Reliability assessment between clinical attachment loss and alveolar bone level in dental radiographs.

BACKGROUND: The clinical attachment level (CAL) and radiographically assessed bone levels are used to assess the loss of periodontal tissue support in periodontitis, a chronic, multifactorial inflammatory disease of the periodontium. However, few studies have been done to study the relationship between these two parameters. According to our knowledge, this is the first study investigating the relationship between the two measurements using intraclass correlation analysis. AIM: The aim of the study is to investigate the relationship between CAL and radiographically assessed bone level in teeth affected with periodontitis. METHODS: A retrospective cross-sectional study was conducted by selecting a sample of 880 periodontal sites in 104 periodontitis patients, aged 25-60 years. CAL and peri-apical radiographs of the selected sites were obtained from the computerized patient records. The distance from the cemento-enamel junction (CEJ) to the base of the alveolar bone level (ABL) was measured. The data was analyzed using SPSS. RESULTS: Intraclass correlation analysis (ICC) revealed a moderate degree of reliability between CAL and CEJ to ABL measurements. The average ICC was 0.68 with a 95% confidence interval of 0.53-0.77 (p < .001) indicating moderate to good reliability. Comparing the types of teeth, the central incisors, particularly the lower central incisors showed the highest ICC values (ICC: 0.822, CI: 0.77-0.86) indicating good reliability while the premolar and molars showed poor to moderate agreement (Maxillary premolars ICC: 0.464, CI: -0.18-0.74; maxillary first molar ICC: 0.516, CI: -0.154-0.772; mandibular first premolar ICC: 0.662, CI: 0.269-0.782; mandibular first molar ICC: 0.625, CI: 0.31-0.82). A moderate correlation existed between the radiographic and the clinical assessments (r = 0.5, p < .001). CONCLUSION: Despite the fact that significant varying levels of reliability has been found between CAL and radiographic bone level, both the clinical and radiographic examinations should be performed for the accuracy of diagnosis.

Accuracy assessment of a novel semiautomatic method evaluating bone grafts around the dental implant: an in vitro and ex vivo study.

The present study aimed to evaluate the accuracy and repeatability of morphological contour interpolation (MCI)-based semiautomatic segmentation method for volumetric measurements of bone grafts around dental implants. Three in vitro (one with a cylinder and two with a geometrically complex form) and four ex vivo models (peri-implant cylinder-shaped bone defect) were created for imitating implant placement with simultaneous guided bone regeneration (GBR) procedure. Cone beam computerized tomography (CBCT) scans of all models were obtained with the same parameters. For volumetric measurements, the actual volumes of bone grafts in models were assessed by computer-aided calculation and both manual and MCI-based methods were utilized as test methods. The accuracy of the methods was evaluated by comparing the measured value and the actual volume. The repeatability was assessed by calculating the coefficients of variation of repeated measurements. For the accuracy of three dimensional (3D) reconstructions, the computer-designed corresponding models were set as the reference and the morphological deviation of 3D surface renderings created by two methods were evaluated by comparing with reference. Besides, measurement time was recorded and a comparison between the two methods was performed. High accuracy of the MCI-based segmentation method was found with a discrepancy between the measured value and actual value never exceeding - 7.5%. The excellent repeatability was shown with coefficients of variation never exceeding 1.2%. The MCI-based method showed less measurement time than the manual method and its 3D surface rendering showed a lower deviation from the reference.

Nitrogen-containing bisphosphonate therapy-Part II: Assessment of alveolar bone tissue inflammatory response in rats-A blind randomized controlled trial.

This study aimed to evaluate the alveolar bone tissue inflammatory response in rats undergoing zoledronic acid therapy. The study sample was composed of 28 Wistar rats. Animals from the test group GTa received a weekly intraperitoneal dose of 0.2 mg/kg of zoledronic acid for 3 weeks, while test group GTb received the same dose for 8 weeks. A physiological saline dose, equivalent to that of the medication, was administered to the controls in groups GCa and GCb. A defect was created in the dental crown of the lower first molars using a drill to simulate pulp and periapical injury. Data were evaluated regarding image grey levels by cone-beam computed tomography and histologically by assigning scores for the presence of inflammatory infiltrate, type of infiltrate, vascularization, bone necrosis and dental resorption. Grey levels in the 3-week therapy group (GTa) showed more pronounced changes in comparison with those seen in the GCa group (P < 0.05). Evaluation of the scores demonstrated no association between any of the variables amongst the groups (>0.05). However, bone remodelling decreased in the groups receiving the medication. Bone necrosis was present more frequently in group GTb than in the control group GCb. The results suggest that the drug interfered in the reaction capacity of the alveolar bone tissue as test group GTa showed higher grey levels in comparison to the control group GCa. In addition, there was less bone remodelling activity, with the appearance of bone necrosis zones and intense acute inflammatory infiltrate associated with the 8-week therapy group GTb.

