Sonography in the diagnosis of peri-implant bone defects: An in vitro study on native human mandibles.

AIM: The aim of this study on native human cadavers was to compare clinical, sonographic, and radiological measurements of fenestrations, dehiscences, and 3-wall bone defects on implants. MATERIALS AND METHODS: The examination was carried out on five human mandibles. After the insertion of 27 implants, dehiscences (n = 14), fenestrations (n = 7) and 3-wall bone defects (n = 6) were prepared in a standardized manner. The direct measurement of the bone defects was carried out with a periodontal probe and the radiological examination was carried out using digital volume tomography (DVT). The ultrasound examination (US) was performed using a clinical 24-MHz US imaging probe. Means and standard deviations of the direct, US, and DVT measurements were calculated. Measurements were statistically compared using the Pearson correlation coefficient and Bland-Altman analysis. RESULTS: Bone defects were on average 3.22 ± 1.58 mm per direct measurement, 2.90 ± 1.47 mm using US, and 2.99 ± 1.52 mm per DVT assessment. Pairwise correlations of these measurements were R = .94 (p < .0001) between direct and US, R = .95 (p < .0001) between DVT and US, and R = .96 (p < .0001) between direct and DVT. The mean differences of the measurements (and 95% CI) between direct and US was 0.41 (-0.47 to 1.29), US and DVT 0.33 (-0.30 to 0.97), and direct and DVT 0.28 (-0.50 to 1.07). CONCLUSION: All peri-implant bone defects could be identified and sonographically measured. US measurements showed a strong correlation with direct and DVT measurements. The sonographic measurement accuracy was highest for dehiscences, followed by fenestrations and 3-wall bone defects.

Influence of gingival phenotype on crestal bone loss at implants : A long-term 2 to 20-year cohort study in periodontally compromised patient.

PURPOSE: The aim of this long-term cohort study in periodontally compromised patients with implants was to analyze the correlation between gingival phenotype and peri-implant crestal bone loss, and between clinical measures and gingival phenotype. METHODS: Implant-supported single crowns and bridges were used to rehabilitate 162 implants in 57 patients. Patients were examined over a 2 to 20-year period on a recall schedule of 3 to 6 months. In addition to recording clinical parameters, intraoral radiographs were taken at baseline (immediately after superstructure insertion) and at 1, 3, 5, 10, 15, and 20 years. Patients were differentiated into phenotype 1 with thin, scalloped gingiva and narrow attached gingiva (n = 19), phenotype 2 with thick, flat gingiva and wide attached gingiva (n = 23), or phenotyp 3 with thick, scalloped gingiva and narrow attached gingiva (n = 15). RESULTS: The mean peri-implant crestal bone loss during the first 12 months was 1.3 ± 0.7 mm. Patients with gingival phenotype 1 had a significantly greater rate of increased crestal bone loss at implants (p = 0.016). No significant differences were present in subsequent years. The prevalence of mucositis at all implants was 27.2%, and the prevalence of peri-implantitis 9.3%. Univariate analyses indicated a significantly higher peri-implantitis risk in patients with gingival phenotype 2 (p-OR = 0.001; p-OR = 0.020). The implants of patients with phenotype 2 had significantly greater probing depths (1st year p < 0.001; 3rd year p = 0.016; 10th year p = 0.027; 15th year p < 0.001). Patients with gingival phenotype 3 showed no significantly increased probing depths, signs of inflammation and crestal bone loss. CONCLUSIONS: Patients with a gingival phenotype 1 have greater crestal bone loss at implants during the first year of functional loading. Patients with gingival phenotype 2 had significantly greater probing depth at implants and risk of peri-implantitis.

The Influence of Crown-to-Implant Ratio on Crestal Bone Loss at Implants with Single Crowns and Bridges.

