Bone level around endodontically treated teeth in periodontitis patients

Objectives: This retrospective study compared the marginal bone level of teeth with root canal fillings with contra‐lateral teeth without. Methods: Of 286 consecutive patients (35 years), referred to practice for periodontology in the Netherlands, 67 full sets of radiographs contained 1 endodontically treated tooth and its contra‐lateral tooth without root canal treatment. Bone level at the mesial and distal of these teeth was scored from the CEJ. In multi‐rooted teeth, the presence of interradicular radiolucency was assessed. The presence of posts, and periapical radiolucencies was assessed. Analysis for differences between treated teeth and contra‐laterals was controlled for tooth surface, presence of a post and tooth type. Results: The mean distance from the root filling to the apex was 2.6 mm. Periapical radiolucencies were found in 14%. The mean bone level was at 4.3 mm for endodontically treated teeth and at 3.7 mm for contra‐laterals. Significantly more bone loss (0.6 mm) was found at the endodontically treated teeth. No difference was found between mesial and distal, teeth without and with posts and different tooth types. The presence of interradicular radiolucency was more frequent in endodontically treated teeth (OR 2.1, p_{(McNemar test)}=0.039). Conclusion: In periodontitis patients, teeth with endodontic treatment had more bone loss as compared with untreated contralaterals.     

Overeruption of periodontally affected unopposed molars in adult rats

Fujita T, Montet X, Tanne K, Kiliaridis S. Overeruption of periodontally affected unopposed molars in adult rats. J Periodont Res 2009; doi: 10.1111/j.1600‐0765.2009.01230.x © 2009 John Wiley & Sons A/S Background and Objective: In clinical practice, anterior teeth with periodontal disease exhibiting signs of overeruption are occasionally encountered. However, the influence of periodontitis on unopposed teeth needs to be further elucidated. This study investigated, in rats, the overeruption pattern of unopposed mandibular molars with experimentally induced periodontitis. Material and Methods: Sixty adult male rats were divided equally into four groups. In two groups, periodontitis was induced by a silk thread placed around the cervix of the right mandibular molar. In two groups with and without experimentally induced periodontitis, the crowns of the right maxillary molars were reduced occlusally by grinding to simulate unopposed teeth. After 4 wk, the animals were killed and scanned using micro‐computed tomography to measure the vertical position of molars and the buccal and lingual alveolar bone levels. Results: There were no significant differences in the overeruption of opposed molars with and without periodontitis. However, the alveolar bone level of opposed molars with periodontitis was lower than that of healthy molars. Healthy unopposed molars were extruded when compared to molars with an antagonist. The alveolar bone level of healthy unopposed molars was not influenced by molar overeruption. Unopposed molars with periodontitis exhibited significantly larger extrusion than healthy unopposed molars. The lingual alveolar bone level of unopposed molars with periodontitis was lower than that of other healthy and periodontally affected teeth. Conclusion: The loss of antagonist causes overeruption of the unopposed tooth, which becomes more prominent in the presence of periodontitis.     

Endodontic instrumentation —quo vadis?*

The flaring of root canal preparations in order to improve instrumentation and enhance root filling condensation has been stressed in recent endodontic literature. Some authors, however, have suggested that too much flaring could be hazardous in molar root canals. This study was prompted by the occurrence of stripping-type perforations and post perforations in the buccal roots of upper molars and in the mesial roots of lowers. Ten operators instrumented 22 molars utilizing a variety of techniques. The teeth were horizontally sectioned and remaining wall thicknesses were measured under magnification. Excessively thin walls were found on the furcation surfaces of the buccal roots of upper molars and the mesial roots of lowers at a level 2–4 mm apical to the trifurcation or bifurcation. A potential for root stripping and post perforation, which was not readily apparent in pre-operative radiographs, was confirmed. The ramifications of these findings are discussed.     

