A Multicenter Retrospective Clinical Study with Up-to-5-Year Follow-up Utilizing a Method that Enhances Bone Density and Allows for Transcrestal Sinus Augmentation Through Compaction Grafting.

PURPOSE: To evaluate the effectiveness and predictability of a novel biomechanical, minimally invasive bone instrumentation technique that enhances bone density through compaction grafting, called osseous densification, and allows for transcrestal sinus membrane elevation and augmentation with simultaneous implant placement. MATERIALS AND METHODS: Patients who were consecutively treated with the bone densification and transcrestal sinus augmentation technique and were followed up in three treatment centers between May 2012 and September 2017 were included in this retrospective study. The summary statistics are presented as means for continuous variables and percentages for categorical variables. RESULTS: In total, 222 patients with 261 implants were included in the final clinical analysis. The included follow-up period ranged from 6 to 64 months with a mean of 35 months. The subsinus residual bone height at baseline was 5.4 mm (SD: 1.9). Following the sinus augmentation, a significant vertical increase of 7 mm (SD: 2.49) was observed. No sinus membrane perforations and no late implant failures were observed from 6 up to 64 months follow-up, yielding a cumulative implant survival rate of 97%. CONCLUSION: This osseous densification technique for maxillary implant site preparation with transcrestal sinus augmentation and simultaneous implant placement led to favorable clinical outcomes with up to 64 months of follow-up.

A network meta-analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation.

BACKGROUND: A wide selection of Interdental Oral Hygiene (IOH) aids is available to consumers. Recommendations for selection are, however, limited by the lack of direct comparisons in available studies. We aimed to assess the comparative efficacy of IOH aids using Bayesian Network Meta-Analysis (BNMA). METHODS: Two independent reviewers performed a systematic literature review of randomized clinical trials assessing IOH aids, based on a focused question. Gingival inflammation (Gingival Index (GI), Bleeding-on-probing (BOP)) was the primary outcome and plaque and probing depth were secondary outcomes A random-effects arm-based BNMA model was run for each outcome; posterior medians and 95% credible-intervals (CIs) summarized marginal distributions of parameters. RESULTS: A two-phase selection process identified 22 trials assessing 10 IOH aids as brushing adjuncts. Interdental brushes (IB) yielded the largest reduction in GI (0.23 [95% CI: 0.09, 0.37]) as toothbrushing adjuncts, followed by water-jet (WJ) (0.19 [95% CI: 0.14, 0.24]). Rankings based on posterior probabilities revealed that IB and WJ had the highest probability of being "best" (64.7% and 27.4%, respectively) for GI reduction, whereas the probability for toothpick and floss being the "best" IOH aids was near zero. Notably, except for toothpicks, all IOH aids were better at reducing GI as compared with control. CONCLUSIONS: BNMA enabled us to quantitatively evaluate IOH aids and provide a global ranking of their efficacy. Interdental brushes and water-jets ranked high for reducing gingival bleeding, whereas toothpicks and floss ranked last. The patient-perceived benefit of IOH aids is not clear because gingival inflammation measures are physical indicators of periodontal health.

Complete Coverage of a Class III (RT2) Gingival Recession With the Combination of a Free Subepithelial Connective Tissue Graft and a Laterally Positioned Flap.

INTRODUCTION: Gingival recession (GR) presents a major concern for patients, especially when associated with tooth sensitivity or esthetic concerns. CASE PRESENTATION: This report describes the complete coverage of a Class III GR with the combination of a free subepithelial connective tissue graft and a laterally positioned flap. After treatment for GR of the mandibular right canine with 12 mm of clinical attachment loss, there was complete coverage and an increase in keratinized gingiva. CONCLUSION: A promising technique is presented that yielded 100% defect coverage and gingival tissue enhancement.

Soft Tissue Surgical Procedures for Optimizing Anterior Implant Esthetics.

Implant dentistry has been established as a predictable treatment with excellent clinical success to replace missing or nonrestorable teeth. A successful esthetic implant reconstruction is predicated on two fundamental components: the reproduction of the natural tooth characteristics on the implant crown and the establishment of soft tissue housing that will simulate a healthy periodontium. In order for an implant to optimally rehabilitate esthetics, the peri-implant soft tissues must be preserved and/or augmented by means of periodontal surgical procedures. Clinicians who practice implant dentistry should strive to achieve an esthetically successful outcome beyond just osseointegration. Knowledge of a variety of available techniques and proper treatment planning enables the clinician to meet the ever-increasing esthetic demands as requested by patients. The purpose of this paper is to enhance the implant surgeon's rationale and techniques beyond that of simply placing a functional restoration in an edentulous site to a level whereby an implant-supported restoration is placed in reconstructed soft tissue, so the site is indiscernible from a natural tooth.

