[A novel periodontal endoscopy-aided non-incisional periodontal regeneration technique：a case series study].

PURPOSE: To investigate the effect of endoscopy-aided non-incisional periodontal regeneration technique (NIT) in the treatment of alveolar bone angular resorption. METHODS: Thirteen patients with severe periodontitis(13 diseased teeth) were selected. All patients had alveolar bone angular resorption on adjacent surface. The patients received NIT treatment 6 weeks after periodontal primary therapy. The visualization of subgingival environment was acquired by the periodontal endoscopy. Following the removal of the subgingival plaque, calculus and intra-bony granulation tissue, bone grafting materials were placed into the intra-bony defects with the assistance of a delicate gingival protector. No flap was elevated and no sutures were applied. Probing depth (PD), gingival recession (GR), clinical attachment level (CAL), as well as radiographic parameters were evaluated at baseline and 2 years after treatment. SPSS 22.0 software package was used for data analysis. RESULTS: At 2-years follow-up, an average CAL gain of (3.65±2.10) mm (P＜0.001), PD reduction of (4.42±1.66) mm (P＜0.001), and minimal increase in GR of (0.38±0.87) mm (P=0.25) were observed. Alveolar bone was significantly improved at 2-years follow-up on radiographs (P＜0.001). CONCLUSIONS: For angular resorption site of alveolar bone, NIT treatment can obtain good periodontal regeneration results without flap inversion.

Immediately placed implants using simvastatin and autogenous tooth graft combination in periodontally compromised sites: a randomized controlled clinical trial.

OBJECTIVES: The present study aimed to assess clinically and radiographically the usage of autogenous tooth bone graft (ATBG) combined with and without Simvastatin (SMV) around immediately placed dental implants in periodontally compromised sites. METHODS: Thirty-nine patients required a single extraction of periodontally compromised tooth were divided into three groups (13 patients each). Group I received immediate implant placement (IIP) without grafting. Group II received IIP with ATBG filling the gap around IIP. Group III received SMV gel mixed with ATBG around IIP. Radiographic changes were reported at the baseline, 6-, and 12-months post-surgery. RESULTS: All implants achieved the success criteria with no complications. At 6- and 12-months post-surgery, group III showed a statistically lower mean ridge width loss compared to Group I and Group II (P < .001). Group II revealed less reduction in the mean alveolar ridge width compared to group I (P < .001). Group III showed a statistically significantly less MBL loss than group I and group II (P < .001). All groups showed a statistically significant increase in BD gain compared to baseline (P < .001). Group III showed statistically significant high BD compared to group II (P < .001). Group II showed statistically significantly higher mean BD gain than that of group I (P < .001). CONCLUSION: SMV combined with ATBG boosts the hard tissue parameters around dental implants over ATBG alone. Clinical trial registration was on August 1, 2021 (NCT04992416). CLINICAL RELEVANCE: ATBG with SMV in periodontally compromised sites could improve implant osseointegration and promote favorable changes in peri-implant tissues.

A cascading learning method with SegFormer for radiographic measurement of periodontal bone loss.

OBJECTIVE: Marginal alveolar bone loss is one of the key features of periodontitis and can be observed via panoramic radiographs. This study aimed to establish a cascading learning method with deep learning (DL) for precise radiographic bone loss (RBL) measurements at specific tooth positions. MATERIALS AND METHODS: Through the design of two tasks for tooth position recognition and tooth semantic segmentation using the SegFormer model, specific tooth's crown, intrabony portion, and suprabony portion of the roots were obtained. The RBL was subsequently measured by length through these three areas using the principal component analysis (PCA) principal axis. RESULTS: The average intersection over union (IoU) for the tooth position recognition task was 0.8906, with an F1-score of 0.9338. The average IoU for the tooth semantic segmentation task was 0.8465, with an F1-score of 0.9138. When the two tasks were combined, the average IoU was 0.7889, with an F1-score of 0.8674. The correlation coefficient between the RBL prediction results based on the PCA principal axis and the clinicians' measurements exceeded 0.85. Compared to those of the other two methods, the average precision of the predicted RBL was 0.7722, the average sensitivity was 0.7416, and the average F1-score was 0.7444. CONCLUSIONS: The method for predicting RBL using DL and PCA produced promising results, offering rapid and reliable auxiliary information for future periodontal disease diagnosis. CLINICAL RELEVANCE: Precise RBL measurements are important for periodontal diagnosis. The proposed RBL-SF can measure RBL at specific tooth positions and assign the bone loss stage. The ability of the RBL-SF to measure RBL at specific tooth positions can guide clinicians to a certain extent in the accurate diagnosis of periodontitis.