直接法与间接法分瓣桩核冠修复磨牙的临床观察

目的:观察直接法与间接法制作分瓣桩核冠修复严重缺损磨牙的临床效果。方法:对42颗经过完善根管充填后的严重缺损的磨牙,19颗行间接法制作分瓣桩冠修复,23颗行直接法制作分瓣桩核修复,并随访3年。结果:两组桩核冠修复的临床效果无显著性差异(P>0.05)。结论:直接法与间接法制作分瓣桩核冠修复严重缺损磨牙均可取得良好的临床效果。     

Bone height changes in individuals with periodontal disease: a 17-year prospective longitudinal study

OBJECTIVE: The aim of this study was to analyse changes in bone height after 17 years in smokers and non-smokers with periodontal disease, and to compare these with clinical assessment outcome. MATERIAL AND METHODS: Participants comprised 50 adults with periodontitis and 18 healthy controls from a randomly selected epidemiological sample. Their mean age at the end of the study was 54.2 (SD+/-3.09) years. The study included radiographic analysis compared with clinical data. RESULTS: The periodontitis group had significantly (p<0.001) higher values than their healthy counterparts for plaque index (PLI), gingival index (GI), calculus index (CI), and bleeding on probing (BOP) at baseline and after 17 years. At the end of the follow-up, never-smokers with periodontitis had higher values for PLI (p<0.05) and ex-smokers and smokers had higher GI and BOP (p<0.001) than the controls. In all individuals with periodontitis, maxillary molars were most affected. Smokers had more severe marginal bone loss over time. Vertical bone defects were more often seen on the mesial side of teeth (p<0.05). CONCLUSION: Marginal bone level in this prospective study did reveal tooth groups at higher risk for progression of periodontal disease.     

Periodontal bone loss of teeth with metal posts

Abstract Periodontal bone loss was compared in teeth with metal posts and contralateral teeth without metal posts by means of intraoral radiographs. 250 subjects with a high standard of dental awareness and a great number of teeth retained were included in the study. The periodontal bone loss was calculated from the ratio of the distance from bone margin to apex (bone height) and the distance from crown tip to apex (tooth length). Intra-individual differences between experimental and control teeth were statistically analyzed with the Student paired t-test. 96 subjects (38%) had 1 teeth with root posts. In all, 172 teeth with posts were found, i.e., on average 1.8 teeth per subject. The means ± SEM of the ratio bone height to tooth length in experimental and control teeth were 0.52 ± 0.007 and 0.56 ± 0.006, respectively. The difference was statistically highly significant (P < 0.001). Statistically significant differences were found for incisors, premolars and molars. Regression analysis indicated more severe bone loss for teeth with longer posts. The results suggest that the periodontal bone support of teeth with metal posts is inferior to that of teeth without metal posts.     

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??Abstract??Objective To study the effect of smoking on alveolar bone defect in patients with chronic peridontitis. Methods Select thirty patients respectively in smoking and non-smoking patients with chronic periodontitis??who are scanned by cone beam CT??CBCT??. Florida probe is applied to measure the PD and AL of all the teeth??including teeth's mesial??distal??buccal??lingual??. NNT software is applied to measure the average degree of alveolar bone defects in different regions??incisor area??canine area??premolar area and molar area??including teeth's mesial??distal??buccal??lingual??. Results The periodontal probing depth and attachment loss level had no significant difference??P > 0.05??in smoking group and non-smoking group??smoking group's alveolar bone defect degree was more serious than non-smoking group??the difference being statistically significant??P < 0.05??. Compared with the non-smoking group??alveolar bone defects in smoking group in each site of the same teeth were more serious??the difference being statistically significant??P < 0.05??. In two groups??the alveolar bone defect of canine area was the mildest??the most serious part of the alveolar bone defect in molar area??P < 0.05??. The alveolar bone defect had significant differences in smoking group among different sites of the same teeth??P < 0.05????while the most serious part in maxillary molars palatal. In smoking group??except for the distal sites of mandibular molar area and buccal and lingual sites of mandibular incisor area??the alveolar bone defect of maxillary teeth was more serious than mandibular teeth??the difference being statistically significant??P < 0.05??. In non-smoking group??the alveolar bone defect of the same site in different teeth showed a decreasing trend from the molar area to the canine area. But the alveolar bone defect of each point in mandibullar incisor area was significantly higher than maxillary incisor area??the difference being statistically significant??P < 0.05??. Conclusion In chronic periodontitis patients??the alveolar bone defect of smokers is more serious than non-smokers. The alveolar bone defects of smokers with chronic periodontitis present teeth and site-specific effects and the most serious area is located in maxillary molars palatal. The application of CBCT is conducive for the clinicians to have a better understanding of the alveolar bone defect forms??and provides more help to the diagnosis and treatment of periodontal disease.     