PURPOSE: To evaluate how the crown-to-implant (C/I) ratio affects the loss of crestal bone at single-crown implants and bridges in patients with periodontal disease. MATERIALS AND METHODS: Thirty-nine patients treated for periodontitis were rehabilitated with 108 implant-supported single crowns and bridges. Each patient was examined over a 5- to 20-year period on a 3 to 6-month recall schedule. At each session, we recorded periodontal clinical parameters. In addition, intraoral radiographs were taken after superstructure insertion (baseline) and then at 1, 3, 5, 10, 15, and 20 years. The study population was divided by anatomical C/I ratio (C/I ≤1, group 1 or C/I 1, group 2). RESULTS: Implants had a 96.2% 5-year survival rate, and 92.6% 20-year survival rate. The overall prevalence was 10.1% for mucositis and 1.1% for peri-implantitis. The survival rate (p = 0.68), mucositis (p = 0.325), or peri-implantitis (p = 0.077) did not significantly differ in the group comparison. The mean annual peri-implant bone loss was 0.09 0.41 mm and not significantly different between the groups. Mean bone loss was not significantly different until the 10th year of observation, during which group 2 presented significantly less bone loss. The correlation of annual bone loss and clinical C/I ratio showed a small but significant negative effect throughout the entire study period (R = -0.217; p <0.01). CONCLUSION: Increased crestal bone loss was not observed with implants with higher C/I ratios, both anatomical and clinical, and they even showed signs of less crestal bone loss.

Correlation between crestal bone loss and PPD at teeth and implants: a 5- to 20-year long-term cohort study in patients with treated periodontal disease.

OBJECTIVE: The correlation between crestal bone loss at teeth and probing pocket depth (PPD) has been established. Whether these findings can also be applied to implants is not known. The objective of this study was to determine the correlation between crestal bone loss and PPD at teeth and implants. METHOD AND MATERIALS: Thirty-one periodontitis-susceptible patients were rehabilitated with fixed implant-supported single crowns and fixed partial dentures. Each patient was examined over a 5- to 20-year period in a 3- to 6-month strict recall program. At each session, periodontal clinical parameters were recorded at teeth and implants. In addition, standardized periapical radiographs were taken after superstructure insertion (baseline) and then at 1, 3, 5, 10, 15, and 20 years. RESULTS: The survival rate of implants (94.0%) and teeth (97.3%) did not significantly differ in all patients after 20 years (P = .68). Almost all patients had a PPD ≥ 5 mm at implants and teeth throughout the observation period. The crestal bone loss at implants and teeth increased continuously, especially in patients with advanced periodontitis, without a correlation with PPD. A few patients (n = 5) had a PPD ≥ 5 mm and annual bone loss ≥ 0.2 mm at one implant, with a correlation between bone loss and PPD. CONCLUSION: In healthy implants and teeth, moderate crestal bone loss is present without correlation with PPD. A few patients showed progressive crestal bone loss at only one implant, with a correlation with PPD.

Implants in GBR-Augmented Sites in Patients Treated for Generalized Aggressive Periodontitis: A 10- to 20-Year Prospective Case Series.

The aim of this case series was to evaluate implants inserted in bone after guided bone regeneration (GBR). Fourteen patients with generalized aggressive periodontitis (GAP) who had lost one or two maxillary teeth in the incisor or premolar region were enrolled in the study. Due to bone resorption, the lateral width and vertical height of the bone were insufficient for implant placement. GBR was carried out in a staged approach using titanium-reinforced e-PTFE (expanded polytetrafluoroethylene) membranes. No bone grafts or bone substitute materials were used. After 6 to 8 months, turned-surface implants (n = 47) were inserted in augmented and nonaugmented bone sites and prosthetically treated with single crowns. All patients were examined during a 3- to 6-month recall schedule over a 10- to 20-year period, and clinical and radiographic examinations were performed. GBR yielded mean vertical and lateral bone gains of 4.5 and 7.0 mm, respectively. The implant survival rate was 100%, mucositis was present in 28.8% of sites, and peri-implantitis was not found. The annual bone loss at tooth sites was significantly higher than at implant sites in augmented bone (0.5% vs 0.2%, respectively; P = .000), and the adjacent teeth had significantly higher annual bone loss (0.8%; P = .000). Thus, severely periodontally compromised patients can be managed successfully in the long-term with the described clinical protocol.

Ultrasonography for noninvasive and real-time evaluation of peri-implant soft and hard tissue: a case series.

