Risk indicators of long-term outcome of implant therapy in patients with a history of severe periodontitis or no history of periodontitis: A retrospective cohort study.

OBJECTIVE: The aim of this retrospective cohort study was to assess factors associated with peri-implant disease in partially edentulous patients with a history of severe periodontitis or no history of periodontitis. METHODS: Partially edentulous patients with a history of severe periodontitis/without history of periodontitis who received implant surgery within the past 6 to 8 years were recalled. Clinical and radiographic examinations were recorded. Periodontal probing depth, marginal bone loss (MBL) and peri-implantitis were considered as the primary outcome and peri-implant bleeding on probing (BOP) was considered as the secondary outcome. The following criteria were considered as the predictors, as well: history of severe periodontitis, gender, age, smoking, brushing frequency, recall interval, full-mouth plaque score, full-mouth bleeding score, splinted prosthesis, open/tight interproximal contact, width of keratinized mucosa, mucosal thickness, implants placed in the grafted bone and implant type. Univariate and multivariate regression analyses were utilized. RESULTS: A total of 88 patients (186 implants) fulfilled the study. Forty-seven patients (108 implants) had a history of severe periodontitis and 41 patients (78 implants) had no history of periodontitis. There was a higher chance of peri-implantitis in patients with a history of severe periodontitis (OR = 11.13; p = 0.045), implants with lack of peri-implant KM (<2 mm) and implants placed in the grafted bone (OR = 14.94, p < 0.001; OR = 4.93, p = 0.047). The risk of peri-implant MBL ≥3 mm was higher in patients with greater FMBS (OR = 1.20; p < 0.001). The chance of peri-implant BOP was independently higher in patients who brushed their teeth at most once per day (OR = 3.20; p = 0.04), higher FMBS (OR = 1.16; p < 0.001) and irregular recall visits (OR = 15.34; p = 0.001). CONCLUSIONS: Partially edentulous patients with the history of severe periodontitis, lack of peri-implant KM and implants placed in bone-grafted sites expressed higher probability of peri-implantitis. In addition, inadequate frequency of brushing (at most once daily) and irregular recall visits were associated with greater chance of peri-implant BOP.

Impacted teeth: Closed flap surgery.

OBJECTIVE: The present pilot study evaluated the impact of closed flap surgical technique on periodontal tissues and the esthetic outcome. MATERIALS AND METHODS: Twenty-four consecutively treated patients with a mean age of 15 (range 12-30) underwent closed flap surgery for the exposure of impacted teeth. The study evaluated periodontal probing depths, bone level, zone of keratinized tissue, and esthetic appearance after the completion of orthodontic treatment. RESULTS: Tooth impaction was more frequent in females (No. 14) than males (No. 10) in this study. Palatal and buccal impactions were 77% and 23%, respectively. Post-orthodontic treatment, periodontal probing depth averaged 2.2 mm and zone of keratinized gingiva averaged 3.6 mm. No discernible radiographic bone loss or root resorption was noticed. Overall, gingival margins provided an esthetic appearance in all cases. CONCLUSION: Closed flap surgical technique was associated with periodontal health and esthetic outcomes for an average of 10 years post-orthodontic treatment. CLINICAL SIGNIFICANCE: The evolution of teeth and maxillary/mandibular bones has distinctively differed in origins and development contributing to tooth impaction and overcrowding. This study demonstrated that closed flap surgery is a reliable procedure for the treatment of impacted teeth that provides periodontal health and esthetic appearance post-orthodontic treatment.

Zirconia dental implants: A clinical and radiographic evaluation.

OBJECTIVE: Limited clinical evidence has been reported in dental literature regarding zirconia dental implants. The aim of the present retrospective consecutive case series was to evaluate the clinical outcome of zirconia dental implants with 1 to 5 years of follow-up. CLINICAL CONSIDERATIONS: The clinical outcome of 24 implants in 12 consecutive patients (male 5, female 7) with a mean age of 55 years (range 27-86) is reported. Radiographic crestal bone level was assessed by the use of "ImageJ" software program. Gingival and plaque indices were recorded at baseline and latest follow-up. CONCLUSION: The overall success rate of zirconia implants was 92%. Within the limitations of the present clinical evaluation, zirconia implants provided excellent clinical results and esthetic outcomes. A mean periimplant bone loss of 0.3 mm was measured in 33.3% of the implants and 66.7% were not affected by radiographic detectable periimplant bone loss. Two implants in two patients failed. Low gingival and plaque indices were predominant values for both interim and final restorations. The apparent less affinity to plaque accumulation may favor soft tissue health around zirconia dental implants and decrease the risk of inflammation or infection. Zirconia dental implant merits further investigation. CLINICAL SIGNIFICANCE: Zirconia dental implants are emerging as an option in clinical practice of implant dentistry providing stable clinical results and esthetic outcomes.

