OBJECTIVES:

The aim of this study was to explore the efficacy of bone density value derived from cone beam computed tomography (CBCT) by evaluating its correlation with implant stability parameters including insertion torque value (ITV) and radiofrequency analysis in relation to different clinical variables including location, gender, age, bone quality, and implant diameter.

MATERIAL AND METHODS:

A total of 65 implants were placed in 17 patients. The bone densities of implant recipient sites were preoperatively recorded using CBCT. Bone quality was subjectively assessed, which depends on the stiffness of the jawbone according to the Lekholm and Zarb index during drilling procedure. The maximum ITV of each implant was recorded using a digital torque meter during implant placement. Resonance frequency measurements were taken using an Osstell(®) Mentor immediately after implant placement. Data were analyzed statistically.

RESULTS:

The mean bone density, insertion torque, and implant stability quotient values of all implants were 556 ± 80, 37.4 ± 3.3 Ncm, and 73.8 ± 7.2, respectively. Statistically significant correlations were found between bone density values from CBCT and implant stability parameters in relation to all variables.

CONCLUSION:

Bone density assessment using CBCT is an efficient method and significantly correlated with implant stability parameters and Lekholm and Zarb index. Thus, it is possible to predict initial implant stability and possibility of immediate or early loading using CBCT scans prior to implant placement.

OBJECTIVES:

To evaluate the influence of instrumentation technique on the early osseointegration histomorphometrics and biomechanical fixation of fully laser-etched microgrooves implant surfaces in a sheep model.

MATERIAL AND METHODS:

Six sheep were subjected to bilateral hip surgeries 3 and 6 weeks before euthanasia. A total of 48 implants (∅4.5 mm, 8 mm in length) were distributed among four sites (8 per animal) and placed in bone sites drilled to 4.6 mm (reamer), 4.1 mm (loose), 3.7 mm (medium) and 3.2 mm (tight) in diameter. After healing, the animals were euthanized and half of the implants were biomechanically tested, while the remainder was subjected to non-decalcified histologic processing. The histomorphometric parameters assessed were bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). Statistical analysis was performed using a mixed-model analysis of variance with significance level set at P < 0.05.

RESULTS:

A general increasing trend is present from 3 to 6 weeks for most of the variables. The groups prepared to be press fit seemed to present higher values, which were maintained throughout the observation period. The reamer group presented the lowest BIC probably due to the drilling technique; however qualitatively, more new bone seemed to be in contact to the implant surface, at 3 weeks, whereas the implants placed in press-fit situations were mainly supported by cortical bone.

CONCLUSION:

The laser-etched microgrooved implant presented osteoconductive and biocompatible properties for all surgical procedures tested. However, procedures providing increasingly higher press-fit scenarios presented the strongest histomorphometric and biomechanical responses at 3 and 6 weeks.

OBJECTIVES:

Single-tooth replacement of anterior mandibular teeth is frequently complicated by insufficient bucco-lingual bone width and limited mesio-distal space available for implant placement. The aim of the present study was to assess implant esthetics in the partially edentulous anterior mandible.

MATERIAL AND METHODS:

Esthetic evaluation of 43 anterior mandibular single-tooth implants in 15 women and 28 men was performed using esthetic indices (PES = Pink Esthetic Score, PI = Papilla Index, SES = Subjective Esthetic Score) as well as subjective patients' Visual Analogue Scale (VAS) ratings. Clinical and radiological parameters (implant and crown dimensions, pocket depth, bleeding on probing, plaque, keratinized mucosa, marginal bone level, and distance to adjacent teeth) were tested for influence.

RESULTS:

Implant esthetics were judged satisfactory (PES ≤10) in 42% of implants compared with a patient satisfaction rate of 87%. Correlation between objective indices (PES/PI: rs  = 0.62, PES/SES: rs  = -0.73, PI/SES: rs  = -0.48) was highly significant (P ≤ 0.001); however, no association to subjective patients' ratings could be observed. Type of prosthetic restoration (single crown vs. tulip-shaped double crowns), mesio-distal crown width as well as anatomic crown length significantly affected esthetic scores. Patients' judgment, by contrast, could not be associated to any prognostic factor.

