A clinical and radiological long-term follow-up study of narrow diameter implants in the aesthetic area.

PURPOSE: To study long-term function of narrow diameter implants (NDI:s) and if reduced implant-tooth distance negatively impacts adjacent teeth. MATERIALS AND METHODS: A clinical and radiological follow-up of NDI:s replacing maxillary laterals and mandibular incisors was performed. Subjects that received 3.0-3.3 mm-diameter single implants from 3 units in Uppsala and Västerås, Sweden, between 2002 and 2011 were offered to participate in this retrospective study. RESULTS: Twenty-seven patients (30 implants) underwent clinical and CBCT examination, mean follow-up time was 63.3 months. On average, the implant-tooth distance was 1.6 mm at the cervical region and 17 implants were placed 1 mm or less to the adjacent root. Additionally, 2 patients (3 implants) underwent clinical examination (I). Twenty-seven patients (36 implants) declined the examination but agreed to an interview (II). At the time of the follow-up, all implants had good function, and implant survival of group I and II together was 97.2%. In both groups, the 2 main patient concerns were discoloration and regression of the buccal gingiva. CONCLUSION: Survival of implants is in accordance to standard diameter studies and although most implants were placed very close to the adjacent teeth, no pathologies could be linked to this except aesthetic concerns.

A long-term prospective cohort study on immediately restored single tooth implants inserted in extraction sockets and healed ridges: CBCT analyses, soft tissue alterations, aesthetic ratings, and patient-reported outcomes.

BACKGROUND: Although many studies have been published on single implants, long-term data remain scarce. PURPOSE: To evaluate immediately restored single implants after at least 8 years of follow-up in terms of buccal bone, soft tissue alterations, aesthetic ratings, and patient-reported outcomes. MATERIALS AND METHODS: This prospective cohort study included patients who were consecutively treated with an immediately restored single implant installed in an extraction socket (IIT) or a healed ridge (CIT) in the anterior maxilla. Biomaterials were never used. CBCTs were taken at study termination, soft tissue alterations, and Pink Esthetic Score were evaluated between 1 year and study termination using standardized clinical images. Patient satisfaction was also registered. RESULTS: About 11/16 initially treated patients in the IIT cohort (10 men, 6 women; mean age 45) and 18/23 initially treated patients in the CIT cohort (12 men, 11 women; mean age 40) could be evaluated after more than 8 years. A buccal bone wall less than 2 mm was found at all implant sites. A thin buccal bone wall less than 1 mm was found at 42% of the implant sites. In the CIT cohort, 8 patients had a missing buccal bone in the crestal area, although bone was present at the time of surgery. Alveolar process deficiency significantly deteriorated (P ≤ .046), whereas vertical soft tissue levels and PES remained stable over time in both cohorts. Patients expressed high overall satisfaction. CONCLUSIONS: Substantial dimensional changes may be expected at the buccal aspect of single implants inserted in the premaxilla. As a result, contour augmentation procedures at the time of implant placement should be considered to counteract these bone alterations, even when implants are fully embedded in bone upon insertion.

Orthodontic treatment in patients with aggressive periodontitis.

INTRODUCTION: Aggressive periodontitis (AP) is a condition that promotes breakdown of the periodontal tissues in a short time. In severe cases, pathologic migration of teeth and tooth loss can occur, producing esthetic and functional problems for the patient. Orthodontic treatment may be recommended to restore esthetics and masticatory function. We assessed the effects of orthodontic movement in the periodontal tissues of treated patients with AP. METHODS: Ten subjects (ages 25.0 ± 5.22 years) with AP received periodontal treatment followed by orthodontic treatment. Maintenance sessions were performed monthly under a strict dental biofilm control. They were compared with 10 periodontally healthy subjects (ages 22.9 ± 5.23 years) who received orthodontic treatment. Probing pocket depth, clinical attachment level, bleeding on probing, and dental plaque index were measured at baseline, after orthodontic treatment, and after 4 months. RESULTS: Statistical analysis showed improvement in all clinical parameters between baseline and 4 months after orthodontic treatment: probing pocket depth (0.29 mm), clinical attachment level (0.38 mm), bleeding on probing (4.0%), and dental plaque index (11%). CONCLUSIONS: The periodontal parameters of the AP patients remained stable during orthodontic treatment under strict biofilm control.

