Instructions for the use of L-PRF in different clinical indications.

Autologous platelet concentrates (APCs) have demonstrated clear benefits across various clinical applications, including alveolar ridge preservation, guided tissue regeneration, guided bone regeneration, sinus floor elevation (both lateral window approach and transcrestal technique), endodontic surgery, the treatment of medication-related osteonecrosis of the jaw bones, and periodontal plastic surgery. To ensure an optimal clinical outcome, clinicians must adhere strictly to the protocol to prepare the APCs and, especially follow evidence-based surgical guidelines, often simple but crucial, to minimize the likelihood of errors. The majority of clinical trials reported on second-generation APCs [the leukocyte- and platelet-rich fibrin (L-PRF) family, including its modifications (A-PRF, A-PRF+, CGF, T-PRF, H-PRF, etc.)]. These second-generation APCs offer additional benefits compared to the first-generation APCs, making them the preferred choice for the development of clinical recommendations. These recommendations have been formulated through a meticulous examination of the available clinical data and the clinical experience of the authors of this paper.

[Innovative methods and developments in oral care. L-PRF: from evidence to clinical use]. / Serie: Innovatieve technieken en ontwikkelingen in de mondzorg. L-PRF: van evidence naar toepassingen in de praktijk.

Leukocyte- and platelet-rich fibrin (L-PRF) is a fully autologous biomaterial made from venous blood drawn from the patient. Due to its regenerative potency, antibacterial capacity, and analgesic activity, L-PRF can be used during surgical procedures as a sole biomaterial or as a bioactive additive along with other natural and synthetic biomaterials. There is sufficient scientific evidence available for applying L-PRF for various indications. The preparation protocol of L-PRF is simple, inexpensive and not time-consuming, making it possible to implement it in the daily practice. The type of centrifuge and blood collection tubes used, the settings of the centrifuge (rotation time and force) as well as the time between the different steps in the protocol have an influence on the biological and mechanical properties of L-PRF.

Influence of tongue brushing and scraping on the oral microflora of periodontitis patients.

OBJECTIVE: To examine the effect of tongue cleaning with a tongue scraper (TS) or toothbrush (TB) in patients with periodontitis. BACKGROUND: The tongue is a possible reservoir for bacterial (re)colonization of the periodontal tissues in patients with periodontitis. To date, it is not known what the influence of tongue cleaning is on the tongue coating of patients with periodontitis. MATERIAL AND METHODS: Eighteen systemically healthy, untreated moderate to severe adult patients with periodontitis with some degree of tongue coating were randomly assigned to the use of a TS or TB for cleaning the tongue. Microbial load of the saliva and tongue dorsum, amount of tongue coating and patient perception about tongue cleaning were studied at baseline and 2 weeks later. RESULTS: Two weeks of tongue cleaning with either a TB or a TS, did not influence the microbiological counts, neither in the saliva, nor in the tongue coating, even though tongue coating was significantly less. The patients themselves experienced no differences in breath odour or taste sensation after 2 weeks of tongue cleaning; however, they felt that their tongue was cleaner at the end of the study compared to baseline. No differences could be detected between the uses of a TS vs a TB. CONCLUSION: In patients with periodontitis, tongue cleaning does not influence the bacterial load in the saliva or on the tongue dorsum.

Clinical concentrations of peroxidases cause dysbiosis in in vitro oral biofilms.

