Monophasic ß-TCP vs. biphasic HA/ß-TCP in two-stage sinus floor augmentation procedures - a prospective randomized clinical trial.

OBJECTIVES: To compare a monophasic (100% ß-TCP) and a biphasic (60% HA and 40% ß-TCP) bone substitute material (BSM) regarding biocompatibility, osteoconductivity and implant stability using histological, radiological and resonance frequency analysis. MATERIAL AND METHODS: Sixty-seven sinus floor elevations were performed in 60 patients. One patient group (monophasic bone substitute [MBS], 30 patients, 32 sinuses) was augmented by the use of the monophasic material (Bioresorb® , Sybron Implant Solutions, Bremen, Germany), while the second group (biphasic bone substitute (BBS), 30 patients, 35 sinuses) received a biphasic material (Maxresorb® , Botiss Biomaterials, Berlin, Germany). Cone beam CT images were taken immediately after augmentation and prior to implant placement after 6 months. Trephines were harvested, while the implant bed was prepared. Resonance frequency analysis was performed immediately after implant placement and 6 months later. Descriptive analysis was performed on all augmented sinus (n = 67). For statistical comparison of the groups, one sinus of each bilaterally treated patient was randomly excluded, resulting in 30 sinuses grafted with MBS and 30 sinuses grafted with BBS (n = 60). RESULTS: Histomorphometrical analysis of all sinuses displayed comparable results for both groups regarding new bone matrix (MBS 36.16 ± 19.37%, BBS 38.42 ± 12.61%), residual BSM (MBS 30.26 ± 11.7%, BBS 32.66 ± 12.57%) and non-mineralized tissue (MBS 34.29 ± 18.32%, BBS 28.92 ± 15.04) %) (P > 0.05, respectively). Radiological volume of BBS was significantly more stable (volume loss of 22.2% for MBS, 6.66% for BBS; P < 0.001), and homogeneity of the graft after 6 months was higher for BBS than that for MBS (P < 0.05). Resonance frequency analysis endorsed a higher implant stability quotient for BBS after 6 months than that for MBS (MBS 78.31 ± 5.81, BBS 80.42 ± 6.31; P < 0.05, Mann-Whitney U-test, respectively). CONCLUSION: Both monophasic and biphasic materials show good biocompatibility and osteoconductivity with satisfactory support on implant stability. BBS remains more stable in terms of volume maintenance and radiological graft homogeneity after a healing period of 6 months.

Severe Generalized Periodontitis in a Patient with an Aplastic Anemia: a 5 Year Follow-up Case Report.

Aplastic anemia is a hematological disorder characterized by pancytopenia. This case report presents a young patient with untreated periodontitis associated with hematological disorders, and cyclosporine therapy. During 2 consecutive days, periodontal therapy which consisted of nonsurgical therapy supplemented with an antibiotic treatment and antifibrinolytic therapy was performed. Commercial microbiological PCR tests and periodontitis IL-1 polymorphism risk test were performed. Following the periodontal therapy, the inflammation was resolved and the patient's occlusion was restored by means of removable partial dentures. After the 5 year follow-up, the patient still remained with shallow probing depths although there was inadequate compliance during the maintenance phase. Aplastic anemia increases the risk of onset of severe forms of periodontitis that can be additionally complicated with cyclosporine therapy. In such patients, periodontal therapy must be supplemented with antibiotics.

Assessment of implant stability following sinus lift procedures with different grafting materials.

OBJECTIVE: The objective of this research was to evaluate implant stability following sinus lift with two grafting materials, and to compare it with the results obtained for the implants placed in a pristine posterior maxilla. MATERIALS AND METHODS: The study included 44 healthy patients with an existing indication for sinus lift procedure (test group). 46 implants were placed following sinus lift with a pure-phase beta-tricalcium phosphate, while 39 implants were placed following augmentation with 60% hydroxyapatite with 40% beta-tricalcium phosphate material. The control group consisted of 48 healthy patients who were treated with 85 implants but without bone augmentation in posterior maxilla. Astra Tech OsseoSpeed implants were placed in all subjects. Resonance frequency analysis was used in both groups for determining implant stability 4 months after insertion. A mean implant stability quotient (ISQ) was calculated on the basis of 3 measurements. RESULTS: No statistical difference was observed in ISQ values of implants placed with and without augmentation procedure (p=0,789). Statistically significant difference was not found when ISQ values of implants placed following particular grafting material were compared with ISQ values of corresponding implants in a pristine bone (p=0.697 and p=0.402). CONCLUSIONS: This study demonstrated that the implant stability is comparable among implants placed in the posterior maxilla regardless of sinus lift and grafting procedure. Implants placed in the grafted posterior maxilla can be predictably loaded as the implants placed in a non-grafted, pristine maxilla.

Discriminant factor analysis of dental arch dimensions with 3-dimensional virtual models.

INTRODUCTION: The form and the size of a dental arch are products of the configuration and the naturally established balance of the jaw, alveolar bone, and muscles. We investigated which arch dimensions mostly discriminate particular dentoalveolar classes and sexes. METHODS: Plaster dental casts were collected from 137 white adolescent subjects (71 girls, 66 boys) aged between 15 and 18 years (mean, 16.0 ± 1.2 years) with Class I (43 subjects: 24 girls, 19 boys), Class II (50 subjects: 28 girls, 22 boys), and Class III (44 subjects: 19 girls, 25 boys) malocclusions. Casts were scanned with the ATOS II SO (small objects) scanner (GOM mbH, Braunschweig, Germany) and measured with ATOS Viewer software (version 6.0.2; GOM mbH). RESULTS: The major discriminating factors of the particular dentoalveolar classes are the mandibular canine width/depth ratio and the maxillary molar width/depth ratio, which explain 82.8% of the total variability (P <0.001). Class III subjects with the widest and shallowest frontal segment of the mandibular arch and the posterior segment of maxillary arch are clearly distinguished from Class II subjects whose abovementioned segments are the deepest and narrowest. Class I subjects are more similar to Class II than to Class III subjects. The most homogenous are Class III subjects, with 61.1% of them correctly classified, followed by Class II (57.8%) and Class I (52.4%). Sex differences are significant in linear measurements, but not in ratios. CONCLUSIONS: Variability of dental arch dimensions and forms is a common characteristic of all dentoalveolar classes. Maxillary arch form is more distinguishing in the posterior segment, and mandibular arch form is more distinguishing in the anterior segment. Class III patients have the most detectable arch form, and Class I the least detectable arch form.