Clinical and esthetic outcome with immediate insertion and provisionalization with or without connective tissue grafting in presence of mucogingival recessions: A retrospective analysis with follow-up between 1 and 8 years.

BACKGROUND: Recessions following immediate implant insertion are frequently reported in the literature. Data regarding implant installation in presence of mucogingival recessions are rare. PURPOSE: This study observes soft tissue level changes following immediate implant insertion and provisionalization of implants with or without connective tissue grafts in the anterior maxilla in patients with initial mucogingival recession within a follow-up period between one and eight years. MATERIALS AND METHODS: Twenty-six patients with marginal gingival recessions, which were designated for extraction and immediate implant insertion in the anterior zone of the maxilla (13-23), were included. Out of a larger group of immediate implants only single tooth replacements with 1 to 3 mm recession and a pre- and post-op CB-CT were selected. Facial bone deficiencies were grafted flaplessly with autologous bone in all sites. In a group of 13 patients the recessions (mean 2.3 ± 0.7 mm, range 1.0-3.0 mm) were grafted additionally by connective tissue (ABG + CTG), in the remaining 13 patients no soft tissue grafting (mean recession 1.8 ± 0.6 mm, range 1.0-3.0 mm) was performed (ABG). The marginal hard and soft tissue level, the width of the keratinized mucosa, the PES, and implant success were evaluated. RESULTS: After a mean follow-up period of 45 months the recessions were significantly reduced in the ABG group from 1.8 to 0.9 mm. The improvement was even more pronounced in the ABG + CTG group (from 2.3 to 0.5 mm). The PES improved significantly in both groups. At final examination all implants were still in function. Within the observational period, in 5 of 13 implants a marginal bone loss of more than 1 mm was noticed in the ABG, but in none of the ABG + CTG group. CONCLUSIONS: These clinical results provide evidence that immediate implant placement might improve the facial soft tissue level. This was more evident in cases with a greater recession and an additional treatment with connective tissue grafts.

The effect of the heights and thicknesses of the remaining root segments on buccal bone resorption in the socket-shield technique: An experimental study in dogs.

BACKGROUND: To date only a few studies have been done on the use of the socket-shield technique for preserving the resorption of the buccal bone in aesthetically sensitive sites. Besides, there have been no further studies on the effect of the heights and thicknesses of the remaining root segments on buccal bone resorption when using this method. PURPOSE: The aim of this study was to evaluate the effect of different heights and thicknesses of the remaining root segments on bone resorption in the socket-shield technique. MATERIALS AND METHODS: Four healthy female beagle dogs were used in this study. The third premolar (P3) and the fourth premolar (P4) on both sides of the mandible were hemisected in the buccal-lingual direction, and the clinical crown of the distal root was beheaded. In the experimental groups, the roots were worn down in the apical direction until they were located at the buccal crestal level (Group A) or 1 mm higher than that level (Group B). In the control group, the distal root segments were extracted. Then, implant placement was performed into the distal root. After 3 months of healing, the specimens were prepared for histological diagnosis. RESULTS: There was no difference between Group A and Group B when using the socket-shield technique, but the results of both groups were better than those of the control group. CONCLUSIONS: The height of the root segments has little effect on the bone absorption of alveolar bone, while the bone absorption was strongly influenced by the thickness of the root segments. More precisely, the absorption may decrease if the thickness of the root fragment increases, when the thickness of the root plate is in the 0.5-1.5 mm range.

The periodontal pocket: pathogenesis, histopathology and consequences.

The conversion of junctional epithelium to pocket epithelium is regarded as a hallmark in the development of periodontitis. Knowledge of factors contributing to the initiation and progression of pocket formation is important and may result in the development of better preventive measures and improve healing outcomes after therapeutic interventions. The periodontal pocket is a pathologically deepened gingival sulcus. In healthy periodontal conditions, the defense mechanisms are generally sufficient to control the constant microbiological challenge through a normally functioning junctional epithelium and the concentrated powerful mass of inflammatory and immune cells and macromolecules transmigrating through this epithelium. In contrast, destruction of the structural integrity of the junctional epithelium, which includes disruption of cell-to-cell contacts and detachment from the tooth surface, consequently leading to pocket formation, disequilibrates this delicate defense system. Deepening of the pocket apically, and also horizontal expansion of the biofilm on the tooth root, puts this system to a grueling test. There is no more this powerful concentration of defense cells and macromolecules that are discharged at the sulcus bottom and that face a relatively small biofilm surface in the gingival sulcus. In a pocket situation, the defense cells and the macromolecules are directly discharged into the periodontal pocket and the majority of epithelial cells directly face the biofilm. The thinning of the epithelium and its ulceration increase the chance for invasion of microorganisms and their products into the soft connective tissue and this aggravates the situation. Depending on the severity and duration of disease, a vicious circle may develop in the pocket environment, which is difficult or impossible to break without therapeutic intervention.

