Contour Augmentation for Periodontal Defects (CAPD) for Periodontally Compromised Teeth with Horizontal Bone Loss: A Prospective Cohort Assessment at 1 Year.

This study assessed the effects of buccal contour augmentation for periodontally compromised teeth with horizontal bone loss. A total of 30 subjects were divided into Group A or Group B (n = 15 subjects per group). Group A received open-flap debridement (OFD) with buccal contour augmentation using deproteinized bovine bone mineral (DBBM), jointly referred to as contour augmentation for periodontal defects (CAPD; test group). Group B received only OFD (control group). Bleeding on probing (BOP), clinical attachment level (CAL), probing depth (PD), gingival recession (GR), keratinized mucosa width (WKM), keratinized mucosa thickness (TKM), and labial cortical plate thickness were compared at baseline and 1 year. BOP, CAL, PD, and GR did not show significant differences. TKM increased by 1.76 mm for Group A but decreased by 1 mm for Group B. WKM increased from 2.86 ± 0.4 mm to 3.6 ± 0.71 mm (P < .001) and from 2.93 ± 0.32 mm to 3 ± 0.7 mm (P = 0.5) for Groups A and B, respectively, which showed statistical significance. Labial cortical plate thickness increased from 0.94 ± 0.3 mm to 1.95 ± 0.54 mm (P < .001) for Group A but decreased from 0.87 ± 0.45 mm to 0.68 ± 0.31 mm for Group B. Visual analog scale scores for pain perception showed no difference between the two groups. CAPD for periodontally compromised teeth improves WKM and TKM. Long-term analyses are needed to determine its benefits in daily clinical practice.

Buccal Contour Grafting for Periodontally Compromised Teeth with Horizontal Bone Loss: Prospective Cohort Assessment at 1 Year.

The effects of buccal contour augmentation, for periodontally compromised teeth with horizontal bone loss, was assessed in this study. 30 subjects were divided into group A (open flap debridement [OFD] with buccal contour augmentation using deproteinized bovine bone mineral [DBBM]), jointly referred to as Contour augmentation for Periodontal Defects (CAPD); and group B (OFD alone). Bleeding on probing (BOP), clinical attachment level (CAL), probing depth (PD), gingival recession (GR), width (WKM) and thickness (TKM) of keratinized mucosa and labial cortical plate thickness were compared at baseline and 1-year. BOP, CAL, PD and GR did not show significant differences. TKM increased by 1.76 mm for group A, while decreased by 1 mm for group B. WKM increased from 2.86 ± 0.4 mm to 3.6 ± 0.71 mm (p<0.001) and 2.93 ± 0.32 mm to 3 ± 0.7 mm (p = 0.5) for groups A and B respectively, which showed a statistical significance. Labial cortical plate thickness increased from 0.94 ± 0.3 mm to 1.95 ± 0.54 mm (p<0.001) for group A, while decreased from 0.87 ± 0.45 mm to 0.68 ± 0.31 mm for group B. Visual analog scale score for pain perception showed no difference between the 2 groups. Contour augmentation (CAPD) with DBBM for periodontally compromised teeth improves WKM and TKM. Long-term analyses are needed to determine its benefits in daily clinical practice.

Comparative Assessment of Bovine Versus Porcine Xenograft for Augmentation: A Randomized Prospective Cohort Study.

This study compared the bone turnover and volume stability of bovine-derived xenografts (Cerabone) vs porcine-derived xenografts (MinerOss XP) in horizontal ridge augmentation (HRA) for veneer contour and extraction socket preservation (ESP), with a 6-month follow-up. Participants were divided into Group 1 (HRA + bovine), Group 2 (HRA + porcine), Group 3 (ESP + bovine), and Group 4 (ESP + porcine). Buccolingual ridge width was measured on CBCT scans at baseline and 6 months. Representative histologic core samples were taken from the ESP groups at 6 months. Each group comprised 10 subjects (40 subjects total). The buccolingual width for Groups 1 and 2 increased from 5.43 ± 1.82 mm and 5.75 ± 1.64 mm (P = .36) to 7.75 ± 1.91 mm and 8.75 ± 1.38 mm (P = .03), respectively. However, the buccolingual widths for Groups 3 and 4 decreased from 6.3 ± 1.26 mm and 6.74 ± 1.29 mm (P = .16) to 5.8 ± 1.21 mm and 6.61 ± 1.56 mm (P = .01), respectively. Significantly lower dimensional changes were noted in Group 4 at 6 months. Porcine xenografts serve as a stable biocompatible osteoconductive bone substitute and expand a clinician's choice of bone grafts in dental applications.