Mesiodistal dental movement toward remodeled edentulous alveolar ridge: Digital model assessment.

INTRODUCTION: The aims of this study were to compare the changes in posterior dental inclination and angulation, and the posterior tooth crown sizes and alveolar ridge thicknesses consequent to the orthodontic procedures of closing and opening of mandibular first molar edentulous spaces. METHODS: The sample comprised 16 patients (4 men, 12 women) with an initial mean age of 34.17 years and unilateral or bilateral absence of mandibular permanent first molars. The space closure group (SCG) comprised 12 hemiarches with a mandibular first molar edentulous space varying from 2 to 7 mm, orthodontically treated with space closure. The space opening group (SOG) comprised 14 quadrants with a mandibular first molar edentulous space varying from 7.1 to 12 mm, orthodontically treated with space reopening for prosthetic replacement. Digital dental models were obtained before treatment and after space closure or opening, and posterior tooth angulation and inclination, cervico-occlusal crown height, and alveolar ridge thickness were evaluated. Interphase and intergroup comparisons were performed with dependent t tests and t tests, respectively (P <0.05). RESULTS: Mandibular second molar uprighting and changes in buccolingual inclination of the posterior teeth were similar in the groups. The second molar cervico-occlusal crown height increased in the SCG and decreased in the SOG. The alveolar ridge thickness increased in the SCG and remained stable in the SOG. CONCLUSIONS: The only significant intergroup differences were that the second molar cervico-occlusal crown height and the alveolar ridge thickness increased in the SCG, and decreased and remained stable in the SOG.

Socket Preservation using Enzyme-treated Equine Bone Granules and an Equine Collagen Matrix: A Case Report with Histological and Histomorphometrical Assessment.

AIM: To histologically assess the effectiveness of a socket-preservation technique using enzyme-treated equine bone granules as a bone-graft material in combination with an equine collagen matrix as a scaffold for soft-tissue regeneration. BACKGROUND: Enzyme-treated equine bone granules and equine collagen matrix recently have been developed to help overcome alveolar bone deficiencies that develop in the wake of edentulism. CASE REPORT: The patient had one mandibular molar extracted and the socket grafted with equine bone granules. The graft was covered with the equine collagen matrix, placed in a double layer. No flap was prepared, and the gingival margins were stabilized with a single stitch, leaving the matrix partially exposed and the site to heal by secondary intention. The adjacent molar was extracted 1 month later, and that socket was left to heal by secondary intention without any further treatment. Three months after each surgery, an implant was placed and a biopsy was collected. The two biopsies underwent histological processing and qualitative evaluation. Histomorphometric analysis was also performed to calculate the percentage of newly formed bone (NFB) in the two cores. Healing at both sites was uneventful, and no inflammation or other adverse reactions were observed in the samples. Soft-tissue healing by secondary intention appeared to occur faster at the grafted site. The corresponding core showed a marked separation between soft and hard tissue that was not observed in the core from the nongrafted site, where soft-tissue hypertrophy could be observed. Newly formed bone at the grafted and nongrafted sites was not significantly different (27.2 ± 7.1 and 29.4 ± 6.2% respectively, p = 0.45). CONCLUSION: The surgical technique employed in this case appeared to facilitate postextraction soft-tissue healing by second intention and simplify soft-tissue management. CLINICAL SIGNIFICANCE: Using a collagen-based matrix to cover a postextraction grafted site may facilitate second intention soft-tissue healing and proper soft-tissue growth.

Assessment of Alveolar Bone Status in Middle Aged Chinese (40-59 Years) with Chronic Periodontitis--Using CBCT.

