Objective: This systematic review evaluates implant survival and the change in the width of the horizontal ridge following immediate implant placement with or without a regenerative procedure. Materials and methods: An electronic search of MEDLINE, EMBASE, and the LILACS database of the Cochrane Central Register of controlled trials was performed, along with a manual search, up to April 2018. Randomized controlled trials (RCTs) and quasi-randomized controlled clinical trials (CCTs) with >10 subjects were eligible for this systematic review. A meta-analysis of the risk difference in implant failure between the regenerative and non-regenerative procedure groups was performed using a fixed-effect model. In addition, a meta-analysis of the change in alveolar bone width was conducted using a fixed-effect model. Results: Seven studies (six RCTs and one CCT) were included. A meta-analysis of three studies found no statistically significant risk difference in implant failure between the regenerative procedure and non-regenerative procedure groups. A meta-analysis of four studies showed that horizontal shrinkage of the alveolar ridge in the site of immediate implant placement was statistically significantly lower with the regenerative procedure than without it (<1 year follow up studies: weighted mean difference (WMD) 0.75 mm, 95% confidence interval 0.41–1.09, p p = .00006; total: WMD 0.84 mm, 95% confidence interval 0.53–1.14, pConclusion: Within the study limitations, immediate implant placement with a regenerative procedure showed similar implant survival and less shrinkage of the ridge width than immediate implant placement without a regenerative procedure. Due to the high risk of bias and small sample sizes of the included studies, further clinical studies are warranted to draw definitive conclusions.
Abstract Objectives: It has been suggested that degranulating platelet α ‐granules release growth factors having a potential to modulate bone formation. The objective of this study was to evaluate the osteoconductive potential of a platelet‐rich plasma (PRP) preparation. Methods: Thirty adult male Sprague–Dawley rats were used. The PRP preparation was obtained from 10 ml of whole blood drawn from one age‐matched donor rat. The preparation was processed by gradient density centrifugation and stored at −80°C until use. Using aseptic techniques, the PRP preparation soak loaded onto an absorbable collagen sponge (ACS) or ACS alone was surgically implanted into contralateral critical size 6‐mm calvaria osteotomies in 18 animals. Twelve animals received ACS versus sham surgery in contralateral defects. Animals were sacrificed at 4 and 8 weeks when biopsies were collected for histologic and histometric analysis. Results: The animals were maintained without adverse events. Bone formation was highly variable in sites receiving PRP and control treatments. Defect bone fill at 4 weeks averaged (±SD) 28.8±27.4% (PRP/ACS) versus 39.1±24.4% (ACS; p =0.2626) and 62.0±20.0% (ACS) versus 71.6±32.2% (sham surgery; p =0.1088), and at 8 weeks 81.0±12.9% (PRP/ACS) versus 64.5±28.1% (ACS; p =0.2626) and 75.6±34.1% (ACS) versus 74.1±24.2% (sham surgery; p =0.7353). Remnants of the ACS biomaterial were observed at both 4 and 8 weeks in sites implanted with PRP/ACS or ACS. Conclusions: The results suggest that the PRP preparation has a limited potential to promote local bone formation.
Purpose: Fibronectin(FN), one of the major components of ECM, mediates wide variety of cellular interactions including cell adhesion, migration, proliferation and differentiation. In this study, we used synthetic peptides based on fibrin binding sites of amino-terminal of FN and evaluated their biologic effects on periodontal ligament(PDL) cells. Materials and methods: PDL cells were cultured on synthetic oligopeptides coated dishes and examined for cell adhesion, proliferation via confocal microscope. For detection of ERK1/2, cells were plated and Western blot analysis was performed. Results: PDL cells on synthetic oligopeptide coated dishes showed enhanced cell adhesion and proliferation. Western blot analysis revealed increased level of ERK1/2 phosphorylation in cells plated on FN fragment containing fibrin-binding domain(FF1 and FF5) coated dishes. Conclusion: These results reveals that FN fragment containing fibrin-binding domain possess an enhanced biologic effect of PDL ligament cells. (J Korean Acad Periodontol 2009;39:45-52)
This clinical pilot study was performed to determine the effectiveness of dual-energy cone-beam computed tomography (DE-CBCT) in measuring bone mineral density (BMD).The BMD values obtained using DE-CBCT were compared to those obtained using calibrated multislice computed tomography (MSCT). After BMD calibration with specially designed phantoms, both DE-CBCT and MSCT scanning were performed in 15 adult dental patients. Three-dimensional (3D) Digital Imaging and Communications in Medicine data were imported into a dental software program, and the defined regions of interest (ROIs) on the 3-dimensional surface-rendered images were identified. The automatically-measured BMD values of the ROIs (g/cm3), the differences in the measured BMD values of the matched ROIs obtained by DE-CBCT and MSCT 3D images, and the correlation between the BMD values obtained by the 2 devices were statistically analyzed.The mean BMD values of the ROIs for the 15 patients as assessed using DE-CBCT and MSCT were 1.09±0.07 g/cm3 and 1.13±0.08 g/cm3, respectively. The mean of the differences between the BMD values of the matched ROIs as assessed using DE-CBCT and calibrated MSCT images was 0.04±0.02 g/cm3. The Pearson correlation coefficient between the BMD values of DE-CBCT and MSCT images was 0.982 (r=0.982, P<0.001).The newly developed DE-CBCT technique could be used to measure jaw BMD in dentistry and may soon replace MSCT, which is expensive and requires special facilities.
