Measurement Of Bone Loss Research Articles

Clinical performance of intentionally tilted implants versus axially positioned implants: A systematic review.

The aim of this review was to determine the clinical performance of dental implants that are intentionally tilted when compared with implants that are placed following the long axis of the residual alveolar ridge. A systematic review of the scientific literature using a predefined research question (PICO) and search strategy was undertaken. This search included five electronic databases. Two independent reviewers examined electronic databases and performed a manual review following search strategy to accomplish the item generation and reduction. Included articles were evaluated to determine the level of evidence. Data were extracted only from level I and level II studies, based on the Oxford Centre for Evidence-based Medicine-Levels of Evidence (March 2009). If included studies were homogeneous in nature, data were to be accumulated. However, if included studies were heterogeneous in nature, only descriptive data would be reviewed and analyzed. A total of 811 articles were identified through the PICO question and search strategy. Detailed review of the abstracts and articles resulted in further item reduction, and 46 articles were included for full-text review. A total of 42 articles were then selected for inclusion in the systematic review. The identified articles included two level I and 20 level II studies. In addition, 15 level IV, one gray literature, and four previous systematic reviews with meta-analyses were also used in the study. The extracted data from the included studies demonstrated heterogeneity that prevented quantitative assessment, and only one level II study directly compared tilted and axially placed implants. Assessment of the descriptive data demonstrated no differences in implant survival, marginal bone loss, prosthesis survival, or patient-reported outcome measures (PROMs) whether implants are placed axially or with intentional inclination of the coronal aspect of the implant toward the distal aspect of edentulous jaws. Based upon the systematic review of the literature, an analysis of the descriptive data suggested no differences in clinical performance between implants that are placed in an axial position relative to the residual alveolar ridge when compared with implants that are intentionally tilted toward the distal aspect of edentulous jaws.

Management of Recurrent Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review to Assess Critical Bone Loss Amounts

Background: There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone block procedures may be lower than previously thought, particularly in the presence of a Hill-Sachs defect. Purpose: To better establish treatment recommendations for anterior shoulder instability among patients with bipolar bone lesions. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review of the literature was performed with PubMed, EMBASE, Cochrane Library, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating outcomes of operative management in anterior shoulder instability that also reported glenoid bone loss in the presence of Hill-Sachs defects were included. Recurrence rates, glenoid bone loss, and humeral bone loss were pooled and analyzed with forest plots stratified by surgical procedure. Methods of quantification were analyzed for each article qualitatively. Results: Thirteen articles were included in the final analysis, with a total of 778 patients. The mean ± SD age was 24.9 ± 8.6 years. The mean follow-up was 30.1 months (range, 11-240 months). Only 13 of 408 (3.2%) reviewed bipolar bone loss articles quantified humeral and/or glenoid bone loss. Latarjet procedures had the greatest glenoid bone loss (21.7%; 95% CI, 14.8%-28.6%), followed by Bankart repairs (13.1%; 95% CI, 9.0%-17.2%), and remplissage (11.7%; 95% CI, 5.5%-18.0%). Humeral bone loss was primarily reported as percentage bone loss (22.2%; 95% CI, 13.1%-31.3% in Bankart repairs and 31.7%; 95% CI, 21.6%-41.1% in Latarjet) or as volumetric defects (439.1 mm3; 95% CI, 336.3-541.9 mm3 in Bankart repairs and 366.0 mm3; 95% CI, 258.4-475.4 mm3 in remplissage). Recurrence rates were as follows: Bankart repairs, 19.5% (95% CI, 14.5%-25.8%); remplissage, 4.4% (95% CI, 1.3%-14.0%); and Latarjet, 8.7% (95% CI, 5.0%-14.7%). Bankart repairs were associated with significantly greater recurrence of instability in included articles (P = .013). Conclusion: There exists a need for universal and consistent preoperative measurement of humeral-sided bone loss. The presence of concomitant Hill-Sachs defects with glenoid pathology should warrant more aggressive operative management through use of bone block procedures. Previously established values of critical glenoid bone loss are not equally relevant in the presence of bipolar bone loss.

