The Association Between Occlusal Status and the Soft and Hard Tissue Conditions Around Single-Unit Dental Implants.

The occlusal status of single-unit dental implants were evaluated using traditional and computerized methods. The type of occlusal contact in maximum intercuspation and the presence of occlusal contacts on the implant during eccentric movements were recorded. A digital sensor was used for computerized analysis of occlusion. Forty-four patients with 74 implants were included. Twenty-nine implants (39%) presented with "heavy" occlusal contacts, 40 implants (54.1%) presented with "light" contacts, and 5 implants (6.8%) presented with "no contact." No statistically significant association was found between the occlusal status and any of the soft and hard tissue condition variables (P > .05).

Laser Assisted Non-surgical Periodontal Therapy: A Double Blind, Randomized Clinical Trial.

The objective of this study was to examine potential benefits of using laser therapy for secular decontamination in conjunction with scaling and root planing in the treatment of chronic periodontitis. The study was performed on 173 teeth in 14 patients in a split-mouth design, one side received scaling and root planing followed by laser therapy using a carbon dioxide (CO2) laser with an ablative handpiece (test group); the contralateral side received scaling and root planing without laser (control group). Clinical and laboratory parameters were evaluated prior to treatment and at 3 and 6 months following therapy; clinical measurements were performed by two blinded examiners. The clinical parameters included measurement of gingival recession (REC), bleeding on probing (BOP), clinical attachment level (CAL), pocket depth (PD), furcation involvement (FUR), and tooth mobility (MOB). Laboratory testing to determine the levels of periodontal pathogens was performed using PCR techniques. The results of the study revealed statistically significant differences in clinical and laboratory parameters at 3 and 6 months after therapy for both test and control groups, but no significant difference was observed between the two groups. However, sites receiving laser therapy tended to show a greater decrease in probing depths, gain in clinical attachment level, and reduced bacterial levels. In conclusion, the overall results of the study suggest a potential benefit of using laser therapy in conjunction with scaling and root planing for the treatment of chronic periodontitis.

Anti-inflammatory protein tumor necrosis factor-α-stimulated protein 6 (TSG-6) promotes early gingival wound healing: an in vivo study.

BACKGROUND: Human multipotent mesenchymal stromal cells (hMSCs) produce tumor necrosis factor (TNF)-α-stimulated protein 6 (TSG-6). TSG-6 modulates proinflammatory cytokine cascades and enhances tissue repair. This study tests the effects of recombinant human TSG-6 (rhTSG-6) on gingival wound healing within the first 2 days post-surgery. METHODS: After gingival resection in 120 Sprague-Dawley rats, 2 µg rhTSG-6 in 5-µL phosphate-buffered saline (PBS) or the same volume of only PBS solution was injected into gingival tissue approximating the surgical wound. Control animals did not receive injections. Tissue biopsies and blood were collected at 1 to 2, 6 to 8, 24, and 48 hours post-surgery (n = 10 per group). Specimens were analyzed via histologic analysis and enzyme-linked immunosorbent assay (ELISA) for quantification and comparison of inflammatory markers interleukin (IL)-1ß, IL-6, TNF-α, and myeloperoxidase (MPO). Wound photographs were taken for a double-masked clinical assessment at each time period. Weights were recorded for all animals pre- and post-surgery. RESULTS: Animals injected with rhTSG-6 had significantly less severe clinical inflammation at 6 to 8 (P = 0.01228), 24 (P = 0.01675), and 48 (P = 0.0186) hours. Sham and control animals had more weight loss at 24 and 48 hours. Sham and control animals had more pronounced cellular infiltrate. rhTSG-6-treated animals had significantly less MPO (P = 0.027) at 24 hours and IL-1ß (P = 0.027) at 24 and 48 hours. IL-6 showed a marginal significant difference at 6 to 8 hours, but there was no significant difference for TNF-α. CONCLUSION: rhTSG-6 reduced postoperative gingival inflammation by reducing levels of proinflammatory cytokines and cellular infiltrate and may offer significant promise as an anti-inflammatory agent for gingival surgery.

Mechanisms of guided bone regeneration: a review.

Post-extraction crestal bone resorption is common and unavoidable which can lead to significant ridge dimensional changes. To regenerate enough bone for successful implant placement, Guided Bone Regeneration (GBR) is often required. GBR is a surgical procedure that uses barrier membranes with or without particulate bone grafts or/and bone substitutes. There are two approaches of GBR in implant therapy: GBR at implant placement (simultaneous approach) and GBR before implant placement to increase the alveolar ridge or improve ridge morphology (staged approach). Angiogenesis and ample blood supply play a critical role in promoting bone regeneration.

