Repeated delivery of chlorhexidine chips for the treatment of peri-implantitis: A multicenter, randomized, comparative clinical trial.

BACKGROUND: Peri-implantitis is a challenging condition to manage and is frequently treated using non-surgical debridement. The local delivery of antimicrobial agents has demonstrated benefit in mild to moderate cases of peri-implantitis. This study compared the safety and efficacy of chlorhexidine gluconate 2.5 mg chip (CHX chips) as an adjunctive treatment to subgingival debridement in patients afflicted with peri-implantitis. METHODS: A multicenter, randomized, single-blind, two-arm, parallel Phase-3 study was conducted. Peri-implantitis patients with implant pocket depths (IPD) of 5-8 mm underwent subgingival implant surface debridement followed by repeated bi-weekly supragingival plaque removal and chlorhexidine chips application (ChxC group) for 12 weeks, or similar therapy but without application of ChxC (control group). All patients were followed for 24 weeks. Plaque and gingival indices were measured at every visit whereas IPD, recession, and bleeding on probing were assessed at 8, 12, 16, 24 week. RESULTS: A total of 290 patients were included: 146 in the ChxC group and 144 in the control. At 24 weeks, a significant reduction in IPD (P = 0.01) was measured in the ChxC group (1.76 ± 1.13 mm) compared with the control group (1.54 ± 1.13 mm). IPD reduction of ≥2 mm was found in 59% and 47.2% of the implants in the ChxC and control groups, respectively (P = 0.03). Changes in gingival recession (0.29 ± 0.68 mm versus 0.15 ± 0.55 mm, P = 0.015) and relative attachment gain (1.47 ± 1.32 mm and 1.39 ± 1.27 mm, P = 0.0017) were significantly larger in the ChxC group. Patients in the ChxC group that were < 65 years exhibited significantly better responses (P < 0.02); likewise, non-smokers had similarly better response (P < 0.02). Both protocols were well tolerated, and no severe treatment-related adverse events were recorded throughout the study. CONCLUSIONS: Patients with peri-implantitis that were treated with an intensive treatment protocol of bi-weekly supragingival plaque removal and local application of chlorhexidine chips had greater mean IPD reduction and greater percentile of sites with IPD reduction of ≥2 mm as compared with bi-weekly supra-gingival plaque removal.

Effect of implant neck design on primary and secondary implant stability in the posterior maxilla: A prospective randomized controlled study.

OBJECTIVE: To compare the early changes in implant stability of implants with different neck design during the first 3 months of healing in the posterior maxilla. MATERIALS AND METHODS: Patients were randomized to receive triangular neck implant (test), or round neck implant (control). Resonance frequency analysis (ISQ) measurements were obtained at surgery and at 2, 4, 7, 14, 21, 28, 45, 60, and 90 days following implant placement. Non-parametric statistic was used for data analysis. RESULTS: Thirty-two patients were included (17 test and 15 controls). Initial ISQ values of the test implants were high (mean: 68.4, SD = 8.4) and increased over time (mean: 74.4, SD = 6.0). Control implants presented a statistically significant higher initial ISQ value at implant placement (mean: 76.9, SD = 8.7), which was maintained over the healing period (mean: 77.6, SD = 3.6) with no significant changes between time intervals. After 6 weeks of healing, both implants displayed comparable ISQ values with no differences between the groups. All implants exhibited a decrease in stability on days 2 and 21 post-placement. All roundneck implants used, and 82% of the triangularneck implants showed initial ISQ values above the suggested threshold for immediate loading (>60). CONCLUSIONS: Implant neck design plays a role in implant primary stability in the posterior maxilla. Both implants show high primary stability, with significantly higher values for the round neck. However, these differences disappeared after 6 weeks of healing. While primary implant stability is partially governed by implant neck design, the role of this result is negligible for the achievement of secondary stability.

Microbial accumulation on different suture materials following oral surgery: a randomized controlled study.

