Success rate of immediate implants placed and restored by novice operators.

AIMS: The primary aim of this study was to evaluate the 1-year crestal bone loss and success rate of an immediately placed single-stage implant placed and restored by novice operators. A secondary aim was to determine the patient's assessment of the appearance of the final restoration. METHODS: Fifty-one patients received a tooth extraction and placement of at least 1 immediate implant by a Graduate Periodontics resident. Clinical and radiographic measurements were taken at the surgical, 4-month, and 1-year follow-up visits. After at least 3 months healing, dental students restored the implants with either a crown or an overdenture. Patient satisfaction was assessed using 5 categories: excellent, very good, good, fair, or poor. RESULTS: Sixty-two immediate implants were placed. The success rate was 100% at the 12-month visit and was subclassified as grade 3 because of the mean first year bone loss of 1.3 +/- 1.0 mm. Using the 2008 classification of Misch et al, 42 implants were classified as success optimum health, 19 as survival satisfactory health, and 1 as survival compromised health. Radiographic bone loss was stratified by implant platform position relative to the alveolar crest and changed from time 0 to time 12 by -1.0 +/- 1.2 mm for the supracrestal group (n = 25, P < 0.05), -1.5 +/- 0.9 mm for the crestal group (n = 31, P < 0.05), and -1.3 +/- 1.2 mm for the subcrestal group (n = 6, P < 0.05). The supracrestal group had significantly less bone loss than either the crestal or the subcrestal group (P < 0.05). The appearance of the final restoration at 1 year was rated excellent by 82% of patients, very good by 16%, and good by 2%. CONCLUSIONS: Immediate implant placement by novice operators using routine dental school procedures was a highly predictable procedure as indicated by the 100% success rate at 12 months. Most patients rated the restoration appearance as excellent.

Root coverage using acellular dermal matrix and comparing a coronally positioned tunnel to a coronally positioned flap approach.

BACKGROUND: The primary aim of this randomized, controlled, masked clinical trial was to compare the percentage of root coverage obtained with a coronally positioned flap plus acellular dermal matrix (ADM) allograft to that of a tunnel technique plus ADM 4 months post-surgically. METHODS: Twenty-four subjects with one site with > or =3 mm Miller Class I or II recession were treated and followed for 4 months. Twelve patients received a coronally positioned flap plus ADM and were considered the positive control group (CPF). The test group consisted of 12 subjects treated with a coronally positioned tunnel technique plus ADM (TUN). Subjects were randomly selected by a coin toss to receive the test or control treatment. RESULTS: The mean facial recession defect at the initial examination for the TUN group was 3.1 +/- 0.3 mm; this was reduced to 0.7 +/- 0.9 mm at the 4-month examination for a gain of 2.4 +/- 1.0 mm or 78% defect coverage (P <0.05). The mean facial recession defect at the initial examination for the CPF group was 3.4 +/- 0.8 mm; it was reduced to 0.2 +/- 0.3 mm at the 4-month examination for a gain of 3.2 +/- 0.9 mm or 95% defect coverage (P <0.05). There was no statistically significant difference between groups (P >0.05). CONCLUSIONS: The coronally positioned flap plus ADM produced a defect coverage of 95%, whereas the tunnel technique plus ADM produced only 78% coverage. This difference was considered clinically significant but was not statistically significant.

Full mouth disinfection versus quadrant debridement: the clinician's choice.

Traditional periodontal therapy is subgingival debridement with maintenance of good oral hygiene. This approach is either definitive or the initial phase before surgical therapy in severe cases of periodontitis. Mechanical therapy, either hand instrumentation or ultrasonic debridement, is the most common therapy for periodontitis and its success is well documented (Badersten et al. 1984). This non-surgical therapy involves considerable amounts of time, a high level of operator skill and dedication, and some unavoidable discomfort for the patient. It has often been remarked that the time taken for periodontal therapy of severe periodontitis cases exceeds that needed for cardiac arterial bypass surgery. Quirynen et al. (1995) re-introduced the one-stage full-mouth disinfection and compared the clinical and microbiological effects of this treatment strategy (FMRP) with the widespread practice of quadrant scaling and root planing at 2-week intervals (QRP). The rationale behind their treatment strategy was to prevent re-infection of the treated sites from the remaining untreated pockets and intra-oral niches. The results revealed a significant reduction in pocket depth for the FMRP over QRP group for deep pockets. Quirynen et al. (2000) concluded that the elimination of the periodontopathogens in addition to the possible host response benefits after the one-stage full-mouth therapy is the effective aspect of this therapy rather than oral chlorhexidine disinfection. Recently, Kinane's group in Glasgow failed to demonstrate differences in the clinical, microbiological or immunological outcome between QRP and FMRP. FMRP was well tolerated by patients and these authors concluded that the clinician should select the treatment modality based on practical considerations related to patient preference and clinical workload. Koshy et al. (2005) re-analysed the effects of FMRP and QRP using ultrasonics and concluded that either full-mouth or quadrant ultrasonic debridement are just as effective.