Prospective, 1-year observational study of double-threaded tapered body dental implants with immediate loading.

STATEMENT OF PROBLEM: Unlike conventional loading protocols, the immediate loading of single implants has not been fully investigated. PURPOSE: The purpose of this study was to assess the prosthetic and esthetic periimplant mucosal outcomes of immediately restored dental implants during a 1-year follow-up. MATERIAL AND METHODS: Twenty participants meeting the established inclusion criteria received double-threaded, tapered body dental implants (SuperLine; Dentium). Implants were placed and stabilized at a minimum of 35 Ncm of torque and restored immediately after the surgery with interim restorations. These were replaced with definitive restorations 6 months after implant placement. Clinical measurements at each visit included resonance frequency analysis, the evaluation of the participants' oral health (gingival and plaque indices), and the esthetic outcome of the interim or definitive restoration. RESULTS: Implants placed in this clinical study had a 100% success rate. The oral health and esthetic outcomes were favorable for all participants. CONCLUSIONS: Double-threaded, tapered body dental implants that were placed and immediately restored with fixed interim prostheses and with definitive prostheses after 6 months remained stable and functional after 1 year.

Photoactivated disinfection using light-emitting diode as an adjunct in the management of chronic periodontitis: a pilot double-blind split-mouth randomized clinical trial.

AIM: This split-mouth double-masked randomized controlled clinical study evaluated the effectiveness of photoactivated disinfection (PAD) using light-emitting diode (LED) as an adjunct in the management of patients affected by moderate to severe chronic periodontitis. MATERIALS AND METHODS: Sixteen patients affected by moderate to severe chronic periodontitis were enrolled. After scaling and root planing (SRP), each quadrant was assigned to one of the following groups: LED group (625-635 nm, maximum power density: 2000 mW/cm(2) ), photosensitizer group (tolouidine blue O, 0.1 mg/ml), PAD group (photosensitizer and LED) and control group (no adjunctive treatment). The adjunctive treatments were repeated after 7 and 14 days. The clinical parameters of bleeding on probing, probing pocket depth and clinical attachment level were measured at baseline and 1 and 3 months after SRP. RESULTS: At 1 and 3 months, all groups showed significant improvements with regard to all clinical parameters compared to baseline (all p: <0.001). There were no significant differences among groups in terms of changes of clinical parameters in any time interval (all p > 0.05). CONCLUSION: The application of PAD using LED with the current setting did not have additional effects on clinical parameters in patients diagnosed with moderate to severe chronic periodontitis compared with SRP alone.

Immediate free iliac bone graft after nonsegmental mandibular resection and delayed implant placement: a case series.

BACKGROUND: Resection of mandibular tumors without proper reconstruction may lead to unfavorable esthetic and function results. The purpose of this case series was to describe clinical results and a technique to prevent tissue loss using nonvascular iliac grafts immediately following tumor resection and long-term stability of the implants. MATERIALS AND METHODS: Three female patients presented with oral neoplasms (2 ameloblastoma and 1 ossifying fibroma). The mandibular reconstruction was performed with nonvascularized iliac grafts simultaneous with tumor removal. Subsequently, 10 dental implants were placed 6 to 9 months after reconstruction and restored. Survival and success of the implants were evaluated. RESULTS: Marginal mandibulectomy in 1 patient and buccal bone resection in 2 patients was performed; the resection sites were reconstructed with an immediate nonvascularized iliac graft. All implants survived and were successful during follow-up periods between 44 and 105 months. Mean marginal bone loss of 10 implants was 0.09 mm. CONCLUSIONS: Immediate reconstruction with nonvascularized iliac grafts following tumor resection may be a viable treatment option for nonsegmental inlay osseous defects. In these case series, the resorption of the iliac bone was minimal after 6 to 9 months consolidation periods.

