Peri-implant tissue conditions following transcrestal and lateral sinus floor elevation: 3-year results of a bi-center, randomized trial.

OBJECTIVES: The present study was performed to comparatively evaluate the peri-implant bone stability and conditions of marginal tissues at 3 years following transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively). MATERIALS AND METHODS: Patients included in a parallel-arm randomized trial comparatively evaluating tSFE and lSFE were recalled at 3 years post-surgery. Twenty-one and 24 patients in tSFE and lSFE groups, respectively, participated in the follow-up visit. Peri-implant bone support was evaluated as the proportion of the entire implant surface in direct contact with the radiopaque area (totCON%) on 3-year periapical radiographs. The conditions of the marginal peri-implant tissues at 3-year visit were classified as peri-implant health, peri-implant mucositis, or peri-implantitis. RESULTS: At 3 years, both groups showed an implant survival rate of 100%. Median totCON% was stable at 3 years, being 100% in both groups (p = 0.124). Peri-implant health and mucositis were diagnosed in 10 (47.6%) and 11 (52.4%) patients, respectively, in the tSFE group, and in 8 (33.3%) and 16 (66.7%) subjects, respectively, in the lSFE group (p = 0.502). CONCLUSIONS: At 3 years following surgery, implants placed concomitantly with tSFE and lSFE fully maintain peri-implant bone support. Peri-implant mucositis was the most prevalent condition, with a similar prevalence between groups. CLINICAL RELEVANCE: Based on 3-year data on peri-implant bone support and prevalence of peri-implant diseases, the study suggests that tSFE and lSFE represent two equally valid options for the rehabilitation of the posterior maxilla. CLINICALTRIALS: gov ID: NCT02415946.

Implant-supported rehabilitation following transcrestal and lateral sinus floor elevation: analysis of costs and quality of life from a bicenter, parallel-arm randomized trial.

BACKGROUND: The aim of this study was to comparatively evaluate costs and specific aspects of oral-health related quality of life (OhRQoL) related to the period between the surgery phase of transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively) and 6 months after delivery of implant-supported prosthesis. METHODS: A bicenter, parallel-arm, randomized trial comparatively evaluating tSFE and lSFE when applied concomitantly with implant placement was conducted. At 6 months after prosthesis delivery, data on cost-associated items related to the post-surgery period and selected aspects of OhRQoL were collected. RESULTS: Analyses of costs and quality of life was conducted on 56 patients (tSFE: 28; lSFE: 28) and 54 patients (tSFE: 26; lSFE: 28), respectively. Significantly lower dose of anesthetic (2 vs. 3 vials), amount of xenograft (420 mg vs. 1975 mg), and duration of surgery (54' vs. 86') were observed for tSFE compared to lSFE. No significant differences in the number of additional surgical sessions, postoperative exams, specialist consultations and drug consumption were found between groups. In a limited fraction of patients in both groups, improvements were observed for pain (tSFE: 3.8%; lSFE: 7.4%), comfort in eating any food (tSFE: 11.5%; lSFE: 3.6%), self-consciousness (tSFE: 19.2%; lSFE: 14.3%), and satisfaction about life (tSFE: 19.2%; lSFE: 10.7%). CONCLUSIONS: The surgery phase of maxillary sinus floor elevation is characterized by more favorable cost-associated items for tSFE compared to lSFE. Differently, tSFE and lSFE do not differ for either costs related to the post-surgery phases or impact of the implant-supported rehabilitation on specific aspects of OhRQoL.

What periodontal recall interval is supported by evidence?