Periodontal inflamed surface area and periodontal case definition classification.

OBJECTIVE: To assess whether a higher periodontal inflamed surface area (PISA) may reflect more severe periodontitis, and if so, to calculate which cut-off point should be used to classify a patient as suffering from periodontitis. MATERIAL AND METHODS: Eighty subjects were selected based on their periodontal status and were divided into 4 groups of 20 each; periodontally healthy, mild periodontitis, moderate periodontitis and severe periodontitis. In addition, demographic data, smoking status and socioeconomic status were also recorded. RESULTS: The highest mean PISA value was obtained for the severe periodontitis group (2309.42 ± 587.69 mm2) and the least for the periodontally healthy (34.30 ± 16.48 mm2). The PISA values corresponding to the three categories of periodontitis severity were significantly higher than the periodontally healthy group. When receiver operating characteristic (ROC) analysis was performed, a PISA value ≥130.33 mm2 predicted the presence of periodontitis with a sensitivity of 98% and a specificity of 100%. CONCLUSIONS: PISA is a periodontal parameter that may be used in conjunction with the Centers for Disease Control and Prevention - American Academy of Periodontology case definition classification in periodontal medicine research.

Moderate- to long-term therapeutic outcomes of treated aggressive periodontitis patients without regular supportive care.

BACKGROUND AND OBJECTIVE: Risk for deterioration in treated aggressive periodontitis (AgP) individuals remained unclear. This retrospective cohort study investigated 7-26 years of periodontal outcomes and oral health-related quality of life (OHRQoL) of young adults with advanced periodontitis. MATERIAL AND METHODS: Eighty-nine previously treated patients with AgP were re-examined. Clinical and radiographic parameters before treatment discontinuation and at re-examination were compared. OHRQoL at re-call was assessed with the short-form Oral Health Impact Profile (OHIP-14S). RESULTS: None of the subjects adhered to suggested periodontal therapy and maintenance after discharge. Mean percentage of sites with probing pocket depth (PPD) ≥6 mm at re-examination was 4.5 ± 5.9%. A total of 182 teeth had been lost over time. Tooth loss rate was 0.14/patient/year. From 68 subjects with documented favorable treatment outcomes, higher percentage of sites with PPD ≥6 mm at re-examination and higher radiographic proximal bone loss was associated with current smoking status. Patients with AgP with <20 teeth at re-call had worse OHRQoL than those with ≥20 teeth. Patients with higher full-mouth mean PPD also reported poorer OHRQoL. CONCLUSION: Treatment in patients with AgP who smoke and neglect proper supportive care, risk periodontal disease progression. Substantial tooth loss and higher full-mouth mean PPD led to poorer OHRQoL in this cohort.

Periodontal treatment modulates gene expression of endothelial progenitor cells in diabetic patients.

BACKGROUND: Periodontitis is closely linked with type 2 diabetes mellitus (T2DM) and endothelial dysfunction. This study investigated the effects of periodontal treatment on immuno-inflammatory gene expression of endothelial progenitor cells (EPCs) in diabetic patients. METHODS: Eighteen T2DM patients with moderate to severe chronic periodontitis were randomly assigned to the Treatment group with oral hygiene instruction (OHI), scaling and root debridement (n = 11), and Control group (n = 7) with OHI alone. Peripheral blood samples were taken for biochemical analysis and culture of EPCs at baseline and 6 months after the treatment. PCR array-based profiling of 84 Toll-like receptor signalling-related genes in EPCs was firstly assessed for four randomly selected patients from the Treatment group. The differentially expressed genes were then further validated by qPCR in both groups. RESULTS: All subjects in the Treatment group significantly improved their periodontal conditions. Among the 84 genes tested, IL-6 and IL-8 transcripts were significantly downregulated with over twofold change after the treatment, and this observation was further validated by qPCR in all subjects from both groups (p < .05). CONCLUSION: This preliminary study suggests that periodontal treatment may contribute to a notable reduction in immuno-inflammatory gene expression measured by IL-6 and IL-8 transcripts in EPCs.

