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Literature Update May - June 2011

Clinical Implant Dentistry and Related Research

Vol. 13 No. 2 (June 2011)

Maló P, de Araújo Nobre M. Implants (3.3 mm diameter) for the rehabilitation of edentulous posterior regions:

a retrospective clinical study with up to 11 years of follow-up. Clin Implant Dent Relat Res 2011;13(2):95-


A total of 147 patients with reduced inter-radicular bone or thin alveolar crest and who received 247 implants in the posterior region of the jaws were included in this analysis the median follow-up time was 5 years. The survival rate for narrow diameter implants after 11 years was 95.1%. Mean marginal bone resorption was 1.16 mm, 1.53 mm and 1.74 mm after 1, 5 and 10 years, respectively. ‘Type of implant’ was identified as a strong protective risk factor against implant failure, while ‘type of rehabilitation’ was identified as a strong risk factor for implant failure. The use of narrow diameter implants in the posterior jaw is therefore viable.


Nissan J, Mardinger O, Calderon S, Romanos GE, Chaushu G. Cancellous bone block allografts for the augmentation of the anterior atrophic maxilla. Clin Implant Dent Relat Res 2011;13(2):104-111.

The study included 31 patients with a bony deficiency of 3 mm horizontally and 3 mm vertically. A total of

46 cancellous freeze-dried block allografts were used for augmentation, and 63 implants were placed after a healing period of 6 months. The mean follow-up time was 34 ± 16 months and the mean bone gain was 5 ±

0.5 mm and 2 ± 0.5 mm horizontally and vertically, respectively. No significant differences in buccal bone resorption or mean bone thickness buccal to the implant neck were observed between implant placement and second-stage surgery. The implant and block survival rates were 98% and 95.6%, respectively.


Baracat LF, Teixeira AM, dos Santos MBF, Prisco da Cuhna VdeP, Marchini L.  Patients’ expectations before and evaluation after dental implant therapy. Clin Implant Dent Relat Res 2011;13(2):141-145.

Implant therapy was performed in 50 volunteers who first answered a questionnaire regarding influencing

variables. The patient’s expectations were verified on a visual analog scale, which was used to rate the post- treatment completion. Mean aesthetic and functional ratings were 5.0 ± 2.6 and 5.0 ± 3.0, respectively, and the post-treatment ratings were 9.1 ± 1.1 and 9.0 ± 1.7, respectively; expectations were significantly exceeded. There were positive correlations between expectations and post-treatment completion ratings for both aesthetics and function and an inverse correlation between age and functional expectations.


Visser A, Raghoebar GM, Meijer HJA, Meijndert L, Vissink A.  Care and aftercare related to implant-retained dental crowns in the maxillary aesthetic region: a 5-year prospective randomized clinical trial. Clin Implant Dent Relat Res 2011;13(2):157-167.

Augmentation was performed in 93 patients using autograft, autograft plus membrane, or Bio-Oss plus

membrane. Implant placement was subsequently performed and metal-ceramic crowns were placed. The

5-year implant survival rate was 96.7%, and the need for aftercare was similar in all three augmentation groups. All patients required routine inspections, 63% required oral hygiene support and 16% required additional prosthetic care. Implant placement in the maxillary anterior following augmentation appeared to be a safe and reliable treatment option.



Clinical Oral Implants Research

Vol. 22 No. 5 (May 2011) Vol. 22 No. 6 (June 2011)

Jokstad A, Ellner S, Gussgard A. Comparison of two early loading protocols in full arch reconstructions in the

edentulous maxilla using the Cresco prosthetic system: a three-arm parallel-group randomized-controlled trial. Clin Oral Implants Res 2011;22(5):455-463.

Five or six implants were placed in the edentulous maxilla of each of 36 patients to support a 10/12 unit FDP.

Cresco components were used in the first two groups, with loading after 10 days (group 1) or 6-8 weeks, (group 2) while conventional components were used in group 3, with loading after 6-8 weeks. Data were available from 30 patients after 3 years, and the adjusted mean change from baseline in crestal bone was significant in all groups (-0.65 mm, -0.5 mm and -0.4 mm in the groups 1, 2 and 3, respectively). An additional mean change of -0.29 mm was expected for each 1 mm the implant was placed deeper. No significant differences were observed between the Cresco and control groups, or between the two Cresco groups. Vertical placement therefore had more effect on bone loss than the fabrication technique.


Mertens C, Steveling HG.  Implant-supported fixed prostheses in the edentulous maxilla: 8-year prospective results. Clin Oral Implants Res 2011;22(5):464-472.

In 17 edentulous patients, a total of 106 implants were placed, with screw-retained bridges placed after 6

months. Clinical and radiographic examinations were performed at 6 months and every year. There was one implant failure, giving an 8-year implant survival rate of 99% and prosthetic survival rate of 100%. Mean crestal bone loss was 0.3 ± 0.72 mm. High levels of patient satisfaction were found, and no higher incidence of periodontal pathogens was noted in all cases except one after 5 years. The treatment technique was therefore predictable and successful.


