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Clinical Implant Dentistry and Related Research

Vol. 12 No. 4 (December 2010)

Dahlin C, Simion M, Hatano N.  Long-term follow-up on soft and hard tissue levels following guided bone regeneration treatment in combination with a xenogeneic filling material: a 5-year prospective clinical studyClin Implant Dent Relat Res 2010;12(4):263-270.

A total of 41 implants were placed conjunction with GBR in 20 patients and followed up for 5 years. The cumulative survival rate was 97.5% and the reduction in mean bone height was from -3.51 mm to -2.38 mm. Marginal soft tissue level was stable throughout the  5-year period. GBR in conjunction with implant placement is therefore a viable treatment option to maintain hard and soft tissue levels.

Hjalmarsson L, Örtorp A, Smedberg J-I, Jemt T. Precision of fit to implants: a comparison of Cresco and Procera implant bridge frameworksClin Implant Dent Relat Res 2010;12(4):271-280.

Titanium or Co-Cr Cresco frameworks and titanium Procera frameworks for implant-supported fixed compete prostheses were fabricated and measurements of fit on implants calculated. The maximal 3D range of center point distortion was 279  μm. Framework width increased in the titanium frameworks but decreased for Cresco-CoCr, and fewer distortions were apparent in the vertical dimension for the Procera versus the Cresco frameworks. However, no complete passive fit was observed for any of the frameworks.

Shibli JA, Grassi S, Piattelli A, Pecora GE, Ferrari DS, Onuma T, D’Avila S, Coelho PG, Barros R, Iezzi G. Histomorphometric evaluation of bioceramic molecular impregnated and dual acid-etched implant surfaces in the human posterior maxillaClin Implant Dent Relat Res 2010;12(4):281-288.

Implants with a dual acid-etched surface (control) and with bioceramic molecular impregnation (test) were placed in 10 subjects (one of each surface in each subject) during conventional implant surgery in the maxilla. The implants were removed and evaluated after 2 months. Significantly higher BIC and osteocyte index values were found for the test implants but there was no significant difference in bone density in threaded area between the two groups. The bioceramic molecular impregnation therefore appeared to have a positive influence on early bone healing.

Gahlert M, Röhling S, Wieland M, Eichhorn S, Küchenhoff H, Kniha H.  A comparison study of the osseointegration of zirconia and titanium dental implants. A biomechanical evaluation in the maxilla of pigsClin Implant Dent Relat Res 2010;12(4):297-305.

Acid-etched zirconia implants and sandblasted and acid-etched titanium implants were placed in the maxillae of 16 pigs 6 months after the extraction of second and third incisors. Removal torque was assessed after 4, 8 and 12 weeks. Removal torque values for the zirconia and titanium implants were 42.4 Ncm and 42.1 Ncm, respectively, after 4 weeks, 69.6 Ncm and 75.0 Ncm, respectively after 8 weeks, and 69.3 Ncm and 73.1 Ncm, respectively, after 12 weeks. The results indicated that bone apposition was similar between zirconia and titanium implants.


Balleri P, Ferrari M, Veltri M. One-year outcome of implants placed  strategically in the retrocanine bone triangleClin Implant Dent Relat Res 2010;12(4):324-330.

A total of 40 implants were placed in the bone anterior to the sinus wall in 20 patients with atrophic posterior maxillae. Three-unit screw-retained FPDs were placed after 6 months. After 1 year of loading, there were no implant failures or biological or mechanical complications, and there were no differences in bone level between axial and tilted implants. Three-unit FPDs supported by two implants therefore showed positive outcomes in the maxillary retrocanine region.

Clinical Oral Implants Research

Vol. 21 No. 11 (November 2010)

Vol. 21 No. 12 (December 2010)

Koong B.  Cone beam imaging: is this the ultimate imaging modality?  Clin Oral Implants Res 2010;21(11):1201-1208.

Cone beam imaging is an essential technique that all clinicians should be familiar with, and should be considered in daily clinical practice if low-dose systems and protocols are used. The technique complements 2D radiographic and other techniques, although multislice computed tomography may be more powerful and flexible, and is the technique of choice for many.  However, all techniques should be evaluated in their entirety, and the clinician skill levels and responsibilities, and medico-legal implications need to be considered. 

Van Der Bilt A, Burgers M, Van Kampen FMC, Cune MS. Mandibular implant-supported overdentures and oral functionClin Oral Implants Res 2010;21(11):1209-1213.

Patients who had received two mandibular implants and an overdenture with magnet, ball-socket or bar-clip attachments were evaluated for oral function 10 years after participation in a clinical trial. Of the original 18 patients, 14 were evaluated at the 10-year follow-up. Maximum bite force increased from 162 N to 341 N after implant treatment, and the number of chewing cycles decreased from 55 to 27; no significant changes were seen after 10 years. The improvement in oral function with implant-supported overdentures was therefore maintained for a long time.

 Van de Velde T, Sennerby L, De Bruyn H. The clinical and radiographic outcome of implants placed in the posterior maxilla with a guided flapless approach and immediately restored with a provisional rehabilitation: a randomized clinical trial. Clin Oral Implants Res 2010;21(11):1223-1233.

Implants were placed in the bilateral maxillary edentulous areas of 14 patients in a split-mouth design: a stereolithographic guide was used in one side and implants were immediately loaded (test; 36 implants), and a conventional protocol and loading after 6 weeks (control; 34 implants) was performed on the other side. Clinical and radiographic analyses were performed after 1 and 6 weeks, and 3, 6, 12 and 18 months. Implant survival was 97.3% and 100% in the test and control groups, respectively. Mean bone level after 18 months was 1.95 ± 0.70 mm and 1.93 ± 0.42 mm for test and control groups, respectively. Differences between test and control sides were found in the first 6 weeks for speech, function, esthetics, self-confidence and overall appreciation, and there was a significant difference change in height of the attached mucosa at implants placed with a conventional flap after 1 and 6 weeks.


Beitlitum I, Artzi Z, Nemcovsky CE. Clinical evaluation of particulate allogeneic with and without autogenous bone grafts and resorbable collagen membranes for  bone augmentation of atrophic alveolar ridgesClin Oral Implants Res 2010;21(11):1242-1250.

