International Journal of Periodontics & Restorative Dentistry, 05/2012

This investigation was designed to evaluate the healing response to the laser-assisted new attachment procedure (LANAP). Eight patients presenting with 12 teeth predetermined to be surgically extracted were enrolled and consented to treatment with full-mouth LANAP therapy. LANAP surgical therapy consisted of a first pass with a 360-µm fiber diameter, laser settings with verified output of 4.0 W and energy density of 1,965 mJ/mm2, 100-µs pulse duration, and 20 Hz applied from the gingival margin to the base of the pocket parallel to the root surface and moved laterally and apically to remove the diseased pocket epithelium. The teeth were aggressively scaled and root planed with piezo ultrasonic instrumentation. A second pass was performed with a 360-µm fiber diameter, laser settings with verified output of 4.0 W and energy density of 1,965 mJ/mm2, 650-µs pulse duration, and 20 Hz applied from the apical extent of the bone defect to the gingival margin. After 9 months of healing, en bloc biopsy extractions were provided. Ten teeth were analyzed histologically to assess the periodontal wound healing. Five teeth evidenced a degree of periodontal regeneration with new cementum, periodontal ligament, and alveolar bone. One tooth had new attachment with new cementum and inserting collagen fibers, and four teeth healed via a long junctional epithelium. LANAP therapy should be further investigated with long-term clinical trials to compare the stability of clinical results to conventional therapy. This report provides evidence that LANAP therapy can induce periodontal regeneration.

This article reports on the efficacy of a technique involving expansion of edentulous ridges of less than 3 mm in width by means of a planned green stick fracture of the labial plate and simultaneous implant placement without the need for membranes. This retrospective case series includes long-term results from 21 patients with 36 sites and 37 implants with a mean follow-up of 4 years, 5 months from the date of restoration. Freeze-dried bone allograft was used in 22 sites (61%) to augment the ridge. Reentry at stage-two surgery confirmed the preservation of the displaced labial plate after implant integration. Three implants were removed prior to the planned uncovering because of incomplete healing of the overlying gingival tissue; therefore, the survival rate of the labial advancement was 92%. No implants failed after definitive prosthetic loading; therefore, the cumulative survival rate of loaded implants was 100%. No significant bone loss was detected at the final follow-up visit. Follow-up after loading ranged from 9 to 148 months. Advancement of the labial plate with simultaneous implant placement to gain horizontal ridge width dimension was shown to be a reliable and practical procedure for single-tooth sites where other grafting methods are often difficult.

Free connective tissue graft techniques are currently considered the most predictable surgical method for root coverage. However, morbidity associated with secondary graft sites has generated interest in other methods. The purpose of this study was to investigate the feasibility of a novel surgical approach to root coverage: the pinhole surgical technique (PST). This retrospective study examined the results of PST used for 43 consecutive patients on 121 recession sites, of which 85 were Class I or II and 36 were Class III. Mean initial recession for all sites was 3.4 ± 1.0 mm. The mean assessment period was 18 ± 6.7 months. No secondary surgical site was necessary, and only bioresorbable membrane or acellular dermal matrix was used as graft material. PST required no releasing incision, sharp dissection, or suturing (when a bioresorbable membrane was used). Only one incision of 2 to 3 mm (for entry) was necessary for the entire procedure. Predictability of PST for Class I and II sites, measured as frequency of complete root coverage, was 81.2%. Effectiveness of PST for Class I and II sites, measured as mean percent defect reduction, was 94.0% ± 14.8%. When data from Class I, II, and III sites were combined, predictability and effectiveness were 69.4% and 88.4% ± 19.8%, respectively. The mean duration per procedure was 22.3 ± 10.1 minutes. The mean level of patient subjective esthetic satisfaction was 95.1% and was realized within a mean 7.34 ± 13.5 days. Postoperative complications were minimal. These results indicate that PST holds promise as a minimally invasive, predictable, effective, and time- and cost-effective method for obtaining optimal patient-based outcomes.

The lack of a standardized classification to differentiate the various degrees of peri-implantitis has resulted in confusion when interpreting the results of studies evaluating the prevalence, treatment, and outcomes of therapy. The purpose of this paper is to propose a classification for peri-implantitis based on the severity of the disease. A combination of bleeding on probing and/or suppuration, probing depth, and extent of radiographic bone loss around the implant is used to classify the severity of peri-implantitis into early, moderate, and advanced categories. The rationale and method of measurement for the classification are presented and discussed. This classification should help in communication between researchers and clinicians and thus provide a better understanding of peri-implantitis.