Purpose:The aim of this study was to determine the relationship between buccal bone thickness and gingival thickness by means of a noninvasive and relatively accurate digital registration method.Methods: In 20 periodontally healthy subjects, cone-beam computed tomographic images and intraoral scanned files were obtained.Measurements of buccal bone thickness and gingival thickness at the central incisors, lateral incisors, and canines were performed at points 0-5 mm from the alveolar crest on the superimposed images.The Friedman test was used to compare buccal bone and gingival thickness for each depth between the 3 tooth types.Spearman's correlation coefficient was calculated to assess the correlation between buccal bone thickness and gingival thickness.Results: Of the central incisors, 77% of all sites had a buccal thickness of 0.5-1.0mm, and 23% had a thickness of 1.0-1.5 mm.Of the lateral incisors, 71% of sites demonstrated a buccal bone thickness <1.0 mm, as did 63% of the canine sites.For gingival thickness, the proportion of sites <1.0 mm was 88%, 82%, and 91% for the central incisors, lateral incisors, and canines, respectively.Significant differences were observed in gingival thickness at the alveolar crest level (G0) between the central incisors and canines (P=0.032) and between the central incisors and lateral incisors (P=0.013).At 1 mm inferior to the alveolar crest, a difference was found between the central incisors and canines (P=0.025).The lateral incisors and canines showed a significant difference for buccal bone thickness 5 mm under the alveolar crest (P=0.025). Conclusions:The gingiva and buccal bone of the anterior maxillary teeth were found to be relatively thin (<1 mm) overall.A tendency was found for gingival thickness to increase and bone thickness to decrease toward the root apex.Differences were found between teeth at some positions, although the correlation between buccal bone thickness and soft tissue thickness was generally not significant.
The purpose of this retrospective study with 4-12 years of follow-up was to compare the marginal bone loss (MBL) between external-connection (EC) and internal-connection (IC) dental implants in posterior areas without periodontal or peri-implant disease on the adjacent teeth or implants. Additional factors influencing MBL were also evaluated.This retrospective study was performed using dental records and radiographic data obtained from patients who had undergone dental implant treatment in the posterior area from March 2006 to March 2007. All the implants that were included had follow-up periods of more than 4 years after loading and satisfied the implant success criteria, without any peri-implant or periodontal disease on the adjacent implants or teeth. They were divided into 2 groups: EC and IC. Subgroup comparisons were conducted according to splinting and the use of cement in the restorations. A statistical analysis was performed using the Mann-Whitney U test for comparisons between 2 groups and the Kruskal-Wallis test for comparisons among more than 2 groups.A total of 355 implants in 170 patients (206 EC and 149 IC) fulfilled the inclusion criteria and were analyzed in this study. The mean MBL was 0.47 mm and 0.15 mm in the EC and IC implants, respectively, which was a statistically significant difference (P<0.001). Comparisons according to splinting (MBL of single implants: 0.34 mm, MBL of splinted implants: 0.31 mm, P=0.676) and cement use (MBL of cemented implants: 0.27 mm, MBL of non-cemented implants: 0.35 mm, P=0.178) showed no statistically significant differences in MBL, regardless of the implant connection type.IC implants showed a more favorable bone response regarding MBL in posterior areas without peri-implantitis or periodontal disease.
Background: The data on the importance of soft-tissue management during surgical treatment of periimplantitis are still limited, and no clinical recommendations are yet available. Aim: To give an overview on the rationale for periimplant soft-tissue augmentation procedures in the light of potential benefits/risks of the presence/absence of keratinized/attached mucosa (KAM) providing recommendations for the clinician. Results: The available evidence indicates that the presence of KAM favors periimplant tissue health evidenced by improved bleeding scores and facilitation of self-performed plaque removal, less mucosal recessions, and more stable marginal bone levels over time. Therefore, the rationales to augment KAM are (a) to optimize the possibility for performing an adequate level of oral hygiene, (b) to help maintaining periimplant soft-tissue health and stability, and (c) to improve esthetics. Various techniques with autogenous or xenogeneic membranes have been described so far for KAM augmentation. Additional soft-tissue grafting in conjunction with a combined regenerative and resective surgical procedure seems to be effective in treating and controlling advanced periimplantitis lesions and improving or maintaining the esthetic outcomes. Conclusions: The limited available data seem to indicate that the best outcome to improve the width of KAM, and the bleeding and plaque scores, as well as to maintain the periimplant marginal bone level is the use of an apically positioned flap combined with a free gingival graft in nondiseased periimplant sites. However, at present, it is unknown: (a) to what extent soft-tissue grafting may additionally improve the outcomes after surgical (resective or regenerative) treatment of periimplantitis compared with the same approaches without soft-tissue grafting, and (b) if considered, when should soft-tissue grafting be performed (eg, before or during surgical treatment of periimplantitis). Clinical Recommendations: Both soft-tissue resective and regenerative approaches may lead to successful outcomes depending on the clinical indication and defect location. However, the selection of one or another surgical approach should be based on defect type (eg, intrabony and suprabony) and location (esthetic or nonesthetic areas). The presence of an adequate width and thickness of KAM may facilitate soft-tissue (flap) management. In patients with a thin phenotype or lack of an adequate width of KAM, soft-tissue grafting may improve the clinical outcomes.