Customized three-dimensional printed ceramic bone grafts for osseous defects: a prospective randomized study.

Ridge resorption can result in insufficient bone volume for implant surgery, necessitating bone substitutes to restore the resorption area. Recent advances in computer-aided design and manufacturing enable the use of alloplastic bone graft materials with customizable compositions or shapes. This randomized study evaluated the clinical effectiveness of a customized three-dimensional (3D) printed alloplastic bone material. Sixty patients requiring guided bone regeneration for implant installation following tooth extraction due to alveolar bone resorption were recruited at two institutions. The participants were randomly allocated to either a group that received 3D-printed patient-customized bone graft material or a group that received conventional block bone graft material. Implant installation with bone harvesting was performed approximately 5 months after bone grafting. Histological and radiological assessments of the harvested bone area were performed. The experimental group had a significantly higher percent bone volume and a smaller tissue surface than the control group. Bone volume, bone surface, bone surface/volume ratio, bone surface density (bone surface/total volume), and bone mineral density did not differ significantly between groups. Patient-customized bone graft materials offer convenience and reduce patient discomfort. The findings suggest 3D-printed patient-customized bone graft materials could be used as an alternative for simpler bone grafting procedures.

Comparison of Peri-Implant Health Parameters among Obese and Non-Obese South Indian Population.

Implant therapy is gaining immense importance in people presenting with missing teeth due to its increased life expectancy. There is a high concern regarding the link between obesity and peri-implant diseases. The aim of this study was to assess the peri-implant health parameters among the obese and non-obese South Indian population. The cross-sectional study was conducted in Department of Implantology, Saveetha Dental College and Hospitals Chennai, India among 859 patients who reported between January 2022-November 2022 and had a minimum of single implant in function for at least 1 year after crown cementation. Among 859 patients, 428 were non-obese (Group A) and 431 were obese (Group B). Patient's data including the menopausal status was recorded. Clinical parameters including peri-implant probing depth (PPD), clinical attachment level (CAL) and radiographic parameter including alveolar bone level (ABL) was recorded and compared between both the groups using independent t-test. The mean PPD among non-obese and obese population were 2.58 ± 0.03 and 4.09 ± 0.04, respectively. The mean CAL among non-obese and obese population were 2.87 ± 0.02 and 4.19 ± 0.01, respectively. The mean ABL among non-obese and obese population were 2.06 ± 0.01 and 3.17 ± 0.03, respectively. Independent t-test revealed there was statistically significant difference in PPD (P = 0.04), CAL (P = 0.05) and ABL (P = 0.04). The present study suggests that the obese individuals demonstrated high peri-implant probing depth, clinical attachment loss and alveolar bone loss as compared to non-obese individuals.

Comparison of Alveolar Bone Level around Osseointegrated Dental Implants among Premenopausal and Postmenopausal Women: A 2-Year Study.

The success of dental implants is affected by bone quality and quantity at the dental implant site. The present study was done to assess the changes in alveolar bone level around osseointegrated dental implants over a period of 2 years among the premenopausal and postmenopausal women. This prospective clinical study was conducted among 50 female patients who reported between January 2020-June 2020 and had a single missing molar in maxillary or mandibular arch. Patients were categorized into 2 groups: premenopause patients (Group A; n = 25) and postmenopause patients (Group B; n = 25). Marginal bone loss (MBL) was recorded at baseline, 12 mo and 24 mo follow-up and compared between both the groups using independent t-test. ANOVA was done to compare MBL between different time periods. On intragroup comparison, a statistically significant difference was observed between different time periods in both Group A (P = 0.05) and Group B (P = 0.04). Also, on intergroup comparison, a statistically significant difference was observed in Group B from Group A at 12 mo and 24 mo (P < 0.05). Increase in marginal bone loss was observed among postmenopausal women. Therefore, clinicians should emphasize the need for oral hygiene maintenance among postmenopausal women for peri-implant health.