A randomized clinical trial of oral hygiene care programmes during stroke rehabilitation.

OBJECTIVES: The objectives of this study were to evaluate and compare the effectiveness of an advanced oral hygiene care programme (AOHCP) and a conventional oral hygiene care programme (COHCP) in improving oral hygiene, and reducing gingival bleeding among patients with stroke during outpatient rehabilitation. METHODS: Subjects were randomized to receive (i) the COHCP comprising a manual toothbrush, toothpaste, and oral hygiene instruction, or (ii) the AOHCP comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, toothpaste, and oral hygiene instruction. Dental plaque, gingival bleeding, and other clinical oral health outcomes were assessed at baseline, the end of the clinical trial, and the end of observation period. Development of infectious complications was also monitored. RESULTS: Participants of both programmes had a significant reduction in the percentages of sites with moderate to abundant dental plaque (p<0.001) and with gingival bleeding (p<0.05). Those in the AOHCP had significantly less plaque and gingival bleeding than those in the COHCP controlling for other factors at the end of the clinical trial period (both p<0.001) and the observational period (plaque: p<0.05, gingival bleeding: p<0.01). CONCLUSIONS: Although both oral hygiene care programmes were effective in terms of plaque and gingival bleeding control, the AOHCP was more effective than the COHCP in reducing dental plaque and gingival bleeding. CLINICAL SIGNIFICANCE: This study highlighted the value of oral hygiene programmes within stroke outpatient rehabilitation and provides evidence to advocate for the inclusion of oral hygiene care programmes within stroke outpatient rehabilitation for patients with normal cognitive abilities.

Reproducibility of a commercially available subgingival plaque sampling strategy and analysis strategy with oligonucleotide probes.

OBJECTIVES: The aim was to evaluate the intra-test agreement of pooled samples from the deepest periodontal pocket of each quadrant with a commercially available test kit based on hybridization of 16S rRNA. MATERIAL AND METHODS: Plaque samples of 50 patients with generalized severe chronic periodontitis before therapy were pooled in two separate vials in order to detect and compare counts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Cohen's κ and interclass correlation coefficients were calculated to judge intra-test agreement. RESULTS: Cohen's κ for detection and counts of Tannerella forsythia and Treponema denticola showed a perfect agreement. Porphyromonas ginigivalis was identified in both tests with a substantial agreement, whereas detection of Aggregatibacter actinomycetemcomitans varied in eight patients resulting in a good agreement. Possible confounding factors could not be identified statistically. CONCLUSION: Test results of the commercial 16S rRNA test are perfectly reproducible regarding detection of red complex pathogens. Intra-test agreement concerning detection of Aggregatibacter actinomycetemcomitans was less favorable. CLINICAL RELEVANCE: Detection of certain periodontal pathogens may alter the treatment and lead to prescription of antibiotics parallel to mechanical debridement. It is quite important not to use antibiotics excessively. Thus, the basis for decision-making in favor of antibiotics should be solid.

Clinical Efficacy of Subgingivally Delivered 1.2 mg Simvastatin in the Treatment of Patients with Aggressive Periodontitis: A Randomized Controlled Clinical Trial.

Simvastatin (SMV) is a specific competitive inhibitor of 3-hydroxy-2-methylglutaryl coenzyme A reductase that promotes bone formation. The present clinical trial was designed to investigate the effectiveness of 1.2 mg SMV as a local drug delivery system and as an adjunct to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP). A total of 68 intrabony defects from 24 patients with AgP were treated either with 1.2 mg SMV gel or placebo gel. The subjects were randomly assigned to SRP + placebo (group 1; n = 12) or SRP + SMV (group 2; n = 12). Clinical parameters were recorded at baseline and at 3 and 6 months and included bleeding index, Plaque Index, probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, radiologic assessment of bone defect fill was done. The mean decrease in PD at 6 months was 1.14 ± 0.04 mm and 3.78 ± 0.62 mm in groups 1 and 2, respectively. Significant gain in mean CAL was found between the groups (P < .05). Furthermore, significantly greater mean percentage of bone fill was found in group 2 (34.01%) compared to group 1 (2.62%). Locally delivered SMV provides a comfortable method to improve clinical parameters and promotes bone formation.