CONCLUSION:

Subjective patient satisfaction with implant esthetics in the partially edentulous anterior mandible is high, however, remains hard to predict or objectively quantify.

OBJECTIVES:

Retrospectively, we assessed the likelihood that peri-implantitis was associated with a history of systemic disease, periodontitis, and smoking habits.

METHODS:

Data on probing pocket depth (PPD), bleeding on probing (BOP), and radiographic bone levels were obtained from individuals with dental implants. Peri-implantitis was defined as described by Sanz & Chapple 2012. Control individuals had healthy conditions or peri-implant mucositis. Information on past history of periodontitis, systemic diseases, and on smoking habits was obtained.

RESULTS:

One hundred and seventy-two individuals had peri-implantitis (mean age: 68.2 years, SD ± 8.7), and 98 individuals (mean age: 44.7 years, SD ± 15.9) had implant health/peri-implant mucositis. The mean difference in bone level at implants between groups was 3.5 mm (SE mean ± 0.4, 95% CI: 2.8, 4.3, P < 0.001). A history of cardiovascular disease was found in 27.3% of individuals with peri-implantitis and in 3.0% of individuals in the implant health/peri-implant mucositis group. When adjusting for age, smoking, and gender, odds ratio (OR) of having peri-implantitis and a history of cardiovascular disease was 8.7 (95% CI: 1.9, 40.3 P < 0.006), and odds ratio of having a history of periodontitis was 4.5 (95% CI 2.1, 9.7, P < 0.001). Smoking or gender did not significantly contribute to the outcome.

CONCLUSIONS:

In relation to a diagnosis of peri-implantitis, a high likelihood of comorbidity was expressed by a history of periodontitis and a history of cardiovascular disease.

OBJECTIVE:

The objective of this prospective study was to determine the prevalence and incidence of marginal bone loss and, in addition, peri-implantitis in subjects and implant sites after 10 years in function.

MATERIAL AND METHODS:

One hundred and thirty-three subjects with a total of 407 implants that had been in function for about 5 years attended a follow-up visit in 2007 (visit 2; V2). 100 of the 133 subjects returned for a new clinical and radiographic examination in 2012 (visit 3; V3). The clinical examination included assessment of "bleeding on probing" (BoP+) and "probing pocket depth." Subjects with implant sites that in the radiograph exhibited crater-shaped marginal bone loss of >0.5 mm were identified as losers.

RESULTS:

During the interval between V2 and V3 (about 5 years), 13 implants in 7 subjects exhibited progressive bone loss and were removed. The overall amount of crestal bone loss that had occurred at the remaining implants between visit 1 (V1; ≥1 year of loading) and V3 (10 years) was small (0.36 ± 1.4 mm). The bone-level reduction was twice as great between V2 and V3 as between V1 and V2. Forty subjects and 75 (26%) implant sites exhibited marginal bone loss of >0.5 mm between V1 and V3. In the interval between V2 and V3, 37 new implant sites lost significant amounts of bone. During the entire 10-year period (V1-V3), 12% of patients and 5% of implants displayed signs of peri-implantitis (bone loss >0.5 mm, BoP+, PPD ≥6 mm), while in the V2-V3 interval, the corresponding numbers were 10% (patients) and 4% (implant sites).

CONCLUSION:

Sites with marginal bone loss of ≥1 mm were not common among implant patients. Peri-implantitis occurred in about 10% of patients and 4% of implant sites.

OBJECTIVE:

i) To test whether or not pH modifications of a PEG hydrogel matrix influence degradation time and bone regeneration in acute and unprepared (chronic) defects; and ii) to test whether or not the addition of a PEG hydrogel to hydroxyapatite/tricalciumphosphate (HA/TCP) can further enhance bone regeneration compared to HA/TCP alone in acute defects.