Clinical outcomes and cost effectiveness of computer-guided versus conventional implant-retained hybrid prostheses: A long-term retrospective analysis of treatment protocols.

Computer-guided systems were developed to facilitate implant placement at optimal positions in relation to the future prosthesis. However, the time, cost and, technique sensitivity involved with computer-guided surgery impedes its routine practice. The aim of this study is to evaluate survival rates and complications associated with computer-guided versus conventional implant placement in implant-retained hybrid prostheses. Furthermore, long-term economic efficiency of this approach was assessed. Patients were stratified according to implant placement protocol into a test group, using computer-guided placement, and a control group, using traditional placement. Calibrated radiographs were used to measure bone loss around implants. Furthermore, the costs of the initial treatment and prosthetic complications, if any, were standardized and analyzed. Forty-five patients (149 implants in the test group and 111 implants in the control group) with a minimum follow-up of 5 years, and a mean follow-up of 9.6 years, were included in the study. While no significant difference was found between both groups in terms of biologic and technical complications, lower incidence of implant loss was observed in the test group (P<0.001). A statistically significant difference in favor of the non-guided implant placement group was found for the initial cost (P<0.05) but not for the prosthetic complications and total cost (P>0.05). Computer-guided implant placement for an implant-supported hybrid prosthesis is a valid, reliable alternative to the traditional approach for implant placement and immediate loading. Computer-guided implant placement showed higher implant survival rates and comparable long-term cost to non-guided implant placement.

Validity of self-reported periodontal measures, demographic characteristics, and systemic medical conditions.

The objective of the present study was to assess self-reported periodontal screening questions, demographic characteristics, systemic medical conditions, and tobacco use for predicting periodontal disease among individuals seeking dental therapy in a university dental clinic. In this retrospective study, a total of 4,890 randomly selected dental charts were evaluated from among patients who had attended the University of Minnesota School of Dentistry clinics for treatment. Radiographic bone loss measurements were used to assess the severity of periodontal disease. Demographic characteristics as well as medical history of the patients were also recorded. Five self-reported periodontal screening questions were included, with answers limited to Yes/No. Generalized logit models were used to assess the association between bone loss and the predictors. The sample's mean age was 54.1 years and included 52.6% males and 14.9% smokers, with a mean of 3.5 missing teeth. Self-reported tooth mobility, history of "gum treatment," and the importance of retaining teeth as well as age, tobacco use, and cancer were statistically significant predictors (P<0.05) of a radiographic diagnosis of moderate and severe periodontal disease. With respect to severe periodontal disease, significant associations (P<0.05) were also found with "bleeding while brushing," gender, diabetes, anxiety, and arthritis. Self-reported periodontal screening questions as well as demographic characteristics, smoking, and systemic medical conditions were significant predictors of periodontal disease, and they could be used as valid, economic, and practical measures.

Isosteviol Derivative Inhibits Osteoclast Differentiation and Ameliorates Ovariectomy-Induced Osteoporosis

NC-8 (ent-16-oxobeyeran-19-N-methylureido) is an isosteviol-derived analogue with multiple biological effects, including anti-inflammation and anti-bacterial activities and inhibition of HBV viral surface antigen gene expression. In this study, we explored the effects of NC-8 on the formation of osteoclasts from RAW 264.7 cells. We found that NC-8 exerts the novel effect of inhibiting osteoclast-like cell formation. Our experiments showed that RANKL-induced ERK, p38, and JNK phosphorylation were inhibited by NC-8. An ovariectomy-induced osteoporosis animal model was used to examine the protective effects of oral treatment with NC-8. Serum analysis was used to examine markers of osteoblasts, osteoclasts, and renal and hepatic function in rats. Micro CT scanning and histological analysis were used to measure bone loss in ovariectomized rats. Oral administration of NC-8 effectively decreased excess bone resorption and significantly antagonized trabecular bone loss in ovariectomized rats. Serum analysis of C-terminal telopeptide of type-I collagen, an osteoclast marker, also showed that NC-8 administration inhibited excess bone resorption. Furthermore, serum analysis showed that renal and liver function were not affected by these doses of NC-8 during long-term treatment. Our results demonstrate that NC-8 inhibits osteoclast differentiation and effectively ameliorates ovariectomy-induced osteoporosis.