BACKGROUND AND OBJECTIVE: Little is known about the initiation of dysbiosis in oral biofilms, a topic of prime importance for understanding the etiology of, and preventing, periodontitis. The aim of this study was to evaluate the effect of different concentrations of crevicular and salivary peroxidase and catalase on dysbiosis in multispecies biofilms in vitro. MATERIAL AND METHODS: The spotting technique was used to identify the effect of different concentrations of myeloperoxidase, lactoperoxidase, erythrocyte catalase, and horseradish peroxidase in salivary and crevicular fluid on the inhibitory effect of commensals on pathobiont growth. Vitality-quantitative real-time PCR was performed to quantify the dysbiotic effect of the peroxidases (adjusted to concentrations found in periodontal health, gingivitis, and periodontitis) on multispecies microbial communities. RESULTS: Agar plate and multispecies ecology experiments showed that production of hydrogen peroxide (H2 O2 ) by commensal bacteria decreases pathobiont growth and colonization. Peroxidases at concentrations found in crevicular fluid and saliva neutralized this inhibitory effect. In multispecies communities, myeloperoxidase, at the crevicular fluid concentrations found in periodontitis, resulted in a 1-3 Log increase in pathobionts when compared with the crevicular fluid concentrations found in periodontal health. The effect of salivary lactoperoxidase and salivary myeloperoxidase concentrations was, in general, similar to the effect of crevicular myeloperoxidase concentrations. CONCLUSIONS: Commensal species suppress pathobionts by producing H2 O2 . Catalase and peroxidases, at clinically relevant concentrations, can neutralize this effect and thereby can contribute to dysbiosis by allowing the outgrowth of pathobionts.

L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth, randomized, controlled pilot clinical trial.

BACKGROUND: This study aims to evaluate the use of the leukocyte- and platelet-rich fibrin (L-PRF) membranes in increasing the width of the keratinized mucosa (KM) around implants. MATERIAL AND METHODS: Eight patients in need for bilateral widening of the KM around implants in the lower jaw were recruited for a spit-mouth randomized controlled trial. At the control site, a free gingival graft (FGG) was used, whereas at the other side (test), L-PRF membranes were applied. The primary outcome was the increase in width of KM around the implants. As secondary outcomes, the postoperative pain and surgical time were assessed. The follow-up period was 6 weeks. RESULTS: A significant increase in the total bucco-lingual width of KM in both groups was observed, with 1.3 mm ± 0.9 extra gain (P < .05) for the FGG sites. Shrinkage of the widened areas in this period was 32.1% at the test site and 23.6% at the control site. All values of the postoperative pain scores at the control site were higher than at the test site. The mean surgery time in the test and control group was 29.1 ± 4.8 and 48.1 ± 7.7 minutes, respectively. CONCLUSION: Within the limitations of this randomized controlled trial with split mouth design, it can be concluded that L-PRF can increase the width of KM around implants. Furthermore, the use of L-PRF results in a lower surgical time with less postoperative discomfort and pain for the patients in comparison to the FGG.

Healing of toothbrush-induced abrasions to keratinized mucosa of the palate in humans: A pilot study.

BACKGROUND AND OBJECTIVE: To the best of our knowledge, the healing time for toothbrush-induced gingival abrasions in humans has not yet been explored. The aim of this study was to evaluate the time needed to heal for toothbrush-induced abrasions of the keratinized mucosa of the palate. MATERIAL AND METHODS: In patients without, with mild periodontitis or with periodontitis, gingival abrasion lesions were induced at the keratinized mucosa of the palate by brushing up to 2 minutes. Healing as observed clinically was followed via calibrated digital photographs of the lesion after staining, every 24 hours until the lesion had resolved. In patients without or with only mild periodontitis, the healing time of lesions caused by 30 seconds and 1 minute of brushing was also recorded. RESULTS: Thirty-one participants (11 without or with mild periodontitis, 20 with periodontitis) met the inclusion criteria. In patients without or with mild periodontitis, the lesions induced by brushing for 2 minutes diminished by 48.7% of their original surface area within 24 hours. In patients with periodontitis the respective outcome was 45.4% (P = .87). Abrasions caused by 2 minutes of brushing needed more than 24 hours to heal completely. When decreasing the time exposed to trauma, fewer lesions were visible at baseline and the time needed to heal decreased. The subgroup of smokers was too small to evaluate any effect. CONCLUSION: The longer the exposure time of the keratinized mucosa of the palate to trauma, the more lesions were visible, the larger the abrasions were and the more time they needed to heal completely. More studies are needed to investigate the role of smoking, gingival biotype and to link these findings with gingival recessions.

Periodontal screening and referral behaviour of general dental practitioners in Flanders.

