graft (CTG) or guided tissue regeneration (GTR), with clinical parameters measured at baseline and after 120 ± 12 months. After 120 months, nine patients were available for analysis. Significant root coverage from baseline was obtained with CTG after 6 and 120 months,  while significantly greater root coverage from baseline was achieved only at 6 months with GTR. A significant loss in coverage occurred in both groups between 6 and 120 months, but the stability of root coverage was significantly better with CTG. More post-surgical discomfort was observed with CTG, but treatment outcomes were significantly better.

Holmlund A, Holm G, Lind L. Number of teeth as a predictor of cardiovascular mortality in a cohort of 7,674 subjects followed for 12 years. J Periodontol 2010;81(6):870-876.

Between 1976 and 2002, 7,674 subjects received a dental examination by periodontal specialists, evaluating number of remaining teeth, severity of periodontal disease, number of deepened periodontal pockets and bleeding on probing in relation to cause of death. A total of 629 subjects died over a median follow-up period of 12 years; 299 died from cardiovascular disease (CVD; 167 from coronary heart disease, 83 from stroke, 49 from aortic aneurysm or congestive heart failure (CHD)). All-cause mortality and mortality in CVD and CHD was significantly predicted by number of remaining teeth, age, gender and smoking, but mortality from stroke was not. The risk of mortality from CHD was increased 7-fold for subjects with < 10 teeth compared to those with > 25 teeth. Severity of periodontal disease, number of deepened periodontal pockets and bleeding on probing were not found to be related to mortality. There appears to be a relationship, therefore, between oral health and CVD.

Renvert S, Ohlsson O, Pettersson T, Persson RG. Periodontitis: a future risk of acute coronary syndrome? A follow-up study over 3 years. J Periodontol 2010;81(7):992-1000.

Periodontal conditions were evaluated in 165 patients with acute coronary syndrome (ACS) and 159 healthy control patients. Recurrence of ACS was observed in 40% of the ACS patients, while 4.4% of healthy patients experienced a first ACS event. The patients with future ACS had significantly higher HDL-lipoprotein, creatinine, and white blood cell counts, and periodontitis was significantly associated with a first ACS event and recurrence of ACS. Recurrent ACS events were significantly predicted by white blood cell counts, creatinine and periodontitis.

Saito A, Hosaka Y, Kikuchi M, Akamatsu M, Fukaya C, Matsumoto S, Ueshima F, Hayakawa H, Fujinami K, Nakagawa T.  Effect of initial periodontal therapy on oral  health-related quality of life in patients with periodontitis in Japan. J Periodontol 2010;81(7):1001-1009.

A total of 58 patients with periodontitis completed initial periodontal therapy and were assessed for perceptions of oral health-related quality of life. An impact of oral health status on quality of life was perceived by 97% of patients at baseline, with pain, eating and chewing and psychologic function influenced. Oral health was initially rated as poor in over half the patients. Oral health-related quality of life was significantly improved by periodontal therapy, and significantly more patients reported never or rarely having problems with pain and eating/chewing.  

Zucchelli G, Mele M, Stefanini M, Mazzotti C, Mounssif I, Marzadori M, Montebugnoli L. Predetermination of root coverage. J Periodontol 2010;81(7):1019-1026.

Distance from apical reference point of a stent was measured and maximum root coverage was predetermined by a periodontist for 50 patients with multiple and single recession defects; 135 defects were then treated using coronally advanced flap (CAF) or subepithelial connective tissue graft (CTG). Distance from apical reference point to a stent and gingival margin were re-evaluated 15, 30 and 90 days after surgery. The distances before and after surgery coincided exactly in 97% of recessions, with no significant differences between maxilla and mandible or CAF and CTG. Then distance measured before surgery was greater in 17.7% of recession defects and lower in 10.3% of gingival recessions than that measured after surgery. Soft tissue margin could therefore be reliably predetermined.

Santamaria MP, Ambrosano GMB, Casati MZ, Nociti FH Jr, Sallum AW, Sallum EA. The influence of local anatomy on the outcome of treatment of gingival recession associated with non-carious cervical lesions. J Periodontol 2010;81(7):1027-1034.

A total of 78 gingival recession defects in maxillary  canines or premolars were treated with coronally advanced flap (CAF) alone or with restoration, or with subepithelial connective tissue graft (CTG) alone or with restoration. Relative reduction in gingival recession and gain in clinical attachment level were evaluated. For relative reduction in gingival recession, there was  a significant association with cervical lesion height when CAF and CTG + restoration, and when overall data from both CTG groups, were analyzed, and there was a significant association with cervical lesion depth with CAF.  Bone level was also significantly associated with relative reduction in gingival recession and with gain in clinical attachment level in the CTG group, and when considering overall data from the CAF groups.

Avila G, Wang H-L, Galindo-Moreno P, Misch CE, Bagramian RA, Rudek I, Benavides E, Moreno-Riestra I, Braun T, Neiva R.  The influence of the bucco-palatal  distance on sinus augmentation outcomes.  J Periodontol 2010;81(7):1041-1050.