Chackartchi T, Iezzi G, Goldstien M, Klinger A, Soskolne A, Piattelli A, Shapira L.  Sinus floor augmentation using large (1-2 mm) or small (0.25-1 mm) bovine bone mineral particles: a prospective, intra-individual controlled clinical, micro-computerized tomography and histomorphometric study. Clin Oral Implants Res


Bilateral sinus floor augmentation with large or small bovine bone mineral particles was performed in 10 patients, with bone samples analyzed after 6 to 9 months. Vertical bone height, post-operative complications and maximal torque were not significantly different between the three groups, but new bone volume was non-significantly greater in the small particle group. The pattern of bone formation was the same in both groups. Both sizes of particles therefore showed a similar performance and achieved the goal of the procedure.


Covani U, Orlando B, Giacomelli L, Cornelini R, Barone A. Implant survival after sinus elevation with Straumann BoneCeramic in clinical practice: ad interim results of a prospective study at a 15-month follow- up. Clin Oral Implants Res 2011;22(5):481-484.

This is an ad interim report of 15 patients from a study with a planned follow-up of 5 years. Patients were edentulous in the premolar/molar areas and received Straumann BoneCeramic and implants in a two-stage technique. The mean follow-up time for this analysis was 14.9 months. The cumulative implant survival rate was 92.5% (three implants failed in a single patient after 6 months). Sinus floor elevation with Straumann BoneCeramic may therefore be a viable clinical option.


Sbordone L, Levin L, Guidetti F, Sbordone C, Glikman A, Schwartz-Arad D. Apical and marginal bone alterations around implants in maxillary sinus augmentation grafted with autogenous bone or bovine bone material and simultaneous or delayed dental implant positioning. Clin Oral Implants Res 2011;22(5):485-


A retrospective study was performed to evaluate patients who received sinus augmentation with bovine bone mineral or autogenous bone and with simultaneous or delayed implant placement. Marginal bone levels and statistical evaluations were performed in a subgroup of patients. A total of 282 implants were placed, with survival rates of 95.6% in autogenous bone and 100% in bovine bone mineral. In the subgroup, 39 patients received 154 implants. Significant differences in apical and marginal bone levels were observed after 1 year but not after 2 years. Significant differences were observed in the bovine bone mineral group between 1 and

2 years. Physiological bone remodelling was therefore slower but more prolonged with bovine bone mineral.


Heberer S, Kilic S, Hossamo J, Raguse J-D, Nelson K.  Rehabilitation of irradiated patients with modified and conventional  sandblasted  acid-etched  implants:  preliminary  results  of  a  split-mouth  study.  Clin  Oral Implants Res 2011;22(5):546-551.

A total of 20 patients received dental implants after ablative surgery and radio-chemotherapy for oral cancer;

50 SLA and 52 SLActive implants were placed in a split-mouth design with unloaded healing of 6 weeks in the mandible (23 SLA, 24 SLActive) and 10 weeks in the maxilla (27 SLA, 28 SLActive). Mean mesial and distal bone loss was 0.4 mm and 0.4 mm, respectively, for SLA implants and 0.3 mm and 0.3 mm, respectively, for SLActive implants. The implant success rates were 96% for SLA and 100% for SLActive. Both SLA and SLActive implants therefore showed high success in irradiated patients.


Soardi CM, Spinato S, Zaffe D, Wang H-L.  Atrophic maxillary floor augmentation by mineralized human bone allograft in sinuses of different size: an histologic and histomorphometric analysis. Clin Oral Implants Res


Mineralized human bone allograft (MHBA) particles were used to augment narrow and wide sinuses in 23 patients with crestal bone 2 mm. Bone core biopsies were taken for assessment at implant placement and after 6 and 9 months. Newly formed bone was observed in all biopsies, with a woven structure after 6 months and a lamellar structure after 9 months. Bone formation after 9 months was 38.7 ± 7% in narrow sinuses and 30.7 ± 3% in wide sinuses; bone formation was significantly greater in narrow sinuses. MHBA appeared to promote satisfactory bone formation, and larger sinuses needed a longer maturation time for suitable new bone formation.


Van Brakel R, Cune MS, van Winkelhoff AJ, de Putter C, Verhoeven JW, van der Reijden W.  Early bacterial colonization and soft tissue health around zirconia and titanium abutments: an in vivo study in man. Clin Oral Implants Res 2011;22(6):571-577.

Two mandibular implants were placed in each of 20 edentulous patients and fitted with zirconia or titanium

abutments. Bacterial sampling was performed and clinical parameters were evaluated after 2 weeks and 3 months. Similar amounts of A actinomycetemcomitans, P gingivalis, P intermedia, T forsythia, P micros, F nucleatum and T denticola were observed at both abutment types at both time points. Clinical conditions were healthy around both abutment types at both time points, with no significant differences in most clinical parameters except probing depth, which was greater around titanium abutments.


Nissan J, Oz-Ari B, Gross O, Ghelfan O, Chaushu G.  Long-term prosthetic aftercare of direct vs. indirect attachment incorporation techniques to mandibular implant-supported overdenture. Clin Oral Implants Res


A total of 45 patients with 130 implants were allocated to be treated with direct (22 patients) or indirect (23 patients) ball attachment incorporation. All surgical and prosthetic interventions were recorded for up to 20 years. The mean follow-up time was 93 ± 57 months. All implants survived, but there was a significantly greater need for prosthetic intervention in the indirect attachment group. Significantly more visits were also required in this group for relief of pressure sores and liner exchange due to loss of retention. The direct attachment technique therefore appeared to be superior.


