Radiographic Bone Level Research Articles

Radiographic peri-implant bone loss after a function time up to 15 years

Objective The aim was to assess the degree of radiographic peri-implant bone loss over a follow-up period up to 15 years. In addition, another aim was to identify risk indicators for peri-implant bone loss and for moderate–severe peri-implantitis at patient- and implant level. Materials and methods This is a cross-sectional clinical and radiological study of 147 patients with a total of 425 implants in combination with data collected retrospectively for baseline variables. To calculate the peri-implant bone loss (primary outcome variable), the radiographic bone level measurements from baseline were compared to the radiographic bone level measurements at the final radiographic measurement. Multilevel analyses were adopted with peri-implant bone loss and peri-implantitis as outcome variables. Results The mean follow-up time was 12.5 years (range 10–15) and the mean age of the patients was 63 years (range 29–83). The mean peri-implant bone loss was 0.94 mm (S.D. 1.3). The prevalence of moderate–severe peri-implantitis at patient level was 17% and 8.9% at implant level. The peri-implant bone loss was significantly more pronounced in healthy implants if moderate–severe peri-implantitis was present in at least one implant within the same patient. The presence of moderate–severe peri-implantitis was significantly associated with general periodontitis Stages III or IV at follow-up and smoking. Conclusion The presence of moderate–severe peri-implantitis at patient level was found to be a risk indicator of peri-implant bone loss in healthy implants, while smoking and general periodontitis Stages III and IV were risk indicators of moderate–severe peri-implantitis.

Tomographic Assessment of reinforcement of acrylic resin denture base for palateless implant locator retained maxillary over denture.

Objectives: This study was conducted to evaluate the effect of metallic (cobalt chromium), glass fiber and nano zirconia oxide reinforcement of acrylic resin denture base on the peri-implant crestal bone level changes in palateless locator retained maxillary over denture. Materials and Methods: Twenty-one completely edentulous male patients with maladaptive experience to maxillary dentures were selected to participate in this study. For all patients maxillary four implant-retained overdenture was constructed following the same basic principles. Every patient received four implants, two in the canine region with (3.6 mm in diameter & 12mm in length), and two in the second premolar region with ( 4.5 mm in diameter & 8mm in length); (Tiologic® Implants, Dentaurum, Ispringen, Germany) . Metal (cobalt chromium) reinforced over denture was constructed for the first group , while 5% fiber reinforced acrylic resin denture was constructed for the second group and Overdenture was reinforced using 5% of nano ZrO2 for the group three patients. . Follow up visits were scheduled twelve and twenty four after implant loading for inspection of the prosthesis and radiographic evaluation Peri-implant crestal bone level changes were assessed using intra-oral radiographs taken . Results: The findings of the present study demonstrates that all the studied denture base reinforcement materials individually showed significance bone loss around implants (p < 0.05) after 12 months follow up period. Conclusion: Within the limitations of this study, reinforcement of polymethyl methacrylate denture base with glass fiber or nano zirconia oxide should be considered in palateless implant retained maxillary over denture.

Annually and Cumulative Radiographic Alveolar Bone Loss Rates using Digital Scanning Image for the Periodontal Disease Groups before and after Periodontal Treatment

The aim of the present study was to assess the cumulative radiographic alveolar bone loss (CRABL) and yearly radiographic periodontal attachment loss (YRABL) of periodontal disease groups over 5 years or more. A total of 53 subjects, who had taken two sets of full-mouth standardized paralleling radiographs with separated periods of 5 years or more in Kaohsiung Medical University Hospital during 1981-2001, were collected for the past 20 years.&#x0D; The radiographic alveolar bone levels at mesial and distal aspects of teeth were assessed by measuring the distance between cemento-enamel junction and alveolar bone crest using an electronic digimatic caliper (EDC) under a 3.5X magnified radiographs.&#x0D; The results revealed that 1) patients with a periodic recall (3-4 times/yr.) showed a significantly lower loss rate than patients without periodic recalls; 2) mean CRPAL was highest in the generalized aggressive periodontitis (GAgP) group (5.52±3.27mm), then the chronic periodontitis (CP) group (4.82±3.47mm), and the localized aggressive periodontitis (LAgP) group (4.47±3.47mm) followed, and lowest in the periodontal healthy (PH) group (1.05±0.59mm); 3) mean YRPAL was the highest in the LAgP group (0.26±0.25mm/yr.), then the GAgP group (0.20±0.13 mm/yr.), and the CP group (0.12±0.09 mm/yr.) followed, and lowest in the periodontal healthy group (0.07±0.06 mm/yr.).&#x0D; It was concluded that: 1) sites with more advanced alveolar bone loss are more likely to undergo further breakdown; 2) patients with a periodic recall showed a significantly lower alveolar bone loss rate and bone gain, irrespective disease groups; 3) mean CPBLs was highest in the GAgP group; mean YRABLs was highest in the LAgP.