BACKGROUND: The diagnosis of soft and hard tissue at dental implants will be challenging in the future, as high prevalence of mucositis and peri-implantitis were described in the population. Ultrasonography is a promising non-invasive, inexpensive, painless, and radiation-free method for imaging hard and soft tissue at implants, especially an ultrasound device with a 25-MHz probe demonstrating a high correlation between ultrasound, clinical, and radiological measurements. CASE PRESENTATION: The following case series demonstrates the use of ultrasonography with high spatial resolution probe in patients with dental implants affected by soft tissue recession and/or crestal bone loss. CONCLUSION: These ultrasound images can provide valuable additional information for the assessment of peri-implant soft and hard tissue.

Comparison of two full-mouth approaches in the treatment of peri-implant mucositis: a pilot study.

OBJECTIVES: The aim of the present study was to test the hypothesis that an additional full-mouth disinfection results in a greater clinical and microbiological improvement compared with sole mechanical debridement within one session in patients with peri-implant mucositis and treated chronic periodontitis. MATERIAL AND METHODS: The study included 13 partially edentulous patients (mean age 51.5 years) with treated chronic periodontitis and 36 dental implants with mucositis (bleeding on probing and/or a gingival index > or =1 at least at one site at baseline, absence of peri-implant bone loss during the last 2 years before baseline). After randomized assignment to a test and a control group, patients received a one-stage full-mouth scaling with or without chlorhexidine. Clinical and microbiological examination was performed at baseline, after 1, 2, 4 and 8 months. Additional microbial samples were taken 24 h after treatment. Microbiological analysis was performed by real-time polymerase chain reaction. RESULTS: Both treatment modalities resulted in significant reductions of probing depth at implant sites after 8 months, with no significant group differences. The bacteria at implants and teeth could be reduced in every group 24 h after treatment; however, this reduction was not significant after 8 months. CONCLUSIONS: Both treatment modalities led to an improvement of the clinical parameters and a temporary reduction of the microflora at implants with mucositis, but without significant inter-group differences after 8 months.

Turned surface implants in patients treated for periodontitis: Preliminary 10- to 20-year results of a long-term cohort study.

PURPOSE: This long-term cohort study investigated the prevalence of mucositis, peri-implantitis, bone loss and survival of turned surface implants in partially edentulous patients treated for periodontitis. MATERIALS AND METHODS: 19 patients treated for generalised chronic periodontitis (GCP) and 20 patients treated for generalised aggressive periodontitis (GAP) were orally rehabilitated with a total of 126 dental implants. Examinations were performed before implant insertion, at the time of superstructure insertion, and in the subsequent years during a 3-month recall schedule over a 10- to 20-year period. At every session, clinical parameters were recorded. Intraoral radiographs were taken after insertion of superstructures and 1, 3, 5, 10, 15 and 20 years later. RESULTS: In total, nine implants were lost during the 20-year observation period. The implant survival rate was 92.1% (GCP patients) and 90.1% (GAP patients). After 10 years, mucositis was present in 21.9% and 21.2% of implants in GCP and GAP patients, respectively. The risk of mucositis was significantly lower in patients with a removable superstructure (OR = 0.061 with P = 0.001). Peri-implantitis was present in 12.2% implants (GCP patients) and 14.1% implants (GAP patients). Implants inserted in bone quality grade 3 showed a significantly higher risk of peri-implantitis (OR = 5.658 with P = 0.003). After 10 years, implants in GAP patients did not show a significant higher bone loss (1.87 ± 1.40 mm) compared with implants in GCP patients (1.50 ± 1.30 mm). After 20 years, the total mean peri-implant bone loss was 1.98 ± 1.64 mm, almost every fifth implant revealed a bone loss > 3 mm. CONCLUSIONS: The implant survival rate in both patient groups was > 90%, and implants showed a moderate mucositis (< 30%) and peri-implantitis (< 25%) rate. Bone quality and type of superstructure seem to have had an influence on peri-implant health. These results suggest that patients with a history of periodontitis treated in a tight recall schedule can be successfully rehabilitated with turned surface implants for a follow-up period of 10 to 20 years.

One-stage full-mouth disinfection versus quadrant and full-mouth root planing.

