Bone Loss In Group Research Articles

Radiographic Evaluation Of Mini-implants Versus Short Implants In Rehabilitation Of Mandibular Edentulous Arch

Objective: the aim of this study was to compare the marginal bone loss between mini-implants and short length implants in patients rehabilitated with implant retained mandibular complete overdenture.Material and methods: Fourteen completely edentulous male patients were selected from those attended the out-patient clinic of Removable Prosthodontic Department, Faculty of Dentistry-Ain Shams University to participate in this study. Based on the cone beam computed tomographic (CBCT) assessment, the selected patients were divided into two equal groups: Group (I): Patients received conventional complete maxillary dentures opposed by mandibular overdentures supported and retained by four Mini-implants of 2.5mm diameter and 12 mm length in the interforaminal region. Group (II): Patients received conventional complete maxillary dentures opposed by mandibular overdentures supported and retained by two conventional short implants of 4mm diameter and 8mm length placed in the lateral-canine regions. CBCT records were obtained upon Overdenture Insertion (Baseline), Six Months, Twelve Months after insertion.The Mesial, Distal, Buccal and Lingual marginal bone heights around the implants were evaluated, using the linear measurement system of the software with flat panel detector supplied by the cone beam CT. Results: Peri-Implant Bone Loss in Group (I):At six months following denture insertion calculated means of the measured bone loss for the Mesial surfaces were 0.5±0.1 mm, for the Distal surfaces were 0.55±0.03 mm ,for the Buccal surfaces were 0.50±0.12 mm and for the Lingual surfaces were 0.49±0.03mm.The calculated means of the measured bone loss was statistically significant at P < 0.05. At twelve months following denture insertion, the calculated means of the measured bone loss for the Mesial surfaces were 0.78±0.1 mm, for the Distal surfaces were 0.92±0.7 mm, for the Buccal surfaces were 0.79±0.1mm and for the lingual surface 0.74±0.03mm. The calculated means of the measured bone loss were statistically significant (P ≤ 0.05). Peri-Implant Bone Loss in Group (II): At six months following denture insertion calculated means of the measured bone loss for the Mesial surfaces were 0.56 ± 0.07 mm,for the Distal surfaces were 0.67 ± 0.06 mm,for the Buccal surfaces were 0.56 ± 0.06 mm and for the Lingual surfaces were 0.55 ± 0.05mm.The calculated means of the measured bone loss were statistically significant at P < 0.05. At twelve months following denture insertion calculated means of the measured bone loss for the Mesial surfaces were 0.7 ± 0.07 mm,for the Distal surfaces were 0.87 ± 0.07 mm,for the Buccal surfaces was 0.7 ± 0.08 mm and for the Lingual surfaces were 0.74 ± 0.007 mm. The calculated means of the measured bone loss were statistically significant ( P ≤ 0.05).The calculated means of the measured bone loss in group I of mini implants were higher than group II of short implants for the Mesial, distal,buccal and lingual surfaces and over all bone loss at 6 months and 12 months but was found statistically insignificant ( P ≤ 0.05).Conclusions: Within the limitation of this study, it could be concluded that marginal bone loss around mini implants supporting and retaining mandibular complete overdenture is higher than the marginal bone loss around conventional short implants supporting and retaining mandibular complete overdenture although the difference was statistically insignificant.

Experimental research on Arginine-gingipain A gene vaccine from Porphyromonas gingivalis that prevents peri-implantitis in Beagle dogs