Risk Indicators Affecting the Survival of the Mandibular First Molar Adjacent to an Implant at the Mandibular Second Molar Site: A Retrospective Study.

This study aimed to compare the survival of mandibular first molars (MnM1s) adjacent to implants placed in mandibular second molar sites (ImM2s) with MnM1s adjacent to mandibular second molars (MnM2s) and to investigate risk indicators affecting the survival of MnM1s adjacent to ImM2s. A total of 144 patients who had MnM1s adjacent to ImM2s and MnM1s adjacent to MnM2s on the contralateral side were included in this study. Clinical variables and radiographic bone levels were evaluated. The survival of MnM1s adjacent to ImM2s or MnM2s was evaluated using a Kaplan–Meier analysis and Cox proportional hazards model. The 5-year cumulative survival rates of MnM1s adjacent to ImM2s and MnM2s were 85% and 95%, respectively. MnM1s adjacent to ImM2s of the internal implant-abutment connection type had higher multivariate hazard ratios (HR) for loss. MnM1s that had antagonists with implant-supported prostheses also had higher HR for loss. The multivariate HR for the loss of MnM1s adjacent to ImM2s with peri-implant mucositis was 3.74 times higher than MnM1s adjacent to healthy ImM2s. This study demonstrated several risk indicators affecting the survival of MnM1s adjacent to ImM2s. It is suggested that supportive periodontal and peri-implant therapy combined with meticulous occlusal adjustment can prolong the survival of MnM1s and ImM2s.

Retrospective evaluation about morse taper versus external hexagon implants placed after maxillary sinus lift.

The aim of this study was to retrospectively evaluate the success and survival rate of implants with different types of prosthetic connections inserted in the posterior maxilla in native bone or in sinuses previously grafted with different biomaterials. A total of 310 implants inserted in 113 patients were evaluated, 87 of which were inserted in association with grafted maxillary sinuses (56 morse taper (MT) implants and 31 external hexagon (EH) implants) in 37 patients, and 223 implants were inserted in native bone areas (112 MT and 111 EH implants) in 76 patients. Peri-implant clinical analyses were performed (bleeding on probing, probing depth, clinical insertion level, peri-implant marginal level, and the presence of mobility or suppuration), and the radiographic bone level was evaluated. Two implants were lost, yielding a survival rate of 99.35%. The MT implants had lower probing depths and peri-implant bone levels than the EH implants in both grafted areas and native bone areas (P<0.05). No statistically significant differences in any parameter evaluated were found between implants inserted in native bone and those inserted in grafting areas. EH implants inserted in native bone areas showed higher peri-implantitis rates. It can be concluded that the MT implants connection reduce peri-implant bone loss, but implants inserted in maxillary sinuses previously grafted with osteoconductive biomaterials do not predispose patients to peri-implant bone loss.

The effectiveness of using the perioscope as an adjunct to non-surgical periodontal therapy: Clinical and radiographic results.

