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Literature Update Jan - Feb 2011

Clinical Implant Dentistry and Related Research

Vol. 13 No. 1 (March 2011)

Scarano A, Piattelli A, Perrotti V, Manzon L, Iezzi G.  Maxillary sinus augmentation in humans using cortical

porcine bone: a histological and histomorphometric evaluation after 4 and 6 months. Clin Implant Dent

Relat Res 2011;13(1):13-18.

A total of 77 specimens were obtained from augmented sinuses after 4 and 6 months and evaluated histologically and histomorphometrically. The proportions of newly formed bone, marrow spaces and residual graft material were 28%, 36% and 37%, respectively. The same proportions after 6 months were 31%, 34% and 37%, respectively. The results indicated that porcine bone can be used in maxillary sinus augmentation without interfering with normal bone processes.


De Coster P, Browaeys H, De Bruyn H. Healing of extraction sockets filled with BoneCeramic prior to implant placement: preliminary histological findings. Clin Implant Dent Relat Res 2011;13(1):34-45.

In 10 patients, 15 sockets were filled with Straumann BoneCeramic and 10 sockets were left to heal naturally

prior to implant placement, with biopsies collected after 6-74 weeks. Softer bone was observed at the substituted sites at implant placement, and loose connective tissue and less woven bone was observed.


Sahrmann P, Attlin T, Schmidlin PR.  Regenerative treatment of peri-implantitis using bone substitutes and membrane: a systematic review. Clin Implant Dent Relat Res 2011;13(1):46-57.

A literature search was conducted for studies using GBR to treat bone defects caused by peri-implantitis.

From an initial list of 399 titles, 17 were included in the review. In terms of qualitative measurements, 10.4%

of implants showed complete bone fill, compared to incomplete defect closure at 85.5% and no bone fill at

4.0%. Information on probing depth before and after treatment was found for only 53.2%, and only three studies reported the inflammatory status of the soft tissues. Complete bone fill with GBR was therefore not predictable, and mucosal health is not well considered.


Clinical Oral Implants Research Vol. 22 No. 1 (January 2011) Vol. 22 No. 2 (February 2011)

Tan  WC,  Lang  NP,  Schmidlin  K,  Zwahlen  M,  Pjetursson  BE.  The  effect  of  different  implant  neck

configurations on soft and hard tissue healing: a randomized-controlled clinical trial. Clin Oral Implants Res


Implants with a 1.8 mm turned neck (test) or a 2.8 mm turned neck (control) were placed in the posterior jaws of 18 patients with multiple missing teeth; each patient received one of each implant. All implants were placed transmucosally to a sink depth of 1.8 mm. After 6 months and 1 year, no significant differences were observed in soft tissue parameters or mean crestal bone levels between the two implant types, but significantly less crestal bone loss was seen at the test implants after 1 year. The percentage of implants with crestal bone levels 1-2 mm below the implant shoulder was also greater at the test implants (50% versus 5.6%) after 1 year. A reduced height of turned neck may therefore reduce crestal bone resorption and maintain higher crestal bone levels.


Truninger TC, Philipp AOH, Siegenthaler DW, Roos M, Hämmerle CHF, Jung RE.  A prospective, controlled, clinical trial evaluating the clinical and radiological outcome after 3 years of immediately placed implants in sockets exhibiting periapical pathology. Clin Oral Implants Res 2011;22(1):20-27.

Each of 29 patients received an implant immediately following tooth extraction, 13 of the sockets exhibited periapical pathology (test) and 16 did not (control). Clinical and radiological parameters were assessed for 3 years.  The  implant  survival  rate  was  100%,  and  no  significant  differences  in  clinical  or  radiological parameters were observed between the test and control groups. The mean distance from the implant shoulder to the first bone-to-implant contact was 1.54 ± 0.88 mm and 1.69 ± 0.92 mm mesially and distally, respectively, in the test group. No retrograde peri-implantitis was observed at the sites with periapical pathology after 3 years. Immediate placement of implants in sites with periapical pathology, with careful debridement of the socket, can therefore be performed.


Schneider D, Grunder U, Ender A, Hämmerle CHF, Jung RE.  Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year results from a prospective cohort study. Clin Oral Implants Res 2011;22(1):28-37.

Implant-supported crowns were used to replace missing central or lateral maxillary incisors in 16 patients.

Impressions were taken before and after implant placement and hard tissue augmentation, after soft tissue augmentation, after crown placement, and after 1 year to assess alterations in peri-implant tissue contours. A mean gain of 1.27 ± 0.67 mm in the labial direction was observed after the surgical procedures, with a mean loss of 0.04 ± 0.31 mm in the labial direction after 1 year. Crown length and papilla height increased by

0.22 ± 0.57 mm and 0.07 ± 0.61 mm, respectively, in the same time. However, changes were highly variable between individuals.


Aglietta M, Siciliano VI, Rasperini G, Cafiero C, Lang NP, Salvi GE. A 10-year retrospective analysis of marginal  bone-level  changes  around  implants  in  periodontally  healthy  and  periodontally  compromised tobacco smokers. Clin Oral Implants Res 2011;22(1):47-53.

A  total  of  40  tobacco  smokers  were  divided  into  two  groups  of  periodontally  healthy  patients  and periodontally compromised patients; the latter had been treated for periodontal conditions before implant placement. Each group received two different types of implants, making four patient groups in all. Bone loss was evaluated over 10 years. Implant survival rates ranged from 70-100% but were not significantly different between the groups. Significantly higher marginal bone loss was observed in the periodontally compromised patients, regardless of the implant system.


Pramstraller M, Farina R, Franceschetti G, Pramstraller C, Trombelli L.  Ridge dimensions of the edentulous posterior maxilla: a retrospective analysis of a cohort of 127 patients using computerized tomography data. Clin Oral Implants Res 2011;22(1):54-61.

