Robert A. Bagramian

The Influence of the Bucco-Palatal Distance on Sinus Augmentation Outcomes

BACKGROUND Maxillary sinus augmentation is one of the most reliable implant site development options to increase vertical bone height. However, graft consolidation requires adequate angiogenesis and migration of cells involved in osteogenesis and bone remodeling. It is speculated that these biologic events are greatly determined by the dimensions of the maxillary sinus cavity. Hence, the purpose of this study is to assess the influence of the distance from the lateral to the medial wall of the maxillary sinus on the outcomes of sinus augmentation procedures. METHODS A total of 25 patients in need of sinus augmentation were recruited for the study. After initial examination, customized radiographic and surgical guides were fabricated and a cone-beam computerized tomography scan was obtained per patient. The bucco-palatal distance (BPD) was measured at 8, 10, and 12 mm from the alveolar crest. Sinus grafting was performed by a lateral window approach using a particulated allograft material. Patients were followed-up for 6 months. At the time of implant placement, bone core biopsies were harvested using the radiographic-surgical guide. Sections of the bone cores at 8, 10, and 12 mm from the alveolar crest were histomorphometrically analyzed. The proportion of vital bone (%VB) was correlated with the BPD using a statistical model. RESULTS Twenty-one patients underwent sinus augmentation for a total of 24 sinuses; however, the data analyzed contained only one sinus per patient. One sinus developed an infection after grafting, resulting in a 96% success rate for the sinus grafting procedure. Twenty sinuses were used in the final statistical analysis. Histomorphometric analysis revealed that mean %VB was 22.71 +/- 19.08, mean percent of remaining allograft was 23.39 +/- 20.85, and average percent of non-mineralized connective tissue was 53.90 +/- 13.23. Analysis of the correlation between %VB and BPD by linear regression, using the actual values of BPD showed a strong negative association (R(2) = 0.141; P <0.001). CONCLUSION The findings suggest that the %VB formation after maxillary sinus augmentation is inversely proportional to the sinus BPD.

Impact of Maintenance Therapy for the Prevention of Peri-implant Diseases: A Systematic Review and Meta-analysis.

At the present time, peri-implantitis has become a global burden that occurs with a frequency from 1% to 47% at implant level. Therefore, we aimed herein at assessing the impact of peri-implant maintenance therapy (PIMT) on the prevention of peri-implant diseases. Electronic and manual literature searches were conducted by 3 independent reviewers using several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, for articles up to June 2015 without language restriction. Articles were included if they were clinical trials aimed at demonstrating the incidence of peri-implant diseases under a strict regime or not of PIMT. Implant survival and failure rate were studied as secondary outcomes. A meta-analysis was conducted to evaluate the influence of PIMT and other reported variables upon peri-implant diseases. Thirteen and 10 clinical trials were included in the qualitative and quantitative analysis, respectively. Mucositis was affected by history of periodontitis and mean PIMT at implant and patient levels, respectively. Similarly, significant effects of history of periodontal disease were obtained for peri-implantitis for both implant and patient levels. Furthermore, mean PIMT interval was demonstrated to influence the incidence of peri-implantitis at implant but not patient level. PIMT interval showed significance at both levels. For implant survival, implants under PIMT have 0.958 the incident event than those with no PIMT. Within the limitations of the present systematic review, it can be concluded that implant therapy must not be limited to the placement and restoration of dental implants but to the implementation of PIMT to potentially prevent biologic complications and hence to heighten the long-term success rate. Although it must be tailored to a patient’s risk profiling, our findings suggest reason to claim a minimum recall PIMT interval of 5 to 6 mo. Additionally, it must be stressed that even in the establishment of PIMT, biologic complications might occur. Thus, patient-, clinical-, and implant-related factors must be thoroughly explored.

Epidemiologic Study of Dental Caries Experience and Between-Meal Eating Patterns

The relationship between dental caries and between-meal snacks was investigated in a study of 1,486 high school students. The participants completed a questionnaire on between-meal habits and then were given dental examinations. The lack of differences in dental caries between racial and geographic groups was not related to the frequency of sucrose-containing, between-meal snacks.

