Significant Bone Gain Research Articles

Potentials of pure xenograft materials in maxillary ridge augmentation: A case series

Many patients require edentulous ridge augmentation for dental implant placement. The main objective of this study was to evaluate the results of maxillary edentulous ridge augmentation exclusively with xenograft materials with and without simultaneous sinus floor elevation. This study reports the data retrieved from the records of 16 patients. The treatment outcome was assessed at least 6 months, postoperatively. Paired samples t-test or Wilcoxon Signed Rank test was used to compare the pre-and postoperative ridge dimensions. Dental implants were placed simultaneously in 7 patients, while 9 patients underwent delayed implant placement. In total, 68 implants were placed, and 12 patients also underwent maxillary sinus floor augmentation. A significant bone gain was achieved in both horizontal and vertical dimensions of edentulous maxillary ridges (P < 0.001). Ridge width increased by an average of 4.35 ± 1.90 mm (95% CI: 3.84 to 4.85 mm) while ridge height in areas of sinus floor augmentation increased by 8.19 ± 2.91 mm (95% CI: 7.33 to 9.05 mm). Within the study limitations, it appears that maxillary ridge augmentation according to the guided bone regeneration (GBR) protocols with exclusive use of xenograft particulate materials can provide optimal bone quantity for dental implant placement.

Clinical and radiographic study of the use of cross-linked gelfoam matrix in the treatment of dehiscence-like defects in Stage III periodontitis.

This clinical study aimed to overcome the difficulty of graft fixation and limited blood supply for dehiscence defects regeneration by using a cross-linked gelfoam matrix jointly with collagen membrane and xenograft. The study included twenty dehiscence-like defects in maxillary anterior teeth with ≥4 mm facial bone loss and ≥5 mm clinical attachment loss (CAL) in patients suffering from Stage III periodontitis. Sites were treated with regenerative surgery using a cross-linked gelfoam matrix with glutaraldehyde, xenograft, and collagen membrane. The recorded parameters were: CAL, probing pocket depth (PPD), and radiographic three-dimensional (3D) volume for dehiscence-like defects (3D volume of facial bone defects) and 3D volume of interproximal defects using cone-beam radiographs. Data of these parameters were collected at both baseline and 6 months postsurgery. "Paired t-test" was used to assess the two variables." Both CAL and PPD showed statistically significant reductions and there was a significant bone gain at 6 months postsurgery in comparison to baseline (P ≤ 0.05). Using a cross-linked gelfoam matrix with glutaraldehyde in combination with xenograft and collagen membrane could enhance the outcome of periodontal regeneration, especially in the treatment of challenging dehiscence defects.

Metformin gel in the treatment of generalized aggressive periodontitis

ObjectivesThe aim of this study was to assess the adjunctive regenerative effect of metformin (MF) gel in the treatment of stage II grade C periodontitis utilizing β-TCP bone graft in the control group, and β-TCP bone graft mixed with 1% MF gel in the test group on clinical, radiographic, and biochemical parameters.Patients and methodsThirty intrabony defects were selected in seven patients who met the inclusion criteria. Patients were randomly distributed in the two study groups and treated with β-TCP bone graft plus collagen membrane in the control group and β-TCP bone graft mixed with 1% MF gel plus collagen membrane in the test group. Clinically, evaluation was carried out by clinical parameters (bleeding on probing, pocket depth, and clinical attachment loss) at 3, 6, and 9 months posttreatment. Biochemically, gingival crevicular fluid concentration of receptor activator of nuclear factor-κB ligand (RANKL) and Osteoprotegerin (OPG) at baseline and 9 months posttreatment were evaluated and RANKL/OPG ratio was calculated. Radiographically, quantitative digital subtraction radiography was used to evaluate bone gain and bone mineral density at 9 months posttreatment follow up period.ResultsThe intragroup comparison in the two studied groups demonstrated statistically significant improvement in all clinical parameters (bleeding on probing, pocket depth, and clinical attachment loss) after 3, 6, and 9 months when they were compared to their corresponding values at baseline, while, the intergroup comparison showed that there is no statistically significant difference regarding all clinical parameters at 3, 6, and 9 months posttreatment except pocket depth which differs statistically significant at 3 months posttreatment. The intragroup comparison of RANKL and OPG was statistically significant between baseline and 9 months posttreatment in the two groups but intergroup comparison revealed that there is no statistically significant difference. Regarding RANKL/OPG ratio, the intragroup analysis revealed that there was a statistically significant change in this ratio from baseline to 9 months posttreatment in the test and control group. Additionally, the intergroup analysis revealed that there was no statistically significant difference in RANKL/OPG ratio between the test and control group at baseline and at 9 month posttreatment. The intragroup quantitative digital subtraction radiography analysis demonstrated statistically significant bone gain and increase in bone mineral density in the two studied groups. Also, the intergroup comparison revealed that no statistically significant increase in bone level in the two groups although increase in bone density was statistically significant.ConclusionThe present study demonstrated that guided tissue regeneration utilizing 1% MF gel combined with β-TCP bone graft showed better radiographic results, when compared with guided tissue regeneration utilizing β-TCP bone graft alone. The adjunctive regenerative action of MF is promising material for periodontal regeneration.