BACKGROUND: The aim of the study was to compare bacterial accumulation on different suture materials following oral surgery. METHODS: Patients scheduled for implant or periodontal surgery were included in the study. Upon flap closure, four different sutures were placed in a randomized sequence-silk, coated polyglactin, nylon, and polyester. Ten days following surgery, the sutures were removed and incubated in aerobic as well as anaerobic conditions for 7 days and colony-forming units (CFUs) were calculated. Association between bacterial accumulation and periodontal diagnosis, type of surgery, and antibiotic treatment were also tested. RESULTS: All sutures in all patients were found to contain bacteria. Overall, nylon sutures showed significantly lower CFU levels compared to silk, coated polyglactin, and polyester sutures. The type of surgery (implant vs. periodontal surgery) did not significantly influence bacterial accumulation. Also, periodontal diagnosis had little impact on CFU counts. Interestingly, post-surgical antibiotic treatment also had only a minor effect on bacterial accumulation on the various sutures. DISCUSSION: The results indicate that the monofilamentous nylon sutures showed less microbial accumulation than the other tested materials that were all braided. This effect may be due to material qualities as well as suture macrostructure. Type of surgery, periodontal diagnosis, and antibiotic consumption have little effect on bacterial accumulation of sutures. CLINICAL RELEVANCE: The study provides the microbial profile of commonly used sutures and may assist in suture selection during clinical procedures.

Myiasis in Travelers.

BACKGROUND: Cutaneous myiasis is a well-established diagnosis in returning travelers from tropical countries. The most common form of myiasis seen in this population is localized furuncular myiasis caused by Dermatobia hominis and Cordylobia anthropophaga. There are limited data on the disease course and outcome in travelers to tropical countries. METHODS: A retrospective observational study of patients who presented with myiasis was conducted between 1999 and July 2014 in the post-travel clinics in Israel. Data regarding exposure history, travel duration, clinical presentation, treatment, and parasitological identification were collected and analyzed. RESULTS: Among 6,867 ill returning Israeli travelers, 1,419 (21%) had a dermatologic complaint, 90 (6.3%) of them were diagnosed with myiasis. Myiasis was acquired in Latin America by 72 (80%) patients, mainly (54%) in the Madidi National Park, Amazonas Basin, Bolivia; 18 cases (20%) were acquired in Africa. In 76% of cases, manual extraction was sufficient to remove the larva; 24% required surgical intervention. Despite the fact that most patients did not receive antibiotic treatment, only one developed secondary infection, upon partial removal of the larva. CONCLUSIONS: This is the largest myiasis case series in ill returning travelers. Myiasis is not a rare dermatologic complaint with most Israeli cases imported from Latin America and specifically the Madidi National Park in Bolivia. Treatment is based on full extraction of the larva after which no antibiotic treatment is needed. Myiasis is a preventable disease and travelers should be informed of the different preventive measures according to their travel destination.

High rate of schistosomiasis in travelers after a brief exposure to the high-altitude Nyinambuga crater lake, Uganda.

Travel-related schistosomiasis is usually associated with prolonged freshwater exposure. Until recently, Uganda's crater lakes were considered schistosomiasis free due to their high-altitude location. We describe an outbreak of acute schistosomiasis after a brief exposure (mean, 22 ± 9.5 minutes) to a high-altitude crater lake.

Acute hepatitis in israeli travelers.

BACKGROUND: Acute hepatitis is a well-described cause of morbidity and sporadic mortality in travelers. Data regarding the epidemiology of hepatitis in travelers are lacking. The aim of this study is to describe the epidemiology of acute viral hepatitis among travelers returning from tropical countries, with particular attention to enterically transmitted hepatitis. METHODS: This study is a prospective observational study of ill-returned travelers who presented at two travel medicine clinics in Israel between the years 1997 and 2012. Data of patients with acute hepatitis were summarized. Only travelers were included, immigrants and foreign workers were excluded. RESULTS: Among 4,970 Israeli travelers who were seen during this period, 49 (1%) were diagnosed with acute hepatitis. Among them, hepatitis E virus (HEV) was the etiology in 19 (39%) cases and hepatitis A virus (HAV) was the etiology in 13 (27%) cases, demonstrating that 65% of all cases were due to enterically transmitted hepatitis. Acquiring acute hepatitis B (two cases) or acute hepatitis C (one case) was uncommon (6.1%). In 27% of the cases, no diagnosis was determined. Fifty-five percent of cases were imported from the Indian subcontinent, with a predominance of HEV infection (84%). A significant male predominance was seen in all groups regardless of etiology. Pre-travel consultation was documented in only 7% of those with vaccine preventable hepatitis (hepatitis A & B) compared to 89% in those with hepatitis E. CONCLUSIONS: Enterically transmitted hepatitis is the main causes of viral hepatitis among travelers. HEV is an emerging disease and has become the most common hepatitis among Israeli travelers. Although an efficacious vaccine has been developed, no licensed HEV vaccine is yet available. Although hepatitis A vaccine is highly efficacious, safe, and easily available, there is a stable number of HAV cases.

A rough surface implant neck with microthreads reduces the amount of marginal bone loss: a prospective clinical study.