CT scans from 127 patients with at least one missing tooth in the posterior maxilla were analyzed for bone height, bone width (1, 3 and 7 mm from most coronal point of alveolar crest; BW1mm, BW3mm and BW7mm) and relative vertical ridge position at the edentulous sites. The maxillary sinus was evident at 50% of first premolar sites and 90-100% of second premolar and molar sites. BW1mm was higher at second molar compared to premolar sites, and BW3mm and BW7mm were higher at molar compared to premolar sites. Bone height 8 mm and BW1mm   6 mm was observed at 86.7% of first premolar, 59.2% of second premolar,

19.8% of first molar and 34.8% of second molar sites. Bone augmentation of the alveolar crest may therefore be required at second premolar sites as well as molar sites for implant placement.


Gallucci GA, Grütter L, Nedir R, Bischof M, Belser UC.  Esthetic outcomes with porcelain-fused-to-ceramic and all-ceramic single-implant crowns: a randomized clinical trial. Clin Oral Implants Res 2011;22(1):62-69. A total of 20 patients received either all-ceramic (test; 10 patients) or porcelain-fused-to-ceramic (control; 10 patients) screw-retained single implant crowns and were followed up for 2 years. No significant differences were found for objective measurements between the test and control groups. Mean PES/WES scores were

13.1 and 13.9 for the test and control groups, respectively; however, major discrepancies were observed for implant crown volume, outline, translucency and characterization with the contralateral teeth. Patient perceptions of the esthetic outcomes were not significantly different between the groups, and similar clinicians’ accuracy scores were achieved. Outcomes were similar between the two groups; implant crown material alone, therefore, does not ensure optimal esthetic outcomes.


Brägger U, Hirt-Steiner S, Schnell N, Schmidlin K, Salvi GE, Pjetursson B, Matuliene G, Zwahlen M, Lang NP.  Complication and failure rates of fixed dental prostheses in patients treated for periodontal diseases. Clin Oral Implants Res 2011;22(1):70-77.

From a cohort of 392 patients with chronic periodontitis treated between 1978 and 2002, 199 were re- examined in 2005; of these, 84 had received 175 ceramo-metal FDPs supported by teeth, implants or both. Over the mean observation time of 11.3 years, 21 FDPs were lost and there were 46 technical and 50 biological complications. The probability of remaining free of complications was between 70.3% and 88.9% in FDPs with end abutments but only 49.8% to 25% in FDPs with extensions after 10 years. High survival rates were therefore achieved in patients treated for chronic periodontitis, but the incidence rate of negative events increased dramatically in FDPs with extensions. Extensions should therefore be avoided or used only after a full clinical evaluation of various options.


Chiapasco M, Romeo E, Coggiola A, Brusati R. Long-term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo-mandibular defects due to extreme atrophy. Clin Oral Implants Res 2011;22(1):83-91.

Extreme atrophy of the edentulous jaws with fibula free flaps was performed in 12 patients, with placement of a total of 75 implants after 5-12 months and prosthetic rehabilitation after a further 4-6 months. The mean follow-up time was 77 months. Three implants were removed during the follow-up period, giving a survival rate of 95.8%. Relevant peri-implant bone loss of (1-7 mm and 1-4.5 mm for maxillary and mandibular implants, respectively) was observed at a number of implants. The results indicated that fibula free flaps do not guarantee dimensional stability of the peri-implant bone.


Bacci  C,  Berengo  M,  Favero  L,  Zanon  E.   Safety  of  dental  implant  surgery  in  patients  undergoing anticoagulation therapy: a prospective case-control study. Clin Oral Implants Res 2011;22(2):151-156.

The  incidence  of  bleeding  complications  following  surgical  implant  therapy  in  50  patients  receiving

anticoagulant therapy was evaluated; 109 comparable healthy patients were evaluated as a control group. A standard protocol of local homeostasis was performed in both groups. The incidence of late-bleeding complications was two and three in the anticoagulant and control groups, respectively; the difference in bleeding risk was therefore not significant. Local homeostasis may therefore help to prevent bleeding complications in patients taking oral anticoagulants.


Tymstra N, Raghoebar GM, Vissink A, Meijer HJA. Dental implant treatment for two adjacent missing teeth in the maxillary aesthetic zone: a comparative pilot study and test of principle. Clin Oral Implants Res


Patients with a missing adjacent central and upper lateral incisor were treated with a single implant and crown with cantilever (five patients) or two implants with separate crowns (five patients). Patients in the incisor group received one regular diameter implant, while patients in the adjacent implant group received one regular and one narrow diameter implant. No implants were lost after 1 year, and pocket probing values were similar between the groups. Papilla index scores were relatively low in both groups, and marginal bone loss was minimal. No differences in soft and hard tissue parameters were therefore observed between the two groups.


European Journal of Oral Implantology

Vol. 3 No. 4 (December 2010)

Canullo L, Bignozzi I, Cocchetto R, Cristalli MP, Iannello G.  Immediate positioning of a definitive abutment versus  repeated  abutment  replacements  in  post-extractive  implants:  3-year  follow-up  of  a  randomised

multicentre clinical trial. Eur J Oral Implantol 2010;3(4):285-296.

A hopeless maxillary premolar was extracted in each of 32 patients and randomized to receive an immediate implant-supported restoration with a provisional abutment or a definitive abutment. Seven patients were excluded from the study after tooth extraction, but the remaining 25 received wide diameter implants with platform-switched titanium provisional or definitive abutments. Provisional crowns were placed, with definitive restorations after 3 months. Provisional abutments were dis- and reconnected several times, while abutment disconnection was avoided in the definitive group. Implant success was 100% in both groups after 3 years. Peri-implant bone resorption was 0.36 mm, 0.43 mm and 0.55 mm at 3 months, 18 months and 3 years, respectively, in the provisional abutment group, and 0.35 mm, 0.33 mm and 0.34 mm, respectively, at the same time points in the definitive abutment group. Radiographic density was also greater in the definitive abutment group. The ‘one abutment-one time’ concept may therefore help to minimize crestal bone resorption.