How teeth moved and alveolar bone changed after mandibular incisor retraction with intrusion: A retrospective cephalometric and CBCT study

ABSTRACT Purpose To investigate the changes of mandibular incisors in position and alveolar bone thickness and height after retraction with intrusion in adults. Materials and Methods Cephalometric radiograph tracings were evaluated before and after retraction and divided into two groups: pure retraction (PR) and retraction with intrusion (RI). Distances of tooth movements and alveolar bone changes were recorded in cephalograms. Tooth movements in anteroposterior and vertical directions were measured at the incisal edge (IE) and root apex(AXE). Changes of labial bone thickness (LaBT), lingual bone thickness (LiBT) and bone height (BH) were assessed at crestal (S1), mid-root (S2), and apical (S3) levels from 86 Cephalograms (46PR/40RI) and 33 CBCT (17PR/16RI). T-tests were applied for cephalometric group (Ceph-M) and non-parametric tests for CBCT groups (CBCT-M). Results Retraction distances at IE were not different between PR and RI but significant intrusion was observed in RI. Amount of retraction and intrusion at AXE was greater in RI. In PR, LaBT was maintained at S1 and S2 in Ceph-M but only S2 in CBCT-M, whereas S3 exhibited significant bone gain. In RI, LaBT was maintained at S1 in Ceph-M but at S2 in CBCT-M, significant bone gain occurred at S2 and S3 in Ceph-M but at only S3 in CBCT-M. LiBT in both groups showed significant bone thinning at all three levels. LaBH and LiBH in both groups exhibited BH loss. RI showed significantly greater bone gain in LaBT at S3. Conclusions RI provided more lingual and apical movement at AXE with comparable labial and lingual bone response to PR with more apical labial bone gain in RI.

İki kemik arttırım yönteminin karşılaştırılması

Aim: This study aims to compare Guided Bone Regeneration (GBR) performed using autogenous block graft to particulate autograft with xenograft from physicians’ and patients’ perspectives.Methods: 30 systemically healthy individuals participated in this study. GBR using block graft (GBR-BAX) was performed in 15 of the patients and GBR using particulate autograft with xenograft (GBR-PAX) was performed in the other 15 patients. Bone thickness was recorded preoperatively and in the 6th month postoperatively. Bleeding, hematoma, flap dehiscence, infection, and paresthesia were evaluated. Patients were requested to record pain intensity and swelling levels using the visual analog scale (VAS) on the 3rd, 7th, and 14th days after surgery. The swelling levels were also recorded by a clinician on the 3rd, 7th, and 14th days after surgery. The cost of the surgery, the time spent on preparing the patient for the surgery, the time spent during the surgery, and the fatigue levels of the physician resulting from surgery were also determined.Results: Both GBR-BAX and GBR-PAX provided significant bone gain. Bleeding, hematoma, flap dehiscence, infection, and paresthesia levels found also similar. Both techniques caused similar pain, swelling, and discomfort on the 3rd, 7th, and 14th days. VAS results showed no differences in terms of pain and discomfort. GBR-BAX was found more time-consuming in both preparation and surgical period and tiring for the physician but was less costly compared to GBR-PAX. Conclusion: Within the limitation of the present study, GBR with autogenous block graft and particulate autograft plus xenograft provided similar bone gain and caused similar complications, pain, and discomfort. In terms of efficacy, none of the two techniques was found superior to the other; however, block graft was more time-consuming, tiring, and costly.