Vertical and/or lateral ridge deficiencies of  ≤ 3 mm in 50 patients were treated with either particulate mineralized freeze-dried bone allograft (FDBA) alone or with bi-layered autogenous bone chips and covered with a cross-linked collagen barrier membrane. Mean vertical and horizontal bone gain were 3.47 ± 1.25 mm and 5 ± 1.28 mm, respectively, for FDBA alone and 3.5 ± 1.2 mm and 3.6 ± 1.72 mm, respectively, for FDBA + bone chips. The addition of autogenous bone chips therefore had no significant effect.

Junker R, Manders PJD, Wolke J, Borisov Y, Jansen JA. Bone reaction adjacent to microplasma-sprayed CaP-coated oral implants subjected to occlusal load, an experimental study in the dog. Part I: short-term results. Clin Oral Implants Res 2010;21(11):1251-1263.

A total of 48 implants (acid-etched, plasma-sprayed CaP ceramic, microplasma-sprayed CaP ceramic or microplasma-sprayed at the apical part only) were placed into the mandibles of six dogs. Functional loading was performed on one side of the mandible after 6 weeks, while the contralateral side served as a control. Implants were assessed after a further 6 weeks. There were no significant differences between the groups for BIC or amount of bone; however, there was a tendency towards crestal bone loss for the functionally loaded non-coated implants. Microplasma-sprayed coatings therefore elicit a favorable bone response, but this does not differ from conventionally sprayed coatings.

Urban T, Wenzel A.  Discomfort experienced after immediate implant placement associated with three different regenerative techniquesClin Oral Implants Res 2010;21(11):1271-1277.

In 92 patients requiring single implants in then molar region. Resulting peri-implant defects were treated with autogenous bone chips, Ossix membrane, or a combination of both. The post-operative course was recorded using visual analogue scales for pain, swelling and bleeding from the wound on the day of surgery and after 1, 2 and 3 days. Peak pain occurred 5-6 hours after surgery, while peak swelling and bleeding occurred after 1 day. Pain scores were higher for smokers than non-smokers, with a significant difference from 1 to 3 days. Pain was also significantly higher in younger (< 50 years) than older patients.


Al-Kalaly AA, Wong RWK, Cheung LK, Purkayastha SK, Schätzle M, Rabie ABM.  Evaluation of bone thickness around the mental foramen for potential fixation of a bone-borne functional appliance: a computer tomography scan studyClin Oral Implants Res 2010;21(11):1288-1293.

Bi-cortical bone thickness in the mental foramen area was measured in 60 patients by assessing the buccal and lingual cortical bone 10 mm and 5 mm anterior, 10 mm and 5 mm posterior and 5 mm below the mental foramen. Buccal cortical thickness ranged from 1.89 mm (10 mm anterior) to 2.16 mm (10 mm posterior), and there was a marginally significant difference between 10 mm and 5 mm anterior. Total bone thickness ranged from 10.19 to 12.06 mm. Although no large variation was observed, evaluation on a case by case basis is advised.

Wahlström M, Sagulin GB, Jansson LE. Clinical follow-up of unilateral, fixed dental prosthesis on maxillary implants. Clin Oral Implants Res 2010;21(11):1294-1300.

Patients who had received FDPs on implants, in function for at least 3 years, were asked to participate in a follow-up evaluation. Of 50 patients invited, 46 were examined. Prior to treatment, tooth extraction was due to periodontal disease in 80% of cases. There was one implant fracture after 3 years and another after 6.5 years. Veneer fractures and loose bridge crews were the most common mechanical complications. Bleeding was more frequent in patients with peri-implant mucositis, and deep periodontal pockets around the remaining teeth were more frequent in patients with peri-implantitis. Fewer teeth, more periodontal pockets ≥ 4 mm, and greater marginal bone loss was found in smoking versus non-smoking patients.  

Koch FP, Becker J, Terheyden H, Capsius B, Wagner W. A prospective, randomized pilot study on the safety and efficacy of recombinant human growth and differentiation factor-5 coated onto β-tricalcium phosphate for sinus lift augmentation. Clin Oral Implants Res 2010;21(11):1301-1308.

Patients requiring unilateral maxillary sinus floor augmentation were treated with a) augmentation with rhGDF-5/β-TCP and 3-month healing, b) augmentation with rhGDF-5/β-TCP and 4-month healing, or c) β-TCP/autologous bone and 4-month healing. Osseous regeneration was similar in all groups, with newly formed bone ranging from 28% to 31.8%. The largest augmentation height was achieved in the rhGDF-5/β-TCP groups. Of 47 implants in the rhGDF-5/β-TCP groups, four failed. Treatment with rhGDF-5/β-TCP was therefore found to be as safe and effective as the control treatment.

Çehreli MC, Kökat AM, Uysal S, Akca K.  Spontaneous early exposure and marginal bone loss around conventionally and early-placed submerged implants: a double-blind study.  Clin Oral Implants Res 2010;21(12):1327-1333.

A total of 46 patients received 103 implants by either conventional or  early placement protocols. Plaque index, cover screw exposure and marginal bone level change were recorded prior to second-stage surgery. Marginal bone level change was higher with early placement, and the use of an interim prosthesis led to higher marginal bone level changes with early placement but not conventional placement. There were significantly more exposed implants with early placement, and the mean plaque score was 11.5 times higher than with early placement. There appeared to be a correlation between screw exposure and early crestal bone loss; more perforations and bone loss was observed with early placement.

Kohal R-J, Wolkewitz M, Mueller C. Alumina-reinforced zirconia implants: survival rate and fracture strength in a masticatory simulation trial. Clin Oral Implants Res 2010;21(12):1345-1352.

Three groups of 24 implants each (two groups of alumina-toughened zirconia (ATZ) and one of tetragonal zirconium dioxide polycrystal (TZP-A)) were evaluated. Chamfer preparation at the implant heads was performed for the TZP-A implants and one group of the ATZ implants. Thermomechanical loading (1.2 or 5 million cycles) of 98 N was performed for eight implants in each group; the remaining eight implants in each group were not cyclically loaded. Fracture strength was then assessed. There were no implant fractures during loading in any group, and mean fracture strength was significantly higher for the ATZ implants in all situations, although modification of  the implant head significantly reduced  fracture strength. The results suggested that ATZ implants could withstand functional loading for up to 20 years.