In an attempt to reduce postextraction alveolar bone resorption, ridge preservation grafting procedures with or without resorbable membranes have become standard-of-care treatments following tooth removal. This prospective case series examined histologic and clinical outcomes following socket grafting with a syringeable paste allograft and a resorbable extracellular matrix membrane at three different time periods following postextraction grafting: 6, 12, and 24 weeks. At each time period, bone core specimens were retrieved for microscopic examination, and implants were placed. Following prosthetic restoration, implants were monitored under long-term occlusal function. At all three time periods, histologic results revealed active bone regeneration. At 6 weeks, localized areas of woven bone were evident, although nonmineralized osteoid was the dominant feature. At 12 and 24 weeks, regenerated woven bone dominated the histologic landscape, with increasing amounts evident in the latter specimens. Regardless of when implants were placed following grafting, implant survival under function occurred.

No studies have been published concerning the comparison between gingival and papillary recession in the maxillary esthetic zone (including incisors, canines, and premolars) regarding age and sex. This study addressed this issue. Adults (n = 250) with fully erupted permanent dentitions, healthy gingivae, and natural teeth in the maxillary esthetic area were included. Visual examinations were performed to detect papillary and gingival recession. Space evident apical to the contact area of adjacent teeth was recorded as papillary recession; a cementoenamel junction visible coronal to the buccal gingival margin was recorded as gingival recession. All sites with papillary and gingival recession were significantly associated with age; however, only some sites with gingival and papillary recession were associated with sex. Papillary recession was more severe than gingival recession in both extent and prevalence in subjects older than 30 years of age. Thus, papillary recession may be expected to be a more common esthetic dental problem.

This article updates the results of a prospective clinical trial of press-fit, sintered, porous-surfaced dental implants placed in the posterior mandible of partially edentulous patients. Implants used had overall lengths (including transgingival collar regions) of 7 or 9 mm with designed intrabony lengths (lengths of sintered surface in contact with bone) of 6 or 8 mm. Forty-eight implants were placed in 24 patients, the majority of which replaced molar teeth, and the mean crown-toroot ratio was 1.4. Over 10 years of implant function, 2 patients with 3 implants died and 3 patients with 4 implants were lost to follow-up because of infirmity or relocation. The survival and success rates were both 95.5%. Two implants failed; the mean cumulative crestal bone loss (measured from the implantabutment interface) for the remaining implants was 1.2 mm. Crestal bone loss was not affected by the crown-to-root ratio, prosthesis design, or whether an implant was the most distal unit in a sextant. However, there was a trend for greater crestal bone loss when implants were opposed by implants rather than by natural teeth.

The aim of this study was to evaluate whether there is a positive correlation between the width of the zone of gingival keratinized tissue and its thickness. Maxillary right canines, lateral incisors, and central incisors of 60 patients (30 men, 30 women) between the ages of 20 and 35 years were examined. Using an endodontic spacer with a rubber cursor and a digital caliper of 0.01-mm resolution, the values of the width of the zone of gingival keratinized tissue and gingival thickness were obtained. It was observed that the lateral incisor has the largest mean zone of gingival keratinized tissue (5.54 ± 1.09 mm), followed by the central incisor (4.62 ± 1.02 mm) and canine (4.32 ± 1.33 mm). The mean gingival thickness was greater in the central incisor (1.17 ± 0.20 mm), followed by the lateral incisor (1.04 ± 0.24 mm) and canine (0.87 ± 0.27 mm). No statistically significant difference was verified for the mean width of the zone of gingival keratinized tissue and gingival thickness between men and women. A positive correlation between gingival thickness and width of the zone of gingival keratinized tissue was observed in the maxillary canine (Pearson r = 0.398, P .05), lateral incisor (Pearson r = 0.369, P .05), and central incisor (Pearson r = 0.492, P .05). In patients 20 to 35 years of age, there was a positive correlation between gingival thickness and width of the zone of gingival keratinized tissue for the maxillary right canine, lateral incisor, and central incisor.

The aim of this study was to measure implant stability quotient (ISQ) values in grafted sites during 5 years of follow-up. Sixteen patients received a total of 36 implants inserted in sites treated with autologous bone (group A) or porcine bone in addition to autologous bone (group B). In both groups, resonance frequency analysis (RFA) values increased during the observation period. At 2 months, statistical analysis showed significantly lower ISQ values for group B than for group A (P = .0134) and significantly higher ISQ values in the mandible than in the maxilla (P = .0251). RFA measurements suggested stable long-term results for implants inserted in both groups.

