Instrument Selection and Application Used to Probe Dental Implants.

PURPOSE: The purpose of this study is to survey clinicians' choice of peri-implant instrument selection and the application used to probe dental implants as well as to evaluate peri-implant probing force and pressure applied as compared to that reported in current literature. MATERIALS AND METHODS: 48 clinicians (16 periodontists/periodontal residents, 16 restorative dentists and 16 hygienists) participated in the study. A questionnaire to determine the frequency and method of probing dental implants was provided and subject to the Chi-square test. Each participant was given a choice of three periodontal probes (Marquis, UNC15, Plastic) to use on the typodont and probing force was recorded blindly. Probing force and pressure data were analyzed with ANOVA among subject groups as well as probe types per site; where statistical differences (p < .05) were detected, Tukey's posthoc test was applied. RESULTS: The questionnaire resulted in a variety of answers although the majority demonstrated an agreement on probing implants in everyday practice. There was no significant difference among provider groups in regard to instrument selection, probing forces and pressure in both maxilla and mandible although the mean probing forces and pressures in all provider groups were higher than the suggested value reported in the literature. CONCLUSION: This study indicates that there are variations among clinical provider groups with regard to peri-implant probe instrument type used and forces applied, though these are not statistically significant. Probe tip diameter should be considered to avoid BOP false positives when probing dental implants especially as the forces generally used by the clinicians may be higher than advised.

Recombinant Human Platelet-Derived Growth Factor-BB in Human Alveolar Ridge Augmentation: A Review of the Literature.

PURPOSE: The objective of this study was to review the available literature regarding the use of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in human alveolar ridge augmentation and to assess its effectiveness for this specific use. MATERIALS AND METHODS: Three electronic searches of the MEDLINE database were performed. RESULTS: This review noted a wide range of study protocols, carrier systems, study periods, and outcome measures. CONCLUSION: Within the limits of this literature review, the use of rhPDGF-BB and bone regeneration/ridge augmentation led to greater clinical attachment level gain and bone regeneration prior to implant placement. More controlled clinical studies are needed to establish the effectiveness of rhPDGF-BB in alveolar ridge augmentation.

Histologic Evaluation of Osseous Regeneration Following Combination Therapy With Platelet-Rich Plasma and Bio-Oss in a Rat Calvarial Critical-Size Defect Model.

Platelet-rich plasma (PRP) is an autogenous source of growth factors shown to facilitate human bone growth. Bio-Oss, an osteoconductive xenograft, is used clinically to regenerate periodontal defects, restore dental alveolar ridges, and facilitate sinus-lift procedures. The purpose of this study was to analyze whether a combination of PRP and Bio-Oss would enhance bone regeneration better than either material alone. PRP and/or Bio-Oss were administered in an 8-mm critical-size defect (CSD) rat calvarial model of bone defect between 2 polytetrafluoroethylene membranes to prevent soft tissue incursion. Eight weeks after the induction of the CSD, histologic sections were stained with hematoxylin and eosin stain and analyzed via light microscopy. Qualitative analyses revealed new bone regeneration in all 4 groups. The Bio-Oss and PRP plus Bio-Oss groups demonstrated greater areas of closure in the defects than the control or PRP-only groups because of the space-maintaining ability of Bio-Oss. The groups grafted with Bio-Oss showed close contact with new bone growth throughout the defects, suggesting a stronger graft. The use of PRP alone or in combination with Bio-Oss, however, did not appear to enhance osseous regeneration at 8 weeks. Areas grafted with Bio-Oss demonstrated greater space-maintaining capacity than controls, and PRP was an effective vehicle for placement of the Bio-Oss. However, at 8 weeks this study was unable to demonstrate a significant advantage of using PRP plus Bio-Oss over using Bio-Oss alone.

The effect of residual calcium in decalcified freeze-dried bone allograft in a critical-sized defect in the Rattus norvegicus calvarium.

