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Literature Update Jul - Aug 2011

Clinical Implant Dentistry and Related Research

Vol. 13 No. 3 (September 2011)

De Bruyn H, Atashkadeh M, Cosyn J, van de Velde T. Clinical outcome and bone preservation of single

TiUnite implants installed with flapless or flap surgery. Clin Implant Dent Relat Res 2011;13(3):175-183.

A total of 53 implants, 25 with flap surgery and 28 with flapless surgery, were placed in 49 patients. The implants were delayed loaded and bone level measured from the implant-abutment junction at baseline and after 1 and 3 years. All implants survived, and the mean bone loss after a mean of 38 months was 1.35 ±

0.91 mm. Bone loss increased during the first year in both groups and was higher in the flapless group. No further bone loss was found after the first year, and there was no significant difference between the groups, indicating stable bone levels regardless of the surgical technique.


Wennerberg A, Fröjd V, Olsson M, Nannmark U, Emanuelsson L, Johansson P, Josefsson Y, Kangnasniemi I, Peltola T, Tirri T, Pänkäläinen T, Thomsen P. Nanoporous TiO2 thin film on titanium oral implants for enhanced human soft tissue adhesion: a light and electron microscopy study. Clin Implant Dent Relat Res


Experimental microimplants with (test) or without (control) TiO2  surface modification were placed in 15 patients and evaluated by light microscopy and transmission electron microscopy. The tissues around the test implants were clinically healthy, while mild erythema and fluid expulsion was observed at two control implants. The amount of surrounding oral mucosa in contact with the implant abutment was significantly greater  for  the  control  implants  (72%  compared  to  48%  for  the  control  implants),  but  no  significant differences were observed for other histological variables. Marginal bone loss was 0.5 mm and 1.7 mm for the test and control implants, respectively.


Vandeweghe S, De Bruyn H.  The effect of smoking on early bone remodeling on surface modified Southern implants. Clin Implant Dent Relat Res 2011;13(3):206-214.

Retrospective data on interproximal radiographic bone levels from 712 implants in function for at least 6

months in 329 patients were obtained. The implant survival rate was 98.3%, but the failure rate was three- fold higher in smokers versus non-smokers. The mean interproximal bone level for a mean follow-up of 12 months was 1.36 ± 0.41 mm. Bone level was found to be independent of the location in the jaw, but bone loss was significantly greater in smokers versus non-smokers, and was significantly greater in the maxilla versus the mandible. The results indicated that smokers may not be more prone to implant loss, but are more prone to bone loss.


Kahnberg  K-E,  Wallström  M,  Rasmusson  L.   Local  sinus  lift  for  single-tooth  implant.  I.  Clinical  and radiographic follow-up. Clin Implant Dent Relat Res 2011;13(3):231-237.

Single-tooth  replacement  was  performed  in  20  patients  in  the  second  premolar  or  molar  areas  using

simultaneous sinus lift and implant placement. Abutments were placed after 6 months. The implant survival rate after 2 years of follow-up was 100%, and residual bone volumes in the sinus area were 2-5 mm, preoperatively, 13 mm after sinus lift, 11.4 mm after 1 year, and 10.6 mm after 2 years. Local sinus lift with bone augmentation and implant placement may therefore be a predictable technique.


Clinical Oral Implants Research

Vol. 22 No. 7 (July 2011) Vol. 22 No. 8 (August 2011)

Weinländer M, Lekovic V, Spadijer-Gostovic S, Milicic B, Wegscheider WA, Piehslinger E. Soft tissue

development around abutments with a circular macro-groove in healed sites of partially edentulous posterior maxillae and mandibles: a clinical pilot study. Clin Oral Implants Res 2011;22(7):743-752.

Each of 10 patients received two implants in posterior sites. The implants were immediately provisionalised

with macro-grooved concave abutments (test) or conventional convex abutments (control), with permanent crowns placed after 3 months. Aesthetic outcomes (using the Pink Esthetic Score, PES), as well as marginal bone level, papilla index, modified plaque index and bleeding index, were recorded. After 1 year, the implant survival rate was 100% and there was no significant difference in marginal bone level between test and control. PES scores were significantly higher in the control group at both prosthesis delivery and after 1 year. Soft tissue level and contour were significantly higher for control sites at the time of prosthesis delivery and after 1 year, and mesial papilla score was also significantly higher after 1-year follow-up. The results indicated that concave macro-grooved abutments did not lead to superior soft tissue development compared to conventional convex abutments.


Hayami T, Hontsu S, Nishikawa H, Kusonoki M. Osteoconduction of a stoichiometric and bovine hydroxyapatite bilayer-coated implant. Clin Oral Implants Res 2011;22(7):774-776.

Commercial titanium implants were coated with stoichiometric hydroxyapatite and bovine hydroxyapatite

using pulsed layer deposition. Control implants were either basic titanium or coated with hydroxyapatite using the flame sprayed method. Osteoconductivities were assessed 4 -24 weeks after placement. Peeling of HA from the implant was observed for the sprayed implants, while the bilayered implants showed close adherence to the bone. A gap containing connective tissue was observed at the basic implants, while bone adhered to the hydroxyapatite coating for the sprayed implants. The implants with bilayer hydroxyapatite deposition showed quick, long-term bone fixation due to dissolution of the film to aid osteoconduction after implant placement.


Covani U, Ricci M, Bozzolo G, Mangano F, Zini A, Barone A.  Analysis of the pattern of the alveolar ridge remodelling following single tooth extraction. Clin Oral Implants Res 2011;22(8):820-825.

A total of 50 patients who had a single tooth extraction in the previous 2 years were selected and the amount

of alveolar crest modelling was assessed. Mean buccal re-absorption was calculated to be 19.4 ± 9.4%, 39.1

± 10.4% and 20.3 ± 10.7% at the mesial, mid- and distal points, respectively, and the mean alveolar crest shift was 59.1 ± 11.2%, 64.8 ± 10.5%, 56 ± 12.5% at the mesial, mid- and distal points, respectively. Buccal wall therefore tends to re-absorb according to a specific pattern, with bone loss at the mid-point double that of the mesial and distal points.


