Interproximal Bone Loss Research Articles

Implant-Supported Vertical Soft Tissue Augmentation for Severe Hard and Soft Tissue Deficiencies at Malpositioned Implants: A Case Report of a Mucogingival and Restorative Approach.

The management of severe mucogingival deformities surrounding malpositioned implants represents a complex issue with a high risk of aesthetic failure. The present case report describes a mucogingival and restorative approach for the treatment of severe localized peri-implant tissue deficiencies with interproximal bone loss combined with an interproximal gingival recession on the adjacent natural tooth. This consists of maintaining a non-restorable malpositioned implant, submerging it through one or multiple vertical soft tissue augmentations, according to the defect severity, and delivering a tooth supported bridge involving the adjacent natural teeth. The step-by-step surgical technique adopted for implant submergence and vertical soft tissue grafting, as well as the subsequent surgical and prosthetic interventions, are described, presenting results at 5 years from implant submergence and 3 years from prosthetic finalization.

THE USE OF A MODIFIED DEEPITHELIALISED FREE GINGIVAL GRAFT IN THE TREATMENT OF GINGIVAL RECESSIONS ASSOCIATED WITH INTERPROXIMAL BONE LOSS. CASE REPORT

The prevalence of gingival recessions is very high, and it increases with age. The gingival recessions occur frequently in populations both with high and low standards of dental care. Gingival recessions are surgically treated to improve aesthetics, reduce root hypersensitivity. Recently, the coronally advanced flap is more frequently used, displacing the free gingival graft and the laterally positioned flap. Connective tissue graft or a deepithelialised free gingival graft is often used in combination with coronally advanced flap. It has been stated, that periodontal plastic procedures may predictably determine complete root coverage in multiple Miller class I and II recessions. According to the treatment of multiple Miller class III recessions, there is lack of evidence by clinical trials in the literature. It should be considered, that dealing with multiple recessions can be associated with different limitations in the same surgical area, such as interproximal bone loss, larger avascular surface, position of the teeth, high muscle and frenulum attachments, etc. There is a quite big difference in the literature according to the data of complete root coverage percentage. Another problem is dealing with black triangles because of interproximal bone loss. Of course, patients expect not only recession closure, but also papillary reconstruction. But it is very hard to predict a complete root coverage at Miller class III recession and papillary reconstruction at the same time. The purpose of this clinical report is to evaluate the effectiveness of the coronally advanced flap in combination with modified deepithelialised free gingival graft (MDFGG). The scalloped form of the deepithelialised free gingival graft in combination with the coronally advanced flap helped to solve two problems simultaneously: recession closure and papillary reconstruction. The results lead to further researches for the treatment of Miller class III and IV recessions, and also papillary reconstruction techniques.

Regeneration of Intrabony Defects Using a Novel Magnesium Membrane.

Background and Objectives: Due to their specific morphology, the regeneration of intrabony defects (IBDs) represents one of the greatest challenges for clinicians. Based on the specific properties of a magnesium membrane, a new approach for the surgical treatment of IBD was developed. The surgical procedure was described using a series of three cases. Materials and Methods: The patients were healthy individuals suffering from a severe form of periodontitis associated with IBD. Based on radiographic examination, the patients had interproximal bone loss of at least 4 mm. Due to its good mechanical properties, it was easy to cut and shape the magnesium membrane into three different shapes to treat the specific morphology of each IBD. In accordance with the principles of guided bone regeneration, a bovine xenograft was used to fill the IBD in all cases. Results: After a healing period of 4 to 6 months, successful bone regeneration was confirmed using radiological analysis. The periodontal probing depth (PPD) after healing showed a reduction of 1.66 ± 0.29 mm. Conclusions: Overall, the use of the different shapes of the magnesium membrane in the treatment of IBD resulted in a satisfactory functional and esthetic outcome.