Bressan E, Paniz G, Lops D, Corazza B, Romeo E, Favero G.  Influence of abutment material on the gingival color of implant-supported all-ceramic restorations: a prospective multicenter study. Clin Oral Implants Res


Implants were placed in the anterior maxilla of 20 patients with an all-ceramic crown on either gold, titanium or zirconia abutments. Peri-implant tissue colour and thickness were evaluated. Tissue colour appeared to be different from the contralateral tooth for all abutments, and the difference was significantly higher with titanium abutments compared with gold and zirconia. There was no correlation between degree of colour difference and peri-implant tissue thickness. Peri-implant tissue colour therefore appears to be different from that at the adjacent teeth, and this difference is more pronounced with titanium implants.


Implant Dentistry

Vol. 20 No. 2 (April 2011)

Cavallaro JS.  Implant survival and radiographic analysis of proximal bone levels surrounding a contemporary

dental implant. Implant Dent 2011;20(2):146-156.

A total of 204 implants (176 in healed ridges and 28 in fresh extraction sockets) were placed in 75 patients. Implant survival rates were 98.6% in healed ridges and 96.4% in extraction sockets. Mesial and distal bone loss up to 12 months was 0.96 mm and 0.83 mm, respectively, and the mesial and distal bone changes from

24 to 36 months were 0.16 mm and 0.19 mm, respectively. The clinical parameters appeared to be comparable to those in other studies.


Khorshid HE, Hamed HAF, Aziz EA. The effect of two different immediate loading protocols in implant- supported screw-retained prostheses. Implant Dent 2011;20(2):157-166.

Each of five patients received six implants, three on each side of the mandibular arch in the premolar/molar

region. On one side, implants were loaded via an immediate functional loading protocol, while on the other side the implants were loaded via an immediate progressive loading protocol. Radiographic analysis was performed at 0, 4, 9 and 24 months. Crestal bone height and peri-implant bone density were significantly better in the progressive loading group. Gradual loading may therefore allow greater bone maturation and density.


International Journal of Oral and Maxillofacial Implants

Vol. 26 No. 2 (March/April 2011)

Arıkan F, Buduneli N, Lappin DF.  C-telopeptide pyridonoline crosslinks of type I collagen, soluble RANKL,

and osteoprotegerin levels in crevicular fluid of dental implants with peri-implantitis: a case-control study. Int

J Oral Maxillofac Implants 2011;26(2):282-289.

Peri-implant  crevicular  samples  were  obtained  and  analysed  and  clinical  parameters  recorded  for  18 implants with peri-implantitis in 12 patients and from 21 healthy implants in 16 patients. Crevicular fluid volume, clinical parameters and duration of implant loading were all significantly greater in the peri-implantitis patients. C-telopeptide pyridinoline crosslinks of type I collagen was also significantly increased in the peri- implantitis group, but sRANKL and osteoprotegerin were significantly greater in the healthy patients. The results suggested an increased risk of bone loss around implants with peri-implantitis.


Bateli M, Att W, Strub JR. Implant neck configurations for the preservation of marginal bone level: a systematic review. Int J Oral Maxillofac Implants 2011;26(2):290-303.

A literature search was conducted for studies with implant neck modifications and marginal bone loss over at

least 5 years. From an initial list of 3,517 articles, 20 met the inclusion criteria and examined the use of microthreads  (one  study),  implant  surface  modifications  (11  studies),  implant  diameter  (four  studies), insertion depth (two studies), one-piece implants (three studies) and platform switching (one study). A statistical analysis was not possible due to the heterogeneity of the studies. The results did not indicate effectiveness for any specific implant neck modification in the preservation of prevention of marginal bone loss.


Bozini T, Petridis H, Tzanas K, Garefis P.  A meta-analysis of prosthodontic complication rates of implant- supported fixed dental prostheses in edentulous patients after an observation period of at least 5 years. Int J Oral Maxillofac Implants 2011;26(2):304-318.

Literature on complication rates with fixed dental prostheses over at least 5 years was searched for. The

initial  search  included  8,216  articles,  of  which  19  were  selected  for  inclusion  in  the  review.  Direct comparisons of the incidence of complications in metal-ceramic versus metal-acrylic resin prostheses in edentulous patients were not found, and there were few studies on metal-ceramic prostheses, most of which were short-term. Various complications were found for metal-acrylic resin prostheses in long-term function, the most common being veneer fracture and material wear.


Geckili O, Bilhan H, Mumcu E, Bilgin T.  Three-year radiologic follow-up of marginal bone loss around titanium dioxide grit-blasted dental implants with and without fluoride treatment. Int J Oral Maxillofac Implants 2011;26(2):319-324.

Each of 52 patients with an edentulous mandible received two implants to retain a mandibular overdenture;

one implant was fluoride-treated and the other was not. Resonance frequency analysis (RFA) was performed at implant placement and radiographs were taken preoperatively, at overdenture connection and after 6 months and 1, 2 and 3 years. All implants survived, and no significant difference in marginal bone loss between the fluoride-treated and non-fluoride-treated implants was observed, and no relationship between RFA value and marginal bone level was observed. Fluoride treatment therefore did not help to prevent marginal bone loss.