Esposito M, Piattelli M, Pistilli R, Pellegrino G, Felice P. Sinus lift with guided bone regeneration or anorganic bovine  bone:  1-year  post-loading  results  of  a  pilot  randomised  clinical  trial.  Eur  J  Oral  Implantol


Ten patients with 1-5 mm residual bone height and 5 mm bone width below the maxillary sinus received either a Bio-Oss or a GTR biodegradable membrane without graft material. Two or three implants were placed after 6 months and loaded with provisional restorations after a further 4 months, which were replaced by definitive restorations after another 4 months. Up to 1 year after loading, one patient dropped out of the study and four complications occurred in three patients in the membrane-only group compared to two complications in the Bio-Oss group. No significant differences in bone loss were observed between the groups. Bone graft, therefore, may not be necessary to augment the atrophic maxillary sinus.


Gianserra R, Cavalcanti R, Oreglia F, Manfredonia MF, Esposito M.  Outcome of dental implants in patients with and without a history of periodontitis: a 5-year pragmatic multicentre retrospective cohort study of 1727 patients. Eur J Oral Implantol 2010;3(4):307-314.

Periodontal status was assessed in 1727 patients requiring implant treatment in four private practices: 258 had no periodontitis, while 839 had moderate periodontitis and 630 had severe periodontitis. In the periodontitis patients, periodontal treatment was given before implant surgery. A total of 647 implants, 2813 implants and 3260 implants were placed in the no periodontitis, moderate periodontitis and severe periodontitis groups, respectively. After 5 years, 250 patients were lost to follow-up. Implant failure rates were 3.0%, 3.1% and 4.5% in the no, moderate and severe periodontitis groups, respectively; 90% of the failures occurred before implant loading. No significant differences were observed between the three groups, indicating that a previous history of periodontitis may not have a significant effect on implant failure.


Anitua E, Errazquin JM, de Pedro J, Barrio P, Begona L, Orive G. Clinical evaluation of Tiny 2.5- and 3.0-mm narrow-diameter implants as definitive implants in different clinical situations: a retrospective cohort study. Eur J Oral Implantol 2010;3(4):315-322.

A total of 89 narrow-diameter implants (2.5 mm or 3.0 mm) in 51 patients with insufficient bone thickness were followed up for at least 3 years after implant loading. After a mean follow-up period of 48 months, the implant survival rate was 98.9% (one implant lost) and six complications were reported. The mean bone loss after 24 months was 1.26 ± 0.51 mm). narrow diameter implants can therefore be used in the treatment of narrow bone ridges.


Davo R, Pons O, Rojas J, Carpio E. Immediate function of four zygomatic implants: a 1-year report of a prospective study. Eur J Oral Implantol 2010;3(4):332-334.

Four zygomatic implants were placed in each of 17 patients with severely atrophic maxillae and immediately

loaded. No implants were lost up to 1 year follow-up, but one implant could not be used due to an unfavorable position. In one patients the orbital cavity was penetrated, but with no relevant clinical consequences. Infection followed by fistula was observed at one implant, but this was successfully treated. Four zygomatic implants may therefore be a viable treatment option for the rehabilitation of patients with severely atrophied maxillae.


Implant Dentistry

Vol. 19 No. 6 (December 2010)

Taschieri S, Rosano G, Weinstein T, Del Fabbro M.  Replacement of vertically root-fractured endodontically

treated  teeth  with  immediate  implants  in  conjunction  with  a  synthetic  bone  cement.  Implant  Dent


The study enrolled 16 patients scheduled for extraction of one tooth and with signs and symptoms of vertical root fracture. Each patient received an implant immediately after tooth extraction, and the gap between the implant and socket wall was filled using synthetic bone graft cement. Prosthesis placement was after 3-4 months. After a mean follow-up period of 13.5 months, implant success and survival was 100%, and prosthesis success was 100%. Mean peri-implant bone loss was 0.48 ± 0.20 mm. Immediate implant placement in conjunction with a synthetic bone graft may therefore be a viable and predictable treatment option in fresh post-extraction sockets.


Chan H-L, El-Kholy K, Fu J-H, Galindo-Moreno P, Wang H-L. Implant primary stability determined by resonance  frequency  analysis  in  surgically  created  defects:  a  pilot  cadaver  study.  Implant  Dent


A total of 10 implants were placed in two cadaver heads, and a series of narrow or wide dehiscence defects and circumferential defects were created around the implants. Implant stability was measured using resonance frequency analysis (RFA) in each case. RFA measurements did not correlate with defect size for narrow defects, but the association was significant for wide and circumferential defects. The association between implant stability and the size of defects was therefore dependent on the type of defect.


International Journal of Oral and Maxillofacial Implants

Vol. 25 No. 6 (November/December 2010)

Simunek A, Strnad J, Kopecka D, Brazda T, Pilathadka S, Chauhan R, Slezak R, Capek L. Changes in

stability   after   healing   of   immediately   loaded   dental   implants.   Int   J   Oral   Maxillofac   Implants


Primary stability and stability after 4 months were measured in immediately loaded implants using resonance frequency analysis; the implants were placed into three groups, defined by high, medium or low primary stability. Primary stability was recorded in 940 implants and 4-month stability was recorded in 526 implants. No association was observed between primary stability and insertion torque, and stability was found to be influenced by implant diameter but not implant length. Stability significantly increased during healing in the low primary stability group, but significantly decreased in the high primary stability group. Correlations were observed between marginal bone loss and final insertion torque, and between marginal bone loss and the difference between 4-month and primary stability.


Enkling N, Utz K-H, Bayer S, Mericske-Stern R. Osseoperception: active tactile sensibility of osseointegrated dental implants. Int J Oral Maxillofac Implants 2010;25(6):1159-1167.