Demineralized freeze-dried bone allograft (DFDBA), a widely used graft material in periodontal regenerative procedures, is processed with hydrochloric acid in the attempt to expose proteins located within the bone matrixes that are capable of inducing new bone formation. However, the degree of DFDBA demineralization varies between tissue banks, which may have an effect on clinical regeneration. This study uses the critical-sized defect (CSD) model to evaluate the wound-healing response to the residual calcium of donor bone. If the percentage of residual calcium in a graft were demonstrated to significantly enhance wound healing, then periodontal patients may benefit from further standardization of human-allograft processing. Sixty adult, male, Harlan Sprague-Dawley rats (Rattus norvegicus) were randomly and equally divided into 4 test groups (ie, DFDBA at 1%, 2%, and 3% to 6% residual calcium levels and FDBA at 23% residual calcium) and a control group (no allograft). An 8-mm-diameter craniotomy was made in the rat calvarium, and polytetrafluoroethylene membranes with pore sizes of 0.50 microm were placed intracranially and ectocranially. Treatment materials were carefully placed into the CSD with a new sterilized dental amalgam carrier. Tetracycline hydrochloride was injected intraperitoneally for labeling new bone growth, and animals were euthanized 12 weeks postsurgery. As a result, histomorphometric bone fill at 12 weeks showed a statistically significant increase in the 2% DFDBA group as compared to all other groups. The authors conclude that a 2% residual calcium level in human DFDBA appears to significantly (P < or = .05) enhance osseous wound healing in the rat calvarium.

In vivo effectiveness of a glycerol-compounded demineralized freeze-dried bone xenograft in the rat calvarium.

BACKGROUND: Demineralized freeze-dried bone (DFDB) is commonly hydrated with sterile water into a paste-like consistency for improved clinical handling or reconstituted with biodegradable barriers, such as glycerol, to promote handling and wound stability following human periodontal surgery. The purpose of this study was to evaluate the in vivo effects of glycerol-compounded human DFDB on bone formation in the rat calvarial critical-sized defect (CSD) model. METHODS: Forty-eight adult male Harland Sprague-Dawley rats were assigned to one of four treatment groups: glycerol, DFDB, DFDB plus glycerol, or a non-grafted control, and placed into 8 mm calvarial CSDs. DFDB (particle size 0.106 to 0.5 mm), glycerol, and their combination were from identical sources. Calvaria were harvested at 8 weeks postsurgery and evaluated histomorphometrically. RESULTS: A statistically significant increased percentage of total bone fill was detected in the glycerol plus DFDB group and DFDB group as compared to glycerol group or the control. However, no significant difference was noted between the DFDB plus glycerol group and the DFDB group. CONCLUSION: The addition of glycerol to DFDB results in comparable osseous regeneration in the rat calvarium defect model versus DFDB alone; however, based upon clinical judgment, handling characteristics of DFDB were greatly improved.

Nicotine stimulates osteoclast resorption in a porcine marrow cell model.

BACKGROUND: Combustible tobacco use is generally linked with accelerated periodontal bone loss and diminished post-surgical wound healing; however, the pathogenesis of this process at the cellular level remains unclear. Nicotine is known to affect human gingival fibroblast orientation, attachment, and beta1 integrin expression, yet little is known about its effects on osteoclasts, the cells most responsible for bone resorption. The purpose of this study was to determine the effects of physiologically relevant nicotine levels on porcine osteoclast function as measured by resorption of calcium phosphate. METHODS: Pure nicotine was diluted in medium to the following concentrations: 0.03 microM, 0.15 microM, 0.30 microM, 0.60 microM, and 1.50 microM. Porcine osteoclasts were seeded onto calcium phosphate multi-test slides and incubated at 37 degrees C with half media changes every 24 hours. Cells received 0, 0.15, 0.30, 0.60, and 1.50 microM nicotine, or 25 nM parathyroid hormone (PTH). Osteoclast resorption was quantified by measuring the resorbed surface area of the calcium phosphate substrate. RESULTS: Osteoclast cultures resorbed bone slices and calcium phosphate substrate. All nicotine concentrations and PTH resulted in statistically significantly greater mean percent resorptions than the control group (P < 0.05). However, no statistical difference was found between the various nicotine doses or PTH. The number of osteoclasts increased in a linear relationship to the increasing nicotine concentrations; however, no correlation was found between osteoclast number and the amount of resorption. CONCLUSIONS: Nicotine is non-toxic to osteoclasts at the clinically relevant levels tested. Nicotine appears to stimulate osteoclast differentiation and resorption of calcium phosphate, the major component of bone. Nicotine-modulated osteoclast stimulation may, in part, explain the increased rapidity of periodontal bone loss and refractory disease incidence in smokers.

