Retrospective analysis of implant survival and the influence of periodontal disease and immediate placement on long-term results.

PURPOSE: The purpose of this study was to investigate the cumulative survival rates of dental implants placed in a private periodontal practice and the effects of periodontal disease and immediate placement on implant survival. MATERIALS AND METHODS: A retrospective chart review was conducted on 149 consecutive patients. Each patient had a single implant placed. For the purpose of analysis, patients were divided into 2 groups: those who were periodontally healthy and those who had periodontal disease. Implants were placed into available bone either immediately or after a healing period. All failed implants were removed and recorded. The effects of periodontal status and placement time on implant survival were evaluated using Cox proportional hazards regression and log-rank tests. RESULTS: Of the 149 implants in the study, 22 failed during the observation period. The 127 censored cases (i.e., implants that had not failed at the end of the observational period) were observed for a mean of 943 days (SD 932, range 35 to 4,030). Failed implants were observed for a mean of 722 days (SD 1,026, range 18 to 3,548). The presence of periodontal disease appeared to be associated with a greater failure rate, but there was no observed effect associated with time of placement. The percentages of censored immediate placement cases and delayed placement cases were nearly identical. Among the 77 implants associated with periodontal disease, placement time was not strongly associated with percentage censored. Forty-three of the 55 immediately placed implants (78.18%) and 18 of the 22 implants (81.18%) whose placement was delayed were censored. Both Cox proportional hazards regression and log-rank tests established that survival was adversely affected by periodontal disease (P < .05) but unaffected by time of placement (P > .50). The lower 1-sided 95% confidence limit for median survival time was 3,548 days for patients without periodontal disease and 1,799 days for patients with disease. DISCUSSION AND CONCLUSION: Implant survival was compromised by a history of periodontitis but not affected by immediate or delayed placement.

Efficacy and safety of BrushPicks, a new cleaning aid, compared to the use of Glide floss.

The objective of this double-blind, four-week clinical study was to evaluate the efficacy of BrushPicks, a new cleaning aid, and Glide floss on the reduction of plaque area, gingivitis and bleeding on probing, and to monitor safety when these products were used in addition to toothbrushing with an ADA-Accepted toothbrush (Oral-B P35) and an ADA-Accepted fluoride-containing dentifrice (Crest Regular). No special instructions on or supervision of product use was conducted, other than requesting twice-a-day (morning and evening) use of the assigned products. Following a baseline examination, 63 qualifying adult male and female subjects from the Philadelphia, Pennsylvania area were randomized into two groups. Subjects were also told to use their assigned dental aid after each toothbrushing. Examinations for efficacy and safety were repeated after two and four weeks' use of the products. Sixty-two subjects completed all aspects of the study. There were no untoward side effects attributed to product use, reported or observed, at the two- or four-week examination times. At baseline, there were no significant differences in plaque, gingivitis or bleeding on probing mean scores between the BrushPicks and Glide floss groups. At the two- and four-week evaluation times, both the BrushPicks and Glide floss had numerically lower plaque scores compared to baseline levels. The only statistically significant reduction (p < 0.01) was in the BrushPicks group, comparing the week two mean with the baseline value. Gingivitis (GI) at four weeks was statistically (p < 0.05) lower in the BrushPicks group as compared to the Glide floss mean value. When the changes in scores from baseline to two weeks and to four weeks were assessed, the mean GI score for the Glide floss group was significantly lower at two weeks (p < 0.01) compared to baseline, and also from two weeks to four weeks (p < 0.001). The change in mean GI score for the Glide floss group from baseline to four weeks was also significant statistically (p < 0.001). When the changes in mean GI scores for the BrushPicks group were assessed, there was a significant decrease from baseline to two weeks (p < 0.001), from two weeks to four weeks (p < 0.001), and from baseline to four weeks (p < 0.001). For bleeding on probing, when the baseline to two- and four-week mean values were compared, only the BrushPicks produced significant (p < 0.001) decreases. At two and four weeks, the BrushPicks group mean bleeding on probing scores were significantly (p < 0.05-0.01) lower than the Glide floss group scores. At the end of this four-week study, the BrushPicks product was significantly more effective than Glide floss in the reduction of gingivitis and bleeding on probing, important attributes of soft-tissue health.

Laboratory evaluations of two battery-powered toothbrushes and a manual toothbrush for efficacy and safety.

Two laboratory testing procedures, predictive of clinical efficacy and safety, have been used to evaluate two battery-powered toothbrushes (a new prototype, Crest SpinBrush Pro and a commercially available product, Crest SpinBrush) and a standard manual toothbrush (Oral-B Indicator). Interproximal access efficacy (IAE) and depth of deposit removal (DDR) have been evaluated in laboratory methods using pressure-sensitive paper placed around simulated anterior and posterior teeth at a brushing pressure of 250 g with horizontal or vertical brushing motions. Twenty-four tests on each toothbrush design were conducted, and results were statistically analyzed using ANOVA and the post hoc Tukey test. Both of the battery-powered toothbrushes had a significantly (p < 0.001) higher mean overall IAE value compared to the Oral-B Indicator product. The Crest SpinBrush Pro was significantly statistically higher (p < 0.05) compared to the Crest SpinBrush for mean overall IAE (access to interproximal spaces). On overall DDR, both of the powered toothbrushes had a significantly (p < 0.05-0.001) lower mean overall value compared to the Oral-B Indicator toothbrush (higher mean indicates higher irritation potential). Based on these results, both the new prototype Crest SpinBrush Pro and the commercially available Crest SpinBrush are predicted to be more effective clinically for plaque removal, and at least as safe on hard and soft intraoral tissues as the standard manual toothbrush (Oral-B Indicator) tested. In addition, the results support that the new prototype Crest SpinBrush Pro is more effective than the Crest SpinBrush with respect to IAE and predicted plaque removal.