Verdugo F, Simonian K, Frydman A, D’Addona A, Pontón J.  Long-term block graft stability in thin periodontal biotype patients: a clinical and tomographic study. Int J Oral Maxillofac Implants 2011;26(2):325-332. Autogenous block grafting was performed in the anterior region of 15 patients, who were followed up yearly for  a  mean  of  40  months.  Peri-implant  bone  volume  maintenance  was  analysed.  In  addition,  clinical parameters  were  assessed  at  prosthesis  delivery  and  follow-up.  The  initial  buccolingual  width  was augmented 2.2-fold, 97% of which was maintained for 3.3 years. The difference in buccolingual width pre- and  post-augmentation  was  significant.  The  implants  displayed  no  mucosal  recession  or  implant transparency after a mean of 40 months. Autogenous block graft in the anterior region was therefore a viable treatment option for alveolar ridge defects.


Erkapers M, Ekstrand K, Baer RA, Toljanic JA, Thor A.  Patient satisfaction following dental implant treatment with   immediate   loading   in   the   edentulous   atrophic   maxilla.   Int   J   Oral   Maxillofac   Implants


In two centres, a total of 51 patients with severely resorbed maxillae each received six implants, which were immediately loaded with a provisional restoration, with definitive restorations placed after 20-24 weeks. Patients completed the Oral Health Impact Profile (OHIP)-49 questionnaire before treatment and on three subsequent occasions. OHIP-49 scores increased in both centres over time. No significant differences in overall scores or individual domains between the centres were found. Significant increases were observed in all seven domains, with the lowest increases in social disability and handicap. The most important domains for patient satisfaction were functional limitation, physical pain, psychologic discomfort, physical disability and psychologic disability.


Ueda T, Kremer U, Katsoulis J, Mericske-Stern R.  Long-term results of mandibular implants supporting an overdenture: implant survival, failures, and crestal bone level changes. Int J Oral Maxillofac Implants


A total of 147 patients with 314 implants supporting mandibular overdentures were evaluated for 10 to 24 years. Implant survival and crestal bone level were assessed. A total of 101 patients were available for evaluation. There were 13 implant failures, giving a cumulative survival rate of 85.9% after 24 years. Two implants were removed due to peri-implantitis and 11 were removed due to mobility. For a mean observation time of 16.5 years, the mean crestal bone loss was 0.54 ± 0.7 mm; bone loss was significantly affected by duration of loading. A typical failure pattern was not elucidated, but more implants without signs of infection were lost than implants with peri-implantitis.


Malchiodi L, Ghensi P, Cucchi A, Corrocher G. A comparative retrospective study of immediately loaded implants in postextraction sites versus healed sites: results after 6 to 7 years in the maxilla. Int J Oral Maxillofac Implants 2011;26(2):373-384.

A total of 81 patients received 239 implants, which were immediately loaded; 101 were placed in healed sites

and 138 in extraction sockets. The mean follow-up time was 6.7 years and the implant success rate was

96.6% (95.7% in extraction sites and 98.0% in healed sites); eight implants failed (six in extraction sockets and two in healed sites). Immediate loading in post-extraction sites was therefore comparable to that in healed sites.


Heberer S, Al-Chawaf B, Jablonski C, Nelson JJ, Lage H, Nelson K. Healing of ungrafted and grafted extraction  sockets  after  12  weeks:  a  prospective  clinical  study.  Int  J  Oral  Maxillofac  Implants


A total of 39 four-walled extraction sockets in 25 patients were filled with Bio-Oss collagen (20 sockets) or left unfilled (19 sockets). Mean new bone formation was significantly lower at the Bio-Oss Collagen sites (25% mean new bone) than the ungrafted sites (44% mean new bone). The difference in bone formation was also significant between the apical and coronal parts of the socket, regardless of healing mode.


Urban  IA,  Nagursky  H,  Lozada  JL.   Horizontal  ridge  augmentation  with  a  resorbable  membrane  and particulated autogenous bone with or without anorganic bovine bone-derived mineral: a prospective case series in 22 patients. Int J Oral Maxillofac Implants 2011;26(2):404-414.

Lateral ridge augmentation of knife-edge ridges was performed using particulate autogenous bone, with or without bovine-derived bone mineral, in 25 ridges in 22 patients. A total of 58 implants were subsequently placed. The mean lateral augmentation achieved was 5.56 ± 1.45 mm after a mean of 8.12 ± 2.32 months. Implant survival was 100% for a mean follow-up time of 45.88 ± 12.43 months. New bone formation and good incorporation of the bovine bone mineral particles was observed.


De Kok IJ, Chang K-H, Lu T-S, Cooper LF.  Comparison of three-implant-supported fixed dentures and two- implant-retained overdentures in the edentulous mandible: a pilot study of treatment efficacy and patient satisfaction. Int J Oral Maxillofac Implants 2011;26(2):415-426.