Higher expression of Th1/Th2‐related cytokines in the intestine of Wistar rats with ligature‐induced periodontitis

This study aimed to investigate the impact of ligature-induced periodontitis (LIP) on histopathological and immunological outcomes in the colon of Wistar rats. It has been repeatedly shown that inflammatory bowel disease (IBD) patients are at higher risk of developing periodontitis and presenting worse oral health than non-IBD patients. However, whether the chronic inflammatory process around teeth contributes to the pathophysiology of IBD needs to be further explored. Thirteen Wistar rats were allocated into LIP (n = 7) and controls (n = 6). Half of the colon was processed for histopathological analyses and immunohistochemical (CD45); the other half was homogenized for immunological analyses. Periodontal destruction was confirmed by measuring the distance from the cementum-enamel junction to the mandible's apical position of the mesial interproximal bone. The immunological analyses were performed with the Bio-Plex Th1/Th2 assay. There was a significantly higher interproximal bone loss in LIP compared to controls. The LIP group showed a moderate infiltrate of inflammatory cells, predominantly mononucleated cells in the intestinal tissues. There was significantly higher expression of GM-CSF, IFN-γ, IL-1α, IL-1β, IL-2, IL-4, IL-5, IL-10, IL-12 (p70), IL-13, and TNF-α in the intestinal tissues of LIP group compared to controls. Ligature-induced periodontitis was associated with an overexpression of Th1/Th2-related cytokines in the colon of Wistar rats.

Tooth Retention and Clinical and Radiographic Long-Term Results Among Patients Treated with the Full-Mouth Laser-Assisted New Attachment Procedure (LANAP): A Case Series.

There are limited long-term treatment results for patients who receive full-mouth laser-assisted new attachment procedure (LANAP). The present study examined cases of full-mouth LANAP therapy for tooth retention, including clinical and radiographic changes. Sixty-six generalized stage III/IV periodontitis patients aged 30 to 76 years were identified via consecutive retrospective chart reviews in a private practice limited to periodontics. Following treatment with the LANAP protocol, differences between baseline and the patient's most recent periodontal maintenance visit (mean: 6.7 years) were determined regarding interproximal probing depths (iPD) and interproximal bone loss (iBL) percentages. Factors affecting tooth loss were analyzed using Cox proportional hazard regression survival analysis. The average tooth loss for the study population was 0.11 teeth/patient/year. Premolars were more likely to be retained compared to the reference group of incisors (hazard ratio = 0.38; 95% CI = 0.16 to 0.90; P = .03), adjusting for canines, molars, and other potential confounding factors. Age at the time of LANAP treatment, gender, history of diabetes, and baseline iBL and iPD were all significantly associated with tooth loss after full-mouth LANAP treatment. Clinical changes in iPD were more significant among premolars and molars when followed up for a period of less than 7 years. Tooth retention after full-mouth LANAP treatment was favorable in this cohort of private practice patients. Int J Periodontics Restorative Dent 2023;43:181-191. doi: 10.11607/prd.6418.

Unraveling the quantification of intrabony defect

Periodontitis a chronic inflammatory disease caused by dysbiotic plaque biofilm is characterized by the destruction of periodontal supporting structures. Based on the direction and angle, interproximal bone loss can either be horizontal or vertical. The identification and evaluation of these defects are imperative to ascertain therapeutic intervention. In this review, a detailed discussion about various methods adopted in evaluating interproximal bone defect is scrutinized.

Bone‐level changes around implants with 1‐ or 3‐mm‐high abutments and their relation to crestal mucosal thickness: A 1‐year randomized clinical trial

To evaluate 1-year bone-level changes around subcrestal platform-switching implants with 1 or 3 mm definitive abutments. The influence of mucosal thickness on bone-level alterations was further analysed. Implants were placed in the posterior sextants and positioned 1.5 mm subcrestally with an abutment of 1 or 3 mm height. Final restorations were delivered after 16 weeks. Radiographic measurements of inter-proximal bone level were the primary outcome and were adjusted by vertical mucosal thickness. Peri-implant clinical conditions and resonance frequency analysis were also compared. A total of 65 subjects with 99 implants were analysed. The overall 1-year implant survival rate between the 1- and 3-mm groups was 96.4% and 94.4%, respectively. Statistically significant lower inter-proximal marginal bone-level changes were observed in the 3-mm group (1 mm: -0.17 ± 0.02 mm at mesial and -0.21 ± 0.02 mm distal; 3 mm: -0.03 ± 0.02 mm at mesial and -0.03 ± 0.02 mm and distal; mesial: p=.001; distal: p < .001). Initial vertical mucosal thickness was not correlated with inter-proximal marginal bone loss. Subcrestal implants with 3-mm abutment were associated with minimal inter-proximal bone loss. Independent of the abutment height, crestal mucosal thickness was not correlated with bone loss.