Suarez-Feito J-M, Sicilia A, Angulo J, Banerji S, Cuesta I, Millar B. Clinical performance of provisional screw-retained metal-free acrylic restorations in an immediate loading protocol: a 242 consecutive patients’ reportClin Oral Implants Res 2010;21(12):1360-1369.

A retrospective analysis was performed for 242 patients who received a total of 1011 implants to support 311 immediate provisional screw-retained restorations. After an healing period of 3 months, at least one fracture was observed in 23 restorations in  20 patients; in 12 cases, the fracture occurred within 4 weeks. The probability of cumulative survival was significantly greater in the mandible, in restorations without cantilever,and in restorations opposed by full restorations or natural teeth. The risk of fracture increased 4.7-fold with an opposing implant-supported prosthesis, while positions in the maxilla increased the risk of fracture 3.4-4.5-fold. However, 92.6% of the restorations remained intact, so the technique was considered reliable.  

Yoon H-I, Yeo I-S, Yang J-H. Effect of a macroscopic groove on bone response and implant stability. Clin Oral Implants Res 2010;21(12):1379-1385.

Twelve rabbits each received four anodized titanium implants, either with or without a macroscopic groove. No difference in BIC was found between the two implant types after 2 and 6 weeks, but implant stability was significantly higher for the grooved implants after 6 weeks and resistance to reverse torque was significantly higher after 2 and 6 weeks. The groove may therefore increase adhesion at the interface with the bone and resistance to shear load.

Nickenig H-J, Wichmann M, Schlegel KA, Nkenke E, Eitner S. Radiographic evaluation of marginal bone levels during healing period, adjacent to parallel-screw cylinder implants inserted in the posterior zone of the jaws, placed with flapless surgeryClin Oral Implants Res 2010;21(12):1386-1393.

Implants placed using a flapless approach (785 implants in 417 patients) were compared with implants placed using a flap technique (459 implants in 227 patients). Marginal bone level was measured at implant placement and after healing. After a median follow-up time of 6 months, no significant differences in marginal bone level were noted between the groups, but differences in marginal bone level were significantly different between smokers and non-smokers in the flapless group.

 Felice P, Pellegrino G, Checchi L, Pistilli R, Esposito M. Vertical augmentation with interpositional blocks of anorganic bovine bone vs. 7-mm-long implants in posterior mandibles: 1-year results of a randomized clinical trialClin Oral Implants Res 2010;21(12):1394-1403.

In 60 patients with edentulous posterior mandibles  (residual bone height 7-8 mm), either short implants (7 mm) were placed without augmentation or  ≥ 10-mm-long implants were placed 5 months after augmentation with anorganic bovine bone  blocks. Provisional prostheses were placed after 4 months, replaced by definitive prostheses after a further  4 months. There was insufficient bone to place longer implants in two mandibles due to breakage of the bone blocks, and prostheses could not be placed in one and three patients in the short and augmented groups, respectively, due to implant failure. Wound dehiscence occurred during graft healing in four cases in the augmented group, compared to none in the short implant group. Mean bone loss after 1 year was approximately 1 mm in both groups. Short implants may therefore be a preferable option to augmentation for residual mandibular bone height of 7-8 mm.


Clinical Oral Investigations

Vol. 14 No. 5 (October 2010)

Vol. 14 No. 6 (December 2010)

Ettl T, Gerlach T, Schüsselbauer T, Gosau M, Reichert TE, Driemel E. Bone resorption and complications in alveolar distraction osteogenesisClin Oral Investig 2010;14(5):481-489.

A total of 36 alveolar distraction procedures were performed in 30 patients, 11 in the maxilla and 25 in the mandible. After a mean consolidation period of 4.5 months, a total of 82 implants were placed. Mean alveolar height achieved was 6.4 mm and the mean resorption was 1.8 mm at the time of implant placement. Implant survival was 95.1% after a mean follow-up of 45.8  months. Them main complications observed were displacement of the transport segment and inadequate soft tissue extension. Mean peri-implant bone resorption of 3.5 mm was recorded after a mean follow-up of 50.4 months. Alveolar distraction osteogenesis is therefore effective but can have complications, and there may be further bone resorption after implant placement.

Heinz B, Kasaj A, Teich M, Jepsen S. Clinical effects of nanocrystalline hydroxyapatite paste in the treatment of intrabony periodontal defects: a randomized controlled clinical study. Clin Oral Investig 2010;14(5):525-531.

Paired intrabony defects in 14 patients were treated with papilla preservation flap alone or in combination with a nanocrystalline HA paste. Probing depth and probing bone levels were measured at baseline and after 6 months. Significant improvements from baseline were seen in both groups, with significantly greater reduction of probing depth and gain of probing bone level in the nano-HA group. Treatment with the nano-HA paste therefore led to improved clinical outcomes versus papilla preservation flap alone. 

Implant Dentistry

Vol. 19 No. 5 (October 2010)

Grecchi F, Zingari F, Raffaella B, Zollino I, Casadio C, Carinci F. Implant rehabilitation in grafted and native bone in patients affected by ectodermal dysplasia: evaluation of 78  implants inserted in 8 patients. Implant Dent 2010;19(5):400-408.

A retrospective analysis of 78 implants in eight patients with ectodermal dysplasia was performed, and patient-, implant-, surgical- and prosthetic-related variables were investigated. The implants replaced 19 incisors, 19 cuspids, 21 premolars and 19 molars. There was one implant loss, and  implant length, grafted sites and type of loading appeared to have an influence on  the analysis. Dental implant rehabilitation is therefore valuable in patients with ectodermal dysplasia.  

Sohn D-S, Kim W-S, Lee W-H, Jung H-S, Shin I-H. A retrospective study of sintered porous-surfaced dental implants in restoring the edentulous posterior mandible: up to 9 years of functioning.  Implant Dent 2010;19(5):409-418.

A total of 43 patients with 122 sintered porous-surfaced implants (either 4.1 mm or 5.0 mm in diameter) were retrospectively analyzed; all implants were restored with fixed prostheses. Radiographic analysis was performed. The mean follow-up time was 55.8 months. The cumulative implant survival rate was 97.5%; survival rates were 100% and 91.2%  for the 4.1 mm diameter and 5.0 mm diameter implants, respectively, indicating a significant difference. However, there was no significant difference in survival rates for implants of different lengths. No implant failures occurred when  the crown-to-implant ratio was < 1.0 or between 1.5 and 2.0, but the failure rate was 6.7% where the  crown-to-implant ratio was between 1.0 and 1.4; the difference was significant.


