Robin Weltman

Ridge Preservation With or Without an Osteoinductive Allograft: A Clinical, Radiographic, Micro-Computed Tomography, and Histologic Study Evaluating Dimensional Changes and New Bone Formation of the Alveolar Ridge

BACKGROUND The aim of this randomized, controlled clinical trial is to determine whether ridge preservation using an osteoinductive allograft (test) would prevent ridge resorption and promote bone maturation compared to extraction alone (control). METHODS Seventeen patients (20 total sites), in need of a non-molar extraction and delayed implant placement were randomly selected to receive either ridge preservation or extraction alone. A cone-beam computed tomography was completed with a radiographic stent in place before extraction and 10 to 12 weeks postoperatively for dimensional and buccal plate analyses. Bone cores were taken for micro-computed tomography (microCT) and histologic analyses. RESULTS Resorption of the alveolar ridge occurred at all sites with no statistically significant differences found between test and control sites. A significant correlation was found between the initial buccal plate thickness and the loss of vertical ridge height. microCT and histologic analyses found a mean new bone volume of 44.9% with microCT and 37.4% with histology in test sites and 39% and 35.5%, respectively, in control sites. The residual graft volume was 2.4% with microCT and 4.5% with histology. CONCLUSIONS Test and control sites lost similar amounts of alveolar ridge, with the loss of buccolingual width occurring predominantly at the expense of the buccal bone. A thicker buccal plate was associated with less ridge loss in the vertical dimension. The percentage of new bone was not statistically significant between either the test or control sites, using either microCT or histologic analyses.

The effect of periodontal therapy on glycaemic control in a Hispanic population with type 2 diabetes: a randomized controlled trial.

OBJECTIVE In the Mexican-American population, the prevalence of Type 2 diabetes mellitus (T2DM) is as high as 50% of the population. This randomized controlled clinical trial was designed to elucidate how treatment of periodontal disease affects HbA1c values in this population. MATERIALS AND METHODS One hundred and fifty-four T2DM patients with periodontal disease were enrolled in the study. The test group was treated with scaling and root planing (SRP); the control group received oral hygiene instructions. At baseline and 4-6 weeks after therapy, a complete periodontal examination was performed. Blood was collected at baseline and 4 months later for HbA1c levels. RESULTS One hundred and twenty-six individuals completed the study. Baseline mean ± SD HbA1c for the test and control groups were 9.0 ± 2.3% and 8.4 ± 2.0% respectively. Non-significant difference in HbA1c reductions (0.6 ± 2.1% and 0.3 ± 1.7%) was found between test and control groups at 4 months. Comparisons of the periodontal clinical parameters between the test and control groups found significant differences with improved results in the test subjects. CONCLUSIONS No statistically significant differences were found in the changes of HbA1c levels between test and control groups. Non-surgical periodontal therapy improved the magnitude of change in periodontal parameters as compared to the control subjects. ClinicalTrials.gov Identifier: NCT01128374.

Prevalences of peri-implantitis and peri-implant mucositis: systematic review and meta-analysis

OBJECTIVES Due to the inconsistent definitions, reporting methods and study characteristics, prevalences of peri-implant diseases significantly varied in studies. This study aimed to systematically analyze implant-based and subject-based prevalences of peri-implant diseases and assess clinical variables potentially affecting the prevalence. SOURCES Electronic search of studies was conducted using MEDLINE (PubMed), EMBASE and Web of Science. Publication screening, data extraction, and quality assessment were performed. STUDY SELECTION Clinical studies having an at least average three-year follow-up period were selected. The numbers of subjects and implants in the studies had to be equal to or more than thirty. DATA Forty seven studies were selected and prevalences of peri-implant diseases were analyzed. Since heterogeneity existed in each outcome (I2=94.7, 95.7, 95.3, and 99.3 for implant-based and subject-based peri-implantitis and peri-implant mucositis, respectively), the random-effects model based on the DerSimonian and Laird method, which incorporate an estimate of heterogeneity in the weighting, was applied to obtain the pooled prevalence. Weighted mean implant-based and subject-based peri-implantitis prevalences were 9.25% (95% Confidence Interval (CI): [7.57, 10.93]) and 19.83% (CI [15.38, 24.27) respectively. Weighted mean implant-based and subject-based peri-implant mucositis prevalences were 29.48% (CI: [22.65, 36.32]) and 46.83% (CI: [38.30, 55.36]) respectively. Functional time and implant to subject ratio were associated with subject-based peri-implantitis prevalence, but not peri-implant mucositis prevalences. CONCLUSIONS Peri-implant diseases were prevalent and prevalence of peri-implantitis increased over time. Prevalences of peri-implantitis and peri-implant mucositis might not be highly associated since the prevalences were influenced by distinct variables. The results should be carefully interpreted because of data heterogeneity. CLINICAL SIGNIFICANCE Peri-implant diseases affect a significant number of dental implants and patients. It is important to understand the difficulties in diagnosis of these diseases and risk factors which may be modified to reduce the potential for disease occurrence or progression.

Survival of Dental Implants Placed in Grafted and Nongrafted Bone: A Retrospective Study in a University Setting.