Comparative evaluation of treatment of angular bone defect related to over-erupted tooth using guided tissue regeneration (GTR) followed by orthodontic intrusion (OI) versus OI followed by GTR: a controlled clinical trial.

BACKGROUND: Prematurity resulted from pathological migration of periodontally involved teeth with the loss of vertical stopping points between teeth, which can lead to teeth over eruption with dimensional changes favoring occlusal discrepancies. Therefore, evaluating and comparing the effect of guided tissue regeneration followed by orthodontic intrusion as opposed to orthodontic intrusion tracked by guided tissue regeneration in the treatment of an over-erupted tooth with angular bone loss. METHODS: Twenty teeth in ten cases were selected with at least two teeth with vertical over-eruption and angular bone loss with the presence of their opposing. In group one, ten teeth over-erupted were treated by guided tissue regeneration followed by orthodontic intrusion, whereas, in group two, ten teeth over-erupted were treated by orthodontic intrusion followed by guided tissue regeneration. They were evaluated clinically for pocket depth, bleeding on probing, and tooth mobility. Radiographical evaluation assessed by cone beam computed tomography. RESULTS: Clinically, there existed a statistically significant difference (P value ≤ 0.05) in favor of group one at six months post and in favor of group two at one year from re-evaluation regarding pocket depth and tooth mobility. Radiographically, in group one, there was a statistically significant improvement (P value ≤ 0.05) at six months post-guided tissue regeneration or orthodontic intrusion regarding defect depth and dimensional changes of the defect area, with a statistically significant difference (P value ≤ 0.05) in favor of group two at one year from re-evaluation phase regarding defect depth and defect area dimensional changes. CONCLUSION: There was a short-term improvement in group one, which deteriorated over a long period compared with group two, so it is preferable to start orthodontic intrusion before guided tissue regeneration.

Periodontitis was associated with mesial concavity of the maxillary first premolar: a cross-sectional study.

The association between the anatomical features of teeth and the pathogenesis of periodontitis is well-documented. This study aimed to evaluate the influence of the mesial concavity of the maxillary first premolar on periodontal clinical indices and alveolar bone resorption rates. Employing a cross-sectional design, in 226 patients with periodontitis, we used cone beam computed tomography(CBCT) to examine the mesial concavity and alveolar bone resorption of 343 maxillary first premolar. Periodontal clinical indicators recorded by periodontal probing in the mesial of the maxillary first premolar in patients with periodontitis. Our findings indicate that the presence of mesial concavity at the cemento-enamel junction of the maxillary first premolar was not significantly influenced by either tooth position or patient sex (p > 0.05). Nonetheless, the mesial concavity at the cemento-enamel junction of the maxillary first premolar was found to exacerbate alveolar bone resorption and the inflammatory condition (p < 0.05). We infer that the mesial concavity at the cemento-enamel junction of the maxillary first premolar may contribute to localized alveolar bone loss and accelerate the progression of periodontal disease.

How do the dimensions of peri-implant mucosa affect marginal bone loss in equicrestal and subcrestal position of implants? A 1-year clinical trial.