Pae A, Kim J-W, Kwon K-R.  Immediate loading of two implants supporting a magnet attachment-retained overdenture: one-year clinical studyImplant Dent 2010;19(5):428-436.

Each of six patients received two implants in the mandible to support immediate overdentures retained by magnet attachments. Clinical and radiographic parameters and implant stability were measured after 1, 2, 6, 12 and 24 weeks and 1 year. Two implants failed in two patients, but all others  remained stable. Crestal bone changes were minimal between 6 weeks and 1 year,  and there were no significant differences in bleeding on probing. Immediate loading with overdentures retained by magnet attachments is therefore a viable treatment option in the fully edentulous arch.

Bilhan H, Kutay O, Arat S, Çekici A, Cehreli MC. Astra Tech, Branemark and ITI implants in the rehabilitation of partial edentulism: two-year resultsImplant Dent 2010;19(5):437-446.

In 26 patients, Astra Tech implants (42), Brånemark  implants (36) and ITI implants (29) were placed; abutment connection was performed for the Astra Tech and Brånemark implants after 3 months and all implants received fixed prostheses after 4 months. Clinical parameters were recorded after 6, 12 and 24 months and radiographic bone level was recorded after 2 years. Implant survival was 100% for all systems. Plaque index and peri-implant inflammation scores were significantly higher for the Brånemark implants in the first year. Marginal bone loss was similar for the  Astra Tech and ITI implants after 2 years, but the marginal bone loss at Brånemark implants was significantly higher than at Astra Tech implants. 

Toffler M, Toscano N, Holtzclaw D. Osteotome-mediated sinus floor elevation using only platelet-rich fibrin:  an early report on 110 patients. Implant Dent 2010;19(5):447-456.

Osteotome-mediated sinus floor elevation with platelet-rich fibrin was performed in 110 patients and 138 implants were placed. Mean subantral bone height of the alveolar ridge was 6.6 mm, and the mean increase was 3.4 mm. Of the 138 implants placed, 97 were restored an in function for a mean of 5.2 months, with a mean healing time of 4 months until abutment placement. The implant survival rate was 97.8% (three implants failed). The procedure therefore led to a high degree of success.

International Journal of Oral and Maxillofacial Implants

Vol. 25 No. 5 (September/October 2010)

Orlando B, Barone A, Giorno TM, Giacomelli L, Tonelli P, Covani U. Insertion torque in different bone models with different screw pitch: an in vitro studyInt J Oral Maxillofac Implants 2010;25(5):883-887.

Wide-pitch or fine-pitch implants were placed in polyurethane foam blocks simulating hard (D1 or D2) or soft (D3 or D4) density bone following the preparation of insertion sites using 1.5 mm or 2.5 mm drills. The final insertion torque was recorded for each implant. Greater insertion torque was noted with wide-pitch implants in cancellous bone. The results suggested that implants with a wide pitch design and 2.5 mm osteotomy are more suitable for dense cortical bone, while wide-pitch implants and 1.5 mm osteotomy are more appropriate for softer bone.


Pessoa RS, Vaz LG, Marcantonio E Jr, Vander Sloten J, Duyck J, Jaecques SVN. Biomechanical evaluation of platform switching in different implant protocols: computed tomography-based three-dimensional finite element analysisInt J Oral Maxillofac Implants 2010;25(5):911-919.

A CT-based element model of a central incisor extraction socket was created with a conical external hex implant with a 4.3 mm shoulder diameter and abutment models of 4.3 mm or 3.8 mm in diameter. Immediately placed, immediately loaded and conventionally loaded protocols were simulated. Differences in the biomechanical environment between platform-switched and non-platform-switched models were minor, but slightly higher EQV stress was noted for the platform-switched model in all cases, but the difference was not significant. Platform-switching therefore has  little influence on the biomechanical environment of implants.

 Drago C, Saldarriaga RL, Domagala D, Almasri R.  Volumetric determination of  the amount of misfit in CAD/CAM and cast implant frameworks: a multicenter laboratory study.  Int J Oral Maxillofac Implants 2010;25(5):920-929.

Acrylic resin models with five interforaminal implants were scanned and master casts constructed. A gold alloy framework and titanium milled bar by CAD/CAM were fabricated to clarify the construction processes, and subsequently five cast and five CAD/CAM frameworks were fabricated at each of three dental schools (15 cast bars and 15 milled bars). Restorative interfaces were scanned and the virtual frameworks fit onto digitized scans of the restorative platforms. Volumetric measurements were used to determine the amount of misfit. Significantly better fit was demonstrated by the frameworks made with CAD/CAM technology, and there were significant differences between the right and left one-screw tests, but no significant differences were observed between the three sites. 

Winter W, Möhrle S, Holst S, Karl M. Bone loading caused by different types of misfits of implant-supported fixed dental prostheses: a three-dimensional finite element analysis based on experimental results.  Int J Oral Maxillofac Implants 2010;25(5):947-952.

Two finite element models were created to simulate strain values of three-unit FPDs on two implants using horizontal, vertical and angular misfits. Horizontal misfit of 36 μm and vertical misfit of 79 μm were required to simulate the experimental strain value results, and comparable levels were obtained from an angular misfit of 0.083°. Bone loading ranged from 50-90 MPa in the cortical area and 2-5 MPa in trabecular bone around implants for horizontal and vertical misfit and up to 20 MPa in the cortical layer and 1 MPa in the cervical part of the trabecular bone for angular misfit. Comparable loading patterns were observed around both implants for horizontal and vertical misfit, and bone loading under angular misfit was mainly where the misfit had been introduced.

Faggion CM, Schmitter M. Using the best available evidence to support clinical decisions in implant dentistryInt J Oral Maxillofac Implants 2010;25(5):960-969.

A strategy for searching, selecting and appraising  scientific literature was developed using a focused question in the PICO (patient, intervention, comparison and outcome) format. Systematic reviews on peri-implantitis were searched, two were found and the quality assessed by two referees using three checklists. The reviews suggested that subgingival debridement (with or without antibiotics) and regenerative procedures may be effective for peri-implantitis. The checklists used showed  that the trials in the reviews were rigorous. Reviewer assessment agreement was good, and the algorithm demonstrated the available options for peri-implantitis management.