Recall sessions are an integral part of supportive periodontal therapy. The aim of the current article is to review the existing evidence to support if and to what extent a predefined frequency of periodontal recall sessions ensures periodontal health and stability. Factors that potentially affect the time interval for recall are described. Moreover, original data on the relevance of residual diseased sites (ie, bleeding pockets) at patient level to predict the progression of periodontitis are presented. Overall, wide heterogeneity was found in the published literature with regards to the proposed supportive periodontal therapy recall frequency once active periodontal therapy has been completed. Available data clearly show that a primary and secondary preventive regimen based on routine supportive periodontal therapy is beneficial to preserve a periodontally healthy dentition and prevent tooth loss. However, convincing evidence regarding the appropriateness, risk-benefit, and cost-effectiveness of different recall intervals is currently scarce. In patients affected by moderate to advanced periodontitis, a supportive periodontal therapy protocol based on a 2-4 month recall interval appears reasonable. Limited data suggest that the amount/proportion of residual diseased sites (intended as pockets or bleeding pockets) and risk assessment tools may be of value in establishing the appropriate recall frequency.

Efficacy of alternative or additional methods to professional mechanical plaque removal during supportive periodontal therapy: A systematic review and meta-analysis.

AIMS: To systematically review the literature addressing the following focused questions: "What is the efficacy of either (#1) alternative or (#2) additional methods to professional mechanical plaque removal (PMPR) on progression of attachment loss during supportive periodontal therapy (SPT) in periodontitis patients?". METHODS: A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome. RESULTS: Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub-antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth ≥4 mm were repeatedly treated. After pooling all data, the results of the meta-analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was -0.233 mm (95% confidence interval: -1.065, 0.598; p = .351). CONCLUSIONS: Weak evidence indicate that in treated periodontitis patients enrolled in a 3-4 month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR.

The impact of graft remodeling on peri-implant bone support at implants placed concomitantly with transcrestal sinus floor elevation: A multicenter, retrospective case series.

OBJECTIVES: To evaluate the impact on peri-implant bone support (as assessed on periapical radiographs) of the remodeling dynamics of varying graft biomaterials used for transcrestal sinus floor elevation (tSFE). METHODS: The study is a multicenter, retrospective series of cases undergone tSFE (performed according to the Smart Lift technique) and concomitant implant placement. At operator's discretion, tSFE was performed with bone core (BC) alone or supplemented by deproteinized bovine or porcine bone mineral (DBBM and DPBM, respectively), synthetic hydroxyapatite in a collagen matrix (S-HA), or ß-tricalcium phosphate (ß-TCP). Immediately after surgery, at 6-12 months post-surgery, and at later (≥24 months) follow-up intervals, the percentage proportion of the implant surface in direct contact with the radiopaque area was calculated for the entire implant surface (totCON%). Also, the height of the graft apical to the implant apex (aGH) was assessed. RESULTS: At 6-12 months following tSFE, median totCON% was 100%, with a median aGH of 1.4 mm. A tendency of aGH to decrease in height was observed at later follow-up intervals for sites treated with all grafting procedures. In all treatment groups, the majority of the implant surface was still surrounded by the radiopaque area at the longest follow-up visits. CONCLUSIONS: Although the height of the peri-implant radiopaque area apical to the implant apex tends to reduce overtime at sites which have received tSFE, the peri-implant bone support seems to be maintained long term irrespective of the graft material used.

Radiographic outcomes of transcrestal and lateral sinus floor elevation: One-year results of a bi-center, parallel-arm randomized trial.

OBJECTIVES: To comparatively evaluate the radiographic outcomes of transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively) when applied concomitantly with implant placement. MATERIALS AND METHODS: Patients with at least 1 edentulous site with residual bone height (RBH) of 3-6 mm were enrolled in a bi-center, parallel-arm, randomized trial. Both tSFE and lSFE were associated with a bovine-derived xenograft, and implants were inserted concomitantly. In lSFE group, the antrostomy was covered with a resorbable collagen membrane. Marginal bone loss and the maturation of the grafted area were evaluated on periapical radiographs at 6 and 12 months. Twelve-month CT/CBCT was used to assess the effect of grafting procedures circumferentially around the implant. A per-protocol analysis was performed. RESULTS: The per-protocol study population consisted of 26 patients in the tSFE group and 28 patients in the lSFE group. At 12 months, the median proportion of the implant surface in contact with the peri-implant radiopaque area was 100% in both groups, with no significant inter-group difference. Suboptimal bone-to-implant contact was observed in 13% and 3.6% of tSFE and lSFE cases, respectively. In both groups, marginal bone loss was minimal (≤1 mm) and infrequent, and the radiographic aspect was suggestive of an advanced stage of maturation. CONCLUSIONS: At sites with RBH of 3-6 mm where implants are placed concomitantly with sinus floor elevation, tSFE and lSFE are both highly predictable in obtaining an implant surface completely embedded in a radiopaque area at 12 months post-surgery. (ClinicalTrials.gov ID: NCT02415946).