OBJECTIVE: This study used con-beam computed tomography (CBCT) to investigate the prevalence and severity of alveolar bone loss in middle-aged (40-59 years) Chinese with chronic periodontitis. MATERIALS AND METHODS: The study group comprised 145 dentate individuals aged 40 to 59 years residing in China who suffered from chronic periodontitis. CBCT and the application of NNT software were used to examine the level and location of alveolar bone loss. RESULTS: The study revealed that 40-59 year old patients with chronic periodontitis had severe bone loss. At 5,286 sites (34.7%), alveolar bone loss was mild; severe alveolar bone loss was found at 5,978 sites (39.2%). A comparison of bone loss in different jaws revealed that the area with the highest degree of bone loss was on the lingual side of the maxillary molar (56.3 ± 7.2%), and that the area with the lowest degree was primarily on the lingual side of the mandibular canine (27.5 ± 6.3%). There was a lower degree of alveolar bone loss in males than females. Differences were observed when comparing the incidence of bone loss between males and females (P < 0.05). Menopause in females and smoking in both genders may affect the level of bone loss. Male smokers experienced a greater degree of bone loss (41.67 ± 5.76%) than male non-smokers (32.95 ± 4.31%). A 42.23 ± 6.34% bone loss was found in menopausal females versus 31.35 ± 3.62% in non-menopausal females. CONCLUSIONS: The study revealed that different sites and teeth exhibited a diverse degree of bone loss. In middle-aged patients with chronic periodontitis, the highest degrees of bone loss in the incisors, premolars, and molars were on the lingual side, mesial side and lingual side, respectively. Menopause in females and smoking may affect the level of bone loss.

The Concept of Platform Switching to Preserve Peri-implant Bone Level: Assessment of Methodologic Quality of Systematic Reviews.

PURPOSE: To assess the methodologic quality of systematic reviews on the effect of platform switching upon peri-implant marginal bone loss. MATERIALS AND METHODS: An electronic literature search of several databases was conducted by two reviewers. Articles were considered for quality assessment if they met the following inclusion criterion: systematic reviews that aimed at investigating the effect of platform switching/mismatch on marginal bone levels around dental implants. Two independent examiners evaluated the review publications using two quality-ranking scales (assessment of multiple systematic reviews [AMSTAR] and Glenny checklist). Descriptive statistics were used to summarize the results, and Cohen's kappa coefficients were calculated to appraise interrater agreement of each checklist. RESULTS: Overall, five systematic reviews (including three of them with meta-analysis) were evaluated. The mean AMSTAR score ± standard deviation was 8.4 ± 2.6 (range, 4 to 11), and the mean Glenny score was 10.8 ± 2.9 (range, 6 to 14), showing high statistical correlation (rs = 0.98, P = .005). Cohen interexaminer test yielded values of κ = 0.88 and κ = 0.86 for the AMSTAR and Glenny checklist, respectively. The AMSTAR items rated positive in 78%, whereas 18% met the criteria for "no" and 4% were "not applicable." Only one review article met all criteria. Items of the Glenny checklist rated positive in 73% and negative in 27%. All but one study with the lowest quality scores (finding no difference) demonstrated a clinical benefit of implant platform switching in preserving the peri-implant marginal bone loss. CONCLUSION: According to the quality-ranking scales appraised, substantial methodologic variability was found in systematic assessment of benefits with the platform switching concept to preserve peri-implant bone level. High-quality systematic reviews, however, generally favored platform switching over platform matching.

Nitrogen-containing bisphosphonate therapy: assessment of the alveolar bone structure in rats - a blind randomized controlled trial.

This study aimed to assess the effect of zoledronic acid exposure on structures of the alveolar bone of rats. The sample was composed of 42 male Wistar rats. Animals in the T1 and T2 groups received weekly doses of 0.2 mg/kg intraperitoneal zoledronic acid for 3 weeks, while animals in the T3 group received the same treatment for 8 weeks. The control groups C1, C2 and C3 received equivalent doses of saline. The first upper molars of Wistar rats in the C2, T2, C3 and T3 groups were extracted. Cone-beam computerized tomography scans were performed, and the image density was analysed by grey levels. The presence and type of inflammatory infiltrate, vascularization and bone necrosis were assigned by histological qualitative scores. Histomorphometric analysis of bone density was performed in the groups without extraction. No significant differences were found in the bone grey density estimated by grey-level value and histomorphometric analysis between the C1 and T1 groups (P > 0.05). The grey levels in the T3 group were lower (P < 0.05) than in the C3 group, corresponding to the bone defect. Histological assessments showed the presence of bone necrosis in the T3 group and lower levels of bone remodelling in the test groups (T2 and T3) compared to the control groups (C2 and C3). The results of qualitative analyses did not differ significantly between the groups (P > 0.05). Zoledronic acid-exposed animals showed maxillary changes including reduced grey levels, the presence of bone necrosis and a higher prevalence of inflammatory signs.