A Clinical Comparison of Linear- and Surface Area–Based Methods of Measuring Glenoid Bone Loss

Background: The purpose of this study was to determine whether linear-based measurement significantly overestimates glenoid bone loss in comparison with surface area–based measurement in patients with recurrent anterior shoulder instability and glenoid bone loss. Hypothesis: Linear-based measurement will significantly overestimate glenoid bone loss in comparison with surface area–based measurement in patients with anterior shoulder instability and glenoid bone loss. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Thirty patients with anterior shoulder instability underwent preoperative bilateral shoulder computed tomography (CT) scans. Three-dimensional CT (3D-CT) reconstruction with humeral head subtraction was performed to obtain an en face view of the 3D-CT glenoid. Glenoid bone loss was measured with the surface area and linear methods of measurement. Statistical analysis was performed with a paired 2-tailed t test. Results: Twenty-eight patients (5 female and 23 male; mean age, 25.1 years; age range, 15-58 years) were included in the study; 17 patients underwent a glenoid augmentation procedure, and 11 underwent arthroscopic Bankart repair. The mean percentage glenoid bone loss calculated with the surface area and linear methods was 12.8% ± 8.0% and 17.5% ± 9.7% (P < .0001), respectively. For the 17 patients who underwent glenoid augmentation, mean percentage bone loss with the surface area and linear methods was 16.6% ± 7.9% and 23.0% ± 8.0% (P < .0001), respectively. Conclusion: Linear measurement of glenoid bone loss significantly overestimates bone loss compared with surface area measurement in patients with anterior glenoid bony defects. These results indicate that these different methods cannot be used interchangeably and cannot be used with the same critical thresholds for glenoid bone loss.

Automated 3D MRI Allows for Accurate Evaluation of Glenoid Bone Loss as Compared to 3D CT

Objectives:Glenoid bone loss is frequently present in the setting of recurrent shoulder instability. The magnitude of bone loss is an important determinant of the optimal surgical treatment. The current gold-standard for measurement of glenoid bone loss is three-dimensional (3D) reconstruction of a computed tomography (CT) scan. CT scans, however, carry an inherent risk of radiation and increased cost for a second modality. Magnetic resonance imaging (MRI) offers excellent soft tissue contrast and may allow resolution of bony structures to generate 3D reconstructions without a risk of ionizing radiation. We hypothesized that automated 3D MRI reconstruction would offer similar measurements of glenoid bone loss as recorded from a 3D CT scan in a clinical setting.Methods:A retrospective review was performed for fourteen patients who had both pre-operative MRI scan and CT scan of the shoulder. All MR scans were performed on a 1.5 T scanner (Siemens) utilizing a Dixon chemical shift separation sequence and the out-of-phase images with 0.90 mm slice thickness. Reconstructions of the glenoid were performed from axial images (Figure 1A) using an open-platform image processing system (3D Slicer; slicer.org). A single point on the glenoid was selected and a standard threshold was used to build a 3D model (Figure 1B). High-resolution CT scans underwent 3D reconstruction in Slicer based on Houndsfield Unit thresholding. Glenoid bone loss on both scans was measured with the Pico method by defining a circle of best fit using the inferior 2/3 of the glenoid and determining the percent area missing from this circle. Pearson’s correlation coefficient was utilized to determine the similarity between MR and CT based measurements. Statistical significance was defined as p<0.05.Results:The correlation between 3D MR and CT-based measurements of glenoid bone loss was excellent (r = 0.95, p<0.0001). The mean bone loss as measured by the 3D MR was 13.2 +- 7.2% and was 12.5 +- 8.6% for the 3D CT reconstruction (p=0.32). Bone loss in this cohort ranged from 3.7-25.4% on 3D MR and 1.4-26.0% on 3D CT. The root-mean-square difference between measurements was 2.7%.Conclusion:There was excellent agreement between automated 3D MR and 3D CT measurements of glenoid bone loss and minimal differences between these measurements. This reconstruction method requires minimal post-processing, no manual segmentation, and is obtained with widely-available MR sequences. This method has the potential to decrease the utilization for CT scans in determining glenoid bone loss.Figure 1.(A) An axial T1-weighted Dixon subtraction MR image of the glenoid is used to develop a three-dimensional reconstruction of the glenoid. The three-dimensional reconstruction is shown for one patient for both MR scan (B) and CT scan (C), both produced in 3D Slicer with a single click on the glenoid and a threshold-based reconstruction method.