吸烟对慢性牙周炎患者牙槽骨缺损影响研究

目的 探讨吸烟对慢性牙周炎患者牙槽骨缺损的影响。方法 从2012年10月至2014年3月中国医科大学附属口腔医院牙周科确诊为慢性牙周炎的患者中选择吸烟与非吸烟患者各30例,分别作为吸烟组与非吸烟组。采用Florida探针检查其全口牙齿近中、远中、唇（颊）侧及舌（腭）侧4个位点的牙周探诊深度（PD）及附着丧失水平（AL）。采用锥形束CT（CBCT）对入选对象进行扫描,并应用其自带的NNT软件测量切牙区、尖牙区、前磨牙区及磨牙区牙齿近中、远中、唇（颊）侧及舌（腭）侧4个位点的牙槽骨缺损程度。结果 吸烟组与非吸烟组的PD和AL差异无统计学意义（P > 0.05）,吸烟组的平均牙槽骨缺损程度较非吸烟组重,差异有统计学意义（P < 0.05）。吸烟组与非吸烟组相比,相同牙位的各个位点牙槽骨缺损都较重,差异有统计学意义（P < 0.05）。两组中各牙位牙槽骨缺损程度最轻的部位位于尖牙区,缺损程度最重的部位位于磨牙区（P < 0.05）。吸烟组中相同牙位的不同位点之间牙槽骨缺损程度差异有统计学意义（P < 0.05）,其中缺损程度最重的位于上颌磨牙区腭侧;除下颌磨牙区远中位点和下颌切牙区颊舌侧位点外,上颌各牙位牙槽骨缺损程度较下颌相应牙位重,差异有统计学意义（P < 0.05）。非吸烟组中不同牙位相同位点的牙槽骨缺损程度自磨牙区向尖牙区呈逐渐减小的趋势;但下颌切牙区各位点牙槽骨缺损程度明显高于上颌切牙区,差异有统计学意义（P < 0.05）。结论 慢性牙周炎患者中,吸烟者较非吸烟者牙槽骨缺损重。吸烟对于慢性牙周炎患者牙槽骨缺损的影响存在牙位和位点特异性表现,最严重的部位位于上颌磨牙区腭侧。CBCT的应用有利于临床医生更好地了解牙槽骨缺损的形式,会对牙周病诊断及治疗提供更大的帮助。     

Influence of projection angles upon position of cementoenamel junction on radiographs

Abstract — The CEJ on radiographs is often used as a reference point in the assessment of alveolar bone loss. The aim of the present study was to test the stability of the radiographic CEJ ("RCEJ") in relation to the alveolar west under varying angulations of the central X-ray beam. In an experimental model four types of extracted teeth were radicrgraphed al 0° and 20° vertical angulation and at 15 horizontal angulations varying from a 17.5° mesial view to a 17.5° distal view. The buccal alveolar bone margin was simulated by a steel needle. RCEJ-"crest" distances were read at a × 10 magnification. Changing the vertical angutation from 0° to 20° reduced the RCEJ-"crest" distances far all tooth types (range ofaverage reduction 2.2–4.1 mm). HorizontaE angulations without concomitant vertical angularion had a significant effect but where without clinical significance. Horizontal anglslations in combination with a 20° vertical angulation bad a considerable influence; in a mesial view, mesial RCEJ-"crest" distances decreas-ed and distal ones increased, and vice wna in a distal view. The deviations from the true CEJ-crest distance demonstrated may be of clinical significance, and a critical attitude to alveolar bone loss measures on radiographs using the RCEJ as reference point is recommended.     