INTRODUCTION: There is evidence that the apico-coronal implant position and the mucosal phenotype can affect the extent of peri-implant bone loss. This clinical trial analyzes the bone remodeling and marginal bone loss that occur around conical-connection implants placed equicrestally and subcrestally, assessing the effect of the peri-implant soft-tissue phenotype. METHODS: Fifty-one patients received 56 implants of distinct diameters (3.5 mm Ø n = 6; 4.3 mm Ø n = 41; 5 mm Ø n = 9) in the posterior part of the maxilla or mandible. The implants were placed equicrestally, 1 mm subcrestally and >1 mm subcrestally, depending on the initial supracrestal tissue height (STH). After 3 months of non-submerged healing, single metal-ceramic screw-retained implant-supported crowns were placed. Longitudinal measurements of STH, mucosal thickness and keratinized mucosa width (KMW) were made at the time of implant placement (T0), crown placement (T1), and after 3 (T2) and 6 months (T3) of prosthetic loading. At each of these points, a radiographic evaluation of bone remodeling and marginal bone loss was also performed. RESULTS: STH was significantly greater for implants placed >1 mm subcrestally than for those placed 1 mm subcrestally. After 12 months of follow-up, a very significant (p < 0.001) loss of KMW was observed, in addition to a marginal bone loss of 0.08 ± 0.1, 0.15 ± 0.2, and 0.14 ± 0.2 mm in the groups placed equicrestally, 1 mm subcrestally and >1 mm subcrestally, respectively. After the multiple linear regression, marginal bone loss was found to depend primarily on KMW (ß = -0.43), while also being affected by STH (ß = 0.32) and implant diameter (ß = -0.28). CONCLUSIONS: Marginal bone loss may be influenced by the position with respect to the bone crest, as well as the KMW, STH, and implant diameter. However, more well-controlled studies are needed to verify these above-mentioned findings with different implant designs and connections.

"Determining the efficacy of a machine learning model for measuring periodontal bone loss".

BACKGROUND: Considering the prevalence of Periodontitis, new tools to help improve its diagnostic workflow could be beneficial. Machine Learning (ML) models have already been used in dentistry to automate radiographic analysis. AIMS: To determine the efficacy of an ML model for automatically measuring Periodontal Bone Loss (PBL) in panoramic radiographs by comparing it to dentists. METHODS: A dataset of 2010 images with and without PBL was segmented using Label Studio. The dataset was split into n = 1970 images for building a training dataset and n = 40 images for building a testing dataset. We propose a model composed of three components. Firstly, statistical inference techniques find probability functions that best describe the segmented dataset. Secondly, Convolutional Neural Networks extract visual information from the training dataset. Thirdly, an algorithm calculates PBL as a percentage and classifies it in stages. Afterwards, a standardized test compared the model to two radiologists, two periodontists and one general dentist. The test was built using the testing dataset, 40 questions long, done in controlled conditions, with radiologists considered as ground truth. Presence or absence, percentage, and stage of PBL were asked, and time to answer the test was measured in seconds. Diagnostic indices, performance metrics and performance averages were calculated for each participant. RESULTS: The model had an acceptable performance for diagnosing light to moderate PBL (weighted sensitivity 0.23, weighted F1-score 0.29) and was able to achieve real-time diagnosis. However, it proved incapable of diagnosing severe PBL (sensitivity, precision, and F1-score = 0). CONCLUSIONS: We propose a Machine Learning model that automates the diagnosis of Periodontal Bone Loss in panoramic radiographs with acceptable performance.

Detection of periodontal bone loss patterns and furcation defects from panoramic radiographs using deep learning algorithm: a retrospective study.

BACKGROUND: This retrospective study aimed to develop a deep learning algorithm for the interpretation of panoramic radiographs and to examine the performance of this algorithm in the detection of periodontal bone losses and bone loss patterns. METHODS: A total of 1121 panoramic radiographs were used in this study. Bone losses in the maxilla and mandibula (total alveolar bone loss) (n = 2251), interdental bone losses (n = 25303), and furcation defects (n = 2815) were labeled using the segmentation method. In addition, interdental bone losses were divided into horizontal (n = 21839) and vertical (n = 3464) bone losses according to the defect patterns. A Convolutional Neural Network (CNN)-based artificial intelligence (AI) system was developed using U-Net architecture. The performance of the deep learning algorithm was statistically evaluated by the confusion matrix and ROC curve analysis. RESULTS: The system showed the highest diagnostic performance in the detection of total alveolar bone losses (AUC = 0.951) and the lowest in the detection of vertical bone losses (AUC = 0.733). The sensitivity, precision, F1 score, accuracy, and AUC values were found as 1, 0.995, 0.997, 0.994, 0.951 for total alveolar bone loss; found as 0.947, 0.939, 0.943, 0.892, 0.910 for horizontal bone losses; found as 0.558, 0.846, 0.673, 0.506, 0.733 for vertical bone losses and found as 0.892, 0.933, 0.912, 0.837, 0.868 for furcation defects (respectively). CONCLUSIONS: AI systems offer promising results in determining periodontal bone loss patterns and furcation defects from dental radiographs. This suggests that CNN algorithms can also be used to provide more detailed information such as automatic determination of periodontal disease severity and treatment planning in various dental radiographs.