Four-Year Clinical Evaluation of GFRC-RBFPDs as Periodontal Splints to Replace Lost Anterior Teeth.

PURPOSE: The aim of this study was to evaluate the clinical performance of glass fiber-reinforced composite-based resin-bonded fixed partial dentures (GFRC-RBFPDs) as periodontal splints for periodontal support-reduced anterior partially edentulous dentition and for replacing lost teeth. MATERIALS AND METHODS: A total of 39 subjects were enrolled who required fixed restorations for lost mandibular anterior teeth where the adjacent teeth offered severely reduced periodontal support. GFRC-RBFPDs were cemented to replace the lost teeth and to stabilize the adjacent teeth. The survival rates were recorded, and the periodontal condition (bone height, bleeding index, and probing depth) was evaluated at 1, 2, 3, and 4 years after the restorations. The results were statistically analyzed with single-factor variance analysis and chi-square tests (α = .05). RESULTS: The complete survival rate was 89.7%, and the functional survival rate was 92.3% at the fourth year. The main reason for failure was fracture of the connector of the GFRC-RBFPDs. In 21.7% of adjacent teeth, the bone height decreased; in the other 78.3%, it increased from 1 year after the restoration to the end of the observation period and the heights were statistically different from the initial values. The periodontal condition of the adjacent teeth was improved after the restoration. CONCLUSIONS: This 4-year clinical evaluation indicated that GFRC-RBFPDs may be useful as fixed prostheses to replace one to three lost anterior teeth with damaged periodontal support in adjacent teeth.

Possible Association Between the Mallampati Score of the Oropharynx and Measures of Tongue Coating, Oral Hygiene and Periodontal Status.

PURPOSE: To assess oral hygiene and the gingival and periodontal disease status in subjects scored under the modified Mallampati classification (MMC) of the oropharynx. PATIENTS AND METHODS: The clinical parameters included recording MMC scores, simplified oral hygiene index (OHI-S), modified gingival index (MGI), tongue coating index (TCI) and periodontal status of the subjects. Eight additional parameters, which included percentage of sites with bleeding on probing (BOP), sites with probing depth (PD) ≥ 5 mm, tooth loss, attachment loss (AL):age ratio, diabetic status, smoking, the interplay of dental status and systemic factors (DS-SFI), and background characteristics (socioeconomic status and stress) were also assessed. RESULTS: Class IV MMC group showed the highest mean scores for OHI-S, periodontal status, AL:age ratio, diabetic status, background characteristics, PD ≥ 5 mm and DS-SFI when compared to other groups. In measures of OHI-S, periodontal status, PD > 5 mm, AL:age ratio and background characteristics, Class IV MMC group showed significant intergroup differences over MMC class I. Regression analysis revealed a highly significant but low degree of correlation (R2 = 0.079; p ≤ 0.001) between the predictors and the dependent values. CONCLUSION: The results suggest that increasing MMC scores can be a possible determinant in identifying gingival and periodontal disease. Any dental professional dealing with a multifactorial disease such as periodontitis can use this classification as a basic screening tool in identifying the modifiable factors of periodontitis.

Sense of coherence and periodontal health outcomes.

OBJECTIVE: Sense of Coherence (SOC) has been associated with perceived oral health measures, but the contribution of SOC to clinical measures is still unclear. The aim of the present cross-sectional study was to evaluate the potential association between periodontal health outcomes, such as periodontal clinical parameters and perceived periodontal health, and SOC. MATERIALS AND METHODS: The study sample comprised 276 individuals, aged 18-60 years, from Belo Horizonte, Brazil. Participants answered questionnaires covering sociodemographic variables, self-perceived periodontal health and SOC. Full-mouth periodontal examinations were performed. The sample was divided into three groups according to SOC score: (a) SOC1 = weak (24-46); (b) SOC2 = moderate (47-51); (c) SOC3 = strong (52-65). Multivariate analyses including appropriate logistic or linear regression models were performed to evaluate the association between periodontal health outcomes and biological, sociodemographic and behavioural variables. RESULTS: Perceived general oral health was associated with family income bracket (p = 0.010), smoking (p = 0.004), dental flossing (p = 0.017) and SOC (weak SOC: p = 0.005). Perceived gum disease and perceived periodontal disease were associated with SOC (weak SOC: p = 0.001 and p = 0.015, respectively). CONCLUSIONS: Overall, perceived periodontal health outcomes were associated with SOC. However, no association between clinical periodontal health outcomes and SOC were observed.

