Conventional versus flap-protected free gingival graft: a multicenter randomized clinical trial.

The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity.

Conventional versus flap-protected free gingival graft: a multicenter randomized clinical trial

Abstract The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity.

Simultaneous Assessment of Soft and Hard Tissue Behaviors After Alveolar Ridge Preservation Using Bone Substitutes.

This study aimed to simultaneously assess hard and soft tissues alterations and their proportions after alveolar ridge preservation (ARP). Participants (n = 65) who were previously enrolled in a clinical trial investigating ARP healing were selected. The CBCT DICOM (Digital Imaging and Communications in Medicine) and the cast STL (stereolithographic) files of each subject were imported, segmented, and superimposed. A cross-section view of the superimposed image presented the outlines from each DICOM and STL file. The center of preserved ridge was selected in the superimposed image and used to draw the reference lines to realize the measurements. Horizontal linear measurements determined ridge width (RW) and its respective hard/soft tissue proportion (H:S) at 1, 3, 5, and 7 mm below the buccal bone crest immediately after ARP and at the 4-month follow-up. At 1 mm, the baseline RW was 11.6 mm and reduced to 10 mm after 4 months. The baseline H:S was 65%:35% and was 43%:57% at the 4-month follow-up. Considering only the buccal half of the ridge, baseline H:S was 77%:23%, while after 4 months it shifted to 58%:42%. A similar pattern was observed at 3, 5, and 7 mm but with decreased resorption degree. The present study showed that hard tissue is mostly responsible for RW loss after healing, especially in the first 3 mm below the buccal bone crest. Soft tissue partially compensated for the hard tissue shrinkage, gaining thickness in the analyzed areas.

Peri-implant tissue changes at sites treated with alveolar ridge preservation in the aesthetic zone: Twenty-two months follow-up of a randomized clinical trial.

AIM: To compare tissue changes at implant sites previously treated with two biomaterials for alveolar ridge preservation (ARP) in the aesthetic zone, 1 year after restoration. MATERIALS AND METHODS: Sixty-six participants were treated with ARP using demineralized bovine bone mineral (DBBM) or DBBM +10% of collagen (DBBM-C), both covered with a collagen matrix (CM). Dental implants were placed, and definitive crowns were installed. Silicon impressions were taken before tooth extraction (T0), 2 weeks after crown insertion (T1) and 1 year after restoration (T2). Mid-facial mucosal level change (MLC), soft tissue thickness changes (TT), and marginal bone loss (MBL) were analysed using inter-group comparisons. RESULTS: Fifty-four participants were included in the analysis. The mid-facial level change between T0-T1 and T1-T2 showed no statistical difference between DBBM and DBBM-C. Between T0 and T1 for soft tissue thickness, DBBM performed significantly better at 3 and 5 mm below the mucosal margin. From T1 to T2, no significant differences between groups were found at any level for soft tissue thickness and MBL. CONCLUSION: At the aesthetic zone, advanced recession from tooth extraction to crown placement can be expected at sites treated with ARP regardless of biomaterial used. However, after crown insertion, tissue stability can be predicted.

Selective outcome reporting in root coverage randomized clinical trials.

BACKGROUND: Outcome discrepancies between protocols and respective publications represent a concerning bias. The purpose of this study was to assess the prevalence of selective outcome reporting (SOR) in root coverage randomized clinical trials (RCTs). METHODS: Published root coverage RCTs (July 2005 to March 2020) were included if a corresponding protocol could be identified in a public registry. Discrepancies between protocol and its correspondent publication(s) were compared regarding primary and secondary outcomes and other study characteristics. Associations between trial characteristics and SOR were evaluated. RESULTS: Forty four studies (54 publications) were included. The majority of studies (77.3%) were retrospectively registered. SOR was frequent (40.9% of trials) and consisted of primary outcome downgrade (22.7%); secondary outcome upgrade (11.4%); new primary outcome introduced in publication (25%); protocol primary outcome omitted from publication (13.6%) and discrepancy in primary outcome timing (18.2%). SOR was unclear in 20.5% of studies and favoured statistical significance in 12 studies (27.3%). SOR was significantly associated with study significance (p < 0.001) and unclear outcome definition in the publication (p < 0.001). Only a third (32.8%) of primary outcomes were completely defined. CONCLUSIONS: The present study identified high prevalence of SOR in root coverage RCTs.

