Oral implants in combination with bone grafts. A 3-year retrospective multicenter study using the Brånemark implant system.

A retrospective, multicenter, Scandinavian study of bone grafting of alveolar processes of severely atrophic jaws in combination with implant insertion was conducted with 150 patients. Five different grafting techniques were assessed: local or full onlay; inlay; combination of onlay/inlay grafts; and LeFort I osteotomies. The majority of the patients were treated using a one-stage approach (n = 125) and all had autogenous bone grafts. A total of 781 Brånemark implants were inserted, of which 624 were placed in bone grafts and alveolar bone. Twenty-five patients (17%) dropped out during the follow-up period of three years. Within the remaining patients, 77% of the inserted implants (n = 516) were still in function at the end of the follow-up period. A further ten implants were kept mucosa-covered, resulting in an overall implant survival rate of around 80%. Onlays, inlays and LeFort I osteotomies showed almost the same success rates (76-84%), whereas the onlay/inlay technique gave rise to less favourable results (60%). Most of the observed losses (n = 131) took place during healing and the first year of loading. More implants were lost when they were inserted simultaneously with the grafting (23%) than when they were placed in a second stage (10%). The latter technique was used mainly in combination with local onlay grafting (16/25). The failure percentage for implants inserted in non-grafted bone (11%) was lower than for those inserted in bone grafts and alveolar bone (25%). The surviving implants of treated and followed patients served, in 88% of the cases (n = 110), to support fixed bridges or overdentures, albeit, in some instances (n = 23), after additional implant placement. In only 15 patients was it necessary to fall back on conventional removable prostheses or fixed partial bridges.

Effect of long-term tetracycline therapy on human periodontal disease.

The present investigation was performed to study the effect of long-term, low dosage tetracycline therapy on advanced periodontal disease in humans. 14 volunteers participated in the trial. Each of the participants had at least 4 pairs of diseased sites around contralateral premolars and incisors with deep pockets and advanced bone loss. The trial extended over a 50-week period and was designed as a double-blind split-mouth study. A Baseline examination included assessments of oral hygiene, gingival conditions, probing depth, attachment level and analysis of the composition of the subgingival microbiota in samples obtained from 8 selected diseased sites. All participants received oral hygiene instruction. In each patient 2 quadrants of the mouth, chosen at random, were treated by scaling and root planing. The 2 remaining quadrants were left unscaled. Following the Baseline examination the patients were randomly distributed into 2 groups of 7 members each. In one of the groups the patients received tetracycline on a daily basis during a 50-week period. The participants of the control group received placebo. Reexaminations were performed 2, 10, 20, 30 and 50 weeks after the Baseline examination. The findings demonstrated that in patients with advanced periodontal disease long-term tetracycline therapy in the absence of scaling resulted in the establishment of a subgingival microbiota almost devoid of motile bacteria and in markedly reduced signs of gingivitis, probing depth and attachment loss. In fact, the alterations observed as a result of tetracycline administration to patients with excellent self-performed plaque control were similar to those obtained by conventional scaling and root planing in the control group.