Plaque score change as an indicator for periimplant health in periodontal patients with immediately restored dental implants.

BACKGROUND: Patients with a history of periodontitis might have a higher risk for implant failure as compared with periodontally healthy subjects. The aim of the present study was to look into this risk factor by examining the association between plaque scores, probing depths (PD), and bleeding on probing (BOP) around teeth and immediately restored dental implants up to 1 year after implant surgery. METHODS: Patients with partial edentulism, diagnosed with and previously treated for generalized chronic periodontitis, received dental implants, abutments, and cemented provisional prostheses up to 72 hours after implant surgery. Plaque scores, PD, and BOP were recorded and evaluated 6 and 12 months postsurgery. RESULTS: Plaque scores deteriorated slightly around teeth and improved around implants. No significant change was observed in the distribution of PD around teeth. The proportion of shallow pockets increased around implants. Improvement in plaque scores was associated with a stable/reduced PD, whereas deterioration in plaque scores was associated with increased PD around implants and teeth. CONCLUSIONS: A direct relationship was found between plaque score improvement and stable/reduced PD. Therefore, partially edentulous patients with a history of periodontitis should be encouraged to improve their plaque scores to maintain shallower pockets around implants.

The in vivo efficacy of Fluorinex topical fluoridation treatment.

OBJECTIVE: This randomized, single-controlled study was performed to validate in vivo the efficacy of single Fluorinex treatment by examining fluoride incorporation into enamel using electron microscopy. METHOD AND MATERIALS: Twenty healthy participants referred for routine dental treatment which also required extractions of at least two teeth as part of their treatment plan were included in this study. For each participant, one randomly selected tooth was extracted and sent for blind electron microscopic fluoride assay (control, C). Next, following a single Fluorinex treatment, the second (test, T) tooth was extracted and sent for the same assay. Intra-individual and intergroup fluoride content comparisons were performed, between control and test teeth. RESULTS: Highly significant intra-individual and intergroup differences were found between the treated and untreated teeth. Fluoride atomic percent (at%) and weight percent (wt%) estimated least squares means of untreated group were found to be 0.56 and 0.48, and in the treated group 17.35 and 14.35. This increase in fluoride at% [16.78 ± 2.3 (SE)], was also significant statistically (P < .0001); likewise, the increase in fluoride wt % [13.86 ± 1.97 (SE)] was similarly significant (P < .0001). The system was well tolerated by the participants with minimal transitional mild side effects. CONCLUSION: In vivo fluoride application using the active Fluorinex system resulted in a significant increase of fluoride content in the enamel of adult permanent teeth compared to untreated internal controls.

Immediate restoration of delayed placement of dental implants in patients with treated periodontal disease: 1-year results.

PURPOSE: To evaluate implant and patient characteristics in a prospective clinical study involving immediate fixed restoration of delayed placement of dental implants. MATERIALS AND METHODS: Patients diagnosed with generalized chronic periodontitis and previously treated were accepted into the study when they expressed a wish to receive immediate restoration of dental implants. Treatment planning and implant placement were computer assisted, using computerized tomography, planning software, and a surgical template. Patients received abutments and cemented provisional prostheses no later than 72 hours following implant surgery. Patients were followed at 2 and 4 weeks, and 3, 6, and 12 months. RESULTS: Eighteen patients were accepted and completed the study, ages ranged from 34 to 69 years (mean 54.5±8.5 years). Five patients (27.8%) were smokers (2.5 to 60 pack years). Fifty implants were placed, ranging between 1 to 8 implants per patient. Median implant length was 13 mm (range, 10 to 13 mm) and median implant diameter was 3.75 mm (range, 3.75 to 5 mm). Mean insertion torque was 43 NCm±6.2 SD (range 30 to 50 NCm). Mean implant stability quotient was 71±11 (range 37 to 85). One implant in a patient who smoked and three implants in another patient who smoked failed for a total of four failed implants. At 12 months, the overall survival rate was 92% (100% and 73% among nonsmokers and smokers, respectively). CONCLUSIONS: The survival of immediately restored dental implants in periodontally treated patients is greater than 90%. Smokers with a past history of chronic periodontitis seem to have a lower implant survival rate.