Risk Indicators of Papillary Recession in the Anterior Maxilla.

PURPOSE: The interdental papilla is the portion of the gingiva that occupies the space between two adjacent teeth. When papillary recession occurs, an array of problems arises ranging from phonetics to food impaction and esthetic concerns. The aim of this study was to identify risk indicators for visible papillary recession in the anterior maxilla among a Caucasian population utilizing an advanced analytical approach. MATERIALS AND METHODS: A dataset of 211 adult dentate Caucasian patients that had undergone intraoral assessment of midline papillary recession and extra-oral assessment of visible papillary recession during maximum ("Duchenne") smile was utilized. An enhanced analytical approach was employed to identify risk indicators for papillary recession. RESULTS: Approximately one-third of the participants (38%) demonstrated papillary recession during maximum smile ("visible papillary recession"). An association between sex (male preference) and visible papillary recession was found in this sample population, while age was found to be a risk indicator for papillary recession in individuals over 65 years of age. CONCLUSIONS: Visible midline papillary recession in the maxilla is a highly prevalent clinical entity in Caucasian individuals, thus the development of efficacious treatment modalities for papillary regeneration is necessary. Findings of the present study on risk indicators for visible papillary absence, namely sex and age, may facilitate clinicians in treating patient with compromised interdental aesthetics as well as identifying patients that are in high risk for loss of interdental tissues. CLINICAL SIGNIFICANCE: Findings of the present study on risk indicators for visible papillary absence, namely sex and age, indicate the need for careful assessment and meticulous treatment planning with respect to preservation of the interdental tissues. The consideration of these risk indicators can help dentists to identify patients at risk for papillary recession.

Association between low-dose aspirin and periodontal disease: results from the continuous national health and nutrition examination survey (NHANES) 2011-2012.

AIM: Low-dose aspirin has been hypothesized as being a potential host modulatory agent for periodontitis treatment. We investigated the relationship between low-dose aspirin use and periodontitis prevalence in the continuous National Health and Nutrition Examination Survey, 2011-2012. METHODS: We analysed n = 2335 adult men and women who received a full-mouth periodontal examination and responded to an aspirin use questionnaire. Periodontal disease was defined as severe, moderate or mild according to established case definitions. Mean full-mouth probing depth, attachment loss and tooth loss were also considered. Low-dose aspirin was defined by any self-reported, physician prescribed aspirin use of ≤162 mg/day. RESULTS: Participants had mean age (SE) 55.8 years (0.42). The prevalences of periodontitis and low-dose aspirin use were 49.5% and 25% respectively. In multivariable logistic regression models controlling for age, sex, race, socioeconomic variables and comorbidities, the odds ratios [95%CI] for moderate or severe periodontitis among low-dose aspirin users (versus non-users) were: 0.91 [0.56-1.50] and 1.06 [0.74-1.50] respectively. Results were unchanged among participants without diabetes or coronary heart disease. CONCLUSIONS: Within the limitations of this cross-sectional study we conclude that low-dose aspirin is not associated with prevalent periodontal status in a nationally representative sample of US adults.

Evaluation of the bone regeneration potential of bioactive glass in implant site development surgeries: a systematic review of the literature.

OBJECTIVES: The aim of this systematic review was to assess the efficacy of bioactive glass (BG) in bone regeneration for implant site development procedures. MATERIAL AND METHODS: The following specific question was formulated with reference to Population, Intervention, Control, Outcomes (PICO): "In persons that undergo bone regeneration surgeries for implant site development, what histological outcomes does the use of BG yield, alone or in combination with AB, compared to positive or negative controls?". RESULTS: The 1st phase of screening yielded 400 titles and abstracts. A total of 12 studies reporting on the use of bioactive glass were scrutinized for inclusion in the final analysis and 5 studies were selected for qualitative synthesis of the results. Data were divided into two categories: ridge preservation (n = 2) and sinus augmentation (n = 3). CONCLUSIONS: Within the limitations of this review, it can be concluded that (1) the combination of BG with AB chips in a 1:1 ratio is an efficacious treatment modality for direct sinus augmentation, with histological results comparable to 100 % AB. (2) When used for ridge preservation, BG yields a high percentage of true bone regeneration. (3) Currently, no reliable controlled studies report histological outcomes from the use of BG in ridge augmentation procedures. CLINICAL RELEVANCE: Clinicians may consider BG bone substitutes as efficacious alternatives for ridge preservation and sinus augmentation surgical procedures. Further controlled clinical studies are warranted to determine if bone-to-implant contact is improved in BG-grafted sites versus controls.