Active tactile sensibility of single-tooth implants was evaluated in 62 patients with implants with naturally

opposing teeth. Copper foils of varying thicknesses (0 to 200 μm) were placed between the implant tooth and the opposing tooth and the tactile perception evaluated. Mean tactile perception at the 50% value estimated by logistic regression was 20.2 ± 10.9 μm, with a slope of 29 ± 15. Sensitivity was much greater for implants with a sandblasted and acid-etched surface compared to TPS or machined surfaces. Tactile sensibility of implants is therefore similar to that of teeth, but the slope of the sensibility curve is flatter. The results may indicate that receptors near the implant form the basis of osseoperception.


de Jong MHM, Wright PS, Meijer HJA, Tymstra N.  Posterior mandibular residual ridge resorption in patients with overdentures supported by two or four endosseous implants in a 10-year prospective comparative study. Int J Oral Maxillofac Implants 2010;25(6):1168-1174.

A  total  of  60  edentulous  patients  with  residual  mandibular  height  of  12-18  mm  were  treated  with overdentures supported by two implants (30 patients) or four implants (30 patients). Radiographs were taken before treatment and after 10 years. The posterior bone area index reduction was significantly greater in the group with two implants compared to the group with four implants, but there was no correlation between posterior residual ridge resorption and peri-implant bone loss.


Degidi M, Nardi G, Piattelli A. Immediate loading of the edentulous maxilla with a definitive restoration supported  by  an  intraorally  welded  titanium  bar  and  tilted  implants.  Int  J  Oral  Maxillofac  Implants


Each of 30 patients with an edentulous maxilla received three axial and four tilted implants, with definitive abutments and a titanium bar connected immediately after placement, followed by a definitive restoration. Mean marginal bone loss was evaluated at surgery and after 6, 12, 24 and 36 months. No framework fractures or alterations were apparent, and the prosthesis success rate was 100% after 3 years. Implant success rates were 97.8% and 99.2% for axial and tilted implants, respectively, and mean marginal bone loss was 0.92 ± 0.75 mm and 1.03 ± 0.69 mm for axial and tilted implants, respectively. Rehabilitation of the atrophic edentulous maxilla with a welded titanium framework is therefore possible on the day of implant surgery.


Vigolo P, Zaccaria M.  Clinical evaluation of marginal bone level change of multiple adjacent implants restored with splinted and nonsplinted restorations: a 5-year prospective study. Int J Oral Maxillofac Implants 2010;25(6):1189-1194.

Three consecutive adjacent implants were placed in the posterior maxilla of each of 44 patients; those in the

left maxilla were restored with splinted cemented restorations and those in the right maxilla were restored with nonsplinted cemented restorations. Marginal bone resorption was measured annually for up to 5 years. Three implants failed at stage two surgery, and six implants were not included because two patients did not complete the study. Mean marginal bone level changes after 5 years were -0.7 ± 0.2 mm and -0.8 ± 0.2 mm for splinted and nonsplinted restoration, respectively. No significant difference was observed, suggesting that multiple nonsplinted implants may be successful in a number of situations.


Siebers D, Gehrke P, Schliephake H.  Delayed function of dental implants: a 1- to 7-year follow-up study of

222 implants. Int J Oral Maxillofac Implants 2010;25(6):1195-1202.

In 76 patients, 111 implants were subjected to immediate functional or non-functional loading, and 111 received delayed loading after submerged healing. After a mean follow-up time of 40.3 months, the overall success rate was 97.7% (100% and 95.5% for delayed and immediately loaded implants, respectively). Of the five implants lost, four had been placed immediately post-extraction. Immediately placed implants with immediate function showed the lowest success rate (91.3%) compared to the delayed placement and delayed  function  implants.  However,  differences  were  not  significant  between  the  groups,  although significant esthetic advantages were noted for the immediate function implants. Good results can therefore be obtained with immediately loaded implants, but the risk of implant loss may be increased with immediate function.


Urban IA, Lozada JL. A prospective study of implants placed in augmented sinuses with minimal and moderate residual crestal bone: results after 1 to 5 years. Int J Oral Maxillofac Implants 2010;25(6):1203-


A total of 245 implants were placed in 100 sinus sites in 79 patients. Anorganic bovine bone and autogenous bone were used for the sandwich bone augmentation technique, protected by a collagen membrane. The cumulative survival and success rtes after 5 years were 99.6% and 96.5%, respectively, while the survival and success rates for implants placed in minimal residual crestal bone were 99.4% and 94.1%, respectively. Survival and success was 100% for implants placed in moderate residual crestal bone. Success of implants in sinus augmentation is therefore similar to that of implants in native bone if a 6-month submerged healing time is used.


Bedrossian E.  Rehabilitation of the edentulous maxilla with the zygoma concept: a 7-year prospective study.

Int J Oral Maxillofac Implants 2010;25(6):1213-1221.

A total of 36 patients with edentulous resorbed maxillae were treated with 74 zygomatic and 98 anterior maxillary implants to support fixed prostheses. In two patients, two zygomatic implants were removed due to mobility and replaced, and maxillary sinus infections occurred in three patients; these were treated with functional endoscopic sinus surgery. The implant survival rate was high, morbidity was reduced, and patient acceptance of the zygomatic implant concept was high. Zygomatic implants are therefore a viable and predictable treatment option.


Cooper LF, Raes F, Reside GJ, Garriga JS, Tarrida LG, Wiltfang J, Kern M, De Bruyn H.  Comparison of radiographic and clinical outcomes following immediate provisionalization of single-tooth dental implants placed in healed alveolar ridges and extraction sockets. Int J Oral Maxillofac Implants 2010;25(6):1222-


Implants were placed in the maxillae of 139 patients: 58 single implants were placed in extraction sockets; 65 implants were placed in healed ridges; and, 23 implants were placed with bone grafting.  All implants were restored with provisional crowns, but a further 11 implants among all groups were no immediately loaded due to lack of initial stability. Three implants in extraction sites and one implant in a healed ridge failed. Mean marginal bone level change was +1.30 ± 2.52 mm and -0.40 ± 1.43 mm in extraction sockets and healed ridges, respectively. In 83.7% of implants in extraction sockets and 87.0% of implants in healed ridges, the mucosal zenith was either stable or moved incisally after definitive crown placement. Bone and soft tissue responses were therefore similar in both groups.