This paper presents a method for measuring gingival volume through the analysis of the tooth crown area of anterior teeth using digital photographs and computer analysis. Three photographs were taken and manipulated to simulate gingival overgrowth to perform a numeric correlation of change in gingival volume. The proposed method is easy, noninvasive, and provides rich data for statistical analysis or clinical classification of the gingival condition.

Functional ankylosis of dental implants in alveolar bone is the current criterion to assess implant osseointegration from a biomechanical standpoint. In this literature review, the clinical significance and current available assessments of implant stability are discussed. However, these assessments demonstrate a variety of correlations to peri-implant structures and as such are difficult to translate to the clinical arena. Calculating the effective stiffness from homogenization of peri-implant tissues appears to be a more reliable approach to predict implant stability in preclinical studies, but the structure-biomechanical relationship remains a clinical challenge. Despite the limitations in functional assessments of dental implant stability and oral implant biomechanics, this review highlights some emerging approaches to adapt these measures to clinical situations.

The aim of this prospective study was to evaluate the concept of intraoral welding as a suitable technique for fabricating a fixed restoration for the edentulous maxilla the day of surgery using standard and zygomatic implants. Ten consecutive patients (four men, six women; mean age, 62.3 ± 11.6 years) were involved in this study, each of whom had an edentulous atrophic maxilla and received two standard and two zygomatic implants. All implants were loaded immediately with a fixed prosthesis supported by an intraorally welded titanium framework. Definitive abutments were connected to the implants, and a titanium bar was welded to them using an intraoral welding unit. This framework was used to support the definitive prosthesis, which was fitted the day of implant placement. Patients were checked for swelling, pain, and framework stability at 1, 3, 6, and 12 months. A total of 20 immediately loaded standard and 20 zygomatic implants were used. The cases included in this study achieved a 100% prosthetic success rate at the 12-month follow-up. No fracture or radiographically detectable alteration of the welded frameworks was noticed. It is possible to successfully rehabilitate the edentulous atrophic maxilla with a permanently fixed prosthesis supported by an intraorally welded titanium framework attached to standard and zygomatic implants the day of surgery.

The purpose of this in vivo study was to verify the accuracy of cone beam computed tomography (CBCT) in the measurement of horizontal periodontal bone defects. Six patients with periodontitis were selected, and eight maxillary molars were assessed. A total of 72 measurements were performed. The images were obtained using CBCT, and measurements were performed using the appropriate software. Periodontal bone defects were measured during the surgical intervention using the cementoenamel junction as the reference point. There were no statistically significant differences between clinical and CBCT measurements (P > .05). CBCT accurately reproduced the clinical measurement of horizontal periodontal bone defects.

The long-standing assumption that active infection is a contraindication for immediate implant placement has been challenged recently. High implant survival rates have been reported even when implants were placed immediately in infected extraction sockets and provisionalized within 36 hours. To further evaluate the impact of nonocclusal loading on implants placed in cleaned periodontically or endodontically infected extraction sites, this retrospective study examined the results of 77 implants placed in 63 patients and followed for between 3 and 24 months. Initial primary stability was achieved for all implants, and reverse torque testing at 3 and 4 months postoperatively showed 76 of 77 implants (98.7%) to be successfully osseointegrated.

The purpose of this investigation was to evaluate the effect of osteoprotegerin (OPG)-modified autologous bone marrow stromal cells (BMSCsOPG) combined with guided tissue regeneration on bone regeneration of periodontal window defects. pSecTag/2B-OPG was transduced into BMSCs by Lipofectamine 2000. The expression of OPG protein in the BMSCs was detected by immunocytochemistry and Western blotting. Periodontal window defects (4 × 4 × 3 mm) were surgically created in the buccal aspect of the mandibular premolars and randomly assigned to receive BMSCsOPG-PLGA (cells + material + OPG), BMSCs-PLGA (cells + material), PLGA (material), or root planing only (negative control). The animals were euthanized at 6 weeks postsurgery for histologic analysis, and histologic measurements were then performed. Results showed that the height of new alveolar bone and cementum and the formation of new connective tissue were significantly greater in the experimental group than in the control groups after 6 weeks (P .05), whereas there was no significant difference between the material control and negative control (P > .05). These findings suggest that delivery of BMSCsOPG-PLGA may be a viable approach to promote bone regeneration of periodontal bone defects.