OBJECTIVE: The aim of this study was to test the hypothesis that the one-stage full-mouth disinfection (FMD) provides greater clinical and microbiological improvement compared with full-mouth scaling and root planing (FM-SRP) within 24 h and quadrant scaling and root planing (Q-SRP) in patients with generalized chronic periodontitis. MATERIAL & METHODS: Twenty-eight patients were randomized into three groups. 25 patients completed the study and were the basis for analysis. The Q-SRP group was scaled quadrant-wise at 1-week intervals. The other groups received a one-stage full-mouth scaling with (FMD) and without (FM-SRP) chlorhexidine. At baseline, after 1, 2, 4 and 8 months clinical parameters were recorded and microbiological analysis was performed. RESULTS: All three treatment modalities resulted in significant clinical improvement at any time. There were only group differences after 1 and 2 months: in the FM-SRP group was a significantly higher reduction of probing depth and bleeding on probing compared with the other two groups. The bacteria could be reduced in every group although this reduction was only significant for Prevotella intermedia in the FMD group 8 months after treatment. CONCLUSION: All three treatment modalities lead to an improvement of the clinical and microbiological parameters, however, without significant group differences after 8 months.

A Double-Crown Concept for Restorations in Patients with Generalized Aggressive Periodontitis: Two Case Reports with 22- and 25-Year Follow-ups.

Implant-supported prosthetics are a suitable option for improving partially and totally edentulous patients' oral life quality, especially those patients with a history of periodontitis who experience early tooth loss and therefore require implant therapy. However, long-term clinical studies on dental implants have indicated that patients with periodontitis show more biologic complications and lower survival and success rates compared to periodontally healthy patients. The two clinical reports presented show that patients with aggressive periodontal diseases treated with a supportive periodontal therapy can be successfully rehabilitated with implant-supported double-crown restorations for a follow-up period of over 20 years.

Prosthodontic Treatment Outcomes in Periodontally Compromised Patients: A 6- to 20-Year Long-Term Cohort Study.

PURPOSE: To report and analyze long-term treatment outcomes in a patient cohort with severe periodontal disease treated with an employed protocol combining use of implants and double-crown prosthetic support. MATERIALS AND METHODS: A convenience sample of 16 patients with generalized severe periodontal disease were prosthodontically managed with support from 83 dental implants and 21 removable prostheses using a double-crown concept (11 implant-tooth supported and 10 implant supported). Each patient was examined 2 to 4 weeks before scheduled teeth extraction and examined again following treatment completion at the time of insertion of the superstructures. Subsequent recall examinations were performed every 3 months over a 6- to 20-year period. Predetermined clinical parameters were recorded at each session, and intraoral radiographs were taken after insertion of the superstructure and at intervals of 1, 3, 5, 10, and 20 years. RESULTS: No implant or tooth loss occurred during the individual observation periods. Mucositis was recorded around 65% of the implants and was accompanied by additional maxillary marginal bone loss around 27.7% of the implants. Mean marginal bone loss at implant sites after 5 years was 0.75 ± 0.66 mm, and after 20 years was 1.50 ± 1.45 mm. Moderate bone loss around teeth was registered after 5 years (2.8%) and 20 years (7.3%). No significant differences were found between implants in patients with tooth-implant-supported and those with implant-supported double-crown restorations. CONCLUSION: These results suggest that severely periodontally compromised patients can be successfully managed in the long term with the described clinical protocol.

Osseointegrated implants in subjects treated for generalized aggressive periodontitis: 10-year results of a prospective, long-term cohort study.