This study aims to use Arginine-gingipain A gene vaccine (pVAX1-rgpA) to immunize adult Beagle dogs and to evaluate its effect during peri-implantitis progression and development. Plasmid pVAX1-rgpA was constructed. The second and third bilateral mandible premolars of 15 adult Beagle dogs were extracted, and the implants were placed immediately. After 3 months, the animals were randomly divided into groups A, B, and C. Afterward, the animals were immunized thrice with plasmid pVAX1-rgpA, with heat-killed Porphyromonas gingivalis, or pVAX1, respectively. IgG in the serum and secretory IgA (sIgA) in saliva were quantitatively analyzed by enzyme-linked immunosorbent assay before and after 2 weeks of immunization. Peri-implantitis was induced with cotton ligatures fixed around the neck of implants. Probing depth (PD) and bleeding on probing were recorded. All animals were sacrificed after ligaturation for 6 weeks. Decalcified sections with thickness of 50 μm were prepared and dyed with methylene blue to observe the bone phenotype around implants. Levels of serum IgG and sIgA in saliva were higher in groups A and B after immunization than before the process (P<0.05) and higher than those in group C (P<0.05). However, no difference was observed between groups A and B (P>0.05). At 4 and 6 weeks after ligaturation, PD of the ligatured side in group C was higher than that in groups A and B (P<0.05). On the other hand, no difference was identified between groups A and B (P>0.05). Bone loss in group A was significantly lower than that of the other groups (P<0.05). Abundant inflammatory cells and bacteria were present in the bone loss area around the implants in the three groups, as identified through hard tissue section observation. However, group C presented the most number of inflammatory cells and bacteria in the bone loss area around the implants. IgG and sIgA can be generated by immunity with rgpA DNA vaccine, which can significantly slow down bone loss during experimental peri-implantitis in dogs.

Survival rate and various clinical indicators of implant restoration in chronic periodontitis

Objective To investigate the influence of chronic periodontitis on implant survival rate and clinical indicators after implant restoration. Methods The chronic periodontitis dentition defect 50 patients (group A) and periodontal health dentition defect 50 patients (group B) with implant prosthesis were selected as the study objects.The implant retention and the amount of marginal bone loss, improved plaque index, modified bleeding index and probing depth at 3 months, 6 months, 12 months and 24 months after restoration were observed. Results The implant survival rate of group A (93.9%) and group B (95.7%) had no statistically significant difference (χ2=0.339, P>0.05). The amount of marginal bone loss of group A at 3 months, 6 months, 12 months and 24 months were (0.41±0.12)mm, (0.99±0.14)mm, (1.16±0.32)mm, (1.25±0.43)mm, respectively, which of group B were (0.38±0.09)mm, (0.87±0.25)mm, (1.08±0.27)mm, (1.19±0.49)mm, respectively, the differences were not statistically significant (t=0.712, 0.613, 0.426, 0.412, all P>0.05). The modified plaque index of group A at 3 months, 6 months, 12 months and 24 months were (1.14±0.12), (1.21±0.38), (1.38±0.21), (1.41±0.26), respectively, which of group B were (0.97±0.08), (1.18±0.34), (1.27±0.29), (1.35±0.22), the differences were not statistically significant (t=0.869, 0.683, 1.521, 0.967, all P>0.05). The modified bleeding index of group A at 3 months, 6 months, 12 months and 24 months were (0.34±0.09), (0.41±0.05), (0.64±0.13), (0.71±0.12), respectively, which of group B were (0.36±0.07), (0.44±0.12), (0.56±0.11), (0.62±0.14), the differences were not statistically significant (t=0.758, 0.534, 1.021, 0.784, all P>0.05). The probing depth of group A at 3 months, 6 months, 12 months and 24 months were (1.57±0.23)mm, (1.97±0.38)mm, (2.01±0.32)mm, (2.05±0.28)mm, respectively, which of group B were (1.48±0.16)mm, (1.81±0.33)mm, (1.83±0.37)mm, (1.84±0.31)mm, the differences were not statistically significant (t=0.783, 0.934, 0.376, 0.745, P>0.05). Conclusion Chronic periodontitis with implant prosthesis treatment after periodontal therapy has no significant effect on implant retention rate and marginal bone loss, improved plaque index, modified bleeding index and probing depth. Key words: Dental implantation; Chronic periodontitis; Retention

Evaluation of peri-implant tissues around nanopore surface implants with or without platelet rich fibrin: a clinico-radiographic study

