Revealing leukocyte populations in human peri-implantitis and periodontitis using flow cytometry.

OBJECTIVE: To identify, quantify, and characterize leukocyte populations in PI and periodontitis using flow cytometry. METHODS: Fresh biopsies from human PI and periodontitis lesions were processed to a single-cell suspension. The immune cell types were identified using flow cytometry. RESULTS: Twenty-one biopsies were obtained and analyzed corresponding to fourteen PI and seven periodontitis samples. Participants' average age was 63.95 ± 14.77 years without a significant difference between PI and periodontitis patients, the female/male ratio was 8/12, and mean PD was 8.5 ± 2.17. High similarity was found between periodontitis and PI in the main immune cell types. Out of the leukocytes, the PMN proportion was 40% in PI and 33% in periodontitis. T-cells 22% in PI and 18% in periodontitis. Similar proportions of B-cells 10% and macrophages 6% were found in PI and periodontitis. Dendritic and NK cells were found in low proportions (~ 1%) in PI and periodontitis. T-cell sub-analysis showed that CD4-positive were more prevalent than CD8-positive in both diseases (CD4/CD8 ratio of 1.2). CONCLUSION: With the use of flow cytometry analysis, the leukocyte populations in human peri-implantitis and periodontitis were classified. In PI and periodontitis, we identified similar proportions of specific (CD4/CD8) and innate (dendritic and NK) immune cells. These results corroborate previous histological studies. CLINICAL RELEVANCE: Flow cytometry analysis can be used to identify and quantify immune cells in PI and periodontitis, including sub-classification of T cells (CD4/8) as well as detection of cells that require multiple markers for identification (such as dendritic cells).

Comparing Operators and Imaging Techniques When Performing Trans-Crestal Sinus Augmentation: A Pilot Study.

The aim of this article was to compare baseline residual ridge height using Cone-beam Computed Tomography (CBCT) and panoramic radiographs. A secondary aim was to examine the magnitude of vertical bone gain 6 months after trans-crestal sinus augmentation and compare it between operators. Thirty patients, who underwent trans-crestal sinus augmentation simultaneously with dental implant placement, were included in this retrospective analysis. Surgeries were done by 2 experienced surgeons (EM and EG) using the same surgical protocol and materials. Preoperative residual ridge height was measured on panoramic and CBCT images. The final bone height and the magnitude of the vertical augmentation were measured on panoramic X ray taken 6 months after surgery. Mean residual ridge height measured preoperatively using CBCT was 6.07 ± 1.38 mm, whereas these same measurements on the panoramic radiographs yielded similar results (6.08 ± 1.43 mm), which were statistically insignificant (P = .535). Postoperative healing was uneventful in all cases. All 30 implants were successfully osseointegrated at 6 months. The mean overall final bone height was 12.87 ± 1.39 mm (12.61 ± 1.21 and 13.39 ± 1.63 mm for operators EM and EG, respectively; P = .19). Likewise, mean postoperative bone height gain was 6.78 ± 1.57 mm, which was 6.68 ± 1.32 and 6.99 ± 2.06 mm for operators EM and EG, respectively (P = .66). A moderate positive correlation was found between residual bone height and final bone height (r = 0.43, P = .002). A moderate negative correlation was found between residual bone height and augmented bone height (r = -0.53, P = .002). Sinus augmentation performed trans-crestally produce consistent results with minimal interoperator differences between experienced clinicians. Both CBCT and panoramic radiographs produced similar assessment of the preoperative residual bone height.

Palatal soft tissue thickness around dental implants and natural teeth in health and disease: A cross sectional study.

