Vertical bone augmentation using different osteoconductive scaffolds combined with barrier domes in the rat calvarium.

PURPOSE: To compare the regenerative potential for vertical bone augmentation of various osteoconductive scaffolds when used in conjunction with barrier domes. MATERIALS AND METHODS: Following exposure and perforation of the calvarium, a gold occlusive dome was filled with the tested scaffold and anchored by fixation screws. Flaps were repositioned and secured. The four treatment groups, three to five rats each, were as follows: Bio-Oss collagen (BOC), ß-tricalcium phosphate (TCP), collagen sponge (COL), and empty domes (C). Rats were sacrificed 8 weeks later, and specimens were prepared for histological and histomorphometric analysis. Vertical bone height and total tissue height were measured. RESULTS: The newly regenerated bone appeared mature, highly vascularized, and with no signs of inflammation. Vertical bone height in the TCP group (mean 2.04 ± 0.2 mm) was greater than all other groups (0.76 ± 0.02, 1.52 ± 0.18, and 1.77 ± 0.61 mm for the BOC, C, and COL, respectively) but significantly only for the BOC group (p = .0145). Total tissue height was significantly higher (p < .0001) in both BOC and TCP groups (4.48 ± 0.23 and 5.5 ± 0.24 mm, respectively) compared with COL (3.22 ± 0.11 mm) and C (2.39 ± 0.3 mm) groups. CONCLUSION: TCP in conjunction with barrier dome resulted in greater vertical bone augmentation in the calvarium of rats.

Reimplantation of dental implants following ligature-induced peri-implantitis: a pilot study in dogs.

OBJECTIVES: This preliminary investigation aimed to evaluate the potential of contaminated implants to reosseointegrate into pristine sites and, in addition, to assess the potential of osseointegration of new implants in peri-implantitis sockets in a canine model. METHODS: All mandibular premolars were bilaterally extracted from two mongrel dogs. Following 12 weeks of healing, two dental implants were inserted on each hemiarch. Forty-five days following implant placement, a silk ligature secured with cyanoacrylate was placed around the implants' cervical region in order to induce peri-implantitis. After another 45 days from ligature placement, the implants were mechanically removed using counter rotation with a ratchet and were reimplanted without any decontamination (neither rinsing nor chemical or mechanical cleaning) in adjacent pristine zones. In sites where implants were removed, new, wider-diameter implants were placed in the infected sockets. Forty-five days following reimplantation surgery, the dogs were sacrificed; nondecalcified specimens were processed and toluidine blue stained for morphologic and morphometric (bone-to-implant contact [BIC]) assessment under an optical microscope. RESULTS: In dog 1 all the implants (both in the pristine and in the infected sites) survived and osseointegrated while in dog 2, six out of eight implants failed to osseointegrate and exfoliated. Overall, the mean BIC of all implants was 51.08% (SD 20.54). The mean BIC for the infected implants placed into pristine sites was 51.48% ± 26.29% (SD) and the mean BIC for the new implants in peri-implantitis socket was 50.58% ± 14.27% (SD). CONCLUSIONS: Within the limitations of this preliminary investigation, especially the small number of animals, osseointegration seems to be achievable both in infected sites and around contaminated implant surfaces.

Guidelines for periodontal care and follow-up during orthodontic treatment in adolescents and young adults.

Aggressive periodontitis is characterized by non-contributory medical history, rapid attachment loss and bone destruction and familial aggregation of cases. Aggressive periodontitis (both localized and generalized) is usually diagnosed in a young population. This is frequently the age that an orthodontic care is provided to this population. The aim of the present paper is to draw guidelines for periodontal evaluation and monitoring prior to and during active orthodontic treatment. Strict adherence to these guidelines as a routine protocol for periodontal examination prior, during and following orthodontic treatment may dramatically decrease the severity and improve the prognosis of patients with aggressive periodontitis in orthodontic clinics.

Guidelines for periodontal care and follow-up during orthodontic treatment in adolescents and young adults

Aggressive periodontitis is characterized by non-contributory medical history, rapid attachment loss and bone destruction and familial aggregation of cases. Aggressive periodontitis (both localized and generalized) is usually diagnosed in a young population. This is frequently the age that an orthodontic care is provided to this population. The aim of the present paper is to draw guidelines for periodontal evaluation and monitoring prior to and during active orthodontic treatment. Strict adherence to these guidelines as a routine protocol for periodontal examination prior, during and following orthodontic treatment may dramatically decrease the severity and improve the prognosis of patients with aggressive periodontitis in orthodontic clinics.