It is well known that following root surface debridement (RSD) residual deposits remain. Periodontal endoscopy has provided a method of directly visualizing root surfaces during periodontal debridement in an intact pocket without the need for surgical incision. The aim of this study was to determine if periodontal debridement using endoscopic visualization was more effective in improving clinical and radiographic parameters as compared to RSD. Thirty-eight subjects were randomized into RSD with perioscope (n=19) or RSD only (n=19) groups. A full-mouth evaluation included probing pocket depths (PPDs), clinical attachment levels (CAL), bleeding on probing (BOP) and plaque scores (PI) recorded at baseline, 3 and 12 months and compared among groups. Radiographs were taken at sites with deepest pockets at baseline and 12-month and the change in radiographic bone levels (RBL) compared. An independent samples T-test was used to assess statistical significance. Both groups had significant improvements in clinical outcomes. The test (T) group had a significantly lower percentage of PPDs 7 to 9mm at three (0.72±1.2%) and 12 months (0.5±1.0%) as compared with the control (C) group (2.25±2.9%; 1.84±2.3%). At 12 months, the test group recorded a significantly lower mean PPD (T: 2.70 + 0.2mm; C: 2.98±0.4mm), BOP% (T: 4.3±3.2%; C: 11.95±7.1%), PI% (T: 25.61±3.9%; C: 30.11±6.3%) and less change in gingival recession (T: -0.13±0.2mm; C: -0.50±0.6mm) (P<0.05). More radiographic bone gain was observed in the test group (0.69±0.3mm) as compared with the control group (0.49±0.2mm). This was also observed around multi-rooted teeth (T: 0.83±0.45mm; C: 0.46±0.36mm). The adjunctive use of the perioscope provided a slight benefit to the outcomes of non-surgical therapy particularly at deeper probing depths.

Regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: A retrospective practice‐based cohort study

Evaluation of the effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic tooth movements in stage IV periodontitis. A total of 526 intra-bony defects in 48 patients were analyzed after regenerative therapy using collagen-deproteinized bovine bone mineral with or without collagen membrane or enamel matrix derivative followed by orthodontic tooth movement initiated 3 months after surgery. Changes in radiographic bone levels (BL) and probing pocket depths (PPD) were evaluated after 1 year and up to 4 years. Tooth loss amounted to 0.57%. Mean BL gain was 4.67mm (±2.5mm) after 1 year and 4.85mm (±2.55mm) after up to 4 years. Mean PPD was significantly reduced from 6.00mm (±2.09mm) at baseline to 3.45mm (±1.2 mm) after 1 year, and to 3.12mm (±1.36mm) after 2 - 4 years. Pocket closure (PPD ≤ 4 mm) was accomplished in 87 % of all defects. Adjunctive antibiotic therapy did not show any statistically significant impact on treatment outcomes. Within the limits of this retrospective study design, the findings suggest that the combination of regenerative treatment and consecutive orthodontic tooth movements resulted in favorable results up to 4 years.

Surgical and non-surgical debridement for the treatment of peri-implantitis: a two-center 12-month randomized trial.

To compare surgical (ST) and non-surgical (NST) debridement for the treatment of peri-implantitis in a two-center randomized trial. Forty-five individuals with 63 implants with probing depth (PPD) ≥5mm, bleeding on probing (BOP), and radiographic bone loss ≥2mm were included. In the NST (30 implants), submucosal debridement was performed. In the ST (33 implants), a mucoperiosteal flap was raised and surfaces were decontaminated only by debridement as performed in NST. Clinical parameters and radiographs were compared at baseline and after 12 months. Means and standard errors were reported. PPD considering all implant sites reduced significantly in NST from 4.14±0.25 to 3.25±0.18mm. In ST, PPD also significantly changed (3.74±0.22 to 3.00±0.29mm). No significant differences were observed between the two groups. For deep sites (≥7mm), PPD was 7.82±0.20mm at baseline and reduced to 5.10±0.30mm in NST, while in ST group, it was 7.11±0.11mm and changed to 5.22±0.91mm (between-groups p value=0.51). BOP significantly reduced from ~60 to 35% of all sites in both groups, without significant differences between them. When sites with radiographic bone level ≥3mm at baseline were analyzed, there was a significant difference between groups in bone gain after 12 months in favor of ST (ST=0.78±0.30mm compared to NST=0.25mm±0.13; p=0.03). Surgical and non-surgical debridement for the treatment of peri-implantitis present similar clinical outcomes. Bone levels were better improved in ST than NST for sites with higher initial bone loss. The treatment of peri-implantitis is still a challenge in clinical practice, since less than half of affected implants achieve health after surgical or non-surgical debridement. Considering the lack of clinically relevant differences between these two treatments, non-surgical debridement should be considered the first therapeutic choice for peri-implantitis, mainly mild to moderate cases.

