Jacopo Buti

Orthodontic and Periodontal Outcomes of Treated Impacted Maxillary Canines

OBJECTIVE To evaluate the influence of pretreatment radiographic features (alpha-angle, d-distance, and s-sector) on (1) the duration of active orthodontic traction and (2) the posttreatment periodontal status (pocket depth [PD] and keratinized tissue width [KT]) of impacted maxillary canines treated by a combined surgical (flap approach) and orthodontic (direct traction to the center of the ridge) treatment. MATERIAL AND METHODS A study population of 168 patients (168 canines) was evaluated. Multiple regression analysis was used. RESULTS Pretreatment radiographic variables were associated significantly with the duration of orthodontic traction. Age, sex, and site of impaction did not significantly affect the duration of traction. No significant differences in PD and KT were present at the end of surgical-orthodontic treatment with respect to any of the variables considered. The analysis of PD and KT variables after orthodontic treatment revealed a healthy periodontium. CONCLUSIONS alpha-angle, d-distance, and s-sector are valid indicators for the duration of orthodontic traction. They are not prognostic indicators of final periodontal status of orthodontically-repositioned canines.

Immediate Occlusal Loading of One-Piece Zirconia Implants: Five-Year Radiographic and Clinical Evaluation.

PURPOSE To evaluate radiographic and clinical outcomes of immediate occlusally loaded one-piece zirconia implants after 5 years of follow-up. MATERIALS AND METHODS This longitudinal clinical investigation included patients older than 18 years, in need of implant-supported single-unit dental rehabilitations. One-piece zirconia in healed and postextraction sites and immediately restored with provisional crowns in light occlusal contact. Definitive zirconia-ceramic restorations were delivered 3 to 4 months after surgery. Primary estimated outcomes were implant survival and success. Periapical radiographs were taken at implant insertion (T0), after 1 year (T1), and after 5 years (T2) to assess marginal bone loss (MBL). Probing depth (PD), modified Bleeding Index (mBI), modified Plaque Index (mPI), and gingival recession (REC) were also measured repeatedly for implants and reference teeth. Changes in parameters over time were assessed using the Wilcoxon signed rank test. In addition, multilevel mixed effects linear and logistic regression models were fitted to take into account within-subject correlations and baseline values. RESULTS Thirty-two implants were inserted in postextraction and healed sites (n = 16 of each) in 17 patients. One immediate implant was lost after 3 months, and one patient with one implant dropped out after T1. Therefore, the cumulative survival rates were 96.9% at T1 and 96.8% at T2 (4.3 to 6 years). No significant differences were observed in mean MBL between immediate and delayed implants at either T1 or T2. Moreover, different baseline parameters (sex, arch, implant location, smoking habits, grafting) did not show any influence on MBL at either time. In general, for all clinical parameters (PD, mBI, mPI, REC), implants seemed to perform similar to if not better than natural teeth. CONCLUSION Radiographic and clinical evaluations after 5 years showed satisfactory amounts of MBL and acceptable soft tissue health.

Influence of inter‐dental tissues and root surface condition on complete root coverage following treatment of gingival recessions: a 1‐year retrospective study

AIM To explore the influence of inter-dental tissues and root surface condition on complete root coverage following surgical treatment of gingival recessions. METHODS Three hundred and eighty-six single recessions treated over 28 years were assessed. Patient-level and periodontal variables, presence/loss of inter-dental tissues, and presence/absence of non-carious cervical lesions (NCCLs) were recorded. Root coverage was assessed 1-year post-surgery. Multilevel analysis was performed to identify predictors of CRC. RESULTS Based on type of root coverage procedure four patient groups were created: free gingival graft (FGG) (n = 116), coronally advanced flap (CAF) (n = 107), CAF+connective tissue graft (CTG) (n = 131), and guided tissue regeneration (GTR) (n = 32). Percentages of complete root coverage (CRC) were 18.1% for FGG, 35.5% for CAF, 35.1% for CAF+CTG, and 18.8% for GTR. There was an OR = 0.26 (p < 0.0001) of achieving CRC in cases with loss of inter-dental tissue compared with cases with no inter-dental tissue loss. Similarly, cases with presence of NCCL showed an OR = 0.28 (p < 0.0001) of achieving CRC compared with cases without a NCCL. FGG achieved less CRC then CAF+CTG (p = 0.0012; OR = 0.32). CONCLUSIONS NCCLs, just like inter-dental tissue loss, are significant negative prognostic factors in achieving CRC following root coverage procedures.

Long-term outcomes of soft tissue augmentation around dental implants on soft and hard tissue stability: a systematic review.