Effect Of Using Two Splinted Mini-Implants Versus Two Conventional Implants Retaining Mandibular Overdenture On Crestal Bone Loss

Objective: was to compare the marginal bone loss around two splinted Mini-implants and two conventional implants retaining mandibular 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 two splinted 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 implants of 4mm diameter and 12mm 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): Six months following denture insertion calculated means of the measured bone loss for the Mesial surfaces were 0.55 ± 0.1 mm, for the Distal surfaces were 0.68 ± 0.03 mm, for the Buccal surfaces were 0.53 ± 0.12 mm and for the Lingual surfaces were 0.51±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 0.68 ± 0.1 mm, for the Distal surfaces were 0.87 ± 0.7 mm, for the Buccal surfaces were 0.69 ± 0.1mm and for the lingual surface 0.67± 0.03mm. The calculated means of the measured bone loss were statistically significant ( P ≤ 0.05).Peri-Implant Bone Loss in Group (II): Six months following denture insertion calculated means of the measured bone loss for the Mesial surfaces were 0.51 ± 0.10 mm, for the Distal surfaces were 0.62 ± 0.08 mm, for the Buccal surfaces were 0.51 ± 0.09 mm and for the Lingual surfaces were 0.50 ± 0.09mm. The calculated means of the measured bone loss were statistically significant (P ≤ 0.05). Twelve months following denture insertion calculated means of the measured bone loss for the Mesial surfaces were 0.64 ± 0.10 mm, for the Distal surfaces were 0.83 ± 0.06 mm, for the Buccal surfaces were 064 ± 0.09 mm and for the Lingual surfaces were 0.64± 0.08 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 the two splinted Mini implants was higher than in group II of the two conventional implants for the Mesial, distal , buccal and lingual surfaces and over all bone loss at 6 months and 12 months but was found not statistically significant at P < 0.05.Conclusions: Within the limitation of this study, it could be concluded that marginal bone loss around two splinted Mini implants supporting and retaining mandibular complete overdenture is higher than the marginal bone loss around two conventional implants supporting and retaining mandibular complete overdenture although the difference was statistically insignificant.

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.

The Relationship Between Marginal Bone Loss Around Dental Implants and the Specific Characteristics of Implant-Prosthetic Treatment

Abstract The marginal bone loss around dental implants is an important indicator that helps to evaluate the course and the final outcome of implant-prosthetic treatment. It is, therefore, important to understand the factors that may affect this. The aim of the study was to assess the impact of the specific characteristics of implant-prosthetic treatment on the marginal bone loss around implants. The study included 28 patients, aged 37-66 years, treated with dental implants. Every patient received at least one of the two types of implants: with Morse taper connection and with internal hexagonal connection. The average marginal bone loss around the implants was evaluated on the basis of the panoramic radiographs. The maximum follow-up period after implantation was 46 months. The peri-implant marginal bone loss was evaluated taking into consideration the implant localisation, the procedure of sinus lift with bone augmentation, implant type, implant diameter, vertical implant position relative to the compact bone level and the type of prosthetic restoration, the time between implantation and loading with prosthetic restoration, as well as the time between loading and the measurement of marginal bone loss. The correlation between bone loss and the selected characteristics of the treatment was assessed using generalised estimating equations (GEE). An objective analysis was enabled via the applied research model: evaluation of an impact of the specific implant-prosthetic treatment characteristics on peri-implant marginal bone loss in patients treated with implants with different implant-abutment interface systems. The results of the study showed that peri-implant marginal bone loss increased significantly with implant localisation in canine sites (compared to the localization in premolar sites), as well as with prosthetic restorations in the form of dentures (compared to bridges), and decreased when implants were placed below the compact bone level (compared to those placed at the bone level). At the same time, marginal bone loss was not significantly related to implant diameter or to the sinus lift procedure. The results obtained seem extremely useful in everyday clinical practice