Objective: To comparatively evaluate peri-implant tissue changes around the nano-pore implant surface with or without platelet rich fibrin (PRF). Material and methods: For the present study, a total of 17 patients was initially enrolled (6 females, 11 males), and 38 sites (19 control and 19 experimental sites) were randomly assigned to either group 1 (control), i.e. extraction site received immediate implants without any PRF, and group 2 (experimental), i.e. extraction sites received immediate implants with PRF. Clinical and radiographic parameters were recorded for 9 months after the implant-loading phase. Results: Clinically, there was a significant (p < 0.001) increase in the peri-implant probing depth from the prosthetic phase up to 9 months in both the groups, and the increase was greater in the control group. However, the mean difference in the changes between the two groups was non-significant. The modified gingiva index for group 2 was significantly lower than that for group 1 in the prosthetic phase. Radiographically, in the control group and experimental group, there was a significant increase (<0.01) in bone loss (BL) in the mesial and distal aspect of the implant from the surgical to prosthetic phase, surgical up to 9 months and from the prosthetic phase up to 9 months. There was greater BL in the control group than in the experimental group in both the mesial and distal aspect of the implant; however the difference in BL was non-significant (<0.01). There was greater BL in the distal aspect than in the mesial aspect in both groups; however, the difference in BL was non-significant. Conclusion: PRF treatment may provide a way to prevent BL during the surgical-to-prosthetic phase. These results were based on a short-term, low sample randomized clinical study, therefore a long-term study with more sites and homogenous sampling is recommended.

Postmenopausal Iron Overload Exacerbated Bone Loss by Promoting the Degradation of Type I Collagen.

117 postmenopausal women were divided into Normal, Bone loss (BL), and Osteoporosis group. Compared with Normal group (120.96 ± 43.18 μg/L), the serum ferritin (Fer) in BL (223.37 ± 130.27 μg/L) and Osteoporosis group (307.50 ± 161.48 μg/L) was significantly increased (p < 0.05). Fer level was negatively correlated with BMD (p < 0.01). TRACP levels in Osteoporosis group (4.37 ± 1.69 U/L) were significantly higher than Normal group (4.10 ± 1.60 U/L, p < 0.05). ALP levels in Osteoporosis group (112.06 ± 62.05 U/L) were significantly upregulated compared with Normal group (80.22 ± 14.94 U/L, p < 0.05). β-CTX and PINP were the degradation products of type I collagen. β-CTX levels in Osteoporosis group (667.90 ± 316.55 ng/L) were significantly increased compared with Normal group (406.06 ± 112.12 ng/L, p < 0.05). PINP levels in Osteoporosis group (78.03 ± 37.31 μg/L) were significantly higher than Normal group (37.60 ± 13.17 μg/L, p < 0.01). More importantly, there was a positive correlation between serum Fer and PINP (p < 0.01). Serum Fer showed a positive correlation of serum β-CTX (p < 0.01). The overloaded iron improved the degradation of type I collagen.

Trabecular bone score in clinical practice (review)

Osteoporosis is a common systemic disease of the skeleton having significant medical and social consequences. In recent years new diagnostic methods which help to determine the risk and early bone loss in groups of population develop. Thus in 2006 the company «Med-Imaps» (Bordeaux, France) patented a new method «TBS Insight»for assessment the mark of quality of trabecular bone tissue (TBS - trabecular bone score) on the lumbar spine (LI–LIV ). The authors analyzed specific information on using of TBS index in clinical practice. It is proved that age has a significant impact on the variability of TBS index. It was shown correlation between TBS index and osteoporotic vertebral fractures, femoral neck fractures and fractures in other sites in postmenopausal women. The results of studies of the effect of various drugs on TBS index were presented. The article also presents the results of research carried out on the basis of Ukrainian scientific and medical center of problems of osteoporosis. There was established significant (p = 0,0003) decline of TBS index (LI–LIV) with age in women living in Ukraine. Significant changes in TBS index (LI–LIV) were observed in women at earlier postmenopausal period – after 4 years or more while changes in bone mineral density were determined in women with postmenopausal duration of 7 years or more. Conclusion: Mark of quality of trabecular bone is independent and has important diagnostic value in analysis of structural and functional state of bone tissue.

