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ITI Literature Update July – August 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
. 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 threefold
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 extractio
n. 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 periimplantitis.

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.
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
. 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 followup.
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
. 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

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
. 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
. 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

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 abovine-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

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

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 nonsurgical
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

Tallarico M, Vaccarella A, Marzi GC, Alviani A, Campana V. A prospective case-control clinical trial
comparing 1- and 2-stage Nobel Biocare TiUnite Implants: resonance frequency analysis assessed by
Osstell Mentor during integration
. Quintessence Int 2011;42(8):635-644.

A total of 35 1-stage and 26 2-stage implants were placed in 29 patients; the implants were Mk III Groovy
implants (32) or NobelSpeedy Groovy implants (29). Implant stability was assessed by ISQ using the Osstell
Mentor device at implant placement and after 8 and 12 weeks. No significant differences in ISQ were found
between the groups at any time point; however, there was a significant difference in the mandible at 12
weeks, but not at baseline or 8 weeks. The overall implant survival was 100%, and high ISQ values were
observed at all times.

Công ty Implant
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