The Relationship Between Periodontal Disease and ABO Blood Groups: A Cross-Sectional Study.

The objective of this cross-sectional study was to evaluate the relationship between ABO blood groups and periodontal diseases. Four hundred sixteen subjects (223 females, 193 males) were recruited according to the eligibility criteria. Periodontal examination was performed, including full-mouth plaque index (PI), bleeding on probing (BOP), clinical attachment level (CAL), and interproximal bone loss (IBL). ABO blood group patterns were determined based on self-reports, confirmed by medical records. The chi-squared test was done to evaluate the data (p < 0.05). Out of the 416 subjects, 52.2% were blood group O, whereas 27.8% were blood group A. 46.8% of patients with blood group O had gingivitis and 49.6% had periodontitis. 31.2% of patients with blood group A had gingivitis,while 29.5% had periodontitis. The blood group with the lowest percentage among patients with gingivitis was AB, with a rate of 6.2%; in this blood group, 8.1% had periodontitis. There is no association between periodontal diseases and ABO blood group types.

Probing single-tooth dental implants with and without prostheses: a cross-sectional study comparing healthy and peri-implant mucositis sites.

To evaluate differences in probing depth (PPD) with and without a prosthesis in implants without interproximal bone loss (IBL). Secondarily, to assess whether the difference in PPD measured with and without the crown was affected by diagnosis or implant location. A cross-sectional study was conducted in patients with a single screw-retained implant-supported crown in the posterior area, without IBL. PPD and was assessed before and after crown removal. A subgroup analysis compared healthy vs. mucositis implants and premolar vs. molar locations. In the 62 implants analysed (23 healthy and 39 with mucositis), the PPD was 1.15mm (SD=1.24mm) deeper without the prosthesis than with it (p<.001). This difference was independent of the implant location (p>.05) except for buccal sites (p=.048). The mean PPD difference for implants with mucositis was 0.95mm (SD=1.19mm; p<.001) while healthy implants had a mean PPD variation of 1.47mm (SD=1.29mm; p<.001). The presence of prosthesis in single-tooth implants in the posterior area without IBL seems to lead to an underestimation of PPD that appears to be significant in implants diagnosed with mucositis, although the difference is even greater in healthy implants. Further studies are needed to confirm these findings.

Crestal bone loss associated with different implant surfaces in the posterior mandible in patients with a history of periodontitis. A retrospective study.

To retrospectively assess the interproximal bone loss (CBL) in external hexagon implants (EHI), with different surface micro-topography, placed in the posterior mandible in patients with a history of periodontitis undergoing supportive periodontal care. 268 consecutive patients received 755 EHI implants in the mandibular molar region between 2007 and 2015 with the following surface characteristics: 72 turned, 145 hybrids (double acid-etched/turned), and 538 anodized. CBL was yearly evaluated by analysing calibrated digital periapical radiographs, with a follow-up of 1-6years. Data on implant survival were also calculated. At 6years (53 patients), the mean CBL was 1.34/1.42mm at patient/implant level, respectively (range: 0-5.2mm). Significantly higher CBL was detected in anodized implants than in turned and hybrid implants (1.92/1.46/1.02mm) (p<.01). The maximum CBL values were found in 2 anodized implants at 4years (6.3 and 8.1mm). CBL≥2mm was detected in 18% of implants at 3years and 35% at 6 (p<2.2×10-16 ), this prevalence being 2.6 times higher in the anodized than in the hybrid and turned group (40%/15.6%, p<.0094). At 6years, 25 anodized implants presented CBL≥3mm (18%). 6 anodized implants (5 patients) were removed between 4 and 5years. A significant higher CBL was observed in anodized, compared to hybrid and turned implants, when placed in the mandibular molar region of periodontal patients, with a follow-up of 1 to 6years.