OBJECTIVES: An intra-individual controlled clinical trial was conducted to evaluate and compare the amount of marginal bone loss (MBL) found around implants of a comparable design, with or without retention grooves (microthreads) or polished necks, during the early stages of healing. MATERIALS AND METHODS: Forty-eight (48) patients with missing mandibular posterior teeth were treated with two commercially available implants of the same brand (MIS): one with microthreads (S-model) and the other with a polished neck (L-model). MBL around each implant was measured on follow-up radiograms taken 4 months after placement (exposure and crown cementation), and 6 and 12 months after loading. RESULTS: Forty-six (46) patients completed the study, making 46 implant pairs available for statistical analysis. None of the implants failed to integrate. All the implants displayed some extent of bone loss throughout the follow-up period. At each time point (exposure, 6 and 12 months after loading), the S-model implants displayed statistically significant lower amounts of bone loss (0.22 vs. 0.76, 0.57 vs. 1.22 and 0.9 vs. 1.5 mm, respectively). Other than the type of the implant, no correlation was found between MBL and the implant stability values (PerioTest), dimensions, site of insertion or any of the other collected variables. CONCLUSIONS: Implants with a roughened neck surface and microthreads are more resistant to MBL during the first phases of healing, as compared with implants with a polished neck.

Removable prostheses may enhance marginal bone loss around dental implants: a long-term retrospective analysis.

BACKGROUND: The aim of the study was to retrospectively evaluate marginal bone loss (MBL) around rough-surface dental implants, placed in a private clinic, and to construct a multivariate model based on formerly proposed prognostic variables. METHODS: Records of patients who were treated previously with dental implants were reviewed. The patients' latest annual clinical examinations and radiograms were used for data collection and the calculation of MBL. A patient-based multivariate model was constructed based on two successive iterations of statistical analysis. RESULTS: Eighty-two patients and 265 implants with > or =30 months of follow-up were evaluated. The overall survival rate was 95.8% (2.6% early loss and 1.5% late loss). By evaluating the data with the single implant as a unit of analysis, MBL was correlated with time. Higher MBL values were found in smokers and around implants supporting removable prostheses. In the patient-based analysis, only smoking and the presence of a removable prosthesis correlated with higher values of MBL. Odds ratios for higher rates of MBL were 1.95 and 2.57 for smokers and around removable prostheses, respectively. Neither time nor any of the other suspected variables correlated with higher MBL. CONCLUSIONS: The present study corroborated the notion that smoking correlates with higher MBL and implied that implants supporting removable prostheses tend to display more bone loss. Further studies are needed to elucidate the latter finding.

Teeth realignment for enhanced posterior single implant restorations.

As the use of dental implants became a widespread and acceptable treatment modality, with an overall good long-term prognosis, treatment concepts changed reciprocally. Nowadays, dental implants are considered routine and are preferred over other modalities such as removable or fixed partial dentures or etched cast restorations supported by neighboring teeth. However, we often find clinical situations that challenge the placement of an implant because of insufficient space. Congenitally missing tooth, loss of a tooth because of periodontal disease, long-lasting extracted sites, or lost tooth structures caused by caries or trauma may give rise to teeth drifting and loss of coronal space that may hamper implant placement. Minimal or minor orthodontic procedures may be used to regain adequate space for implant placement. The 3 clinical cases presented in this article discuss the various considerations and the use of teeth as mediators in small scale orthodontic treatment performed to achieve enhanced results for single implant restorations to replace missing teeth.

Orthodontic extrusion of an extensively broken down anterior tooth: a clinical report.

A predictable esthetic restoration is not limited to the restored teeth; it has to include the gingival unit and its interface with the teeth involved. Failure to deliver restorations that maintain gingival health jeopardizes the success of any restorative procedure and creates potential for periodontal problems. Perforations, fractures, root resorption, or caries in the cervical area of the tooth, especially in the anterior part of the mouth, present many challenges to the clinician. Failure to place the crown margins on sound tooth material may violate the biologic width and should be considered a restorative failure. Orthodontic root extrusion or forced eruption is a well-documented clinical method for altering the relation between a nonrestorable tooth and its attachment apparatus, elevating sound tooth material from within the alveolar socket. It has some advantages over surgical crown lengthening, which is less conservative considering the sacrifice of supporting bone and the negative change in the length of the clinical crowns of both the tooth and its neighbors. This article presents a case of a maxillary right lateral incisor, extensively broken down following trauma, treated with orthodontic extrusion combined with gingival fiberotomy, without a need for a corrective surgical procedure.