Comparison of deep learning methods for the radiographic detection of patients with different periodontitis stages.

OBJECTIVES: The objective of this study is to assess the accuracy of computer-assisted periodontal classification bone loss staging using deep learning (DL) methods on panoramic radiographs and to compare the performance of various models and layers. METHODS: Panoramic radiographs were diagnosed and classified into 3 groups, namely "healthy," "Stage1/2," and "Stage3/4," and stored in separate folders. The feature extraction stage involved transferring and retraining the feature extraction layers and weights from 3 models, namely ResNet50, DenseNet121, and InceptionV3, which were proposed for classifying the ImageNet dataset, to 3 DL models designed for classifying periodontal bone loss. The features obtained from global average pooling (GAP), global max pooling (GMP), or flatten layers (FL) of convolutional neural network (CNN) models were used as input to the 8 different machine learning (ML) models. In addition, the features obtained from the GAP, GMP, or FL of the DL models were reduced using the minimum redundancy maximum relevance (mRMR) method and then classified again with 8 ML models. RESULTS: A total of 2533 panoramic radiographs, including 721 in the healthy group, 842 in the Stage1/2 group, and 970 in the Stage3/4 group, were included in the dataset. The average performance values of DenseNet121 + GAP-based and DenseNet121 + GAP + mRMR-based ML techniques on 10 subdatasets and ML models developed using 2 feature selection techniques outperformed CNN models. CONCLUSIONS: The new DenseNet121 + GAP + mRMR-based support vector machine model developed in this study achieved higher performance in periodontal bone loss classification compared to other models in the literature by detecting effective features from raw images without the need for manual selection.

Evaluation of Peri-Implant Parameters and Functional Outcome of Immediately Placed and Loaded Mandibular Overdentures: A 5-year Follow-up Study.

PURPOSE: To evaluate the peri-implant parameters of immediately placed and loaded mandibular overdentures over a 5-year follow-up period. MATERIALS AND METHODS: All subjects who had been advised and planned for two-implant mandibular overdenture treatment were included in this study. The peri-implant parameters -including plaque index (PI), bleeding index (BI) and peri-implant pocket depth (PIPD) as well as marginal bone loss (MBL) - were assessed. In addition, prosthodontic parameters including abutment-, implant- and denture-related complications were assessed. Patients were evaluated at follow-up visits, scheduled at 1, 12, 24, 36, 48, and 60 months. The data distribution was analysed with the Shapiro-Wilk test. Data within follow-up categories were compared using ANOVA and the Tukey-Kramer test. A p-value < 0.05 was considered statistically significant. RESULTS: Among the 32 participants, 19 were males and 13 were females, with a mean age of 60.5 ± 7.33. The mean plaque index (PI), bleeding index (BI) and peri-implant pocket depth (PIPD) varied over time. However, no statistically significant difference was observed in the plaque index, bleeding index and peri-implant pocket depth over time (p > 0.05). The mean value at baseline was found to be -0.9 ± 0.3. The values increased over time, with the highest value observed at 60 months 2.6 ± 0.7, which was statistically significant (p < 0.001). CONCLUSION: Immediately placed and loaded mandibular implant overdentures using two un-splinted implants with locator attachments showed acceptable PI, BI and PIPD at the 5-year follow-up. Statistically significantly greater marginal bone loss was observed from baseline to follow-up, but it was within acceptable limits. A moderate number of restorative and abutment complications were observed during the follow-up of IODs.