An Epidemiologic Study of Dental Caries in Race and Geographic Area

Dental caries experience was determined for white and black high school students in a northern and a southern city of the United States. Expected racial and geographic differences were not found. White and black students showed similar caries experiences, and black students had a higher incidence of caries than reported in earlier studies.

Sealant Effectiveness for Children Receiving a Combination of Preventive Methods in a Fluoridated Community: Two-Year Results

A series of preventive methods in combination have been used to reduce dental caries in children including dental health education, prophylaxes, pit and fissure sealants, topical application of fluoride and restorative care. Prophylaxes, sealant, and fluoride procedures are repeated every six months. Two-year results show reductions of occlusal caries increments of 74.3% for first graders and 77.1% for sixth graders. Sealant loss, as defined in this study, varied from 33% to 90% with the highest loss occurring in the newly erupted permanent molars during the first six months of the project. These high sealant loss rates are thought to be related to the age of the population which was designed to include children at the ages of peak eruption of permanent molar teeth (ages six and twelve). These teeth were often only minimally erupted and maintaining the dry field required for sealant retention was extremely difficult. However, in spite of these high rates of sealant loss, caries reduction on occlusal surfaces was highly significant in comparison to that of children who did not receive sealants.

Explaining Variability in Caries Experience Using an Ecological Model

A model including diet, oral hygiene, and dental treatment and three ecological levels was tested to study variability in caries experience. Analysis produced a rank order of explanation for the ecological variables: (1) community, (2) family, (3) individual. The treatment factor contributed more to oral condition than oral hygiene or diet within each ecological level.

Dental Health Status of Third Grade Children and Their Families within the Context of a Community??s Dental Health Care System

Utilizing structure, process, and outcomes as conceptual dimensions of appraisal of quality, data were analyzed to present an evaluation of the quality of a community’s dental health core, system as reflected in a population subgroups’ dental health status. Data were collected from 838 Caucasian third-graders and their parents through interviews, mail questionnaires, and dental screening examinations. Indicators of structure were: status of community water fluoridation in the study community, dentist to population ratio, and dental care resources in the public sector available to eligible residents. Process indicators of quality were: 1) screening, case finding, examinations, and quality of restorations as measures of provider behaviors, and 2) complaints, compliance, conditioned behaviors, level of dental health knowledge, and utilization of dental services as measures of client behaviors. Outcomes subjected to analysis included indices indicative of dental disease experience. Variables operationally defined as indicators of the subgroup’s dental health status were subjected to a descriptive analysis and were then crosstabulated with the socioeconomic status of the child’s family to identify socioeconomic differences in the process of obtaining care and in dental health outcomes. Findings indicate which elements in a community’s prevailing dental health care system function well and which would need alteration to maximize dental health for the subgroup.

Dental health status and patient-reported outcomes at baseline in patients participating in the osteonecrosis of the jaw registry study, SWOG S0702

PurposeSWOG S0702 was a cohort study of patients with cancer with bone metastases due to any cancer. Using baseline data from S0702, this report characterizes the oral health and oral health-related quality of life (OHRQoL) of patients with advanced cancer.MethodsS0702 case report forms captured dental assessment and patient-reported outcome (PRO) data. This analysis compares PRO dental discomfort with selected clinical assessments of dental health. This analysis focuses on the 2294 patients who underwent baseline dental examination prior to study registration, but also reports on the 1235 patients for whom only OHRQol data are available. Dental characteristics including the number of teeth and the presence of gingivitis and periodontal disease were examined for correlation with PRO of oral pain, interference with eating, smiling, speech, or quality of life.ResultsThe median age of the study participants was 62. Greater than 60% of the 2294 patients with baseline dental assessments had none to mild plaque, calculus, gingivitis, or periodontal disease, suggesting that most of this cohort had good oral hygiene. However, in each of these same categories, approximately 6% had dental findings classified as severe conditions (poor oral hygiene). There was strong evidence that the presence of periodontal disease, gingivitis, and number of teeth was correlated with lower OHRQoL across multiple domains, including pain (mouth or jaw), interference with eating, smiling and speech, and overall quality of life.ConclusionsThis report characterizes the oral health and OHRQoL of patients with advanced bone metastases receiving palliative therapy.Trial registrationClinicalTrials.gov Identifier: NCT00874211