Periodontal bone loss in dry mandibles of South African blacks: a biometric study

Periodontal bone loss associated with periodontitis results in increase in the distance between the cemento-enamel junction (CEJ) and the alveolar bone crest (ABC). This study analyzed periodontal bone loss in 100 mandibles of South African blacks who were never exposed to preventive or restorative dental treatment. Specimens were equally distributed over the third to the seventh decade of adult life. CEJ-to-ABC (CA) distances were measured along 4904 surfaces of 1076 teeth. Analysis of the measurements showed that, generally, CA distances increased with age; differences were substantial between the first and fifth age groups. The incisors were most severely affected in all age groups, and bone loss was less severe around posterior teeth. Pre-molars and second molars lost the least bone. No significant differences between measurements on the buccal, lingual, mesial, or distal surfaces for these teeth were found. Measurements on the right and left sides of the mandible did not differ significantly. These observations may, in part, have been influenced by mid-life loss of teeth caused by severe periodontitis; their absence from the sample may have masked the true extent of periodontal bone loss. The difference in age of eruption and, therefore, the difference in period of exposure to the oral environment may account for the more severe bone loss in the anterior teeth, especially in specimens from younger individuals (21-30 years).     

Histomorphometrical analysis of the effects of the bisphosphonate alendronate on bone loss caused by experimental periodontitis in monkeys

This study tested the efficacy of alendronate, a bisphosphonate, in reducing alveolar bone loss caused by experimental periodontitis in cynomolgus monkeys. Periodontitis was initiated in adult monkeys by ligating mandibular molar teeth at the cementoenamel junction (CEJ) and subsequently inoculating the ligature with Porphyromonas (Bacteroides) gingivalis . Controlateral, homologous non-ligated teeth served as controls. Animals received, intravenously, either saline (placebo) or alendronate at 0.05 or 0.25 mg/kg every 2 weeks for 16 weeks. After the animals were sacrificed, coronal sections through mandibular molars were subjected to histomorphometrical analysis. No overt side-effects were observed in any of the animals participating in this study. In placebo-treated animals, ligation and inoculation resulted in significant bone loss both at the CEJ and at the furcation. Alendronate at 0.05 mg/kg significantly reduced bone loss associated with the experimental periodontitis at both sites. In contrast, the dose of 0.25 mg/kg was ineffective in attenuating alveolar bone loss in the furcation area and only slightly effective in preventing it at the CEJ area. The results of the histomorphometric analysis correlate closely with those of the radiographic analysis of the same experiment. These data indicate that alendronate could reduce the loss of alveolar support associated with periodontitis and suggest that bisphosphonates, by virtue of their significant inhibitory action on osteoclasts, may become a treatment modality in the battle against alveolar bone destruction during periodontal disease.     

Prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults

The aim of this study was to assess the prevalence and risk factors of apical periodontitis in endodontically treated teeth in a selected population of Brazilian adults. A total of 1,372 periapical radiographs of endodontically treated teeth were analyzed based on the quality of root filling, status of coronal restoration and presence of posts associated with apical periodontitis (AP). Data were analyzed statistically using odds ratio, confidence intervals and chi-square test. The prevalence of AP with adequate endodontic treatment was low (16.5%). This percentage dropped to 12.1% in cases with adequate root filling and adequate coronal restoration. Teeth with adequate endodontic treatment and poor coronal restoration had an AP prevalence of 27.9%. AP increased to 71.7% in teeth with poor endodontic treatment associated with poor coronal restoration. When poor endodontic treatment was combined with adequate coronal restoration, AP prevalence was 61.8%. The prevalence of AP was low when associated with high technical quality of root canal treatment. Poor coronal restoration increased the risk of AP even when endodontic treatment was adequate (OR=2.80; 95%CI=1.87-4.22). The presence of intracanal posts had no influence on AP prevalence.     