Preclinical evaluation of a new synthetic carbonate apatite bone substitute on periodontal regeneration in intrabony defects.

OBJECTIVE: To evaluate the potential of a novel synthetic carbonate apatite bone substitute (CO3 Ap-BS) on periodontal regeneration. BACKGROUND: The use of various synthetic bone substitutes as a monotherapy for periodontal regeneration mainly results in a reparative healing pattern. Since xenografts or allografts are not always accepted by patients for various reasons, a synthetic alternative would be desirable. METHODS: Acute-type 3-wall intrabony defects were surgically created in 4 female beagle dogs. Defects were randomly allocated and filled with CO3 Ap-BS (test) and deproteinized bovine bone mineral (DBBM) or left empty (control). After 8 weeks, the retrieved specimens were scanned by micro-CT, and the percentages of new bone, bone substitute, and soft tissues were evaluated. Thereafter, the tissues were histologically and histometrically analyzed. RESULTS: Healing was uneventful in all animals, and defects were present without any signs of adverse events. Formation of periodontal ligament and cementum occurred to varying extent in all groups without statistically significant differences between the groups. Residues of both bone substitutes were still present and showed integration into new bone. Histometry and micro-CT revealed that the total mineralized area or volume was higher with the use of CO3 Ap-BS compared to control (66.06 ± 9.34%, 36.11 ± 6.40%; p = .014, or 69.74 ± 2.95%, 42.68 ± 8.68%; p = .014). The percentage of bone substitute surface covered by new bone was higher for CO3 Ap-BS (47.22 ± 3.96%) than for DBBM (16.69 ± 5.66, p = .114). CONCLUSIONS: CO3 Ap-BS and DBBM demonstrated similar effects on periodontal regeneration. However, away from the root surface, more new bone, total mineralized area/volume, and higher osteoconductivity were observed for the CO3 Ap-BS group compared to the DBBM group. These findings point to the potential of CO3 Ap-BS for periodontal and bone regeneration.

Immediate implant placement for chronic peri-apical periodontitis in the molar region: a randomised controlled trial.

The aim of this study was to evaluate the feasibility of immediate implantation for chronic peri-apical periodontitis in the molar region. Seventy-four molars were selected and allocated randomly to two groups. The experimental group (n = 38) received immediate implantation by flap surgery and the control group (n = 36) received delayed implantation. CBCT was performed immediately after surgery (T1) and 12 months after the permanent repair (T3). The implant survival rate at T3 was 100% in both groups. There was no significant difference in buccal or lingual vertical marginal bone loss between the groups (P = 0.515, P = 0.736). However, the buccal horizontal margin bone loss was significantly greater in the experimental group: 0.98 ± 0.34 mm vs 0.77 ± 0.27 mm in the control group (P = 0.003). In the experimental group, the highest point of buccal and lingual implant-bone contact increased at T3. The buccal and lingual jump gap widths were 3.21 ± 1.10 mm and 2.92 ± 1.01 mm at T1, and CBCT showed no jump gap around the implants at T3. The clinical outcomes showed immediate implantation to be feasible for chronic peri-apical periodontitis in the molar region.

Clinical and radiographic outcomes of implants placed in extraction sites treated with alveolar ridge preservation: a 10-year retrospective analysis of a case series.