Morbidity following transcrestal and lateral sinus floor elevation: A randomized trial.

AIM: To comparatively evaluate the morbidity following maxillary sinus floor elevation according to either transcrestal (tSFE) or lateral (lSFE) approach with concomitant implant placement. MATERIALS & METHODS: Patients with ≥1 edentulous maxillary posterior site with residual bone height (RBH) of 3-6 mm were enrolled. tSFE was performed in association with a xenograft and a collagen matrix. For lSFE, the sinus was grafted with the xenograft, and the antrostomy was covered with a membrane. Implants were inserted concomitantly. The postoperative course was assessed through questionnaires. Pain level (VASpain ) was recorded using a 100-mm visual analogue scale. RESULTS: Twenty-nine and 28 patients were included in tSFE and lSFE group, respectively. On the day of surgery, VASpain was significantly higher for tSFE compared to lSFE, and similar from day 1 to 14. tSFE was characterized by significantly lower incidence of swelling, bruising and nasal discharge/bleeding. Significantly less severe limitation in swallowing, continuing daily activities, eating, speaking, opening the mouth and going to school/work was found for tSFE only at specific postsurgery intervals. CONCLUSIONS: lSFE was associated with lower pain on the day of surgery, and tSFE revealed lower postoperative morbidity as well as more tolerable postoperative course.

Patient-reported outcomes of implant placement performed concomitantly with transcrestal sinus floor elevation or entirely in native bone.

AIM: Based on the hypothesis that maxillary sinus floor elevation with a transcrestal approach (tSFE) does not increase the morbidity of implant surgery, the study evaluated the patient-reported outcomes as well as the type and incidence of complications when implants are placed either concomitantly with tSFE (performed according to Trombelli et al. 2008, 2010a,b) or entirely in native bone. METHODS: Data from the record charts of patients undergone implant placement for single-tooth rehabilitation in the posterior maxilla were retrospectively obtained from four clinical centers. Cases for tSFE group were included if they showed an extent of sinus lift ≥4 mm concomitantly to implant placement. Cases for N group were included when implant placement was performed entirely in native bone. Patient-reported outcomes had been assessed using 100-mm visual analog scales (postoperative pain, VASpain ) and visual rating scales (level of discomfort, VRSdiscomfort ; willingness to undergo the same surgery, VRSwillingness ). The dose of analgesics had been self-recorded. RESULTS: A convenience sample of 14 patients and 17 patients (contributing with one implant site each) treated with tSFE and N, respectively, was obtained for this study. Membrane perforation occurred in 1 tSFE case, without compromising the completion of the procedure. VASpain remained low (<12) in both groups. A tendency of VASpain to decrease with time was observed in both groups. The area under the curve for VASpain (AUCpain ), indicating the level of pain experience through the first week following surgery, was 18.0 (IR: 8.5-85.0) and 11.5 (IR: 4.5-18.5) in tSFE and N groups, respectively, with no significant inter-group differences (P = 0.084). The dose of analgesics was similarly low between groups. No significant inter-group difference in VRSdiscomfort and VRSwillingness was observed. CONCLUSIONS: Implant placement performed either concomitantly with tSFE (according to Trombelli et al. 2008, 2010a,b) or entirely in native bone is associated with limited incidence of complications, low postoperative pain and medication and are both well tolerated.