Stemmed femoral implants show lower failure rates in revision total knee arthroplasty

BackgroundStemmed femoral implants are not universally used in revision total knee arthroplasty. The aim of this study was to evaluate whether the re-revision rate would be greater for revision total knees performed without stemmed femoral implants compared with revision total knees performed with stemmed femoral implants. MethodsAll revision cases performed at a single institution between 2004 and 2011 were retrospectively reviewed. A total of 130 revision total knee arthroplasty procedures (63 Group 1; 67 Group 2) met the inclusion criteria. ResultsRevisions performed without femoral stems failed more often than revisions with femoral stems (44% vs 9%, p<0.001) despite more severe pre-operative bone loss in groups that were revised with stems (p<0.05). ConclusionsWe recommend that femoral stems be used routinely in procedures where a femoral implant is revised following a prior total knee arthroplasty.

Peri‐implant evaluation of immediately loaded implants placed in esthetic zone in patients with diabetes mellitus type 2: a two‐year study

The aim of this study was to evaluate implant survival and primary stability parameters in patients with diabetes with different levels of glycosylated hemoglobin Alc (HbA1c) treated with immediate placement and provisionalization of implant-supported, single-tooth replacements over 2years. Eighty-five patients were divided into three groups according to their HbA1c levels: 33 patients in Group 1 (<6, control group); 30 patients in Group 2 (6.1-8); and 22 patients in Group 3 (8.1-10). Each patient received one-one-piece implant in the anterior zone of the upper maxillary. The implant survival rate was analyzed for each group, together with three variables to evaluate the general state of peri-implant health: probe depth, bleeding on probing, marginal bone loss. Marginal bone loss increased in relation with higher HbA1c levels. For marginal bone loss in Group 1, mean resorption values ranged from 0.51 after 6months to 0.72 after 2years in comparison with respective values of 1.33 and 1.92 in Group 3. This pattern was repeated for bleeding on probing, both parameters showing significant differences between groups. For bleeding on probing, mean bleeding levels varied from 0.36 in Group I at 6months after implant placement, to 0.59 in Group 3 (P=0.041 between the three groups). Peri-implant pocket depth showed the same tendency to increase in relation to HbA1C but differences between groups did not reach statistical significance. Patients with diabetes can receive implant-based treatments with immediate loading safely, providing they present moderate HbA1c values.

RgpA DNA Vaccine Induces Antibody Response and Prevents Alveolar Bone Loss in Experimental Peri‐Implantitis

Peri-implantitis is one of many reasons for dental implant failure. This study is designed to prevent experimental peri-implantitis by arginine-specific gingipain A (rgpA) DNA vaccine. The bilateral mandibular second and third premolars from 15 male beagle dogs were extracted, and 60 implants were immediately implanted. Three months after implantation, the animals were randomly divided into groups A, B, and C and immunized with plasmid vector-rgpA, heat-killed Porphyromonas gingivalis, and plasmid vector, respectively. Cotton ligatures infiltrated with P. gingivalis were placed in the submarginal position around the neck of the implants to induce peri-implantitis. Clinical measurements, including probing depth (PD) and bleeding on probing, were recorded every 2 weeks postoperatively, and P. gingivalis-specific immunoglobulin G (IgG) in serum and secretory IgA (sIgA) in saliva were quantitatively analyzed by enzyme-linked immunosorbent assay at the same time. Animals were sacrificed after 6 weeks, 50-μm undecalcified histologic sections were prepared using methylene blue dye, and bone loss around implants was measured. Higher levels of IgG in serum and sIgA in saliva could be measured in groups A and B but not in group C after immunization. There were statistical differences (P <0.05) between, before, and after immunization, but no difference was found between groups A and B (P >0.05). Both peri-implant PD and bone loss in group A were significantly less than in groups B and C. IgG and sIgA could be generated by immunization with rgpA DNA vaccine, which could significantly slow down bone loss in the experimental peri-implantitis canine model.