A fixed reconstruction of fully edentulous patients with immediate function using an apically tapered implant design: a retrospective clinical study

BackgroundImmediate function has become an accepted treatment modality for fixed restorations in completely edentulous jaws. It is known that implant microtopography (surface) may enhance osseointegration, while implant macrotopography (macrodesign) plays an important role in primary stability in the patient requiring an immediate loading. The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of the edentulous subjects treated with narrow and/or regular diameter, which placed and loaded immediately.MethodsForty-two consecutive patients received 171 implants, including regular and narrow diameter implants (NDIs). Each jaw, 19 mandibles and 24 maxillae, was treated with a fixed-full arch prosthesis according to the Straumann® Pro Arch concept. The majority (95%) of the restorations were supported by four implants, of which the posterior two implants were tilted. A provisional functional acrylic prosthesis was delivered on the day of surgery. All patients were followed up to 55 months. Cumulative survival rate was determined using Kaplan-Meier analysis. Radiological measurement of marginal bone level was performed.ResultsThe overall follow-up time for survival rate was up to 55 months. Four implants (3 implants in maxilla, 1 implant in mandible) were lost, resulting in an overall cumulative implant survival rate of 97.7%. Implant survival rate in the axial and tilted implants was not statistically significant. The mean of interproximal marginal bone loss was 0.15 mm after 24 months. Good soft tissue health was observed in almost 99% of patients. The final prosthesis survival rate was 100%.ConclusionsThe results of this retrospective pilot study indicated that total edentulous patients requiring an immediate implant placement and loading can be successfully treated with this implant design. The improved mechanical properties of these implants might give a more conservative treatment option for the jaws showing a severe horizontal alveolar bone resorption.

Digital vs. Freehand Anterior Single-Tooth Implant Restoration.

Replacing a single tooth in the anterior maxilla is one of the greatest challenges in dentistry. Both functional and aesthetic results are to be strictly pursued. Planning and executing such a case through a totally digital methodology eventually guarantee many advantages, above all patient's operative and postoperative comfort. To ascertain this, a BOP analysis was performed which allowed us to evaluate soft tissues health, and more; crestal bone resorption was measured to evaluate hard tissues stability. This assumption was studied through four cases in which patients were alternatively treated with analogic and digital techniques. Four homogeneous patients were recruited. They all needed to extract one of the upper incisors, due to different clinical reasons, and then to replace it with an implant. Each patient was treated with an immediate postextractive implant which was immediately loaded, and finally, analogical and digital techniques were compared. All patients underwent a preoperative CBCT examination. After surgery, patients were checked by the surgeon after 10 days and one month to evaluate the progress of healing and to exclude any prosthetic problem. At 6 months (T1), one year (T2), and three years (T3), intraoral x-rays were performed using customized centring devices, according to the parallel beam technique. All data have been collected in a table and statistically processed; mean and standard deviation were measured. All patients entered an oral hygiene program with six months recall. Dental hygienist checked the BOP at T1, T2, and T3. At every step, similar levels of BOP were recorded. About interproximal bone loss, all patients showed an initial moderate loss (between T1 and T2), followed by stable values between T2 and T3. Despite the important limitations of a study with few cases, these results show a similar outcome comparing digital and analogical methods.

A graphical user interface for automated 2- or 3-dimensional image registration in dental treatment recovery planning: the DentIR application.

Cone-beam computed tomography (CBCT) scans enable quantification of interproximal bone loss after implant procedures in dental patients. In order for this quantification to be accurate, software is typically used to manipulate image sets captured before and after implantation to obtain their exact registration (i.e., alignment). However, no affordable CBCT image registration software is currently available for dental applications. Thus, the aim of the present study was to develop a freely available graphical user interface, called DentIR, that automates 2-dimensional (2-D) or 3-D image registration for use in planning dental treatment. The DentIR app was designed using the MATLAB environment, downloaded to a desktop personal computer (PC and Mac), and tested for its ease of use and alignment accuracy in the absence of the MATLAB environment. The DentIR app enabled previewing of the CBCT images in 3-D to allow for filtering of each frame to reduce noise and blurring before registration. The 2-D or 3-D registration was tested with four transformation methods. The accuracy of each method was assessed by comparing the mean squared error and the peak signal-to-noise ratio values that were provided by the DentIR app. The registered images could be saved as Portable Network Graphics (PNG) images. The free, user-friendly DentIR app was easily downloadable to Mac or PC platforms. It provided accurate image registration to aid in the planning of dental treatment. Future updates of the DentIR app include adding the ability to register more than two images at once, enhancing image editing options and enabling registration of a cropped portion of the image for more in-depth analyses.