Rinke S, Ohl S, Ziebolz D, Lange K, Eickholz P.  Prevalence of periimplant disease in partially edentulous patients: a practice-based cross-sectional study. Clin Oral Implants Res 2011;22(8):826-833.

Retrospective data from 89 patients who received dental implants were evaluated. The overall patient-related

prevalence rate of peri-implant mucositis was 44.9%, compared to the rate of 30.4% in non-smokers without periodontal history and 80% in smokers with periodontal history. Peri-implant mucositis was significantly independently associated with smoking. The overall patient-related prevalence of peri-implantitis was 11.2% (2.8% for non-smokers and 53.3% for smokers with periodontal history); peri-implantitis was also significantly associated with smoking. No significant association was observed between periodontal history and peri- implantitis.


Karabuda ZC, Abdel-Haq J, Arısan V.  Stability, marginal bone loss and survival of standard and modified sand-blasted, acid-etched implants in bilateral edentulous spaces: a prospective 15-month evaluation. Clin Oral Implants Res 2011;22(8):840-849.

A total of 96 SLA and modified SLA (SLActive) implants were placed in 22 patients, and implant stability by

RFA was measured at surgery and after 1, 3 and 6 weeks. Panoramic x-rays were taken and implant stability measured at loading and the implants were followed for 1 year. Implant survival was 100% for SLA and

97.91% for SLActive implants (one implant lost after 3 weeks). Marginal bone loss was significantly lower at loading for the SLActive implants (0.18 ± 0.05 mm versus 0.22 ± 0.06 mm) and the RFA values were significantly higher for SLActive implants at loading than any other time point for both implant types. The SLActive implants therefore showed greater stability and less bone loss at loading.



European Journal of Oral Implantology

Vol. 4 No. 2 (July 2011)

Annen BM, Ramel CF, Hämmerle CHF, Jung RE.  Use of a new cross-linked collagen membrane for the

treatment  of  peri-implant  dehiscence  defects:  a  randomised  double-blinded  clinical  trial.  Eur  J  Oral

Implantol 2011;4(2):87-100.

Implants were placed in 16 patients with osseous defects with subsequent guided bone regeneration using either a collagen membrane (control) or a new cross-linked membrane (test) in a split-mouth design. Mucoperiosteal flaps were raised after 6 months to assess vertical bone fill, newly formed tissue, defect height, depth and width, and augmentation depth. The study was discontinued early following unacceptable safety and infection issues with the cross-linked membrane in nine patients; this membrane also showed significantly more soft tissue dehiscence than the collagen membrane. Removal of the cross-linked membrane was necessary in three patients due to infection. Quality of newly formed tissue was not significantly different between the groups, and the mean density was 24.4% and 35.0% at test and control sites, respectively. No significant differences were observed in the histological data. The cross-linked membrane therefore showed longer resorption time, more adverse events and no advantages over the control treatment.


Van Assche N, Pittayapat P, Jacobs R, Pauwels M, Teughels W, Quirynen M.  Microbiological outcome of two screw-shaped titanium implant systems placed following a split-mouth randomised protocol, at the 12th year of follow-up after loading. Eur J Oral Implantol 2011;4(2):103-116.

Implants (34 Astra Tech and 32 Brånemark) were placed in 18 patients according to a split-mouth design, and  periodontal  parameters  and  radiographic  bone  loss  were  evaluated  at  the  last  follow-up  visit. Subgingival plaque samples were also taken for microbiological analysis. Over 12 years, there were five patient drop-outs and one Brånemark implant was lost. Mean bone loss from loading to 12 years was 0.7 mm and 0.4 mm for Astra Tech and Brånemark implants, respectively, and there were no significant microbiological differences between the groups. Both systems therefore proved to be successful in patients with good oral hygiene and stable periodontal conditions, and the presence of periodontopathogens did not necessarily result in bone loss.


Schlee M, Esposito M.  Human dermis graft versus autogenous connective tissue grafts for thickening soft tissue and covering multiple gingival recessions: 6-month results from a preference clinical trial. Eur J Oral Implantol 2011;4(2):119-125.

A total of 42 patients with gingival recession defects were given the choice of treatment with either a human

dermis graft (HDG) or an autogenous connective tissue graft (ACT) from their palate. ACT was subsequently used for 100 recessions in 21 patients, and HDG was used for 160 recessions in 21 patients. One minor complication at an HDG site was observed. Recessions were significant decreased in both groups, but root coverage and gain in clinical attachment level of 0-5 mm was significantly improved in the ACT group, and there was 18% more root coverage compared to the HDG group. HDG may therefore be an effective treatment, but may provide less root coverage than ACT.


Rotundo R, Mori M, Bonaccini D, Baldi C.  Intra- and inter-rater agreement of a new classification system of gingival recession defects. Eur J Oral Implantol 2011;4(2):127-133.

A new classification system for gingival recession defects was proposed based on amount of keratinised

tissue, presence/absence of non-carious cervical lesions and presence/absence of proximal attachment loss. A total of 120 lesions were assessed using this system and the intra- and inter-rater agreement with three examiners was analysed. The intra- and inter-rater agreements were 0.74-0.96 and 0.70-0.85 for keratinised tissue, 0.67-0.94 and 0.54-0.59 for non-carious lesions, and 0.70-0.92 and 0.54-0.77 for interproximal attachment loss, indicating moderate to substantial agreement between investigators.


Rotundo R, Nieri M, Briccoli L, Barone R, Clauser C. Radiographic interpretation agreement in implant dentistry. Eur J Oral Implantol 2011;4(2):135-143.