BACKGROUND: The aim of this prospective 10-year study of partially edentulous subjects treated for generalized aggressive periodontitis and periodontally healthy subjects was a clinical, microbiologic, and radiographic comparison of teeth and implants and assessment of the implants' success rate. METHODS: Five subjects treated for generalized aggressive periodontitis (GAgP) and five periodontally healthy subjects who were orally rehabilitated with osseointegrated implants participated in the study. First, they were examined 2 to 4 weeks before extraction of the non-retainable teeth (baseline) and 3 weeks after insertion of the final abutments. All further examinations were performed during a 3-month recall schedule over a 10-year period. At every session, clinical parameters were recorded, and the composition of the subgingival microflora was determined. Radiographs were taken at baseline after insertion of the superstructure and 1, 3, 5, 8, and 10 years later. RESULTS: Throughout the follow-up period, the peri-implant gingival index of GAgP subjects was significantly higher than in periodontally healthy subjects. There was no difference in plaque index between teeth and implants or between the two groups. The peri-implant probing depths were comparable in the two groups and remained < or =4 mm throughout the follow-up. The probing depth was significantly higher around the teeth of the GAgP subjects compared to periodontally healthy subjects. Implants of GAgP subjects showed a significantly higher attachment loss (Ø 2.4 mm). The attachment level at teeth and implants of the periodontally healthy subjects and at teeth of the GAgP subjects was almost unchanged. Microbiologically, GAgP subjects had fewer cocci and more motile rods and filaments at teeth and implants than periodontally healthy subjects. GAgP subjects showed significantly more peri-implant bone loss in the first year (Ø 2.07 mm) and in the subsequent 9 years (total 1.3 mm). Bone loss at teeth also was significantly higher at baseline (Ø 26.39%) and in the following years (total 9.3%). Implant survival rates were 100% in periodontally healthy subjects versus 83.33% in GAgP subjects. CONCLUSIONS: This 10-year study showed that partially edentulous subjects treated for GAgP can be rehabilitated successfully with osseointegrated implants. However, the bone and attachment loss at the implants were higher than in periodontally healthy subjects.

A telescopic crown concept for the restoration of partially edentulous patients with aggressive generalized periodontitis: a 3-year prospective longitudinal study.

This prospective longitudinal 3-year study compared clinical parameters and implant success rates of removable superstructures supported by both teeth and implants in patients with treated generalized aggressive periodontitis (GAP) and of cemented, implant-retained fixed superstructures in periodontally healthy patients. A total of 17 partially edentulous patients with 54 implants took part in the study. Nine patients with treated GAP received removable superstructures according to the Marburg double crown system, and eight periodontally healthy patients received fixed superstructures. Teeth were examined 2 to 4 weeks before extraction of the nonretainable teeth (baseline) and 3 weeks after insertion of the definitive abutments. Every 3 months over a 3-year period, clinical parameters were recorded and the composition of the subgingival microflora was determined. Intraoral radiographs were obtained at baseline, just after insertion of the superstructure, and 1 and 3 years later. Both groups showed mean plaque and gingival indices below 0.43 at implants and teeth. Mean probing depths around implants increased by approximately 0.7 mm and remained virtually constant for the teeth. Mean attachment loss at implants was 0.9 mm in GAP patients and 0.5 mm in healthy patients. The morphologic distribution of microorganisms in both groups showed healthy conditions. Moderate bone loss at teeth and implants was registered. Implant success rates were 100% in the healthy patients and 97.6% in the GAP patients. No significant differences were seen in the results between the groups.

Mucositis, peri-implantitis, and survival and success rates of oxide-coated implants in patients treated for periodontitis 3- to 6-year results of a case-series study.

AIM: The aim of this case-series study is to evaluate the prevalence of mucositis, peri-implantitis, and survival and success rates of oxide-coated implants in subjects treated for periodontitis. MATERIALS AND METHODS: Twenty-four subjects treated for generalized chronic periodontitis (GCP) and five treated for generalized aggressive periodontitis (GAP) were orally rehabilitated with a total of 130 dental implants. Subjects were examined 2 to 4 weeks prior to extraction of non-retainable teeth and at insertion of superstructure. Additional examinations were performed during a 3-month recall schedule over a 3- to 6-year follow-up period. Radiographs were taken after insertion of the superstructure and 1, 3, and 5 years later. RESULTS: The results showed implant survival rates of 97.1% in GCP subjects versus 96.2% in GAP subjects. The implant success rate was 77.9% in GCP subjects and 38.5% in GAP subjects. In GCP subjects, mucositis was present in 7.7% and peri-implantitis in 12.5% of the implants. In GAP subjects, 28.0% of the implants showed mucositis and 32.0% peri-implantitis. Implant failure, mucositis, and peri-implantitis were more evident in GAP subjects. Peri-implantitis was more prevalent for implants in the maxilla and implants >10 mm. After 5 years, the mean peri-implant bone loss in GAP subjects was 2.89 mm and in GCP subjects 1.38 mm. CONCLUSIONS: Periodontally diseased subjects treated in a supportive periodontal therapy can be successfully rehabilitated with oxide-coated dental implants for a follow-up period of 3- to 6-years. Implants in the maxilla and GAP subjects were more susceptible to mucositis and peri-implantitis, with lower implant survival and success rates.