Comparative analysis of dimensional alterations following extraction of maxillary molars using three-dimensional images' superimposition: a CBCT study.

The aims of this study were to (i) evaluate the bone alterations following maxillary molar extraction and (ii) identify the factors associated with bone alterations using a tomographic analysis. Cone Beam Computer Tomographies (CBCTs) of 17 subjects with 25 maxillary molars were analyzed, before and, in average, 12 months following extraction. Fifty CBCTs were segmented as 3D models that were used as reference for analysis. Cross-sectional planes were established to measure the dimensional changes in the vertical, horizontal aspects, and the area of the alveolar bone. Associations between root divergence, initial bone location related to the maxillary sinus, and the thickness of buccal and palatal bone at baseline was assessed using mixed-effect models. Overall, the average reduction in vertical bone height was 35.23% (2.61 ± 1.76 mm). The mean reduction of area of alveolar process and horizontal bone width were 18.89% (56.08 ± 44.23 mm2) and 65.10% (8.33 ± 4.51 mm), respectively. There was a marginal significant association between horizontal bone changes and the thickness of palatal bone (p = 0.05). The results of the present study indicated that following maxillary molar extraction, significant dimensional changes occur in both the vertical and horizontal directions. The vertical changes were mainly attributed to remodeling on the coronal aspect of the alveolar ridge and sinus pneumatization was rare.

Treatment of multiple recessions with collagen matrix versus connective tissue: a randomized clinical trial.

The objective of this study was to determine whether collagen matrix (CM) is an alternative to connective tissue graft technique (CTG) in the treatment of multiple gingival recessions (GR). The indication of CM for the treatment of multiple GR is not yet clear. More studies are needed to better understand this treatment modality, as an alternative to CTG. In this single-blind, split-mouth randomized clinical trial, fifteen patients with multiple Miller class I upper GR were selected and randomly assigned to control group (CTG) or test group (CM). Root coverage (RC) and patient-centered outcomes were evaluated at baseline and after 3, 6, and 12 months. A total of 82 GRs were treated. There was no significant difference regarding GR depth (GRD, primary outcome) between CTG (0.5 ± 0.9 mm) and CM groups (0.6 ± 1.0 mm) (p = 0.225). Percentage of RC was 82.14% in CTG and 77.7% in CM. Both groups demonstrated a gain in keratinized tissue width at 12 months (p < 0.05). Dentine hypersensitivity was effectively reduced in both groups. Postoperative pain was significantly higher in the CTG (p = 0.001). Esthetic satisfaction was high for both groups, with no significant difference (p > 0.05) between groups. After 12 months, both surgical treatments were able to promote RC, and GRD was similar in both CTG and CM groups.

Effect of magnification on root coverage surgery: a systematic review

Root coverage surgery can be performed in patients with gingival recession to cover the exposed root aiming to control hypersensitivity and promotes better aesthetic. Optical magnification has been proposed as a refinement in this surgical technique to increase root coverage. This approach may lead to enhanced soft tissue stability, less post-operative discomfort, better predictability and esthetic appearance. Aim: This systematic review aimed to evaluate the effectiveness of magnification on root coverage surgery when compared to procedures performed without magnification. Methods: Randomized controlled trials with a follow-up of at least 6 months that compared surgeries for root coverage performed under optic magnification versus conventional (macro) root coverage surgery were screened. The primary outcome was mean root coverage (mm) (MRC) and secondary outcomes were percentage of root coverage (PRC) and complete root coverage (CRC). Results: Of 569 papers relevant to this review, seven were included. Meta-analysis showed that the use of magnification may favor greater PRC (7.38%, 95% CI 3.66-11.09). Conclusion: Magnification can increase PRC in root coverage surgeries. More randomized trials with the use of magnification may be necessary to verify if this benefit is clinically relevant, in order to justify the use of this device

Clinical treatment of necrotizing ulcerative gingivitis: a case report with 10-year follow-up.