Use of a Carbon Dioxide Laser as an Adjunct to Scaling and Root Planing for Clinical New Attachment: A Case Series.

INTRODUCTION: Severe, chronic periodontitis (CP) is typically treated either with scaling and root planing (SRP) or surgical therapy in an effort to gain clinical attachment. The advantage of non-surgical therapy is decreased morbidity to the patient; however, the site typically heals by formation of a long junctional epithelium. The advantage of surgical therapy is access for debridement and the use of bone or bone substitutes in combination with a barrier membrane for epithelial exclusion. Compared with a non-surgical approach, surgical therapy is more invasive, and patient acceptance of treatment is typically more challenging. The use of lasers in dentistry appears to be rapidly increasing, as evidenced by the influx of new lasers into the dental market as well as numerous anecdotal reports of beneficial results with their use. CASE SERIES: This report presents a novel approach to the treatment of severe CP using a carbon dioxide (CO2) laser in combination with SRP. This study presents the findings of 17 patients (nine males and eight females, aged 34 to 71 years; mean age: 54 years) that were compared in a split-mouth design and followed for 3 months. To the best of the authors' knowledge, this is the first reported case series using a CO2 laser for de-epithelialization in combination with SRP for the treatment of CP. CONCLUSION: Sites treated with the CO2 laser tended to show a greater decrease in probing depths, greater amounts of recession, and greater gains in clinical attachment levels, but the results were not statistically significantly better than SRP alone.

Comparison of the effects of phosphate-coated and sandblasted acid-etched titanium implants on osseointegration: a microcomputed tomographic examination in the canine model.

PURPOSE: This study tested the effects of phosphate treatment of titanium on bone volume fraction (BV/TV) at 30 to 60 Μm from the implant surface using microcomputed tomography to analyze the mineralized tissue. MATERIALS AND METHODS: Electrolytically phosphated (50/100 volts [T1/T2]) or nonphosphated 3.3- X 8-mm titanium implants (C) with sandblasted acid-etched surfaces were placed in 40 mandibular sites in five foxhounds 6 weeks after the extraction of the premolars. After 4 weeks, the animals were sacrificed, and BV/TV was analyzed using microcomputed tomography. RESULTS: The mean BV/TV (± standard deviation) of the control implants was 31.4% ± 15.3% (range, 10.9% to 55.3%). For the T1 implants, a mean BV/TV of 38.4% ± 10.7% (range, 21.6% to 57.3%) was seen, and for T2 implants, the mean BV/TV was 40.3% ± 15.1% (range, 16.5% to 61.1%). Mean BV/TV values for the groups were not significantly different. For all groups (C, T1, and T2), there were no significant differences in BV/TV at the most coronal slices. For all groups, there was a positive slope showing more bone apposition as the slices moved from coronal to apical. The T2 group showed significantly increased mineralized tissue moving from the coronal to the apical section of the implant, compared to the control and T1 implants. CONCLUSION: Access to better blood supply and bone cells from the marrow spaces in the apical regions may lead to a better trabecular bone response. Increased mineralized tissue apposition may allow for accelerated loading and more predictable implant placement in sites with poor quality bone or patients with compromised bone healing.

A comparative study of root defect coverage using an acellular dermal matrix with and without a recombinant human platelet-derived growth factor.

BACKGROUND: The objective of this case series is to compare root defect coverage results and healing responses of bilateral recession defects treated with acellular dermal matrix (ADM) with and without recombinant human platelet-derived growth factor (rhPDGF). METHODS: Seventeen patients with 40 bilateral gingival recession defects were compared. Each defect was ≥2 mm and treated with ADM and a coronally advanced flap. Using split-mouth design, the control-side ADM was hydrated in sterile saline, whereas the test-side ADM was hydrated in rhPDGF. The patients were evaluated at 1 week, 1 month, 3 months, and 6 months. Standardized measurements were taken preoperatively at 3 and 6 months. Healing was clinically assessed at 1 week and 1 month post-surgically. RESULTS: Both test and control groups showed significant gain in root defect coverage over the 6-month period for all individuals, with the test group showing a 69.0% gain and the control group showing a 76.7% gain. Patients divided into Miller Class I and Class III defects were also found to have a significant gain in root defect coverage over 6 months. The test group showed 84.1% gain, and the control group showed 84.7% gain for Miller Class I defects. For Miller Class III defects, the test group showed 51.5% gain, and the control group showed a 60.8% gain. One week after surgery, 35% of the test group showed better healing, whereas 15% of the control group showed better healing. One month after surgery, 20% of the test group showed better healing, whereas 15% of the control group showed better healing. CONCLUSION: Based on the results of this case series, there were no statistically or clinically significant differences in root defect coverage, keratinized tissue, clinical attachment level, or clinical healing for treatment of root recession with a coronally advanced flap and ADM with and without rhPDGF.

