James E. Hinrichs

Platelet-Derived Growth Factor Promotes Periodontal Regeneration in Localized Osseous Defects: 36-Month Extension Results From a Randomized, Controlled, Double-Masked Clinical Trial

BACKGROUND Recombinant human platelet-derived growth factor (rhPDGF) is safe and effective for the treatment of periodontal defects in short-term studies up to 6 months in duration. We now provide results from a 36-month extension study of a multicenter, randomized, controlled clinical trial evaluating the effect and long-term stability of PDGF-BB treatment in patients with localized severe periodontal osseous defects. METHODS A total of 135 participants were enrolled from six clinical centers for an extension trial. Eighty-three individuals completed the study at 36 months and were included in the analysis. The study investigated the local application of β-tricalcium phosphate scaffold matrix with or without two different dose levels of PDGF (0.3 or 1.0 mg/mL PDGF-BB) in patients possessing one localized periodontal osseous defect. Composite analysis for clinical and radiographic evidence of treatment success was defined as percentage of cases with clinical attachment level (CAL) ≥2.7 mm and linear bone growth (LBG) ≥1.1 mm. RESULTS The participants exceeding this composite outcome benchmark in the 0.3 mg/mL rhPDGF-BB group went from 62.2% at 12 months, 75.9% at 24 months, to 87.0% at 36 months compared with 39.5%, 48.3%, and 53.8%, respectively, in the scaffold control group at these same time points (P <0.05). Although there were no significant increases in CAL and LBG at 36 months among all groups, there were continued increases in CAL gain, LBG, and percentage bone fill over time, suggesting overall stability of the regenerative response. CONCLUSION PDGF-BB in a synthetic scaffold matrix promotes long-term stable clinical and radiographic improvements as measured by composite outcomes for CAL gain and LBG for patients possessing localized periodontal defects ( ClinicalTrials.gov no. CT01530126).

Impact of cigarette smoking on clinical outcomes of periodontal flap surgical procedures: a systematic review and meta-analysis.

BACKGROUND Periodontal flap surgery is frequently used to remove subgingival deposits, yielding consequential reductions in gingival inflammation and probing depth (PD) with a gain in clinical attachment level (CAL) to treat advanced periodontal disease. However, clinical studies have reported diminished periodontal healing in smokers compared with non-smokers. The aim of the present systematic review and meta-analysis was to assess the impact of cigarette smoking on clinical outcomes following periodontal flap surgical procedures. METHODS A systematic electronic review of articles relevant to periodontal flap surgical procedures in smokers was conducted from 1977 to March 2014 inclusive, using predefined, optimized search strategies. Meta-analyses were done separately for changes in the two primary outcomes of PD and CAL. RESULTS The initial search yielded 390 titles and abstracts. After screening, eight controlled clinical studies were finally selected. Three studies were assessed as having a low risk of bias, two as having moderate risk of bias, and three as having a high risk of bias. Qualitative assessment of the articles consistently showed an improved treatment effect among non-smokers versus smokers. The reduction in PD in smokers and non-smokers ranged from 0.76 to 2.05 mm and 1.27 to 2.40 mm, respectively. For CAL, the gain in non-smokers versus smokers ranged from 0.29 to 1.6 mm and 0.09 to 1.2 mm, respectively. Meta-analysis on eight studies reporting on 363 study participants demonstrated an increased reduction in mean (95% confidence interval) PD of 0.39 (0.33 to 0.45) mm. Similar results were found for mean gain in CAL (0.35 [0.30 to 0.40] mm, n = 4 studies). CONCLUSIONS Considering the relatively homogenous information available, the authors conclude that active smokers could be candidates for periodontal flap surgical procedures. However, the magnitude of the therapeutic effect is compromised in smokers compared with non-smokers. Therefore, cigarette smokers should be: 1) encouraged to abstain from smoking; and 2) thoroughly informed preoperatively of substantial reduction in clinical outcomes compared with non-smokers.

Periodontal evaluation of canines erupted through grafted alveolar cleft defects.

Two to eight years after receiving autogenous iliac crest grafts for treatment of alveolar cleft defects, eighteen patients who had unilateral cleft palate were evaluated for their periodontal status. When cleft-associated canines were compared with contralateral control canines, no statistically significant differences were found between specific surface values for plaque index, gingival index, or probing depths. Attachment loss was found to be greater (less than 0.72 mm) on the mesio-facial, facial, and mesio-palatal surfaces of the cleft-associated canines than on the control canines. Fifty-six per cent of the cleft-associated canines required surgical exposure and 44% also required orthodontic assistance to erupt to a functional occlusion. Osseous grafting of alveolar cleft defects resulted in satisfactory clinical periodontal support for cleft-associated canines.

A randomized, blinded, controlled clinical study of particulate anorganic bovine bone mineral and calcium phosphosilicate putty bone substitutes for socket preservation.