The aim of this case report is to describe the diagnosis and treatment of a patient with necrotizing ulcerative gingivitis. An 18-year-old man with no systemic problems reported with chief complaints of gingival bleeding during toothbrushing and spontaneous pain. Clinical examination revealed significant plaque accumulation on the surfaces of all teeth as well as papillary necrosis involving mainly the anterior teeth. Treatment included an initial phase of supragingival plaque and calculus removal along with at-home use of 0.12% chlorhexidine gluconate mouthrinse twice a day for 30 days. After the initial phase, subgingival scaling was performed, and regular oral hygiene methods were resumed by the patient. After active therapy was completed, a periodontal maintenance regimen was established, and the patient was recalled for periodontal maintenance therapy. Follow-up occurred weekly throughout treatment, monthly for the first 6 months posttreatment, and 2-3 times a year during the periodontal maintenance therapy. Clinical results after 10 years showed that this approach controlled the acute phase and maintained the patient's periodontal health over time.

Effect of Different Doses of Synthetic Parathyroid Hormone (1-34) on Bone around Implants: a Preclinical Rat Model.

The aim of this study was to evaluate the effect of a lower dose of parathyroid hormone- PTH (1-34) on osteogenic potential of bone healing around titanium implants inserted into the tibia of rats. A blind parallel study was conducted in 45 adult male Wistar rats. Each rat received one titanium implant (4.5 x 2.2 mm) and was randomly assigned to receive subcutaneous injections, three times/week for 30 days, of the following treatments: group 1 - 40 µg/kg of PTH (1-34) (n=15); group 2 - 2 µg/kg of PTH (1-34) (n=15) and; group 3 - only the vehicle required for hormone dissolution (n=15). Thirty days after surgery, the animals were sacrificed and specimens containing the implant and the surrounding bone were removed and processed for non-decalcified sections. The sections were evaluated according to the following histometric parameters: proportion of mineralized tissue (PMT) adjacent to the implant threads (500 µm band); bone filling within the limits of the threads (BF) and; bone-to-implant contact (BIC). For the cortical region, both hormone dosages (groups 1 and 2) promoted better results, for all parameters, when compared to control group (p<0.05). Similar results were observed for the BF parameter in the cancellous region (p=0.0394). Therefore, systemic administration of PTH (1-34) stimulates bone formation around titanium implants, even at low doses.

Comparison between two bone substitutes for alveolar ridge preservation after tooth extraction: Cone-beam computed tomography results of a non-inferiority randomized controlled trial.

AIM: To test the non-inferiority of demineralized bovine bone mineral (DBBM) compared to DBBM with 10% collagen (DBBM-C) for maintenance of bone volume after tooth extraction in the anterior maxilla. MATERIALS AND METHODS: Sixty-six patients were randomly treated with DBBM or DBBM-C, both of which were covered with a collagen matrix for ridge preservation in the anterior maxilla. Cone-beam computed tomographic analysis was performed immediately and 4 months after treatment. The primary outcome, for which non-inferiority of DBBM was tested, was change in the horizontal ridge width 1 mm below the buccal alveolar crest (HW-1) 4 months after extraction. RESULTS: Four months after extraction, HW-1 measured -1.60 mm ± 0.82 mm for DBBM-C, while the DBBM group showed a mean loss of -1.37 mm ± 0.84 mm (p = 0.28, 0.23 [95% CI: -0.19; 0.64]). The horizontal ridge width at 3 mm (HW-3) showed -0.98 mm (±0.67 mm) for DBBM-C and -0.84 mm (±0.62 mm) for DBBM (p = 0.40, 0.12 [95% CI: -0.19; 0.45]), and the horizontal ridge width at 5 mm (HW-5) showed -0.67 mm (±0.47 mm) for DBBM-C and -0.56 mm (±0.48 mm) for DBBM (p = 0.36, 0.11 [95% CI: -0.13; 0.34]). CONCLUSIONS: The present clinical trial demonstrated non-inferiority of DBBM compared to DBBM-C for maintenance of alveolar bone volume 4 months after tooth extraction in the anterior maxilla.