OBJECTIVES: The objective of this study was to investigate the screening and referral behaviour of Flemish dentists concerning periodontitis and more specific, the use of the Dutch Periodontal Screening Index (DPSI). MATERIALS AND METHODS: An online questionnaire was electronically distributed through the different professional dental societies. It consisted of two parts: the first aimed at describing the profile of the dentist. The second part inquired the screening method, when this was applied, periodontal risk factors and referral behaviour. RESULTS: One thousand fifty dentists attended to the questionnaire. One hundred fifty-nine questionnaires were excluded since they did not match the target audience. Sixty-four percent of Flemish dentists used DPSI as a periodontal screening method, 28% screened based on probing pocket depth, 4% used solely radiographs and 4% had no screening method at all. The usage of DPSI is influenced by the year of graduation: the longer the dentists were graduated, the less they used DPSI. No influence of sex, education centre and location was found. Referral behaviour is influenced by different patient- and dentist-related factors. CONCLUSIONS: Regarding the screening behaviour, there seems a consensus among Flemish dentists that a periodontal probe should be used. For referral, there is no consensus about if and when to refer to a specialist. CLINICAL RELEVANCE: It is encouraging that 92% of the Flemish general dental practitioners use a probe when screening for periodontitis. However, DPSI is mainly used by younger dentists. An effort should be made to encourage all dentists to use this, so that in every patient, periodontitis can be detected timely, securing the best treatment outcome.

Oral implant placement and restoration by undergraduate students: clinical outcomes and student perceptions.

INTRODUCTION: Universities are developing and implementing implant dentistry training to prepare dental professionals for the growing treatment needs. This study describes how implant dentistry is taught at the KU Leuven and focuses on implant-related clinical outcomes. Perspectives of participating undergraduate students are analysed with a view to improve oral implant dentistry training. MATERIALS AND METHODS: Implant dentistry training at the KU Leuven consists of theoretical lectures, pre-clinical hands-on workshops and clinical (surgical/prosthetic) experience. Questionnaires were used to investigate the perceptions of students on the educational programme. Radiographs were taken at implant insertion, at healing abutment connection, at restoration/prosthesis insertion and after 1 and 2 years of functional loading. The marginal bone level was measured from the implant-abutment connection to the first visible bone-to-implant contact. RESULTS: One hundred and twelve implants were placed by 56 undergraduate students (61.5% of the total students) in 56 patients. After a follow-up time of 3 years, the cumulative implant survival rate, at implant level, was 97.1%. The mean marginal bone loss after 1 and 2 years in function was 0.35 mm and 0.39 mm, respectively. Eighty percentage of students were satisfied with the training, and they considered this sufficient preparation to perform implant placement under close supervision. CONCLUSIONS: The clinical outcome of implant treatment performed by undergraduate students under close supervision is similar to that reported by experienced clinicians/research teams. Clinical, surgical as well as restorative experience in addition to theoretical and pre-clinical training seems beneficial when implementing implant dentistry in the undergraduate programmes.

Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) when compared to SRP alone in patients with untreated chronic periodontitis. BACKGROUND: Although chronic periodontitis is mostly treated without adjunctive systemic antibiotics, some recent meta-analyses have shown clinical benefit for some systemic antibiotics when used as an adjunct to SRP. However, there is a wide variety of systemic antibiotic regimens used today. It remains unclear if the selected type of systemic antibiotic influences the magnitude of clinical benefit. MATERIAL AND METHODS: The MEDLINE-PubMed database was searched from their earliest records through May 16, 2013. Several journals were hand searched and some authors were contacted for additional information. Outcome measures analysed were mean bleeding on probing change, mean clinical attachment level gain and mean probing pocket depth reduction. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed. RESULTS: The search yielded 281 abstracts. Ultimately, 95 studies were selected, describing 43 studies meeting the eligibility criteria. Systemic antibiotics showed a significant (p < 0.05) additional pocket depth reduction for moderate (at 3 mo 0.27 mm ± 0.09, at 6 mo 0.23 mm ± 0.10 and at 12 mo 0.25 mm ± 0.27) and deep pockets (at 3 mo 0.62 mm ± 0.17, at 6 mo 0.58 mm ± 0.16 and at 12 mo 0.74 mm ± 0.30). Statistically, no specific type of antibiotic was superior over another. However, when analysing the clinical data for initially moderate pockets or deep pockets, some trends became apparent. CONCLUSION: Systemic antibiotics combined with SRP offer additional clinical improvements compared to SRP alone. Although there were no statistically significant differences, there was a trend that for initially moderate and deep pockets, metronidazole or metronidazole combined with amoxicillin, resulted in clinical improvements that were more pronounced over doxycycline or azithromycin. Additionally, there was a trend that the magnitude of the clinical benefit became smaller over time (1 year).

Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) compared to SRP alone in patients with untreated aggressive periodontitis. BACKGROUND: In patients with aggressive periodontitis, SRP is often combined with the use of systemic antibiotics. However, the effectiveness of these antibiotics over time and differences in effectiveness between different antibiotics are hardly known. MATERIAL AND METHODS: The MEDLINE-PubMed database was searched from their earliest records until January 20, 2014. Several journals were hand searched and some authors were contacted for additional information. The following outcome measures were analysed: mean probing pocket depth reduction, mean clinical attachment level gain and mean bleeding on probing change. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed. RESULTS: The search yielded 296 abstracts. Ultimately, 101 articles were selected of which 14 articles met the eligibility criteria. Systemic antibiotics showed a significant (p < 0.05) additional pocket depth reduction for moderate (0.36 ± 0.22 mm at 3 mo, 6 mo 0.42 ± 0.22 mm and 12 mo 0.88 ± 0.27 mm) and deep pockets (0.74 ± 0.36 mm at 3 mo, 6 mo 0.85 ± 0.55 mm and 12 mo 1.26 ± 0.81 mm) and a significant clinical attachment gain for moderate (0.26 ± 0.18 at 3 mo, 6 mo 0.52 ± 0.15 and 12 mo 0.83 ± 0.38) and deep pockets (0.59 ± 0.18 at 3 mo, 0.96 ± 0.21 at 6 mo and 1.00 ± 0.80 at 12 mo). CONCLUSION: For the treatment of patients with aggressive periodontitis, systemic antibiotics combined with non-surgical periodontal therapy resulted in a significant additional effect compared to non-surgical therapy alone. There is a visible trend that showed metronidazole + amoxicillin is the most potent antibiotic combination.

Depth and lateral deviations in guided implant surgery: an RCT comparing guided surgery with mental navigation or the use of a pilot-drill template.

AIM: To assess the accuracy of guided surgery compared with mental navigation or the use of a pilot-drill template in fully edentulous patients. MATERIAL AND METHODS: Sixty consecutive patients (72 jaws), requiring four to six implants (maxilla or mandible), were randomly assigned to one of the following treatment modalities: Materialise Universal(®) mucosa, Materialise Universal(®) bone, Facilitate(™) mucosa, Facilitate(™) bone, mental navigation, or a pilot-drill template. Accuracy was assessed by matching the planning CT with a postoperative CBCT. Deviations were registered in a vertical (depth) and horizontal (lateral) plane. The latter further subdivided into BL (bucco-lingual) and MD (mesio-distal) deviations. RESULTS: The overall mean vertical deviation for the guided surgery groups was 0.9 mm ± 0.8 (range: 0.0-3.7) and 0.9 mm ± 0.6 (range: 0.0-2.9) in a horizontal direction. For the non-guided groups, this was 1.7 mm ± 1.3 (range: 0.0-6.4) and 2.1 mm ± 1.4 (range 0.0-8.5), respectively (P < 0.05). The overall mean deviation for the guided surgery groups in MD direction was 0.6 mm ± 0.5 (range: 0.0-2.5) and 0.5 mm ± 0.5 (range: 0.0-2.9) in BL direction. For the non-guided groups, this was 1.8 mm ± 1.4 (range: 0.0-8.3) and 0.7 mm ± 0.6 (range 0.0-2.9), respectively. The deviation in MD direction was significantly higher in the non-guided groups (P = 0.0002). CONCLUSION: The most important inaccuracy with guided surgery is in vertical direction (depth). The inaccuracy in MD or BL direction is clearly less. For non-guided surgery, the inaccuracy is significantly higher.