PURPOSE The purpose of this study was to compare the clinical efficacy of an anorganic bovine bone graft particulate to that of a calcium phosphosilicate putty alloplast for socket preservation. MATERIALS AND METHODS Thirty teeth were extracted from 24 patients. The sockets were debrided and received anorganic bovine bone mineral (BOV, n=12), calcium phosphosilicate putty (PUT, n=12), or no graft (CTRL, n=6). The sockets were assessed clinically and radiographically 5 months later. Eight sockets in the BOV group and nine in the PUT group received implants 5 to 6 months postgrafting. The maximum implant insertion torque (MIT) was measured as an index of primary implant stability. The data were analyzed with the Mann-Whitney test. RESULTS Both test groups had statistically significantly less reduction in mean ridge width (BOV: 1.39±0.57 mm; PUT: 1.26±0.41 mm) in comparison to the control group (2.53±0.59 mm). No statistically significant difference was identified between the test groups. MIT for PUT was ≤35 N/cm² (MIT grade 4) for seven of the nine implants. MIT values in the BOV group ranged from grade 1 (10 to 19 N/cm²) to grade 4, which was statistically significantly lower than for the PUT group. The overall implant success rate was 94.1% (16 of 17 implants were successful). No implants were lost in the PUT group; one implant failed in the BOV group. CONCLUSION Both tested bone substitutes can be recommended for preservation of alveolar ridge width following extraction. PUT might be more suitable for achieving primary stability for implants placed at 5 to 6 months postextraction.

Patient-Related and Financial Outcomes Analysis of Conventional Full-Arch Rehabilitation Versus the All-on-4 Concept: A Cohort Study

Background:Patient-related variables such as cost of treatment, length of the treatment period, and comfort provided by the interim prosthesis when treatment planning for full-arch rehabilitation are often neglected in dental publications. Methods:Two patient cohorts were followed up longitudinally in this study: the “All-on-4 treatment concept group” and the “historical group.” The number of implants, total treatment time, number of surgical procedures, number of sinus grafts, necessity for immediate provisional implants, adjusted cost associated for treatment in each group, and the quality of interim prosthesis were compared. Results:The total adjusted cost for patients receiving All-on-4 treatment concept averaged at

Management of the dental patient receiving corticosteroid medications

42,422 ± 3860 (&OV0556;31,392 ± 2856), whereas the mean total adjusted cost for the historical group was

A Systematic Review of Observational Studies Evaluating Implant Placement in the Maxillary Jaws of Medically Compromised Patients

57,944 ± 20,198 (&OV0556;42,879 ± 2113) (P = 0.01). The difference in cost had a mean value of

Prognostic factors in periodontal therapy and their association with treatment outcomes

7307 (&OV0556;5407) per jaw. Factors associated with complexity of treatment and patient comfort, such as the quality of interim prosthesis, number of surgeries, and duration of treatment time, all significantly favored the All-on-4 treatment concept group in comparison with conventional treatment modalities. Conclusions:When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.

Potential Damage to Bone–Implant Interface When Measuring Initial Implant Stability

Patients who have undergone therapy with glucocorticoids present unique problems for the dentist. Persons currently receiving steroid therapy have altered responses to infection and wound healing. More important, many patients who are taking or have taken glucocorticoids have a high risk of developing acute adrenal insufficiency when placed in a stressful situation. When treating patients with a history of glucocorticoid therapy, one must obtain precise information from the medical history to determine the relative risk of pituitary-adrenal suppression. If the patient is at risk, the dentist must determine the need for the following prophylactic measures: (1) systemic antibiotic therapy, (2) anxiety control, and (3) increased administration of glucocorticoids (steroid prep). If a patient experiences adrenal crisis, the dentist must be capable of interpreting the signs and administering appropriate therapy.

Comparison of Initial Implant Stability of Implants Placed Using Bicortical Fixation, Indirect Sinus Elevation, and Unicortical Fixation.

BACKGROUND Even though the efficacy of implant treatment and the excellent success rates that modern implant surfaces yield remain unchallenged, there is limited information available on implant success rates in medically compromised patients. PURPOSE The aim of this systematic review was to evaluate the survival of implants placed in the maxillary jaws of medically compromised patients. MATERIALS AND METHODS Two reviewers using predefined selection criteria performed an electronic search complemented by a manual search, independently and in duplicate. RESULTS After the final selection, 11 studies reporting on four distinct medical conditions were included out of 405 potentially eligible titles. In detail, three studies reported on implants placed in diabetic patients, six on implants placed in patients with a history of oral cancer, one on implants in patients with a history of epilepsy, and one on implants in patients with autoimmune rheumatoid arthritis. CONCLUSIONS Placement of maxillary implants in medically compromised patients seems to yield acceptable survival rates. Implant survival in well-controlled diabetic patients, patients diagnosed with rheumatoid arthritis, and patients treated for severe epilepsy is comparable to that in healthy patients. Implants placed in the maxillae of patients treated for oral cancer may attain osseointegration less predictably than in the mandible.