AIM To investigate whether the height and volume of the soft tissues and peri-implant bone levels around dental implants are stable, when soft tissue augmentation has been performed. MATERIALS AND METHODS Three operators conducted a search on electronic databases (MEDLINE, COCHRANE, EMBASE) and a hand searching on the main journals dealing with periodontology and implantology until 30 October 2014. Only articles that considered peri-implant soft tissue augmentation performed in a group of at least 10 patients and with a follow-up of at least 1 year were selected. The outcome variables were peri-implant attached/keratinized tissue width (KTW) changes, peri-implant marginal soft tissue level (PSL) changes, and peri-implant marginal bone level (PBL) changes. The review was performed according to the PRISMA statements. RESULTS Ten articles were selected for the qualitative synthesis, but only one meta-analysis was accomplished, indicating that 1 year after implant recession coverage procedures, a mean gain of 1.65 ± 0.01 mm (90% CrI [1.44; 1.85]) was observed. CONCLUSIONS There is no long-term evidence whether augmented soft tissues can be maintained over time and able to influence the peri-implant bone levels.

Immediate Loading With LASER-Treated Surface Implant Two-Year Resonance Frequency Analysis Follow-up

BackgroundThe chemical, physical, and morphologic characteristics of the implant surface play a fundamental role during the osteointegration process. Implant design is of paramount importance in determining implant primary stability and implant ability to sustain loading during and after osteointegration. LASER treatment of the surface allows defining the precise parameters of roughness to obtain a regular and repeatable surface in total absence of contamination. PurposeThe aim of this study was to analyze the behavior of implant stability of LASER-treated surface implants by repeated resonance frequency analysis (RFA) measurements during 2 years in patients with complete upper maxilla edentulism subject to an immediate-loading protocol. MethodsTen patients were included, and each treated with the insertion of 6 or 8 LASER surface implants according to the individual surgical-prosthetic planning. During the bone drilling and implant insertion, torque values were monitored with a specific handpiece and software. All implants were loaded within 24 hours from the insertion with the application of a temporary full-arch prosthesis. Subsequent follow-up has been done at 24 months from the loading with radiographic controls (OPT) and RFA measurement on all implants at time of implant insertion and at 1, 3, 6, 12, and 24 months from loading. ResultsResonance frequency analyses at 3 and 6 months from the implant loading have shown a rapid increment of implant stability quotient (ISQ) values in the first phases of bone remodeling, subsequent to the peri-implant bone remodeling. The paired comparisons between mean ISQ values by patient showed a statistically significant decrease in primary stability from baseline up to 1 month (P = 0.0039). Subsequent measurements revealed a statistically significant increase in implant stability from 1 up to 3 months (P = 0.0156), from 3 up to 6 months (P = 0.0020), from 6 up to 12 months (P = 0.020), and 12 up to 24 months (P = 0.0391). ConclusionsResonance frequency analysis of the LASER-treated surface implants showed good ISQ values at all time point measurements. These results are consistent with data from literature on the analysis of RFA in protocols of immediate loading at the upper maxilla.

Critical Evaluation of Complete Root Coverage as a Successful Endpoint of Treatment for Gingival Recessions

Two differing evaluation criteria for complete root coverage (CRC) were used to compare incidence of CRC after root coverage procedures. Clinical records of 363 patients (386 single recessions) treated between 1984 and 2012 were screened. CRC was assessed 1 year after surgery using two separate evaluation criteria: CRC1, in which the gingival margin was at or above the cementoenamel junction (CEJ), measured using a periodontal probe directly on patients by a single examiner; and CRC2, in which the gingival margin was above the CEJ, rendering it completely invisible based on a visual assessment of high-magnification digitalized images by two calibrated examiners. Descriptive and inferential statistics were performed. The k statistic was also calculated to test the agreement between the two examiners. Four treatment groups were identified: free gingival graft (FGG; n = 116), coronally advanced flap (CAF; n = 107), CAF + connective tissue graft (CTG; n = 131) and guided tissue regeneration (GTR; n = 32). The overall difference between the proportion of CRC1 and CRC2 was statistically significant (P < .0001), as were the intragroup differences for FGG (P = .0002), CAF (P = .0009), and CTG (P = .0002). Treatment of gingival recessions should only be deemed completely successful when root coverage is associated with a gingival margin and a crevice probing depth that is coronal to the CEJ. When root coverage is regarded as complete with gingival margin located at the level of CEJ, it does not represent complete treatment success.

From initial case report to randomized clinical trial through 20 years of research in periodontal therapy

AIM Case reports (CRs) are often the first publication of a new treatment, but randomized clinical trials (RCTs) are needed to confirm the data. The aim of this study was to evaluate how many therapies published as CRs were followed by RCTs of these therapies over a 20-year period. MATERIAL AND METHODS Two researchers conducted a search through international periodontal journals and found the CRs on periodontal treatments published from 1984 to 1986. Subsequent electronic searches made it possible to verify how many of the treatments published as CRs were also investigated through RCTs over the following 20 years. RESULTS Thirty-one different therapies were selected out of the 33 published CRs; 15 (48%) of these 31 treatments were investigated by RCTs over the next 20 years. CONCLUSIONS As 52% of the CRs were not validated by RCTs, practitioners should view their results with caution.