Clinical and radiographic evaluation of narrow- vs. regular-diameter dental implants: a 3-year follow-up. A retrospective study.

OBJECTIVES: Narrow-diameter implants (NDIs) are used in severely resorbed mandibles. The reduced implant diameter means a reduction in the total contact surface between the implant and bone. The question arises whether the implant can be sufficiently osseointegrated to withstand loading forces. If not, marginal bone loss can result from overload. The aim of this retrospective study was to compare clinical and radiographic measurements and patient satisfaction of NDIs with those of regular-diameter implants (RDIs) placed in edentulous patients to support an overdenture via either a ball or a locator connection. MATERIAL AND METHODS: Retrospectively over a 7-year period, a total 119 patients fulfilled the inclusion criteria and were selected for this study. The patients received two 3.3- or 4.1-mm-diameter standard titanium implants in the mandible to support an overdenture. At maintenance examinations after 1 and 3 years, clinical peri-implant and prosthetic conditions, marginal bone (MB) and patient satisfaction were investigated. RESULTS: None of the 238 implants were lost during the 3-year follow-up period. Overall MB loss was statistically higher in the NDI group when compared with the RDI group. At the site level, a greater MB loss was observed at the distal side of both implant types. Implants with a locator showed significantly greater MB loss (0.38 mm) compared with the implants with a ball attachment (0.14 mm) over the two-year evaluation period (P = 0.006). Patient satisfaction significantly favoured the NDI (8.3) and the locator attachment (8.6). CONCLUSIONS: The results suggest that during the first three years after implantation, NDIs were associated with more marginal bone loss compared with RDIs. Regardless of implant diameter, the locator attachment showed more marginal bone loss over time compared with the ball attachment.

Long-term changes in microbiology and clinical periodontal variables after completion of fixed orthodontic appliances.

OBJECTIVES: The aim of this prospective study was to monitor patients' microbiological and clinical periodontal parameters prior and up to 2 years after orthodontic treatment. MATERIAL AND METHODS: Twenty-four adolescents were treated with brackets. Fourteen of them received bands on upper first molars for extra-oral force application before bonding brackets to the remaining teeth. Microbiology, periodontal probing depth, bleeding on probing (BOP), and gingival crevicular fluid (GCF) flow were assessed at baseline (T1), bracket removal (T2), and 2 years post-treatment (T3). A statistical comparison was made over time and between bands and brackets. RESULTS: A significant increase from T1 to T2 and a decrease from T2 to T3 in pathogenicity of plaque were noted. No significant difference was observed concerning supragingival colony-forming units (CFU) ratio (aerobe/anaerobe) between T3 and T1. However, the subgingival CFU ratio (aerobe/anaerobe) at T3 did significantly differ from the ratio at T1. Periodontal probing depth, BOP and GCF flow showed a significant increase between T1 and T2 and a reduction between T2 and T3, resulting in the absence of significant differences between T3 and T1, except for BOP at banded sites. CONCLUSION: Placement of fixed appliances has an impact on periodontal parameters. The results showed that not all parameters were normalized at T3, indicating that the changes are only partially reversible.

RCT comparing minimally with moderately rough implants. Part 2: microbial observations.