A total of 20 completely edentulous patients received either three implants to support fixed dentures or two implants to support overdentures. Ball attachments were inserted after 8 weeks; overdentures were placed at  8  weeks  and  fixed  dentures  were  placed  at  16  weeks.  Radiographs  and  patient  satisfaction  were assessed after 6 and 12 months. Quality of life and patient satisfaction were improved in both groups. All implants were in place after 12 months, and prosthetic complications were rare and manageable. Mandibular fixed prostheses can be placed on three implants, but a longer follow-up time is necessary for validation.


Tsuda H, Rungcharassaeng K, Kan JYK, Roe P, Lozada JL, Zimmerman G.  Peri-implant tissue response following connective tissue and bone grafting in conjunction with immediate single-tooth replacement in the esthetic zone: a case series. Int J Oral Maxillofac Implants 2011;26(2):427-436.

Tooth extraction and immediate implant placement with subepithelial connective tissue grafting was performed in 10 patients. Clinical and radiographic evaluation was performed before surgery, after implant placement and after 3, 6 and 12 months. No implants failed after 1 year, and the mean marginal bone and facial gingival level changes were +0.10 mm and -0.05 mm, respectively. After 1 year, over 50% papilla fill was observed at 80% of sites. The facial gingival level can therefore be maintained following connective tissue grafting.



International Journal of Periodontics and Restorative Dentistry

Vol. 31 No. 2 (March/April 2011)

Rasperini G, Roccuzzo M, Francetti L, Acunzo R, Consonni D, Silvestri M.  Subepithelial connective tissue graft  for  treatment  of  gingival  recessions  with  and  without  enamel  matrix  derivative:  a  multicenter,

randomized controlled clinical trial. Int J Periodontics Restorative Dent 2011;31(2):133-139.

Connective tissue graft (CTG), with or without enamel matrix derivative (EMD), was used to treat 56 Miller class I and II recession defects. Clinical parameters were evaluated at baseline and after 12 months. Mean recession reduction was 3.6 ± 1.5 mm for CTG alone and 3.9 ± 0.8 mm for CTG + EMD; mean root coverage was significantly greater with CTG + EMD (90%) compared to CTG alone (80%), and more complete root coverage was obtained (62% and 47% for CTG + EMD and CTG alone, respectively). Good soft tissue coverage was observed in both groups.


Stimmelmayr M, Allen EP, Gernet W, Edelhoff D, Beuer F, Schlee M, Iglhaut G. Treatment of gingival recession in the anterior mandible using the tunnel technique and a combination epithelialized-subepithelial connective tissue graft – a case series. Int J Periodontics Restorative Dent 2011;31(2):165-173.

The technique used for gingival recession coverage in this case series involved root coverage with a combination epithelialized-subepithelial connective tissue graft, since the recession may not be completely covered with a standard connective tissue graft. The epithelialized part of the graft was placed directly over the exposed roots. The results showed no displacement of the mucogingival junction or flattening of the vestibule.


Noelken R, Kunkel M, Wagner W.  Immediate implant placement and provisionalization after long-axis root fracture and complete loss of the facial bone lamella. Int J Periodontics Restorative Dent 2011;31(2):175-


A total of 16 patients who had lost the facial bony lamella received 18 implants, simultaneously with subperiosteal bone augmentation, and immediate provisionalisation. All implants were stable and implant survival after 13-36 months follow-up was 100%. Interproximal marginal bone stabilized at 1.0 to 1.3 mm above the first implant thread. Restoration of the facial lamella was confirmed, and soft tissue aesthetics were preserved, but oral hygiene status was a negative prognostic factor for the aesthetic outcome.


Journal of Clinical Periodontology

Vol. 38 No. 5 (May 2011) Vol. 38 No. 6 (June 2011)

Sexton WM, Lin Y, Kryscio RJ, Dawson DR III, Ebersole JL, Miller CS.  Salivary biomarkers of periodontal

disease in response to treatment. J Clin Periodontol 2011;38(5):434-441.

A case-control study was performed in patients with chronic periodontitis; 33 received only oral hygiene instructions, while 35 also received scaling and root planing. Salivary biomarkers were measured at weeks 0,

16 and 28. A significant improvement in periodontal health was observed in both groups, with a greater improvement in the scaling/root planing group after 16 and 28 weeks. Osteoprotegerin and TNF-α changed significantly in both groups, but IL-1β and MMP-8 decreased significantly only in the scaling/root planing group. Significant reductions in osteoprotegerin, MMP-8 and MIP-1α were observed in responders versus non-responders. Salivary biomarkers therefore reflected disease severity and response to therapy.


Yeh H-C, Lai H.  Association between patients’ chief complaints and their compliance with periodontal therapy.

J Clin Periodontol 2011;38(5):449-456.

Data on periodontal diseases, chief complaints and compliance with periodontal therapy were obtained from

1,196 patients. Complaints were symptomatic in 36.9%, acutely symptomatic in 22.4% and asymptomatic in

40.7%. Patients with acute complaints were 60% more likely to receive periodontal treatment than symptomatic subjects; however, patients with acute complaints were also 60% less likely to complete treatment. Chief complaints were therefore associated with compliance with periodontal therapy.


Ng MC-H, Ong MM-N, Lim LP, Koh CG, Chan YH.  Tooth loss in compliant and non-compliant periodontally treated patients: 7 years after active periodontal therapy. J Clin Periodontol 2011;38(5):499-508.

