Harvest graft substitute for soft tissue volume augmentation around existing implants: A randomized, controlled and blinded multicenter trial.

BACKGROUND: Using a single-blind, randomized, controlled, multicenter, practice-based clinical trial, a volume-stable collagen matrix (VCMX) was compared with connective tissue graft (CTG) for soft tissue augmentation around existing dental implants. METHODS: Sixty patients (31 VCMX and 31 CTG) were included. The primary outcome was a soft tissue thickness change 3 mm below the gingival margin (GM). Secondary outcomes included clinical measures, such as keratinized tissue widths (KTw), probing pocket depths, and pink esthetic scores, and patient-reported outcomes (PRO). RESULTS: There were no significant differences between test and control patient demographics or clinical measures throughout the 1-year study. VCMX "grafts" were by design larger than CTG, and surgery time was less (27% less, p = 0.0005). Three millimeters below the GM (primary endpoint), tissue thickness increase was noninferior for VCMX compared with CTG (0.93 ± 0.80 mm vs. 1.10 ± 0.51 mm, respectively), inferior (by 0.25 mm) at 1 mm, and noninferior at 5 mm. Postoperative pain was significantly less for VCMX patients (p < 0.0001), but all other PRO measures, including esthetics and satisfaction, improved similarly for both therapies. CONCLUSIONS: Given the inclusion criteria for this study, namely soft tissue augmentation around existing implants with some evidence of KTw and minimal recession, VCMX provided soft tissue thickness and volume increases similar (noninferior) to CTG. Clinical measures and PRO were similar between therapies-site sensitivity and esthetics improved similarly for both therapies-but surgery time and pain following surgery were significantly less for VCMX.

A Prospective, Randomized, Controlled, Multicenter Evaluation of Extraction Socket Management Comparing a Wound Dressing and a Soft Tissue Substitute.

Postextraction bone grafting and implant placement help preserve alveolar bone volume. Collagen wound dressings and soft tissue graft substitutes may help protect extraction socket bone grafts and provide better gingival contours. This randomized, controlled, multicenter, and double-blinded study was conducted to compare a control (wound dressing) and a test (soft tissue graft) substitute in nearly intact extraction sockets. Both test and control sockets were grafted with a xenogeneic bone graft. Graft containment, extraction socket soft tissue gap closure, gingival contour, and gingival thickness were examined over 16 weeks, at which time implants were placed. Healing was uneventful for both groups, and there was no significant difference (P < .05) between the times required to close the extraction socket soft tissue gap (~80% of sites closed by 8 weeks). Bone grafts were covered and contained longer in the test group (~4 weeks vs ~2 weeks), with less contour disruption out to 4 weeks; however, at implant placement, soft tissue contours in both groups were comparable, and soft tissue thicknesses were not significantly different.

Virucidal Properties of Molecular Iodine Oral Rinse Against SARS-CoV-2.

BACKGROUND: Saliva is an active carrier of SARS-CoV-2, and antimicrobial mouthrinses can be rendered less effective by saliva. Aerosol-generating procedures are commonplace in dentistry, and preprocedural mouthrinses and/or irrigation with effective SARS-CoV-2 virucidals should be tested in the presence of saliva. METHODS: With the use of an in vitro virucidal suspension test, molecular iodine oral rinse was assayed against SARS-CoV-2 with and without saliva after 30- and 60-second exposures to the rinse. Log10 infectivity and consequent virus reductions were calculated at each timepoint. RESULTS: Virus load reductions with saliva were 4.75 log10 after 30 seconds of exposure and ≥5.25 log10 after 60 seconds. Without saliva, infectivity was reduced by 5.00 log10 and ≥5.75 log10 after 30 and 60 seconds, respectively. CONCLUSIONS: Molecular iodine oral rinse appears effective in reducing SARS-CoV-2 infectivity in vitro and, to date, appears to be the most effective oral rinse tested both in the presence of and without human saliva.

Periodontal Regeneration - Intrabony Defects: Practical Applications From the AAP Regeneration Workshop.

Focused Clinical Question: What are important considerations for selecting a predictable regenerative surgical approach for intrabony defects? Summary: The predictable regeneration of intrabony defects remains an important goal in the management of periodontitis. Clinical and histologic evidence of periodontal regeneration has been shown for multiple regenerative therapies, including bone replacement grafts, guided tissue regeneration, and biologics, when used alone or in combination. Regenerative therapies improve periodontal health, as evidenced by gains in clinical attachment level, reductions in probing depth, and gains in radiographic bone fill. Important patient-related factors (e.g., smoking) and defect/site-related factors (e.g., defect morphology and gingival biotype) can influence the potential to achieve periodontal regeneration. The regeneration of intrabony defects generally becomes more challenging with increasing loss of height, proximity, and number of bony walls. Therefore, combination therapies may be necessary to achieve predictable regeneration. Clinical improvements after regenerative therapy can be maintained over extended periods (≥10 years) with professional maintenance at appropriate intervals and adequate home care. Conclusions: Periodontal regeneration of intrabony defects is possible using a variety of regenerative strategies. Management should be coupled with an effective oral hygiene and supportive periodontal maintenance program for long-term success.