Stainless steel crowns as a restoration for permanent posterior teeth in people with special needs: A retrospective study

BackgroundLimited information exists regarding the use of stainless steel crowns (SSCs) in permanent teeth. The objective of this retrospective cohort study was to present the long-term clinical outcomes of the SSC compared with those of amalgam and composite resin restorations and the SSC radiographic outcomes in a special-needs population. MethodsThis study included 271 patients with at least 1 SSC restoration from the Mount Sinai Hospital Dentistry Clinic for Persons with Special Needs in Toronto, Ontario, Canada. A total of 2,621 posterior permanent tooth restorations were documented: 766 SSCs, 1,651 amalgam restorations, and 204 composite resin restorations. Clinical analysis included patient demographics, treatment parameters, and outcome assessments for each restoration recorded. Radiographic analysis of SSC restorations included 127 bite-wing radiographs and 118 periapical radiographs, measurement of interproximal bone loss, and assessment of periapical status using the Periapical Index Scale. ResultsThe 10-year survival rates for new SSC and amalgam restorations were 79.2% and 63.5%, respectively. The 91 SSC failures included 2 recementations, 33 replacements, and 56 extractions. Primary diagnoses at the time of failure included chronic periodontal disease (25) and loose or lost SSCs (24). Of the 528 failed conventional restorations that were replaced, 60% were replaced with SSCs. The mean alveolar bone loss from mesial and distal sites was 1.36 millimeters and 1.40 mm, respectively. Therefore, 93% of the sites recorded were less than 2 mm and classified as healthy. All pre-SCC and post-SSC periapical radiographs had healthy Periapical Index Scale scores (1 or 2) recorded over an average duration of 8.4 years (1-29.1 years). ConclusionsSSCs are a durable treatment option for the restoration of the posterior permanent dentition. Practical ImplicationsPosterior permanent teeth restored with stainless steel crowns can be expected to last for 10 years and represent a viable treatment choice for severely carious or fractured posterior permanent teeth.

Influence of Z Shaped Incisions on Healing and Interproximal Bone Loss in Comparison With Conventional Sulcular Incisions in Implant Surgery

Influence of Z Shaped Incisions on Healing and Interproximal Bone Loss in Comparison With Conventional Sulcular Incisions in Implant Surgery

The Effect of Platform-Switching Plus Laser Grooving on Peri-implant Hard and Soft Tissue Level: A Randomized, Controlled, Blinded Clinical Trial

Twenty patients were randomly assigned to receive either a platform-switched or platform-matched implant to replace a single maxillary anterior tooth. Primary outcome variables were the implant interproximal bone loss, facial recession, and papilla fill at 12 months. The platform-switched group showed crestal bone loss of 0.1 ± 0.3 (mesial) and 0 mm (distal) while the platform-matched group showed losses of 0.6 ± 0.5 mm (mesial) and 0.7 ± 0.7 mm (distal) (P < .05). Facial recessions for the platform-switched and platform-matched groups were 0.1 ± 0.3 mm and 0.4 ± 0.8 mm, respectively.

Laterally positioned flap with chorion membrane for coverage of isolated gingival miller class III recession

The treatment of gingival recession (GR) defects is indicated for esthetic reasons, to reduce root sensitivity, to remove muscle pull, and to create or augment keratinized tissue. Various root coverage procedures have been used to cover localized GRs, such as laterally repositioned flaps (LPF), coronally advanced flaps, free gingival grafts, connective tissue pedicle flaps with a free gingival graft, subepithelial connective tissue grafts, acellular dermal matrix allografts, and guided tissue regeneration. The predictability of these perioplastic surgery procedures may be associated with different conditions, especially the initial recession classification. This report discusses Miller Class III isolated GR case with interproximal bone loss and wide and deep defects treated with a combination procedure of an LPF and chorion membrane.