MATERIALS AND METHODS:

In 11 mini-pigs, three acute standardized defects and one chronic site were prepared in each hemi-mandible. The following treatment modalities were applied in acute defects: PEG hydrogel regular (PEG 8.7), PEG hydrogel pH-modified plus (PEG 9.0), PEG hydrogel pH-modified minus (PEG 8.4), PEG 8.7 mixed with HA/TCP granules (PEG-HA/TCP), HA/TCP granules (HA/TCP), and empty control (control). In chronic sites, PEG 8.7 and PEG 9.0 were applied. Subsequently primary wound closure was obtained and animals sacrificed at 10 (n = 6) and 21 days (n = 5). Descriptive histology and histomorphometric analyses were performed including measurements for newly formed bone, remaining hydrogel, and percent defect fill. Standard descriptive statistics were calculated, and regression analysis used to determine the difference between treatments, taking into account relevant factors and correction for multiple comparisons.

RESULTS:

In acute defects, the amount of newly formed bone increased statistically significantly over time for all treatments. The increase was higher for PEG 8.7 (35.9%) compared with PEG 8.4 and PEG 9.0 and was higher for PEG-HA/TCP (24.7%) than for HA/TCP (14.6%). The remaining hydrogel ranged between 7.6 ± 13.3% for PEG 8.4 and 17.7 ± 12.8% for PEG 8.7 at 10 days. At 21 days, no remaining hydrogel was found except for PEG-HA/TCP (11.5 ± 10.4%). In chronic sites, at 10 days, the remaining hydrogel covered 29.5 ± 10.3% (PEG 9.0) and 25.6 ± 21.8% (PEG 8.7) of the area. At 21 days, the amount of hydrogel (29.7 ± 31.7% for PEG 9.0; 1.4 ± 2.5% for PEG 8.7) decreased, while the amount of bone increased to 14.0 ± 16.3% for PEG 9.0 and to 37.9 ± 15.7% for PEG 8.7.

CONCLUSIONS:

The PEG hydrogel matrix with a mid-range pH (PEG 8.7) may serve as a matrix for localized bone regeneration with or without the addition of a bone substitute material. This was demonstrated by enhanced bone regeneration in acute and chronic defects compared with control hydrogels and HA/TCP alone.

AIM:

To investigate the relationship of tobacco consumption with alveolar crest height (ACH) loss and mandibular bone mass estimated by digital panoramic radiography and cone-beam computed tomography (CBCT).

MATERIAL AND METHODS:

We studied 315 patients (43.2% [n = 136] men and 56.8% [n = 179] women) with mean age of 36.6 ± 5.3 (range 21-30 years (16.2%), range 31-46 years (83.8%); 9% (n = 71) were smokers (>10 cig./day). A mean of 13.0 ± 2.0 mandibular teeth were present: 37.5% of patients had 6-12 teeth and 62.5% 13-16 teeth. We analyzed 315 digital panoramic radiographs (2D) and calculated the ACH, mandibular cortical width, and basal and alveolar bone gray level values. ACH and bone density were also measured on CBCT (3D) in the 110 patients scheduled for implantation.

RESULTS:

In the univariate analysis, ACH loss was greater in older patients (P = 0.012) and in those with fewer mandibular teeth (P < 0.001) and showed a relationship with tobacco consumption that was close to significant (P = 0.079). In the multivariate analysis, the number of mandibular teeth (P < 0.001) and tobacco consumption (P = 0.048) were significantly associated with ACH. Alveolar and basal bone densities were associated, respectively, with number of mandibular teeth (P = 0.012) and cortical width (P = 0.030).

CONCLUSION:

In a Caucasian population aged 21-46 years, tobacco consumption was significantly associated with ACH loss. However, ACH loss showed no significant relationship with mandibular bone mass estimated either as mandibular cortical width index or bone density on digital panoramic radiographs or as bone density on CBCT. ACH loss was a local event independent of mandibular bone mass status.

PURPOSE:

While extensive references are present in the literature dealing with the correlation between subjective and objective evaluation of tooth shade, there is a lack of information on this correlation regarding the soft tissue color. The purpose of this experimental study was to verify whether a correlation between the objective and subjective evaluation exists in analyzing soft tissue color.