Immediate and early loading of hydrothermally treated, hydroxyapatite-coated dental implants: a 7-year prospective randomized clinical study

BackgroundExisting research on marginal bone stability around hydroxyapatite (HA)-coated implants often lacks adequate long-term follow-up. The purpose of this randomized prospective study was to evaluate the 7-year outcome of patients with immediate and early loaded single-tooth restorations supported by implants with plasma-sprayed, partially HA-coated surfaces. Forty-two patients in need of 50 single implants were treated in in the Postgraduate Periodontics Clinic of Louisiana State University School of Dentistry. Implants were randomly divided into 2 groups: Group A was immediately loaded, and Group B was early loaded. Continuous follow-up with periodic maintenance care and radiographic evaluations was performed. The primary outcome of interest was implant survival, characterized using the Kaplan–Meier method. Secondary study outcome consisted of peri-implant crestal bone level changes. Data on age, sex, bone quality, implant location, length and diameter, and prior augmentation of the site were collected. Multiple regression analyses were conducted to determine whether the independent variables were associated with bone loss.ResultsOne implant failed to maintain stability and was removed at 3 weeks. Thirty-four patients (14 males, 20 females with a total of 42 implants) completed the 7-year follow-up visit. Average age of evaluable patients was 52 in Group A and 55 in Group B. No significant difference was observed regarding sex and age distribution between the 2 groups. No significant difference was detected in the distribution of implant locations, types of bone, implant length, implant diameter, and augmentation status of the bone between the 2 groups. After 7 years of functioning for the 42 implants examined, implant survival rate was 100% for Group A and 95.5% for Group B. The results from this study of 50 implants showed that HA-coated Zimmer Tapered Screw-Vent Implants were clinically effective, with an overall cumulative 7-year survival rate of 98.0%. When comparing radiographic bone levels between 2-year and 7-year follow-ups, no significant differences in bone loss were found between Group A and Group B.ConclusionsAfter 7 years in function, implants partially coated with plasma-sprayed and hydrothermally treated HA were clinically predictable when restored in occlusion immediately after or 3 weeks after implant placement.

Interproximal open contacts between implant restorations and adjacent natural teeth as a risk-indicator for peri-implant disease-A cross-sectional study.

The primary aim of this study was to investigate the relationship between interproximal open contacts and peri-implant disease. The secondary aim was to assess patient-reported outcome measures in relation to contact status. A cross-sectional study was performed on 61 patients with 142 implants adjacent to at least one natural tooth. Patients underwent a clinical examination to assess contact status and width, plaque index (PI), gingival index (GI), periodontal probing depths (PPD), and bleeding on probing (BoP). Radiographic marginal bone level was measured in vertical bitewings taken within one year. A diagnosis was given to each implant. Last, subjects completed a brief questionnaire. Rao-scott chi-squared tests and generalized estimating equations (GEE) models were used to compare outcomes between groups. Seventy-seven (54.2%) implants were found to have ≥1 interproximal open contact. Sixty-five (45.8%) implants had closed contacts only. Implants with interproximal open contacts were significantly associated with peri-implant mucositis and peri-implantitis (p=.003) and increased prevalence of peri-implant disease (adjusted PR=1.57; 95% CI: 1.09-2.27, p=.015). Open contact status was also associated with higher PPD (p=.045), PI scores (p=.036), and GI scores (p=.021). Open contact prevalence was 75.4% on the patient-level and 54.2% on the implant-level, involving the mesial surface of the implant restorations 68.5% of the time (p<.001). Interproximal open contacts between implant restorations and adjacent natural teeth are a risk indicator for peri-implant disease. Adequate contact between implant restorations and natural teeth may contribute to the health of peri-implant tissues.

