Joseph A. Toljanic

A prospective pilot study to evaluate a new dental assessment and treatment paradigm for patients scheduled to undergo intensive chemotherapy for cancer.

Patients scheduled to receive chemotherapy frequently undergo pretherapy dental treatment to eliminate potential sources of odontogenic infection. A prospective study was conducted to assess a new protocol emphasizing minimal pretherapy dental treatment.

Prospective multicenter study of marginal bone level and soft tissue health of a one-piece implant after two years

STATEMENT OF PROBLEM A novel 1-piece implant purported to provide for stable tissue support, immediate function, and immediate placement in extraction sockets has been developed. Stabilization of the marginal bone level over time requires documentation. PURPOSE The aim of this study was to evaluate marginal bone level differences and soft tissue health between the 1- and 2-year follow-up of a 1-piece implant design. MATERIAL AND METHODS Eighty-two implants, restoring both single teeth and multiple edentulous situations, in 56 consecutively treated patients, were included. Marginal bone level was evaluated on radiographs made at implant insertion, 6-month follow-up, and annually thereafter. At 3-, 6-month, and 1-year follow-ups, presence of plaque and the soft tissue response were evaluated using plaque and bleeding on probing indexes. The papilla index was used to determine papilla size at implant insertion with the provisional restoration in place and at the insertion of the definitive restoration. The change over time in marginal bone level was analyzed with a 1-way analysis of variance (ANOVA) paired design with time as main effect (1 to 2 years) and subjects as block effect (alpha=.05). RESULTS One implant failure occurred, resulting in a 98.8% cumulative survival rate (CSR) for the follow-up time of 2 years. The mean (SD) change in bone level between years 1 and 2 was 0.08 mm (1.19) (95% CI-0.30 to 0.46) (P=.68), demonstrating a stable marginal bone level. Normal implant mucosa was noted for approximately 90% of the sites at the 1-year follow-up. The mean (SD) papilla score at placement was 1.3 (0.66) and increased to 1.7 (0.67) at insertion of the definitive prosthesis. CONCLUSIONS The stable marginal bone level and soft tissue health observed indicate that the 1-piece implant tested has the ability to preserve both hard and soft tissue. Based on the high implant survival rate and favorable tissue response, the 1-piece implant can be recommended for clinical use.

An evaluation of a dentifrice containing salivary peroxidase elements for the control of gingival disease in patients with irradiated head and neck cancer

Patients who have undergone irradiation for head and neck tumors commonly have xerostomia. Loss of the protective constituents normally found in saliva leaves patients at greater risk for development of significant dental pathologic disorders, including gingival and periodontal disease. Periodontal disease and tooth extractions are currently accepted as etiologic factors for the development of osteoradionecrosis. This double-blind crossover trial was conducted to assess the efficacy of a dentifrice containing salivary peroxidase elements in the reduction of gingivitis in a population of patients with irradiated cancer. Subjects were instructed to brush with the dentifrice provided. Plaque and gingival index values were obtained and statistically compared with baseline values. A weak positive effect was found between use of the dentifrice and a reduction in gingival inflammation. Patient compliance was a limiting factor in this treatment effect. The results suggest possible efficacy for the dentifrice in augmenting traditional measures of postradiation oral health maintenance.

A Longitudinal Clinical Comparison Plaque-Induced Inflammation Between Gingival and Peri-Implant Soft Tissues in the Maxilla

BACKGROUND Little information exists concerning the periimplant soft tissue response to plaque compared to the gingiva of the dentition. The purpose of this study was to compare this relative tissue response to plaque in humans over time. METHODS Two hundred seventy-five (275) hydroxyapatitecoated implants were placed in the maxillae of 50 subjects followed by prosthetic rehabilitation. Baseline gingival (GI) and plaque (PI) index scores were obtained for all implants. Two to 4 teeth per subject were similarly measured, serving as controls. Measurements were repeated at 6-month intervals over 30-months. GI scores were evaluated relative to PI scores at 4 separate sites for each implant, to implant location within the oral cavity, and to length of time that each implant was in function. RESULTS The peri-implant mucosa demonstrated a significantly greater likelihood of having elevated GI scores relative to PI scores when compared to the gingiva (chi-square for combined PI scores of 0 and 1 = 85.0, df = 1, P <0.001; for combined PI scores of 2 and 3 = 114.6, df = 1, P <0.001). A logistic generalized linear model confirmed the significance of these results (Student t for implant effect = 21.602). It further demonstrated significantly elevated GI scores for implant sites over time and for implants located in the posterior oral cavity. CONCLUSIONS The results indicate that maxillary peri-implant soft tissues are at increased risk for plaque-induced inflammation relative to the gingiva of the dentition. Hygiene recall standards and treatment regimens may require revisions to minimize peri-implantitis and prevent bone loss. J Periodontol 2001;72:1139-1145.

A longitudinal clinical assessment of spark erosion technology in implant-retained overdenture prostheses: a preliminary report.