Evaluation of the SEDline to improve the safety and efficiency of conscious sedation.

Brain function monitors have improved safety and efficiency in general anesthesia; however, they have not been adequately tested for guiding conscious sedation for periodontal surgical procedures. This study evaluated the patient state index (PSI) obtained from the SEDline monitor (Sedline Inc., San Diego, CA) to determine its capacity to improve the safety and efficiency of intravenous conscious sedation during outpatient periodontal surgery. Twenty-one patients at the periodontics clinic of Baylor College of Dentistry were admitted to the study in 2009 and sedated to a moderate level using midazolam and fentanyl during periodontal surgery. The PSI monitoring was blinded from the clinician, and the following data were collected: vital signs, Ramsay sedation scale (RSS), medications administered, adverse events, PSI, electroencephalography, and the patients' perspective through visual analogue scales. The data were correlated to evaluate the PSI's ability to assess the level of sedation. Results showed that the RSS and PSI did not correlate (r = -0.25) unless high values associated with electromyographical (EMG) activity were corrected (r = -0.47). Oxygen desaturation did not correlate with the PSI (r = -0.08). Satisfaction (r = -0.57) and amnesia (r = -0.55) both increased as the average PSI decreased. In conclusion, within the limits of this study, PSI appears to correlate with amnesia, allowing a practitioner to titrate medications to that effect. It did not provide advance warning of adverse events and had inherent inaccuracies due to EMG activity during oral surgery. The PSI has the potential to increase safety and efficiency in conscious sedation but requires further development to eliminate EMG activity from confounding the score.

A comparative study of root coverage using two different acellular dermal matrix products.

BACKGROUND: Gingival recession remains an important problem in dental esthetics. A new dermal matrix material has been introduced, but its effectiveness has not been studied and compared to current dermal matrix material. The aim of this study is to compare the healing associated with a coronally advanced flap for root coverage in areas of localized tissue recession when using Alloderm (ADM) and Puros Dermis (PDM). METHODS: A split-mouth design was used for this study, with 52 contralateral sites in 14 patients with Miller Class I or III facial tissue recession. Twenty-six sites were treated with coronally advanced flap using PDM, and 26 sites were treated with coronally advanced flap using ADM, all followed for 6 months. Clinical measurements of vertical recession, keratinized tissue, probing depths, and attachment levels were made initially, at 3 months, and at 6 months. RESULTS: Both groups had significant improvement in the amount of recession coverage with means of 2.83 mm for the PDM and 3.13 mm for the ADM. The percentage of root coverage was 81.4% for the PDM and 83.4% for the ADM; differences between the materials were not statistically significant. CONCLUSIONS: Based on the results of this study, there was no statistical or clinical difference in the amount of root coverage, probing depth, or keratinized tissue in coronally advanced flaps for root coverage with either of the two acellular dermal matrix materials. Both materials were successful in achieving root coverage.

Effect of phosphate treatment of Acid-etched implants on mineral apposition rates near implants in a dog model.

PURPOSE: This study evaluated the effects of phosphate coating of acid-etched titanium on the mineral apposition rate (MAR) and new bone-to-implant contact (BIC) in a canine model. MATERIALS AND METHODS: Titanium implants (2.2 3 4 mm) with acid-etched surfaces that were electrolytically phosphated or not were placed in 48 mandibular sites in six foxhounds. Tetracycline and calcein dyes were administered 1 week after implant placement and 1 week before sacrifice. At 12 weeks after implant placement, the animals were sacrificed. MAR and BIC were evaluated using fluorescence microscopy. Light microscopic and histologic evaluations were performed on undecalcified sections. RESULTS: Microscopic evaluation showed the presence of healthy osteoblasts lining bone surfaces near implants. Similar BIC was observed in phosphated and nonphosphated titanium implant sites. MAR was significantly higher around the nonphosphated titanium implant surfaces than around the phosphated titanium samples. No significant differences were found between dogs or implant sites. CONCLUSION: Acid-etched implants showed significantly higher MARs compared to acid-etched, phosphate-coated implants. Int J Maxillofac Implants 2010;25:278-286.