Comparison of longitudinal changes in clinical periodontal parameters of canines and first molars treated with fixed orthodontic appliances.

INTRODUCTION: Our objective was to learn the possible effects of fixed orthodontic therapy on the periodontium of the extraction sites adjacent to canines and first molars. This was a prospective cohort study. METHODS: Sixty-two systemically healthy subjects were selected. The study was divided into the period of oral hygiene instructions and the period of active orthodontic treatment. Plaque index, gingival index, probing pocket depth, and clinical attachment loss were recorded for the canines and first molars at baseline, after 1 month of orthodontic therapy, and every 3 months until the completion of the orthodontic treatment. RESULTS: There was a statistically significant increase in all clinical parameters (plaque index, gingival index, probing pocket depth, and attachment loss; P <0.05) on the first molars compared with the canines. Significant increases in attachment loss were noted in both the canines (baseline, 0.06 ± 0.01 mm; end of treatment, 0.17 ± 0.02 mm) and the molars (baseline, 0.07 ± 0.01 mm; end of treatment, 0.20 ± 0.02 mm). CONCLUSIONS: Attachment loss cannot be explained solely by the effect of plaque or the banding of teeth. Other factors such as tooth extractions adjacent to the canines, tooth movement, and occlusal trauma may have contributing roles in the loss of periodontal support in adolescent patients.

Congenitally missing maxillary lateral incisors: Long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion.

INTRODUCTION: The aims of this investigation were to evaluate associations between orthodontic space closure (including first premolar intrusion and canine extrusion for esthetic reasons) and periodontal tissue deterioration over a 10-year period in subjects with one or both missing maxillary lateral incisors and to investigate the occurrence of signs or symptoms of temporomandibular disorder (TMD). METHODS: This was a retrospective cohort study comprising patients treated by the same orthodontist. The agenesis group included 26 consecutive adolescent and young adult patients (9 male, 17 female) treated with space closure. The control group consisted of 32 orthodontic patients (12 male, 20 female) with no missing teeth and no need for extractions. In the agenesis group, full-mouth probing pocket depths and bleeding on probing were recorded at 6 locations for each of 657 teeth (3942 periodontal sites). In the control group, comparative data were collected for the maxillary first molars, premolars, canines, and lateral incisors, a total of 264 teeth (1584 periodontal sites). Mobility and gingival recession were also evaluated. Patients in both groups completed questionnaires concerning symptoms related to TMD. RESULTS: The full-mouth assessments in the agenesis group generally demonstrated periodontally healthy conditions, with probing depths below 4 mm and few bleeding sites. Some slight recessions were found, mostly on molars and second premolars, and there was normal mobility of first premolars that substituted for canines. Comparisons between the agenesis and control groups showed no statistically significant differences for the maxillary teeth regarding increased pocket depth (≥4 mm) or increased mobility. Interproximal sites in the agenesis group showed less bleeding on probing than in the control group; this was statistically significant. Anterior teeth in the agenesis group did not show any more recession than in the controls. In addition, we observed no difference in signs or symptoms between the 2 groups; this might be due to the limited sample size or the drawbacks of the surveys of TMD through subjects' recall. Thus, the long-term periodontal tissue health and the incidence of dysfunction or TMD signs were similar in the space-closure agenesis group and in the control group of nonextraction orthodontic patients. CONCLUSIONS: Orthodontic space closure including first premolar intrusion and canine extrusion in patients with missing lateral incisors does not incur risks for periodontal tissue deterioration or TMD in the long term.

Clinical and Radiographic Evaluation of a Small-Diameter Dental Implant Used for the Restoration of Patients with Permanent Tooth Agenesis (Hypodontia) in the Maxillary Lateral Incisor and Mandibular Incisor Regions: A 36-Month Follow-Up.