BACKGROUND: Previous studies focused on the influence of buccal mucosa thickness on peri-implant bone loss and inflammation, with inconclusive results. We observed substantially thicker palatal mucosal tissues at peri-implantitis sites. Therefore, we hypothesize that thick palatal peri-implant mucosa may be associated with deeper pockets and disease severity. PURPOSE: To compare the thickness of the palatal tissue between natural teeth and implants in periodontal health and disease. METHODS: Adult, non-smoker, healthy patients who visited our department for periodontal examination or treatment with restored implants in the posterior maxilla were recruited. Probing depth (PD), plaque index (PI), gingival index (GI) and radiographic measurements were recorded around implant and the contralateral tooth. Palatal tissue thickness was measured using a 30G needle that was inserted perpendicular into the mucosa at the bottom of the periodontal/peri-implant pocket and 3 mm coronally. Differences in the palatal tissue thickness between teeth and implants (in the same patient) was performed using t-test; as well as between peri-implantitis and non-peri-implantitis sites (among patients). RESULTS: Sixty patients were included. Thirty-four implants were diagnosed with peri-implantitis and 26 healthy/mucositis implants with corresponding 24 healthy/gingivitis teeth and 36 teeth with attachment loss. Mean PD was higher around implants (4.47 ± 1.57 mm) than teeth (3.61 ± 1.23 mm, p = 0.001). The thickness of implants' palatal mucosa was higher than in teeth, at the base of the pocket and 3 mm coronally (4.58 ± 1.38 mm vs. 3.01 ± 1.11, p = 0.000; 3.58 ± 2.15 vs. 1.89 ± 1.11, p = 0.000, respectively). Mean palatal tissue thickness was 4.32 ± 2.35 mm for the peri-implantitis group while only 2.61 ± 1.39 in healthy implants, 3 mm coronal to the base of the pocket (p = 0.001). Palatal thickness at peri-implantitis sites was higher (4.32 ± 2.35) compared to periodontitis sites (2.23 ± 0.93), p = 0.000. Implant sites with palatal mucosa >4 mm (n = 32) had deeper mean pockets (5.58 ± 1.98) compared with thinner (≤4 mm) sites (n = 28) (4.48 ± 1.18, p = 0.018). CONCLUSION: Thicker palatal tissue around implants is associated with deeper palatal pockets. Thick palatal tissue was found around implants diagnosed with peri-implantitis.

Digital photometric analysis of gingival response to periodontal treatment.

OBJECTIVES: The color is a major factor in determining inflammation status in most gingival indices. Current indices have limitations mainly due to subjective nature. Digital color analysis can provide objective and accurate measurements. Thus, the present study aimed to assess by digital tool the gingival color in the different stages of an active periodontal treatment. METHODS: Forty patients (19 males and 21 females) diagnosed with periodontitis (stage III/ IV, grade C) and treated surgically were included in the study. Clinical data (probing depth, bleeding on probing, clinical attachment level, gingival index, and gingival recession) and photographs by digital single-lens-reflex (DSLR) camera were recorded before initial periodontal treatment, which included scaling and root surface debridement (T0); the same parameters were then re-evaluated 6-8 weeks (T1) and 3 months after periodontal surgery (regenerative/resective) (T2). Differences between clinical parameters were calculated. The color space defined by the International Commission on Illumination (CIELab) was used to analyze gingival color. RESULTS: In 56 periodontal surgical sites, 168 photographs were taken. The a*-value of the CIELab color system (higher a*- value translate to a stronger red color) was significantly reduced between T0 to T1 and further decreased at T2 (32.01, 29.28, and 27.45 respectively). Significant improvement in clinical parameters were found between T0 to T1 and T1 to T2. Sub-analysis of two distinct surgical interventions revealed that only regenerative procedure improved the a*-value, which was significantly correlated with pocket depth reduction. CONCLUSIONS: Photometric analysis can be used to assess gingival color change during periodontal treatment of patients with periodontitis. CLINICAL SIGNIFICANCE: Gingival inflammation is a major factor in periodontal assessment; nevertheless, all current gingival inflammation indices are partially subjective and only semi-quantitative. The digital photometric analysis may allow for accurate and objective gingival color assessment during periodontal treatment.

Histological and dimensional changes of the alveolar ridge following tooth extraction when using collagen matrix and collagen-embedded xenogenic bone substitute: A randomized clinical trial.