Novel implant design for initial stability of dental implants inserted in fresh extraction sockets: a preliminary study.

OBJECTIVES: To evaluate a novel implant design for immediate implantation. This implant presents a specially designed expanded diameter midcrestal "wing" thread, which is aimed to provide added bone contact for greater insertion torque and primary stability. METHODS: Mandibular premolars were extracted in 2 mongrel dogs, and immediate dental implants were inserted into the fresh extraction sockets. Implants were evaluated for stability using a resonance frequency analysis device immediately after insertion and after 4 and 8 weeks. Removal torque of 1 randomly selected implant in each hemimandible was measured as well. At 8 weeks, the remaining 6 implants were processed histologically. RESULTS: Mean implant stability quotient at implant placement was 64.38 (5.03) and 74.5 (3.08) at 8 weeks. Average removal torque immediately after implant placement was 49.65 (20.3) N.cm and 98.33 (12.34) N.cm at 8 weeks. The mean bone-to-implant contact value at 8 weeks was 38.89% (7.65%). CONCLUSIONS: The examined implant with the expanded diameter midcrestal "wing" thread showed good results of resonance frequency analysis and removal torque during the initial healing phase, and as such, it might be used for immediate implantation and loading.

Periodontal and space maintenance considerations for primary teeth presenting with aggressive periodontitis: a case report.

Aggressive periodontitis is diagnosed mainly by clinical and radiographic examination. Diagnosis in the primary dentition indicates a choice between conservative and radical treatment that involves extractions, depending on the severity of the case. The purpose of this report was to present a case of aggressive periodontitis in a systemically healthy child and to discuss the periodontal and orthodontic aspects. A 7-year-old girl presented with bleeding on probing of approximately half of the dentition, deep periodontal pockets around all primary molars, and increased tooth mobility. An individual oral hygiene program was initiated. The primary maxillary right molar and all primary mandibular molars were extracted, and clear vacuum-formed removable retainers were fabricated and used as space maintainers. The patient was followed longitudinally for 2 years, and no space loss was recorded. Clear vacuum-formed removable retainers mainly involve occlusal crown attachment and, therefore, decrease the risk of plaque accumulation, gingival irritation, and aggressive periodontitis in the permanent dentition.

Intraoperative bleeding during open flap debridement and regenerative periodontal surgery.

BACKGROUND: The objective of this study was to measure the intraoperative bleeding during periodontal flap surgery. METHODS: Patients scheduled for periodontal surgery were recruited for this study. Data regarding smoking habits, general health, and medications were collected. The amount of the local anesthetic that was injected was then recorded, as well as the number of teeth in the operative field and the duration of the procedure. During surgery, the liquids from the oral cavity were suctioned and collected into a sterile empty vial. To calculate the net amount of blood volume in the liquids, colorimetric assay using capillary blood fructosamine as a reference molecule was used. RESULTS: Twenty-six patients were included in this study. The amount of blood lost during the procedure ranged from 6.0 to 145.1 mL, with an overall mean of 59.47 ± 38.2 mL. Patients taking aspirin (acetylsalicylic acid) showed mean blood loss of 43.26 ± 31.5 mL, whereas the mean blood loss among patients that did not use this medication was higher (65.4 ± 39.4 mL) but not statistically significant. Local anesthetic amount, surgical field size, and the operation duration did not relate to blood-loss volume. The mean blood loss among current smokers was significantly higher (96.47 ± 44.2 mL) compared to former (12 ± 8.4 mL) or never (54.74 ± 30.5 mL, P = 0.011) smokers. CONCLUSION: The results of the current study support previous papers and confirm that blood loss during periodontal surgery is minimal.

Stem cell therapy for bone regeneration: present and future strategies.

Alveolar bone atrophy may occur due to trauma, malignancy and periodontal disease. Restoring the lost bone is crucial for the rehabilitation of the patient's functioning, phonetics and aesthetics. Currently the methods available for vertical bone augmentation prior to dental implant placement are rather limited. This paper describes present and future concepts of utilizing mesenchymal stem cells (MSC) as well as endothelial progenitor cells (EPC) for enhancing bone growth in severe atrophic cases. Stem/progenitor cell-based regenerative therapy may prove to be the best option to meet individual patient needs and open new horizons in periodontal, maxillofacial and implant surgery.

Full-mouth rehabilitation using dental implants in a patient with scleroderma.