Digital volume tomography in the diagnosis of peri-implant defects: an in vitro study on native pig mandibles.

BACKGROUND: The aim of this study of native pig mandibles was to investigate the accuracy and quality of the representation of peri-implant defects by intraoral radiography (IR), panoramic radiography (PR), computer tomography (CT), and digital volume tomography (DVT). METHODS: The examination was carried out on 19 native pig mandibles. In the toothless sections of the mandibles, one or two implants were inserted. Following the standardized preparation of peri-implant defects (11 each of dehiscences, fenestrations, and 2- to 3-walled intrabony defects), IR, PR, CT, and DVT were performed. The peri-implant defects were measured using appropriate software on the digitized IR and PR image programs. As a control method, the peri-implant bone defects were measured directly using a reflecting stereomicroscope with measuring ocular. The statistical comparison between the measurements of the radiographic scans and those of the direct readings of the peri-implant defects was performed with Pearson's correlation coefficient. The quality of the radiographic scans was determined through the subjective perception and detectability of the peri-implant defects by five independent observers. RESULTS: In the DVT and CT scans, it was possible to measure all the bone defects in three planes. Comparison with the direct peri-implant defect measurements yielded a mean deviation of 0.17+/-0.11 mm for the DVT scans and 0.18+/-0.12 mm for the CT scans. On the IR and PR images, the defects could be detected only in the mesio-distal and cranio-caudal planes. In comparison with the direct measurements of the peri-implant defects, the IR images revealed a mean deviation of 0.34+/-0.30 mm, and the PR images revealed a mean deviation of 0.41+/-0.35 mm. The quality rating of the radiographic images was highest for the DVT scans. CONCLUSIONS: Overall, the CT and DVT scans displayed only a slight deviation in the extent of the peri-implant defects. Both radiographic imaging techniques permitted imaging of peri-implant defects in three planes, true to scale, and without overlay or distortion. The DVT scans showed the best imaging quality.

Bioabsorbable membrane and bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis: results of a 5-year clinical and radiological study.

BACKGROUND: The aim of this clinical and radiological prospective 5-year study was to compare the long-term effectiveness of a bioabsorbable membrane and a bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis. METHODS: Sixteen patients (11 women and five men) with generalized aggressive periodontitis were enrolled in the study. The investigations were confined to 1- to 3-walled intrabony defects with a depth >/=4 mm and with preoperative probing depths (PDs) >/=7 mm. Teeth with furcation involvement were excluded. Twenty-two of the defects were treated with the membrane (RXT group) and 20 with the bioactive glass (PG group). Allocation to the two groups was randomized. The clinical parameters plaque index (PI), gingival index (GI), PD, bleeding on probing (BOP), gingival recession (GR), clinical attachment level (CAL), and tooth mobility were recorded before surgery and at 6 months and every year for 5 years after surgery. Intraoral radiographs were taken using a standardized paralleling technique at baseline and every year for 5 years. Statistical analysis was based on Kolmogorov-Smirnov and Wilcoxon signed-rank tests, analysis of covariance, and Spearman's bivariate correlation analysis. RESULTS: After 5 years, a reduction in PD of 3.6 +/- 0.8 mm (P = 0.016) and a gain in CAL of 3.0 +/- 2.0 mm (P = 0.01) were registered in the RXT group. There was a slight increase in GR by 0.6 +/- 1.4 mm (P = 0.334). In the PG group, a reduction in PD of 3.5 +/- 1.4 mm (P = 0.01) and a gain in CAL of 3.3 +/- 2.1 mm (P = 0.01) were recorded, whereas GR increased by 0.2 +/- 1.7 mm (P = 0.525). The 1-, 2-, 3-, and 4-year results did not differ significantly from the 5-year results. Radiographically, the defects (the point on the proximal surface of the defective tooth at which the projected alveolar crest intersected the root surface [xCA] to the most coronally located point at the proximal surface of the tooth on the defect side up to which the periodontal ligament space still displayed a uniform width [xBD]) were found to be filled by 47.5% +/- 38.3% (P = 0.001) in the RXT group and by 65.0% +/- 50.5% (P = 0.001) in the PG group. Crestal resorption (the most apical point of the enamel at the proximal surface of the tooth on the defect side [xCEJ] to the xCA) was 19.0% +/- 30.2% (P = 0.374) in the RXT group and 12.3% +/- 38.6% (P = 0.647) in the PG group. The xCEJ to the xBD was significantly more in the PG group (28.4 +/- 24.6 versus 7.3 +/- 21.8, P = 0.048). A good standard of oral hygiene and inflammation-free periodontal tissue in the postoperative phase improved the treatment outcome. No dependence of attachment gain was found on the tooth type, number of walls involved in the defects (r = 0.075; P = 0.319), or intraoperative depth (r = 0.114; P = 0.307). CONCLUSIONS: Highly significant improvements in the parameters PD and CAL were recorded after 5 years with both regenerative materials. Radiographically, the defects (the xCED to the xBD) were found to be filled significantly more in the bioactive glass group. A good standard of oral hygiene and inflammation-free periodontal tissue in the postoperative phase improved the treatment outcome.