Comparative assessment of the interfacial soft and hard tissues investing implants and natural teeth in the macaque mandible.

OBJECTIVES: The aim of this study was to conduct a comparative qualitative and quantitative assessment of the interfacial soft and hard tissues investing implants and natural teeth. MATERIALS AND METHODS: The test sample consisted of six adult healthy male Macaca fascicularis with three-unit splinted crowns, each crown supported by an Ankylos screw-shaped titanium implant. These implants were placed in the mandibular premolar-second molar region, one side by an immediate-loading (IL) and the other by delayed-loading (DL) protocol. The animals were sacrificed after 3 months of functional loading. Another two monkeys with natural dentition served as controls. Nondecalcified sections were prepared for assessment of optical intensities (OI) under a confocal laser scanning microscope. RESULTS: In both the test (IL and DL) and control, the soft tissue complexes demonstrated a highly fluorescent keratinized layer and diminished cytoplasmic and enhanced membranous fluorescence in the remaining epithelium. Peri-implant mucosa was further characterized by an intense fluorescence at the junctional epithelium-implant interface and in the stromal mononuclear infiltrate. Connective tissue contact and periodontal ligament were weakly fluorescent. In hard tissues, a high fluorescence was observed in peri-implant woven bone and along the implant-bone interface. Mean OI was significantly higher in peri-implant woven bone than around teeth (P < 0.05). In the remaining soft and hard tissue complexes, no significant differences in mean OI between the test and control were observed (P > 0.05). CONCLUSIONS: Present findings suggest that peri-implant woven bone is highly mineralized, while the peri-implant and gingival mucosa share structural similarities. CLINICAL RELEVANCE: Optical intensities of interfacial tissues investing implants and teeth are related to their biological properties.

Histologic assessment of alveolar bone remodeling around immediate implants placed in single and multiple contiguous extraction sites.

The aim of this study was to histologically assess alveolar bone remodeling around immediate implants placed in single and multiple contiguous extraction sites. Ten dogs were divided into three groups (with six sites per group) on the basis of premolar teeth extraction: group 1 = one tooth extracted, group 2 = two contiguous teeth extracted, and group 3 = more than two contiguous teeth extracted. Immediate implants were placed in each group. Histologic assessment of arches showed no evidence of vertical bone loss (VBL) around implants in group 1 compared with groups 2 (P < .001) and 3 (P < .001). Buccal and lingual bone thicknesses and bone-to-implant contact (BIC) were higher around implants in group 1 compared with groups 2 (P < .001) and 3 (P < .05). Buccal and lingual bone thicknesses, BIC, and VBL are compromised around implants in multiple contiguous extraction sites compared with those in a single extraction site.

Accuracy of CBCT images in the assessment of buccal marginal alveolar peri-implant defects: effect of field of view.

OBJECTIVES: To investigate the reliability and accuracy of cone beam CT (CBCT) images obtained at different fields of view in detecting and quantifying simulated buccal marginal alveolar peri-implant defects. METHODS: Simulated buccal defects were prepared in 69 implants inserted into cadaver mandibles. CBCT images at three different fields of view were acquired: 40 × 40, 60 × 60 and 100 × 100 mm. The presence or absence of defects was assessed on three sets of images using a five-point scale by three observers. Observers also measured the depth, width and volume of defects on CBCT images, which were compared with physical measurements. The kappa value was calculated to assess intra- and interobserver agreement. Six-way repeated analysis of variance was used to evaluate treatment effects on the diagnosis. Pairwise comparisons of median true-positive and true-negative rates were calculated by the χ² test. Pearson's correlation coefficient was used to determine the relationship between measurements. Significance level was set as p < 0.05. RESULTS: All observers had excellent intra-observer agreement. Defect status (p < 0.001) and defect size (p < 0.001) factors were statistically significant. Pairwise interactions were found between defect status and defect size (p = 0.001). No differences between median true-positive or true-negative values were found between CBCT field of views (p > 0.05). Significant correlations were found between physical and CBCT measurements (p < 0.001). CONCLUSIONS: All CBCT images performed similarly for the detection of simulated buccal marginal alveolar peri-implant defects. Depth, width and volume measurements of the defects from various CBCT images correlated highly with physical measurements.