A retrospective study on molar furcation assessment via clinical detection, intraoral radiography and cone beam computed tomography

BackgroundAccurate determination of bone loss at the molar furcation region by clinical detection and intraoral radiograph is challenging in many instances. Cone beam computed tomography (CBCT) is expected to open a new horizon in periodontal assessment. The purpose of this study was to compare and correlate accuracy of molar furcation assessment via clinical detection, intraoral radiography and CBCT images.MethodsEighty-three patients with chronic periodontitis who had existing CBCT scans were included. Furcation involvement was assessed on maxillary and mandibular first molars. Periodontal charts (modified Glickman’s classification), intraoral (periapical and/or bitewing) radiographs (recorded as presence or absence) and axial CBCT reconstructions were used to evaluate furcation involvement on buccal and palatal/lingual sites. The correlation of furcation assessment by the three methods was evaluated by Pearson analysis.ResultsThere were significant correlations (p < 0.05) between clinical detection and intraoral radiography, clinical detection and CBCT, as well as intraoral radiography and CBCT at all the measured sites (r values range between 0.230 to 0.644). CBCT generally exhibited higher correlation with clinical detection relative to intraoral radiography, especially at distal palatal side of maxillary first molar (p < 0.05). In addition, CBCT provided more accurate assessment, with bone loss measurement up to 2 decimals in millimeters, whereas clinical detection had 3 classes and the intraoral radiographs usually only detected the presence of furcation involvement in Glickman Class 2 and 3.ConclusionsThis study validates that CBCT is a valuable tool in molar furcation assessment in addition to clinical detection and intraoral radiography.

A retrospective study on the crestal bone loss associated with different implant surfaces in chronic periodontitis patients under maintenance.

To analyze retrospectively interproximal crestal bone loss (CBL) on external-hex "non-identical" (NI) dental implants with different surface topography, when placed in the same intra-oral location in patients with a history of chronic periodontitis following maintenance care. The patient population consisted of 206 consecutive patients with a history of chronic periodontitis who underwent implant surgery between 2007 and 2010; 755 NI implants with different implant surfaces were placed at posterior mandibular sites: 72 machined, 145 acid-etched/machined (hybrid), and 538 anodized. Crestal bone loss measurements were carried out analyzing the calibrated digital X-rays taken at 1-year intervals as part of the maintenance program, being the time of this retrospective examination from 1 to 3years. At 3years (51 patients), the mean CBL was 1.36/1.35mm at implant/patient level (range: 0-6mm). A higher CBL was observed at anodized surface implants, when compared to machined and hybrid implants, being the mean CBL 1.48, 0.96, and 0.77mm, respectively (p=.005). CBL between 2 and 3.9mm was found in 10.6% of the implants at 3years (95% CI: 6%-15%), ≥4mm in 5% (95% CI: 2%-8%). Anodized surface implants had CBL >2mm at 2years of 9% (95% CI: 6%-12%) and at 3years of 18% (95% CI: 12%-24%), which were 2.5 times higher than hybrid implants with 3.6% (95% CI: 0.8%-4%) and 7.4% (95% CI: 0%-17%), respectively. A higher CBL was observed in the anodized surface implants group, when compared to the hybrid implants group in patients with a history of chronic periodontitis followed during 1-3years.