Horizontal Bone Augmentation in the Posterior Atrophic Mandible and Dental Implant Stability Using the Tenting Screw Technique.

The aim of this study was to analyze horizontal bone augmentation using the tenting screw technique in the posterior mandible. Included subjects had a 3-mm bone width and 9-mm bone height, measured by CBCT. After the surgical approach, two to four screws were inserted, leaving 4 mm of extraosseous space; reconstruction was achieved using allogeneic biomaterial and leukocyte- and platelet-rich fibrin together with an absorbable membrane. After 4 months, a new CBCT scan was obtained to compare the bone gain and implant placement. Early and secondary stability were measured by the implant stability quotient (ISQ); prosthetic load was performed 16 weeks later. Student t test was used to compare bone gains and implant stability, with significance set at P < .05. Fourteen subjects and 27 surgical sites initially exhibited a mean bone width of 2.95 ± 0.75 mm. Four months after augmentation, the bone width was 7.15 ± 1.87 mm, confirming a significant bone gain (4.2 ± 1.26 mm). Twenty-seven implants were placed with a minimum insertion torque of 35 Ncm; the primary stability was 69.3 ± 7.16 ISQ, and the secondary stability was 75.9 ± 3.29 ISQ (P > .05). It may be concluded that the tenting screw technique is predictable in terms of bone gain and that it facilitates implant stability.

Regenerative Treatment of Peri-Implantitis: A Systematic Revie.

Objectives:The aim of this systematic review was to assess the clinical efficacy of bone regeneration for treatment of peri-implantitis.Materials and Methods:Electronic search of the literature was performed to identify randomized clinical trials (RCTs) and case series on treatment of peri-implantitis using bone regeneration procedures with at least 6 months of follow-up. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) were applied. The risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias tool.Results:Two RCTs and 16 case series with a total of 520 treated patients (2002 implants) were included. Bone regenerative procedures showed controversial results regarding bone fill. Two studies reported statistically significant bone gain while four studies reported insignificant bone gain. Other studies reported bone gain with no P value. Pocket depth (PD) reduction varied among the studies since four studies reported a significant reduction in PD while four others reported insignificant reduction in PD. Other studies reported a reduction in PD with no P value. Bone regeneration procedures seemed to decrease bleeding on probing (BOP) but they did not seem conducive to increase the width of keratinized gingiva. Increased keratinized gingiva was noted in cases with subepithelial grafts.Conclusion:Evaluation of the effectiveness of bone regeneration techniques in this systematic review presented limitations related to heterogeneity in patient selection (age, history of periodontitis, smoking status and implant system), means of disinfection and decontamination, and variability of the materials used for treatment.

Comparative evaluation of crestal bone levels following placement of implant in delayed implant bed: An in vivo clinical study.

Background:Restoring lost dentition using dental implant is one of the most promising treatment modality, for both complete and partially dentulous situation. In order to have more predictable outcome, the quest for coming up with a surgical protocol has been never ending. Keeping the same in mind the present study was conducted to place implant in delayed implants beds, i.e., 14 days after the osteotomy site was prepared.Materials and Methods:For the purpose of the study, ten implants measuring 4.2 mm × 10 mm were placed in ten healthy individuals with missing mandibular first molars in site prepared 14 days before actual placement of implants, i.e., delayed implant beds.Results:The study revealed that, on evaluation of the bone levels at the time of placement of prosthetic loading revealed, a bone gain was maximum after 3 months of prosthetic loading.Conclusion:A significant bone gain with a mean of 0.8 mm makes this technique of placing implants in delayed implant beds a more predictable technique than conventional protocol.