Fluoxetine reduces periodontal disease progression in a conditioned fear stress model in rats

Recent evidence suggests that the use of fluoxetine could reduce periodontal disease severity. However, the effect of fluoxetine on periodontal disease has not been tested in the context of conditioned fear stress (CFS). We hypothesized that inhibition of chronic stress by fluoxetine might decrease the levels of bone loss in periodontal disease. The aim of the present study was to analyze the effect of fluoxetine on bone loss in chronic periodontitis. Fourteen Wistar rats were submitted to ligature-induced periodontal disease and divided into four groups (A-D). Groups A (n=3) and B (n=4) were not stressed, while Groups C (n=3) and D (n=4) were submitted to a CFS paradigm for 38d. Daily fluoxetine (20mg/kg) was administered to Groups B and D from day 20 to day 39, at which point the rats were submitted to an open field test and killed on day 40. Mandibles were removed for histological and immunohistochemical analyses. Stress was associated with a higher level of bone loss in Group C compared with Group A. Additionally, no differences in bone loss were observed among Groups A, B and D. We showed that stress is associated with the progression of bone loss in a CFS model in rats and that fluoxetine treatment reduces the bone loss.

Marginal bone loss around unsplinted mini-implants supporting maxillary overdentures: a preliminary comparative study between partial and full palatal coverage.

To evaluate and compare marginal bone loss around mini-implants supporting maxillary overdentures with either partial or full palatal coverage. Nineteen edentulous patients complaining of retention problems involving their maxillary dentures were randomly allocated in two groups. Group I (n = 10) received maxillary dentures with full palatal coverage, and group II (n = 9) received maxillary dentures with partial palatal coverage. In total, 114 mini-implants (6 per patient) were inserted using the nonsubmerged flapless surgical approach and loaded immediately with maxillary overdentures. Each implant was evaluated at the time of initial prosthetic loading and at 6, 12, and 24 months thereafter. Radiographic evaluation was performed in terms of vertical and horizontal bone loss. Implant mobility (via Periotest values) was measured using a Periotest device, and patient satisfaction was evaluated with a visual analog scale. The cumulative survival rate was calculated using Kaplan-Meier analysis. After 2 years, the mean vertical bone loss in groups I and II was 5.38 and 6.29 mm, respectively, while the mean horizontal bone loss in groups I and II was 1.52 and 1.93 mm, respectively. Most bone resorption occurred within 6 months after overdenture insertion in both groups. Group II recorded significant higher vertical bone loss and Periotest values than group I at all observation times. The cumulative survival rates of the mini-implants were 78.4% and 53.8% for groups I and II, respectively. All patients were satisfied with their maxillary overdentures in terms of retention and chewing ability. Rehabilitation of edentulous maxillae with unsplinted mini-implants supporting overdentures and in particular with a combination of partial palatal coverage is not recommended because of excessive marginal bone resorption and the higher failure rate of mini-implants than was expected.

Treatment of experimental periodontal disease with antimicrobial photodynamic therapy in nicotine‐modified rats

The aim of this study was to compare antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to scaling and root planing (SRP) for induced periodontitis in nicotine-modified rats. A total of 240 rats were evenly divided into two groups: C - saline solution treatment; N - nicotine treatment. Periodontal disease was induced in both groups at the first mandibular molar. After 7days, the ligature was removed. All animals were submitted to SRP and were divided according to the following treatments: SRP - irrigation with saline solution; Toluidine Blue-O (TBO) - irrigation with phenothiazinium dye (100μg/ml); LLLT - laser irradiation (660nm; 0.03W; 4J); and aPDT - TBO and laser irradiation. Ten animals in each group/treatment were euthanized at 7, 15 and 30days. The histometric and immunohistochemical values were statistically analysed. Intragroup analysis demonstrated that in both groups the aPDT treatment resulted in lower bone loss (BL) when compared to SRP in all experimental periods. Intergroup analysis demonstrated that aPDT treatment resulted in lower BL in Group N than in Group C treated with SRP in all experimental periods. Antimicrobial photodynamic therapy was an effective adjunctive treatment to SRP for induced periodontitis in nicotine-modified rats.