MATERIAL AND METHODS:

A total of 39 patients with at least one implant-supported restoration in the anterior maxilla were included in the study. The shade of the peri-implant mucosa was compared with the shade of the gingiva at the adjacent tooth in a subjective and in an objective manner. The subjective evaluation was performed by five dental professionals (prosthodontist, periodontist, general dentist, dental hygienist, and dental assistant) in a subjective scale (ranging from 1 to 4). The objective evaluation was obtained by means of a spectrophotometer in a CIELAB* Color Scale, and the differences were evaluated through formula ΔE=[(ΔL)2+(Δa)2+(Δb)2]1/2. To correlate the subjective and the objective evaluation, for each arithmetical median value of the subjective evaluation, a mean value of objective evaluation has been calculated, and the Spearman's rank correlation coefficient has been used. The differences have been also analyzed for thin and thick tissue biotypes.

RESULTS:

The mean ∆E value for the subjective evaluation between peri-implant soft tissue and adjacent tooth gingival tissue was ∆E = 9.74. Also, mean ∆E values of 10.35 and 7.54 have been reported for thin and thick biotypes, respectively. Mean values of ∆E = 6.63, 8.54, and 15.54 were presented by median values of 1 (perfect matching), 2 (good matching), and 3 (clinically distinguishable), respectively. The threshold for the distinction of differences of mucosal color by the human eyes between perfect or good matching and distinguishable values has been calculated in ∆E = 8.74.

CONCLUSIONS:

Within the limitation of this study, a correlation between the subjective and the objective evaluation of the peri-implant soft tissue exists and the threshold for the distinction of mucosal color differences between perfect or good matching and distinguishable subjective values has been calculated in ∆E = 8.74 in the objective evaluation.

OBJECTIVES:

To investigate the impact of cover screw, resin embedment, and implant angulation on artifact of microcomputed tomography (micro-CT) scanning for implant.

MATERIALS AND METHODS:

A total of twelve implants were randomly divided into 4 groups: (i) implant only; (ii) implant with cover screw; (iii) implant with resin embedment; and (iv) implants with cover screw and resin embedment. Implants angulation at 0°, 45°, and 90° were scanned by micro-CT. Images were assessed, and the ratio of artifact volume to total volume (AV/TV) was calculated. A multiple regression analysis in stepwise model was used to determine the significance of different factors. One-way ANOVA was performed to identify which combination of factors could minimize the artifact.

RESULTS:

In the regression analysis, implant angulation was identified as the best predictor for artifact among the factors (P < 0.001). Resin embedment also had significant effect on artifact volume (P = 0.028), while cover screw had not (P > 0.05). Non-embedded implants with the axis parallel to X-ray source of micro-CT produced minimal artifact.

CONCLUSIONS:

Implant angulation and resin embedment affected the artifact volume of micro-CT scanning for implant, while cover screw did not.

OBJECTIVE:

Periodontal pathogens in dental plaque are the main causative agents of periodontitis and peri-implantitis. Detection of the presence of such periodontal pathogens early would serve as a useful tool in the diagnosis and treatment of this disease. Therefore, the purpose of this study was to investigate whether the periodontal pathogen levels in saliva were correlated with the periodontal status of patients receiving implant treatment.

MATERIALS AND METHODS:

A total of 291 patients visiting Tokyo Dental College Chiba Hospital were divided into four groups: a no-periodontitis (np) group, a mild-periodontitis (mip) group, a moderate-periodontitis (mop) group, and a severe-periodontitis (sp) group. The levels of the following five periodontal pathogens in saliva were evaluated using real-time polymerase chain reaction: Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Treponema denticola, and Prevotella intermedia.

RESULTS:

The levels of P. gingivalis and T. forsythia were significantly higher in mop group than in np group (P < 0.05). The levels of all periodontal pathogens tested except A. actinomycetemcomitans were significantly higher in sp group than in np group (P < 0.05).

CONCLUSION:

The detection levels of the periodontal pathogens targeted in saliva samples were correlated with the periodontal status. This suggests that using saliva to screen for periodontopathic bacteria offers an easier-to-use clinical tool than the paper point method in the diagnosis and treatment of periodontitis and peri-implantitis.