The application of Periodontal Screening and Recording (PSR) in a military population.

Periodontal Screening and Recording trade mark (PSR) is a diagnostic screening tool for the early detection of periodontal disease. The purposes of this study are to utilize PSR to estimate the periodontal health status of a representative military population and to compare the results with other studies of varying populations. When used to evaluate the periodontal health of a randomly-selected military population, PSR demonstrated the following: (1) males and females had a similar prevalence of being designated PSR+ (having PSR Code 3 score in two or more sextants or a PSR Code 4 score in at least one sextant), (2) Blacks and Hispanics had a similar prevalence of PSR+, and (3) both groups were twice as likely to be PSR+ as were Caucasians. Although income did not appear to be a significant predictor of PSR+, PSR+ did appear to be inversely proportional to education levels. When comparing PSR scores by sextant, the following was noted: (1) the maxillary central sextant was the most disease-free, (2) the mandibular central sextant most often presented with calculus, (3) mucogingival defects were observed more frequently in maxillary posterior sextants, and (4) the maxillary right sextant demonstrated the most destruction from periodontal disease.

Evaluation of a novel alloplast for osseous regeneration in the rat calvarial model.

BACKGROUND: Alloplasts are inert foreign bodies acting as osteoconductive space maintainers during osseous wound healing. They may also function as carriers for growth factors that are known to enhance neovascularization and osteoinduction; human recombinant transforming growth factor beta (rhTGF-beta1) is one such factor. The purpose of this study was to evaluate di-vinyl styrene beads (DVSb) and rhTGF-beta1 effects on osseous regeneration in the rat calvaria critical-sized defect model. METHODS: Di-vinyl styrene beads (DVSb) with and without rhTGF-beta1 were placed between gelfilm membranes in a critical-sized defect in the rat (Rattus norvegicus) calvaria. Actual bone fill; percentage bone fill; bone formation rate (BFR); and mineralization at 3, 6, and 12 weeks postsurgery were measured using densitometry, histomorphometry, scanning electron microscopy (SEM), and vital staining with tetracycline-HCl. RESULTS: Mean radiographic density and percentage fill were statistically greater for DVSb treatment groups as compared with controls (P < or = 0.05). BFR was consistently between 3 and 7 microm per day for all groups; alloplast group BFR was significantly greater than controls or the rhTGF-beta1 groups at 6 weeks (P < or = 0.05); however, at 3 and 12 weeks, the control BFR was greater than treatment groups (P < or = 0.05). Membranes often collapsed and little bone fill or mineralization occurred in defects without DVSb. Mineralization appeared to occur adjacent to the alloplast by 12 weeks in the histologic and SEM sections. While DVSb fibrous attachment occurred in some specimens, there was no evidence of an inflammatory response. CONCLUSION: Di-vinyl styrene beads, with or without rhTGF-beta1, significantly enhance bone regeneration in the rat calvaria defect model.

External root resorption following partial-thickness connective tissue graft placement: a case report.

We report an unusual case of external root resorption (ERR) that developed in a 37-year-old black male approximately 1 year following routine partial thickness connective tissue graft surgery. The lesion was accessed via flap surgery, thoroughly root planed, and the mucoperiosteal flap replaced. The site healed uneventfully and the patient has been closely observed for over 1 year without symptoms or recurrence of the resorptive lesion and the affected tooth remained vital. Clinicians performing partial-thickness connective tissue grafts should be alert to the possible occurrence of root resorption over extended periods of time. The authors speculate that retention of the donor periosteum with placement on the recipient dentin and root biomodification may limit the resorptive response following connective tissue graft procedures to treat tooth root recession.