Clinical radiographic and immunological effects of surgical treatment of peri‐implantitis 1‐year longitudinal clinical study

Background: Peri-implant infections are pathological conditions surrounding dental implants. Mucositis refers to inflammation and ulceration in the soft tissues around an implant and is a reversible host response to periodontal pathogens. Peri-implantitis, the destructive inflammatory process affecting both soft and hard tissue surrounding a dental implant, is more severe and leads to bone loss. So far there is no consensus on the treatment of peri-implantitis Aim/Hypothesis: The aim of the present study was to evaluate the clinical, radiographic and immunological effects of surgical treatment for peri-implantitis after 1 year. Materials and Methods: Twenty-one patients with peri-implantitis participated in this study (mean age 56.0 ± SD 9.6 years). Patients were divided into a test and control group at random. The following clinical parameters were used: probing depth (PS); plaque INDIAx (PI)and probing bleeding INDIAx (BOP). Radiographic parameter (Periapical, baseline and 1 year) Peri-implant fluid samples were collected with periopaper. Bone metabolism biomarkers included TNF-α, SOST, PTH, OPG, OPN, OC, Leptin, IL-6, IL-1β FGF-23. Patients in both groups received peri-implant surgical treatment for scaling. The test group underwent a aPDT with 0.2% toluidine blue, that pulsed infrared radiation is emitted at a wave length of 2.94 mm. The laser parameters were set at 100 mJ/pulse (12.7 J/cm2) and 10 pps (pulse energy at the tip: about 85 mJ/pulse). Clinical data were collected (baseline, 3 months, 6 months and 1 year). Radiographic and immunological (baseline and 1 year). Biomarkers were measured using a multiplex immunoassay. Results: The results showed a significant reduction in clinical parameters 3 months after treatment, in both groups. In the baseline, the control group presented the values of PBS 8.5 mm ± 0.9, ISS 100%, ISG 100% VPI 100%, while the test group presented PBS 8.6 mm ± 0.700%, ISS 100% and ISG 100% After 3 months, the average values of PBS, ISS, and VPI were 5.7 mm ± 0.5, 11% and 20% in the control group and 5.7 mm, 8% and 20% in the test group (P < 0.05). These values remained constant until the 12-month follow-up, at which point a statistically significant bone gain was observed in the control group (baseline 6.2 ± 1 mm × 12 months 5.7 ± 0.6 mm) (P = 0.008). The radiography analyse after 01 year statistically insignificant The immunological analysis showed a significant reduction in the levels of IL6 and OC in both groups, after 1 year of treatment. However, in the test group there was a significant reduction in Leptin (P = 0.05) and a tendency towards a reduction in OPN levels (P = 0.08) Conclusions and Clinical Implications: Peri-implant surgical therapy led to a significant improvement in peri-implant clinical parameters after 1 year, a bone gain in the control group, and a reduction in biomarkers in both groups. The additional use of photodynamic therapy for surgical treatment in the test group did not present superior results to those observed in the control group. Keywords: Peri-implantitis, Cytokines, Surgical treatment, Bone resorption, Biomarkers

Predictability of a New Orthodontic Extrusion Technique for Implant Site Development: A Retrospective Consecutive Case-Series Study.

In clinical daily practice, there are situations in which implant sites have vertical and/or horizontal bone defects and often we must improve their morphology and dimensions before fixture insertion. It is crucial to carefully evaluate the surgical site as regards the characteristics of both hard and soft tissues. The orthodontic extrusion technique can be used for nonsurgical augmentation of the implant site as an alternative to traditional regenerative/reparative surgical therapies. The orthodontic extrusion is based on a biological mechanism that uses the portion of periodontal ligament, still present on the root before the tooth extraction, for the increase of hard and soft tissues. In the literature, there is no evidence of common guidelines for this technique but only tips based on personal experience and/or previous studies. The aim of this study was to investigate and to validate the reliability of a new orthodontic extrusion technique (MF Extrusion Technique, by Dr. Mauro Fadda) by means of a retrospective consecutive case-series study. After we have done a review of the literature, we evaluated the X-rays of twelve consecutively treated patients before the orthodontic extrusion (T0) and after the stabilization period (T1), in order to quantify, by two different measurements, area and linear, the bone gain obtained by the application of the new technique. All the patients examined showed a significant increase in bone areas with an average value of 31.575 mm2. The linear bone gain had an average value of 4.63 mm. Data collected were statistically analysed by the Wilcoxon signed-rank test. The results obtained both from area and linear measurements at T0 and at T1 times showed that there was a statistically significant bone gain with p < 0.01.