Learning Curve of a Minimally Invasive Technique for Transcrestal Sinus Floor Elevation: A Split-Group Analysis in a Prospective Case Series With Multiple Clinicians.

AIMS: To assess the learning curve of a minimally invasive procedure for maxillary sinus floor elevation with a transcrestal approach (tSFE) and evaluate the influence of clinician's experience in implant surgery on its outcomes. MATERIALS AND METHODS: Patients were treated by clinicians with different levels of experience in implant surgery and inexperienced with respect to the investigated tSFE technique. The initial (n = 13) and final (n = 13) groups treated by the expert clinician were compared for tSFE outcomes. Additionally, the high, moderate, and low groups (n = 20 each) treated by the expert, moderately experienced, and low experienced clinician, respectively, were compared. RESULTS: (1) No significant differences in clinical and radiographic outcomes were observed between initial and final groups; (2) high, moderate, and low groups showed substantial vertical augmentation in limited operation time with treatment outcomes being influenced by the level of experience in implant surgery. CONCLUSIONS: The investigated technique allows for a substantial vertical augmentation at limited operation times when used by different clinicians. The extent of sinus lift (as radiographically assessed) seems to be influenced by the clinician's level of experience in implant dentistry.

Incremental, transcrestal sinus floor elevation with a minimally invasive technique in the rehabilitation of severe maxillary atrophy. Clinical and histological findings from a proof-of-concept case series.

In the posterior maxillary sextants, the residual dimensions of the edentulous ridge can considerably limit the insertion of implants with the desired length and diameter. A minimally invasive procedure for transcrestal sinus floor elevation (tSFE), namely the Smart Lift technique, which is based on a standardized sequence of specifically designed drills and osteotomes, was introduced in 2008 and subsequently validated in a series of recent studies. The present technical note describes the use of the technique by a staged approach, called incremental tSFE (i-tSFE), in the augmentation of severely resorbed edentulous ridges. The i-tSFE consists of 2 staged tSFE procedures performed with a transcrestal access, the second of which is performed concomitantly with implant placement. In the present case series, 3 patients with severe bone atrophy (residual bone height, 2 to 3 mm) in the edentulous posterior maxilla were treated with i-tSFE. At the second surgical stage of i-tSFE, implants at least 8 mm long were placed at all sites, and the success of the implant-supported restoration was monitored to 6 months (1 patient) or 3 years (2 patients). Histologic findings from an augmented site showed the presence of newly formed bone, bone marrow spaces with numerous vascular canals, and residual graft particles occupying approximately 50%, 15%, and 35% of the total area, respectively. The results of the study showed that i-tSFE can be performed successfully with the Smart Lift technique to rehabilitate atrophic maxillary posterior sextants.

Effect of professional mechanical plaque removal performed on a long-term, routine basis in the secondary prevention of periodontitis: a systematic review.

AIMS: To systematically review the evidence evaluating the efficacy of long-term, routine, professional mechanical plaque removal (PMPR) in the prevention of periodontitis progression. METHODS: A literature search was conducted to identify prospective studies evaluating the effect of PMPR in periodontitis patients undergoing active periodontal therapy and enrolled in a maintenance programme including PMPR for at least 3 years. RESULTS: No RCTs evaluating the efficacy of the intervention when compared with no treatment during maintenance were found. Nineteen prospective studies assessing the effect of PMPR as part of the supportive therapy were included. In general, studies reported no to low incidence of tooth loss during follow-up. The weighted mean yearly rate of tooth loss was 0.15 ± 0.14 and 0.09 ± 0.08 for follow-up of 5 years or 12-14 years, respectively, with no significant differences between groups. Mean clinical attachment loss was <1 mm at follow-up ranging from 5 to 12 years. CONCLUSIONS: Supportive therapy, which encompasses PMPR, may limit the incidence and yearly rate of tooth loss as well as the loss in clinical attachment in patients treated for periodontitis. However, whether and to what extent the intervention may impact on long-term periodontal parameters still needs to be assessed.