Assessment of the regenerative potential of allogeneic periodontal ligament stem cells in a rodent periodontal defect model.

BACKGROUND AND OBJECTIVE: The complex microenvironment of the periodontal wound creates many challenges associated with multitissue regeneration of periodontal lesions. Recent characterization of mesenchymal stem cell-like populations residing in periodontal ligament tissues has shown that these cells exhibit features of postnatal stem cells. Despite these advances, a lack of consistency in design of preclinical studies and a limited study of allogeneic transplantation applications has restricted our understanding of their clinical utility in the treatment of periodontal disease. The aim of this study was to assess the regenerative potential of allogeneic periodontal ligament stem cells (PDLSCs) in a rat periodontal fenestration defect mode and to identify an optimal end time-point suitable for quantitative assessment of tissue regeneration. MATERIAL AND METHODS: Periodontal fenestration defects, created in Sprague Dawley rats, were treated with allogeneic PDLSCs seeded onto Gelfoam(®) (Absorbable gelatin sponge; Pharmacia Corporation, Kalamazoo, MI, USA) or with Gelfoam(®) alone, or remained untreated. Experimental rats were killed at 7, 14, 21 or 28 d after surgery and the tissues were processed for immunohistochemical and histomorphometric examination. RESULTS: Defects treated with PDLSCs showed significantly greater percentage bone fill and length of new bone bridge compared with the untreated group or the group treated with Gelfoam(®) alone on days 14 and 21. Similarly, a statistically significant difference was achieved within specimens retrieved on day 21 for analysis of regeneration of cementum/periodontal ligament (PDL)-like structures. CONCLUSION: The present investigation shows that allogeneic PDLSCs have a marked ability to repair periodontal defects by forming bone, PDL and cementum-like tissue in vivo. The results suggest that treatment periods of 14 and 21 d are optimal end time-points for quantitative assessment of periodontal regeneration within the rodent fenestration-defect model utilized in the present study.

Morphometric assessment of periodontal tissues in relation to periodontal disease in dogs.

Dimensions of periodontal tissues are thought to predispose to the development of periodontal disease in man and dogs. Several studies have suggested that thin gingiva correlates with an increased incidence of periodontal disease. In this study, we hypothesized that the dimensions of periodontal tissues will vary in different breeds of dogs and could possibly correlate with the incidence of periodontal disease. Forty-two jaws of dogs aged up to 5-years were examined post-mortem and gingival and alveolar bone thickness were measured using methods of transgingival probing and digital calipers, respectively. Dogs were divided into three groups based on their body weight. Group I (< 5.0 kg; n=21), group II (5 to 10 kg; n=11), and group III (10 to 15 kg; n=10). Thickness of gingiva ranged from 0.30-mm to 3.2-mm and was relatively thinner in group I than in group II and III based on the means of ratios comparison. Alveolar bone thickness ranged from 0.27-mm to 4.1-mm and was relatively thinner in group I compared with groups II and III. Our study showed significantly thinner gingiva and alveolar bone in toy breed dogs compared with small and medium-sized breed dogs. Both gingival and alveolar bone dimensions may be predictors for severity of periodontal disease and influence clinical outcome in certain periodontal surgical procedures.

Quality assessment of systematic reviews on alveolar ridge preservation.