Treatment of multiple recessions with collagen matrix versus connective tissue: a randomized clinical trial

Abstract The objective of this study was to determine whether collagen matrix (CM) is an alternative to connective tissue graft technique (CTG) in the treatment of multiple gingival recessions (GR). The indication of CM for the treatment of multiple GR is not yet clear. More studies are needed to better understand this treatment modality, as an alternative to CTG. In this single-blind, split-mouth randomized clinical trial, fifteen patients with multiple Miller class I upper GR were selected and randomly assigned to control group (CTG) or test group (CM). Root coverage (RC) and patient-centered outcomes were evaluated at baseline and after 3, 6, and 12 months. A total of 82 GRs were treated. There was no significant difference regarding GR depth (GRD, primary outcome) between CTG (0.5 ± 0.9 mm) and CM groups (0.6 ± 1.0 mm) (p = 0.225). Percentage of RC was 82.14% in CTG and 77.7% in CM. Both groups demonstrated a gain in keratinized tissue width at 12 months (p < 0.05). Dentine hypersensitivity was effectively reduced in both groups. Postoperative pain was significantly higher in the CTG (p = 0.001). Esthetic satisfaction was high for both groups, with no significant difference (p > 0.05) between groups. After 12 months, both surgical treatments were able to promote RC, and GRD was similar in both CTG and CM groups.

Maxillary sinus floor pneumatization and alveolar ridge resorption after tooth loss: a cross-sectional study.

This is a cross-sectional study that aimed to estimate maxillary sinus floor (MSF) pneumatization in single missing tooth of posterior maxilla, by using cone-beam computed tomography (CBCT). CBCT images were analyzed bilaterally and divided into 2 groups: edentulous site (EdS) - edentulous single region of upper second premolar, first or second molars; Tooth site (TS) - contralateral region homologous to the EdS region, with tooth present. Variables evaluated were: sinus height (SH), estimated sinus pneumatization (eSP: ∆ EdS - TS), healed ridge height (HR) and presence of localized sinus pneumatization (LSP) in molars teeth at TS. HR were categorized according to therapeutic option for posterior maxilla. 183 CBCT scans were included and it was observed that EdS presented a higher SH than the TS (p < 0.001) showing an eSP of 0.9 ± 2.93 mm. First molars presented the highest SH for both sides, although significant differences were detected when compared to second molars. First molars were mostly affected by LSP at TS (36 out of 43). Individuals with LSP at TS presented lower HR than the ones without LSP (p < 0.05). 54% of the cases presenting LSP obtained HR < 5 mm, which indicates sinus lift surgery. The present study showed that tooth loss in posterior maxilla favors sinus pneumatization and the identification of LSP at molar roots seems to indicate a greater necessity for sinus lift surgeries.

Narrow- and regular-diameter implants in the posterior region of the jaws to support single crowns: A 3-year split-mouth randomized clinical trial.

OBJECTIVES: The objective of this 3-year split-mouth randomized controlled clinical study was to compare narrow-diameter implants (NDIs) to regular-diameter implants (RDIs) in the posterior region of the jaws (premolars and molars) in regards to (i) the marginal bone level (MBL) and (ii) implant and prosthesis survival and success rates. MATERIAL AND METHODS: A total of 22 patients were included in the study. Each patient received at least one implant of each diameter (Ø3.3 and Ø4.1 mm), placed either in the maxilla or mandible to support single crowns. A total 44 implants (22 NDIs and 22 RDIs) were placed and included in the study. Twenty-one implants were placed in the premolar, whereas 23 were placed in molar areas. Radiographic evaluations to access the MBL were performed immediately after implant placement, 1 and 3 years after implant loading. Peri-implant clinical variables including probing pocket depth (PPD) and bleeding on probing (BoP) were obtained after crown delivery, 1 and 3 years after loading. Furthermore, the survival and success rates of the implants and prosthesis were also evaluated. RESULTS: Twenty patients were able to complete the study. There was no statistically significant difference regarding MBL between groups at implant placement (p = .084), 1-year (p = .794) and 3-year (p = .598) time intervals. The mean peri-implant bone loss at 3-year follow-up was -0.58 ± 0.39 mm (95% CI: -0.751 to -0.409) and -0.53 ± 0.46 mm (95% CI: -0.731 to -0.329) for NDIs and RDIs, respectively. BoP was present at 15% and 10% of NDIs and RDIs, respectively, at 3-year follow-up. PPD >5 mm was observed in 5% and 0% of the implants of NDIs and RDIs, respectively, at 3-year follow-up. At the 3-year examination, the implant success rates were in the NDIs and RDIs sites, respectively, 95% and 100%. The corresponding values for prosthesis success rates were 90% for NDIs and 95% for RDIs. CONCLUSION: The present study demonstrated that NDIs placed to support single crowns in the posterior region did not differ to RDIs in regards to MBL, implant survival, and success rates.

