Khalaf F. Al-Shammari

Implant Plastic Surgery: A Review and Rationale

Implant dentistry has been established as a predictable treatment modality with high clinical success rates. Esthetic considerations of implant restorations have been gaining increased interest over the years. The role of periodontal plastic surgical procedures in the creation and maintenance of peri-implant soft tissue heights to facilitate better esthetics has become more popular. The available plastic surgery procedures and their clinical applications are reviewed in this article. Emphasis is placed on factors to consider for proper case selection and ideal treatment planning.

Creation of interimplant papillae through a split-finger technique

PurposeThe purpose of this pilot study is to propose a technique, the split-finger approach, to preserve/promote papillae formation. Materials and MethodsTwenty-one patients with 39 implants consecutively placed in the maxillary anterior region were evaluated at 6 months to 1 year after prosthodontic restoration. The implants evaluated included 16 single-tooth implants, 1 2-unit implant prosthesis, 2 4-unit tooth implants, 1 6-unit prostheses, and 1 7-unit restoration. The papillae were recorded as 0 = no papillae; 1 = ≤50% of the gingival embrasure height; 2 = >50% but <100% of embrasure height; 3 = 100% closure of the proximal space; and 4 = overgrowth of the interproximal tissue. ResultsData from this pilot study showed no class 0, class 1, or class 4 interproximal papillae after the final restoration. The 16 single-tooth restorations and 32 papillae had an average mesial papilla score of 3 and an average of 2.82 for the distal interproximal space. The average papilla score of the other implant papillae sites were 2.7 at 6 months to 1 year. A lower papilla score was noted in interimplant papillae. ConclusionsThe proposed split-finger technique could serve as a clinically useful alternate procedure to promote/augment papillae formation around dental implants.

Periodontal Health of Children with Type 1 Diabetes Mellitus in Kuwait: A Case-Control Study

Objective: The aim of this study was to evaluate periodontal health in children diagnosed with type 1 diabetes mellitus. Subjects and Methods: Periodontal health was clinically examined and compared in 95 children diagnosed with type 1 diabetes and 61 healthy control subjects (4–14 years old). Plaque index, gingival index, clinical attachment loss and bleeding on probing were assessed on the 6 Ramfjord index teeth. Diabetes history was recorded based on information provided by the physician from the medical record of each diabetic child. Diabetes history included date of diagnosis, diabetes duration, age at diagnosis, latest reading for glycosylated hemoglobin and any existing diabetes complications. Data were analyzed using the Statistical Package for Social Science software, version 18. ‘Periodontitis’ was defined as at least one site with clinical attachment loss >2 mm on at least 2 teeth. Results: Sixty-two of the diabetic children (65%) had poor compliance with dental care, and 42 of them (44%) had never visited the dentist before. The children with type 1 diabetes mellitus had a significantly higher plaque index and gingival index and more bleeding on probing than control subjects (p < 0.001). In the diabetic group, periodontitis was significantly associated with longer duration of diabetes (odds ratio 2.230, confidence interval 1.308–3.801; p = 0.003) and older age at diagnosis of diabetes (odds ratio 1.838, confidence interval 1.091–3.096; p = 0.022). Conclusions: Periodontal disease in young patients with type 1 diabetes was more evident than in those without diabetes. These data showed that diabetes duration may play a significant role in the progression of periodontal disease in diabetic children.

Factors Associated with Implant Recommendation for Single-tooth Replacement

The use of dental implants for single-tooth replacement has been established as a predictable treatment option; yet, limited data are available as to how frequently this option is recommended to patients. The aim of the present study was to examine the frequency of implant recommendation by general dental practitioners after single-tooth extraction and factors influencing their decision to recommend an implant. All single-tooth extractions performed in 26 general dental practice clinics in Kuwait over a 30-day period were examined. Dentists in these centers used the study form to record demographic data, the type of tooth extracted, reason for extraction, and replacement options presented to the patients. Univariate and logistic regression analyses were used to examine associations between background factors and decisions to recommend implant therapy. A total of 1367 patients (mean age, 37.9 ± 11.8 years) had an extraction of one tooth during the study period. Forty-three patients were offered implants as a replacement option (3.3% of the total sample; 8.6% of patients who were offered tooth replacement options). Factors associated significantly with the recommendation of an implant by Kuwaiti dentists to their patients included younger age, regular dental maintenance visits, and adequate oral hygiene practices (P <0.05; binary logistic regression). Dental implant recommendation for single-tooth replacement in the present sample of dentists was low. Factors associated significantly with dentist recommendation of an implant for single-tooth replacement included age, history of dental maintenance, and oral hygiene practices.