Is the Bare Spot reliable for the bone loss measurement?

To evaluate the reliability of the Bare Spot (BS) as an anatomical landmark for the intra-operative definition of bone loss in anterior shoulder instability. The distances from the BS to the anterior (BS-A), posterior (BS-P) and inferior margins of the glenoid cavity were determined both under arthroscopic visualization and by an open approach in 20 shoulders. The BS did not coincide with the centre of the glenoid cavity of the studied shoulders because the BS-P distance was greater than the BS-A distance (p < 0.05) and was located 40% closer to the anterior margin. The authors suggest a correction factor: BP-A × 1.25/BP-P = 1. The BS is located at a mean distance of 40% of the joint diameter, relative to the anterior margin of the glenoid. This point may be used as a landmark, using a correction factor of its mostly anterior positioning. Arthroscopy was reliable for bone measurements of the shoulder joint.

Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Outcomes in Arthroscopic Treatment

Background: Glenoid bone loss is a well-accepted risk factor for failure after arthroscopic stabilization of anterior glenohumeral instability. Glenoid bone loss in posterior instability has been noted relative to its existence in posterior instability surgery. Its effect on outcomes after arthroscopic stabilization has not been specifically evaluated and reported. Purpose: The purpose was to evaluate the presence of posterior glenoid bone loss in a series of patients who had undergone arthroscopic isolated stabilization of the posterior labrum. Bone loss was then correlated to return-to-duty rates, complications, and validated patient-reported outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted at a single military treatment facility over a 4-year period (2010-2013). Patients with primary posterior instability who underwent arthroscopic isolated posterior labral repair were included. Preoperative magnetic resonance imaging was used to calculate posterior glenoid bone loss using a standardized “perfect circle” technique. Demographics, return to duty, complications, and reoperations, as well as outcomes scores including the Single Assessment Numeric Evaluation and the Western Ontario Shoulder Instability Index (WOSI) scores, were obtained. Outcomes were analyzed across all patients based on percentage of posterior glenoid bone loss. Bone loss was then categorized as below or above the subcritical threshold of 13.5% to determine if bone loss effected outcomes similar to what has been shown in anterior instability. Results: There were 43 consecutive patients with primary, isolated posterior instability, and 32 (74.4%) completed WOSI scoring. Mean follow-up was 53.7 months (range, 25-82 months) The mean posterior glenoid bone loss was 7.3% (0%-21.5%). Ten of 32 patients (31%) had no appreciable bone loss. Bone loss exceeded 13.5% in 7 of 32 patients (22%), and 2 patients (6%) exceeded 20% bone loss. Return to full duty or activity was nearly 90% overall. However, those with >13.5%, subcritical glenoid bone loss, were statistically less likely to return to full duty (relative risk = 1.8), but outcomes scores, complications, and revision rates were otherwise not different in those with no or minimal bone loss versus those with more significant amounts. Conclusion: Posterior glenoid bone loss has not previously been evaluated independently relative to patients with shoulder instability repairs. Sixty-nine percent of our patients had measurable bone loss, and 22% had greater than 13.5%, or above subcritical bone loss. While these patients were statistically less likely to return to full duty, the reoperation rate, complications, and patient-reported outcomes between groups were not different.

Comparison of digital protocols for the measurement of peri-implant marginal bone loss.

BackgroundThe measurement of peri-implant marginal bone loss is currently carried out using digital methods of radiographic analysis assisted by various types of software. The purpose of this study was to compare the characteristics of three different softwares: specific radiology software for the development and visualization of radiological images in DICOM format (3Dicom Viewer®), advanced level software for professional editing of bitmap images (or raster graphics) (Adobe Photoshop®), and mid-level software for processing bitmap-type images, programmed in Java and in the public domain (ImageJ®).Material and MethodsIt was verified that the three softwares used are valid for the measurement of peri-implant marginal bone loss provided that the appropriate protocol is fulfilled.ResultsThe results showed no significant differences between Adobe Photoshop® and ImageJ® with respect to 3Dicom Viewer® in the measurements of mesial and distal bone loss of the implants, without influence of the dental sector where they were located.ConclusionsThe measurements made with ImageJ® looked more like those of the control software (3Dicom Viewer®) than those of Adobe Photoshop®, but with a greater degree of dispersion. Thus, Adobe Photoshop® is a slightly inaccurate method but with less dispersion. Key words:Digital measurement, measurement software, peri-implant marginal bone loss, implants.