A total of 76 members of the Italian Society of Oral Surgery were asked to score radiographic images of 12

simulated dental implant cases, involving baseline and follow-up images, different implant lengths and 1 to 5 years of follow-up. Sixty-three members participated, and the inter-rate agreement was 0.86 (CI 95% 0.74;

0.95). No differences were detected at 1 or 5 years when bone loss was absent, but scores were higher for the 5-year follow-up when bone loss was present; the lowest score was for 5 mm bone loss at 1-year follow- up. A significant difference between short and long implants was observed. Radiographic evaluation by experienced clinicians is therefore relatively uniform, and bone loss, implant length and follow-up time were important factors in the perception of implant success.


Sisti A, Canullo L, Nieri M, Mottola MP, Iannello G. A case series on crestal sinus elevation with rotary instruments. Eur J Oral Implantol 2011;4(2):145-152.

Sinus floor elevation was performed in 50 edentulous patients with residual crest height 1.2 to 9.8 mm and

width > 7 mm. After elevation of the sinus mucosa, hydroxyapatite granules were placed and a total of 64 implants were immediately placed, with definitive crowns placed after 3 months. After 18 months follow, all implants survived and only minimal post-operative patient discomfort was reported. The only complication was a minor perforation of the sinus membrane. Mean residual bone height was 6.20 ± 2.22 mm at implant placement, 15.26 ± 3.19 mm after surgery and 15.40 ± 4.21 mm after last follow-up, respectively. Sinus elevation and implant placement were therefore achieved.



Implant Dentistry

Vol. 20 No. 3 (June 2011)

Makary C, Rebaudi A, Mokbel N, Naaman N.  Peak insertion torque correlated to histologically and clinically

evaluated bone density. Implant Dent 2011;20(3):182-191.

Implant site preparation with concomitant bone biopsy was performed for 40 implant sites in 18 patients, and bone type was assessed by tactile sense during drilling; implants were subsequently placed and peak insertion torque values were recorded. Osseointegration was achieved at all but one implants. The mean insertion torque was 78.30 Ncm (range 15 to 150 Ncm) and was significantly higher in D1 bone (126.67

Ncm) and lower in D4 bone (40.22 Ncm). A significant correlation between insertion torque and bone volume was found, but there was no significant correlation between insertion torque and implant length/diameter.


Lee CYS, Prasad HS, Suzuki JB, Stover JD, Rohrer MD. The correlation of bone mineral density and histologic data in the early grafted maxillary. Implant Dent 2011;20(3):202-214.

A total of 34 implants were placed in the grafted sinus of 15 patients. In 12 patients, the sinuses were grafted

with autogenous bone alone or in combination with another bone graft material; this group received a total of

25 implants after 14-20 weeks, with restoration 12 weeks later. Follow-up for these 12 patients was at 52 weeks; implant surgery in the remaining three patients was completed after the 52-week period, for various reasons, but bone maturation could be observed after 68, 88 and 260 weeks. Bone mineral density was recorded at the different healing periods. The bone mineral density increased in all patients during the 52- week period and beyond. The data indicated a correlation of bone mineral density with the formation of new, vital autogenous trabecular bone.


Bilhan H, Mumcu E, Geçkili O, Atalay B.  The evaluation of the success of immediately placed single implants: a retrospective study. Implant Dent 2011;20(3):215-225.

Data from 117 patients who had received 165 immediately placed implants and who had completed the 3-

year follow-up were analysed. There were 10 implant failures, giving an implant survival rate of 93.94%. There were no significant differences in bone level according to age, gender, grafting, localisation or implant system, and grafting had no significant influence on plaque index, gingival index or probing depth.


Casado PL, Otazu IB, Balduino A, de Mello W, Barboza EP, Duarte MEL. Identification of periodontal pathogens in healthy implant sites. Implant Dent 2011;20(3):226-235.

A total of 30 partially edentulous, non-smoking patients were classified into 3 groups of 10 patients each:those with peri-implant health; those with peri-implant mucositis; and, those with peri-implantitis. Peri-implant tissues were clinically examined, radiographic analysis was performed and samples of peri-implant crevicular fluid were taken for analysis of periodontal pathogens. Peri-implant disease was found to be associated with history  of  periodontal  disease.  All  of  the  periodontal  pathogens  evaluated  were  found  in  healthy  and diseased peri-implant conditions and are therefore not only related to sites with peri-implant disease.


International Journal of Oral and Maxillofacial Implants

Vol. 26 No. 3 (May/June 2011)

Botos S, Yousef H, Zweig B, Flinton R, Weiner S.  The effects of laser microtexturing of the dental implant

collar on crestal bone levels and peri-implant health. Int J Oral Maxillofac Implants 2011;26(3):492-2-498. Patients received four implants (two with machined and two with laser microtextured collars) in the anterior mandible to support an overdenture. The implants were placed in alternating order; the mesial implants were not loaded, while the distal implants were immediately loaded with ball abutments and overdentures. Bone loss was recorded in both groups after 6 and 12 months, and periodontal parameters were recorded for the loaded group. Significantly lower probing depths were found for the microtextured implants at both 6 and 12 months, and crestal bone loss was lower for the microtextured implants in both the loaded and unloaded groups.


Emam  H,  Beheiri  G,  Elsalanty  M,  Sharawy  M.   Microcomputed  tomographic  and  histologic  analysis  of anorganic bone matrix coupled with cell-binding peptide suspended in sodium hyaluronate carrier after sinus augmentation: a clinical study. Int J Oral Maxillofac Implants 2011;26(3):561-570.

Ten patients received sinus augmentation with anorganic bone matrix (ABM) coupled with cell-binding peptide (P15), and each patient received two implants, which were removed after 8 or 16 weeks using a trephine bur; wide diameter implants were then immediately placed. Bone mineral density, bone volume and percent bone contact were evaluated. Bone mineral density was significant increased around implants at 8 and 16 weeks compared to residual (control) bone, but there was no significant difference in bone volume or percent bone contact. The mean increase in bone height was 9.63 ± 1 mm after 16 weeks. ABM-P15 was therefore found to be a promising graft material for sinus augmentation.