AIM: To assess the horizontal and vertical dimensional changes of the alveolar ridge when using a collagen matrix in combination with collagen embedded xenogenic bone substitute, in comparison with natural healing after tooth extraction. METHODS: Patients that required extraction in non-molars areas were included. Test group-15 sockets were treated with deproteinized bovine bone mineral containing 10% collagen (DBBM-C), covered by a procaine collagen membrane (CMXs). Control group-15 sockets left for spontaneous healing. We used a custom-made acrylic stent as a reference for alveolar ridge measurements. Six-month postoperative, a single implant was placed in the experimental site. A core biopsy was taken from the site, using a trephine bur. Histomorphometric analysis assessed bone area, connective tissue, bone marrow, and residual bone graft. RESULTS: Six months later, horizontal ridge width at -3 mm showed a significant (p < 0.05) reduction in both groups albeit smaller in the test group 1.19 ± 1.55 mm, compared with the control 2.27 ± 1.52 (p = 0.087). At -5 mm sub-crestally, statistically non-significant reduction was noted in both groups, 1.61 ± 1.53 and 1.96 ± 1.52 mm for the test and control groups, respectively (p = 0.542). Vertical changes were smaller in the test group (0.14 ± 1.84 mm) compared with control (0.98 ± 1.49 mm). Keratinized tissue (KT) width was 7.3 ± 2.13 and 7.5 ± 3.49 mm in the test and control groups, respectively. Newly formed bone occupied 33.79 ± 17.37% and 51.14 ± 23.04% in the test and control groups, respectively, (p = 0.11). Connective tissue volume was 33.74 ± 13.81% and 30.12 ± 18.32% in the test and control groups, respectively (p = 0.65). Bone marrow occupied 19.57 ± 10.26% and 18.74 ± 17.15% in the test and control groups, respectively (p = 0.91). Residual graft occupied 12.9 ± 9.88% in the test group. CONCLUSION: Alveolar ridge preservation using DBBM-C resulted in reductions of the vertical and horizontal dimensions albeit not reaching statistical significance. The larger than anticipated standard deviation and smaller inter-group differences might account for this phenomenon.

Volumetric assessment of changes in the alveolar ridge dimension following guided bone regeneration using a combination freeze-dried bone allograft with collagen membrane or novel resorbable scaffold: A prospective two-center clinical trial.

BACKGROUND: The aim of this study was to examine osseous changes following lateral bone augmentation using a novel scaffold (OV) alone and compare it to combination therapy using freeze-dried bone allograft (FDBA) and resorbable collagen membrane (FDBA/CM). METHODS: Thirty patients completed this 9-months prospective two-center cohort clinical trial. Before surgery and 9-months re-entry, linear measurements were performed, and impressions taken. Cone-beam computed tomography (CBCT) were done at baseline and 9 months. DICOM slice data were converted into volumetric images using 3D Slicer. Following 3D volumetric image construction, pre- and post-op Standard Triangle Language files were superimposed and volumetric data were extracted for a 10-mm region of interest. Linear measurements were compared similarly. RESULTS: Baseline clinical parameters were similar in both groups (4.22 and 4.53 mm for OV and FDBA/CM at -2 mm, respectively). Following treatment, vertical distance from the stent had changed minimally (-0.36 and -0.12 mm, respectively). Similarly, lateral bone gain ranged from 0 to 0.4 mm, for both groups. To the contrary, the CBCT measurements showed a significantly greater increase in horizontal width in the control at -2 mm (0.95 ± 0.2 mm) compared with -0.62 mm for the OV (P = 0.000). Similar changes were observed at -5 mm (0.63 and -0.41 mm, respectively, P = 0.01). Sites volume had increased from 266 ± 149 mm3 to 360 ± 138 mm3 (P = 0.001) for FDBA/CM with negligible changes for OV (from 334 to 335 mm3 , P = 0.952). these between-group changes being statistically significant (P = 0.023). CONCLUSION: FDBA/CM yielded better albeit moderate increase in the volume of the edentulous ridge, while OV scaffolds failed to produce similar results.

Severe Complications Following Maxillary Sinus Augmentation Using Poly L-lactide-co-ε-caprolactone-Coated Bovine Bone: A Retrospective Study.