BACKGROUND: The authors conducted a study to assess the quality of systematic reviews (SRs) published on the topic of alveolar ridge preservation (ARP). TYPES OF STUDIES REVIEWED: The authors conducted a search for SRs on ARP on the basis of a set of eligibility criteria (only SRs involving ARP, with or without meta-analyses, written in English). The authors assessed the quality of the SRs independently of one another by using two established checklists. RESULTS: The authors selected eight SRs. The results of all of the SRs indicated that ARP was effective in preserving the ridge volume as compared with extraction alone, but it did not fully prevent bone-resorptive events. None of the SRs, however, received the highest possible score in either of the checklists. One SR that had a score of 5 (of a possible 11) using one checklist and 5 (of a possible 14) using the other checklist had the lowest overall score. The results of this assessment revealed that a significant proportion of the investigators in the SRs did not include non-English language articles, perform hand searching of published literature or evaluate the gray literature. Assessment of publication bias and reporting of conflicts of interest also was lacking in some studies. Practical Implications. Although ARP appears to be an effective approach to preventing resorption after tooth extraction, significant structural and methodological variability exists among SRs on this topic. Future SRs on ARP should consider the use of quality assessment checklists to minimize methodological shortcomings for better dissemination of scientific evidence.

Three-dimensional assessment of buccal alveolar bone after rapid and slow maxillary expansion: a clinical trial study.

INTRODUCTION: The purposes of this study were to analyze and compare the immediate effects of rapid and slow maxillary expansion protocols, accomplished by Haas-type palatal expanders activated in different frequencies of activation on the positioning of the maxillary first permanent molars and on the buccal alveolar bones of these teeth with cone-beam computerized tomography. METHODS: The sample consisted of 33 children (18 girls, 15 boys; mean age, 9 years) randomly distributed into 2 groups: rapid maxillary expansion (n = 17) and slow maxillary expansion (n = 16). Patients in the rapid maxillary expansion group received 2 turns of activation (0.4 mm) per day, and those in the slow maxillary expansion group received 2 turns of activation (0.4 mm) per week until 8 mm of expansion was achieved in both groups. Cone-beam computerized tomography images were taken before treatment and after stabilization of the jackscrews. Data were gathered through a standardized analysis of cone-beam computerized tomography images. Intragroup statistical analysis was accomplished with the Wilcoxon matched-pairs test, and intergroup statistical analysis was accomplished with analysis of variance. Linear relationships, among all variables, were determined by Spearman correlation. RESULTS AND CONCLUSIONS: Both protocols caused buccal displacement of the maxillary first permanent molars, which had more bodily displacement in the slow maxillary expansion group, whereas more inclination was observed in the rapid maxillary expansion group. Vertical and horizontal bone losses were found in both groups; however, the slow maxillary expansion group had major bone loss. Periodontal modifications in both groups should be carefully considered because of the reduction of spatial resolution in the cone-beam computerized tomography examinations after stabilization of the jackscrews. Modifications in the frequency of activation of the palatal expander might influence the dental and periodontal effects of palatal expansion.

Histometric assessment of the effect of diabetes mellitus on experimentally induced periodontitis in rats.

OBJECTIVE: The aim of this interventional animal study was to assess histologically the effect of experimental diabetes in rats with experimental periodontitis in terms of alveolar bone loss and the effect of experimental periodontitis on glucose levels in diabetes. MATERIALS AND METHODS: Forty-seven Wistar rats were studied: 12 healthy controls (C), 10 with experimental diabetes (D), 12 with experimental diabetes and experimental periodontitis (DP) and 13 with experimental periodontitis (P). Diabetes was induced by streptozotocin injection and periodontitis was induced at the right second maxillary molar by ligation. Serum glucose levels were measured at specific time points. Sixty-one days after ligation, the rats were sacrificed. Histometric analysis assessed alveolar crest level. For ligated groups, alveolar bone loss was expressed as the difference in alveolar crest level between right and left maxillary molars. RESULTS: Diabetes alone did not statistically significantly affect alveolar crest level. The combination of diabetes and periodontitis caused greater alveolar bone loss (946.1 +/- 719.9 microm) than periodontitis alone (639.7 +/- 294.2 microm); however, the difference did not reach statistical significance. Periodontitis did not significantly increase glucose levels in diabetic rats. The average glucose levels were 545.4 (499 - 563) and 504.5 (445 - 560) mg/dL for diabetic and diabetic ligated rats, respectively. CONCLUSION: Within its limits, this study demonstrated that the severity of alveolar bone loss in periodontitis was not significantly aggravated by diabetes and the serum glucose levels in diabetes were not affected by periodontitis.

Five-year longitudinal assessment of the prognosis of apical microsurgery.