Radiographic outcomes of transcrestal sinus floor elevation performed with a minimally invasive technique in smoker and non-smoker patients.

OBJECTIVES: To evaluate the association between smoking status and the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive technique (Smart Lift). METHODS: Forty-five implants were placed in 25 non-smoker (NS) and 20 smoker (S) patients in conjunction with the tSFE procedure. In all cases, an additional graft, chosen among different hydroxyapatite-based or ß-tricalcium phosphate-based biomaterials, was pushed into the sinus by gradual increments. Immediately after surgery, residual bone height, implant penetration into the sinus, extent of sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs. At 6 months after surgery, SL and aGH were reassessed. RESULTS: (i) The Smart Lift procedure resulted in substantial 6-month SL and aGH in both treatment groups; (ii) smoking status did not significantly affect the 6-month radiographic outcomes; (iii) a similarly low incidence of intra- and postoperative complications was observed in NS and S patients. CONCLUSIONS: Smoking has a limited impact on the outcomes of tSFE performed with the Smart Lift technique.

Minimally invasive transcrestal sinus floor elevation with deproteinized bovine bone or ß-tricalcium phosphate: a multicenter, double-blind, randomized, controlled clinical trial.

AIMS: To evaluate the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive procedure (Smart Lift technique) combined with the additional use of deproteinized bovine bone mineral (DBBM) or ß-tricalcium phosphate (ß-TCP). METHODS: In a multicenter randomized controlled trial, 38 sites in 38 patients were treated with the Smart Lift technique in association with DBBM (n = 19) or ß-TCP (n = 19). The extent of the sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs taken immediately after surgery and at 6 months following surgery. RESULTS: (i) Substantial aGH and SL were observed immediately after surgery and at 6 months, with no significant differences between DBBM and ß-TCP groups; (ii) a significant graft remodelling was observed from post-surgery to 6-months in the ß-TCP group and (iii) limited incidence of complications as well as limited post-operative pain and discomfort were associated with the use of both graft materials. CONCLUSIONS: The Smart Lift technique in conjunction with the additional use of either DBBM or ß-TCP may provide a substantial elevation of the maxillary sinus floor along with limited post-surgical complications and post-operative pain/discomfort.

Minimally invasive transcrestal sinus floor elevation with graft biomaterials. A randomized clinical trial.

OBJECTIVES: The present study was performed to comparatively evaluate the effectiveness and post-operative morbidity of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive procedure (Smart Lift technique) combined with the additional use of two graft biomaterials. METHODS: Thirty sites in 30 patients were randomly assigned to tSFE in association with either deproteinized bovine bone mineral (DBBM) (n = 15) or synthetic hydroxyapatite in a collagen matrix (S-HA) (n = 15). In both groups, the extent of the sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs taken immediately after surgery and at 6 months following surgery. Surgical and post-surgical complications as well post-surgical pain and discomfort were also assessed. RESULTS: The results of the study indicated that (i) immediately post-surgery, both DBBM and S-HA resulted in substantial SL and aGH, which were maintained at 6 months, (ii) greater aGH and SL were observed in S-HA group compared with DBBM group at 6 months post-surgery and (iii) limited surgical complications and post-operative pain/discomfort were associated with the use of both graft biomaterials. CONCLUSIONS: The Smart Lift technique in conjunction with the additional use of either S-HA or DBBM may provide a predictable elevation of the maxillary sinus floor along with limited post-surgical complications and post-operative pain/discomfort. SL and aGH were significantly greater at 6 months for S-HA than DBBM.

Alveolar ridge dimensions in maxillary posterior sextants: a retrospective comparative study of dentate and edentulous sites using computerized tomography data.