Chow J, Wat P, Hui E, Lee P, Li W.  A new method to eliminate the risk of maxillary sinusitis with zygomatic implants. Int J Oral Maxillofac Implants 2010;25(6):1233-1240.

A new approach for zygomatic implant placement was used in 16 patients who received 37 zygomatic

implants, which were placed completely outside the displaced maxillary sinuses. For the follow-up period, ranging from 6-24 months, no implants failed and there were no cases of maxillary sinusitis. The new approach appeared to lower the risk of maxillary sinusitis in zygomatic implant placement.


International Journal of Periodontics and Restorative Dentistry

Vol. 30 No. 6 (November/December 2010)

Veis A, Parissis N, Tsirlis A, Papadeli C, Marinis G, Zogakis A.  Evaluation of peri-implant marginal bone loss

using modified abutment connections at various crestal level placements. Int J Periodontics restorative

Dent 2010;30(6):609-617.

A total of 193 implants with straight abutment connections and 89 implants with platform-switched abutment connections were placed, with the implant cervical platforms at crestal, supracrestal or subcrestal level. Bone resorption from the implant platform to the first BIC was evaluated at implant placement and after 2 years. Significant differences were observed between the straight and platform-switched groups. Significantly less bone loss was observed in the platform-switched group in subcrestal locations, but bone resorption was higher in both groups when the implant-abutment connection was placed at crestal level.


Barter S.  Computer-aided implant placement in the reconstruction of a severely resorbed maxilla a 5-year clinical study. Int J Periodontics restorative Dent 2010;30(6):627-637.

Procedures that may enable flapless implant placement in patients who previously received onlay grafting for

a severely resorbed maxilla were evaluated in this study. A total of 39 implants were placed in six patients. For a mean follow-up period of 48.8 months, the implant survival rate was 97.7% and the prosthetic success rate was 100%. Use of these techniques may avoid secondary exposure of the grafted site.


Journal of Clinical Periodontology Vol. 38 No. 1 (January 2011) Vol. 38 No. 2 (February 2011)

Sreenivasan PK, Vered Y, Zini A, Mann J, Kolog H, Steinberg D, Zambon JJ, Haraszthy VI, da Silva MP, De

Vizio W.  A 6-month study of the effects of 0.3% triclosan/copolymer dentifrice on dental implants. J Clin

Periodontol 2011;38(1):33-42.

In this double-blind, two-treatment parallel-group study, 120 patients with dental implants and contralateral teeth were randomized to brush twice daily with either a triclosan/copolymer dentifrice (test; 60 patients) or a fluoride dentifrice (control; 60 patients). Plaque and gingival inflammation were assessed at baseline and after 3 and 6 months. dental plaque, gingivitis and bleeding on probing were significantly lower in the test group after 3 and 6 months, and significantly fewer Gram-negative aerobic organisms were detected. Dental implant maintenance may therefore be enhanced with the use of a triclosan/copolymer dentifrice.


Griffiths GS, Ayob R, Guerrero A, Nibali L, Suvan J, Moles DR, Tonetti MS.  Amoxicillin and metronidazole as an adjunctive treatment in a generalized aggressive periodontitis at initial therapy or re-treatment: a randomized controlled clinical trial. J Clin Periodontol 2011;38(1):43-49.

Re-treatment of sites with remaining pockets 5 mm was performed in 38 of 41 patients from a previous 6- month trial of adjunctive antimicrobial therapy. The patients who received placebo in the first phase received adjunctive antibiotics for 7 days in the second phase, and clinical parameters were assessed after 2 months. A significant improvement in pocket depth reduction was demonstrated in patients who received antibiotics at initial therapy compared to those who received antibiotics at re-treatment; the mean differences were 0.9 mm for pockets 7 mm, and 0.4 mm for pockets ≥ 5 mm to 4 mm. Significant benefits were therefore observed in patients who received antibiotics at initial therapy.


Nibali L, Pometti D, Tu Y-K, Donos N.  Clinical and radiographic outcomes following non-surgical therapy of periodontal infrabony defects: a retrospective study. J Clin Periodontol 2011;38(1):50-57.

Clinical and radiographic data following non-surgical periodontal therapy in 143 patients were assessed;

radiographic evaluation was performed at baseline and after 12-18 months. In 68 of these patients, 126 infrabony defects were identified at baseline, and the results showed significant reductions in probing depth, clinical attachment loss, defect depth and widening of the defect angle. A positive association was found between initial defect depth and adjunctive antibiotics with reduction in defect depth, but smoking had a negative association with defect depth reduction. Non-surgical therapy therefore showed favorable clinical and radiographic outcomes.


Renvert S, Lindahl C, Jansåker MR, Persson R.  Treatment of peri-implantitis using an Er:YAG laser or an air-abrasive device: a randomized clinical trial. J Clin Periodontol 2011;38(1):65-73.

Intervention using either an air-abrasive device or an Er:YAG laser was performed in 21 patients with severe

peri-implantitis.  Bleeding  on  probing  and  suppuration  were significantly reduced in both groups. Mean probing depth reduction and bone loss in the air-abrasive group were 0.9 ± 0.8 mm and -0.1 ± 0.8 mm, respectively, while the corresponding values in the Er:YAG group were 0.8 ± 0.5 mm and -0.3 ± 0.9 mm, respectively; the differences were not significant. Treatment outcomes were therefore similar between the groups.


Tymstra N, Raghoebar GM, Vissink A, Den Hartog L, Stellingsma K, Meijer HJA.  Treatment outcome of two adjacent implant crowns with different implant platform designs in the aesthetic zone: a 1-year randomized clinical trial. J Clin Periodontol 2011;38(1):74-85.