Age-dependent differential expression of apoptosis markers in the gingival tissue.

OBJECTIVE: The current study was performed to test the hypothesis that periodontal disease produces age-dependent activation of apoptotic markers in the gingival tissues. METHODS: To address the hypothesis a prospective experimental study was designed and twenty-two patients were enrolled. Out of the twenty-two patients, gingival tissue biopsies samples were obtained from active sites of ten and twelve periodontal-healthy (HS) and periodontal disease (PD, probing depths >5mm patients, respectively. The groups were further divided into 25-50 and <5 years age subgroups. RESULTS: A significant decrease in the expression of TRADD (Tumour Necrosis Factor Receptor-Associated Death Domain) was observed in 25-50 years of PD group compared to the HS group. Bax (BCL(2)-associated X protein) expression in the PD groups was significantly decreased in PD 25-50 years age group but increased in the >50 years age group compared to respective HS age groups. PD patients of both 25-50 years and >50 years age exhibited a significant increase in the expression of Cytochrome C and Caspase-3 compared to the respective HS groups. The PD patients exhibited a stronger correlation with age in the expression of TRADD and Bax compared to the HS groups. Further analyses revealed that the expression of Caspase-3 correlated with an increase in the age of the healthy patients. CONCLUSIONS: The data suggested that modulation of apoptotic cascade may contribute to the damage of gingival tissues particularly in PD patients >50 years age.

Effects of phosphated titanium and enamel matrix derivatives on osteoblast behavior in vitro.

PURPOSE: The purpose of this study was to evaluate the effects of phosphated titanium and enamel matrix derivatives (EMD) on osteoblast function. MATERIALS AND METHODS: Primary rat osteoblasts were cultured on disks of either phosphated or nonphosphated titanium. In half of the samples 180 microg of EMD was immediately added. The medium was changed every 2 days for 28 days and then analyzed using transforming growth factor-beta1 (TGF-beta1) and interleukin-1beta (IL-1beta) enzyme-linked immunosorbent assays (ELISAs). Scanning electron microscopy and light microscopy were used to evaluate nodule formation and mineralization. RESULTS: Microscopic evaluation revealed no differences in osteoblast attachment between the 4 groups. Osteoblast nodule formation was observed in all groups. In the absence of mineralizing media, nodules on the nonphosphated titanium samples showed no evidence of mineralization. All nodules on the phosphated titanium had evidence of mineralization. ELISA revealed no significant differences in IL-1beta production between any of the groups. The EMD-treated osteoblasts produced significantly more TGF-beta1 than non-EMD-treated cells for up to 8 days, and osteoblasts on phosphated titanium produced significantly more TGF-beta1 at 8 days. DISCUSSION AND CONCLUSION: Osteoblast attachment appeared unaffected by surface treatment. EMD initiated early TGF-beta1 production, but production decreased to control levels within 10 days. Phosphated titanium increased TGF-beta1 production at 8 days and induced nodule mineralization even in the absence of mineralizing medium.

Bone regeneration around implants in the canine mandible with cultured fibroblasts in polyglactin mesh.

