International Journal of Periodontics & Restorative Dentistry, 05/2018

The aim of this study was to document the performance of a novel technique (OnlyOne), involving immediate restoration of postextraction implants supporting a partial or full-arch restoration. A retrospective analysis of patients with at least 3 years of follow-up was performed. Implants were tilted mesiodistally and vestibulopalatally according to the available bone. Prosthetically guided definitive abutments were connected at surgery and never disconnected. Anorganic bovine bone grafting was done to preserve the buccal bone and the ridge contour. Patients received a screw-retained provisional prosthesis within 24 hours of surgery and a final screw-retained prosthesis within 1 year. Prostheses emerged from natural soft tissue. Clinical and radiographic evaluation was routinely performed. A total of 70 patients received 153 implants in fresh extraction sockets. The mean follow-up was 38.0 ± 3.0 months (range 36 to 51 months). One implant failed at the 3-year follow-up. Implant survival was 99.3%. Marginal bone level change averaged -0.68 ± 1.2 mm at the last radiographic control. Immediate placement and restoration of implants designed for high primary stability with a definitive abutment placed at surgery and final screw-retained prosthesis with no artificial gingiva is a viable procedure with excellent medium-term outcomes.

The objective of this study was to examine wound healing in extraction sockets following ridge preservation and the outcome of implants placed in those sites. Extraction sockets (N = 31) were grafted with anorganic bovine bone mineral (ABBM) and covered with dense polytetrafluoroethylene membrane. Bone cores obtained during implant placement were examined histologically and histomorphometrically. Percentages of vital bone and residual graft were 37.5% ± 21.3% and 12.5% ± 8.9%, respectively. New vital bone showed a negative correlation with patient age. Percentage of vital bone formation in sockets was correlated with neither postgraft wound healing time nor peri-implant marginal bone level.

This study aimed at evaluating the influence of veneering of the submucosal part of zirconia abutments on biologic, radiographic, technical, and esthetic outcomes in single-tooth implant sites. A total of 20 patients each received a zirconia abutment to support an all-ceramic implant-supported crown. Patients were randomly assigned to the test group (n = 10), in which the abutment was modified with pink veneering ceramic, or to a control group (n = 10) without further submucosal customization. Patients were followed up at baseline (after the insertion of the final reconstruction) and yearly thereafter. Wilcoxon-Mann-Whitney test was used to evaluate the difference between the medians of the two groups, whereas Wilcoxon signed rank test allowed calculation of the differences per group. At 3 years, 18 patients could be recalled. The survival rates reached 100% (implant level) and 95% (restorative level). Two implant crowns experienced minor chipping, one in each group. No significant intergroup differences were observed regarding mucosa thickness between the groups. The width of keratinized tissue did not change significantly over time in either group. The radiographic evaluation showed no significant differences regarding the marginal bone level at any timepoint between the groups. Changes over time reached -0.27 mm (SD 0.41, median −0.26) for the test group and -0.21 mm (SD 0.30, median −0.31) for the control group. Statistical significance was not reached within or between the groups. Veneering of the submucosal part of zirconia abutments did not significantly influence biologic and technical outcomes in single-tooth implant sites up to 3 years.

The purpose of this study was to evaluate the survival of 525 composite indirect restorations in premolars and molars after a follow-up of 20 years. For each patient, the following variables were recorded and analyzed: age, sex, smoking status, presence of plaque according to O'Leary index, and presence of bruxism. For each restoration, the following variables were collected: restoration class, tooth type (premolar or molar), and restoration material. Mean 20-year survival rate of composite restorations was 57%, ranging from 44% to 75%. The Kaplan- Meier method demonstrated a probability of survival at 10 years of 80% and 90%. Surviving restorations kept their clinical characteristics extremely well, as assessed on the basis of the United States Public Health Service criteria. The results of this study demonstrate the efficacy of indirect composite restorations, confirming their reliability as a posterior prosthetic clinical option.