OBJECTIVES: The aim of the present study was to evaluate clinical and radiographic outcomes of implants placed in alveolar sockets treated by means of alveolar ridge preservation after 10 years of follow-up. METHOD AND MATERIALS: Eleven patients treated with 11 implants placed after alveolar ridge preservation using bovine-derived xenograft particles and collagen membrane were selected. Full-mouth plaque score, full-mouth bleeding score, probing depth at four sites per implant, and radiographic marginal bone level at mesial and distal aspects for each implant were recorded at baseline and after 10 years of follow-up. The primary outcome was the radiographic marginal bone loss. The marginal bone loss was considered as the difference between marginal bone level at baseline and after 10 years of observation time. RESULTS: After 10 years of follow-up, full-mouth plaque score increased significantly (P < .05), while no statistically significant differences were found in the change in full-mouth bleeding score (P ≥ .05). At the 10-year observation period, a significant increase in probing depth was observed at all sites (P < .05), except at the mesial aspects (P ≥ .05). Radiographic marginal bone loss was 1.1 ± 0.1 mm and 1.0 ± 0.1 mm at mesial and distal sites, respectively. CONCLUSION: Whitin the limitations of the present study, implants placed in post-extraction sockets treated with alveolar ridge preservation yielded stable clinical and radiographic results after 10 years of follow-up.

Long-term outcomes and prognostic factors of surgical treatment of peri-implantitis - A retrospective study.

AIM: To evaluate long-term outcomes and prognostic factors of non-reconstructive surgical treatment of peri-implantitis. MATERIALS AND METHODS: One hundred forty-nine patients (267 implants) were surgically treated for peri-implantitis and followed for an average of 7.0 (SD: 3.6) years. The primary outcome was implant loss. Additional bone loss and surgical retreatment were secondary outcomes. Patient/implant characteristics, as well as clinical and radiographic parameters collected prior to initial surgery, were evaluated as potential predictors of implant loss. Flexible parametric survival models using restricted cubic spline functions were used; 5- and 10-year predicted rates of implant loss were calculated according to different scenarios. RESULTS: Fifty-three implants (19.9%) in 35 patients (23.5%) were lost during the observation period. Implant loss occurred after a mean period of 4.4 (SD: 3.0) years and was predicted by implant surface characteristics (modified surface; HR 4.5), implant length (HR 0.8 by mm), suppuration at baseline (HR 2.7) and disease severity (baseline bone loss: HR 1.2 by mm). Estimates of 5- and 10-year implant loss ranged from 1% (best prognostic scenario; initial bone loss <40% of implant length, turned implant surface and absence of suppuration on probing (SoP)) to 63% (worst prognostic scenario; initial bone loss ≥60% of implant length, modified implant surface and SoP) and from 3% to 89%, respectively. Surgical retreatment was performed at 65 implants (24.3%) in 36 patients (24.2%) after a mean time period of 4.5 (3.1) years. In all, 59.5% of implants showed additional bone loss, were surgically retreated or lost. CONCLUSIONS: Recurrence of disease is common following surgical treatment of peri-implantitis. The strongest predictor for implant loss was implant surface characteristics. Implant length as well as suppuration and disease severity at baseline were also relevant factors.

The impact of maxillary non-impacted third molars on the distal alveolar bone of adjacent teeth using CBCT: a retrospective study.

OBJECTIVE: The purpose of the study was to determine how the maxillary non-impacted third molars impact the distal region of alveolar bone of adjacent second molars. METHOD AND MATERIALS: The periodontal condition of maxillary second molars for which the neighboring third molars were missing (NM3- group) and those with intact non-impacted third molars (NM3+ group) was analyzed in a retrospective study. Using CBCT, the patients were categorized based on the presence or absence of periodontitis, and the alveolar bone resorption parameters in the distal area of the second molars were measured. RESULTS: A total of 135 patients with 200 maxillary second molars were enrolled in this retrospective study. Compared to the NM3- group, the second molars of the NM3+ group exhibited greater odds of increasing alveolar bone resorption in the distal region (health, OR = 3.60; periodontitis, OR = 7.68), regardless of the presence or absence of periodontitis. In healthy patients, factors such as female sex (OR = 1.48) and age above 25 years old (OR = 2.22) were linked to an elevated risk of alveolar bone resorption in the distal region of the second molars. In patients with periodontitis, male sex (OR = 3.63) and age above 45 years old (OR = 3.97) served as risk factors. CONCLUSIONS: Advanced age, sex, and the presence of non-impacted third molars are risk factors associated with alveolar bone resorption in individuals with adjacent second molars. In addition, the detrimental effects of non-impacted third molars in the population with periodontitis may be exacerbated. From a periodontal perspective, this serves as supportive evidence for the proactive removal of non-impacted third molars.