Risk factors for failure of glass fiber-reinforced composite post restorations: a prospective observational clinical study

Glass fiber-reinforced endodontic posts are considered to have favorable mechanical properties for the reconstruction of endodontically treated teeth. The aim of the present investigation was to evaluate the survival of two tapered and one parallel-sided glass fiber-reinforced endodontic post systems in teeth with different stages of hard tissue loss and to identify risk factors for restoration failure. One-hundred and forty-nine glass fiber-reinforced endodontic posts in 122 patients were followed-up for 5-56 months [mean +/- standard deviation (SD): 39 +/- 11 months]. Glass fiber-reinforced endodontic posts were adhesively luted and the core was built with a composite resin. Cox proportional hazards models were used to evaluate the association of clinical variables and failure rate. Higher failure rates were found for restorations of anterior teeth compared with posterior teeth [Hazard-Ratios (HR): 3.1; 95% confidence interval (CI): 1.3-7.4], for restorations in teeth with no proximal contacts compared with at least one proximal contact (HR: 3.0; 95% CI: 1.0-9.0), and for teeth restored with single crowns compared with fixed bridges (HR: 4.3; 95% CI: 1.1-16.2). Tooth type, type of final restoration and the presence of adjacent teeth were found to be significant predictors of failure rates in endodontically treated teeth restored with glass fiber-reinforced endodontic posts.     

Mandibular second molar periodontal status after third molar extraction.

BACKGROUND: Extraction and treatment of third molars have been cited as causing periodontal problems. To evaluate the long-term effects of third molar extraction on the periodontal health of the mandibular second molar, a comparison of the periodontal status was performed around 2 groups of mandibular second molars, with and without third molar extraction. METHODS: A total of 312 sites in 57 adult periodontitis patients were examined and the buccal and lingual locations of the mesial and distal root surfaces around the second molars were recorded. Two-hundred and thirty-two sites were experimental teeth; i.e., third molars had been surgically removed more than 5 years ago, 80 sites served as control molars; i.e., congenitally missing third molars. Clinical periodontal parameters including probing depth, attachment loss, and gingival recession and radiographic intrabony level were measured. The effects of the surgery and the examination (buccal or lingual) locations on the measurements were statistically analyzed. RESULTS: Neither extraction history nor examination location affected the probing depth on mesial surfaces. However, significant effects of the surgical history on the probing depth were observed on the distal surfaces. Similar results of greater attachment loss and radiographic alveolar bone loss were observed only at the distal sites of the experimental group. In addition, the increased radiographic bone loss was only found at the distal sites (adjacent to the surgical location) and not at the mesial sites (distant from the surgical location) on the experimental group. CONCLUSIONS: In this study, greater periodontal breakdown, including probing depth, attachment loss, and radiographic alveolar bone loss, was found at the distal sites, but not at the mesial sites, of the experimental molars where the third molar was surgically extracted compared with the control teeth (no surgery). In the experimental molars, more radiographic bone loss was found at the sites adjacent to the surgical location than at the sites distant to the surgical location. Therefore, we suggest that the surgical removal of the mandibular third molar may lead to a periodontal breakdown on the distal surface of the second molar. Periodontal re-evaluation after the initial healing of third molar extraction is indicated.     

