The effect of timing of orthodontic therapy on the outcomes of regenerative periodontal surgery in patients with stage IV periodontitis: A multicenter randomized trial.

AIM: To compare the outcomes after early (4 weeks post surgery) or late (6 months post surgery) orthodontic therapy (OT) following regenerative surgery of intra-bony defects (IDs). MATERIALS AND METHODS: In a multi-center, parallel-group, randomized clinical trial, 43 patients with stage IV periodontitis were randomized to receive either early (n = 23) or late OT (n = 20) following regenerative surgery of IDs. Primary outcome was change in clinical attachment level (CAL) in one target ID at 12 months after surgery. Secondary outcomes were changes of probing pocket depth (PPD), bleeding on probing (BOP), and frequency of pocket closure. RESULTS: No statistically significant differences between groups could be observed for CAL gain (5.4 mm [±2.1 mm] for early; 4.5 mm [±1.7 mm] for late OT). PPD was reduced by 4.2 mm (±1.9 mm) in the early group and by 3.9 mm (±1.5 mm) in the late group (p > .05). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects in early compared to 85% in late OT. CONCLUSION: In the inter-disciplinary treatment of periodontitis stage IV, OT can be initiated already 4 weeks after regenerative surgery of IDs with favourable results, thus reducing the overall treatment time.

Synergy of Regenerative Periodontal Surgery and Orthodontics Improves Quality of Life of Patients with Stage IV Periodontitis: 24-Month Outcomes of a Multicenter RCT.

In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery.

Supportive periodontal therapy and dental implants: an analysis of patients' compliance.

OBJECTIVES: The purpose of this retrospective study was to evaluate the compliance to supportive periodontal therapy (SPT) in a population of adult periodontal patients, and to determine the impact of clinical procedures performed such as the type of active periodontal therapy and the insertion of dental implants. MATERIAL AND METHODS: Ninety-six patients were evaluated. The subjects were divided into two groups, according to the active periodontal procedure (surgical/non-surgical), and were also classified as having or not-having osseointegrated implants. The number of visits for SPT after the end of active therapy was evaluated, and subjects were classified as compliant or non-compliant. RESULTS: At the end of a 5-year evaluation, 77.1% of patients completely complied with SPT while 22.9% of patients had insufficient compliance degree. No significant difference was found in compliance between subjects that had surgical or non-surgical periodontal treatment. However, patients that had the insertion of one or more dental implant registered a significant higher degree of compliance than patients that had no fixtures insertion. CONCLUSION: The results suggest that it is possible to have excellent degree of patients' compliance for SPT. The performance of periodontal surgical therapy itself is not a reason able to motivate the patients to maintenance care, while the insertion of osseointegrated implants seems to be a reliable reason to positively affect the compliance with SPT.

Influence of Abutment Design and Platform Switching on Peri-implant Marginal Bone Level: A Randomized Controlled Clinical Trial with 1-Year Results.

The purpose of this randomized clinical study was to evaluate the efficacy of platform-switching (PS) vs platform-matching (PM) implants when paired with a newly designed marginless abutment (MA) vs a conventional abutment (CA) in maintaining peri-implant tissue stability. Marginal bone level (MBL) and probing depth were measured up to 1 year postloading. Eighty implants were inserted in 42 patients and randomly assigned to one of four groups, each with a different implant/abutment configuration: Group 1 (PM+CA), Group 2 (PM+MA), Group 3 (PS+CA), and Group 4 (PS+MA). Data were collected at implant placement (T0), abutment placement (T1), final crown placement (T2), and 1 year postloading (T3). At the 1-year follow-up, MBL was more stable in Groups 3 and 4 compared to Groups 1 and 2. These results suggest that the role played by the implant-abutment connection (PS vs PM) is more important than the type of abutment preparation (MA vs CA).

Preservation of Peri-implant Hard Tissues Following Immediate Postextraction Implant Placement. Part I: Radiologic Evaluation.