Juodzbalys G, Wang H-L. Socket morphology-based treatment for implant esthetics: a pilot studyInt J Oral Maxillofac Implants 2010;25(5):970-978.

A total of 25 maxillary anterior teeth were extracted from 25 patients; soft and hard tissue assessments were made and therapeutic approaches proposed using a decision tree. The morphology of the sockets was adequate (five sockets), compromised (12 sockets) or deficient (eight sockets). Adequate esthetic results were achieved in Type I sockets regardless of treatment, while Type II sockets with immediate-delayed implant placement were adequate in 87.5% of cases at prosthesis placement and in 62.5% of cases after 1 year. For Type III sockets treated with delayed implant placement, 75% were adequate at both evaluation periods.

Nothdurft FP, Doppler KE, Erdelt KJ, Knauber AW, Pospiech PR.  Influence of artificial aging on the load-bearing capacity of straight or angulated zirconia abutments in implant/tooth-supported fixed partial denturesInt J Oral Maxillofac Implants 2010;25(5):991-998.

Four test groups representing anterior implant/tooth-supported FPDs; groups 1 and 2 simulated an ideal situation allowing for a straight, prefabricated zirconia abutment, and groups 3 and 4 simulated a compromised situation requiring an angulated abutment.  Implants and metal tooth analogs with simulated mobility were mounted in polymethyl methacrylate, and FPDs were cemented; groups 2 and 4 were thermomechanically loaded, with static loading until failure. All samples survived thermomechanical loading, and no significant increase in load-bearing capacity in the straight or angulated abutments was observed. Fracture loads were significantly higher for the restorations on angulated abutments than those on straight abutments. Compensating for angulated  positions with angulated abutments  is therefore possible with no reduction of the load-bearing capacity of the FPDs.


Deng F, Zhang H, Zhang H, Shao H, He Q, Zhang P. A comparison of clinical outcomes for implants placed in fresh extraction sockets versus healed sites in periodontally compromised patients: a 1-year follow-up report. Int J Oral Maxillofac Implants 2010;25(5):1036-1040.

Hopeless teeth were extracted form periodontally compromised patients, the sites debrided and implants placed using a surgical guide. An immediate provisional restoration was placed and a definitive restoration delivered after 6 months. A total of 84 implants were placed, 32 of which were in fresh extraction sockets. The implant survival rate was 95.2% (92% and 100% in the maxilla and mandible, respectively); all of the failed implants had been placed in fresh extraction sockets. All prostheses survived and the mean change in bone level at 12 months was -1.12 ± 0.18 μm. A relatively high risk for implant failure in the periodontallycompromised maxilla was therefore noted.

International Journal of Periodontics and Restorative Dentistry

Vol. 30 No. 5 (September/October 2010)

Alves CC, Correia AR, Neves M.  Immediate implants and immediate loading in periodontally compromised patients – a 3-year prospective clinical studyInt J Periodontics Restorative Dent 2010;30(5):447-455.

In each of 23 periodontally compromised patients, 168 implants were placed (mostly six Straumann implants distributed along the arch according to surgical guide or bone availability); 83 were placed in the maxilla and 85 in the mandible. Most were immediately loaded except nine maxillary implants that underwent delayed loading. The prosthesis was adapted in the first 48 hours and a definitive restoration placed after 2 months. The 3-year cumulative survival rate was 98.74% (98.65% and 98.82% in the maxilla and mandible, respectively); two implants failed. The 3-year cumulative prosthesis survival rate was 100%, indicating that immediate loading is a predictable technique for periodontally compromised patients.

Stappert FJ, Tarnow DP, Tan JH-P, Chu SJ. Proximal contact areas of the maxillary anterior dentitionInt J Periodontics Restorative Dent 2010;30(5):471-477.

Proximal contact area (PCA) between  the eight maxillary anterior teeth was calculated by measuring 140 PCA sites and 160 crown lengths in 20 patients. The mean PCA dimensions were 4.2 mm between central incisors, 2.9 mm between central and lateral incisors, 2.0 mm between lateral incisors and canines, and 1.5 mm between canines and first premolars; the corresponding mesial mean proximal area contact portions were 41%, 32%, 20% and 18%, respectively. Significant differences were noted between all PCAs, except for canine/first premolar sites. Natural proximal area contact portions were well defined and should be considered in clinical anterior restorations.

Journal of Clinical Periodontology

Vol. 37 No. 11 (November 2010)

Vol. 37 No. 12 (December 2010)

Mattila PT, Niskanen MC, Vehkalahti MM, Nordblad A, Knuuttila  MLE.  Prevalence and simultaneous occurrence of periodontitis and dental cariesJ Clin Periodontol 2010;37(11):962-967.

In a study population of 5,255 subjects as part of a national Health 2000 survey, pocket depths and dental caries were recorded. Periodontal disease (pocket depth  ≥ 4 mm) was noted in 64%, severe periodontal disease (≥ 6 mm) in 21% and dental caries in 29%. Dental caries was significantly more prevalent in subjects with periodontal disease, and more so in subjects with severe periodontal disease. Subjects with dental caries were also significantly more likely to have severe periodontal disease. Periodontal disease and dental caries therefore tend to accumulate in the same subjects.


Bernabé E, Marcenes W.  Periodontal disease and quality of life in British adults.  J Clin Periodontol 2010;37(11):968-972.

The short-form oral health impact profile (OHIP)-14 was used to assess 3,122 subjects in a cross-sectional study. Periodontal disease (at least two sites with loss of attachment  ≥ 4 mm and one proximal site with pocket depth  ≥ 4 mm) was found to be associated with OHIP-14 score, even after adjustment for demographic, socioeconomic and clinical factors, therefore indicating that periodontal disease is associated with quality of life.

Nedir R, Nurdin N, Vazquez L, Szmukler-Moncler S, Bischof M, Bernard J-P. Osteotome sinus floor elevation technique without grafting: a 5-year prospective studyJ Clin Periodontol 2010;37(11):1023-1028.