Alveolar ridge changes 1-year after early implant placement, with or without alveolar ridge preservation at single-implant sites in the aesthetic region: A secondary analysis of radiographic and profilometric outcomes from a randomized controlled trial.

OBJECTIVES: To assess both the radiographic and profilometric outcomes of early implant placement with or without alveolar ridge preservation (ARP) (using two different ARP techniques) after 1 year of loading. MATERIALS AND METHODS: Seventy-five patients with a failing single tooth in the anterior maxilla were randomly allocated to three groups (1:1:1): (a) ARP using demineralized bovine bone mineral containing 10% collagen (DBBM-C) covered by a collagen matrix (CM), (b) ARP using DBBM-C covered with a palatal graft (PG), and (c) unassisted socket healing (control). Eight weeks after tooth extraction, early implant placement was performed in all patients. Cone-beam computed tomography (CBCT) and impressions were taken 8 weeks after tooth extraction (ARP/unassisted healing) prior to implant placement and 1-year post-loading. Radiographic and profilometric outcomes were evaluated. RESULTS: Out of the 70 patients available for re-examination at 1-year post-loading, 55 datasets could be assessed (ARP-CM 19; ARP-PG 17; Control 19). The need for additional guided bone regeneration (GBR) at implant placement amounted to 31.6% (ARP-CM), 29.4% (ARP-PG), and 68.4% (unassisted healing). Adjusted models revealed that residual buccal bone height and additional GBR at implant placement significantly influenced the magnitude of the alveolar changes at 1 year (p < 0.05). In patients with ARP (group ARP-CM or ARP-PG) without additional GBR, the presence of bone convexity amounted to 36.0% (9/25) at 1-year post-loading. For patients that received ARP and additional GBR at implant placement, the frequency of bone convexity increased to 72.7% (8/11) (p = 0.042). Regarding profilometric measurements, a tendency toward agreement with radiographic outcomes was observed. CONCLUSIONS: Early implant placement with ARP can attenuate alveolar ridge changes at 1-year post loading by minimizing both radiographic and profilometric alterations. However, early implant placement with simultaneous GBR consistently yields superior radiographic and profilometric outcomes, regardless of whether ARP is performed.

A novel periodontal endoscopy-aided non-incisional periodontal regeneration technique in the treatment of intrabony defects: a retrospective cohort study.

BACKGROUND: Gingival recession and post-operation discomfort are still a problem for patients receiving the periodontal regeneration surgery for intra-bony defects. To further reduce the trauma and the post-operation gingival recession, a novel periodontal endoscopy-aided non-incisional regeneration technique (NIT) was proposed in the treatment of intra-bony defects. METHODS: Retrospective analysis of 21 subjects treated with NIT and 21 subjects with periodontal endoscopy-aided scaling and root planing (PSRP) at baseline and 1-year evaluation was conducted. After removing the subgingival calculus and granulation tissue, bone grafting materials were placed into intrabony defects with the assistance of a gingival retractor in the NIT group. Probing depth (PD), gingival recession (GR), clinical attachment level (CAL), as well as the distance between bone crest (BC) level and base of the defect (BD) (intrabony defect depth, IBD) were evaluated at baseline and 1 year after treatment. RESULTS: At 1-year follow-up, the value of CAL, PD and IBD were statistically significant different compared with baseline in both two groups (p<0.001). CAL gain (p = 0.012) and PD reduction (p = 0.004) was greater in the NIT than PSRP. However, no difference in the IBD reduction was found between the NIT group and PSRP. Better CAL gain and PD reduction was achieved in the 1-year term in the NIT when compared with PSRP. CONCLUSION: NIT have resulted in significant gains in both clinical and radiographic parameters. NIT might be utilized as an alternative of the surgical treatment for periodontal intrabony defects. TRIAL REGISTRATION: This clinical trial registration was registered retrospectively (August 3, 2023) and the number is ChiCTR2300074317.