Two adjacent implants with a scalloped platform or two adjacent implants with a flat platform were placed in the esthetic zone of each of 20 patients, and soft and hard tissue changes were evaluated after 1 year. Marginal bone loss was significantly greater in the scalloped implant group (2.7 ± 1.4 mm versus 0.9 ± 0.8 mm) and inter-implant crestal bone loss was also significantly greater (1.8 ± 1.4 mm versus 1.0 ± 0.9 mm). papilla index and patient satisfaction were not significantly different between the groups. A harmonious  and predictable esthetic result was difficult to achieve in both groups.


Canullo L, Pellegrini G, Allievi C, Trombelli L, Annibali S, Dellavia C.  Soft tissues around long-term platform switching implant restorations: a histological human evaluation. Preliminary results. J Clin Periodontol


A total of 37 peri-implant soft tissue samples were obtained from 14 patients 48 months following implant restoration with traditionally restored implants (control) or implants with mismatching platforms ranging from

0.25-0.85 mm (test groups). No significant differences in inflamed connective tissue, microvascular density or collagen content were found between the groups, and a well-preserved junctional epithelium and localized inflammatory infiltrate were observed in most cases. Platform switching therefore appeared to be a suitable concept leading to better maintenance of peri-implant bone levels.


Kaner D, Friedmann A.  Soft tissue expansion with self-filling osmotic tissue expanders before vertical ridge augmentation: a proof of principle study. J Clin Periodontol 2011;38(1):95-101.

Tissue expanders were implanted in 24 sites in 12 patients requiring vertical bone augmentation. Onlay

grafting was performed after 2 months and implants were placed 4-6 months after augmentation. Complications noted included perforation and infection, but the incidence of graft exposition after augmentation was low. Higher vertical bone gain (mean 7.5 ± 2.4 mm) was found at implant placement and a good bone volume/tissue volume ratio was observed. The technique therefore provided well structured bone for implant placement, with minimal complications.


Koromantzos  PA,  Makrilakis  K,  Dereka  X,  Katsilambros  N,  Vrotsos  IA,  Madianos  PN.  A  randomized, controlled trial on the effect of non-surgical periodontal therapy in patients with type 2 diabetes. Part I: effect on periodontal status and glycaemic control. J Clin Periodontol 2011;38(2):142-147.

Sixty patients with type 2 diabetes and moderate-to-severe periodontal disease were randomized to receive either periodontal treatment (scaling and root planing; test group) or delayed periodontal treatment after 6 months (control group). HbA1c and periodontal parameters were assessed after 1, 3 and 6 months. Periodontal parameters significantly improved in the test group, and the decrease in HbA1c level was significantly greater, independent of confounding factors. Periodontal treatment therefore appears to contribute to improved glycemic control in patients with type 2 diabetes.


Li X, Tse HF, Yiu KH, Li LSW, Jin L. Effect of periodontal treatment on circulating CD34+ cells and peripheral vascular endothelial function: a randomized controlled trial. J Clin Periodontol 2011;38(2):148-156.

In 50 patients with moderate-to-severe chronic periodontitis, periodontal treatment was performed either

immediately (test) or after completion of the study (3 months, control). Circulating progenitor cells and peripheral endothelial function were evaluated at baseline and after 3 months. The effects of periodontal treatment  on  endothelial  function  were  neutral,  but  there  was  a  significant  decrease  in  CD34+  cells compared to control, and this reduction was positively correlated with a decrease in sites with bleeding on probing or periodontal pockets ≥ 4 mm.


Jayakumar A, Rajabubu P, Rohini S, Butchibabu K, Naveen A, Krishnajaneya Reddy P, Vidyasagar S, Satyanarayana D, Pavan Kumar S. Multi-centre, randomized clinical trial on the efficacy and safety of recombinant human platelet-derived growth factor with β-tricalcium phosphate in human intra-osseous periodontal defects. J Clin Periodontol 2011;38(2):163-172.

Periodontal osseous defects in 54 patients were treated with β-tricalcium phosphate (β-TCP) alone or combined with recombinant human platelet-derived growth factor (rhPDGF). Primary and secondary parameters were evaluated after 3 and 6 months. linear bone growth and percent bone fill were significantly higher with rhPDGF + β-TCP, with significantly higher clinical attachment gain and greater reduction in probing depth. The incidence of adverse events was similar in both groups, and there were no serious adverse events.


den Hartog L, Raghoebar GM, Stellingsma K, Vissink A, Meijer HJA. Immediate non-occlusal loading of single implants in the aesthetic zone: a randomized clinical trial. J Clin Periodontol 2011;38(2):186-194. Single  implants  were  placed  to  replace  an  anterior  maxillary  tooth  in  62  patients  and  restored  either immediately out of occlusion or after 3 months conventionally. Marginal bone level changes, implant survival, soft tissue parameters, esthetics and patient satisfaction were evaluated. After 18 months, there were no significant differences in any of the measured parameters between the two groups, suggesting that non- occlusal immediate restoration was as favorable as conventional loading.


Machtei EE, Horwitz J, Mahler D, Grossmann Y, Levin L. Third attempt to place implants in sites where previous surgeries have failed. J Clin Periodontol 2011;38(2):195-198.

A total of 15 implants were placed in 12 patients where implant failure had occurred twice previously. All

three attempts in each patient involved the same surgeon and implant type, and no variation in implant length and diameter occurred between the attempts. Six of the 15 implants failed, giving a survival rate of

60%; the remaining implants were followed for a mean of 44.1 ± 35 months. Survival rates were significantly lower for third attempt implants than for similar procedures in pristine sites.


Journal of Oral Implantology

Vol. 36 No. 6 (December 2010)

Birdi H, Schulte J, Kovacs A, Weed M, Chuang S-K.  Crown-to-implant ratios of short-length implants. J Oral

Implantol 2010;36(6):425-433.