Ponsi J, Lahti S, Rissanen H, Oikarinen K. Change in subjective oral health after single dental implant treatment. Int J Oral Maxillofac Implants 2011;26(3):571-577.

Of 90 patients who received single implants, 80 completed the Oral Health Impact Profile 14 (OHIP-14)

questionnaire before and after treatment. A total of 131 implants and restorations were placed. A significant decrease in OHIP-14 score was observed from before (10.4) to after treatment (3.1). Before and after scores went from 13.4 to 1.5 for the anterior region, 11.2 to 4.3 for the premolar region, and 6.5 to 3.0 for the molar region. Oral impacts were reported approximately three times more often by women than men. Single implant tooth replacement may therefore significantly improve subjective oral health.


Luo Z, Rongsheng Z, Luo Z, Chen Z.  Single implants in the esthetic zone: analysis of recent peri-implant soft tissue  alterations  and  patient  satisfaction.  A  photographic  study.  Int  J  Oral  Maxillofac  Implants


Single implants were placed in the aesthetic zone in 28 patients and photographs were taken to assess the peri-implant soft tissue at baseline and after 3 months using the Pink Esthetic Score (PES). Patient satisfaction was assessed via a visual analog scale (VAS). Mean PES values at baseline and 3 months were

8.68 ± 2.69 and 10.37 ± 2.13, respectively, and there was a significant correlation between VAS and PES scores. PES data can therefore be assessed using photographs, and there is a marked improvement in the aesthetic outcome after 3 months.


de Almeida FD, Carvalho ACP, Fontes M, Pedrosa A, Costa R, Noleto JW, de Almeida Barros Mourão CF. Radiographic evaluation of marginal bone level around internal-hex implants with switched platform: a clinical case report series. Int J Oral Maxillofac Implants 2011;26(3):587-592.

A total of 42 implants were placed in 26 patients, who were split into two groups: one group (control) received components according to the original protocol, while the other group (test) received narrower components. The mean follow-up time was 33.45 months. Noticeable bone remodelling was observed in the control group (mean bone loss 2.30 mm), whereas stable bone levels were observed in the test group (mean bone loss 0.27 mm). Platform switching of Frialit-2 implants may therefore help to minimise bone loss.


Romanos GE, May S, May D.  Treatment concept of the edentulous mandible with prefabricated telescopic abutments and immediate functional loading. Int J Oral Maxillofac Implants 2011;26(3):593-597. Retrospective data from 488 implants placed in 122 patients with at least 1-year follow-up were reviewed. Of these,  84  implants  were  placed  in  fresh  extraction  sockets  and  all  were  placed  2  mm  subcrestally. Prefabricated conical abutments were immediately placed and complete dentures (which were to remain in situ for 10 days to ensure implant immobility) were fitted and relined chairside. For a mean follow-up time of

79 ± 29.8 months, there were eight implant failures and 21 implants showed > 2 mm bone loss; the overall success rate was therefore 94.06%. Patients were satisfied with the prosthesis stability, and there were no prosthetic or peri-implant problems identified.


Krennmair  G,  Seemann  R,  Weinländer  M,  Piehslinger  E.  Comparison  of  ball  and  telescopic  crown attachments in implant-retained mandibular overdentures: a 5-year prospective study. Int J Oral Maxillofac Implants 2011;26(3):598-606.

Two implants were placed in the interforaminal region of each of 25 patients with an edentulous mandible;

ball attachments were used in 13 patients and telescopic attachments were used in 12 patients. Peri-implant parameters, implant success, prosthodontic maintenance and patient satisfaction were assessed each year for up to 5 years. Significantly more complications/interventions were noted during the study for the ball attachment group (61.1% versus 37.9%), but there were no significant differences in patient satisfaction, implant success or peri-implant conditions. The biggest differences in prosthodontic maintenance were found in the second and third years, but maintenance at the end of the study was similar for both systems. Both attachment systems are therefore viable.


Canullo  L,  Iannello  G,  Götz  W.   The  influence  of  individual  bone  patterns  on  peri-implant  bone  loss: preliminary report from a 3-year randomized clinical and histologic trial in patients treated with implants restored  with  matching-diameter  abutments  or  the  platform-switching  concept.  Int  J  Oral  Maxillofac Implants 2011;26(3):618-630.

A total of 24 implants of four different diameters (3.8, 4.3, 4.8 or 5.5 mm) were placed in 10 patients and

restored with abutments of 3.8 mm diameter. Biopsies were taken prior to implant placement for histologic and immunohistochemical analysis. Radiographic measurement of the bone levels were made after implant placement and 36 months after loading. Mean bone resorption was 1.358 mm for non-platform-switched implants (3.8 mm) and was 0.832 mm, 0.486 mm and 0.375 mm for implants of 4.3 mm, 4.8 mm and 5.5 mm diameter, respectively. There was a borderline direct correlation between peri-implant bone change and levels of biglycans and a borderline indirect correlation between bone change and TNG-α levels. There appeared to be a correlation between local bone structure and peri-implant bone resorption.


Fung K, Marzola R, Scotti R, Tadinada A, Schncaglia GP. A 36-month randomized controlled split-mouth trial comparing immediately loaded titanium oxide-anodized and machined implants supporting fixed partial dentures in the posterior mandible. Int J Oral Maxillofac Implants 2011;26(3):631-638.

In 10 patients with bilateral edentulism, 42 implants were placed, either on the control side (machined implants) or the test side (titanium oxide-anodized implants). The implants were immediately loaded and radiographic bone level was evaluated at baseline and after 12 and 36 months. The cumulative implant success rate after 36 months was 95%, and the mean change in bone level was 0.35 mm and 0.32 mm for test and control implants, respectively; the difference was not significant. The bone level decreased in both groups between 12 and 36 months, but the decrease was significant only in the control group. Immediate loading of both implant types may therefore be suitable for treatment of mandibular posterior edentulism.