The objective of this case series was to describe surgical approaches that can be used to efficiently and effectively treat peri-implantitis as measured by positive changes in clinical parameters. A total of 32 patients with 45 implants were treated surgically to eliminate peri-implantitis. Baseline clinical parameters measured prior to surgery were compared to those made 6 months postsurgery to evaluate the efficacy of each procedure. Implants demonstrating signs of peri-implantitis were treated by one of three approaches: (1) regenerative surgery, (2) osseous resective surgery, or (3) apically repositioned flap surgery. In all instances, the exposed implant surfaces were debrided and decontaminated. Relative to baseline values, regenerative surgery yielded statistically significant changes in probing depth (PD) (7.21 ± 0.27 mm to 4.09 ± 0.14 mm) and percentage of sites exhibiting bleeding on probing (BoP) (100.0% ± 0.0% to 10.6% ± 3.3%) as measured at the 6-month recall visit (P ≤ .05). The decrease in probing depth was not dependent on the type of graft material used (P ≤ .05). Resective surgery yielded statistically significant changes in PD (5.86 ± 0.23 mm to 3.63 ± 0.14 mm) and the percentage of sites exhibiting BoP (100.0% ± 0.0% to none) (P ≤ .05). Finally, the implants treated via apically repositioned flap surgery demonstrated statistically significant decreases (P ≤ .05) in both PD (6.79 ± 0.27 mm to 4.32 ± 0.16 mm) and BOP (100.0% ± 0.0% to 14.3% ± 6.7%) (P ≤ .05). Regenerative, resective, and apically positioned flap surgery can be utilized to successfully treat peri-implantitis.

This case series evaluated the healing of deep intrabony defects treated with a combination of enamel matrix derivative and autologous particulate bone harvested from the buccal and lingual/palatal cortical plate with a Piezosurgery device. A total of 15 defects with a predominantly one- or two-wall component were consecutively treated in 15 patients with advanced chronic periodontitis. In all selected sites, the three-wall component was ≤ 25% of the total defect depth. Clinical and radiographic parameters were recorded at baseline and 12 and 24 months postoperatively. All defects showed favorable clinical and radiographic outcomes at the 24-month follow-up. The probing depth reduction was 4.4 ± 1.6 mm, and more than 50% of the defects presented clinical attachment level gain of at least 5 mm. The bone fill was 3.1 ± 1.6 mm.

Root coverage in the anterior mandible is challenging due to a thin gingiva, shallow vestibule, and/or high frenulum. This case series reports on the flattening of the root surface to create a new emergence profile conceived with a two-step surgical approach aimed at providing more space for the graft, increasing the thickness of the gingival margin, and getting extra soft tissue in the open area of the recession. A total of 10 patients with recessions affecting the mandibular incisors were treated to evaluate this two-step approach, which included odontoplasty of the root followed by a connective tissue graft. At 1 year, the mean coverage was 100% in Class II recessions, and 80.5% in Class III. The mean keratinized tissue increase was 5.80 ± 1.75 mm. This surgical approach could be proposed as an alternative when treating mandibular anterior teeth with root prominence or with a buccally tilted position.

The objective of this study was to present a novel procedure for cortical bone repositioning (CBR) that maintains a secure space under the periosteum by replacement of the lateral cortex via fixation, employing titanium screws. Seven systemically healthy patients presenting with horizontal alveolar bone defects in radiographs and CT images were enrolled for CBR technique for horizontal alveolar bone augmentation. A lateral cortical bone block was cut in the defects and freed from the original bony surface. A screw was inserted into the block, and the block was placed laterally to allow fixation. The block was checked for adequate stability, and the flap was closed after creation of periosteal releasing incisions to ensure tension-free closure. There were no complications, and 16 implants were placed uneventfully. Preoperative bone width in the defect area was 3.28 mm; the postoperative 4-month bone width in the same area was 6.46 mm. The mean implant stability quotient (ISQ) at placement was 68. At the secondary operation for changing to a healing abutment, the mean ISQ was 72. All patients were functionally and esthetically rehabilitated with implant-supported dentures. CBR technique is a simple procedure without the use of any biomaterials or devices. The main advantage of this technique in comparison to autogenous grafts is the lack of donor site issues. This technique has the possibility of inducing the patient's regenerative ability for bone healing.