BACKGROUND: Human fibroblast-derived dermal substitute (HFDDS) is a tissue-engineered material that consists of polyglactin mesh seeded with cultured fibroblasts. Cultured fibroblasts are not as differentiated as tissue fibroblasts and retain the ability to differentiate into other cells types. HFDDS also is capable of stimulating angiogenesis and wound healing. The purpose of this study was to attempt to evaluate the effects of HFDDS on guided bone regeneration at sites with 1.5-mm peri-implant defects in the canine mandible. METHODS: Fifty sand-blasted acid-etched test implants were placed into the edentulous areas of mandibular ridges of five American foxhounds. Each site had a standardized 1.5-mm circumferential peri-implant defect in the coronal half of the implant, created by a specialized drill at the time of osteotomy. In each canine two implants received no treatment of the defects, four implants were treated with polyglactin mesh (carrier only) wrapped around the circumference of the defect wall, and four implants were treated with HFDDS placed in a similar fashion to the mesh. Implant sites healed submerged for 10 weeks, at which time sacrifice took place and sections were prepared, processed, and analyzed histomorphometrically. RESULTS: The mean distance from the top of the fixture to the first point of bone-implant contact was 2.20 mm, 2.25 mm, and 2.60 mm for the HFDDS, carrier, and control sites, respectively (P = 0.202). Overall mean percentage of bone-to-implant contact (BIC) in the defects was 32.8%, 31.0%, and 22.8% for the HFDDS, carrier, and control groups, respectively. These differences were not statistically significant, but approached statistical significance for the control group compared to HFDDS and carrier (P = 0.057). Overall mean bone fill in the defects calculated histometrically was 36.0%, 35.8%, and 33.9% for the HFDDS, carrier, and control groups, respectively. These differences were not statistically significant. Sites with dehiscence at the time of implant placement had significantly greater distance to first bone-implant contact (P = 0.002), a smaller percentage of BIC (P = 0.006), and significantly less bone fill (P = 0.006) in the defects. It was consistently found that when dehiscence occurred on the buccal side of the implant, the outcomes for all parameters measured were significantly inferior on the lingual side as well. Factorial analysis, which grouped outcomes by dehiscence categories (none, partial, or full dehiscence), revealed that with intact defects without dehiscence, HFDDS had less bone fill compared to the carrier. However, in defects with partial or full dehiscence, HFDDS had more bone fill compared to carrier sites. These differences were statistically significant (P = 0.034). CONCLUSIONS: In intact sites without dehiscence, the presence of cultured fibroblasts in 1.5-mm-wide peri-implant defects did not significantly enhance bone regeneration compared to the carrier, polyglactin mesh. However, sites with partial or full dehiscence treated with HFDDS had significantly greater bone fill compared to the carrier (P = 0.034). When dehiscence occurs during immediate implant placement on narrow ridges without the use of membranes, bone regeneration tends to be inferior on the side of the dehiscence as well as the opposite side of the implant.

A comparative study of root coverage using acellular dermal matrix with and without enamel matrix derivative.

BACKGROUND: The aim of this study was to compare root coverage using acellular dermal matrix (ADM) with and without enamel matrix derivative (EMD) on the percentage of root coverage, probing attachment level, and the amount of keratinized tissue in the treatment of localized recession. METHODS: Eighty-two contralateral sites in 14 patients with >or=2 mm of Miller Class I or III buccal tissue recession were treated. Forty-one test sites were treated with coronally advanced flap (CAF) using ADM in conjunction with EMD, whereas 41 control sites were treated with CAF using ADM alone. A split-mouth design was used for this study with 82 sites. Patients were followed for 3 and 6 months. A paired t test was conducted with the subject as the unit of analysis. RESULTS: Based on paired t tests, both groups had significant improvement in the percentage of root coverage, probing attachment levels, and increased keratinized tissue. Only keratinized tissue in the test group demonstrated a statistically significant greater increase compared to controls at the 6-month evaluation (P = 0.006). CONCLUSION: The use of EMD in conjunction with ADM resulted in a statistically significant effect on keratinized tissue increase, but no significant effects on probing attachment level or percentage of root surface coverage.

Comparison of salivary calmodulin binding proteins in Sjögren's syndrome and healthy individuals.

BACKGROUND: Reduction in salivary secretion is the hallmark of Sjögren's syndrome (SS). Calmodulin (CaM) and calmodulin binding proteins (CaMBPs) play a key role in the secretory process of saliva. Recent studies have suggested that SS-B, an autoantibody associated with SS, is a CaMBP. This finding suggests that CaMBP may contribute to the loss of saliva in SS. To better understand the role(s) of these proteins in SS, the purpose of this study was to compare salivary CaMBPs in Sjögren's patients and controls. METHODS: Saliva samples were collected from 20 patients and 20 age-, race-, and gender-matched controls. CaM overlay was used to identify CaMBPs in saliva of patients and controls. RESULTS: Higher number of salivary CaMBPs was observed among patients than controls. CONCLUSIONS: The increased number of salivary CaMBPs in SS may suggest a potential role for these proteins in the pathogenesis of the disease.

Accuracy of prescription medication reporting among active duty U.S. Army dental patients.

Dentist routinely ask patients about medication usage before dental treatment. The purpose of this study was to determine if active duty personnel relate accurate information about medications they have been prescribed in the 6 months before an annual dental examination. This study also examined whether patients knew the dosage of the medication they were prescribed. The information in this study was obtained from 100 active duty soldiers at their dental examinations. The data were verified through the Composite Health Care System computer information system. In this study, 35% of patients had been prescribed at least one medication. Fifty-one percent of the patients prescribed medication in this study accurately reported their prescription history in the 6 months before their dental examinations. Forty-five percent of the patients that reported being prescribed medication actually knew the correct dosage of the medication they were prescribed.