Immediately placed dental implants in smokers with plasma rich in growth factor versus without plasma rich in growth factor: A comparison.

Introduction:The placement of implants into fresh extraction sockets was introduced in 1970. This approach has been reviewed extensively during the past decade. Immediate postextraction implant placement is a well-accepted protocol. The concept of placement of dental implants soon after the removal of a tooth in smokers, however, is still a matter of controversy.Purpose:(i) To access failure rate of dental implant in smokers (ii) To evaluate added advantage of plasma rich in growth factors (PRGFs) in immediate placement of dental implants in smokers.Materials and Methods:The sample of 30 patients was obtained from the different Outpatient Department of Faculty of Dental Sciences; King George's Medical University, Lucknow, who had visited for rehabilitation of missing teeth by implants between April 2013 and July 2015. They were randomly divided into two groups (without use of PRGF and with use of PRGF) of 15 each. Pre- and postoperative assessment included a thorough history and clinical examination, regression of pain and swelling, implant stability by resonance frequency analysis (RFA), and implant stability according to the bone type as well as radiographic interpretation for measurement of bone loss on the mesial and distal surfaces of the implant.Results:In this study, pain and swelling were significantly (P < 0.05) higher in Group A than in Group B across the time interval. RFA score for implant stability was lower in Group A across the period than Group B. At the end of 3 months, RFA score (mean) in Group A was having 72.55 ISQ value, and in Group B, it was 75.71 ISQ value. In this study, postoperative crestal bone loss was more in patients in Group A as compared to patients in Group B. There was significant difference in mesial (P = 0.003) and distal (P = 0.001) crestal bone loss at 6 months between the groups.Conclusion:The immediate placement of dental implants in smokers with use of PRGF is shown to be efficient in relation to postoperative pain and swelling, stability, stability according to bone type, as well as bone loss.

New concepts of radiologic preoperative evaluation of anterior shoulder instability: on-track and off-track lesions.

The shoulder is the most frequently dislocated joint in the body due to a larger range of motion and a small area of articulation between the humeral and glenoid surfaces. Traumatic shoulder dislocations, especially those associated with injury to the labroligamentous or bony stabilizers of the joint, lead to further reduction of articular surface contact with resultant glenohumeral instability and recurrent shoulder dislocations. Imaging plays an increasingly important role in the preoperative evaluation of patients with traumatic shoulder instability by evaluating glenohumeral bone loss (uni- or bipolar), assessing soft tissue injuries and identifying patients at risk of postoperative recurrence. Quantification of bone loss is key to differentiate engaging vs. non-engaging Hill-Sachs lesions, while newer concepts of "on-track" vs. "off-track" lesions are being discussed that can determine the required surgical approaches. In this article, we review the preoperative imaging approaches, traditional treatments, outline the bone loss measurement strategies and review these new tracking concepts with relevant case examples.

Volumetric Bone Measurement Around Dental Implants Using 3D Image Superimposition: A Methodological and Clinical Pilot Study.