Sealing Socket Abutments (SSAs) in Molar Immediate Implants with a Digitalized CAD/CAM Protocol: Soft Tissue Contour Changes and Radiographic Outcomes After 2 Years

Immediate implant placement in molar sites has the potential to improve the patient experience by reducing the number of appointments and the overall treatment time. However, primary closure remains a technical challenge. The present prospective case series evaluated the soft tissue contours and the radiographic bone levels of 17 patients who received immediate implants in molar sites and a digitally customized CAD/CAM sealing socket abutment. At the 2-year follow-up, the mean buccal tissue contours at the most coronal portion were reduced horizontally by an average of 1 mm at 1, 2, 3, and 4 mm below the gingival margin. A mean 0.53-mm apical migration of the gingival margin was seen, and the mean interproximal bone level at the 2-year follow-up was 0.89 mm. The use of CAD/CAM-generated customized healing abutments in immediate molar sites yielded minimal hard and soft tissue changes at the 2-year follow-up.

Peri-implant radiographic bone level and associated factors in Spain.

To evaluate radiographic bone level (RxBL) at dental implants and its associated factors in Spain. This cross-sectional study was performed by a network of sentinel dentists from regions of Spain. RxBL was defined as the distance from the implant shoulder to the first clearly visible contact between the implant surface and the bone. Radiographic measurements were performed by two trained and experienced periodontists. Implant and patient data were also collected. Descriptive, bivariate, discriminative and multivariate analyses were done. A total of 49 sentinel dentists provided data 275 patients. Mean RxBL from 474 implants (5-13years) was 1.87mm (range: 0.00-13.17mm). Statistically significant associations between RxBL and clinical output variables (bleeding on probing, oedema, plaque, probing depth, suppuration, keratinized tissue) were found. In the multiple regression analysis, statistically significant associations for RxBL were found for smoking habit, implant diameter, years of follow-up and type of prosthesis (p<0.01). Peri-implant RxBL ranged from 0 to 13.17mm. It was significantly associated with clinical output variables and with some potentially predictor variables, at patient- (smoking >10cigarettes/day) and implant- (diameter, years of follow-up, Toronto bridge) levels.

Diagnosis of peri-implantitis in the absence of baseline data: A diagnostic accuracy study.

The aim of the present study was to evaluate the diagnostic accuracy of clinical and radiographic evaluations made at a single time point during follow-up in identifying (a) a history of peri-implant bone loss and (b) the presence of peri-implantitis. 427 patients provided with implant-supported reconstructions 9years earlier were evaluated clinically by Probing Pocket Depth, Bleeding or Suppuration on Probing (PPD, BoP & SoP) and radiographically. Bone levels were assessed relative to the most coronal point of the intra-osseous part of the implant. A history of bone loss and diagnosis of peri-implantitis was confirmed through baseline documentation (direct evidence). Diagnostic accuracy of radiographic bone levels at 9years and clinical findings (indirect evidence/secondary case definition) in identifying a history of bone loss and peri-implantitis were evaluated through correlation and multilevel regression analyses as well as receiver operating characteristic curves. Results were expressed as sensitivity/specificity and area under the curve (AUC). Bone levels observed at 9years were highly accurate in identifying pronounced bone loss (>2mm; AUC=0.96; 95% CI 0.95-0.98). In the absence of baseline documentation, a secondary case definition based on the presence of BoP/SoP & bone level≥1mm (indirect evidence) provided the overall best diagnostic accuracy (AUC=0.80; 95% CI 0.77-0.82) in identifying peri-implantitis cases (direct evidence: BoP/SoP & bone loss>0.5mm). Moderate/severe peri-implantitis (BoP/SoP & bone loss>2mm) was most accurately identified by the combination of BoP/SoP & bone level≥2mm (AUC=0.93; 95% CI 0.91-0.96). Sensitivity of the secondary case definition suggested by the 2017 World Workshop of Periodontology (WWP) (BoP/SoP≥1 site & bone level≥3mm & PPD≥6mm) was low. The present results underline the importance of baseline documentation for the correct diagnosis of peri-implantitis, especially in its early/incipient forms. The secondary case definition of peri-implantitis suggested at the 2017 WWP demonstrated a high level of specificity but low sensitivity. Moderate/severe peri-implantitis was most accurately identified by the combination of BoP/SoP & bone level≥2mm.