Bone gain through implantoplasty without graft material

Background The prevalence of peri-implantitis is high. All surgical treatment approaches include a surface decontamination protocol but implantoplasty goes one step beyond. The removal of all macro and microstructures on the exposed implant surface creates a radical change of environment. Several reports indicate that implantoplasty can stop further bone loss but, at this stage, significant bone gain obtained without graft material has never been associated with implantoplasty. Aim/Hypothesis The aim of this study was to assess the clinical outcome of peri-implantitis lesions after using a peri-implantitis resective surgical treatment protocol that included systematic removal of all prosthetic components in order to create optimal conditions for implantoplasty. Material and Methods Forty eight patients (60 implants) were included in the study and were followed for a mean observation time of 20 months. Surgical technique- after removal of all prosthetic components, flaps were elevated, granulation tissue removed and implantoplasty performed on all the exposed implant surfaces using special helical cylindrical carbide burs (H375 and HK375, Dexter) and a high speed turbine. Titanium particles were carefully removed, the prosthesis was placed and flaps sutured. No additional decontamination protocol was used, nor grafting material. The implants were evaluated through a clinical and radiographic analysis the day of treatment and, at least, 6 months later. The measurement system used known implant sizes and inter thread distances. Results Three implants were lost (5%) due to further bone loss and recurrence of the disease. 6 implants (10%) presented bone loss up to 2 mm, 27 implants (45%) showed no change in marginal bone levels and 24 implants (40%) presented bone gain up to 3 mm. This outcome was observed without the use any graft material. The mean marginal bone level change was a bone gain of 0.52 mm. No inflammation and or suppuration were observed for all remaining implants. Conclusion and Clinical Implications Implantoplasty is a reliable surgical treatment option for peri-implantitis bone lesions. A bone regeneration process can be observed without graft material.

Early intervention of peri-implantitis and periodontitis using a mouse model.

Peri-implantitis is an inflammatory response to bacterial biofilm resulting in bone loss and can ultimately lead to implant failure. Because of the lack of predictable treatments available, a thorough understanding of peri-implantitis's pathogenesis is essential. The objective of this study is to evaluate and compare the response of acute induced peri-implantitis and periodontitis lesions after insult removal. Implants were placed in one-month-old C57BL/6J male mice eight weeks post extraction of their left maxillary molars. Once osseointegrated, ligatures were placed around the implants and contralateral second molars of the experimental groups. Controls did not receive ligatures. After one week, half of the ligatures were removed, creating the ligature-retained and ligature-removed groups. Mice were sacrificed at two time points, 5 and 14 days, from ligature removal. The specimens were analyzed via micro-computed tomography and histology. By 5 and 14 days after ligature removal, the periodontitis group experienced significant bone gain, whereas the peri-implantitis group did not. Histologically, all implant groups exhibited higher levels of cellular infiltrate than any of the tooth groups. Osteoclast numbers increased in peri-implantitis and periodontitis ligature-retained groups and decreased following insult removal. Collagen was overall more disorganized in peri-implantitis than periodontitis for all groups. Peri-implantitis experimental groups revealed greater matrix metalloproteinase-8 and NF-kB levels than periodontitis. Implants respond slower and less favorably to insult removal than teeth. Future research is needed to characterize detailed peri-implantitis disease pathophysiology.

Injectable simvastatin gel for minimally invasive periosteal distraction: In vitro and in vivo studies in rat.