A comparative evaluation of immediate dental implant with autogenous versus synthetic guided bone regeneration

Immediate implant is a placement of the implant immediately into fresh extraction socket site after tooth extraction and is considered to be a predictable and acceptable procedure. The present work is designed to evaluate the periodontal condition after immediate implant placement and the success rate of implant with autogenous versus synthetic guided bone regeneration. Twenty adult male patients with an endodontic failure, tooth fracture decayed tooth (hopeless tooth) were included in this study. Patients were divided into 2 groups: One group (I) received immediate implants augmented with autogenous bone graft, and the other (group II) received immediate implants augmented with a synthetic bone graft. The results revealed that there was a significant difference between the groups for pocket depth and clinical attachment level. The difference between the groups was statistically highly significant only at 12 months (P < .01). In addition, there was statistically significant difference between the groups at 9 and 12 months (P < .001). Moreover, there was significant decrease of marginal bone loss in group I compared with group II (P < .01). In addition, there was statistically significant difference between the both groups at 9 and 12 months for bone density (P < .001). Moreover, there was significant decrease of marginal bone loss in group I compared with group II (P < .01). In conclusion, the immediate dental implant placement with autogenous bone graft showed a significant superiority to synthetic bone graft. In addition, the immediate placement-delayed loaded dental implant remains the procedure of choice for predictable achieving of osseointegration.

Bone level alterations at implants placed in the posterior segments of the dentition: outcome of submerged/non‐submerged healing. A 5‐year multicenter, randomized, controlled clinical trial

To determine if longitudinal bone level change at Astra Tech implants placed in the posterior part of the dentition was influenced by the healing conditions provided following implant placement, i.e., submerged or non-submerged healing. Eighty-four patients and 115 fixed partial dentures (FPDs or cases) entered the study. The cases were randomized into two implant installation groups: initially non-submerged (group A) or initially submerged (group B) implants. Three hundred and twenty-four implants were installed (group A=153; group B=171): 145 in the maxilla and 179 in the mandible. Radiographs from the implant sites were obtained at FPD insertion (baseline) and subsequently every 12 months. In the radiographs, the position of the marginal bone at the mesial and distal aspects of the implants was determined and the radiographic (Rx) bone level change over time was calculated. Seven implants failed to integrate (four in group A and three in group B). During the 5 years of monitoring, three implants had to be removed and 35 implants were lost to follow-up. The Rx bone level alteration that occurred during year 1 was 0.02+/-0.38 mm in group A and 0.17+/-0.51 mm in group B. During the subsequent 4 years there was some further Rx bone loss in group B (0.02+/-0.62 mm), while in group A there was some gain of bone (0.07+/-0.5 mm). The peri-implant bone level change and number of biological complications that took place during the 5 years was small and unrelated to the surgical protocol used for implant placement.

The Effect of Low-Dose Cholecalciferol and Calcium Treatment on Posttransplant Bone Loss in Renal Transplant Patients: A Prospective Study

Background/Aim. Posttransplant steroid doses have been reduced with the use of new and potent immunosuppressive agents. However, posttransplant osteoporosis is still a serious problem. Our aim in this study was to investigate the effect of low-dose cholecalciferol and calcium supplementation on bone loss after transplantation in renal transplant patients. Methods. Fifty-eight renal transplantation patients were included in the study. Fourteen newly transplanted patients (group 1) and 44 renal transplantation patients with a graft age of at least six months (group 2) were involved. All patients received 400 IU/day orally cholecalciferol (vitamin D3) and 600 mg/day orally calcium replacement starting from the second day posttransplantion. All patients baseline serum and urine biochemistry, serum 25-hydroxy vitamin D3 (25 (OH)D3), and bone mineral density (BMD) tests were performed. Also, the same measurements were performed at the 12th month in group 1. Results. After one year of treatment, BMDs were improved in group 1. Patients in group 1 had a nonsignificant increase of lumbar spine (8.12 ± 18.64% of baseline BMD) and femoral total (7.10 ± 13.48% of baseline BMD) BMD at the end of the first year. On the other hand, there was a significant increase in femoral neck (10.06 ± 15.70% of baseline BMD, p < 0.05) measurements. The baseline results of group 2 were similar to group 1. In group 1, 25 (OH)D3 levels were increased while PTH levels were decreased at the end of the year. Conclusion. In renal transplant patients who use low-dose metilprednisolon and new immunosuppressive agents together, low doses of vitamin D3 and calcium replacement for one year provides a reduction in lumbar spine, femoral neck, and femoral total bone loss and prevents bone loss in group 2. In addition, it contributed to the normalization of PTH levels.