Clinical and radiographic evaluation of implant-supported single-unit crowns with cantilever extension in posterior areas: A retrospective study with a follow-up of at least 10 years.

Implant-supported restorations with cantilever extension may display high rates of biological and technical complications. To report the outcomes of single-unit crowns with cantilever extension (SCCs). Patients with SCCs were reevaluated after ≥10 years of loading. Radiographic marginal bone levels (mBLs) at baseline (ie, delivery of SCCs) and follow-up were calculated and compared between implant surfaces adjacent to and distant from the cantilever extension. Implant survival and success rates were calculated. Twenty-one patients with 25 SCs supported by 25 implants were reevaluated after a mean of 13.6 ± 3.8 years (range: 10-19 years). No implants were lost. The mean overall mBLs changed from 0.99 mm ± 0.95 at baseline to 0.95 mm ± 0.99 at follow-up (p = 0.853). The mean pocket probing depths changed from 3.39 mm ± 0.62 at baseline to 3.34 mm ± 0.54 at follow-up (p = 0.635). Loss of retention occurred 3× in 2 patients (14.3%). At follow-up, peri-implant health was diagnosed in 10 (48%) and peri-implant mucositis in 11 (52%) patients, respectively. Within the limitations of the present study, the use of implant-supported SCs with cantilever extension in posterior areas represents a reliable long-term treatment option with a 100% implant survival rate and minimal marginal bone level changes.

The impact of supportive periodontal treatment on the outcome of regenerative surgical therapy in aggressive periodontitis patients.

Objective: The aim was to evaluate the efficacy of periodontal regenerative therapy using enamel matrix derivatives (EMDs) in aggressive periodontitis patients, and to determine the contribution of maintenance via periodic supportive periodontal treatment. Method and materials: In total, 28 patients were evaluated, comprising 74 intrabony sites. In 50 sites EMD gel was applied, and in 24 sites EMD was combined with deproteinized bovine xenograft. Patients were assigned to a supportive periodontal treatment program; 18 patients fulfilled the program, defined as the well-maintained (WM) group; 10 did not comply, defined as the nonmaintained (NM) group. Probing depth (PD), clinical attachment level (CAL), and radiographic bone level (BL) were recorded. Data were compared presurgically (T0), 6 months postsurgery (T1), and 3 to 10 years posttreatment (T2). Results: Both surgical modalities achieved similar PD reduction, CAL gain, and BL gain, maintained over time. T1 to T2 showed a mean gain/loss of 0.21 ± 0.5 mm and 0.04 ± 1.1 mm, and -0.65 ± 3.0 mm and -0.73 ± 3.0 mm for PD and CAL, respectively, at the WM/NM groups, respectively. BL gain was 21.6% and 11.5% for the WM/NM groups, respectively (P < .05). The courses of the PD, CAL, and BL differed between the WM and NM groups during the observation periods (P < .05). Conclusion: Periodontal regeneration via EMD with/without the combination of deproteinized bovine xenograft can be maintained in aggressive periodontitis cases. It appears that periodic supportive periodontal treatment is a determinant factor in achieving this task.

Clinical factors affecting the longevity of fixed retainers and the influence of fixed retainers on periodontal health in periodontitis patients: a retrospective study.