To evaluate whether the subperiosteal injection of simvastatin (SIM) with a novel in situ gel-forming system, SrHA/Alg (strontium hydroxyapatite/alginate), can stimulate vertical bone augmentation in a rat calvarial model. The SrHA/Alg solution was synthesized and combined with different doses of SIM (0.01, 0.02, 0.1, and 0.2mg) to form the following groups: (1) SrHA/Alg only, (2) SrHA/Alg/0.01, (3) SrHA/Alg/0.02, (4) SrHA/Alg/0.1, and (5) SrHA/Alg/0.2. The SIM release pattern was analyzed, and rat primary periosteum-derived cell (PDC) responses were investigated. Twenty male Wistar rats were enrolled in the calvarial subperiosteal injection experiment with each animal receiving a 200-μl single subperiosteal injection of SrHA/Alg with different amounts of SIM (0, 0.01, 0.02, and 0.1mg) incorporated (n=5). The 0.2mg dose group was not tested in vivo due to the severe toxicity found in vitro. The new bone formation was assessed histologically and radiologically at 8weeks. The slow release of SIM was confirmed, and PDC viability decreased in the SrHA/Alg/0.2 group. Alkaline phosphatase positive areas and mineralization areas were significantly greater in the SrHA/Alg/0.01 and SrHA/Alg/0.02 groups (p<.05). The mRNA expression level of Runx2 significantly increased in the SrHA/Alg/SIM-0.02 group by day 7 (p<.05) and significantly higher levels of VEGF were found in the SrHA/Alg/0.01 and SrHA/Alg/0.02 groups at different time points (p<.05). In vivo, no prominent clinical sign of inflammation was observed, and the most significant bone gain was shown in the SrHA/Alg/0.02 group (p<.05). The osteoclast formation within the newly formed bone area was reduced in the SrHA/Alg/0.1 group (p<.05). When combined with SrHA/Alg system, the 0.02mg SIM seemed to be the optimal dose to stimulate subperiosteal bone formation without inducing inflammation. This combination may hold potential therapeutic benefits for clinical bone augmentation in a minimally invasive manner.

Split crest: immediate expansion rim technique for rehabilitation of atrophic maxilla. A case report.

While the deploy planning, we come across morphological changes in the intervention area and the bone volume, which is extremely important for the treatment outcome. The objective of this study is to describe the technique Split-Crest through a clinical case in which success was obtained. Demonstrate indications and advantages of the technique in order to gain a significant increase in bone density to achieve an excellent aesthetic and functional result. Female patient, leucoderma, 46 years old, attended the Dental Clinic of Specialization in Implantodontics of ESAMAZ, with report of early teeth loss and poorly adapted prosthesis in the upper anterior region of the pre jaw. During the clinical evaluation was observed Edentulism in the anterior arch of the jaw. Total tomographic filming was done on the jaws, the initial diagnosis was a severe resorption present in the premaxilla requiring regenerative process to achieve bone gain. During surgery the patient had immediate installation of previous implants in the region of the elements 12 and 22 through the technique of “Slplit-Crest”, which consisted of two vertical cuts on the vestibular cortical portion and longitudinal osteotomy followed by the the shift vestibular cortical-spongy plate. Eight weeks later, the patient had clinically significant bone gain, proving the viability and success of the technique. A minimally invasive surgical procedure with well executed manipulation of tissue grafts and accelerates the clinical outcome, the working hours by the end of the treatment is smaller, has lower morbidity and lower operating costs.

Split crest: técnica de expansão imediata de rebordo para reabilitação de maxila atrófica. Um relato de caso clínico

While the deploy planning, we come across morphological changes in the intervention area and the bone volume, which is extremely important for the treatment outcome. The objective of this study is to describe the technique “Split-Crest” through a clinical case in which success was obtained. Demonstrate indications and advantages of the technique in order to gain a significant increase in bone density to achieve an excellent aesthetic and functional result. Female patient, leucoderma, 46 years old, attended the Dental Clinic of Specialization in Implantodontics of ESAMAZ, with report of early teeth loss and poorly adapted prosthesis in the upper anterior region of the pre jaw. During the clinical evaluation was observed Edentulism in the anterior arch of the jaw. Total tomographic filming was done on the jaws, the initial diagnosis was a severe resorption present in the premaxilla requiring regenerative process to achieve bone gain. During surgery the patient had immediate installation of previous implants in the region of the elements 12 and 22 through the technique of “Slplit-Crest”, which consisted of two vertical cuts on the vestibular cortical portion and longitudinal osteotomy followed by the the shift vestibular cortical-spongy plate. Eight weeks later, the patient had clinically significant bone gain, proving the viability and success of the technique. A minimally invasive surgical procedure with well executed manipulation of tissue grafts and accelerates the clinical outcome, the working hours by the end of the treatment is smaller, has lower morbidity and lower operating costs.