Width of Keratinized Mucosa at Implant Sites in Patients Treated for Generalized Aggressive Periodontitis: A Cohort Study.

PURPOSE: The aim of this cohort study was to evaluate the width of keratinized mucosa at implant sites of partially edentulous patients who were treated for generalized aggressive periodontitis. MATERIALS AND METHODS: Dental implants were placed in 35 patients who were treated for generalized aggressive periodontitis and 18 periodontally healthy individuals (controls). At baseline, the keratinized mucosa of all implants was ≥ 2 mm. Follow-up examinations were conducted every 3 months over a 4-year period. RESULTS: The implant survival rate was 97.3% in patients with generalized aggressive periodontitis and 100% in the control group. Four years after implant insertion, patients with generalized aggressive periodontitis had significantly higher clinical attachment levels at the teeth and implants compared with the controls. At all time points, in both groups the mean probing depth at the implants was significantly larger than at the teeth. The mean widths of keratinized mucosa and keratinized gingiva were not significantly different between the two groups. In both groups, the widths of keratinized mucosa and keratinized gingiva were significantly higher at the maxilla than at the mandible. Four years after baseline, the implants in the mandible showed the smallest keratinized mucosa (mean: ≤ 1 mm). CONCLUSION: During the first 4 years after implant placement, no significant changes in the keratinized mucosa at implants could be shown, either in periodontally healthy patients or in patients treated for generalized aggressive periodontitis. The keratinized gingiva at the teeth was generally significantly wider than the keratinized mucosa at the implants.

Effectiveness of Computer-Based Training on Toothbrush Skills of Patients Treated With Crowns: A Randomized Controlled Trial.

BACKGROUND: This study was conducted to assess plaque removal skills in patients with fixed dental prostheses (FDP), and effectiveness of computer-based training (CBT) of different brushing techniques (Fones versus Bass technique in their common modifications). METHODS: Ninety-three patients with FDP were randomly allocated to one of three training groups: 1) C (control group); 2) F (Fones technique group); and 3) B (Bass technique group). All patients received CBT of the basics of toothbrushing. Group C received no further instructions while groups F and B received additional CBT of the modified Fones or the modified Bass technique, respectively. Plaque levels were assessed immediately after patients had been asked to perform oral hygiene to the best of their abilities. RESULTS: Prior to training, persistent plaque deposits were found at 80% of marginal sites of natural teeth immediately after patients had performed oral hygiene. Considerably fewer plaque deposits were found on FDP (43%). No significant group differences were observed 6 and 12 weeks after training, either for natural teeth or for FDP (all P >0.05). CONCLUSIONS: Plaque removal skills are low in patients with FDP. Apparently, they do not profit from CBT of the techniques studied here. Studies observing their actual brushing behavior should be conducted to elucidate reasons for their deficits and to explore why CBT does not work in this group of patients.