Periodontal regeneration - intrabony defects: a consensus report from the AAP Regeneration Workshop.

BACKGROUND: Treatment of intrabony defects is an important therapeutic goal of periodontal therapy. The goal of this consensus report was to critically appraise the evidence for the available approaches for promoting periodontal regeneration in intrabony defects. In addition to evaluating the effectiveness of new regenerative approaches for intrabony defects, recommendations for future research were defined for this area. METHODS: A systematic review was conducted using computerized searches of PubMed and Cochrane databases, supplemented with screening of references in original reports, review articles, and a hand search in selected journals. All searches were focused on regenerative approaches with histologic evidence of periodontal regeneration (proof of principle), clinical trials, and case reports. For purposes of analysis, change in intrabony defect fill was considered the primary outcome variable, with change in clinical attachment as a secondary outcome. The SORT (Strength of Recommendation Taxonomy) grade was used to evaluate the quality and strength of the evidence. During the consensus meeting, the group agreed on the outcomes of the systematic review, pertinent sources of evidence, clinical recommendations, and areas requiring future research. RESULTS: The systematic review, which was conducted for the consensus conference, evaluated the effectiveness of the use of biologics for the treatment of intrabony defects. Enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB) with ß-tricalcium phosphate were shown to be efficacious in regenerating intrabony defects. The level of evidence is supported by multiple studies documenting effectiveness. The clinical application of biologics supports improvements in clinical parameters comparable with selected bone replacement grafts and guided tissue regeneration (GTR). Factors negatively affecting regeneration included smoking and excessive tooth mobility. CONCLUSIONS: Periodontal regeneration in intrabony defects is possible on previously diseased root surfaces, as evidenced by a gain in clinical attachment, decreased pocket probing depth, gain in radiographic bone height, and overall improvement in periodontal health. These clinical findings are consistent with available histologic evidence. Clinical improvements can be maintained over long periods (>10 years). Although bone replacement grafts have been the most commonly investigated modality, GTR, biologics, and combination therapies have also been shown to be effective. Future research should emphasize patient-reported outcomes, individual response differences, and emerging technologies to enhance treatment results. CLINICAL RECOMMENDATIONS: Early management of intrabony defects with regenerative therapies offers the greatest potential for successful periodontal regeneration. The clinical selection and application of a regenerative therapy or combination of therapies for periodontal regeneration should be based on the clinician's experiences and understanding of the regenerative biology and technology. This decision-making process should take into consideration the potential adverse influence of factors, such as smoking, poor oral hygiene, tooth mobility, and defect morphology, on regeneration. Management should be coupled with an effective maintenance program for long-term success.

Dental implants' future: the need for a team approach.

Long-term success of dental implants is linked to well-trained implant surgeons and restorative dentists working together with the most advanced treatment modalities. General dentists are challenged to identify early in the diagnosis patients who are at greatest risk for developing complications and partner with specialists in formulating treatment plans.

Multicenter retrospective analysis of wide-neck dental implants for single molar replacement.

PURPOSE: To evaluate the predictability of Straumann wide-neck dental implants (6.5-mm prosthetic neck with a 4.8-mm endosseous sandblasted, large-grit, acid-etched-surface body) used for molar replacement. MATERIALS AND METHODS: Four hundred ninety-nine single-tooth implants were restored in molar sites in 410 patients (mean time of loading 23 months; range, 1 to 54 months) by 6 clinicians throughout the United States. Three hundred-fifty nine implants were placed in the mandible and 148 implants in the maxilla. RESULTS: The overall cumulative survival rate was 98.4% for all sites (8 failures). Survival rates of 99.2% for mandibular molars (3 failures) and 96.6% for maxillary molars (5 failures) were achieved. Survival rate of implants placed in conjunction with the bone-added osteotome procedure in the maxillary molars was 89%, with 5 of 45 procedures leading to failure. DISCUSSION: Minimal restorative problems were encountered. No cases of abutment loosening or fractures were observed for cemented restorations on solid abutments. CONCLUSION: The data suggest that the Straumann solid-screw, wide-neck implants can be a satisfactory choice for molar single-tooth replacement.

Histologic evaluation of mineralized and demineralized freeze-dried bone allograft for ridge and sinus augmentations.

The objective of this study was to quantify new bone formation from biopsies of demineralized freeze-dried bone allograft (DFDBA) and freeze-dried bone allograft (FDBA) following ridge and sinus augmentations. Ninety-three patients who received maxillary sinus or ridge augmentation grafts agreed to core biopsies of their grafts when the implants were placed. Samples ranged from 6 to 36 months postgrafting. These samples were sectioned, stained, and examined histomorphometrically Seventy-two FDBA and 21 DFDBA samples were examined, and the mean percentages of new bone formed were 41.89% and 41.74%, respectively. There was no statistical difference, irrespective of graft site.