Data were collected from 194 patients with 309 single implant-supported restorations with implants 5.7 or 6.0 mm  in  length.  Crown  and  implant  lengths  were  measured  radiographically  and  first  BIC  levels  were evaluated. The mean follow-up time was 20.6 ± 23.2 months. Mean crown length and crown-to-implant ratio were 13.4 ± 2.6 mm and 2.0 ± 0.4, respectively. No relationship was observed between increasing crown-to- implant ratios and decreasing first BIC levels. All parameters were within the established guidelines for success.


Toscano N, Holtzclaw D, Mazor Z, Rosen P, Horowitz R, Toffler M.  Horizontal ridge augmentation using a composite  graft  of  demineralised  freeze-dried  allograft,  mineralized  cortical  cancellous  chips,  and  a biologically  degradable  thermoplastic  carrier  combined  with  a  resorbable  membrane:  a  retrospective evaluation of 73 consecutively treated cases from private practices. J Oral Implantol 2010;36(6):467-474. Composite demineralized freeze-dried allograft, cancellous bone chips and a thermoplastic carrier were used together with a resorbable membrane for 73 lateral ridge augmentations in 67 patients in five private practices. Mean horizontal width gain was 3.5 mm, and bone density was predominantly type 3. The results suggested that horizontal ridge augmentation can be effective using this combination of materials.


Padmanabhan TV, Gupta RK. Comparison of crestal bone loss and implant stability among the implants placed with conventional procedure and using osteotome technique: a clinical study. J Oral Implantol


In the anterior maxilla of five patients, 10 implants were placed using either a conventional drilling or an osteotome technique. Implant stability was measured at each implant using resonance frequency analysis at implant placement and after 180 days, and peri-implant bone loss was evaluated. Implants placed with the drilling technique had higher mean stability after 180 days, but the difference was not significant; however, implants in this group had significantly less mean crestal bone loss. The osteotome technique should therefore not be considered as an alternative to conventional implant placement procedures.


Journal of Periodontology

Vol. 81 No. 12 (December 2010) Vol. 82 No. 1 (January 2011)

Chaffee BW, Weston SJ.  Association between chronic periodontal disease and obesity: a systematic review

and meta-analysis. J Periodontol 2010;81(12):1708-1724.

A literature review was performed for epidemiologic studies on chronic periodontal disease and obesity. The search identified 554 citations, of which 70 met the inclusion criteria. Most studies were cross-sectional in design and a positive association was suggested by the results of 41 studies. The odds ratio was 1.35 (95% CI: 1.23 to 1.47), with a stronger association suggested in younger patients, women and non-smokers. Greater mean clinical attachment loss was suggested in obese individuals, higher BMI was suggested in periodontal patients, and increasing odds of periodontal disease was suggested with increasing BMI. However, the relative lack of quality longitudinal studies did not allow the order of events to be elucidated.


Ogihara S, Wang H-L.  Periodontal regeneration with or without limited orthodontics for the treatment of 2- or

3-wall infrabony defects. J Periodontol 2010;81(12):1734-1742.

Infrabony defects 6 mm in depth in 47 patients were treated with a combination of EMD + demineralized freeze-dried bone allograft, with or without orthodontics. Clinical attachment level and probing depth were measured at baseline and after 1 year, and re-entry surgery was performed 6 months after the initial surgery. A significant improvement from baseline was observed in both groups, with no significant difference between the groups. Gain in open probing attachment level was significantly greater in 2-wall defects in the group with orthodontic treatment.


Shibly O, Patel N, Alabandar JM, Kutkut A. Bone regeneration around implants in periodontally compromised patients: a randomized clinical trial of the effect of immediate implant with immediate loading. J Periodontol


A total of 60 patients received implants immediately after tooth extraction; in half of patients the implants were loaded immediately, and in the other half the implants were loaded after 3 months. The patients were followed up after 3, 6, 12 and 24 months to assess bone level changes, esthetic outcomes and implant survival. Implant survival rates were 96.7% and 93.3% in the immediate and conventional loading groups, respectively, and the mean bone gain was 1.19 mm and 1 mm, respectively. The main increase in papilla index and the majority of bone gain occurred in the first year. The results in the immediate loading group were similar to those in the conventional loading group.


Cairo F, Nieri M, Cattabriga M, Cortellini P, De Paoli S, De Sanctis M, Fonzar A, Francetti L, Merli M, Silvestri M,  Trombelli  L,  Zucchelli  G,  Pini-Prato  GP.   Root  coverage  esthetic  score  after  treatment  of  gingival recession: an interrater agreement multicenter study. J Periodontol 2010;81(12):1752-1758.

Eleven periodontists, each with 15 years of clinical experience, were trained in the use of the root coverage esthetic score (RES) prior to receiving and assessing baseline and post-treatment photographs of Class I and II gingival recessions in 41 patients. The interrater agreement achieved was 0.92 (95% CI: 0.88 to 0.95), indicating that the RES is a reliable method for assessing esthetic outcomes of root coverage procedures.


Chaushu G, Mardinger O, Peleg M, Ghelfan O, Nissan J.  Analysis of complications following augmentation with cancellous block grafts. J Periodontol 2010;81(12):1759-1764.

A total of 137 severe atrophic alveolar ridges in 101 patients were augmented with cancellous bone block

grafts, and 271 implants were subsequently placed. Complications associated with the block graft were recorded. Partial and total graft failure was observed at 7% and 8% of sites, respectively, and the implant failure rate was 4.4%. Other complications included membrane exposure (30.7%), incision line opening (30%), perforation of the mucosa over the graft (14%) and infection (18%). The location of the ridge deficiency was noted to have a significant effect on outcome, with significantly more complications noted in the mandible.


Beck TM, Mealey BL. Histologic analysis of healing after tooth extraction with ridge preservation using mineralized human bone allograft. J Periodontol 2010;81(12):1765-1772.