Sinus augmentation using a lateral window approach and particulate allograft was performed in 24 sinuses in 21 patients after the fabrication of radiographic and surgical guides, and measurement of the bucco-palatal distance at 8, 10 and 12 mm from the alveolar crest. Biopsies were harvested at the time of implant placement, and bone core sections from the three distances from the alveolar crest were evaluated. The success rate for the grafting procedure was 96%. Histomorphometry showed that the mean proportion of vital bone was 22.71 ± 19.08% and the mean remaining allograft was 23.39 ± 20.85%, with a mean 53.90 ± 13.23% non-mineralized connective tissue. There was a strong negative association between proportion of vital bone and bucco-palatal distance.

Journal of Prosthetic Dentistry

Vol. 103 No. 6 (June 2010)

Vol. 104 No. 1 (July 2010)

Pettersson A, Kero T, Gillot L, Cannas B, Fäldt J, Söderberg R, Näsström K. Accuracy of CAD/CAM-guided surgical template implant surgery on human cadavers: Part I. J Prosthet Dent 2010;103(6):334-342.

Implant placement with 145 implants was planned using software in 10 maxillae and seven mandibles from cadavers and placed using a CAD/CAM surgical template. Pre- and post-operative CT scans were matched and the differences between the virtual and actual positions of the implants evaluated. The mean differences were 1.25 mm at the apex, 1.06 mm at the hex, 0.28 mm for depth deviation, 0.71 mm for translation deviation and 2.64° for angular deviation. The results indicated significant differences between actual and planned implant positions.

Kero T, Pettersson A, Fäldt J, Andersson M, Gillot L, Cannas B, Näsström K, Söderberg R. Virtual variation simulation of CAD/CAM template-guided surgeries performed on human cadavers: Part II. J Prosthet Dent 2010;104(1):48-55.

Computer-aided planning was used for the placement of 145 implants in 17 cadaver specimens; 10,000 virtual surgeries were performed for each, giving a total of 1,450,000 virtual surgeries. The results were compared with those from the actual surgeries. The difference between the simulated average mean of the mean and the surgical average of the median was 0.22 mm at the apex and -0.35 mm at the hex in the maxilla and -0.19 mm at the apex and -0.69 at the hex in the mandible. There were significant differences in implant distributions between the  simulations and surgeries at both  apex and hex. However, definitive geometrical variations were not static and depend on individual jaw anatomy and ability to place the guided template in the correct position.


Quintessence International

Vol. 41 No. 5 (May 2010)

Vol. 41 No. 6 (June 2010)

Vol. 41 No. 7 (July/August 2010)

Blus C, Szmukler-Moncler S, Vozza I, Rispoli L, Polastri C. Split-crest and immediate implant placement with ultrasonic bone surgery (Piezosurgery): 3-year follow-up of 180 treated implant sites.  Quintessence Int 2010;41(6):463-469.

A total of 61 split-crest procedures were performed with piezosurgery in 43 patients, and 180 implants were immediately placed. Mean initial ridge width was 3.3 ± 0.7 mm (range 1.5 to 5.0 mm). The mean split length was 14.8 ± 10.8/ mm and the mean final ridge width achieved was 6.0 ± 0.4 mm. Five implants failed to osseointegrate by second-stage surgery; the implant success rate was 97.2% (95.1% and 100% in the maxilla and mandible, respectively). No further implant failures occurred during the 3-year follow-up. Piezosurgery is therefore a predictable technique for split-crest procedures and reduced the risk of soft tissue alteration.

Eccellente T, Piombino M, Piattelli A, Perrotti V, Iezzi G. A new treatment concept for immediate loading of implants inserted into the edentulous mandible. Quintessence Int 2010;41(6):489-495.

A total of 39 patients were treated with mandibular overdentures based on immediate loading of four interforaminal implants (total = 156  implants). The dentures were retained by prefabricated conical crowns inserted into the existing denture base. After a mean observation period of 30.3 months, two implants failed, giving an implant survival rate of 98.7%, while the prosthesis survival rate was 100%. Healthy peri-implant tissue was observed at all other implants. The concept allowed for stable denture retention, reduction of the denture base and improved oral hygiene.

Deppe H, Hohlweg-Majert B, Hölzle F, Schneider KTM, Wagenpfeil S. Pilot study for periodontal treatment and pregnancy outcome: a clinical prospective study. Quintessence Int 2010;41(6):e101-e110.

A total of 302 pregnant women were invited for periodontal examination, of whom 62 agreed to screening and 54 met the inclusion criteria. No periodontal treatment was indicated in 28 patients, while 12 patients consented to therapy (full-mouth disinfection) and 14 declined therapy. Gestational age at end of pregnancy, birth weight and growth restriction were evaluated. Periodontal measurements were improved in the periodontally treated group, but there  were no significant differences in gestational age, birth weight or growth restrictions between patients who received periodontal therapy and those who did not, and there were no significant differences from the group not requiring periodontal therapy. Further studies are therefore required in this field.

da Silva Araújo AC, Gusmão ES, Batista JEM, Cimões R.  Impact of periodontal disease on quality of life. Quintessence Int 2010;41(6):e100-e118.

A cross-sectional study was performed in 401 patients where periodontal, OHIP-14, socioeconomic and demographic data were collected. Chronic periodontitis was found in 56.7% of  patients, and functional limitation affected 91.5% of the  population. The highest impact scores  were observed in patients with aggressive periodontitis and the highest OHIP-14 scores were in those with aggressive or chronic periodontitis. Impact on quality of life was significantly associated with age, income and periodontal disease.




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