PURPOSE To compare dental implant survival rates when placed in native bone and grafted sites. Additionally, risk factors associated with dental implant loss were identified. This study was based on the hypothesis that bone grafting has no effect on implant survival rates. MATERIALS AND METHODS A retrospective chart review was conducted for patients receiving dental implants at the University of Texas, School of Dentistry from 1985 to 2012. Exclusion criteria included patients with genetic diseases, radiation and chemotherapy, or an age less than 18 years. To avoid misclassification bias, implants were excluded if bone grafts were only done at the same time of placement. Data on age, sex, tobacco use, diabetes, osteoporosis, anatomical location of the implant, implant length and width, bone graft, and professional maintenance were collected for analysis. RESULTS A total of 1,222 patients with 2,729 implants were included. The cumulative survival rates at 5 and 10 years were 92% and 87% for implants placed in native bone and 90% and 79% for implants placed in grafted bone, respectively. The results from multivariate analysis (Cox regression) indicated no significant difference in survival between the two groups; having maintenance therapy after implant placement reduced the failure rate by 80% (P < .001), and using tobacco increased the failure rate by 2.6-fold (P = .001). CONCLUSION There was no difference in the dental implant survival rate when implants were placed in native bone or bone-grafted sites. Smoking and lack of professional maintenance were significantly related to increased implant loss.

Role of supportive maintenance therapy on implant survival: a university-based 17 years retrospective analysis

OBJECTIVE The objective of this study was to determine whether professional maintenance appointments were related to a decrease on dental implant loss. METHODS We performed a retrospective review (1995-2012) of 1020 patient dental charts to collect data including a cadre of different variables such as age, gender, race, diabetes, osteoporosis, jaw location, implant dimensions and professional maintenance therapy. As a patient may have multiple implants which are correlated, we selected one random implant per patient to assure independence of observations assumption of the Cox proportional hazards regression model. Data analysis was performed using Kaplan-Meier survival curves and multivariate analysis using Cox proportional hazards regression analysis. RESULTS Our results demonstrate that subjects with no maintenance had the lowest cumulative survival rate as compared to subjects with regular maintenance. In a multivariate Cox regression model, regular maintenance patients had the dental implant failure rate reduced by 90% as compared to no maintenance (P = 0.001). If patients had less than one maintenance visit per year, the failure rate was reduced by 60% as compared to no maintenance, but the difference was not statistically significant (P = 0.08). CONCLUSION From this research, we conclude that a professional administered periodontal maintenance at least on an annual basis is a critical factor for implant survival.

Management of Retrograde Peri-Implantitis Using an Air-Abrasive Device, Er,Cr:YSGG Laser, and Guided Bone Regeneration

Background The placement of an implant in a previously infected site is an important etiologic factor contributing to implant failure. The aim of this case report is to present the management of retrograde peri-implantitis (RPI) in a first maxillary molar site, 2 years after the implant placement. The RPI was treated using an air-abrasive device, Er,Cr:YSGG laser, and guided bone regeneration (GBR). Case Description A 65-year-old Caucasian male presented with a draining fistula associated with an implant at tooth #3. Tooth #3 revealed periapical radiolucency two years before the implant placement. Tooth #3 was extracted, and a ridge preservation procedure was performed followed by implant rehabilitation. A periapical radiograph (PA) showed lack of bone density around the implant apex. The site was decontaminated with an air-abrasive device and Er,Cr:YSGG laser, and GBR was performed. The patient was seen every two weeks until suture removal, followed by monthly visits for 12 months. The periapical X-rays, from 6 to 13 months postoperatively, showed increased bone density around the implant apex, with no signs of residual clinical or radiographic pathology and probing depths ≤4 mm. Conclusions The etiology of RPI in this case was the placement of an implant in a previously infected site. The use of an air-abrasive device, Er,Cr:YSGG, and GBR was utilized to treat this case of RPI. The site was monitored for 13 months, and increased radiographic bone density was noted.

Cone Beam Computerized Tomography Measurement of Alveolar Ridge at Posterior Mandible for Implant Graft Estimation.

Damaging the inferior alveolar nerve (IAN) is the most serious complication when harvesting an autogenous graft from posterior mandible. The objective of this study was to use cone beam computerized tomography (CBCT) to measure dimensions of the alveolar ridge in the posterior mandible for estimation of a safe graft size, and then analyze how it is related to the gender, age, and dentition status of subjects. CBCT scans were screened to include 59 subjects without interfering pathologies. Alveolar height was measured from the alveolar crest to superior border of IAN and also to the inferior border of the mandible. Alveolar width (from buccal to lingual cortical plates) and buccal bone thickness (from buccal cortical plate to mandibular molar mesial root buccal surface) were measured at the coronal, middle, and apical thirds divided from the alveolar crest to the IAN. It was found that males and dentate sites had larger alveolar dimensions than did females and edentulous sites, respectively. Bone volume did not correlate significantly with age. Buccal bone thicknesses increased from coronal to apical and from the first to the third molar generally. A larger bone graft could be harvested from male than female patients, with a mean harvestable graft dimension (height × width in mm) for male was 15.5 × 3.2, and for female was 14.1 × 2.9. In conclusion, males and dentate arches demonstrate larger alveolar volumes than do females and edentulous regions, respectively. Larger alveolar grafts can be harvested from males compared to the females. Age does not seem to affect alveolar dimension/graft volume.