Osteotome sinus floor elevation was performed without grafting in 17 patients (mean residual bone height 5.4 ± 2.3 mm) and a total of 25 implants (10 mm in length) were placed. Implant survival after 5 years was 100% and the mean increase in peri-implant bone was 3.2 ± 1.3 mm, while implant protrusion into the sinus decreased from 4.9 ± 1.9 mm at baseline to 1.5 ± 0.9 mm. Mean crestal bone loss was 0.8 ± 0.8 mm, which stabilized over 5 years; bone gain after 1 year was noted at 20 implants. Grafting is therefore not required for bone gain of at least 3 mm.


Artzi Z, Nemcovsky CE, Tal H, Weinberg E, Weinreb M, Prasad H, Rohrer MD, Kozlovsky A. Simultaneous versus two-stage implant placement and guided bone regeneration in the canine: histomorphometry at 8 and 16 months. J Clin Periodontol 2010;37(11):1029-1038.

Four sites were established in each of seven dogs: 1) implant placed in bovine bone grafted site after 6 months of healing; 2) implant placed with simultaneous bovine bone grafting and membrane coverage; 3) implant placed in non-grafted defect with membrane coverage; and, 4) implant placed in naturally healed site. Histomorphometric measurements were performed after 8 and 16 months. BIC ranged from 62-79% at all sites, and particle area fraction ranged from 17-27%. Bone area fraction was significantly smaller at the group 2 sites, and osteoconductivity was significantly less at the group 1 sites; crestal bone resorption and vertical intrabony defect were also smaller at group 2 sites versus group 1 sites. Enhanced newly formed bone was observed with the staged approach, with more osteoconduction and less bone loss.

Casarin RCV, Del Peloso Ribeiro E, Nociti FH Jr, Sallum AW, Ambrosano GMB, Sallum EA, Casati MZ. Enamel matrix derivative proteins for the treatment of proximal class II furcation involvements: a prospective 24-month randomized clinical trialJ Clin Periodontol 2010;37(12):1100-1109.

A total of 12 patients with bilateral proximal furcation defects ≥ 5 mm and bleeding on probing were treated with open flap debridement and EDTA alone (control) or in combination with EMD (test). Clinical parameters were evaluated prior to treatment and after 6, 12 and 24 months. No significant differences were observed after 24 months. Probing depth reduction was 1.9 ± 1.6 mm and 1.0 ± 1.3 mm in the test and control groups, respectively, and the gain in relative horizontal clinical attachment level was 1.4 ± 0.9 mm and 0.7 ± 1.3 mm in the test and control groups, respectively. After 24 months, only five class II furcations remained in the test group, compared to 10 in the control group.


Jacobs R, Pittayapat P, Van Steenberghe D, De Mars G, Gijbels F, Van Der Donck A, Li L, Liang X, Van Assche N, Quirynen M, Naert I. A split-mouth comparative study up to 16 years of two screw-shaped titanium implant systemsJ Clin Periodontol 2010;37(12):1119-1127.

Clinical and radiographic records from 18 patients who received Astra Tech and Brånemark implants in a split-mouth study were evaluated for up to 16 years. No significant differences were observed between the systems over time. Peri-implant bone density significantly increased after 10 years, while Periotest values significantly decreased. Mean bone loss after 15 years was 0.02 mm and 0.31 mm for the Astra Tech and Brånemark systems, respectively.


Journal of Oral and Maxillofacial Surgery

Vol. 68 No. 11 (November 2010)

Kacer CM, Dyer JD, Kraut RA. Immediate loading of dental implants in the anterior and posterior mandible: retrospective study of 120 casesJ Oral Maxillofac Surg 2010;68(11):2861-2867.

Of 2,904 implants placed in the mandibles of 979 patients in a 2-year period, 256 were immediately loaded; 161 were anterior to the mental foramen and 95 were posterior to the mental foramen. There were four implant failures, three in the anterior and one in the posterior mandible; the survival rate was 99.4% and 97% in the anterior and posterior mandible, respectively.


Journal of Oral Implantology

Vol. 36 No. 5 (October 2010)

Chrcanovic BR, Oliveira DR, Custódio AL.  Accuracy evaluation of  computed tomography-derived stereolithographic surgical guides in zygomatic implant placement in human cadavers.  J Oral Implantol 2010;36(5):345-355.

In four cadavers, 16 zygomatic implants were placed (four  per cadaver) using CT-generated stereolithographic surgical guides. CT scans were  taken again after implant placement and the angle between the actual and planned implants calculated. Mean angular deviation of the long axis was 8.06° ± 6.40 and 11.20° ± 9.75 for the anterior-posterior and caudal-cranial views, respectively; large deviations were therefore noted. The sinus slot technique in combination with a CT-based drilling guide may help to improve results.

Park Y-S, Lee S-P, Han  C-Y, Kwon JH, Jung Y-C.  The microtomographic evaluation of marginal bone resorption of immediately loaded scalloped design implant with various microthread configurations in canine mandible: pilot studyJ Oral Implantol 2010;36(5):357-362.

Scalloped implants of four different designs  (machined scalloped collar, sandblasted and acid-etched scalloped collar, horizontal microthreads, or parabolic microthreads) were placed in dog mandibles; prostheses were immediately placed and the implants  evaluated after 12 weeks. The pattern of marginal bone loss was analogous to the scalloped margin for the  implants with parabolic microthreads. Marginal bone resorption was therefore influenced by microthread geometry, but further studies under controlled conditions are necessary to confirm the results.


Bilhan H, Mumcu E, Arat S. The role of timing of loading on later marginal bone loss around dental implants: a retrospective clinical studyJ Oral Implantol 2010;36(5):363-376.

A total of 252 implants placed in 57 patients were retrospectively evaluated and the time between implant placement and loading assessed. The results suggested that delayed loading increased the risk of marginal bone loss around implants, and that bone loss was less for implants placed next to a tooth on one or both sides. There were no differences in rate of bone  loss between single or splinted implants, or between implants with a smooth collar or with microgeometry at the neck. Early loading of implants therefore appears more favorable.

Journal of Oral Rehabilitation

Vol. 37 No. 11 (November 2010)

Vol. 37 No. 12 (December 2010)

Abduo J, Lyons K, Swain M.  Fit of zirconia fixed partial  denture: a systematic review.  J Oral Rehabil 2010;37(11):866-876.