Immediate implant placement may represent a possible treatment plan for single tooth restoration. This study evaluated the insertion of osseointegrated implants in intact fresh extraction sockets in the anterior maxilla. The bone-to-implant gap was accurately grafted with a bovine bone mineral prior to implant engagement, and an immediate screw-retained restoration was delivered. After 3 months, the provisional crown was replaced with the definitive ceramic crown. Marginal bone levels remained stable after 1 year. The horizontal ridge dimension was also evaluated at three levels using CBCT scans after 1 year. The horizontal width of the postextraction crest was well preserved independently from the thickness of the buccal bone plate at baseline.

Preservation of Peri-implant Soft Tissues Following Immediate Postextraction Implant Placement. Part II: Clinical Evaluation.

Soft tissue contour changes were evaluated in 20 patients who underwent immediate implant placement with provisional restoration. The bone-to-implant gap was accurately grafted with xenograft prior to implant placement, and enamel matrix derivative was applied prior to delivery of an immediate screw-retained restoration. No significant differences were observed between baseline and 1 year after implant placement in soft tissue contour measurements and the Pink Esthetic Score. Furthermore, no differences were observed between thin or thick biotypes. It was shown that the use of immediate single-tooth implants with immediate restoration resulted in the maintenance of the soft tissue contour and esthetics when compared to pretreatment independently from the soft tissue phenotype.

Alveolar Ridge Preservation Using Tridimensional Collagen Matrix and Deproteinized Bovine Bone Mineral in the Esthetic Area: A CBCT and Histologic Human Pilot Study.

Alveolar ridge preservation is of great importance for successful implant therapy. This study investigated the effects of a xenogeneic tridimensional collagen matrix (CM) in conjunction with deproteinized bovine bone mineral blended with 10% collagen (DBBM-C) on the healing of 12 intact extraction sockets in the esthetic area. Cone beam computed tomograpy examinations revealed nearly stable alveolar ridge dimensions (> 90% of the ridge horizontal dimension was preserved). New bone formation of approximately 45% and adequate resorption of the grafted material were histologically observed. Thus, application of CM together with DBBM-C using minimally invasive flapless approach can preserve the original ridge volume and support bone formation, contributing to adequate bone volume for implant insertion.

Bio-Oss collagen and orthodontic movement for the treatment of infrabony defects in the esthetic zone.

The aim of the present study was to evaluate whether it is possible to orthodontically move migrated teeth into infrabony defects augmented with a biomaterial. Three adult patients suffering from chronic periodontitis were treated. Each of the patients presented with an infrabony defect adjacent to a migrated maxillary central incisor. After cause-related therapy was completed, a surgical procedure was performed using the papilla preservation technique. The defects were filled with a collagen bovine bone mineral; after 2 weeks, an orthodontic device was activated using light, continuous forces. Orthodontic treatment time varied from 4 to 9 months; during this period, patients were enrolled in an oral hygiene recall program. At baseline and 6 months after the end of therapy, probing pocket depths (PPD) and clinical attachment levels (CAL) were assessed. In addition, the vertical and horizontal dimensions of the defects were measured on standardized radiographs. Residual mean PPD was 3.33 mm, with a mean reduction of 3.67 mm. Mean CAL gain was 4.67 mm. Radiologic vertical and horizontal bone fills were, on average, 3.17 mm and 2.0 mm, respectively. The present case series shows the effectiveness of a combined periodontic-orthodontic approach for the treatment of infrabony defects. Reduction of PPD to physiologic values, CAL gain, and radiologic defect resolution were obtained. No detrimental effects from the orthodontic movement were observed on the augmentation material.

Evaluation of Dental Implants Placed in Preserved and Nonpreserved Postextraction Ridges: A 12-Month Postloading Study.