Data were retrospectively obtained from 273 compliant patients and cross-sectionally from 39 non-compliant

patients for at least 7 years following active periodontal therapy for comparison. The rate of tooth loss in the compliant patients was 1.3 teeth/patient during therapy and 0.9 teeth/year thereafter, and the rate due to periodontitis was 0.03 teeth/patient/year. For non-compliant patients, the rate of tooth loss was 1.1 teeth/patient during therapy and 2.7 teeth/patient thereafter, and the rate due to periodontitis was 0.22 teeth/patient/year, a 7-fold increase compared to the compliant patients. No significant predictors of tooth loss were identified.


Pennington M, Heasman P, Gaunt F, Güntsch A, Ivanovski S, Imazato S, Rakapakse S, Allen E, Flemmig T, Sanz M, Vernazza C. The cost-effectiveness of supportive periodontal care: a global perspective. J Clin Periodontol 2011;38(5):553-561.

The  costs  of  supportive  periodontal  care  (SPC)  and  of  replacing  teeth  were  estimated,  together  with

estimates of the effectiveness of SPC in preventing the loss of attachment or teeth. Outcomes with SPC were greater in specialist periodontal practices, but costs were higher than in public or private systems; however, SPC was also more cost-effective in specialist practices. SPC was cost-effective in private dental practices in the UK, Spain and Australia for modest attachment loss, whereas a higher valuation on avoiding attachment loss was needed to justify SPC in private or specialist practices in Ireland, Germany, Japan and the US.


Rosa EF, Corraini P, de Carvalho VF, Inoue G, Gomes EF, Lotufo JPB, De Micheli G, Pannuti CM. A prospective 12-month study of the effect of smoking cessation on periodontal clinical parameters. J Clin Periodontol 2011;38(5):562-571.

A total of 93 patients enrolled from a smoking cessation clinic received non-surgical periodontal treatment

concurrent with smoking cessation treatment. A structured questionnaire was administered, and periodontal examination was performed at baseline and after 3, 6 and 12 months. After 1 year, 52 patients remained in the study, of whom 17 ceased smoking and 35 continued or oscillated. Significant gain in clinical attachment level was observed in those who ceased smoking, but there were no significant differences between the groups for periodontal parameters after 1 year.


Ozcelik O, Haytac MC, Seydaoglu G.  Treatment of multiple gingival recessions using a coronally advanced flap procedure combined with button application. J Clin Periodontol 2011;38(5):572-580.

Coronally advanced flap (CAF) was performed in 41 patients with a total of 155 Miller class I or II recession

defects; 20 patients were assigned to the control group and 21 were assigned to the test group, where orthodontic buttons were used to stabilise the flaps. Measurements were taken at baseline and after 7 days and 6 months. Complete root coverage was observed for 84% and 61% of the test and control group, respectively. Aesthetic satisfaction was also high in the test group compared to the control group. CAF plus orthodontic button was therefore an effective treatment for multiple gingival recessions.


Quirynen M, Van Assche N.  Microbial changes after full-mouth tooth extraction, followed by 2-stage implant placement. J Clin Periodontol 2011;38(5):581-589.

Implants were placed in 10 patients with severe periodontitis 6 months after tooth extraction, and abutments

were placed after a further 3-6 months. Plaque samples were extracted and analysed up to 1 year following abutment connection. Colony-forming units of aerobic and anaerobic bacteria were reduced and the salivary concentration of P gingivalis and T forsythia decreased. No changes were observed for A actinomycetemcomitans and negligible changes were seen for P intermedia. Pristine subgingival niches were rapidly colonised by key pathogens.


Roos-Jansåker A-M, Lindahl C, Persson RG, Renvert S.  Long-term stability of surgical bone regenerative procedures of peri-implantitis lesions in a prospective case-control study over 3 years. J Clin Periodontol


A total of 32 patients with 56 implants received bone substitute alone (15 patients, 27 implants) or with a resorbable membrane (17 patients, 29 implants). Systemic antibiotics and chlorhexidine rinsing were subsequently administered for 10 days. No significant differences in bone fill were found between the groups after 1 and 3 years. Plaque index decreased from approximately 40% to approximately 10% after 1 year and remained stable during the following 2 years. Defect fill could therefore be maintained in both groups.


Journal of Oral Implantology

Vol. 37 No. SP1 (March 2011) [Special Issue Future of Implant Dentistry] Vol. 37 No. 2 (April 2011)

Hahn JA.  Four-year treatment and radiographic outcomes of 1-piece implants used in immediate function: a

prospective study in a single private practice. J Oral Implantol 2011;37(2):259-265.

In 30 patients in a single practice, a total of 47 1-piece implants were placed and immediately loaded, and evaluated for up to 4 years. The cumulative survival rate was 97.9% and marginal bone levels were found to be stable over 4 years.


Herford AS, Cooper TC, Maiorana C, Cicciù M.  Vascularised connective tissue flap for bone graft coverage.

J Oral Implantol 2011;37(2):279-285.