PURPOSE: To describe the postoperative complications following lateral wall sinus augmentation using (poly L-lactideco-ε-caprolactone; PLCL) and natural polysaccharides polymers-coated bovine bone (PBB). The secondary aims were to examine histologic findings and to propose complication management alternatives. MATERIALS AND METHODS: This retrospective study included 61 subjects who underwent 67 lateral wall sinus augmentation procedures using PBB in the standard protocol. In cases that presented complications, treatment included additional antibiotic therapy, implant removal, or sinus reentry and total removal of the grafting material. In three cases, biopsy specimens were taken from the sinuses, and histologic analyses were performed. RESULTS: The prevalence of postoperative complications was 32.8% (22 of 67 cases) in 18 of the patients (29.5%). The most prevalent symptoms were persistent pain (68.2%), swelling (63.6%), and oroantral fistula (54.5%). Radiographic signs appeared in 45.5% of the complications. A total of 24 implants failed; thus, an overall 80.3% survival rate was established at 19 months. The vast majority of complications (86.4%) were treated eventually with reentry surgery and revealed that the sinus was full with granulation tissue surrounding pieces of a nonossified rubber-like material. In cases where implants were placed, nonosseointegrated implants were surrounded by soft tissue. The sinus was cleaned thoroughly; the graft material remnants were removed together with inflamed parts of the sinus membrane, followed by chlorhexidine and saline lavages. In the biopsy specimens taken from the sinus cavity, there were no histologic features of new bone formation around the grafted material. CONCLUSION: Lateral wall maxillary sinus augmentation using PBB was associated with an acute sinus infection histologic appearance and with a 7-times-higher failure rate compared with previous reports. This serious adverse event suggests that PBB cannot be recommended for maxillary sinus augmentations.

A single application of chlorhexidine gel reduces gingival inflammation and interleukin 1-ß following one-stage implant placement: A randomized controlled study.

BACKGROUND: Chlorhexidine (CHX) is a broad-spectrum antimicrobial agent commonly used in medicine. Application of (CHX) during abutment connection reduced the bacterial load at the implant-abutment interface. We hypothesize this treatment may consequently reduce peri-implant soft tissue inflammation and marginal bone loss. PURPOSE: To evaluate the effect of a single application of CHX gel inside the dental implant internal hexagon on peri-implant tissue. METHODS: Forty patients were recruited to this randomized, double-blinded, clinical trial. At the time of implant installation, a 4-mm healing abutment was connected to the implant. In the test group, chlorhexidine gel 1% was applied inside the implant hex, whereas control implants did not receive any gel. Clinical and radiographic measurements included soft tissue recession (REC), plaque index (PI), gingival index (GI), plaque index (PI), keratinized mucosa width (KM), probing depth (PD), and a peri-apical parallel x-ray. Peri-implant crevicular fluid (PICF) was collected for cytokine analysis. t-Test was used to compare changes from baseline to 3 months. Mann-Whitney U test and t test were used to compare test and control groups. RESULTS: Twenty patients in the test group and 17 in the control group completed the study. One implant in the control group failed to osteointegrate. There were no significant differences between the control and test groups for REC changes, bone loss, and PD. GI was significantly lower in the test group after 1 week (1.79 ± 0.24 vs 0.75 ± 0.18, respectively) and 3 months (1.18 ± 0.21 vs 0.25 ± 0.12, respectively) although PI was equal. At 3 months, interleukin 1-ß (IL1-ß) was higher in the control group (p < 0.01) and a positive correlation was found between GI and IL1-ß (rs  = 0.60424, p = 0.00032). CONCLUSIONS: Application of chlorhexidine gel reduced inflammation and IL1-ß levels in the peri-implant soft tissue.

The effect of a surgeon's position on the axial inclination of dental implants placed freehand: a single-blind study.

OBJECTIVES: To examine whether a surgeons' position affects the axial angulation of dental implants placed freehand. METHOD AND MATERIALS: Implants' axial angulation was assessed on digital panoramic radiographs. An occlusal line was plotted based on the neighboring teeth/crowns. The mesial angle between the long axis of the implant and the occlusal line was measured. In addition, post-hoc ideal implant-positioning planning was done on the panoramic digital image, and the angle of the intersection between the long axis of the actual and post-hoc ideal implant was measured. Student t test for unpaired observations and the Kolmogorov-Smirnov nonparametric tests were utilized to compare the ipsi- and contralateral sides and between clinicians. RESULTS: Seventy-seven patients (149 implants) were eligible for the study. Implants had slight mesial inclination (mean 97.7 ± 8.7 degrees) which was similar for both the ipsi- (98.2 ± 8.4 degrees) and contralateral sides (97.2 ± 9.1 degrees), P = .491. For the post-hoc planning versus actual placement comparison, the overall median (interquartile range) of implant angular deviation was minimal (-0.25 degrees [-2.98, +3.47]). This was true for both the ipsilateral (-0.5 degrees [-2.9, +2.9]) and contralateral (-0.2 [-4.2, +5.4]) sides, P = .55. For the actual versus post-hoc planning, most observations clustered around the midline (zero to minimal deviation), while for the implant to occlusal plane angle, a tendency towards slight mesial angulation was observed. CONCLUSIONS: Dental implants placed freehand by experienced clinicians have only slight axial deviation as measured from post-hoc optimal position. Implants placed in ipsilateral and contralateral sides and by left- and right-dominant-hand clinicians had similar angulations.