STATEMENT OF PROBLEM As adapted for the dental profession, spark erosion technology permits precise machining of retentive metal overdenture frameworks for use in implant prosthetics. PURPOSE The resultant prostheses are retentive and provide a number of benefits offered by both conventional overdenture and fixed prosthetic designs. MATERIAL AND METHODS Preliminary data collected from an ongoing 5-year clinical trial were reviewed to qualitatively assess the clinical results obtained from 25 spark eroded implant-retained overdenture prostheses placed in 24 subjects. RESULTS Throughout an evaluation period of 13.33 months (range 4 to 19 months), subject responses measured by questionnaire were uniformly good. Few complications were encountered and were limited to resin denture base/tooth fractures or retentive component failures that were easily repaired. CONCLUSION Overdenture prostheses retained by spark eroded milled frameworks offer an acceptable treatment alternative for patients undergoing dental implant therapy.

Immediate Loading of Implants in the Edentulous Maxilla with a Fixed Provisional Restoration without Bone Augmentation : A Report on 5-Year Outcomes Data Obtained from a Prospective Clinical Trial

PURPOSE Successful immediate loading of implants in the edentulous maxilla has been previously reported. The purpose of this 5-year prospective study was to further assess long-term outcomes following immediate loading of implants in the edentulous maxilla with fixed provisional restorations without the use of bone augmentation procedures. MATERIALS AND METHODS Subjects with edentulous maxillary arches each received six implants placed in native bone without augmentation. Where insufficient posterior bone volume existed, angled implant placement was employed. Fixed provisional restorations were delivered within 24 hours of implant placement. Implant placement locations, insertion torque values, and implant dimensions were recorded. Definitive fixed prostheses were placed within 24 weeks following implantation. Baseline implant site marginal bone levels were measured using periapical radiographs. Baseline peri-implant plaque and bleeding scores were obtained. Subjects were examined 6 months after implant placement and then annually for 5 years with follow-up periapical radiographs and plaque/bleeding scores obtained. RESULTS Fifty-one subjects received a total of 306 implants. Forty subjects with 232 implants returned for the final follow-up appointment representing a 5-year implant survival proportion of 93% with a mean marginal bone loss of 0.44 ± 1.25 mm for this group. Thirty-nine of these 40 subjects continued to function with fixed restorations with the remaining subject functioning with a non-implant-retained removable prosthesis. CONCLUSION Within the limitations of this study, predictable long-term implant rehabilitation outcomes were demonstrated for the edentulous maxilla using an immediate loading protocol without bone augmentation.

Three-year follow-up of immediately loaded implants in the edentulous atrophic maxilla: a study in patients with poor bone quantity and quality.

PURPOSE Immediate loading of implants in the edentulous maxilla has previously been successfully performed and reported. Severe resorption of the maxillary alveolar crest presents a more demanding situation for the restorative team. Thus, it would be valuable to assess outcomes for this immediate loading treatment protocol in subjects with marked maxillary alveolar crest atrophy. This study evaluated the 3-year results of dental implants that were immediately restored with provisional fixed prostheses in atrophic maxillae without previous augmentation. MATERIALS AND METHODS Two centers enrolled subjects with resorbed edentulous maxillae (Lekholm and Zarb quality 3 or 4 and quantity C, D, or E). Six implants were placed in each subject and restored with screw-retained fixed provisionals within 24 hours. Impressions were taken for definitive restorations, which were placed 20 to 24 weeks later. Radiographs were used to analyze marginal bone level changes throughout the study. RESULTS Fifty-one patients received 306 implants. Forty-five patients remained in the study at the 3-year follow-up visit and successfully used their definitive prostheses. Sixty-two percent of the implants were placed in bone quantity C and quality 3 or 4, and 38% were placed in quantity D and quality 3 or 4 bone. Thirteen implants in six subjects were lost, resulting in a cumulative survival rate of 96% after 3 years. The mean marginal bone loss during the first year was -0.4 ± 0.8 mm (255 implants); at 3 years it was -0.6 ± 1.1 mm (253 implants). CONCLUSION Data from the first 3 years of this study revealed good clinical outcomes. Careful selection of patients and planning by the restorative team can enable successful treatment outcomes for patients presenting with marked resorption of the edentulous maxilla.

Immediate Loading of Tilted and Axial Posterior Implants in the Edentulous Maxillary Arch: A Retrospective Comparison of 5-Year Outcomes.

PURPOSE The purpose of this study was to retrospectively compare long-term outcomes for immediately loaded tilted and axial implants placed in the posterior region of the edentulous maxillary arch. MATERIALS AND METHODS Data obtained from a 5-year prospective study designed to assess clinical outcomes following immediate loading of implants with screw-retained fixed restorations in the edentulous maxillary arch were retrospectively reviewed. Where insufficient alveolar bone was available for axial placement of the posterior-most implant on each side of the arch, tilted placement was employed. Implant survival and marginal bone level changes for these tilted and axial posterior implants were compared. RESULTS Fifty-one subjects received 64 tilted and 38 axial posterior implants. Forty subjects with 53 tilted and 34 axial posterior implants returned for follow-up after 5 years. Five tilted and seven axial implants failed, representing an 89% and 86% survival proportion, respectively. The mean marginal bone loss was 0.79 (SD: 1.42) mm for tilted implants and 0.14 (SD: 0.34) mm for axial implants. The differences in survival proportions and marginal bone loss between axial and tilted implants were not statistically significant. CONCLUSION Predictable long-term implant rehabilitation may be achieved in the edentulous maxillary arch using posterior tilted implants in combination with immediate loading.