Forty-eight single dental implants were inserted 4 months after tooth extraction following ridge preservation (RP; n = 24) or spontaneous healing (EXT; n = 24). During surgery, 1 (7%) of 24 implants in the RP group and 14 (58%) of 24 in the EXT group required additional bone grafting, and the implant stability quotient value was similar in the two groups. The survival rate of the implants in both groups was 100% at the 1-year follow-up. The success rate was 95.83% in the RP group and 91.66% in the EXT group. No statistically significant differences in the marginal bone level were detected between the two groups. Similar outcomes of implants inserted in preserved or spontaneously healed ridges can be anticipated, but the use of an RP procedure reduces the need for further bone augmentation.

Soft tissue contour changes at immediate postextraction single-tooth implants with immediate restoration: a 12-month prospective cohort study.

In the maxillary arch from premolar to premolar, 26 single dental implants were inserted in fresh extraction sockets and immediately provisionalized. The bone-to-implant gap was grafted with a bovine bone mineral. After 3 months, definitive ceramic crowns were placed. At baseline and after 1 year, the soft tissue horizontal width, mesiodistal papillary level, midfacial gingival level, and pink esthetic score were evaluated. No statistical differences were found between baseline and 1 year for all parameters. Immediate single-tooth implants, with immediate restoration, are capable of maintaining the soft tissue contour and esthetics compared to the pretreatment status.

Relationship between the buccal bone plate thickness and the healing of postextraction sockets with/without ridge preservation.

In 48 postextraction sites, sockets were grafted with bovine bone mineral plus collagen membrane (test) or had spontaneous healing (control). After 4 months, horizontal ridge width reduction was 0.71 mm in the test group and 4.04 mm in the control group, while vertical ridge loss was 0.58 mm and 1.67 mm, respectively. No correlation was found between the thickness of the buccal bone wall and the alveolar bone loss in the test group, while an inverse correlation was found in the control group. Ridge preservation compensated for postextraction alveolar ridge resorption irrespective of the buccal plate thickness, whereas leaving the extraction socket undisturbed may result in alveolar bone loss.

Soft tissue contour changes at immediate implants: a randomized controlled clinical study.

In 52 patients, single anterior teeth were extracted and replaced by immediate implants. The peri-implant gap was left either untreated (control) or was grafted and covered with a membrane (test group). After 12 months the horizontal bone resorption was significantly lower in the test group (test sites: 0.69 ± 0.68 mm, 8.13%; control sites: 1.92 ± 1.02 mm, 21.62%; P = .001), and there was less reduction in ridge height (test sites: 0.58 ± 0.77 mm; control sites: 1.69 ± 1.74 mm;P = .004). Ridge preservation considerably limited the amount of horizontal and vertical soft tissue alterations when compared with implant placement alone.

Coronally advanced flap with and without a xenogenic collagen matrix in the treatment of multiple recessions: a randomized controlled clinical study.

Multiple adjacent recession defects were treated in 32 patients using a coronally advanced flap (CAF) with or without a collagen matrix (CM). The percentage of root coverage was 81.49% ± 23.45% (58% complete root coverage) for CAF sites (control) and 93.25% ± 10.01% root coverage (72% complete root coverage) for CM plus CAF sites (test). The results achieved in the test group were significantly greater than in the control group, indicating that CM plus CAF is a suitable option for the treatment of multiple adjacent gingival recessions.

Vertical ridge augmentation with a collagen membrane, bovine bone mineral and fibrin sealer: clinical and histologic findings.

This study evaluated the treatment of alveolar bone deficiencies combined with dental implant placement. Thirty-five endosseous implants were inserted into 20 patients. After implant placement, the mean height of the supracrestal bone defects measured 4.25 ± 1.34 mm. Bone regeneration procedures were performed using a combination of a bovine bone-derived mineral stabilized with a fibrin-fibronectin sealing system and covered with a bilayered porcine collagen membrane. Healing was uneventful in all instances with maintenance of primary closure throughout the healing period. Stage-two surgery was performed after 6 months, and a hard bonelike tissue was detectable at the defect sites. Histologic examination confirmed the presence of newly formed bone with residual particles of xenograft. The mean bone gain was 3.95 ± 1.47 mm. The positive outcomes in terms of bone regeneration and low complication rate demonstrated the potential of this technique for the treatment of supracrestal ridge deficiencies. Bovine bone mineral combined with a fibrin sealer and protected by a collagen membrane should be considered as an alternative in the treatment of vertical peri-implant bone defects.