Periodontal Status Among Schoolchildren in the Republic of Moldova: A Cross-Sectional Study Using the Pathfinder Study Design.

OBJECTIVES: To screen a sample of Moldavian schoolchildren to establish their periodontal condition using the Pathfinder study design of the World Health Organization (WHO). METHODS: Two cohorts - 12- and 15-year schoolchildren - were screened in 12 schools around the country: four schools in the capital city; four more schools in two other larger cities (two schools in each city); and four village schools (one school in each village). In addition to demographic data, the periodontal parameters dental plaque, calculus and bleeding on probing (BOP) were collected. Periodontal pocket depth (PPD) was also measured but only in the cohort of 15-year-old schoolchildren. Measurements were recorded for the six Ramfjord index teeth. RESULTS: In total, 720 children were surveyed: 365 (50.7%) were 12 years of age and 355 (49.3%) were 15 years of age; 351 (48.8%) were girls and 369 (51.2%) were boys; 490 (68%) lived in an urban area and 230 (32%) lived in a rural area. Only 4.5% of 15-year-old children presented with a pocket depth of ≥3.5 mm. Children who lived in rural areas had higher plaque scores than children who lived in urban areas (64.8% vs. 54.1%, P = 0.007). In addition, children who lived in urban areas had significantly less calculus (P = 0.047) and shallower PPDs (P = 0.019). Deeper PPD was associated with higher PI and calculus scores. CONCLUSIONS: Moderate-to-deep periodontal pockets were not uncommon in children in the 15-year-old cohort. Periodontal status was worse in children from rural areas than in children from urban areas. It is therefore suggested that an educational programme, together with preventive and interceptive protocols, should be adopted in early adolescence and especially in rural regions.

Repeated delivery of chlorhexidine chips for the treatment of peri-implantitis: A multicenter, randomized, comparative clinical trial.

BACKGROUND: Peri-implantitis is a challenging condition to manage and is frequently treated using non-surgical debridement. The local delivery of antimicrobial agents has demonstrated benefit in mild to moderate cases of peri-implantitis. This study compared the safety and efficacy of chlorhexidine gluconate 2.5 mg chip (CHX chips) as an adjunctive treatment to subgingival debridement in patients afflicted with peri-implantitis. METHODS: A multicenter, randomized, single-blind, two-arm, parallel Phase-3 study was conducted. Peri-implantitis patients with implant pocket depths (IPD) of 5-8 mm underwent subgingival implant surface debridement followed by repeated bi-weekly supragingival plaque removal and chlorhexidine chips application (ChxC group) for 12 weeks, or similar therapy but without application of ChxC (control group). All patients were followed for 24 weeks. Plaque and gingival indices were measured at every visit whereas IPD, recession, and bleeding on probing were assessed at 8, 12, 16, 24 week. RESULTS: A total of 290 patients were included: 146 in the ChxC group and 144 in the control. At 24 weeks, a significant reduction in IPD (P = 0.01) was measured in the ChxC group (1.76 ± 1.13 mm) compared with the control group (1.54 ± 1.13 mm). IPD reduction of ≥2 mm was found in 59% and 47.2% of the implants in the ChxC and control groups, respectively (P = 0.03). Changes in gingival recession (0.29 ± 0.68 mm versus 0.15 ± 0.55 mm, P = 0.015) and relative attachment gain (1.47 ± 1.32 mm and 1.39 ± 1.27 mm, P = 0.0017) were significantly larger in the ChxC group. Patients in the ChxC group that were < 65 years exhibited significantly better responses (P < 0.02); likewise, non-smokers had similarly better response (P < 0.02). Both protocols were well tolerated, and no severe treatment-related adverse events were recorded throughout the study. CONCLUSIONS: Patients with peri-implantitis that were treated with an intensive treatment protocol of bi-weekly supragingival plaque removal and local application of chlorhexidine chips had greater mean IPD reduction and greater percentile of sites with IPD reduction of ≥2 mm as compared with bi-weekly supra-gingival plaque removal.