The aim of this study was to evaluate the health or pathology of bilateral maxillary sinuses using cone beam computed tomography (CBCT) with a lowdose protocol, and to analyze potential influencing factors. The study included only CBCT scans with complete visualization of bilateral maxillary sinuses. The scans were taken using a medium to large field of view and a low-dose protocol, as indicated by the manufacturer. CBCT images were analyzed with regard to the morphology of the sinus membrane and surrounding bone twice by one observer. Influencing factors such as age, sex, or status of the remaining dentition in the posterior maxilla, including periodontal and endodontic parameters, were evaluated. The study included 134 CBCT scans (268 maxillary sinuses). Using a low-dose protocol, intraobserver reliability of the measurements was almost perfect (kappa value range 0.875 to 1). More than half the sinuses evaluated (63.1%) did not show visible morphologic changes. The most frequently identified pathologic appearance was a flat, shallow thickening of the sinus membrane of > 2 mm (47 positive findings [17.5%]). Only 15 (5.6%) sinuses were associated with teeth with endodontic treatment and/or pathology, and 10 (3.7%) with teeth exhibiting periodontal pathology. CBCT scans with a low-dose protocol can be recommended as a feasible adjunctive tool to evaluate health or pathology of the maxillary sinuses prior to surgical interventions such as sinus floor augmentation. Of all morphologic changes seen, only a small portion of the cases were considered to need further medical diagnosis/treatment.

This study evaluated the influence of timing after endodontic treatment and type of resin cement used on the bond strength of fiber posts to epoxy resin-obturated canals. A total of 80 bovine incisor roots were divided into four groups (n = 20). Glass fiber posts were cemented at two different times, immediately or 7 days after endodontic treatment, using either a dual-curing resin cement (RelyX ARC, 3M ESPE) or a self-adhesive resin cement (RelyX U200, 3M ESPE). Following post cementation, the samples were cross-sectioned into slices containing root dentin, cement, and fiber post at the cervical, mid, and apical root thirds. The push-out test was performed on a universal testing machine. Three-way analysis of variance for randomized blocks showed no significant effect within the triple interaction (P = .394) or between the double interactions cement-timing (P = .395), cement-root thirds (P = .996), and timing-root thirds (P = .331). The main factor cement revealed a significant effect, showing that regardless of the timing and root third, RelyX ARC provided significantly higher bond strength values than U200. Regardless of root third and timing, the dual-curing resin cement showed higher bond strength to root dentin when the canals were filled with epoxy resin-based cement.

Immediate implant placement and provisional restoration has become a popular and well-supported method of tooth replacement in the maxillary anterior dentition. Aside from achieving osseointegration, esthetic demands have grown with better understanding of the behavior of hard and soft tissues following this mode to therapy. Stability of gingival contours, texture of the surrounding tissues, and blending of prosthetic components with the natural dentition are critical for successful outcomes to be maintained long-term. Increasing soft tissue thickness at the time of therapy plays an important role in this regard. A technique combining the proven principles of immediate implant placement and provisional restoration with hard and soft tissue augmentation using nonautogenous materials is demonstrated with comparisons to nongrafted, temporized historical controls.

A prospective case series was performed to examine the clinical and radiographic changes to peri-implant tissues 2 years after resective treatment of peri-implantitis, including an apically positioned flap, osteoplasty, and implantoplasty. In total, 25 patients with 40 titanium implants of multiple brands and advanced peri-implantitis were included in this study. After 2 years, all implants survived, mean probing pocket depth was reduced from 8.7 to 3.3 mm, and bone level remained stable in 92.5% of the implants. Findings suggest the approach of an apically positioned flap combined with osteoplasty and implantoplasty as an effective and reliable strategy against peri-implantitis, although increased gingival recessions may limit its application in esthetic areas.