Scleroderma is an autoimmune multisystem rheumatic condition that affects connective tissues. Oral manifestations of the disease are directly relevant to the dental and periodontal diagnosis, treatment plan, and management of patients diagnosed with scleroderma. In the presented case, progressive limitation of mouth opening together with severe caries and periodontal disease warranted a fixed implant-supported rehabilitation using dental implants. Three-year follow-up revealed good oral hygiene and clinical appearance with no radiologic evidence of bone loss around the implants. Implant-supported rehabilitation might be a viable treatment option in patients with scleroderma under chronic use of systemic steroids. Further studies with long-term follow-up are warranted.

Novel ultrasonic device to measure the distance from the bottom of the osteotome to various anatomic landmarks.

BACKGROUND: The aim of the present study is to intraoperatively measure the distance from the bottom of the osteotome to the inferior alveolar canal (IAC) and maxillary sinus floor using a novel ultrasonic device and to compare the measurements to those using conventional radiographs. METHODS: Patients scheduled for dental implant placement in the posterior regions were recruited for this pilot study. Mucoperiosteal flaps were elevated, and a recipient site was initiated using a standardized 2-mm-diameter pilot drill. The distance from the bottom of the osteotome to the IAC and maxillary sinus floor was assessed using a newly developed ultrasonic device and compared to a standard panoramic radiograph that was used to measure the same residual distance from the bottom of the drill. RESULTS: Fourteen consecutive patients (21 implants) were enrolled. Eleven implants were placed in posterior mandibles, and 10 implants were placed in posterior maxillae. The mean +/- SE radiographic distance from the apex of the pilot drill to the nearest cortical bone was 5.64 +/- 0.51 mm, which was very similar to the distance measured by the ultrasonic device (5.22 +/- 0.37 mm; P = 0.341). In posterior mandibles (n = 11), the distances were 5.18 +/-0.61 mm (radiographic) and 5.26 +/- 0.61 mm (ultrasonic), which were not statistically significant (P = 0.593). A very strong positive correlation was observed between the two measurements in mandibles (r = 0.967; P = 0.0001). CONCLUSION: The results of this in vivo study support the value of this ultrasonic system in measuring the residual osseous depth from the bottom of the osteotome to the roof of the IAC.

The "dome phenomenon" associated with maxillary sinus augmentation.

AIM: This case series is aimed to report a new phenomenon, the "dome phenomenon," which was observed in infected augmented sinuses over several years. METHODS: Five patients are presented in whom sinus lift augmentation resulted in postoperative infection with inflammation and suppuration. The patients received aggressive anti-inflammatory treatment and surgical debridement of the inflamed tissue, including some grafted material performed through the lateral window of the primary procedure. RESULTS: The inflammatory condition was reversed, and the site healed clinically. Radiographically, a dome-shaped, radio-opaque tissue was observed at the superior most aspect of the grafted sinus. This "dome phenomenon" was further confirmed during dental implant placement, which indicates healing potential adjacent to the maxillary sinus membrane. CONCLUSIONS: The current report, as well as other studies and case series, suggests that there is great potential for healing and bone formation in the maxillary sinus membrane. The precise mechanism is not known. Further clinical and histologic studies are needed to understand the regenerative potential of the Schneiderian membrane.

The dimensions of keratinized mucosa around implants affect clinical and immunological parameters.

OBJECTIVES: To investigate the association between keratinized mucosa (KM) width and mucosal thickness (MTh) with clinical and immunological parameters around dental implants. METHODS: Sixty-three functioning dental implants (3I osseotite) were examined. Clinical examinations included plaque index (PI), probing depth (PD), bleeding on probing (BOP), KM width, MTh and buccal mucosal recession (MR). Peri-implant crevicular fluid (PICF) samples were collected for PgE2 assay. RESULTS: KM width ranged from 0 to 7 mm (mean 2.5+/-2), MTh ranged from 0.38 to 2.46 mm (mean 1.11+/-0.4) and the mean MR was 0.62 mm, ranging from 0 to 3 mm. A negative correlation was found between MTh and MR (r=-0.32, P=0.01); Likewise, KM width showed a negative correlation with MR, periodontal attachment level (PAL) and PgE2 levels (r=-0.41, P<0.001; r=-0.26, P=0.04; r=-0.26, P=0.04, respectively). In contrast, a positive correlation was found between KM width and PD (r=0.27, P=0.03). When data were dichotomized by KM width, a wider mucosal band (>1 mm) was associated with less MR compared with narrow (or=1 mm) was associated with lesser recession compared with a thin (<1 mm) mucosa (0.45 and 0.9 mm, respectively, P=0.04). CONCLUSION: The KM around dental implants affects both the clinical and the immunological parameters at these sites. These findings are of special importance in the esthetic zone, where thin and narrow KM may lead to a greater MR.