Subapical osteotomy to correct dental implant malpositioning and vertical ridge deficiency: a clinical report.

This clinical report describes a subapical osteotomy to correct vertical ridge deficiency and malpositioned maxillary anterior implants. A 37-year-old woman with a noncontributory medical history presented with the chief complaint of an unesthetic implant-supported prosthesis. The maxillary left central and lateral incisors were restored with metal ceramic restorations. Gingiva-colored porcelain was fabricated to compensate for severe vertical and horizontal soft tissue deficiency. The patient was dissatisfied with the esthetics associated with the restorations and soft tissues since she presented with a high smile line and gingival display. Under general anesthesia, a subapical osteotomy was performed. The implant and ridge segment was coronally repositioned to correct the ridge deficiency. The surgical procedure and postoperative healing were uneventful. The surgical outcome was stable for a follow-up period of 3 years. The subapical osteotomy provided a satisfactory clinical outcome in managing a severely deficient residual ridge and malpositioned maxillary anterior implants as an alternative treatment to other surgical approaches.

Down syndrome-associated periodontitis: a critical review of the literature.

Down syndrome, or trisomy 21 (T21), was first described by John Langdon Down in 1866. Down identified the phenotypic expression of patients with circulation and coordination problems as having Down syndrome. More than a century later, Jerome Lejeune hypothesized that nondysjunction during meiosis could lead to trisomy of the 21st chromosome. The incidence of T21 is one in 800 to 1,000 live births in the United States. Generally, these patients now live to age 50 and some to age 60. As life expectancy increases, medical and social costs garner greater attention. Also, societal changes have allowed for better quality of life. Dental practitioners are challenged by the high incidence of early onset aggressive periodontal disease in T21; these patients have higher levels of periodontal pathogens and periodontitis-associated interproximal bone loss. The complex anatomy, physiology, immunology, and microbiology underscore the need for further investigation in specific areas related to dental treatment of these patients. This article is a critical review of the periodontal research concerning T21. Creating awareness enables dental professionals who have the power and knowledge to appropriately address the needs of those affected by T21.

Esthetic transformation of a failed implant reconstruction to fixed-supported prosthesis: a case report.

This article describes a clinical situation where an ill-fitting prosthesis supported by malpositioned dental implants was esthetically transformed to fixed definitive restorations. Provisional restorations were used as a blueprint for fabrication of definitive restorations.

Effects of Mouthwash on Oral Cytomegalovirus, Epstein-Barr Virus, Herpes Simplex Virus Type-1.

Background: Cytomegalovirus (HCMV), Epstein-Barr virus (EBV), and herpes simplex virus type-1 (HSV-1) are pathogens. Objectives: The goal of the present double-blinded, randomized study was to compare the effect on oral viral load of twice daily use over 60 days of Lumineux MouthwashRvs. de-ionized water. The main composition of the mouthwash was Dead Sea salt. Methods: 30 participants were randomized to test or control. For 60 days, participants rinsed for 60s twice daily with 20ml of their allocated mouthwash, after morning and evening meals. On Day 0 and 60, before eating and oral hygiene and at least 60 minutes after drinking, unstimulated saliva was collected. Samples underwent mRNA analysis. Study endpoints were changes in Log Salivary Viral Load. Result: After adjusting for baseline differences, the reduction in viral load was significantly greater for the test group, all p-values <0.001. Baseline differences did not have an effect on the differences between groups in change over time. Conclusion: After adjusting for baseline differences, the reduction in viral load was significantly greater for the test group, all p-values <0.001. Baseline differences did not have an effect on the differences between groups in change over time.

The migration of the bovine-derived xenograft particles: A case series.

The long-term safety of xenografts and their potential association with disease are valid concerns. Bovine bone substitutes which are by far the most commonly used xenografts in dentistry are not biodegradable. The aim of the present report was to raise awareness on the long-term risks of the bovine-derived xenografts. Patients who experienced clinical complications after xenografting are reported. Patients' demographic, significant medical, and dental findings are reported. Complications included migration/encapsulation/displacement of the graft material, chronic inflammation, and soft-tissue disturbances/fenestrations. Albeit some xenograft complications are not significant enough to compromise the initial outcomes achieved, the xenografted particles seemed to be left intact favoring conditions for migration. The authors observed the inability of the human host to biodegrade the xenograft particles. The intact/migrated bovine bone particles present a risk to patients and may contribute to long-term clinical complications in implant dentistry.