Maxillary sinus floor pneumatization and alveolar ridge resorption after tooth loss: a cross-sectional study

Abstract This is a cross-sectional study that aimed to estimate maxillary sinus floor (MSF) pneumatization in single missing tooth of posterior maxilla, by using cone-beam computed tomography (CBCT). CBCT images were analyzed bilaterally and divided into 2 groups: edentulous site (EdS) - edentulous single region of upper second premolar, first or second molars; Tooth site (TS) - contralateral region homologous to the EdS region, with tooth present. Variables evaluated were: sinus height (SH), estimated sinus pneumatization (eSP: ∆ EdS - TS), healed ridge height (HR) and presence of localized sinus pneumatization (LSP) in molars teeth at TS. HR were categorized according to therapeutic option for posterior maxilla. 183 CBCT scans were included and it was observed that EdS presented a higher SH than the TS (p < 0.001) showing an eSP of 0.9 ± 2.93 mm. First molars presented the highest SH for both sides, although significant differences were detected when compared to second molars. First molars were mostly affected by LSP at TS (36 out of 43). Individuals with LSP at TS presented lower HR than the ones without LSP (p < 0.05). 54% of the cases presenting LSP obtained HR < 5 mm, which indicates sinus lift surgery. The present study showed that tooth loss in posterior maxilla favors sinus pneumatization and the identification of LSP at molar roots seems to indicate a greater necessity for sinus lift surgeries.

Influence of Piezosurgery on Bone Healing around Titanium Implants: A Histological Study in Rats

Abstract The aim of this study was to evaluate histomorphometrically the influence of two techniques of dental implant site preparation on bone healing around titanium implants. Fifteen male Wistar rats (±300 g) were used in the study. Each tibia was randomly assigned to receive the implant site preparation either with a conventional drilling technique (control - DRILL group) or with a piezoelectric device (PIEZO group). The animals were sacrificed after 30 days and then the following histomorphometric parameters were evaluated (percentage) separately for cortical and cancellous regions: proportion of mineralized tissue (PMT) adjacent to implant threads (500 μm adjacent); bone area within the threads (BA) and bone-implant contact (BIC). The results demonstrated that there were no statistically significant differences between both groups for cancellous BIC (p>0.05) and cortical PMT (p>0.05). On the other hand, a higher percentage of BA was observed in the PIEZO group in the cortical (71.50±6.91 and 78.28±4.38 for DRILL and PIEZO groups, respectively; p<0.05) and cancellous regions (9.62±4.06 and 19.94±14.18 for DRILL and PIEZO groups, respectively; p<0.05). The piezosurgery also showed higher PMT values in the cancellous zone (9.35±5.54 and 18.72±13.21 for DRILL and PIEZO groups, respectively; p<0.05). However, the DRILL group presented better results for BIC in cortical region (80.42±10.88 and 70.25±16.93 for DRILL and PIEZO groups, respectively; p<0.05). In conclusion, for the implant site preparation, the piezosurgery was beneficial to bone healing rates in the cancellous bone region, while the drill technique produced better results in the cortical bone.