Accuracy of a computerized tomography-guided template-assisted implant placement system: an in vitro study.

OBJECTIVES: To evaluate the accuracy of computer-assisted 3D planning and implant insertion using computerized tomography (CT). MATERIALS AND METHODS: Nine implants were planned on pre-operative CTs of six resin models, which were acquired with radiographic templates, using a planning software (E implants). Each resin model contained three pre-existing control implants (C implants). Radiographic templates were converted into operative guides containing 4.8-mm-diameter titanium sleeves. A single set of insertable sleeves was used for consecutively drilling the six models, followed by implant insertion through the guide sleeves. Models were further divided into group A (the first three models) and group B (the last three models). Post-operative CTs were used to compare implant positions with pre-operative planned positions. Statistical analysis included the Mann-Whitney U test for E and C implants and the Wilcoxon's signed ranks test for groups A and B. RESULTS: The mean apex depth deviations for E and C implants [0.49 mm+/-0.36 standard deviation (SD) and 0.32 mm+/-0.21 SD, respectively], and the mean apex radial deviations (0.63 mm+/-0.38 SD and 0.49 mm+/-0.17 SD, respectively) were similar (P>0.05). The mean angulation deviations for E and C implants were 2.17+/-1.06 degrees SD and 1.33+/-0.69 degrees SD, P<0.05. E implant deviations of all the parameters in group A were significantly smaller than E implant deviations in group B. CONCLUSIONS: Computer-assisted implant planning and insertion provides good accuracy. Deviations are mainly related to system and reproducibility errors. Multiple use of drills and titanium sleeves significantly reduces system accuracy.

Radiographic changes around immediately restored dental implants in periodontally susceptible patients: 1-year results.

PURPOSE: There is little information available about radiographic bone changes around immediately restored implants in periodontally compromised patients. The aims of this study were to evaluate the effect of immediate restoration on radiographic bone changes and to compare radiographic changes between arches and between healed and extraction sites in periodontally susceptible patients. MATERIALS AND METHODS: Patients received periodontal treatment. "All in one" implant surgery was then performed: Hopeless teeth were extracted, debridement around remaining adjacent teeth was performed, implants were inserted guided by a surgical stent, and a prefabricated screwed provisional restoration was immediately delivered on selected implants. Periapical radiographs using a parallelism appliance were taken at implant surgery and 6 and 12 months postsurgery. The distance between the alveolar crest and the implant shoulder was measured at the mesial and distal aspect of each implant. Bone changes were compared between immediately restored, submerged, and nonrestored implants; between arches; and between healed and extraction sites. RESULTS: Nineteen patients received 74 implants. Twelve implants in 4 patients failed within the first 6 months. Mean bone changes (+/- SE) between baseline and 12 months ranged between -1.19 +/- 0.19 mm and -1.88 +/- 0.3 mm. No difference was found between restored versus nonrestored sites or between maxillary and mandibular sites. Bone loss was slightly higher in healed sites. CONCLUSIONS: First-year bone changes around immediately restored dental implants in periodontally susceptible patients were slightly higher than most reports in the literature. This indicates a potential influence of periodontal disease on the success rate of dental implants.

Dental implants placed in previously failed sites: survival rate and factors affecting the outcome.

OBJECTIVES: The purpose of the present study was to evaluate the survival rate of dental implants in previously failed implant sites. In addition, factors that might affect the outcome of these redo procedures were also explored. MATERIAL AND METHODS: Patients that had failed dental implants, which were replaced with the same implant type at the same site, were included. Data on the failed implants were collected. The same parameters, along with the interval between retrieval and re-implantation, were collected for the second set of implants. Descriptive statistics were used to describe the patients and implants. Life table analysis of these implants was tabulated for both implant sets. The effect of systemic, environmental and local factors on the survival of the redo dental implants was evaluated. RESULTS: Fifty-six patients with a total of 79 redo implants were included in this study. Implants were followed for 7-78 months (mean 29.9+/-2). Thirteen implants failed that resulted in an overall survival rate of 83.5%. Successful implants had greater diameter (4.05+/-0.52 mm) than failed implants (3.72+/-0.56 mm); however, these differences were only marginal (P=0.06). Conversely, smoking habits, implants length and location, mode of placement and spontaneous exposure did not have a significant effect on the outcome of this procedure. CONCLUSION: Redo of dental implants has a lesser survival rate compared with previous reports for implants in pristine sites. These results were not associated with most implant- and/or patient-related factors. Thus, a possible negative effect that is associated with the specific implant's site might account for this phenomenon.