D-PLEX500: a local biodegradable prolonged release doxycycline-formulated bone graft for the treatment for peri-implantitis. A randomized controlled clinical study.

OBJECTIVES: In the present pilot, multicenter, randomized, single-blinded, controlled study, surgical treatment with or without the administration of D-PLEX500 (a biodegradable prolonged release local doxycycline formulated with ß-tricalcium phosphate bone graft) was accessed for the treatment of peri-implantitis. METHOD AND MATERIALS: Subjects undergoing surgical treatment for intrabony peri-implantitis defects after flap elevation were randomly assigned, to adjunct D-PLEX500 placement group or to control group. Clinical and radiographic parameters were measured at 6 and 12 months. RESULTS: Twenty-seven subjects (average age: 64.81 ± 7.61 years) were enrolled; 14 patients (18 implants) were randomized to the test group and 13 (14 implants) to the control group. There was no difference in plaque scores between the groups. There was no difference in the changes of mean periodontal probing depth between the test and control groups between baseline and the 6-month follow-up, whereas statistically significant difference was observed after 12 months' follow-up when analyzed for all sites averaged. There was a statistically significant difference in the changes of clinical attachment levels and radiographic bone levels between the groups between baseline and 12 months. These improvements were demonstrated when analyzed at both implant and subject levels. Only D-PLEX500 treatment led to improved bone levels at both time points. The improvement in bone levels was significant in the D-PLEX500 treatment group already after 6 months, and further improved over the 12-month follow-up. Implants were lost only in the control group (14%). CONCLUSIONS: D-PLEX500 sustained release local antibiotic formulated with bone filler showed promising results in enabling healing of peri-implantitis lesions. The antibacterial component of the bone graft material might create favorable conditions that enable implant surface decontamination and soft and hard tissue healing over a prolonged period.

Traumatic Dental Injuries among Adolescents In Republic of Moldova.

Objectives: The aim of this investigation was to evaluate the epidemiological data on dental injuries in permanent teeth among seventh and tenth grade schoolchildren in the Republic of Moldova. Study design: The pathfinder study model was chosen to evaluate the prevalence of Traumatic Dental Injuries (TDI). Schoolchildren ages 12 and 15 years old were examined: In the capital city (four schools), in two other major cities-(two schools each city), and in four villages (one per each village) in accordance with the WHO's recommendations. Results: A total of 720 seventh and tenth grade schoolchildren were examined. The overall prevalence of TDI was found to be 16.4% (total of 118 children). The prevalence of TDI was greater in the older age cohort (p<0.05). Children from rural areas presented with greater prevalence of TDI compared to children who live in urban region (p<0.03). The maxillary central incisors were found to be the most common teeth affected by trauma constituting 57.1% of the evaluated TDI cases. Enamel fracture was the main type of TDI (83%). Conclusions: The TDI mainly involved enamel fractures. Urban schoolchildren show lower rates of TDI compared to rural schoolchildren.

Ridge preservation procedures revisited: A randomized controlled trial to evaluate dimensional changes with two different surgical protocols.

BACKGROUND: The effect of different surgical techniques for ridge preservation on soft tissue parameters has seldom been investigated. The objective of this study was to compare the effect of two different ridge preservation techniques on soft and hard tissue dimensions. METHODS: Thirty patients requiring tooth extraction were randomly allocated to either control group C (allograft covered with a non-crosslinked collagen membrane with primary closure) or experimental group E (allograft covered with cross-linked collagen membrane left exposed). Sites were surgically re-entered at 6 months. Soft and hard tissue measurements, cone beam computed tomography (CBCT), and cast measurements were taken at baseline and 6 months. RESULTS: Twenty-eight patients were included in this analysis. When the two treatment groups were compared, the width of the buccal keratinized tissue in the E group showed an increase of 0.43 ± 0.42 mm compared to net loss of 1.57 ± 0.51 mm for the C (P = 0.006). Similarly, buccal tissue thickness has increased in the E group 0.46 ± 0.22 mm compared to a loss of 0.15 ± 0.23 mm in the C group (P = 0.068). Volumetric assessment of the changes in the alveolar ridge for the E group showed a slight decrease (68.3 ± 17 mm3) whereas the C group has experienced almost double this loss (107.5 ± 11 mm3; P = 0.07). Crestal width, measured on the CBCT scan, has shown significant reduction in the C group (4.18 ± 0.56 mm) compared to only 1.74 ± 0.4 mm in the E group (P = 0.003). CONCLUSION: Crosslinked collagen membrane with allograft placed intentionally non-submerged resulted in better preservation of the keratinized tissues (width and thickness) with similar and at times better osseous preservation following extraction.