Ozkan Y, Akoglu BC, Kulak-Ozkan Y. Five-year treatment outcomes with four types of implants in the posterior maxilla and mandible in partially edentulous patients: a retrospective study. Int J Oral Maxillofac Implants 2011;26(3):639-647.

A retrospective analysis was performed of 83 patients who received a total of 244 implants (90 Camlog, 86

Straumann, 35 Swiss Plus and 33 Frialit); clinical and radiographic parameters were recorded. A total of 93 single crowns and 71 FPDs (62 implant-supported and nine implant-tooth-supported) were placed. Plaque accumulation was significantly increased from baseline to 5 years in all groups. Mean probing depths for Camlog, Frialit, Swiss Plus and Straumann implants were 2.33 ± 0.58 mm, 2.29 ± 0.46 mm, 1.87 ± 0.64 mm and 1.77 ± 0.52 mm, respectively; corresponding mean bone loss values were 0.27 ± 0.06 mm, 0.24 ± 0.07 mm, 0.26 ± 0.07 mm and 0.19 ± 0.07 mm, respectively. The mean bone loss for Straumann implants was significantly lower than that of the other groups.


Katsoulis J, Brunner A, Mericske-Stern R.  Maintenance of implant-supported maxillary prostheses: a 2-year controlled clinical trial. Int J Oral Maxillofac Implants 2011;26(3):648-656.

The study enrolled 41 patients who received implant-supported maxillary prostheses 16 received an

overdenture with a gold bar, 12 received a CAD/CAM overdenture with a titanium bar, and 13 received a CAD/CAM fixed prosthesis. Bars and frameworks were screw-retained, and maintenance was recorded for 2 years, after which the OHIP questionnaire was administered. Matrix and bar extension fracture only occurred with gold bars, and hyperplasia of the peri-implant mucosa was observed in most of the patients in this group. Maintenance rates were 1.24, 1.36 and 0.98 in the gold bar overdenture, titanium bar overdenture and CAD/CAM prosthesis groups, respectively, and the corresponding mean OHIP values were 6.7, 7.3 and

1.7; ratings were significantly better in the CAD/CAM prosthesis group. The maintenance service was typical for maxillary implant prostheses, and a trend towards fewer problems was found with the CAD/CAM prosthesis group.


Migliorança RM, Coppedê A, Rezende RCLD, de Mayo T. Restoration of the edentulous maxilla using extrasinus zygomatic implants combined with anterior conventional implants: a retrospective study. Int J Oral Maxillofac Implants 2011;26(3):665-672.

Patients with completely edentulous maxillae or partially edentulous maxillae with remaining teeth scheduled

form extraction were included in the study. Each patient received at least four implants, with at least one zygomatic implant placed outside of and lateral to the sinus. A total of 436 implants (286 conventional and

150 zygomatic) were placed in 75 patients. Two failures occurred with conventional implants, and two zygomatic implants were removed, but no cases of sinusitis or loose/fractured screws were observed and all prostheses were successful. A combination of extrasinus zygomatic implants and conventional implants may therefore be suitable for the treatment of the atrophic edentulous maxilla.



International Journal of Periodontics and Restorative Dentistry

Vol. 31 No. 3 (May/June 2011)

Nevins  M,  Camelo  M,  De  Angelis  N,  Hanratty  JJ,  Khang  WG,  Kwon  J-J,  Rasperini  G,  Rocchietta  I, Schupbach P, Kim DM.  The clinical and histologic efficacy of xenograft granules for maxillary sinus floor

augmentation. Int J Periodontics Restorative Dent 2011;31(3):227-235.

Sinus augmentation with cancellous bovine bone was performed in 14 patients, and sufficient bone volume was achieved for implant placement in all patients. Bone formation was observed at the osteotomy site after

6 months, and histological analysis showed integrated xenograft granules surrounded by woven and lamellar bone. The mean percentage of newly formed bone was 27.5 ± 8.9%.  Vital bone formation with xenograft granules was therefore observed.


Franchiani  I,  Capelli  M,  Fumagalli  L,  Parenti  A,  Testori  T.  Multicenter  retrospective  analysis  of  201 consecutively placed Camlog dental implants. Int J Periodontics Restorative Dent 2011;31(3):255-263. Data from a total of 201 implants placed using different procedures and for different indications in 96 patients were retrospectively analysed after functional loading of between 12 and 78 months. The implant survival rate was 99.5%. No increased risk of implant failure was observed with immediate loading, short implants or titled implants.


Simon BI, Gupta P, Tajbakhsh S.  Quantitative evaluation of extraction socket healing following the use of autologous platelet-rich fibrin matrix in humans. Int J Periodontics Restorative Dent 2011;31(3):285-295. Platelet-rich fibrin matrix was used as graft material in 21 extraction sockets and evaluated after 4 months. The mean resorption in height was 0.67 mm, equating to a loss of 7.13%, and the mean width resorption 3 mm and 5 mm from the crest were 0.32 mm and 0.57 mm, respectively, equating to loss of 4.71% and

7.38%, respectively. Rapid healing, minimal flap re-opening and excellent bone density were noted. The technique may have fewer healing problems and less resorption than GBR procedures.



Journal of Clinical Periodontology

Vol. 38 No. 7 (July 2011) Vol. 38 No. 8 (August 2011)

Uzel NG, Teles FR, Teles RP, Song XQ, Torresyap G, Socransky SS, Haffajee AD.  Microbial shifts during

dental biofilm re-development in the absence of oral hygiene in periodontal health and disease. J Clin

Periodontol 2011;38(7):612-620.

Periodontal bacteria were evaluated from samples of supra- and subgingival plaque at 28 teeth in 38 healthy patients and 17 patients with periodontitis before and immediately after tooth cleaning; samples from seven randomly selected teeth after 1, 2, 4 and 7 days of no oral hygiene were also evaluated. Total bacterial counts were significantly higher in periodontitis patients on entry and reached or exceeded baseline numbers within 2 days. Increases in supragingival V parvula, F nucleatum ss vincenti and N mucosa were observed from 2 to 7 days, and increased counts of subgingival Actinomyces, green and orange complex species were also seen. Significant differences in supragingival counts were observed for 17 of the 41 species evaluated at entry and 0 after 7 days, compared to 39 of 41 species for subgingival counts at entry and 17 of 41 after 7 days.