Fracture analysis of one/two-piece clinically failed zirconia dental implants.

OBJECTIVES: Analyzing factors that may have led to fracture of zirconia implants by macro/micro-fractography. METHODS: Six one-piece and ten two-piece full-ceramic zirconia implants from two manufacturers, Z-Systems and CeraRoot, were retrieved after clinical failure. The time-to-failure ranged from 3 to 49 months. Optical and scanning electron microscopy (SEM) were used to analyze the fracture planes at the macro- and microscopic level. Treatment planning, surgical protocol, fracture-origin location and characteristic fracture features were assessed. RESULTS: The fracture of all implants seemed to have been primarily due to overload in bending mode, while the fracture-initiation sites varied for the one- and two-piece implants. The fracture of all one-piece implants originated in the constriction region between two threads in the endosseous implant part. For two-piece implants, the abutment neck, internal abutment-implant connections and inner threads were found to be the main fracture-initiation sites. Surface defects at the root area for one-piece implants and damages at the abutment surface for two-piece implants were connected to the fracture origins. Importantly, the clinical failures of implants were often found to result from combined effects related to patient aspects, treatment planning/protocols, a high bending moment at the weakest link, implant-surface conditions and specific implant designs. SIGNIFICANCE: This study provided information to be considered for future optimization of treatment planning and the surgical protocol for zirconia implants. Optimization of the surface conditions and the zirconia-starting powder were also suggested.

Latin America: native populations affected by early onset periodontal disease.

Millions of individuals are affected by early onset periodontal disease in Latin America, a continent that includes more than 20 countries. The decision-makers claim that the disease is not commonly encountered. In 2009, 280,919 authorized immigrants were registered in the United States versus 5,460,000 unauthorized (2,600,000 in California). The objective of the present article is to raise awareness about the high prevalence of the disease among Latin Americans and the good prognosis of preventive measures associated with minimal financial cost.

Dynamic therapeutic approach for individuals affected with aggressive periodontitis.

Management of patients affected with aggressive periodontitis is complicated by several poorly understood etiological and modifying factors that create difficulty in establishing a universal treatment recommendation. The goal of this manuscript is to underscore the complexity of therapy and to provide some guidelines in the decision-making process and interdisciplinary therapy. A dynamic approach is presented to formulate strategies in diagnosis and treatment planning that is both patient-and site-specific.

Comparison of peri-implant clinical outcomes of digitally customized and prefabricated abutments: A systematic review and meta-analysis.

BACKGROUND: Digitally customized abutments are increasingly used in contemporary implant prosthodontics. PURPOSE: This systematic review and meta-analysis aimed at comparing the peri-implant clinical outcomes of digitally customized and prefabricated abutments. MATERIALS AND METHODS: The search strategies included electronic databases (PubMed, Embase, Scopus, and Cochrane clinical trials database) and related journals up to September, 2020. A qualitative and quantitative synthesis was performed on data extracted from the included studies. RESULTS: Three RCTs (number of patients = 120; number of dental implants = 120) and two prospective cohort studies (number of patients = 144; number of dental implants = 144) with one to three-year follow-up periods were included. The quantitative analyses did not demonstrate a significant difference between digitally customized and prefabricated abutments for peri-implant pocket depth (P = 0.62), plaque index (P = 0.67), bleeding on probing (P = 0.43), keratinized mucosa width (P = 0.75), and pink aesthetic score (P = 0.30) at one-year follow-up visit. The qualitative analyses for marginal bone level change, calculus accumulation, implant survival rate, implant success rate, white aesthetic score, and patient-reported outcomes did not demonstrate a significant difference between two groups during 1 to 3-year follow-up visits. CONCLUSION: The current data do not provide evidence of significant differences between two abutment fabrication methods in terms of peri-implant clinical outcomes within short-term period (CRD42020170807).

Restoration using gingiva-colored ceramic and a ridge lap pontic with circumferential pressure: a clinical report.