Prospective randomized controlled clinical trial to compare hard tissue changes following socket preservation using alloplasts, xenografts vs no grafting: Clinical and histological findings.

PURPOSE: To compare dimensional changes and bone quality of two different grafting materials used for socket preservation. MATERIALS AND METHODS: Thirty-three patients requiring extraction were recruited and randomly assigned to receive: biphasic calcium sulfate/ hydroxyapatite (BCS/HA); bovine derived xenograft (BDX) or no grafting (Control). Ridge width (at -3 and -6 mm) and vertical distance from a stent were measured at the time of extraction/grafting. Measurements were repeated at reentry and core biopsies were harvested. RESULTS: Baseline vertical distance for the BDX, C and BCS/HA groups were 7.45 ± 3.1, 7.69 ± 4.2, and 6.75 ± 3.5 mm, respectively (P = .830). Post-op, C group had greater vertical loss (1.71 ± 0.4 mm) compared to BCS/HA (0.65 ± 0.5) and BDX (0.25 ± 0.2 mm), P = .059. Mean baseline width at -3 mm was 8.69 ± 1.1 mm, 8.31 ± 1.4 mm, and 9.0 ± 1.1 mm, respectively (P = .509). Post-op, this width was reduced by 2.96 ± 0.3 mm (C), 1.56 ± 0.4 mm (BDX), and 0.5 ± 0.4 mm (BCS/HA), P = .001. Mean ridge width at -6 mm for the C (6.5 ± 1.7 mm) was significantly smaller than BCS/HA (7.95 ± 2.8 mm) and BDX (8.85 ± 1.9 mm), P = .043. Histologically, the BDX group had greater residual scaffold material and less vital bone compared to the BCS/HA group. Pain scores were relatively low for all groups. CONCLUSIONS: BCS/HA may be used for socket preservation with similar or better results compared to BDX. The significance of greater residual scaffold found in the BDX group is yet to be determined.

Can extra-short dental implants serve as alternatives to bone augmentation? A preliminary longitudinal randomized controlled clinical trial.

OBJECTIVE: A randomized trial to assess clinical and radiographic outcomes of short versus standard dental implants placed with concomitant vertical bone augmentation. METHOD AND MATERIALS: Patients requiring dental implants were randomized to receive either 6-mm implants (experimental) or 10-mm implants with vertical augmentation (control). Custom load-bearing healing abutments were connected to allow for indirect resonance frequency analysis measurements. Standardized radiographs were taken at implant placement (baseline), and at 3 and 12 months. Implants were restored at 3 to 6 months, and final measurements were taken at 12 months. RESULTS: Fifty patients with 25 implants per group were included. Five implants failed, four experimental and one control (84% and 96% cumulative survival rate, respectively). Short implants required significantly less surgical time (51.6 ± 23 versus 68.5 ± 35 minutes, P = .05). Implant stability quotients at baseline (67.9 ± 8.3 experimental and 70.8 ± 7.6 control, P = .215) and 12 weeks (70.17 ± 7.4 and 72.03 ± 5.9, respectively, P = .513) were similar and unchanged. Positive correlation was found between the two measurement methods (r2 = .6, P = .025). One-year average marginal bone loss was slightly lower for the experimental group (0.6 ± 0.16 mm) compared to the control group (0.86 ± 0.19 mm); however, this was not statistically significant (P = .287). CONCLUSION: Short dental implants may offer an alternative for implant placement in an atrophic jaw; however, they are associated with reduced first-year survival rate. Short dental implants should be used judiciously in light of this potential predicament, and alternatives assessed.

Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.

Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.