A literature search was performed for studies evaluating the accuracy of fit of zirconia FPDs. Of 115 articles, 15 met the inclusion criteria, of which 12 were in vitro and three were in vivo. Superior results were observed with CAD/CAM, post-sintered milling, straight framework configuration and shorter span frameworks, compared to CAM, pre-sintered milling, curved framework configuration and longer span frameworks. A deterioration in fit was seen with veneered zirconia frameworks, but aging had no effect.


Bilhan H, Geckili O, Mumcu E, Bozdag E, Sünbüloğlu E, Kutay O.  Influence of surgical technique, implant shape and diameter on the primary stability in cancellous bone. J Oral Rehabil 2010;37(12):900-907.

Implant beds were prepared in the proximal region of cow ribs and 90 implants with three different shapes and two different diameters were placed using two different surgical techniques. Primary stability was compared using insertion torque and resonance frequency analysis (RFA). Significantly higher RFA and insertion torque by both methods was obtained when under-dimensioned drilling was used, and significantly higher insertion torque was observed with wider implants. There were significant correlations between insertion torque and RFA. The use of wide diameter, partially conical implants placed with a modified surgical technique appeared to enhance primary stability in cancellous bone.

 Journal of Periodontal and Implant Science

Vol. 40 No. 5 (October 2010)

Kim T-I, Chung C-P, Heo M-S, Park Y-J, Rhee S-H. Periodontal regeneration capacity of equine particulate bone in canine alveolar bone defectsJ Periodontal Implant Sci 2010;40(5):220-226.

Mandibular second and fourth premolars were extracted from 12 dogs and allowed to heal for 8 weeks, after which defects were created at the mesial and distal sides of the third premolars and left untreated (negative control) filled with equine particulate bone or bovine particulate bone, both covered with a collagen membrane, or membrane alone. Histomorphometry and μ-CT were performed after 10, 16 and 24 weeks. Significantly decreased probing depth an first BIC were observed for the equine particulate group compared to the negative control and membrane alone groups, but there were no significant differences between the equine and bovine particulate sites for new cementum length, are of newly formed bone, or volume of newly formed bone. Equine particulate bone therefore appeared  to be equivalent to bovine particulate bone for periodontal regeneration.

Moon S-H, Um H-S, Lee J-K, Chang B-S, Lee M-K. The effect of implant shape and bone preparation on primary stability. J Periodontal Implant Sci 2010;40(5):239-243.

Two types of dental implants (straight or tapered screw) were placed in bovine rib blocks with different drilling depths: standard preparation, 1 mm over-preparation or 1 mm under-preparation. Implant stability (ISQ) was measured for each implant after insertion. No significant differences were found in the ISQ values between the two implant types, and the depth of bone preparation had no significant influence for the straight screw implants; however, ISQ was  significantly increased for the tapered implants with under-preparation and was significantly reduced by over-preparation.

Yi J-M, Lee J-K, Um H-S, Chang B-S, Lee M-K. Marginal bone changes in relation to different vertical positions of dental implantsJ Periodontal Implant Sci 2010;40(5):244-258.

A total of 200 implants placed in 107 patients were examined and classified according to the position of the implant-abutment connection (at, below or above bone level). Marginal bone level was assessed after implant placement, second-stage surgery and 6 and 12 months after loading. The mean distance from the microgap to the first BIC was 0.06 ± 0.68 mm, 0.43 ± 0.83 mm, 1.36 ± 0.56 mm and 1.53 ± 0.51 mm at implant placement, second surgery, 6 months post-loading and 12 months post loading, respectively. The change in bone level between placement and 12 months was approximately 2.25 mm in the ‘below bone level’ group, 1.47 mm in the ‘at bone level’ group and 0.89 mm in the ‘above bone level’ group; bone change was therefore larger for implants placed below bone level and smaller for implants placed above bone level.


Journal of Periodontal Research

Vol. 45 No. 6 (December 2010)

Weinberg E, Topaz M, Dard M, Lyngstadaas P, Nemcovsky C, Weinreb M.  Differential effects of prostaglandin E2 and enamel matrix derivative on the proliferation of human gingival and dermal fibroblasts and gingival keratinocytesJ Periodontal Res 2010;45(6):731-740.

Gingival and dermal fibroblasts and gingival  keratinocytes were treated with PGE2 or EMD and cell proliferation subsequently assessed. Proliferation of gingival fibroblasts was inhibited by PGE2 but stimulated by EMD, which counteracted the inhibition by PGE2 if together. The amount of p-ERK was increased by serum, inhibited by PGE2 and restored by EMD. EMD also stimulated  the proliferation of dermal fibroblasts and inhibited the proliferation of gingival keratinocytes. Inhibition of dermal fibroblast proliferation by PFE2 was milder, and PGE2 had no effect on gingival keratinocytes. The different sensitivities of the cells to PGE2 appeared to be due to different levels of EP2 expression.

 Khader YS, Al Habashneh R, Al Malalheh M, Bataineh A.  The effect of full-mouth tooth extraction on glycemic control among patients with type 2 diabetes requiring extraction of all remaining teeth: a randomized clinical trial. J Periodontal Res 2010;45(6):741-747.

Patients with type 2 diabetes and advanced periodontitis and who required extraction of all teeth were either treated (teeth extracted) or untreated. Of 58 patients, 50 were subsequently included in the analysis. Fasting blood glucose and HbA1c levels were measured at baseline and after 3 and 6 months. HbA1c decreased significantly from baseline to 3 months in the  treated group and continued to decrease to 6 months. In contrast, no significant reduction was observed in the untreated group. Full-mouth tooth extraction therefore improved glycemic control in patients with type 2 diabetes, but larger trials are needed to confirm this result.


Journal of Periodontology

Vol. 81 No. 10 (October 2010)

Vol. 81 No. 11 (November 2010)

Atieh MA, Ibrahim HM, Atieh AH. Platform switching for marginal bone preservation around dental implants: a systematic review and meta-analysisJ Periodontol 2010;81(10):1350-1366.

Database and hand searching was performed for literature on controlled trials of marginal bone level changes and survival of platform-switched implants. The analysis included 10 studies with a total of 1,239 implants. Marginal bone loss was significantly less around platform-switched implants compared to those without platform switching, and there were no differences in implant failure rate between the two groups. A more favorable bone response was detected when the difference in diameter between implant and abutment was  ≥ 0.4 mm. Platform switching may therefore help to preserve bone height, but further randomized, controlled trials are necessary to confirm the concept.