Immediate and delayed restoration of dental implants in periodontally susceptible patients: 1-year results.

PURPOSE: Immediate restoration of dental implants in patients with a history of periodontal disease was examined. The influence of insertion torque and implant stability quotient (ISQ) on the survival rate was compared in immediately restored, nonrestored, and submerged implants. MATERIALS AND METHODS: Patients received periodontal treatment after which "all in one" implant surgery was performed: hopeless teeth were extracted, debridement around remaining adjacent teeth was performed, implants were inserted and, in some cases, a prefabricated screw-retained provisional restoration was immediately delivered. Insertion torque and ISQ were recorded at baseline and 6 and 12 months postsurgery. RESULTS: Nineteen patients were treated, and 74 implants were placed. Twelve implants, 10 of which were maxillary, failed in 4 patients. Survival rates were 100% in partial-arch restorations, 94% in the mandible, and 78% in the maxilla. The survival rate of restored implants was 65% in extraction sites versus 94% in healed, nonextraction sites. Implants exhibited a decrease in ISQ at 6 months followed by an increase at 12 months. There were no statistically significant differences in insertion torque or ISQ between failed and successful implants, restored and nonrestored implants, or extraction-site and nonextraction-site implants. Mandibular implants demonstrated higher insertion torque and higher ISQ at baseline and 6 and 12 months. CONCLUSIONS: Within the limits of this study, immediate restoration of dental implants in periodontally susceptible patients had a variable success rate. Several factors were shown to affect these results.

Amine fluoride/stannous fluoride and chlorhexidine mouthwashes as adjuncts to single-stage dental implants: a comparative study.

BACKGROUND: The growing popularity of non-submerged dental implants in recent years requires a greater emphasis on microbial plaque control. Chlorhexidine (CHX), the most commonly used mouthwash in implant surgery, is sometimes associated with tooth staining and alteration in taste perception. Amine fluoride/stannous fluoride (AmF/SnF2) mouthwash has been shown to have anti-infective properties; however, it has not been tested as an adjunct anti-infective means in non-submerged dental implants. The purpose of this trial was to compare AmF/SnF2 and CHX mouthwashes as adjuncts to single-stage dental implants. METHODS: Thirty-three patients aged 34 to 79 (mean 54.30 +/- 8.69 SD) requiring dental implants were accepted into the study. Following comprehensive periodontal therapy patients received one to three non-submerged dental implants (maxilla: 17; mandible: 45; anterior: 3, posterior: 59). After surgery patients were given analgesics and antibiotics as well as 2,400 ml of coded mouthwash bottles previously randomized between the two above mentioned formulations. Clinical and radiographic parameters were recorded at baseline and 3 and 12 months post-surgery. RESULTS: Twelve-month survival rates were 100% and 92.9% for the AmF/SnF2 and CHX groups, respectively. Compliance was slightly higher in the AmF/SnF2 group (84.35% +/- 3.39% versus 78.15% +/- 4.59% SE) but statistically similar. There was no statistically significant difference between the AmF/SnF2 and CHX groups in staining index at 3 months (1.519 +/- 0.22 versus 1.457 +/- 0.24 SE) and patient subjective evaluation of the mouthwashes. Radiographic bone loss was 0.79 +/- 0.23 and 1 +/- 0.13 SE at 3 months and 1.06 +/- 0.13 and 1.27 +/- 0.25 at 12 months for the CHX and AmF/SnF2 groups, respectively; the difference was statistically insignificant (P = 0.388 and 0.504, respectively). CONCLUSION: Both CHX and AmF/SnF2 mouthwashes can be used post-surgically after one-stage implant surgery.