Implants in patients treated for generalized aggressive and chronic periodontitis: a 3-year prospective longitudinal study.

BACKGROUND: The aim of the present prospective longitudinal study of periodontally diseased and periodontally healthy patients was a clinical, microbiological, and radiographic comparison of teeth and implants and an assessment of the implant success rate. METHODS: Thirty-nine partially edentulous patients provided with a total of 150 implants were enrolled in the study. Oral rehabilitation was undertaken in 15 patients treated for generalized aggressive periodontitis (GAgP), 12 patients treated for generalized chronic periodontitis (GCP), and 12 periodontally healthy patients. The examinations of the teeth and implants were carried out within the framework of a 3-month recall schedule over a 3-year period. At each session, clinical parameters for probing depth (PD), gingival recession (GR), attachment level (AL), gingival index (GI), and plaque index (PI) were recorded, and the composition of the subgingival microflora determined by dark-field microscopy. In the periodontally diseased patients, Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), and Prevotella intermedia (P.i.) were detected at teeth and implants by DNA analysis in the first and third years after insertion of the superstructure. Intraoral radiographs of the teeth and implants were taken at baseline, immediately after insertion of the superstructure, and then 1 and 3 years later. RESULTS: The GI and PI at implants and teeth remained below 0.25 and 0.6, respectively, in all patient groups throughout the study period. At the implants and teeth, a slight increase in PD and a continuous attachment loss was recorded in the GAgP patients. The attachment loss was greater at the implants than at the teeth in all groups. The morphological distribution of the microorganisms revealed virtually healthy conditions in all groups. A.a. was detected in two GAgP patients, whereas P.g. and P.i. were found more frequently both in the GAgP and in the GCP patients. Radiographically detected bone loss was higher after 3 years at implants and teeth in the GAgP patients than in the other two groups. The implant success rates recorded were 100% in the periodontally healthy and GCP patients, and 95.7% in the maxilla and 100% in the mandible of the GAgP patients. CONCLUSIONS: The results show that oral rehabilitation can be performed with implants in patients treated for generalized aggressive and chronic periodontitis. However, slight attachment loss and bone loss were registered at the implants and teeth in the patients with aggressive periodontitis.

Digital volume tomography in the diagnosis of periodontal defects: an in vitro study on native pig and human mandibles.

BACKGROUND: The aim of this study of native pig and human mandibles was to investigate the accuracy and quality of the representation of periodontal defects by intraoral radiography (IR), panoramic radiography (PR), computed tomography (CT), and digital volume tomography (DVT) in comparison with histologic specimens. METHODS: Following the standardized preparation of periodontal defects (14 dehiscences, fenestrations, 2- to 3-walled intrabony defects, respectively; Class I, II, and III furcation involvement) in six pig and seven human mandibles, IR, PR, CT, and DVT were performed. The histologic specimens were produced by cutting blocks with the individual defects out of the mandibles, embedding them in acrylic, and producing sagittal and axial microsections. The intrabony defects were measured using appropriate software on the digitized IR and PR images programs. The histologic sections were measured by reflecting stereomicroscopy. The statistical comparison between the measurements of the radiographic images and those of the histologic specimens was performed with Pearson's correlation coefficient. The quality of the radiographic images was determined through the subjective perception and detectability of the intrabony defects by five independent observers. RESULTS: All intrabony defects could be measured in three planes in the CT and DVT scans. Comparison with the histologic specimens yielded a mean deviation of 0.16 +/- 0.10 mm for the CT scans and 0.19 +/- 0.11 mm for the DVT scans. On the IR and PR images, the defects could be detected only in the mesio-distal and craniocaudal planes. In comparison with the histologic specimens, the IR images revealed a mean deviation of 0.33 +/- 0.18 mm and the PR images a mean deviation of 1.07 +/- 0.62 mm. The quality rating of the radiographic images was highest for the DVT scans. CONCLUSIONS: Overall, the CT and DVT scans displayed only a slight deviation in the extent of the periodontal defects in comparison with the histologic specimens. Both radiographic imaging techniques permitted imaging of anatomic osseous structures in three planes, true to scale, and without overlay or distortion. The DVT scans showed the best imaging quality.