PURPOSE: For patients with narrow, single-tooth edentulous ridges as a result of permanent tooth agenesis (hypodontia) in the maxillary lateral and mandibular incisor regions, dental implant treatment may present a reliable and predictable restorative treatment solution. The aim of the present study was to evaluate the clinical reliability and outcome of small-diameter dental implants placed in a one-stage procedure with early loading replacing maxillary lateral or mandibular incisor teeth. MATERIALS AND METHODS: Patients with hypodontia in the maxillary lateral incisor or mandibular incisor region analyzed in this report were selected from a larger prospective multicenter study. Small-diameter dental implants (AstraTech OsseoSpeed TX 3.0 S, Dentsply) of different lengths were placed using a one-stage surgical protocol with a 6- to 10-week healing period before loading. Probing pocket depth, bleeding on probing, and gingival zenith score were assessed after 6, 12, 24, and 36 months. Radiographic examination was assessed at 6, 12, and 36 months. RESULTS: In total, 38 patients were included in this analysis and 62 small-diameter implants were placed. The mean distance between adjacent teeth was 6.30 mm (SD: 1.36). All patients received a titanium transmucosal abutment and cement-retained ceramic crown after 6 to 10 weeks of healing. Two implants were lost during the healing period before loading, providing a total implant survival rate of 96.8%. No implant fractures were reported. Mean marginal bone level change from surgery to follow-up visits at 6, 12, and 36 months were 0.39 mm, 0.22 mm, and 0.23 mm, respectively. The condition of soft tissue was stable at all follow-up visits with clinically insignificant changes in probing depth, bleeding on probing, and gingival zenith score. CONCLUSION: This study evaluated the behavior over 36 months of AstraTech Osseospeed TX 3.0 S dental implants placed into narrow one-tooth defect edentulous ridges as a result of hypodontia. The data collected highlighted the stability of the marginal bone level and soft tissues around the dental implants in conjunction with durable mechanical function. Small-diameter implants can be considered a valid solution in the restorative treatment of hypodontia in the maxillary lateral and mandibular incisor regions.

Peri-implant Outcomes with Laser vs Nanosurface Treatment of Early Loaded Implant-Retaining Mandibular Overdentures.

PURPOSE: To compare peri-implant changes seen with two early loading protocols for modifying surface treatment of dental implants-one modifying the collar portion (Laser-Lok implant) and the other modifying the implant surface (nanosurface-treated implant). MATERIALS AND METHODS: Thirty-six completely edentulous patients were chosen for this research. Conventional complete dentures were constructed for all patients. Two implants were used for each patient corresponding to mandibular canines. The patients were classified into two groups. Eighteen patients in group 1 received 36 laser-collar-treated implants; 18 patients in group 2 received 36 nanosurface-treated implants. The implants were early loaded 2 weeks after implant insertion. The peri-implant outcome was evaluated using the following variables: (1) modified Plaque Index, (2) modified Bleeding Index, (3) probing depth, (4) implant mobility using the Periotest instrument, and (5) marginal bone loss as recorded at the time of the overdenture insertion and 6 and 12 months after insertion. RESULTS: At all times of the study, the differences between the groups were not significant with regard to peri-implant tissue changes around implants. CONCLUSION: Both the laser collar- and nanosurface-treated dental implants showed the same peri-implant tissue changes with the early loading protocol. This study found that both early loading protocols are reliable, with good implant stability.

Comparative Assessment of Oral Health Related Quality of Life in Chronic Periodontitis Patients of Rural and Urban Populations in Punjab.

PURPOSE: To assess and compare the oral health related quality of life in patients suffering from chronic periodontitis using the short questionnaire of oral health impact profile (OHIP-14) in rural and urban populations of Punjab state, India. MATERIALS AND METHODS: One hundred patients suffering from chronic periodontitis were screened and divided into two groups, rural and urban (50 participants in each group). The clinical parameters plaque index (PI), gingival index (GI), pocket probing depth (PPD) and OHIP-14 were assessed in all patients. RESULTS: The mean PI (2.11 ± 0.635), GI (1.61 ± 0.45), PPD (3.12 ± 0.692) and OHIP-14 (11.49 ± 9.733) scores were significantly higher in the rural than in the urban population (1.69 ± 0.45, 1.56 ± 0.355, 3.30 ± 0.973, 5.88 ± 5.588, respectively) suffering from chronic periodontitis. The most affected domain in the rural population was functional limitation, whereas psychological disability was the most affected in the urban population. A statistically significant positive correlation was observed between the periodontal parameters and OHIP-14 (p < 0.001) in both groups. CONCLUSION: Within the limitations of the study, periodontal status and oral health related quality of life are significantly correlated with each other in both rural and urban populations.