PurposeThe aim of this study was to evaluate clinical factors affecting the longevity of fixed retainers and the influence of fixed retainers on periodontal health in periodontitis patients.MethodsIn total, 52 patients with at least 2 years of follow-up after periodontal and orthodontic treatment were included in this study. After scaling and root planing, orthodontic treatment with fixed appliances or clear aligners was performed. Fixed retainers with twist-flex stainless steel wires were bonded to the palatal or lingual sides of anterior teeth. Changes in clinical parameters, including the plaque index, gingival index, calculus index (CI), probing pocket depth, and radiographic bone levels, were evaluated before bonding of fixed retainers and at a 12-month follow-up. Cumulative survival rates (CSRs) for retainer failure were evaluated according to sex, site, CI, stage of periodontitis, and the severity of the irregularity with the log-rank test and hazard ratios (HRs).ResultsTwelve months after bonding of fixed retainers, improvements were observed in all clinical parameters except CI and radiographic bone gain. The overall CSR of the retainers with a CI <1 at the 12-month follow-up after bonding of fixed retainers was significantly higher than that of the retainers with a CI ≥1 at the 12-month follow-up (log-rank test; P<0.001). Patients with stage III (grade B or C) periodontitis had a higher multivariate HR for retainer failure (5.4; 95% confidence interval, 1.22–23.91; P=0.026) than patients with stage I (grade A or B) periodontitis.ConclusionsAlthough fixed retainers were bonded in periodontitis patients, periodontal health was well maintained if supportive periodontal treatment with repeated oral hygiene education was provided. Nonetheless, fixed retainer failure occurred more frequently in patients who had stage III (grade B or C) periodontitis or a CI ≥1 at 12-month follow-up after bonding of fixed retainers.

Single-flap versus double-flap approach for periodontal pocket reduction in supraosseous defects: a comparative study.

PurposeThe single-flap approach (SFA) is a minimally invasive technique with limited mucoperiosteal flap elevation to gain access to the buccal/palatal aspects, thus limiting post-surgical complications. The purpose of the present study was to gain insights into the impact of the SFA over the double-flap approach (DFA) on periodontal flap treatment outcomes and patient compliance in terms of discomfort and time taken for surgical procedures.MethodsTwenty patients with persistent probing pocket depths of ≥5 mm were scheduled for the SFA (test site) and for the DFA (control site). All the clinical periodontal parameters were recorded at baseline, 3 months, and 6 months. Radiographic bone level (cone-beam computed tomography) was evaluated at baseline and 6 months. Patients' postoperative pain perception and wound healing were also assessed.ResultsThe SFA showed a significant reduction in periodontal pocket depth, gain in clinical attachment level (CAL), and gain in bone level when compared with the DFA. The SFA substantially improved wound healing and induced less postoperative pain than the DFA.ConclusionsThe SFA resulted in substantial improvement in the composite outcome measures, as shown by a reduction in pocket depth with minimal gingival recession, gain in CAL, early wound healing, less postoperative discomfort, and better patient-centered outcomes.Trial RegistrationClinical Trials Registry-India Identifier: CTRI/2018/05/013562

Prevalence and risk/protective indicators of peri-implant diseases: A university-representative cross-sectional study.

To evaluate the prevalence of peri-implant diseases and to identify risk/protective indicators of peri-implantitis. Two hundred and forty randomly selected patients from a university clinic database were invited to participate. Those who accepted, once data from their medical and dental history were collected, were examined clinically and radiographically to assess the prevalence of peri-implant health and diseases. Peri-implantitis was defined as the presence of BoP/SoP together with radiographic bone levels (BL) ≧2mm. An intermediate peri-implant health category between peri-implant mucositis and peri-implantitis was also identified, defined by the presence of BoP/SoP together with 1mm ≦BL<2mm. A multilevel multivariate logistic regression analysis was carried out to identify those factors associated either positively (risk) or negatively (protective) with peri-implantitis. Ninety-nine patients with a total of 458 dental implants were analyzed. The prevalences of pre-periimplantitis and of peri-implantitis were, respectively, 31.3% and 56.6% at patient-level, while 31.7% and 27.9% at implant level. The following factors were identified as risk indicators for peri-implantitis: smoking (OR=3.59; 95% CI: 1.52-8.45), moderate/severe periodontitis (OR=2.77; 95% CI: 1.20-6.36), <16 remaining teeth (OR=2.23; 95% CI: 1.05-4.73), plaque (OR=3.49; 95% CI: 1.13-10.75), implant malposition (too vestibular: OR=2.85; 95% CI: 1.17-6.93), implant brand (Nobel vs. Straumann: OR=4.41;95% CI: 1.76-11.09), restoration type (bridge vs. single crown: OR=2.47; 95% CI: 1.19-5.12), and trauma as reason of tooth loss (vs. caries: OR=6.51; 95% CI: 1.45-29.26). Conversely, the following factors were identified as protective indicators: interproximal flossing/brushing (OR=0.27; 95% CI: 0.11-0.68), proton pump inhibitors (OR=0.08; 95% CI: 0.01-0.90), and anticoagulants (OR=0.08; 95% CI: 0.01-0.56). Peri-implant diseases are highly prevalent among patients with dental implants in this university-based population. Several factors were identified as risk- and protective- indicators of peri-implantitis.