Gingival levels of monocyte chemoattractant protein-1 (MCP-1) in diabetes mellitus and periodontitis: an experimental study in rats

The objectives of this study were to investigate and compare the monocyte chemoattractant protein-1 (MCP-1) levels of gingival tissues in diabetes mellitus (DM) and periodontitis and to reveal the effects of MCP-1 on periodontal inflammation and destruction in these diseases. DM was created in 15 rats (group 1) by streptozotocin injection, and periodontitis was obtained by ligature induction in 15 rats (group 2). Fifteen systemically and periodontally healthy rats were used as control (group 3). Gingival MCP-1 levels were measured by enzyme-linked immunosorbent assay (ELISA). Periodontal inflammation was quantified by the inflammatory cell infiltration in the gingival samples, whereas periodontal destruction was assessed by the alveolar bone loss in the experimental regions. MCP-1 concentrations were higher in groups 1 and 2 than in group 3 (p < 0.001). Increased gingival inflammatory cell infiltration and alveolar bone loss were observed in groups 1 and 2 compared to group 3 (p < 0.001). There were positive correlations among the MCP-1 level, gingival inflammatory cell infiltration, and alveolar bone loss in groups 1 and 2 (p < 0.001). Our results suggest that (1) DM may lead to enhanced MCP-1 production in periodontal tissues likewise for periodontitis and (2) there may be a positive correlation between the MCP-1 concentration and diseased nature of periodontium in both diseases.

Continuous bone loss around a tapered uncemented femoral stem: A long-term evaluation with DEXA

Background Periprosthetic bone loss is a well-docu-mented phenomenon after uncemented total hip arthroplasty (THA); however, little is known about how bone mineral density (BMD) changes after 2 years.Patients and methods 14 patients with hip arthrosis (group A) were operated with a proximally porous- and hydroxyapatite-coated stem and followed for 10 years with DEXA, radiographs and Harris hip score (HHS). Another group of 14 patients (group B) was evaluated at 6 and 14 years using the same prosthesis and protocol.Results No stem was revised and all stems were well-Fixed. At final follow-up, HHS was 97 points in group A after 10 years and 94 points in group B after 14 years. Bone mineral changes in group A were greatest in Gruen zones 1 and 7, where the losses were 31% and 26%, respectively, after 2 years on the operated side. The decrease in BMD continued after 2 years and in Gruen zone 7 it was faster than the rate of bone loss on the control side. In group B, the annual change in BMD on the operated side was not significantly different from the bone loss in group A.Interpretation Up to 14 years after implantation of a tapered uncemented stem, the BMD in the calcar region continues to decrease faster than would be expected from normal ageing.

Effect of Long-Term Calcitonin Administration on Steroid-Induced Osteoporosis after Cardiac Transplantation