Treatment of gingival recession defects using coronally advanced flap with a porcine collagen matrix compared to coronally advanced flap with connective tissue graft: a randomized controlled clinical trial.

BACKGROUND: Connective tissue graft (CTG) plus coronally advanced flap (CAF) is the reference therapy for root coverage. The aim of the present study is to evaluate the use of a porcine collagen matrix (PCM) plus CAF as an alternative to CTG+CAF for the treatment of gingival recessions (REC), in a prospective randomized, controlled clinical trial. METHODS: Eighteen adult patients participated in this study. The patients presented 22 single Miller's Class I or II REC, randomly assigned to the test (PCM+CAF) or control (CTG+CAF) group. REC, probing depth, clinical attachment level (CAL), and width of keratinized tissue (KG) were evaluated at 12 months. In addition, the gingival thickness (GT) was measured 1mm apical to the bottom of the sulcus. RESULTS: At 12 months, mean REC was 0.23 mm for test sites and 0.09 mm for control sites (P <0.01), whereas percentage of root coverage was 94.32% and 96.97%, respectively. CAL gain was 2.41 mm in test sites and 2.95 mm in control sites (P <0.01). KG gain was 1.23 mm in the test group and 1.27 mm in the control group (P <0.01). In test sites, GT changed from 0.82 to 1.82 mm, and in control sites, from 0.86 to 2.09 mm (P <0.01). CONCLUSIONS: Within the limits of the study, both treatment procedures resulted in significant reduction in REC at 12 months. No statistically significant differences were found between PCM+CAF and CTG+CAF with regard to any clinical parameter. The collagen matrix represents a possible alternative to CTG.

Socket preservation using bovine bone mineral and collagen membrane: a randomized controlled clinical trial with histologic analysis.

After tooth extraction, varying amounts of bone resorption occur because of qualitative and quantitative changes at the edentulous site of the alveolar process. The aims of this randomized controlled clinical trial were (1) to compare the postextraction changes in residual ridge dimensions during spontaneous healing with those during socket preservation, (2) to analyze the histologic and histomorphometric aspects of the grafted sockets, and (3) to compare probing procket depth (PPD) and clinical attachment level (CAL) changes at teeth adjacent to extraction sites. Forty-eight teeth were extracted from 41 patients referred for extraction of 1 or more maxillary or mandibular premolars or molars. The edentulous sites were randomly assigned to the control (EXT, extraction alone) or experimental groups (SP, extraction and socket preservation). In the SP group, the sockets were filled with bovine bone mineral and covered with porcine collagen membrane. At baseline and after 4 months, PPD, gingival recession (REC), and CAL were measured at teeth adjacent to the edentulous sites. The changes in ridge dimensions from baseline to 4 months were assessed on dental casts. At 4 months, bone was harvested from the grafted areas in the SP group and the edentulous areas in the EXT group. PPD, REC, and CAL were comparable between groups. However, from baseline to 4 months, the SP group showed significantly less reduction in ridge width (1.04 ± 1.08 mm vs 4.48 ± 0.65 mm, P < .001) and height (0.46 ± 0.46 mm vs 1.54 ± 0.33 mm, P < .001). Histologically, the grafted sockets exhibited various stages of bone maturation and formation without inflammatory responses. No significant difference in the mineralized and nonmineralized fractions was noted between the groups. Socket preservation using bovine bone mineral and porcine collagen membrane considerably limits the amount of horizontal and vertical bone resorption when compared with extraction alone.