Feng HS, Bernardo CC, Sonoda LL, Hayashi F, Romito GA, De Lima LAPA, Lotufo RFM, Pannuti CM. Subgingival  ultrasonic  instrumentation  of  residual  pockets  irrigated  with  essential  oils:  a  randomized controlled trial. J Clin Periodontol 2011;38(7):637-643.

Non-surgical  periodontal  therapy  was  performed  in  63  patients  with  chronic  periodontitis  and  residual pockets 5 mm were treated with ultrasonic instrumentation with either essential oils (test) or negative control. Periodontal parameters were measured at baseline and after 4, 12 and 24 weeks. A significant reduction in probing depth and bleeding on probing, and gain in clinical attachment level, were observed in both groups, with no significant differences between the groups. However, significantly greater gain in attachment level was found in the test group for initially deep pockets (≥ 7 mm).


Bäumer A, Pretzl B, Cosgarea R, Kim T-S, Reitmeir P, Eickholz P, Dannewitz B.  Tooth loss in aggressive periodontitis after active periodontal therapy: patient-related and tooth-related prognostic factors. J Clin Periodontol 2011;38(7):644-651.

After a mean of 10.5 years of supportive periodontal therapy, 84 patients with aggressive periodontitis, with a

total of 2,054 teeth, were evaluated. Evaluations included baseline bone loss, tooth location and type, furcation involvement, follow-up time and patient-related factors. A total of 113 teeth were lost during supportive periodontal therapy, and tooth loss was significantly influenced by maxillary location, tooth type, use  as  abutment  tooth,  and  baseline  bone  loss;  molars  showed the  highest risk  of tooth loss. Other influential factors included time of follow-up and the patient’s educational status.


Meyle J, Hoffmann T, Topoll H, Heinz B, Al-Machot E, Jervøe-Storm P-M, Meiß C, Eickholz P, Jepsen S.  A multi-centre randomized controlled clinical trial on the treatment of intra-bony defects with enamel matrix derivatives/synthetic bone graft or enamel matrix derivatives alone: results after 12 months. J Clin Periodontol 2011;38(7):652-660.

In 73 patients with chronic periodontitis, intra-bony defects 2 mm wide and 4 mm deep were treated with

EMD alone or in combination with synthetic bone graft and assessed after 6 and 12 months. The mean defect fill was 2.7 ± 1.9 mm and 2.8 ± 1.6 mm in the EMD/graft and EMD groups, respectively, and the mean gain in clinical attachment level was 1.7 ± 2.1 mm and 1.9 ± 1.7 mm, respectively. Greater defect fill was observed in deeper defects in both groups. Both treatment modalities therefore showed similar outcomes.


Cairo F, Nieri M, Cincinelli S, Mervelt J, Pagliaro U.  The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. J Clin Periodontol 2011;38(7):661-666.

Patients with at least one buccal gingival recession were recruited into the study; recessions were classified

as RT1 (no loss of interproximal attachment), RT2 (loss of interproximal attachment less than or equal to buccal site) or RT3 (higher interproximal attachment loss than buccal site) by two examiners, and intra- and inter-rate agreement was assessed. Root coverage outcomes after 6 months for treated recessions were also retrospectively evaluated. A total of 116 recession in 25 patients were assessed, and the intra-class coefficient was 0.86, indicating almost perfect agreement between examiners. The classification was predictive of the final recession reduction after 6 months in 109 treated recessions.


Friedmann A, Gissel K, Soudan M, Kleber B-M, Pitaru S, Dietrich T.  Randomized controlled trial on lateral augmentation using two collagen membranes: morphometric results on mineralized tissue compound. J Clin Periodontol 2011;38(7):677-685.

Alveolar ridge alterations were evaluated 6 months after one-stage augmentation of bone dehiscences using

biphasic calcium phosphate and either ribose cross-linked collagen (test) or non-cross-linked (control) membranes. The effect on dimensional changes in the crestal bone level at implants was evaluated. Soft tissue dehiscences were noted at 70.5% of test sites and 55% of control sites, and there was significantly greater gain in newly mineralised tissue at the crestal level, in both lateral and vertical dimensions, in the test group. However, there was no significant difference between the groups for lateral dimension on the second measurement at the border of the reflected flap.


Graetz C, Dörfer CE, Kahl M, Kocher T, El-Sayed KF, Wiebe J-F, Gomer K, Rühling A. Retention of questionable  and  hopeless  teeth  in  compliant  patients  treated  for  aggressive  periodontitis.  J  Clin Periodontol 2011;38(8):707-714.

Patients with aggressive or chronic periodontitis (34 of each) who each had at least two teeth with 50%

bone loss were evaluated; teeth were categorised as ‘questionable’ or hopeless’. In patients with aggressive periodontitis, 262 teeth were designated questionable and 63 as hopeless, and 25 questionable and 26 hopeless teeth were extracted; 28 questionable and 15 hopeless teeth were removed during supportive periodontal therapy. In the chronic periodontitis group, there were 149 questionable and 51 hopeless teeth, and 12 and 16 questionable and hopeless teeth, respectively, were extracted; during supportive periodontal therapy 28 questionable and 15 hopeless teeth were removed. No significant differences in tooth loss or progression of probing depth were found between the groups.


Pini Prato G, Rotundo R, Franceschi D, Cairo F, Cortellini P, Nieri M.  Fourteen-year outcomes of coronally advanced flap for root coverage: follow-up from a randomized trial. J Clin Periodontol 2011;38(8):715-720. Bilateral recessions 2 mm in 10 patients were assigned to root planing (control) or polishing (test), both in combination with coronally advanced flap, and evaluated after 3 months and 1, 5 and 14 years. One patient dropped out after 1 year; in the remaining patients, recession depth after 14 years was 0.9 ± 1.2 mm and 0.9

± 0.9 mm for test and control sites, respectively, and there was a significant interaction between treatment and keratinized tissue. There was a slight increase in recession over time in both groups.