BACKGROUND: Most current implants have a moderately rough surface (compared with older minimally rough "turned" implants) to facilitate osseointegration. This randomized controlled trial (RCT), with split-mouth design, examined whether this increased surface roughness influenced the initial subgingival plaque formation. MATERIAL AND METHODS: Ten fully edentulous and eight partially edentulous patients, all with a history of severe periodontitis, received 4-6 implants (mandible or maxilla). Per jaw, both minimally (turned) and moderately rough (TiUnite) implants (MKIII; Nobel Biocare) were alternated. Also, the healing and final abutments had similar surface characteristics. Subgingival biofilm formation was followed up for 1 year, and samples were analyzed by culture technique, qPCR and checkerboard RESULTS: Over the entire period, no statistically significant differences could be detected in subgingival microbiota between the minimally and moderately rough surfaces. In partially edentulous patients, the biofilm matured to a higher concentration of pathogens when compared with fully edentulous patients. The subgingival implant composition and concentration in partially edentulous patients were comparable to the subgingival microbiota along teeth. CONCLUSION: The roughness of the more modern implants did not influence the biofilm formation during the first year of implant loading.

Extra short dental implants supporting an overdenture in the edentulous maxilla: a proof of concept.

OBJECTIVES: This study investigates the outcome of short implants additionally placed with longer implants to support a maxillary overdenture. MATERIALS AND METHODS: Twelve patients received six implants to support a maxillary overdenture. Only one patient still had two molars in the maxilla, while the others had no remaining teeth. The status of the opposing arch was diverse. The distal implant in each quadrant was 6 mm in height (S) and the middle implants ranged between 10 and 14 mm (L). All implants were placed following a one-stage procedure and early loaded (6 weeks). Clinical and radiological parameters were assessed 6, 12 and 24 months after loading. RESULTS: One short implant failed 2 weeks after surgery, probably due to early mobilization by the provisional prosthesis. The mean bone loss on the rough part of the implant was 0.7 mm (S) vs. 1.3 mm (L) during the first year and 0.3 mm (S) vs. 0.2 mm (L) during the second year after loading. The mean implant stability quotient values were 67 (S) vs. 70 (L) at placement and 75 (S) vs. 78 (L) after 1 year. At the 2-year follow- up, all prostheses were still stable and comfortable. CONCLUSION: An overdenture on six implants, of which two have a reduced length, might represent a successful treatment option. No significant difference could be found between both implant lengths at 2 years' follow-up. However, bone loss with short implants may increase the likelihood of failure.

Sleeping vs. loaded implants, long-term observations via a retrospective analysis.

OBJECTIVE: Several theories have been presented to explain initial and secondary marginal bone loss around dental implants (e.g. microbial load, adverse loading, microbial leakage, compromised healing/adaptation of host-implant interface). MATERIAL AND METHODS: This study compared the long-term outcome (up to 12 years) of sleeping with loaded implants in the mandible via a split-mouth concept. Fourteen patients with overdentures were enrolled (10 women, mean age at implant insertion: 56 years [range: 33-71]). They presented with 28 loaded (position 33/43) and 14 sleeping implants (mostly position 31/41). At several follow-up visits, intra-oral radiographs (long-cone principle) were taken to observe marginal bone level changes. RESULTS: At each observation, compared with abutment connection, the submerged non-loaded implants showed less bone loss (P-values: 1st year 0.007, 3 years 0.000, 5 years 0.002, 8 years 0.007, 12 years 0.000) than their neighbouring functional implants. This difference was primarily due to a more significant bone loss during the first year of loading (0.8 vs. 0.1 mm respectively), since afterwards, the bone level changes remained quite similar for both implant types. CONCLUSIONS: Our data suggest that the first months of loading have a significant impact on the bone level (initial difference sleeping vs. loaded implants), followed by a more physiological bone level change afterwards. This initial difference might be explained by the adaptation of the surrounding bone to the loaded implant.

Model-based guided implant insertion for solitary tooth replacement: a pilot study.

OBJECTIVE: The impact of the implant position on the restorative outcome could justify guided surgery even for the single implants particularly in the aesthetic zone and especially when a simplified concept is available. MATERIAL AND METHODS: Based on a plaster model, on which the soft tissues were mimicked (according to the thickness measured on a Cone-Beam CT), a tooth-supported, surgical template was prepared. The latter guided all drills so that even flapless implant insertion became possible. All implants were placed by students of the master-after-master training program in Periodontology. RESULTS: The prospective cohort included a total of 34 implants, all of AstraTech (Osteospeed(®)) type, which were successfully inserted in 29 patients, 16 flapless, 32 onestage. The marginal bone along the integrated implants remained stable over time, with 0.13 mm loss during the first year. The aesthetic parameters were reassuring. CONCLUSIONS: This simple model-based concept seems to be reliable for the guided placement of single implants and the pre-operative preparation of their restorations.