This study describes the development of a methodology for using three-dimensional (3D) image superimposition to measure volumetric changes in bone level around dental implants in comparison with linear measures. The sample was comprised of 46 dental implants of 6-mm length and 4.1-mm diameter placed in the posterior maxilla and posterior mandible in 20 patients. All implants received screw-retained single crowns. Radiographic images were taken using cone beam computed tomography (CBCT) and digital periapical radiography after implantation and after 12 and 24 months of functional loading (after crown installation). Tridimensional reconstructions of the bone perimeter closest to the implant were developed, superimposed, and volumetrically measured. Linear measures of bone levels were recorded in periapical radiography images. A multilevel regression model tested volumetric and linear bone loss. The mean peri-implant linear bone loss for the first and second years was 0.2 ± 0.4 mm and 0.1 ± 0.2 mm, respectively, and the mean volumetric bone loss for the first and second years was 7.2 ± 6.1 mm³ and 6.4 ± 7.8 mm³, respectively. It was estimated that an increase of 1 mm of linear bone loss was associated with a mean volumetric bone loss of approximately 14 mm³ (P < .001). The findings showed that linear and volumetric bone loss measures are related. Measuring volumetric bone changes around implants is possible provided that the CBCT images have proper contrast and sharpness, particularly around the implant outline. Improvements in image quality and in the filters for bone tissue detection would be important for this methodology to be made faster and used clinically.

The influence of crown-to-implant ratio on marginal bone levels around splinted short dental implants: A radiological and clincial short term analysis.

The amount of marginal bone resorption around dental implants is considered to have a significant impact on implant stability as well as implant survival rates. The aim of this prospective study was to investigate the influence of prosthetic as well as patient specific factors on marginal bone loss around short dental implants. Seventy-six implants, which supported splinted crowns were included for investigation. All implants were from the same type and had an intraosseous length of 6.5 mm and a diameter of 4.0 mm. Twenty implants were additionally splinted onto longer ones. Measurements of marginal bone loss were performed at a mean of 12.38 months after prosthetic loading and the mean follow-up for clinical evaluation was 20.52 months. Overall two implant failures were recorded, revealing a survival rate of 97.3%. Marginal bone resorption around 72 short implants measured 0.71 mm (SD: 0.74 mm) and was found to have a strong correlation with calculated Crown-to-Implant ratio (r = .71; P < .001). Age, gender, insertion torque, implant surface area, location, position, bone quality, and insertion torque did not influence peri-implant bone loss after one year of loading. Within the limitations of the study, it is suggested that Crown-to-Implant ratios should not exceed 1.7 to avoid increased early marginal bone loss.

Effects of Curcumin on Alveolar Bone Loss in Experimental Periodontitis in Rats: A Morphometric and Histopathologic Study

Background: Curcumin is found in the rhizomes of the turmeric plant that has been showed antioxidant and anti-inflammatory effect. The aim of this study was to evaluate the effects of systemic curcumin therapy on alveolar bone loss in an experimental periodontitis model in rats. Material and Methods: Thirty-two male Wistar rats were randomly divided to 4 groups: 75 mg/kg/daily curcumin (C75; n =8), 150 mg/kg/daily curcumin (C150; n =8), Control (n =8), and Ligated (n =8). Curcumin was administrated using gastric gavage. After 12 days, the rats were sacrificed. Right mandibles samples were histopathologically examined. Alveolar bone loss was measured. Interleukin 1β (IL-1β) and interleukin 10 (IL-10) were evaluated in the serum samples and gingival homogenates. Results: The measurements of alveolar bone loss in the mandibular molars revealed significantly higher bone-loss values in the Ligated group than the Control, C75 and C150 groups. The IL-1β levels in the gingival homogenates were significantly increased in the Ligated group compared to those of the Control, C75 and C150 groups. The serum IL-1β levels in the Ligated group were significantly higher than the Control group. The mean osteoblast numbers in the Ligated group were lower than those of the Control, C75 and C150 groups. The C150 groups showed significantly more osteoblasts than the Control group. The osteoclast numbers in the Ligated group increased significantly compared to the C75, C150 and control groups. Conclusion: This study demonstrates that systemic administration of curcumin at the 75 and 150mg/kg doses reduced alveolar bone loss in the periodontal disease in rats. Keywords: Alveolar bone loss, Antioxidant, Curcumin, Ligature-induced, Histomorphometric, Micronutrition.