AIM: To compare the alveolar ridge dimensions between edentulous sites and contralateral dentate sites of maxillary posterior sextants in the same individuals. MATERIALS AND METHODS: Computerized tomography scans of 32 patients with one fully edentulous and one fully dentate maxillary posterior sextants were analyzed. RESULTS: When compared with dentate sextants, edentulous sextants showed (i) a lower bone height (BH) at second premolar, first molar and second molar sites, which was associated with a more coronal position of the maxillary sinus floor at second premolar site; (ii) a more apical position of the ridge at second premolar and second molar sites; (iii) a lower bone width (BW)(1 mm) at first and second premolar sites, and a lower BW(3 mm) at all sites, (iv) a lower, although not significant, prevalence of premolar and molar sites with BH ≥8 mm and BW(1 mm) ≥6 mm. CONCLUSIONS: The edentulous sextants in the posterior maxilla showed a reduced height and width of the ridge when compared with contralateral dentate sextants. The reduced vertical dimensions observed in edentulous sextants were variably associated with ridge resorption as well as sinus pneumatization.

Ridge dimensions of the edentulous posterior maxilla: a retrospective analysis of a cohort of 127 patients using computerized tomography data.

OBJECTIVES: to evaluate the edentulous ridge dimensions of maxillary posterior sextants with a tridimensional radiographic technique. The influence of the presence/absence of teeth adjacent to the edentulous site on the dimensions of the edentulous ridge was also evaluated. MATERIAL AND METHODS: computerized tomography (CT) scans of 127 patients (65 males and 62 females; mean age: 55.2 ± 10.1 years) with at least one missing tooth in the maxillary posterior sextants were analyzed. On CT cross sections, bone height (BH), bone width (BW) at 1, 3, and 7 mm from the most coronal point of the alveolar crest (BW(1 mm) , BW(3 mm) , and BW(7 mm) , respectively) and the relative vertical ridge position (rVRP) were assessed at the first premolar, second premolar, first molar and second molar edentulous sites. RESULTS: the results of the study indicate that (i) the maxillary sinus was radiographically evident in about 50% of first premolar sites and 90-100% of second premolar and molar sites; (ii) BH showed a significant decrease from first premolar to molar sites; (iii) BW(1 mm) was higher at second molar site compared with the first and second premolar sites, BW(3 mm) and BW(7 mm) were higher at each molar site compared with each premolar site; (iv) the proportion of sites with BH ≥ 8mm and BWI mm ≥ 6mm was 28.3%, 18.4%, 8.0% and 18.2% [corrected] at first premolar, second premolar, first molar and second molar sites, respectively. The absence of teeth adjacent to the edentulous site negatively affected rVRP, but not BH and BW. CONCLUSIONS: The results of the study indicate that at premolar and molar sites, [corrected] the dimensions of the alveolar crest may call for bone augmentation procedures for proper implant placement in a substantial amount of edentulous patients. When both mesial and distal tooth adjacent to the edentulous site are absent, the placement of implants of adequate dimensions may be more challenging due to a more apical position of the alveolar ridge compared with sites where both adjacent teeth are present.

Minimally invasive technique for transcrestal sinus floor elevation: a case report.

The present report describes a minimally invasive technique for transcrestal sinus floor elevation, namely the Smart Lift technique, which is based on the controlled use of drills and osteotomes. The rationale of this technique is to provide predictable vertical bone augmentation into the sinus cavity by (1) using the existing residual bone as a viable graft and (2) limiting the incidence of membrane perforation and postsurgery morbidity. Surgical steps of the procedure are thoroughly illustrated by means of a paradigmatic case. The Smart Lift procedure was compatible with sinus floor elevation and implant stability for up to 1 year following surgery. No complications occurred during or after surgery. On periapical radiographs, a radiopaque area corresponding to the augmented sinus floor was present above the apical portion of the implant.

Transcrestal sinus floor elevation with a minimally invasive technique.