Minimally  traumatic  extraction  was  performed  for  38  single-rooted  teeth  in  33  subjects,  and  ridge

preservation was performed using mineralized human bone allograft. Healing was for either a mean of 14 weeks (16 sites) or 27 weeks (22 sites), whereupon histomorphometric analysis was performed. New bone formation was evident in all cases, and most residual graft particles were surrounded by woven bone. No significant differences were observed between the early and delayed healing groups for new bone, residual graft material or connective/non-mineralized tissue, indicating that delayed healing does not provide greater new bone or less residual bone than early healing.


Garcia MN, Hildebolt CF, Miley DD, Dixon DA, Couture RA, Anderson Spearie CL, Langenwalter EM, Shannon WD, Deych E, Mueller C, Civitelli R.  One-year effects of vitamin D and calcium supplementation on chronic periodontitis. J Periodontol 2010;82(1):25-32.

Patients with at least two interproximal sites with ≥ 3 mm clinical attachment loss were recruited at two centers;  23  patients  were  taking  vitamin  D  and  calcium  supplements  and  28  were  not.  Periodontal parameters  and  alveolar  bone  loss  were  evaluated  at  baseline  and  after  6  and  12  months.  Clinical parameters improved over time on both groups, and the results indicated that vitamin D and calcium supplementation had a moderate positive effect on periodontal health.


Kolerman R, Moses O, Artzi Z, Barnea E, Tal H.  Maxillary sinus augmentation by the crestal core elevation technique. J Periodontol 2010;82(1):41-51.

Following the extraction of 57 maxillary molars in 45 patients, core preparations were made by drilling the

extraction sites with a trephine bur and imploding the inter-radicular bone and sinus membrane into the sinus. The crater and socket were then filled with deproteinized bovine bone or freeze-dried bone allograft, protected with a collagen membrane and covered with coronally positioned flaps. Implants were placed after

4 months. The technique was successful in 68.9% of sites and partially successful in 13.3% of sites, while failure was observed at 17.8% of sites. Implant survival was 100%. The benefits and clinical limitations of the technique were demonstrated.


Mangano C, Mangano F, Shibli JA, Tettamanti L, Figliuzzi M, d’Avila S, Sammons RL, Piattelli A. Prospective evaluation of 2,549 Morse taper connection implants: 1- to 6-year data. J Periodontol 2010;82(1):52-61. Clinical, radiographic and prosthetic parameters were assessed from 2,549 implants placed in 893 patients over a 6-year period. The implant supported fixed partial prostheses (462 units), fixed full-arch prostheses (60 units), single crowns (531 units) and overdentures (93 units). The implant survival rate was 98.23% (97.25% and 99.05% in the maxilla and mandible, respectively). The mean distance from implant shoulder to first BIC after 6 years was 1.10 ± 0.30 mm. Morse taper connection implants were therefore successful in partially and completely edentulous arches.


Siciliano VI, Andreuccetti G, Siciliano AI, Blasi A, Sculean A, Salvi GE.  Clinical outcomes after treatment of non-contained intrabony defects with enamel matrix derivative or guided tissue regeneration: a 12-month randomized controlled clinical trial. J Periodontol 2010;82(1):62-71.

A total of 40 intrabony defects in single-rooted teeth in 40 patients were treated with EMD alone or with a non-resorbable titanium-reinforced membrane. Probing depth and clinical attachment level were evaluated at baseline and after 12 months. Mean gain in clinical attachment level was significantly greater in the EMD + membrane group than with EMD alone, and the probability of increase in clinical attachment level 4 mm was also significantly greater, while the probability of residual probing depth 6 mm was significantly decreased. The addition of a membrane to EMD treatment therefore improved clinical outcomes in non- contained intrabony defects.


Fernandes PG, Novaes AB Jr, de Queiroz AC, de Souza SLS, Taba M Jr, Palioto DB, de Moraes Grisi MF. Ridge preservation with acellular dermal matrix and anorganic bone matrix cell-binding peptide P-15 after tooth extraction in humans. J Periodontol 2010;82(1):72-79.

In 18 patients requiring extraction of maxillary anterior teeth, socket preservation was performed using acellular dermal matrix (ADM) alone (control) or combined with peptide P-15 (test). Clinical parameters were recorded at baseline and after 6 months. No significant differences in external vertical palatal or buccal measurement or in alveolar horizontal measurement were observed between the two groups. The results indicated that the combination can be used for alveolar ridge preservation following extraction of anterior maxillary teeth.


Quintessence International

Vol. 42 No. 1 (January 2011)

de Almeida EO, Filho HG, Goiatto MC.  The use of transitional implants to support provisional prostheses

during the healing phase: a literature review. Quintessence Int 2011;42(1):19-24.

A literature review was conducted for information on the characteristics and osseointegration of transitional implants to support provisional prostheses. A total of 14 articles met the inclusion criteria, of which 11 were clinical studies/techniques and three contained histological/histomorphometric data. The advantages demonstrated by transitional implants included retention and stability of dentures, maintenance of chewing and phonetics, bone graft protection, easier surgical and prosthetic procedures, lower costs, and re- establishment of esthetics. Transitional implants could therefore be a successful conservative procedure for conventional loading if correctly indicated.


Farina R, Scapoli C, Carrieri A, Guarnelli ME, Trombelli L.  Prevalence of bleeding on probing: a cohort study in a specialist periodontal clinic. Quintessence Int 2011;42(1):57-68.

Bleeding on probing (BoP) was evaluated in 601 patients in a retrospective investigation and the percentage

of BoP-positive sites calculated for the entire dentition and for different areas. Most patients showed at least one BoP-positive site, and the median total BoP percentage was 26.4%; this was significantly correlated with age and number of sites with 5 mm probing depth. Patients in the lowest and highest BoP quartiles had significantly different total BoP values. BoP was therefore highly prevalent and variable between patients and types of dentition.

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