Achieving an optimal esthetic result when replacing missing teeth with implant-supported restorations in the esthetic zone is a demanding surgical and restorative challenge. This clinical report describes the use of a cantilevered, cemented, implant-supported restoration with gingiva-colored ceramics and a circumferential pressure-ridge lap pontic to replace 2 incisors and the adjacent tissue.

The impact of early-in-life periodontal infection on the smiles of children: a worldwide view.

Little attention has been directed toward evidence that an early-in-life oral infection with the potential to reach epidemic proportions is threatening the health of youths throughout world. Health professionals and the public seem unaware that the silent disease process of early-in-life periodontal infection is targeting thousands of children and young adults, their smiles, and, consequently, their emotional and psychologic lives. Yet, the literature is replete with reports that many periodontopathic microorganisms are multiplying at an alarming rate with a serious impact on youths in many cities, towns, and villages throughout the globe. However, clinical measurement of reported periodontal disease has been fraught with problems that have confused and clouded messages to policymakers in government and health professionals in treatment settings. The aim of this article is to help raise the level of awareness so that those who have the power and knowledge can appropriately address the suffering of the youngest members of societies.

Influence of artificial aging on mechanical properties of commercially and non-commercially available zirconia dental implants.

OBJECTIVE: To evaluate the effect of artificial aging on the mechanical resistance and micromechanical properties of commercially and noncommercially available zirconia dental implants. METHODS: Scanning electron microscopy (SEM) and X-ray computed tomography (X-CT) were performed on implant systems including: Z-systems®, Straumann®, Zibone® and commercially and non-commercially available TAV dental® with varying grain sizes. Accelerated aging was performed at 134 °C and 2-bar pressure for 30 hours. Before and after aging, the mechanical load to failure was investigated and the bending moments were calculated. Nanoindentation responses of the representative Zibone implant before and after aging were performed to evaluate the effects of aging on hardness (H) and Young's modulus (E). A two-sample t-test statistical analysis was used to determine significant differences of bending moments within groups. RESULTS: All implants presented with compact and homogenous core structures without porosities. The bending moment was significantly increased after aging for all groups (P ≤ 0.05) except for Z-systems (significant decrease (P = 0.022)) and TAV group 3 (no significant increase (P = 0.181)). The increase in bending moment was less pronounced with increasing grain size in TAV groups (group 1: P = 0.036, group 2: P = 0.05, group 3: P = 0.18). E and H were reduced approximately 32% and 18% respectively following aging within the transformed, microcracked zone of the presentative Zibone implant. CONCLUSIONS: Aging led to both increase and decrease of the mechanical properties of the implant systems analyzed. The apparent contrast amongst groups can be explained based on differences in grain sizes and surface features. Aging decreased micromechanical properties of one implant system which warrants further investigation.

Periodontal biotype influence on the volume maintenance of onlay grafts.

BACKGROUND: Autogenous osseous transplants have advantages, including the maintenance of bone density and high concentrations of growth factors. Little is known about the potential long-term influence of periodontal biotype on the volume maintenance of block grafts. METHODS: Forty patients who received autogenous block transplants prior to implant placement were included in the study. Digital photographs and periapical radiographs were taken after restoration. Clinical parameters, including bleeding on probing, mobility, suppuration, mucosal recession, and buccal tissue transparency, were recorded at yearly intervals. A computerized tomography (CT) scan was taken at an average of 42 months (n = 20) postaugmentation. RESULTS: The clinical examination revealed no implant transparency, mucosal recession, mobility, bleeding on probing, or suppuration (n = 40) at 48 months. CT scans showed varying thicknesses (0.5 to 4 mm) of buccal cortical bone around the implants. The increased width at the recipient site postgraft was 7.6 mm, maintaining, on average, 98% of the augmented width. The buccal osseous thickness at the implant sites averaged 2.0 +/- 0.8 mm compared to 0.7 +/- 0.5 mm for the adjacent teeth (95% confidence interval: 0.85 to 1.65 mm; P <0.0001). Even when adjacent teeth had a thin biotype, the transplanted sites maintained statistically significant thicker buccal cortical plate at all sites (P <0.0001). CONCLUSIONS: Grafted site phenotype did not seem to be influenced by the adjacent teeth biotype. Autogenous osseous transplants can predictably reconstruct function and esthetics and seemed to maintain stable bone volume around implants at an average of 3.5 years.