Shiau HJ, Reynolds MA.  Sex differences in destructive periodontal disease: a systematic review.  J Periodontol 2010;81(10):1379-1389.

A literature search was performed for population surveys with prevalence data on periodontal disease in males and females. A total of 12 surveys, with 50,604 subjects, met the inclusion criteria. There was a 9% difference in prevalence of destructive periodontal disease between males and females (37.4% versus 28.1%), and this difference was found to be similar regardless of disease severity or other risk factors. Males are therefore at greater risk of destructive periodontal disease than females. 

Shum I, Leung P-C, Kwok A, Corbet EF, Orwoll ES, Phipps KR, Jin L. Periodontal conditions in elderly men with and without osteoporosis or osteopenia. J Periodontol 2010;81(10):1396-1402.

This study enrolled 200 elderly subjects (67 with osteoporosis, 66 with osteopenia and 67 age-matched controls), who were given questionnaires and a full-mouth periodontal examination. Sites with clinical attachment los ≥ 6 mm were significantly more prevalent in the osteoporosis subjects compared to those with osteopenia, and the percentage of sites with interproximal gingival recession  ≥ 5 mm was significantly greater in osteoporosis subjects versus controls. The significant associations remained after adjusting for age, supragingival plaque and number of teeth lost.

Koutouzis T, Lundgren T.  Crestal bone-level changes around implants  placed in post-extraction sockets augmented with demineralized freeze-dried bone allograft: a retrospective radiographic studyJ Periodontol 2010;81(10):1441-1448.

Records from 30 patients with implants placed in  post-extraction sockets augmented with demineralized freeze-dried bone allograft and from 30 patients with implants placed in native bone were examined. Implant survival was 100% in both groups, and mean marginal bone loss after 12 months was 0.15 mm; no significant differences were found between the groups. Bone loss was therefore minimal around implants placed in post-extraction sockets


Angaji M, Gelskey S, Nogueira-Filho G, Brothwell D. A systematic review of the clinical efficacy of adjunctive antibiotics in the treatment of smokers with periodontitisJ Periodontol 2010;81(11):1518-1528.

A literature search was performed for trials comparing periodontal therapy with and without adjunctive antibiotics in smokers. The analysis included five randomized controlled trials. For surgical therapy, there was little evidence for adjunctive antibiotics in smokers; however, for non-surgical therapy one study showed improvements after the use of azithromycin, and another study showed significant improvements in probing depths and clinical attachment level with the use  of adjunctive doxycycline  gel and minocycline spheres. However, overall evidence for an additional benefit of adjunctive antibiotic therapy in smokers was inconclusive, and further trials are necessary.

Andrade PF, Grisi MFM, Marcaccini AM, Fernandes PG, Reino DM, Souza SLS, Taba M Jr, Palioto DB, Novaes AB Jr.  Comparison between micro- and macrosurgical  techniques for the treatment of localized gingival recessions using coronally positioned flaps and enamel matrix derivative.  J Periodontol 2010;81(11):1572-1579.

Gingival recession in 30 patients were treated with  coronally positioned flap and EMD; a microsurgical approach was performed in 15 patients (test) and a macrosurgical approach was performed in the other 15 (control). No difference in root coverage was found between the groups after 6 months (98% and 83% for test and control, respectively), but the increase in width and thickness of keratinized tissue was significantly greater in the test group. Both procedures were well tolerated by the patients. 


Holtzclaw DW, Toscano NJ, Rosen PS. Reconstruction of posterior mandible alveolar ridge deficiencies with the piezoelectric hinge-assisted ridge split technique: a retrospective observational report.  J Periodontol 2010;81(11):1580-1586.

A total of 17 alveolar ridge deficiencies in 13 patients were treated with the piezoelectric hinge-assisted ridge-split procedure, with 31 implants placed after an average of 14 weeks. Mean gain in horizontal width from surgery to implant placement was 4.03 ± 0.67 mm. No adverse outcomes were reported, and all implants were successful after 6 months. The piezoelectric hinge-assisted ridge split procedure can therefore achieve substantial gains in horizontal width with no associated morbidity. Further prospective studies are required to assess the technique in comparison with more conventional approaches.

Paolantonio M, Femminella B, Coppolino E, Sammartino G, D’Arcangelo C, Perfetti G, Perinetti G. Autogenous periosteal barrier membranes and bone grafts  in the treatment of periodontal intrabony defects of single-rooted teeth: a 12-month reentry randomized clinical trialJ Periodontol 2010;81(11):1587-1595.

A total of 42 patients with at least one intrabony defect ≥ 6 mm were treated with open-flap debridement (OFD), guided tissue regeneration (GTR) or a combined treatment using periosteal membranes and autogenous bone chips (aCPRT). After 1 year, significant changes in clinical parameters were observed in all groups, with significantly greater gains in clinical attachment level and defect bone level and reductions in probing depth in the GTR and aCPRT groups compared to the OFD group. Gingival recession was significantly smaller and the gain in defect bone level was significantly greater in the aCPRT group versus the GTR group. 

Barker TS, Cueva MA, Rivera-Hidalgo F, Beach MM, Rossmann JA, Kerns DG, Crump TB, Schulman JD. A comparative study of root coverage using two different acellular dermal matrix products.  J Periodontol 2010;81(11):1596-1603.

In 14 patients with Miller Class I or III facial tissue recession, 52 contralateral sites were treated using coronally advanced flap, 26 in combination with Alloderm and 26 in combination with Puros Dermis. Recession coverage significantly improved in both groups after 6 months, with no significant differences between the groups. Both acellular dermal matrix materials were therefore successful in achieving root coverage.  

Nesse W, Dijkstra PU, Abbas F, Spijkervet FKL, Stijger A, Tromp JAH, van Dijk JL, Vissink A.  Increased prevalence of cardiovascular and autoimmune diseases in periodontitis patients: a cross-sectional study. J Periodontol 2010;81(11):1622-1628.

Dental records from 1,276 patients attending either a dental or periodontal clinic were examined retrospectively, and data on cardiovascular and autoimmune disease were elucidated by questionnaire. The prevalence of hypertension, rheumatoid arthritis and diabetes mellitus was significantly greater in patients with periodontitis. After controlling for confounding  factors, diabetes mellitus was

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