Water jet with adjunct chlorhexidine gel for nonsurgical treatment of peri-implantitis.

BACKGROUND: Peri-implant disease following successful integration of an endosseous implant is the result of an imbalance between bacterial load and host defense, which may affect not only the peri-implant mucosa but also involve the supporting bone. OBJECTIVES: The aim of this study was to evaluate the adjunctive effect of a dental water jet rinse mixed with chlorhexidine gel to the nonsurgical treatment for peri-implantitis. METHOD AND MATERIALS: A prospective randomized interventional cohort study was conducted. Forty consecutive patients presenting with peri-implantitis were recruited and randomly assigned into two treatment groups. Initially all patients received scaling/surface debridement and oral hygiene instruction. Patients in the study group received a water jet device containing chlorhexidine gel (Silonite®) for home use twice daily while the control group performed the recommended oral hygiene measures with no water jet usage. Three months following baseline visit, patients were reevaluated clinically and radiographically. RESULTS: In total, 39 patients completed the study and were available for final examination. Three months following baseline visit the test group exhibited greater mean probing depth reduction (0.75 mm vs 0.27 mm; P = .029) as well as greater reduction in the number of sites presenting with bleeding on probing (2.26 vs 0.45 sites; P = .011). No significant change in bone level was observed at 3 months (mean bone gain was 0.18 mm). CONCLUSIONS: Water jet mixed with chlorhexidine gel might supplement the response to nonsurgical treatment for peri-implantitis lesions. Further, larger-cohort studies are warranted.

Tensile mechanical properties of swine cortical mandibular bone.

Temporary orthodontic mini implants serve as anchorage devices in orthodontic treatments. Often, they are inserted in the jaw bones, between the roots of the teeth. The stability of the mini implants within the bone is one of the major factors affecting their success and, consequently, that of the orthodontic treatment. Bone mechanical properties are important for implant stability. The aim of this study was to determine the tensile properties of the alveolar and basal mandible bones in a swine model. The diametral compression test was employed to study the properties in two orthogonal directions: mesio-distal and occluso-gingival. Small cylindrical cortical bone specimens (2.6 mm diameter, 1.5 mm thickness) were obtained from 7 mandibles using a trephine drill. The sites included different locations (anterior and posterior) and aspects (buccal and lingual) for a total of 16 specimens from each mandible. The load-displacement curves were continuously monitored while loading half of the specimens in the oclluso-gingival direction and half in the mesio-distal direction. The stiffness was calculated from the linear portion of the curve. The mesio-distal direction was 31% stiffer than the occluso-gingival direction. The basal bone was 40% stiffer than the alveolar bone. The posterior zone was 46% stiffer than the anterior zone. The lingual aspect was stiffer than the buccal aspect. Although bone specimens do not behave as brittle materials, the diametral compression test can be adequately used for determining tensile behavior when only small bone specimens can be obtained. In conclusion, to obtain maximal orthodontic mini implant stability, the force components on the implants should be oriented mostly in the mesio-distal direction.

Bone preservation in dehiscence-type defects using composite biphasic calcium sulfate plus biphasic hydroxyapatite/ß-tricalcium phosphate graft: a histomorphometric case series in canine mandible.

OBJECTIVES: To examine bone formation in dehiscence defects using biphasic hydroxyapatite/ß-tricalcium phosphate plus biphasic calcium sulfate (BCP/BCS). MATERIAL: After extractions, 24 mandibular buccal dehiscence defects (3 × 3 mm) were treated with BCP/BCS (E), membrane (MC), or control (NC). Histology and histomorphometric analysis were performed. RESULTS: After 6 weeks, bone formation was noticeable in most sites. In subsequent phases, the woven bone was gradually remodeled into lamellar bone and marrow. Vertical new bone height in the E and MC groups (1.06 and 0.85 mm.) was substantially greater than that in the NC group (-0.28 mm). For all groups, there was an overall increase in the height of the newly formed bone through the observation. At week 12, the vertical bone height was 1.95, 2.07, and 0.29 mm, respectively. The mean new bone area in the E and MC groups was much greater than that in the NC group (2.85, 2.80, and -0.20 mm, respectively). Percent new bone in all 3 groups was similar (36.25%, 34.84%, and 28.34%, respectively). CONCLUSIONS: This study demonstrates the efficacy of BCP/BCS graft for bone augmentation in dehiscence-type extraction socket defect.