A systematic review of observational studies evaluating implant placement in the maxillary jaws of medically compromised patients.

BACKGROUND: Even though the efficacy of implant treatment and the excellent success rates that modern implant surfaces yield remain unchallenged, there is limited information available on implant success rates in medically compromised patients. PURPOSE: The aim of this systematic review was to evaluate the survival of implants placed in the maxillary jaws of medically compromised patients. MATERIALS AND METHODS: Two reviewers using predefined selection criteria performed an electronic search complemented by a manual search, independently and in duplicate. RESULTS: After the final selection, 11 studies reporting on four distinct medical conditions were included out of 405 potentially eligible titles. In detail, three studies reported on implants placed in diabetic patients, six on implants placed in patients with a history of oral cancer, one on implants in patients with a history of epilepsy, and one on implants in patients with autoimmune rheumatoid arthritis. CONCLUSIONS: Placement of maxillary implants in medically compromised patients seems to yield acceptable survival rates. Implant survival in well-controlled diabetic patients, patients diagnosed with rheumatoid arthritis, and patients treated for severe epilepsy is comparable to that in healthy patients. Implants placed in the maxillae of patients treated for oral cancer may attain osseointegration less predictably than in the mandible.

Prognostic factors in periodontal therapy and their association with treatment outcomes.

During the incipient steps of periodontal treatment, clinicians are usually asked to predict the prognosis of teeth with compromised periodontium. The aim of this literature review was to investigate the association between periodontal Prognosis, Tooth Loss and risk indicators, such as smoking and genetics. Results showed that the definition of good prognosis has much higher predictability than the one for questionable prognosis. Several risk indicators for periodontal prognosis and tooth loss are discussed as well as different definitions of questionable prognosis and their success in predicting tooth loss. In conclusion, the major focus of future studies should be to construct simplified prognostic models with high predictability that will increase the confidence of dentists and periodontists when assigning teeth prognosis.

A clinical and radiographic case series of implants placed with the simplified minimally invasive antral membrane elevation technique in the posterior maxilla.

The aim of the present case series was to evaluate a simplified minimally invasive transalveolar sinus elevation technique utilizing calcium phosphosilicate (CPS) putty for hydraulic sinus membrane elevation. The simplified minimally invasive antral membrane elevation technique is based on the application of hydraulic pressure via a viscous bone graft that acts as an incompressible fluid. In this retrospective study, 21 patients (mean age: 48.5 ± 12 years) consecutively treated with the simplified minimally invasive transalveolar sinus elevation technique were evaluated. 28 tapered implants were placed in posterior maxillary sites with less than 6 mm of residual bone height as determined radiographically on cone beam volumetric tomographs. No sinus membrane perforations were noted and none of the patients complained of symptoms of sinusitis post-operatively (0%). The mean gain in bone height post-operatively was 10.31 ± 2.46 mm (p < 0.001). All implants successfully integrated (100% success rate) and were loaded with cement-retained prostheses. The proposed technique is a simple, efficacious, minimally invasive approach for sinus elevation that can be recommended for sites with at least 3 mm of residual height.

Prevalence of maxillary midline papillae recession and association with interdental smile line: a cross-sectional study.

The objectives of this study were to record the prevalence and degree of absence of the maxillary midline interdental papilla and the proportion of patients displaying the maxillary midline papilla during maximum smile among a Caucasian population. Papillary recession was found in 46.4% of study participants (n = 211), while the prevalence of visible recession among maxillary midline papilla during maximum smile was 38.4%, which was statistically significantly less than that of patients diagnosed intraorally with loss of papillary height (P < .001). Correlations between age and level of lip line as well as age and visible papillary recession were identified for individuals over 65 years of age. The high prevalence of midline papillary recession in the maxilla found in this population suggests that loss of papillary height constitutes a substantial clinical challenge.