INTRODUCTION: Apical surgery is an important treatment option for teeth with post-treatment apical periodontitis. Knowledge of the long-term prognosis is necessary when weighing apical surgery against alternative treatments. This study assessed the 5-year outcome of apical surgery and its predictors in a cohort for which the 1-year outcome was previously reported. METHODS: Apical microsurgery procedures were uniformly performed using SuperEBA (Staident International, Staines, UK) or mineral trioxide aggregate (MTA) (ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK) root-end fillings or alternatively Retroplast capping (Retroplast Trading, Rorvig, Denmark). Subjects examined at 1 year (n = 191) were invited for the 5-year clinical and radiographic examination. Based on blinded, independent assessment by 3 calibrated examiners, the dichotomous outcome (healed or nonhealed) was determined and associated with patient-, tooth-, and treatment-related variables using logistic regression. RESULTS: At the 5-year follow-up, 9 of 191 teeth were unavailable, 12 of 191 teeth were extracted, and 170 of 191 teeth were examined (87.6% recall rate). A total of 129 of 170 teeth were healed (75.9%) compared with 83.8% at 1 year, and 85.3% were asymptomatic. Two significant outcome predictors were identified: the mesial-distal bone level at ≤ 3 mm versus >3 mm from the cementoenamel junction (78.2% vs 52.9% healed, respectively; odds ratio = 5.10; confidence interval, 1.67-16.21; P < .02) and root-end fillings with ProRoot MTA versus SuperEBA (86.4% vs. 67.3% healed, respectively; odds ratio = 7.65; confidence interval, 2.60-25.27; P < .004). CONCLUSIONS: This study suggested that the 5-year prognosis after apical microsurgery was 8% poorer than assessed at 1 year. It also suggested that the prognosis was significantly impacted by the interproximal bone levels at the treated tooth and by the type of root-end filling material used.

Presurgical infant orthopedics.

This article focuses on current practices and controversy in the area of presurgical infant orthopedics in patients born with cleft lip and palate.

Horizontal bone augmentation: the decision tree.

The emergence of implant dentistry has led to the need for bone augmentation procedures. With the removal of a tooth, there is an inevitable three-dimensional (3D) loss of alveolar bone. More often than not, horizontal bone loss occurs at a faster rate and to a greater extent compared to vertical bone loss. This led to the development of several horizontal bone augmentation techniques, such as guided bone regeneration, ridge expansion, distraction osteogenesis, and block grafts. These proposed augmentation techniques aim to place the implant in an ideal 3D position for successful restorative therapy. The literature has shown that horizontal bone augmentation is fairly predictable if certain criteria are fulfilled. However, with numerous techniques and materials currently available, it is difficult to choose the most suitable treatment modality. A search of the literature available was conducted to validate the decision-making process when planning for a horizontal ridge augmentation procedure. The decision tree proposed in this paper stems from the 3D buccolingual bone width available at the site of implant placement (⋝ 3.5 mm, < 3.5 mm, or 4 to 5 mm). In each dimension, techniques are advised after considering factors such as the tissue thickness, the arch position, and the availability of autogenous bone. The decision tree provides insight on how clinicians can choose the most appropriate and predictable horizontal ridge augmentation procedure to minimize unnecessary complications.

Factors that dentists use to decide whether or not to render a patient edentulous. Part 1. A qualitative study of East Lancashire general dental practitioners' views.

AIMS: To identify the factors that dentists use to decide whether to render a patient edentulous, prior to developing a questionnaire to investigate the factors that dentists use when making this decision. METHOD: This was a qualitative study involving two groups of seven dentists practising in primary care in East Lancashire who were given scenarios involving patients of different types to facilitate discussion and identify all factors. Audio recordings were used during the focus groups and were subsequently fully transcribed. Two members of the research team independently coded the transcripts and then used thematic analysis to identify key themes. RESULTS: Analysis of the results identified 12 factors that the dentists considered when making a patient edentulous. These were caries, periodontal disease, position of the teeth, aesthetics, bone support, the transition from partial dentures, patient motivation, medicolegal issues, age of the patient, patient choice, cost of treatment, and the dentist's attitude and skills. CONCLUSION: The dentists identified a large number of factors that they might consider before making a patient edentulous. There was a consensus that the change should be made gradually, if possible.