BACKGROUND: Recently, we proposed a minimally invasive technique to limit the postoperative morbidity of transcrestal sinus floor elevation procedures. The technique is based on the use of specially designed drills and osteotomes. The purpose of the present study is to present data on the clinical outcomes and postoperative morbidity of sinus floor elevation procedures performed using the proposed technique. METHODS: Fourteen implants were placed in the posterior portions of the maxilla areas of 11 patients using the proposed technique. Postoperative pain and discomfort were assessed using a 100-mm visual analog scale (VAS). The incidences of intra- and postoperative complications were recorded. The position of the grafted sinus floor with respect to the implant apex was assessed on periapical radiographs 6 months post-surgery. RESULTS: The augmented sites had a presurgery residual bone height of 6.1 mm, whereas the mean length of the implants inserted in augmented sites was 10.3 +/- 0.9 mm. Immediately after surgery, VAS scores for pain and discomfort were 9.4 +/- 13.4 and 17.0 +/- 22.2, respectively. The 7-day VAS score for pain was 2.1 +/- 4.9. No complications were observed during or after the surgical procedure. Six months after surgery, a newly formed mineralized tissue was found at or beyond the level of the implant apex in all cases. CONCLUSION: The proposed technique represents a suitable option to elevate the sinus floor due to a predictable displacement of the sinus floor and a limited post-operative morbidity.

Single-flap approach with buccal access in periodontal reconstructive procedures.

BACKGROUND: New surgical techniques have been developed to optimize primary closure as well as to minimize the surgical trauma in the reconstructive procedures of periodontal intraosseous defects. Recently, we proposed a minimally invasive procedure, the single-flap approach (SFA), specifically indicated when the defect extension is prevalent on the buccal or oral side. The basic principle of the SFA is the elevation of a flap to access the defect only on one side (buccal or oral), leaving the opposite side intact. The present case series reports preliminary data on the clinical effectiveness of SFA with buccal access in conjunction with a collagen membrane and a hydroxyapatite (HA)-based biomaterial in the reconstructive treatment of deep periodontal intraosseous defects. METHODS: Ten intraosseous defects in 10 patients were accessed with a buccal SFA and treated with a collagen membrane and an HA-based graft biomaterial. The follow-up period following the regenerative procedure ranged from 6 to 14 months (mean: 10.0 +/- 3.0 months). RESULTS: Clinical attachment level (CAL) decreased from 11.2 +/- 2.6 mm presurgery to 6.4 +/- 1.9 mm post-surgery. Probing depth was 9.0 +/- 2.8 mm before surgery and 3.8 +/- 1.5 mm post-surgery. Gingival recession increased from 2.2 +/- 1.9 mm presurgery to 2.6 +/- 1.3 mm post-surgery. CONCLUSIONS: Challenging intraosseous defects, surgically accessed with a buccal SFA and treated with a combined graft/guided tissue regeneration technique, may heal with a substantial CAL gain. Limited postsurgical recession indicates that SFA may represent a suitable option to surgically treat defects in areas with high esthetic demands.

Adjunctive effect of chlorhexidine in ultrasonic instrumentation of aggressive periodontitis patients: a pilot study.

AIM: The aim of the present pilot randomized clinical trial was to evaluate the effects of ultrasonic mechanical instrumentation (UMI) associated with the professional use of chlorhexidine (CHX) formulations compared with UMI alone during periodontal supportive therapy in patients with generalized aggressive periodontis (G-AgP). MATERIAL AND METHODS: Nine patients (test group) received a single session of UMI associated with subgingival irrigation under cavitation with CHX 0.02%. A 0.2% CHX solution was used for professional tongue brushing and mouthrinsing. Ten patients (control group) received a similar session of UMI associated with subgingival irrigation and professional tongue brushing and mouthrinsing with a control formulation. Clinical and microbiological parameters were assessed pre-treatment at 3, 6 and 12 weeks post-treatment. RESULTS: UMI either with or without additional CHX use determined a significant reduction of supragingival plaque and gingival inflammation as well as a significant reduction of subgingival bacterial pathogens. The additional use of CHX did not result in any additional clinical and microbiological benefit with respect to mere UMI. CONCLUSIONS: The adjunctive professional use of CHX formulations to UMI seems to produce no additional effects over UMI alone during supportive therapy in G-AgP patients.