Purpose: The objective of this clinical presentation was to present a clinical case series report of socket preservation, sinus augmentation, and bone grafting using a horse-derived biomaterial. Methods: A horse-derived biomaterial was used in 8 patients for different indications including socket preservation following tooth extraction, osseous bone grafting, and sinus augementation procedures. Surgeries were performed by a well trained specialist and clinical radiographs were obtained at designated intervals. Biopsy cores of 2 × 8 mm prior to implant placement was obtained following a healing interval of 4 - 6 months. A clinical and histologic evaluation was performed to evaluate the clinical effectiveness and biocompatibility of the biomaterial. Results: All surgeries in 8 patients were successful with uneventful healing except for one case with membrane exposure that eventually resulted with a positive outcome. Radiographic display of the healing phase during different intervals showed increased radiopacity of granular nature as the healing time increased. No signs of adverse effect or infection was observed clinically and the tissues surrounding the biomaterial seemed well-tolerated with good intentional healing. The augmented sinuses healed uneventfully suggesting in part, good biocompatibility of the biomaterial. Dental implants placed following socket preservation were inserted with high initial torque suggesting good initial stability and bone quality. Conclusions: Our results show that at least on a tentative level, a horse-derived biomaterial may be used clinically in socket preservation, sinus augmentation, bone grafting techniques with good intentional healing and positive results. (J Korean Acad Periodontol 2009;39:287-291)
The aim of this study was to evaluate the efficacy of deproteinized bovine bone mineral with 10% collagen (DBBM-C) soaked with hyaluronic acid (HA) for ridge preservation in compromised extraction sockets.Bilateral third, fourth premolars and first molar were hemisected, distal roots were extracted, and then combined endodontic periodontal lesion was induced in the remaining mesial roots. After 4 months, the mesial roots were extracted and the following four treatments were randomly performed: Absorbable collagen sponge (ACS), ACS soaked with HA (ACS+HA), ridge preservation with DBBM-C covered with a collagen membrane (RP), ridge preservation with DBBM-C mixed with HA and covered with a collagen membrane (RP+HA). Animals were sacrificed at 1 and 3 months following treatment. Ridge dimensional changes and bone formation were examined using microcomputed tomography, histology, and histomorphometry.At 1 month, ridge width was significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups, while the highest proportion of mineralized bone was observed in ACS+HA group. At 3 months, ridge width remained significantly higher in the RP and RP+HA groups than in the ACS and ACS+HA groups. ACS+HA and RP+HA treatments featured the highest proportion of mineralized bone and bone volume density compared with the other groups. No statistical difference was observed between ACS+HA and RP+HA treatments.Ridge preservation with the mixture DBBM-C/HA prevented dimensional shrinkage and improved bone formation in compromised extraction sockets at 1 and 3 months.
This study was to investigate and assess salivary biomarkers as a means of diagnosing periodontitis. A total of 121 subjects were included: 28 periodontally healthy subjects, 24 with stage I, 24 with stage II, 23 with stage III, and 22 with stage IV periodontitis. Salivary proteins including active matrix metalloproteinase-8 (MMP-8), pro-MMP-8, total MMP-8, C-reactive protein, secretory immunoglobulin A and planktonic bacteria including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas nigrescens, Parvimonas micra, Campylobacter rectus, Eubacterium nodatum, Eikenella corrodens, Streptococcus mitis, Streptococcus mutans, Staphylococcus aureus, Enterococcus faecalis, and Actinomyces viscosus were measured from salivary samples. The performance of the diagnostic models was assessed by receiver operating characteristics (ROC) and area under the ROC curve (AUC) analysis. The diagnostic models were constructed based on the subjects’ proteins and/or microbial profiles, resulting in two potential diagnosis models, which achieved better diagnostic powers with an AUC value &gt; 0.750 for the diagnosis of stage II, III, and IV periodontitis (Model PC-I; AUC: 0.796, sensitivity: 0.754, specificity: 0.712) and for the diagnosis of stage III and IV periodontitis (Model PC-II; AUC: 0.796, sensitivity: 0.756, specificity: 0.868). This study can contribute to screening for periodontitis based on salivary biomarkers.
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