A Retrospective Analysis of Mandibular Bone Height Changes Associated with 81 Screw-Retained Implant-Supported Prostheses with Distal Cantilevers: A Long-Term Follow-up Analysis

The aims of this study were (1) to evaluate long-term changes in bone height beneath mandibular screw-retained implant-supported prostheses with distal cantilevers and (2) to determine whether the reversal of residual ridge resorption in the posterior mandible is temporary or continues over the long term. Panoramic radiographs, obtained at surgery and at two follow-up visits, of 81 patients rehabilitated with mandibular screw-retained implant-supported prostheses with distal cantilevers supported by four, five, or six implants were followed for 5 to 19 years (overall mean follow-up, 9.00 years. Changes and trends in bone height adjacent to the most distal implant were evaluated between each follow up visit as well as from time of surgery (baseline) to the final visit using two-way analysis of variance, a two-sample t test, and piecewise linear regression. Average bone height distal to the distal most implant at placement was 10.34 ± 6.87 mm. From baseline to the first follow-up exam, a mean bone gain of 0.68 mm was noticed, and a mean gain of 0.26 mm was observed from baseline to the second follow-up exam. A statistically significant bone gain (0.92 mm) was noticed in women (n = 49) between the first and second exams, compared to 0.33 mm in men (n = 32). Individuals experienced both bone gain and loss during the study, with an overall gain. Patients with lower initial bone height experienced greater growth, but this was not statistically significant. Bone growth is associated with mandibular screw-retained implant-supported prostheses with distal cantilevers, and both bone loss and bone growth may occur in the same patient over time. Within the diverse population of this study, women experienced 2.5 times more gain in bone height than men. No correlation could be established between initial bone height and overall bone height changes.

Comparison of applying particulate demineralized bone matrix (DBM), putty DBM and open flap debridement in periodontal horizontal bone defects. A 12‐month longitudinal, multi‐center, triple‐blind, split‐mouth, randomized, controlled clinical study. Part 1 – clinical and radiographic evaluation

Putty form graft materials may have additional favourable effects when compared with particulate ones in periodontal bone defects. The purpose of this study was to assess clinical and also radiographic changes following application of (i) putty form demineralized bone matrix (DBM), (ii) particulate form DBM and (iii) open flap debridement (control), using modified curtain suturing technique in the treatment of interproximal suprabony (horizontal) defects. Twenty-five chronic periodontitis patients with 125 sites (radiologically >or=4 mm horizontal bone defect) were selected to participate in this triple-blind, split mouth, randomized, controlled clinical trial. Putty and particulate form DBM grafts were placed at experimental sites. Clinical measurements included probing depth (PD), relative attachment level (RAL), gingival recession and bone probing depth (BPD) were made at baseline and repeated 12 months after the operations. Standardized digital radiographs were also taken to measure radiographic bone level (RBL) at baseline and 12 months later to be compared in a software. Probing depth reductions and RAL gains were significantly improved in all treatment groups (P < 0.001). No significant differences in soft tissue parameters were found among three groups (P > 0.05). Bone probing depth measurements indicated comparable significant bone gain in graft applied groups (P < 0.01) and a significant bone resorption in open flap debridement group (P < 0.01). Radiographic evaluation did not show any significant bone gain or resorption in all treatment groups (P > 0.05). The results of this study indicate that either putty or particulate DBM demonstrates similar enhancements in soft and hard tissue parameters. Applying putty or particulate form DBM results with slight bone formation when compared with open flap debridement in horizontal bone defects at 1-year post-operative examination according to BPD measurements.