RCT comparing minimally with moderately rough implants. Part 1: clinical observations.

AIM: This 1-year prospective RCT compared the outcome of minimally (turned) and moderately rough (TiUnite) implant surfaces. MATERIAL AND METHODS: Two subgroups of patients were formed; one group (n = 10) where all teeth had been extracted due to severe periodontitis, another group (n = 8) with teeth in the antagonistic jaw with a history of periodontitis and some remaining medium pockets (4-6 mm). Implants (n = 85, 43 turned & 42 TiUnite) were installed randomly in each patient. After 3-6 months of submerged healing, healing abutments were connected, followed by final abutments 2 weeks later, all with the same surface characteristics as the supporting implant. Peri-implant parameters and intra-oral radiographs were recorded up to 1 year after abutment connection. RESULTS: Two turned implants failed in the partial edentulous group during the initial healing period (CSR: 95%) and none of the TiUnite (CSR: 100%) surface. No statistically significant differences in clinical parameters could be observed between both surfaces. The partial edentulous subgroup showed more bone loss compared to the full edentulous subgroup. CONCLUSION: Moderately rough implants have a similar clinical outcome (at 1 year of loading in periodontitis susceptible patients) compared to minimally rough implants.

Accuracy of computer-aided implant placement.

AIM: To assess the accuracy of static computer-guided implant placement. MATERIAL AND METHODS: Electronic and manual literature searches were conducted to collect information on the accuracy of static computer-guided implant placement and meta-regression analyses were performed to summarize and analyse the overall accuracy. The latter included a search for correlations between factors such as: support (teeth/mucosa/bone), number of templates, use of fixation pins, jaw, template production, guiding system, guided implant placement. RESULTS: Nineteen accuracy studies met the inclusion criteria. Meta analysis revealed a mean error of 0.99 mm (ranging from 0 to 6.5 mm) at the entry point and of 1.24 mm (ranging from 0 to 6.9 mm) at the apex. The mean angular deviation was 3.81° (ranging from 0 to 24.9°). Significant differences for all deviation parameters was found for implant-guided placement compared to placement without guidance. Number of templates used was significant, influencing the apical and angular deviation in favour for the single template. Study design and jaw location had no significant effect. Less deviation was found when more fixation pins were used (significant for entry). CONCLUSION: Computer-guided implant placement can be accurate, but significant deviations have to be taken into account. Randomized studies are needed to analyse the impact of individual parameters in order to allow optimization of this technique. Moreover, a clear overview on indications and benefits would help the clinicians to find the right candidates.

The effect of mouthrinses on oral malodor: a systematic review.

OBJECTIVE: The objective of this study is to systematically review the literature regarding the impact of mouthrinses on oral malodor and present evidence for the treatment effects of mouthrinses on oral malodor. MATERIAL AND METHODS: PubMed-MEDLINE, the Cochrane-CENTRAL and EMBASE were searched through February 10, 2012 to identify appropriate studies. Volatile sulphur compound measurements, organoleptic measurements and tongue coating were selected as outcome variables. SEARCH RESULTS: The independent screenings of 333 unique titles and paper abstracts revealed 12 publications (12 experiments) that met the eligibility criteria. Means and standard deviations were extracted. The results were separated into short-term (<3 weeks) and longer-term (≥3 weeks) studies. CONCLUSION: In this review, nearly all mouthwashes with active ingredients had beneficial effects in reducing oral malodor in both short- and longer-term studies. The most compelling evidence was provided for chlorhexidine mouthwashes, and those that contained a combination of cetyl pyridinum chloride and zinc provided the best evidence profile on oral malodor. Little data with respect to tongue coating were available, and none of the studies showed a beneficial effect for this parameter.