Impact of Modifiable Risk Factors on Bone Loss During Periodontal Maintenance.

The aim of this study was to analyze modifiable patient risk factors from dental chart histories and radiographs for progressive mild-moderate periodontitis during periodontal maintenance (PM). Bitewing radiographs of 442 elderly periodontal maintenance patients were taken before and after two years of periodontal maintenance. Each progressive periodontitis (PP) patient (with at least one site of posterior interproximal bone loss of ≥2 mm, n=71) was matched to a periodontitis stable (PS) patient (no sites with bone loss, n=71) of the same gender and age (±five years) to control for these variables and was compared for measurements of general patient (medical history, smoking, hygiene and compliance habits) and tooth-related (bone loss, overhangs, interproximal dimensions) factors at baseline. Fisher exact and t-tests were used to compare groups. While the elderly PM patients with mild-moderate periodontitis were generally stable, 71 of 442 were PP patients. No significant differences from PS patients were observed at baseline with regard to the systemic factors measured. However, the PP group had less cementoenamel junction to bone length (bone loss p<0.0001) and more interproximal width (2.3±1.0 mm) than did the PS group (1.7±0.6 mm, p=0.0016). This was reflected in more open sites without adjacent tooth contact in PP (42% vs 15%, p=0.0006). In the short term, systemic and behavior factors are of limited value in identifying mild-moderate periodontitis patients on PM at increased risk of bone loss. However, interproximal width and lack of adjacent tooth contacts are related to the likelihood of losing interproximal bone during periodontal maintenance, suggesting the need for restorative therapy.

Impact of endodontic post material on longitudinal changes in interproximal bone level: a randomized controlled pilot trial.

Aim was to evaluate the impact of glass fiber versus titanium endodontic posts on the interproximal bone level around severely damaged endodontically treated teeth. Thirty-eight participants of a randomized controlled trial on glass fiber (n = 18) and titanium post-endodontic restorations (n = 20) received radiographs at two different times after post placement (T0 = <12months and T1 = 36-72months after post placement). A total of 76 radiographs were analyzed with an image-editing software. Medians of changes in mesial and distal interproximal bone level (∆MBL, ∆DBL) were calculated and tested for statistical significance with respect to post material using Mann-Whitney U test (p < 0.05). Impact of post material on bone level changes was assessed in multilevel mixed-effect linear regression models. The mean observation period was 54months for glass fiber and 50months for titanium posts. Interproximal bone loss was small in both groups during the study period with no significant differences between groups (glass-fiber group, ∆MBL = - 0.03mm and ∆DBL = - 0.06mm; titanium group, ∆MBL = - 0.07mm and ∆DBL = - 0.17mm; both p > 0.05). Overall, impact of post material on bone loss was almost negligible with a nonsignificant difference between materials of 0.10mm during the entire study period. The rigidity of endodontic post material has no impact on the level of alveolar bone support of severely damaged endodontically treated teeth. Post-endodontic restorations of severely damaged teeth can achieve steady levels of periodontal bone support as a parameter of periodontal health, irrespective of post material.

Peri-implant inflammation and marginal bone level changes around dental implants in relation to proximity with and bone level of adjacent teeth.

This retrospective study assessed radiographic bone changes and prevalence of inflammation around teeth and neighbouring implants supporting a single-unit fixed dental prosthesis (FDP), in relation to implant- positioning and characteristics. Patients with an implant-supported FDP in function for at least 1 year were recruited. The radiographic horizontal and vertical position of the implants were identified. Probing depth (PD), bleeding on probing (BOP) and radiographic bone level around implants and adjacent teeth at the time of placement, prosthesis delivery, and the most recent review were assessed. 98 patients with 195 implants were evaluated for a mean of 37.8 months. Survival rate was 99.6% and success ranged from 31.3% to 91.3% when different success criteria were utilized. Significantly greater interproximal bone loss around teeth and higher prevalence of interproximal peri-implant inflammation occurred when the horizontal distance of BL implants was <1 mm, but not with TL implants. There was no significant impact of the corono-apical positioning of the implants on marginal bone loss. Proximity of implants to adjacent teeth of <1 mm leads to increased prevalence of inflammation and interproximal bone resorption at the teeth adjacent to bone level implants.