Levin L, Ofec R, Grossmann Y, Anner R.  Periodontal disease as a risk for dental implant failure over time: a long-term historical cohort study. J Clin Periodontol 2011;38(8):732-737.

All patients treated over a 10-year period at a periodontal clinic were assessed; the cohort comprised 736

patients with 2,336 implants. The mean follow-up time was 54.4 ± 35.6 months and the overall implant survival rate was 95.9%. At 108 months, Kaplan-Meier estimates for cumulative survival rate were 0.96, 0.95 and 0.88 for healthy, moderate chronic periodontitis and severe chronic periodontitis, respectively. Severe chronic status was shown to be a significant risk factor for implant failure after 50 months follow-up, and smoking showed a near-significant effect.


Roccuzzo M, Bonino F, Bonino L, Dalmasso P.  Surgical therapy of peri-implantitis lesions by means of a bovine-derived xenograft: comparative results of a prospective study on two different implant surfaces. J Clin Periodontol 2011;38(8):738-745.

Crater-like defects with probing depth 6 mm around either TPS (control) or SLA (test) implants in 26

patients  were  filled  with  bovine-derived  xenograft  following  debridement  of  the  implant  surfaces  and treatment with 24% EDTA and 1% chlorhexidine. A significant reduction in probing depth was found after 1 year in both groups (2.1 ± 1.2 mm and 3.4 ± 1.7 mm for control and test implants, respectively. Complete defect fill was observed around 3/12 test implants but no control implants, and several deep pockets were still observed around control implants. Significant reductions in bleeding on probing were also observed for both groups. The clinical outcome may therefore be influenced by implant surface characteristics.


Cosyn J, Eghbali A, De Bruyn H, Collys K, Cleymaet R, De Rouck T.  Immediate single-tooth implants in the anterior maxilla: 3-year results of a case series on hard and soft tissue response and aesthetics. J Clin Periodontol 2011;38(8):746-753.

Single-tooth replacement was performed in 30 patients who had thick gingival biotype, ideal gingival level

and intact socket walls. Implants were immediately placed with mucoperiosteal flap elevation and graft material between the implant and socket wall. An initial provisional restoration was replaced by a cemented crown after 6 months. Implant survival, complications and hard and soft tissue conditions were evaluated after 3 years, and aesthetic outcomes were assessed using the Pink and White Esthetic Scores (PES/WES). After 3 years, 25 patients could be assessed, and the implant survival rate was 96%. Mean mesial and distal bone loss was 1.13 mm and 0.86 mm, respectively, and the mean probing depth was 3.17 mm. Mesial papillae showed significant re-growth between 1 and 3 years. In five cases, PES < 8 and WES < 6 indicated aesthetic failures, while another five showed almost perfect outcomes; aesthetics were acceptable in the remainder of cases.



Journal of Oral Implantology

Vol. 37 No. 3 (June 2011)

Zahid  TM,  Wang  B-Y,  Cohen  RE.   Influence  of  bisphosphonates  on  alveolar  bone  loss  around

osseointegrated implants. J Oral Implantol 2011;37(3):335-346.

The treatment records of 362 patients (227 women, 135 men) who received implants over an 11-year period were examined; the analysis included implant characteristics, surgical complications and implant failure. A total of 51 implants were found to be placed in patients receiving bisphosphonates; the implant-based and subject-based success rates were 94.11% and 88.46%, respectively, and there was a significant association between use of bisphosphonates and implant thread exposure; no association with implant failure or thread exposure was found for any other parameters evaluated.



Journal of Periodontology Vol. 82 No. 6 (June 2011) Vol. 82 No. 7 (July 2011)

Yilmaz S, Kabadayi C, Ipci SD, Cakar G, Kuru B. Treatment of intrabony periodontal defects with platelet-rich

plasma versus platelet-poor plasma combined with a bovine-derived xenograft: a controlled clinical trial. J Periodontol 2011;82(6):837-844.

A total of 79 intrabony defects (≥ 3 mm intrabony component) in 20 patients were treated with bovine-derived

xenograft in combination with either platelet-rich plasma (PRP) or platelet-poor plasma (PPP). Periodontal parameters were recorded at baseline and after 12 months. Similar results were observed in both groups for probing depth reduction, recession, attachment gain, clinical bone gain and radiographic bone gain, with no significant differences between the groups. The similar outcomes suggested that PPP may demonstrate similar clinical efficacy to PRP when platelet counts are taken into consideration.


Aimetti M, Romano F, Guzzi N, Carnevale G. One-stage full mouth disinfection as a therapeutic approach for generalized aggressive periodontitis. J Periodontol 2011;82(6):845-853.

One-stage  full-mouth  disinfection  was  performed  in  27  patients  with  advanced  generalized  aggressive

periodontitis, and clinical and biological parameters were assessed at baseline and after 3 and 6 months. Subgingival samples from moderate and deep pockets were analysed for periodontal pathogens. Significant improvements in all parameters were observed, with significant reductions in probing depth and clinical attachment level. A 61% reduction in probing depth was noted for sites with initial probing depth of ≥ 5 mm, and 40% of moderate pockets and 27% of deep pockets proved to be free from periodontal pathogens.


Sridharan S, Ganiger K, Satyanarayana A, Rahul A, Shetty S.  Effect of environmental tobacco smoke from smoker  parents  on  gingival  pigmentation  in  children  and  young  adults:  a  cross-sectional  study.  J Periodontol 2011;82(7):956-962.

The study evaluated 153 non-smoking patients who had at least one parent who was a smoker. The subjects

were divided into three groups according to age and the smoking history of the parents was assessed. Gingival  pigmentation  was  also  assessed  in  the  participants.  A  significant  prevalence  of  gingival pigmentation was found in passive smokers, and increased levels of urinary cotinine were observed in all three age groups; the 19-24-year-old age group showed the highest levels.