Three-Dimensional Alveolar Bone Assessment of Mandibular First Molars with Implications for Immediate Implant Placement.

The aim of this retrospective study was to evaluate the alveolar dimensions of the mandibular molar using cone beam computed tomography (CBCT) for immediate implant placement. The width of buccal (WB) and lingual (WL) bone; width of interradicular bone 2 and 4 mm apical to the furcation and at the apex (IRB2, IRB4, and IRBA, respectively); and distance to the inferior alveolar nerve from the furcation (IAN-F) and mesial (IAN-M) and distal (IAN-D) roots were evaluated from CBCT records of 126 subjects (200 mandibular first molars). Mean WB (0.84 ± 0.39 mm) and WL (2.71 ± 1.17 mm) measurements showed significant differences (P = .003). Differences between IAN-F, IAN-M, and IAN-D measurements averaged at 14.14 ± 2.57 mm, 4.31 ± 1.06 mm, and 4.61 ± 1.02 mm, respectively. IRB2, IRB4, and IRBA dimensions were 1.93 ± 0.65 mm, 2.54 ± 0.9 mm, and 4.46 ± 1.91 mm, respectively. The findings of the study demonstrate the alveolar bone morphology of the mandibular first molar and the need for CBCT scans for proper treatment planning for immediate implant placement.

Quantitative Assessment of the Edentulous Posterior Maxilla for Implant Therapy: A Retrospective Cone Beam Computed Tomographic Study.

AIM: Dimensional changes of the alveolar bone are often noted in horizontal and vertical planes as a sequel to tooth extraction, particularly in the maxillary posterior region due to alveolar bone resorption combined with pneumatization of the sinus. The aim of this retrospective study was to quantitatively assess the maxillary residual alveolar ridge using cone beam computed tomography (CBCT) scans. MATERIALS AND METHODS: A total of 349 edentulous sites from 250 CBCTs were evaluated. The apico-coronal bone height and bucco-palatal crest width were measured in sagittal and coronal slices, respectively. Additionally, the obliqueness of the sinus floor at the edentulous sites was also evaluated. RESULTS: One hundred and twelve (55.45%) of the molar and 74 (54.42%) of the premolar sites had a horizontal ridge dimension < 6 mm, whereas 137 (67.83%) of the molar and 61 (44.86%) of the premolar sites showed an apico-coronal height < 8 mm. Furthermore, 183 (54.14%) of the evaluated sites had an oblique sinus floor morphology. CONCLUSION: Additional augmentative procedures are thus required in a high percentage of the population at the edentulous maxillary posterior site for rehabilitation using a standard dimension implant. This study stresses on the need for a three-dimensional CBCT prior to implant surgery for proper treatment planning.

Squamous cell carcinoma in association with dental implants: an assessment of previously hypothesized carcinogenic mechanisms and a case report.