The purpose of this study was to histologically evaluate new bone formation and dimensional soft tissue changes of two different healing protocols (16 weeks and 32 weeks) using deproteinized bovine bone mineral (DBBM) covered with collagen matrix (CM) for alveolar ridge preservation in the anterior esthetic zone prior to dental implant placement. Compared to baseline, both treatments yielded statistically significant differences in several clinical parameters and in the microarchitecture of the native bone and in the newly formed bone in the augmented sites. However, the protocol at 32 weeks determined greater new vital bone formation and fewer dimensional tissue changes.

Lateral periodontal cysts (LPCs) are rare odontogenic cysts of developmental origin. A 52-year-old man presented with an asymptomatic gingival swelling located between the mandibular left canine and first premolar, both of which were vital. Radiography showed a well-circumscribed radiolucent area and loss of the lamina dura around the tooth socket in contact with the lesion and of the interproximal buccal bone. The lesion was enucleated. The defect was immediately grafted with a 1:1 mixed autologous and heterologous bone graft covered with a collagen membrane. Histology confirmed the diagnosis of LPC. At 12- and 24-month clinical and radiologic follow-up, complete bone and periodontal healing was found, with no sign of recurrence.

The purpose of this study was to evaluate whether the use of removable partial dentures affects the periodontal status of abutment teeth. An observational crosssectional study was done on a sample of patients rehabilitated with removable partial dentures (2010 to 2013). At a recall appointment, a clinical examination was done to collect data related to the rehabilitation and periodontal status of the abutment teeth. Of 145 invited patients, 54 attended the requested follow-up appointment (37.2%). Mean patient age was 59.1 years, and the study population was 42.6% male and 57.4% female. The mean follow-up time for the prosthesis was 26 months. Abutment teeth had higher values in all periodontal variables (P .001). Occlusal clasps had the worst results in relation to clasps with a gingival approach (P .005). Significant differences were also found in mandibular abutment teeth of Kennedy Class I and II compared to Class III (P .048). The periodontal status of the abutment teeth of removable partial dentures is affected by these rehabilitations. A recall program for these patients involving removable prosthodontics and periodontology appointments is mandatory.

The aim of this study was to evaluate different cleaning procedures for customized laser-microtextured titanium abutments. A total of 20 customized lasermicrotextured abutments were randomized into four groups: no cleaning (control group), ultrasonic treatments + autoclave cycle (group 1), ultrasonic treatments + argon plasma (group 2), and only argon plasma (group 3). Surface contaminants were assessed through scanning electron microscopy and energy-dispersive x-ray spectroscopy microanalysis. In the control group, 99.96% of the abutment surfaces were contaminated with organic and inorganic pollutants. Group 3 showed the second highest contamination percentage, with almost 23% of the analyzed surfaces polluted. Samples in groups 1 and 2 were almost clean, with negligible traces of microparticles (0.009% and 0.047% of the surfaces were contaminated, respectively). These results were statistically significant for differences between control and test groups, and between groups 1 and 2 in comparison to 3 (P .001). Abutment decontamination with argon plasma alone might not be as effective on laser-microtextured surfaces as other cleaning protocols.

Bicortical dental implantation technique was regarded as an alternative to internal sinus lift technique with bone grafting in dental implantation in atrophic maxillae. The purpose of this retrospective study was to evaluate the survival rates and bone stability of 6- and 10-mm implants in the posterior maxilla using bicortical dental implantation techniques after 1 to 5 years of prosthetic loading. A total of 53 patients received posterior maxillary implant treatments. Of these, 31 patients received bicortical dental implantation (group A), and 25 patients received traditional implantation (group B). Three patients received an implant with bicortical engagement and another implant without bicortical engagement. The survival rates were calculated, and the marginal bone heights were measured on radiographs at baseline and follow-up. The survival rate of group A was 100%. In contrast, the survival rate of group B was only 74.68%, with survival rates of 51.85% in the 6-mm implant subgroup and 93.33% in the 10-mm implant subgroup. In terms of variations in implant marginal bone heights, a significant difference was found only between the 6-mm subgroups in groups A and B. Significant intrasinus bone gain was found on the mesial and distal sides of the implants in group A. Application of bicortical dental implantation techniques with 6-mm implants could achieve better clinical outcomes in atrophic posterior maxillae.