Bone grafting and implants were used to treat 17 patients with anterior maxillary defects; an apically repositioned split thickness connective tissue flap design was used, either at the time of bone grafting (nine patients) or at the time of implant uncovering (eight patients). No flap necrosis or dehiscence with graft exposure occurred, and keratinized tissue increased in all patients. The flap design was therefore a suitable technique, and could be performed at the same time as the graft procedure.


Bilhan H, Geckili O, Sulun T, Bilgin T.  A quality-of-life comparison between self-aligning and ball attachment systems for 2-implant-retained mandibular overdentures. J Oral Implantol 2011;37(SP1):167-173.

Each of 25 patients with an edentulous mandible received two implants and either ball or self-aligning

attachments to retain overdentures. Patients were switched to the second attachment type after 3 months. The Oral Health Implant Profile (OHIP)-14 assessment was used to evaluate quality of life. OHIP scores in the physical disability domain were significantly better for the self-aligning attachment, and in a subgroup of, patients with below-average attachment space, OHIP scores for functional limitation, psychological discomfort, physical disability, psychological disability and total score were significantly better for the self- aligning attachment.


Journal of Periodontology Vol. 82 No. 4 (April 2011) Vol. 82 No. 5 (May 2011)

Ribeiro FV, Casarin RCV, Júnior FHN, Sallum EA, Casati MZ.  The role of enamel matrix derivative protein in

minimally invasive surgery in treating intrabony defects in single-rooted teeth: a randomized clinical trial. J Periodontol 2011;82(4):522-532.

Intrabony defects in 30 patients were treated using a minimally invasive surgical technique (MIST) alone or in

combination with enamel matrix derivative (EMD) and evaluated after 3 and 6 months using clinical, radiographic and gingival crevicular fluid marker assessments. Significant reductions in probing depth, gains in clinical attachment level, and stability of the gingival margin were observed in both groups. No significant differences were observed between the groups.


Kim E-J, Jin B-H, Bae K-H.  Periodontitis and obesity: a study of the Fourth Korean National Health and

Examination Survey. J Periodontol 2011;82(4):533-542.

A total of 4,246 subjects in the Fourth Korean National Health and Examination Survey (KNHANES) underwent periodontal and anthropometric examination and completed a questionnaire. Body mass index (BMI) and waist circumference measurements were also taken. No association was found between BMI and periodontitis, but a significant association was found between abdominal obesity and periodontitis. The adjusted odds ratio for periodontitis in obese subjects was 1.358 (CI 1.003 to 1.839).


Cengiz Mİ, Yayla N, Cengiz K, Bagci H, Taşkın E.  Interaction between periodontal disease and systemic secondary amyloidosis: from inflammation to amyloidosis. J Periodontol 2011;82(4):566-574.

This  study  included  and  evaluated  112  patients  with  secondary  amyloidosis  (59  patients  with  familial

Mediterranean fever (FMF), 40 with chronic infection or malignant disease and 13 with periodontitis) and 22 healthy subjects as controls. Periodontal health and disease were assessed and the concentrations of serum acute phase reactants measured 4 and 6 weeks following non-surgical periodontal therapy. In patients with FMF, the prevalence of moderate to severe periodontitis was 74.5% compared to 72.5% in patients with chronic infection or malignant disease and 84.6% in patients with periodontitis. A significant reduction in serum  acute  phase  reactants  was  observed  in  amyloidosis  patients  following  non-surgical  periodontal therapy. The prevention or treatment of periodontitis may therefore help to alleviate the progression of amyloidosis.


Stashenko P, Van Dyke T, Tully P, Kent R Jr. Sonis S, Tanner ACR.  Inflammation and genetic risk indicators for early periodontitis in adults. J Periodontol 2011;82(4):588-596.

A total of 199 patients with early signs of periodontitis or who were periodontally healthy were clinically

monitored at 6-month intervals; gingival crevicular fluid and blood samples were also collected at each visit to assess IL-1β content and IL-1 genotype. A correlation was observed between increasing IL-1β levels and severity of disease, but no association was found between IL-1 genotype and disease or extent of disease. IL-1 genotype therefore did not appear to be a risk indicator for early periodontitis.


Aspriello SD, Zizzi A, Spazzafumo L, Rubini C, Lorenzi T, Marzioni D, Bullon P, Piemontese M.  Effects of enamel matrix derivative on vascular endothelial growth factor expression and microvessel density in gingival tissues of periodontal pocket: a comparative study. J Periodontol 2011;82(4):606-612.

Scaling and root planing was performed in 56 periodontal sites in 28 patients and enamel matrix derivative (EMD) gel (test) or the PGA vehicle (control) were applied to the root surfaces for 3 mins. Gingival biopsies were collected for analysis after 48 h. there was a significant difference in microvessel density and VEGF expression between test and control sites, indicating that EMD induces proliferation, viability and angiogenesis of human microvascular cells. High correlations were shown at test sites among clinical attachment level, endothelial VEGF and microvessel density, but no such correlations were found at control sites.


Bae J-H, Kim Y-K, Myung S-K. Effects of platelet-rich plasma on sinus bone graft: a meta-analysis. J Periodontol 2011;82(5):660-667.