Although dental implants have seen tremendous clinical success over the past few decades, there are some worrying reports in literature describing squamous cell carcinoma (SCC) in close association with dental implants. This article also provides a critical assessment of the published literature relating to the presence of carcinoma in association with dental implants, analyzing the previously published and hypothesized carcinogenic responses to an implant, to try and come to a conclusion regarding the plausibility and clinical risk for cancer formation in association with dental implants. An unusual case of an SCC noted in close proximity to a dental implant is also presented. A systematic search was conducted using Medline (PubMed), Cochrane Database, and Google Scholar with the search terms "cancer," "squamous cell carcinoma," "dental implant," "SCC," "peri-implantitis," "oral cancer," and "implantology" and using multiple combinations using Boolean operators "or" and "and." The search was not limited to dental literature; orthopedic and biomedical literature was also included. The results were then hand screened to pick out the relevant articles. In total, 14 previous published reports were found, where 24 dental implants were reported to be associated with SCC. Not all the reported patients had a history of cancer, but contributory factors such as smoking were found. An analysis of the biological plausibility of previously proposed carcinogenic mechanisms, such as corrosion, metallic ion release, and particulate debris, did not support the etiologic role for dental implants in cancer development, and the standardized incidence ratio was found to be extremely low (0.00017). Peri-implantitis should be assessed cautiously in patients receiving implants who have a previous history of cancer. Dental implants are a safe treatment modality based on the published data, and any change in surgical protocol is not mandated.

Holding up the oral health safety net: the role of National Health Service Corps alumni dentists in North Carolina.

BACKGROUND: Access to oral health care among low income populations is a growing problem. The National Health Service Corps (NHSC) might increase the supply of dentists motivated to provide services for this population. OBJECTIVE: To determine if North Carolina dentists who began a service obligation with the NHSC in 1990-1999 continued to provide care for underserved populations and if they differ from non-NHSC alumni primary care dentists who started practice in the state during that same period. METHODS: All 19 NHSC alumni and 50 comparison dentists were surveyed by mail. NHSC alumni also responded to selected items in a telephone follow-up interview. The two groups were compared using difference of means tests and multivariate contingency tables. RESULTS: National Health Service Corps alumni were more likely to be African-American (38%vs. 10%), work in safety net practices (84%vs. 23%), and see more publicly insured patients (60%vs. 19%) than comparison dentists. Yet their job satisfaction was comparable to non-NHSC alumni dentists. Analyses suggested that current practice in safety net settings is affected by dentists' race, altruistic motivations and previous NHSC participation. CONCLUSION AND POLICY IMPLICATION: Targeted recruitment of African-American dentists and others wanting to work in underserved communities could amplify the effectiveness of the financial incentive of NHSC loan repayment and induce dentists to remain in 'safety net' settings.

Clinical decisions and the quality of evidence available for dental implants.

As more types of implants have become available, clinicians have been faced with the task of choosing a specific implant from a wide array of options for a given clinical situation, which has led to an ever-increasing need for clinical evidence to help clinicians choose an implant. This article highlights the need for clinicians to look beyond the claims proposed by manufacturers because several of those claims are not substantiated by randomized controlled trials but by in vitro data alone. Recent advances in clinical evidence-based decision portals might enable busy clinicians to adopt an evidence-based approach to choosing implant systems. Also, the standardization of study-reporting criteria might enable comparisons across implant systems in the future.

Long-term follow-up and tomographic assessment of an intrabony defect treated with enamel matrix derivative.

BACKGROUND: Enamel matrix derivative (EMD) has an extensive documentation of use in the treatment of periodontal defects. Digital volume tomography (DVT) has been in use in dental medicine since the late 1990s, with a major advantage of decreased radiation and cost-effectiveness compared to conventional computed tomography (CT). To the best of our knowledge, there is no peer-reviewed report documenting long-term tomographic assessment of an intrabony defect treated with EMD alone. METHODS: In this case report, we document the long-term response of an isolated intrabony defect treated with flap surgery plus EMD and monitored for 30 months with a DVT scan. We also compare clinical and radiographic findings for the defect at 7 and 30 months postoperatively. RESULTS: With regenerative treatment, significant improvements in probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were observed both short and long term. No recession occurred, and papillary heights were maintained throughout the monitoring period. Although intraoral radiography suggested bone fill at the defect site at 7 months, DVT confirmed that the intrabony defect was eliminated at 30 months. CONCLUSIONS: Treatment of an intrabony defect with surgery plus EMD demonstrated excellent bone fill as assessed with conventional radiographic and tomographic examinations performed over 30 months. Larger studies are needed to further assess the use of DVT imaging as an appropriate adjunctive diagnostic tool for evaluating the responses of intrabony defects to regenerative techniques.