Resumo O objetivo deste estudo foi avaliar histomorfometricamente a influência de duas técnicas de preparo para implante dentário sobre a reparação óssea ao redor de implantes de titânio. Foram utilizados 15 ratos machos Wistar, com aproximadamente 300 g. Uma tíbia dos animais foi aleatoriamente selecionada para o preparo do leito para instalação de um implante de titânio com um motor rotatório convencional (Grupo ROTATÓRIO) e a outra com ultrassom cirúrgico piezoelétrico (Grupo PIEZO). Após 30 dias, os animais foram sacrificados e foram avaliados os seguintes parâmetros histomorfométricos (em porcentagem), separadamente, para a região cortical e medular: a proporção de tecido mineralizado (PTM) na região adjacente ao implante (500 μm adjacentes); área de tecido mineralizado (AO) dentro dos limites das roscas do implante e a extensão de tecido ósseo em contato direto (CD) com a superfície do implante. Os resultados deste estudo mostraram que não foram observadas diferenças para CD na região medular (p>0,05) e para PTM na região cortical (p>0,05). Por outro lado, um maior preenchimento das roscas foi observado quando utilizou-se ultrassom cirúrgico piezoelétrico tanto na região cortical (71,50±6,91 e 78,28±4,38 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05) quanto na região medular (9,62±4,06 e 19,94±14,18 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05). Resultados semelhantes foram observados para o parâmetro PTM na região medular (9,35±5,54 e 18,72±13,21 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05). No entanto, o grupo ROTATÓRIO foi superior ao grupo PIEZO em relação a CD na região cortical (80,42±10,88 e 70,25±16,93 para os grupos ROTATÓRIO e PIEZO, respectivamente; p<0,05). Pode-se concluir que, para o preparo do leito para implantes, a piezocirurgia favoreceu o reparo ósseo na região medular, enquanto a técnica convencional promoveu melhores resultados no osso cortical.

Multidisciplinary Treatment for Peri-Implantitis: A 24-Month Follow-Up Case Report.

INTRODUCTION: Although osseointegrated implants are a highly predictable and effective alternative in the rehabilitation of partially or totally edentulous patients, the prevalence of implant biologic complications has been rising. This report describes a case of peri-implantitis involving multiple maxillary implants that was successfully treated by combining the removal of two implants, surgical debridement associated with implantoplasty of the remaining implants, and prosthetic design changes. CASE PRESENTATION: A 50-year-old female patient with a fixed full-arch implant-supported maxillary prosthesis presented with chief complaints of halitosis and difficulty in maintaining proper oral hygiene. Based on clinical and radiographic findings, a diagnosis of peri-implantitis was established. Two implants were removed because of advanced peri-implant bone loss and inadequate prosthetic positioning. The remaining implants were treated with access surgery, removal of granulation tissue, and implantoplasty of the exposed implant threads. Three months after surgery, an O-ring-retained bar overdenture was delivered. At 6, 12, and 24 months after treatment completion, peri-implant probing depths (PDs) were reduced significantly. None of the implants exhibited residual PDs >4 mm, bleeding on probing, or suppuration. Moreover, peri-implant bone levels remained stable over time. CONCLUSION: Surgical therapy combined with implantoplasty of the exposed threads and prosthetic design changes can be used successfully for treating peri-implantitis.

Synthetic Parathyroid Hormone May Augment Bone Volume in Autogenous Grafts: A Study in Rats.

BACKGROUND: Synthetic parathyroid hormone [PTH(1-34)] has been investigated for its benefits on bone healing and osteoporosis treatment; however, there is little information regarding bone grafts. This study therefore investigates the effect of PTH(1-34) on autogenous bone graft healing. METHODS: Bone grafts were harvested from the calvarium of rats with a trephine bur (3-mm internal diameter) and placed on the cortex near the mandible angle with a titanium screw. Animals were randomly assigned to group 1 (control): subcutaneous injections of saline solution, three times a week (n = 15); group 2: 2 µg/kg PTH(1-34), three times a week (n = 15); and group 3: 40 µg/kg PTH(1-34), three times a week (n = 15). Thirty days postoperatively, the animals were killed, and specimens (implant + bed + graft) were removed and used for undecalcified sections. The following histometric parameters were evaluated: total bone thickness (TT) (bed + gap + graft), graft thickness (GT) (adjacent to the implant), bone-to-implant contact (BIC), and bone area (BA) (within the limits of the threads). Five additional animals were sacrificed immediately after surgery (zero hour) to register bed and graft sizes before healing. RESULTS: Group 3 showed significantly greater bone gain compared with groups 1 and 2 (TT and GT, P <0.05). In relation to initial thickness (zero hour), groups 1 and 2 showed a total decrease in volume of 15.91% and 20.83%, respectively, whereas group 3 showed a slight bone gain (1.21%). Data analysis revealed a significant difference for group 3 compared with groups 1 and 2 (P <0.01). No differences were observed for BIC and BA (P >0.05). CONCLUSION: Systemic administration of PTH(1-34) augmented bone volume in autogenous grafts.