Gomes-Filho IS, Coelho JMF, da Cruz SS, Passos JS, de Freitas COT, Farias NSA, da Silva RA, Pereira

MNS,   Lima   TL,   Barreto   ML.    Chronic   periodontitis   and   C-reactive   protein   levels.  J  Periodontol


Of 359 subjects assessed in this study, 144 were admitted to hospital due to a first myocardial infarction, 80 were in hospital for other reasons, and 135 were living in the community. Each subject completed a demographic/lifestyle questionnaire and received clinical periodontal examinations and anthropometric assessments. C-reactive protein levels, plasma glucose levels and lipid profiles were evaluated, together with blood tests for infectious or inflammatory conditions. Subjects were characterised as having or not having chronic periodontitis. Mean C-reactive protein levels were significantly higher in the chronic periodontitis group; the likelihood of increased C-reactive protein was 2.26-fold higher in this group (95% CI:

1.30 to 3.93), taking into account age, education level, sex, smoking, HDL cholesterol and diabetes.


Rosalem  W,  Rescala  B,  Teles  RP,  Fischer  RG,  Gustafsson  A,  Figueredo  CM.  Effect  of  non-surgical treatment on chronic and aggressive periodontitis: clinical, immunologic, and microbiologic findings. J Periodontol 2011;82(7):979-989.

Clinical data and samples of gingival crevicular fluid and subgingival plaque were collected at baseline and 3

months after periodontal treatment in 20 patients with generalised chronic and 14 patients with generalised aggressive periodontitis. Levels of bacterial species were measured and levels of IL-1β, IL-4, IL-8 and IFN-γ were analysed, as was elastase activity. Significant clinical improvements were noted in both groups after periodontal therapy, and there were significant reductions in the proportions of orange and red bacterial complexes and an increase in Actinomyces species. Elastase activity was significantly reduced in shallow and  deep  sites  in  aggressive  periodontitis,  and  in  deep  sites  in  chronic  periodontitis.  No  significant differences in the response to therapy between generalised chronic and aggressive periodontitis were found.


Cochran DL, Jackson JM, Jones AA, Jones JD, Kaiser DA, Taylor TD, Weber HP, Higginbottom FL, Richardson JR, Oates T. A 5-year prospective multicenter trial of non-submerged dental implants with a titanium plasma-sprayed surface in 200 patients. J Periodontol 2011;82(7):990-999.

A total of 626 implants were placed in 200 patients in a prospective multicentre trial. Two implant designs, both with a TPS surface, were used according to the clinical indication; non-submerged hollow cylindrical implants were used in the maxillary anterior, and non-submerged solid screw implants were used in the mandible. One early failure (before prosthesis delivery) and three late failures (at 6, 12 and 18 months) occurred, giving survival and success rates of 99.4% and 92.5%, respectively, after 5 years. There were no serious adverse events and patient satisfaction was good to excellent for 96.1% of implants in relation to aesthetics.


Lee S-J, Oh T-J, Bae T-S, Lee M-H, Soh Y, Kim B-I, Kim HS.  Effect of bisphosphonates on anodized and heat-treated titanium surfaces: an animal experimental study. J Periodontol 2011;82(7):1035-1042.

A   total   of   36   implants   with   three   different   surfaces   (machine-turned,   anodized/heat-treated   or

anodized/bisphosphonate-treated) were placed in both tibiae of 18 rats, and removal torque and μCT were performed after 2 and 4 weeks. Peri-implant bone tissue was evaluated for type I collagen and osteocalcin expression. The anodized/bisphosphonate-treated implants showed the highest removal torque after both 2 and 4 weeks, followed by the anodized/heat-treated and machine-turned implants; values in the latter group were significantly lower than the other groups. Type I collagen and osteocalcin expression were significantly higher in the anodized/bisphosphonate-treated group, and μCT images showed a denser appearance. Surface loading with bisphosphonate therefore appeared to improve the degree of osseointegration around implants.



Quintessence International

Vol. 42 No. 7 (July/August 2011) Vol. 42 No. 8 (September 2011)

Stratul S-I, Sculean A, Rusu D, Didilescu A, Kasaj A, Jentsch H. Effect of smoking on the results of a

chlorhexidine digluconate treatment extended up to 3 months after scaling and root planing a pilot study.

Quintessence Int 2011;42(7):555-563.

Periodontal parameters were evaluated in 42 smoking and 85 non-smoking patients with generalized chronic periodontitis at baseline and 1 and 3 months after scaling and root planing, during which 0.2% chlorhexidine digluconate solution and 1% chlorhexidine digluconate gel were used, and a 0.2% solution was used for 3 months. Significant improvements in the periodontal variables were observed in both groups after 1 and 3 months. The maximum changes between 1 and 3 months for clinical attachment level and probing depth were significantly different between the groups, but no significant differences in the other parameters were observed. The use of chlorhexidine digluconate may therefore lead to significant improvements after non- surgical periodontal therapy in both smokers and non-smokers.


Bremer  F,  Grade  S,  Kohorst  P,  Stiesch  M.   In  vivo  biofilm  formation  on  different  dental  ceramics.

Quintessence Int 2011;42(7):565-574.

Five volunteers wore acrylic appliances to which specimens of different ceramic materials were attached: these were veneering glass-ceramic, lithium disilicate glass-ceramic, yttrium-stabilised zirconia (Y-TZP), hot isostatically pressed (HIP) Y-TZP, and HIP Y-TZP with 25% alumina. The appliances were worn for 24 hours, after which the biofilms adhering to the specimens were evaluated. The HIP Y-TZP ceramic showed the lowest surface coating and biofilm thickness, while lithium disilicate glass-ceramic showed the highest values. Zirconia therefore showed low plaque accumulation, making it a promising material for various indications.


Tallarico  M,  Vaccarella  A,  Marzi  GC,  Alviani  A,  Campana  V.