Evaluation of pluronic polyols as carriers for grafting materials: study in rat calvaria defects.

BACKGROUND: Pluronic polyols are a family of non-ionic surfactants currently used as drug carriers for antibiotic, anti-inflammatory, and anti-neoplastic agents. Therapeutic administration of non-ionic surface-active agents is known to facilitate early collagen synthesis and microcirculation, thus promoting wound healing. The purpose of this study was to determine the in vivo effects of pluronic polyols combined with either an allograft or an alloplast on the healing of critical-sized calvarial defects. METHODS: One hundred fifty (150) adult (95 to 105 days old) male Sprague-Dawley rats weighing between 375 and 425 g were randomly and evenly assigned to each of 15 separate treatment groups and anesthetized, and 8 mm calvarial critical-sized defects were created. Pluronic F-68 (F-68) or pluronic F-127 (F-127) was administered either topically or systemically and in conjuction with demineralized bone powder (DBP), tricalcium phosphate (TCP), or non-grafted controls. Pluronic polyols are easily mixed with either DBP or TCP to improve handling ease. Calvaria were harvested at 12 weeks postsurgery and evaluated histomorphometrically, by contact radiography with subsequent densitometric analysis, through energy spectrometry utilizing a scanning electron microscope, and by fluorescent microscopy. RESULTS: There was a significant difference in the percentage of bone fill among the control, TCP, and DBP only groups, P <0.05. The only significant difference within any of these groups was between the TCP control and TCP plus systemic F-127, P<0.05. CONCLUSIONS: Although there were isolated differences, the overall trend was that the pluronic polyol and the mode of administration did not result in a significant change in bone wound healing as measured by the percentage of bone fill. Pluronic polyols may be considered as carriers for osseous graft materials.

The effects of varying degrees of allograft decalcification on cultured porcine osteoclast cells.

BACKGROUND: Demineralized freeze-dried bone allograft (DFDBA) is widely used in periodontal therapy as a scaffold for new bone formation in periodontal defects. It is demineralized, theoretically, to expose osteoinductive or osteoconductive bone matrix proteins that should facilitate osteogenesis. The degree of DFDBA demineralization varies between tissue banks and may affect clinical regeneration. A 2% residual calcium level in DFDBA has been shown to result in the highest alkaline phosphatase activity levels in cultured human periosteal cells and is optimally osteoinductive or osteoconductive for new bone formation. The purpose of this study was to evaluate the effect of 4 different residual calcium levels in commercially available DFDBA samples on porcine osteoclast activity as measured by resorption on calcium phosphate-coated disks. METHODS: Bone marrow was harvested from the femurs of 3-week-old farm pigs and cultured for 3 weeks. Hematopoietic stem cells were allowed to differentiate into mature active polykaryons displaying genuine osteoclast characteristics. The osteoclast cells displayed a dense actin band inside the margins of the cytoplasm under light microscopy. Culture media was decanted and collagenase added to free the attached cells. Equal cell samples were pipetted onto calcium phosphate-coated disks in 24-well plates. DFDBA samples with 1.44%, 2.41%, and 5.29% residual calcium; FDBA (30% residual calcium); and control cultures without allograft samples were prepared and all samples incubated for 1 week. Cells were fixed and stained for tartrate-resistant acid phosphatase (TRAP), Oregon Green 488-phalloidin, a stain for cytoskeletal proteins, and counterstained with propidium iodide. Specimens were examined by light and fluorescence microscopy using epi-illumination. Calcium phosphate disks were then rinsed in 5% sodium hypochlorite to remove adherent osteoclasts, and substrate surface changes were measured by white light interferometry and image analysis. RESULTS: A higher yield of TRAP-positive cells was produced without DFDBA; however, resorptive activity appears to be significantly increased in the presence of 2.41% residual calcium as compared to all other experimental groups (P<0.0065). CONCLUSION: In this in vitro model, porcine osteoclasts show significantly more resorptive activity as measured on calcium phosphate-coated disks in the presence of 2.41% residual calcium in DFDBA than in other DFDBA residual calcium levels.