Avaliação das condições periodontais e de higiene bucal em escolares com transtornos neuropsicomotores / Evaluation of periodontal conditions and oral hygiene in school children with neuropsychomotor disorders

Introdução: A doença cárie e as alterações periodontais são problemas frequentemente encontrados em pacientes com deficiência. Objetivo: Avaliar as condições periodontais e de higiene bucal em escolares com deficiência neuropsicomotora matriculados em um centro de reabilitação. Método: A pesquisa envolveu entrevista com os responsáveis e exame clínico do escolar, para registro do índice de placa e do índice de sangramento. Após o exame, foi realizada profilaxia profissional, orientação de higiene bucal e esclarecimento de dúvidas. Os dados foram observados por meio de estatística descritiva. Resultado: A amostra foi constituída por 41 escolares com deficiência neuropsicomotora, com idades entre sete e 14 anos, sendo 20 do sexo feminino (48,8%) e 21 do sexo masculino (51,2%), e com idade média de 10,8 anos. A maioria dos pacientes tinha a figura da mãe como principal cuidador (85%). Observou-se que 71% dos escolares necessitavam de ajuda para realizar a higiene bucal e quase 40% dos cuidadores apresentavam dificuldade para realizá-la, principalmente pelo fato de o paciente "não abrir a boca". Quase a totalidade dos escolares não usava fio dental. Constatou-se, ainda, que 87,2% apresentaram sangramento gengival à sondagem e que, em 84,7%, verificou-se índice de placa maior ou igual a "2". Conclusão: Concluiu-se que os escolares com deficiência neuropsicomotora incluídos neste estudo apresentaram condições periodontais e de higiene bucal insatisfatórias, demonstrando a necessidade de serem instituídas ações preventivas focadas na orientação aos pacientes e cuidadores, para a efetividade da higiene bucal. .

Introduction: Caries and periodontal disease are problems frequently affecting patients with disabilities. Objective: In this study we aim to evaluate the periodontal conditions and the oral hygiene in students with neuropsychomotor disorders enrolled in a rehabilitation center. Method: Data collect was based in interview with the responsible and the scholar's clinical exam to register the plaque index and the bleeding index. After the clinical exam were performed professional prophylaxis, oral hygiene orientation and explanation of doubts. Result: The sample consisted of 41 students with neuropsychomotor disabilities, with ages among 7 and 14 years, 20 females (48.8%) and 21 males (51.2%) with a mean age of 10.8 years. Most patients had the figure of the mother as primary caregiver (85%). It was observed that 71% of students need help in performing oral hygiene and nearly 40% of caregivers had difficulty doing it, in most of the cases because the patient "did not open his mouth". Almost the totality of the students doesn't use dental floss. It was also found that 87.2% had gingival bleeding and 84.7% had the plaque index greater or equal to 2. Conclusion: It was concluded that disabled students included in this study had bad periodontal conditions and poor oral hygiene. It shows the need of preventive programs to guide themselves and the caregivers, seeking for effectiveness of oral hygiene. .

Soft Tissues Changes After Immediate and Delayed Single Implant Placement in Esthetic Area: A Systematic Review.

The aim of the present study was to conduct a systematic review of the literature to compare soft tissue aspects of immediate and delayed implant placement in esthetic areas. This review of literature was conducted in the following databases: MEDLINE (PubMed), Lilacs, Scielo, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). For those studies that met the inclusion/exclusion criteria, the results were analyzed and summarized according to the treatment protocol used for implant placement. The primary parameters taken into consideration were papilla level (PL) and marginal mucosa level (MML) around implants. Four randomized controlled trials (RCT) were selected for analysis, but all were deemed as being of poor quality according to quality assessment. No studies reported any statistically significant differences concerning the soft tissue esthetic parameters analyzed around immediate or delayed implants at any follow-up periods reported. However, PL results seemed to be more reliable than were MML results, due to the PL standardization of the method of analysis, which showed a tendency for poorer results around immediately placed implants. In conclusion, although the results are based on only a few poor quality RCTs, both treatment options for implant placement demonstrated similar outcomes in the esthetic area, especially when PL was considered.