A literature search was performed for articles on the effect of PRP on sinus graft. From a total of 61 articles

searched, eight articles, detailing 352 bone grafts in 191 patients, were selected for inclusion. In four studies, no significant difference in implant survival was found between the two groups assessed. In five studies in the random-effects model, bone formation was found to be significantly greater in the intervention group; however, in two studies in the random-effects model, no significant differences in BIC were found between the two groups. Evidence therefore supports the use of PRP for bone formation, but there was no evidence for an effect on implant survival or BIC.


Silvestri M, Rasperini G, Milani S.  120 infrabony defects treated with regenerative therapy: long-term results.

J Periodontol 2011;82(5):668-675.

In this study, infrabony defects were treated with various regenerative techniques, including bioabsorbable membrane and autogenous bone (five defects), bioabsorbable membranes with deproteinized bovine bone (47 defects), non-resorbable membranes (seven defects), enamel matrix derivative (EMD; 41 defects) or a combination (20 defects). The mean follow-up time was 9 years. The tooth survival rate after 13 years was

90% and the gain in clinical attachment level was maintained for 11 years in 82% of defects. Long-term outcomes were influenced by smoking and oral hygiene maintenance. A high percentage of long-term success was therefore achieved.


Zuza EP, Barroso EM, Carrareto ALV, Pires JR, Carlos IZ, Theodoro LH, Toledo BEC.  The role of obesity as a modifying factor in patients undergoing non-surgical periodontal therapy. J Periodontol 2011;82(5):676-


Periodontal parameters were measured before and 3 months after periodontal therapy in a total of 52 subjects with generalized chronic periododontitis (27 obese subjects and 25 normal-weight subjects). Anthropometric measurements and serum analyses were also performed. Plaque index, gingival index, bleeding on probing, probing depth 4-6 mm or 7 mm, and clinical attachment level 4-6 mm or ≥ 7 mm were all significantly decreased by non-surgical periodontal therapy. Proinflammatory cytokines significantly decreased in both patient groups, but IL-6 and TNF-α remained significantly higher in obese patients.


Kehl M, Swierkot K, Mengel R.  Three-dimensional measurement of bone loss at implants in patients with periodontal disease. J Periodontol 2011;82(5):689-699.

A  total  of  119  implants  were  placed  in  patients  with  generalized  chronic  or  generalised  aggressive

periodontitis (17 patients each). Clinical examination was performed on a 3-month recall schedule and radiographs were taken at regular intervals. Cone-beam CT was used to evaluate the circumferential 3- dimensional bone levels and determine the thickness of the keratinised mucosa. Significant bone loss at the buccal aspect was observed in both groups, and mean bone loss was significantly greater in the patients with generalised aggressive periodontitis. Thickness of keratinised mucosa was lowest in the anterior mandible in both groups. A significant correlation was found between clinical parameters and bone loss in patients with generalised aggressive periodontitis.


Nazareth CA, Cury PR.  Use of anorganic bovine-derived hydroxyapatite matrix/cell-binding peptide (P-15) in the treatment of isolated class I gingival recession of defects: a pilot study. J Periodontol 2011;82(5):700-


In 15 patients, Miller class I gingival recession defects were treated with coronally positioned flap (CFP) alone (control) or with anorganic bone mineral/peptide P-15 (test). Gingival recession was significantly reduced in both groups after 6 months, with no significant difference between the groups. Mean coverage of the exposed root was 85.56 ± 21.69% and 90.00 ± 18.42% in the test and control groups, respectively. Gingival thickness was significantly greater in the test group, and the gain in clinical attachment level was significant in both groups, with no significant difference between the groups. A positive correlation between bone height at baseline and reduction in gingival recession was noted in the test group.


Quintessence International Vol. 42 No. 5 (May 2011) Vol. 42 No. 6 (June 2011)

Kumar PG, Kumar JA, Anamula N, Reddy KP, Avula H, Hussain SN. Volumetric analysis of intrabony

defects in aggressive periodontitis patients following use of a novel composite alloplast: a pilot study.

Quintessence Int 2011;42(5):375-384.

A total of 20 intrabony defects in 10 patients were treated using open flap debridement alone or with a composite alloplast bone graft. Clinical parameters were recorded at baseline and 6 months, and plaque and gingival indices were recorded at baseline and 3 and 6 months. All parameters were significantly improved in both groups, but clinical and radiographic outcomes were significantly better in the alloplast group, indicating that the alloplast provided better treatment outcomes than open flap debridement alone.


Schmitt J, Wichmann M, Eitner S, Hamel J, Holst S.  Five-year clinical follow-up of prefabricated precision attachments:  a  comparison  of  uni-  and  bilateral  removable  dental  prostheses.  Quintessence  Int


Removable dental prostheses on the residual dentition with two types of attachments were placed in 23 patients with shortened dental arches. After 5 years, 70% of the prostheses in bilateral shortened arches were  clinically  functional,  compared  to  only  25%  of  those  in  unilateral  shortened  arches.  Fracture  of abutment teeth was the most common cause of failure in the bilateral arches, while wear of the precision attachment was the most common cause in unilateral arches. There was no mean reduction in pocket depth for  the  abutment  teeth,  but  there  was  a  significant  improvement  in  oral  hygiene  status.  Removable prostheses with bilateral retention may therefore be a suitable treatment for shortened arches, but unilateral prostheses cannot be recommended.

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