Early, rapid bone loss and fractures after cardiac transplantation are well-documented complications of steroid administration; therefore, we undertook this study on the effects of long-term calcitonin on steroid-induced osteoporosis. Twenty-three heart transplant recipients on maintenance immunosuppression with cyclosporine, mycophenolate mofetil and prednisone were retrospectively studied. All patients received long-term prophylactic treatment with elemental calcium and vitamin D. Twelve (52.2%) patients also received long-term intranasal salmon calcitonin, whereas 11 (47.8%) received none. Bone mineral density and vertebral fractures were assessed at yearly intervals. Statistical comparisons between each group's bone loss during the first year and in the early (1 to 3 years), intermediate (4 to 6 years) and late (7+ years) post-transplantation periods were done. Lumbar spine bone loss was significant during the early follow-up period in the group not receiving calcitonin (0.744 +/- 0.114 g/cm(2) vs 0.978 +/- 0.094 g/cm(2) [p = 0.002]). The calcitonin group showed bone mineral density (BMD) levels within normal average values throughout the study period. BMD increased in the no-calcitonin group during the intermediate (4 to 6 years) and late (7+ years) follow-up periods, with values approaching normal average and no significant difference between the 2 groups (0.988 +/- 0.184 g/cm(2) vs 0.982 +/- 0.088 g/cm(2) [p = 0.944] and 0.89 +/- 0.09 g/cm(2) vs 1.048 +/- 0.239 g/cm(2) [p = 0.474], respectively). Prophylactic treatment with intranasal salmon calcitonin prevents rapid bone loss associated with high-dose steroids early after cardiac transplantation. Long-term administration does not seem warranted in re-establishing BMD.

Simplified Methods of Implant Treatment in the Edentulous Lower Jaw: A 3‐Year Follow‐Up Report of a Controlled Prospective Study of One‐Stage versus Two‐Stage Surgery and Early Loading

Interest in the use of one-stage surgery and immediate loading of oral implants has lately been increasing. The aim of this study was to compare the 3-year results of one-stage surgery versus two-stage surgery, early loading versus loading after a 3-month healing period, and the use of one-piece implants versus the use of two-piece implants. The study included 108 patients with edentulous mandibles. Each patient was treated with four Brånemark System implants (Nobel Biocare AB, Göteborg, Sweden) and with full fixed prostheses. Patients were consecutively treated and were distributed in four groups: group A (one-stage surgery), group B (control group with two-stage surgery), group C (one-piece implants), and group D (early loading). In groups A and B Brånemark Standard implants and standard abutments were used. In group C the conical one-piece Brånemark implant was used, and in group D the patients had Brånemark System Mk III implants together with multiunit abutments. All patients were observed for 3 years. Of the 432 inserted implants, 24 were lost. Survival rates in the three experimental groups ranged from 93.2 to 93.3% whereas the survival rate in group B (the control group with two-stage surgery) was 97.5%. The differences between the groups were not statistically significant. The changes in marginal bone level were measured from fixture insertion to the final follow-up at 3 years. The bone loss in group D (early loading) was significantly less than in group B (the control group) whereas there were no differences in marginal bone change between the other groups. Early loading seemed to give good results in the anterior part of the mandible. The survival rate of the early-loaded implants did not significantly differ from that of implants inserted with the conventional two-stage procedure, but the mean marginal bone loss around the surviving implants was less with early loading.

Surgical Approach Influences Periprosthetic Femoral Bone Density

Our hypothesis was that the bone mineral density of the proximal femur is altered significantly by surgical approach. The change in long-term periprosthetic bone mineral density in relation to the alteration of the musculature after the anterolateral (Group A) and transgluteal approaches (Group B) has been compared. There were 35 hips (30 patients) in Group A and 47 hips (37 patients) in Group B. No significant differences were seen between groups with respect to age, gender, diaphyseal bone mineral density distribution, or average stem size in a Wilcoxon-Mann-Whitney test. Measurement of bone mineral density in femoral Gruen zones revealed a significant bone loss in Group B compared with Group A in the multivariate analysis, which was confirmed by univariate post hoc tests in Zones I, II, VI, and VII (multiple significance according to Bonferroni-Holm's procedure). The functional outcome, however, showed no significant differences between the two groups postoperatively. A potential reason for the bone mineral density shift might have been a redistribution of the musculoskeletal loading across the hip after a transgluteal, compared with an anterolateral, surgical approach. A difference in the muscular damage caused by the two surgical approaches seems to have a significant influence on the long-term bone loss.