Clinical and radiographic outcomes of implant-supported fixed dental prostheses with cantilever extension. A retrospective cohort study with a follow-up of at least 10 years.

To report the clinical and radiographic outcomes of implant-supported fixed dental prostheses with cantilever extensions (FDPCs) after a function time ≥10years. Patients with FDPCs in posterior areas were clinically and radiographically re-evaluated. Mesial and distal radiographic marginal bone levels (mBLs) from baseline (i.e. delivery of FDPC) to the follow-up examination were calculated and compared between implant surfaces adjacent to and distant from the cantilever extension. Implant survival rate, pocket probing depth (PPD), presence/absence of bleeding on probing (BoP) and presence/absence of mechanical/technical and biological complications were recorded. Twenty-six patients with 30 FDPCs supported by 60 implants were re-evaluated after a mean loading time of 13.3±2.7years (range: 10-18.6years). One diameter-reduced implant carrying a cantilever extension fractured, yielding a patient-based survival rate of 96.2% (95% CI: 0.95/1.0). The mean marginal bone level change was not statistically significantly different from baseline to follow-up (1.2mm±0.9 to 1.6mm±1.7; 95% CI: -0.1/0.9; p>.05). The mean PPD changed statistically significantly from 3.4mm±0.7 to 3.7mm±0.7 (95% CI: 0.04/0.6; p=.02). Loss of retention occurred≥1x in 9 patients (34.6%, 95% CI: 0.44/0.83). At follow-up, peri-implant health was diagnosed in 12 (46.2%), peri-implant mucositis in 7 (26.9%) and peri-implantitis in 7 (26.9%) patients, respectively. Despite a high rate of loss of retention, the use of implant-supported FDPCs in posterior areas represents a reliable long-term treatment option with a high implant survival rate and minimal peri-implant bone level changes irrespective of the location of the cantilever extension.

Comparative Evaluation of Porcelain Fused to Metal (PFM) Material used for Fixed Partial Prosthesis Placed on Vital &amp; Non-vital Abutments on the Periodontal Status – A Two Year Retrospective Follow-up

Objective: Sound periodontal foundation of abutment teeth is essential for successful restorative therapy and also for long-term success of prosthodontic restorations. Porcelain fused to metal (PFM) has been a popular choice of novel esthetic material in fixed prosthodontics over the last few decades. The present study aimed to assess the long term effect and tissue responses of fixed partial prosthesis using PFM material on vital and non- vital abutments on the periodontal parameters both clinically and radiographically.&#x0D; Methodology: Following ethical committee approval, the study group comprised of 86 abutment teeth in 41 systemically healthy patients (24 males and 17 females) aged between 18 – 45 years who had received 3 unit fixed prosthesis made of PFM, having equigingival margins using vital and non-vital abutments. The following parameters were assessed at baseline, phase 1, 3 and 4 (1 year follow up) – CAL, Probing depth, Distance between CEJ/ cervical crown margin and alveolar crest of the abutment teeth (radiograph).&#x0D; Results: Statistical analysis carried out by SPSSV22 software revealed no significant changes in probing depth and CAL (p&gt;0.05) and significant changes in radiographic bone levels (p&lt;0.05) in vital abutments whereas significant changes in probing depth and CAL from baseline to the end of 2 years (p&lt;0.05) with no changes in radiographic parameters (p&gt;0.05) with non vital abutments. However, significant differences were observed between vital and non vital abutments with regard to probing depth at the end of 2years, CAL and radiographic bone levels at 6months, 1 year and 2 years (p&lt;0.05)&#x0D; Conclusion: The response of the periodontal tissues to the PFM material used on fixed prosthesis on both vital and non vital abutment teeth although favorable, were marginally better in vital abutments.