Interimplant papilla reconstruction: assessment of soft tissue changes and results of 12 consecutive cases.

BACKGROUND: Loss of soft tissue between adjacent implants is a frequent occurrence. Reconstruction of the papilla between adjacent implants is often necessary where there are esthetic demands. The purpose of this article is to describe a fixed and reproducible reference line which can be used to measure changes in the height of the interimplant papillae. A surgical technique carried out at the time of the abutment connection surgery is also described to show the changes that may occur over a 12-month period. Assessment of changes in the soft tissue dimension is shown following a modified flap technique at the time of abutment connection. METHODS: With the aid of clinical photographs taken preoperatively, a reference line can be drawn between the highest point of the gingival margins on teeth distal to the intended site of soft tissue surgery. This reference line can be reproduced on clinical photographs postoperatively. Using this reference line, the changes in soft tissue height using a modified flap technique in 12 consecutive patients are presented. Assessment of the vertical height of the interimplant papillae before and after treatment is described. RESULTS: Four patients showed an increase in the height of the papillae when reviewed 12 months following abutment connection. One patient showed no change in the height of the papillae, and 7 patients showed a loss in papillary height. There was an average loss of 0.5 mm in height of the interimplant soft tissue. CONCLUSIONS: Use of a fixed reference line to assess the outcome of treatment is necessary when evaluating vertical changes in soft tissue. This reference line is used to assess a soft tissue flap technique carried out at the time of implant exposure.

Bacteremia due to periodontal probing: a clinical and microbiological investigation.

BACKGROUND: Infective endocarditis can occur in susceptible individuals due to bacteremia of oral origin. The aim of this study was to investigate the occurrence of bacteremia caused by full mouth periodontal probing. METHODS: Forty patients, 20 with adult periodontitis (10 males, 10 females; mean age 43.0 years) and 20 with chronic gingivitis (11 males, 9 females; mean age 35.5 years) were investigated. Prior to and immediately following periodontal probing, 20 mL of venous blood were obtained from each patient and inoculated into aerobic and anaerobic blood culture bottles and incubated. Negative bottles were monitored continuously for 3 weeks before being discarded. Bottles which signalled positive were subcultured and isolates identified to genus level. Periodontal probing consisted of measuring pockets at 6 points around each tooth and recording the presence or absence of bleeding. A plaque index (PI) was assessed on the 6 Ramfjord teeth. RESULTS: Probing caused bacteremia of oral origin in 8 (40%) of the periodontitis patients and 2 (10%) of the gingivitis patients. Streptococcus spp. were the most common isolates in both groups. Compared with the gingivitis group the odds ratio (OR) for bacteremia in the periodontitis group was 5.993 (95% CI 1.081 to 33.215). Bleeding on probing (OR 1.025, 95% CI 1.004 to 1.047) and mean probing depth per tooth (OR 1.444, 95% CI 1.055 to 1.977) were significantly associated with bacteremia. No significant correlations were found between bacteremia and age, number of teeth probed, smoking status, PI, or total probing depth. CONCLUSIONS: Patients with untreated adult periodontitis are at greater risk of bacteremia due to periodontal probing than patients with chronic gingivitis. For individuals at risk of infective endocarditis, radiographic assessment prior to periodontal probing would be advisable to identify those with periodontitis so that appropriate antibiotic prophylaxis can be provided.