An evaluation of endodontically treated vertical root fractured teeth: impact of operative procedures

Vertical root fractures of endodontically treated teeth are a frustrating complication that leads to extraction. The aim of the current survey was to evaluate the role of operative procedures in the etiology of this complication. A total of 154 endodontically treated vertical root fractured teeth were cleaned and washed after extraction and maintained in individual vials. Periapical radiographs before extraction, clinical findings and previous operative procedures were recorded. A post was observed in 95 teeth (61.7%), with 66 of these ending at the coronal third of the root. Most were screw posts of the Dentatus type (n = 64) and tapered cast posts (n = 14). A full crown was observed in 118 teeth, and 65 of these (55%) were extracted between 1 to 5 yr after final restoration. In 24 crowned teeth extraction was conducted within 1 yr after restoration and in 28 teeth after >5 years. It was concluded that post placement and root canal treatment are the major etiological factors for root fractures. Because signs and symptoms can appear years after the operative procedures in the root have been completed, coronal restorations would not interfere with the correct clinical diagnosis of vertical root fractures. Frequent recalls are recommended to diagnose vertical root fractures early, especially in susceptible teeth, such as premolars and mesial roots of mandibular molars.     

“Ferrule Comes First. Post Is Second!” Fake News and Alternative Facts? A Systematic Review

Introduction

Both the role of an endodontic post and the ferrule effect have been discussed for decades. The clinical impact of endodontic posts compared with post-free restoration with or without ferrule support was not systematically reviewed so far. It was assumed that the effect of an endodontic post compared with a post-free restoration can be evaluated only when at the same time a ferrule or no-ferrule situation was clinically compared.

An in vitro study of coronal microleakage in endodontically-treated teeth restored with posts

Coronal microleakage has received considerable attention as a factor related to failure of endodontic treatment and much emphasis is placed on the quality of the final restoration. Posts are frequently used for the retention of coronal restorations. These can be custom-made or prefabricated. Many authors have examined coronal microleakage with respect to gutta-percha root fillings and plastic coronal restorations, but few have investigated the coronal seal afforded by various post systems. The seal provided by a cemented post depends on the seal of the cement used. The purpose of this study was to compare coronal microleakage around cast and prefabricated posts using a dye-penetration method. Sixty extracted single-rooted human teeth were chemomechanically prepared. The root canals were filled with gutta-percha and sealer and they were then prepared for standard posts. Six groups, each of 10 teeth, were restored with either cast post or prefrabricated post. The posts were cemented with either glass ionomer cement (GIC), Variolink II or Durelon. The teeth were thermocycled and placed in Indian ink for one week. They were then demineralised and rendered transparent. Linear coronal dye penetration around the post was measured and compared. The least dye-penetration was observed in roots restored with a cast post and Variolink II. Dentatus posts demonstrated the most microleakage. It appears that the dentine-bonding cements have less microleakage than the traditional, non-dentine-bonding cements and adaptation of the post with the canal may be more important than the cement used.     

Assessment of root curvature and distance using computed tomography

The safety and efficacy of subgingival root surface instrumentation may be enhanced by optimized adaptation between instrument and treated surface. Thus, detailed knowledge of root geometry may allow advances in instrument design. The aim of this study was therefore to measure root radii of various tooth types as well as distances between tooth roots using computed tomography. Two hundred sixteen teeth in eight patients were studied, with cross sections of teeth at the level of the cemento-enamel junction (CEJ) being regarded as ellipses. The maximum radii of ellipses were calculated and averaged for each tooth surface within various tooth groups. In addition, the spacing between roots at CEJ level and 5 mm below the CEJ was measured. Mean radii varied from 1.09+/-0.50 mm (lower incisor, lingual) to 13.7+/-0.96 mm (upper molar, mesial). Radii of 1 mm to 6 mm were most frequently found at buccal, palatal, and lingual surfaces, whereas the majority of radii were between 2 mm and 11 mm at mesial and distal sites. Root distance varied between 1.04+/-0.49 mm (lower incisors, CEJ level) and 2.81+/-1.70 mm (lower molars, 5 mm below CEJ). The curvature of an instrument for root surface instrumentation should correspond to a radius of at least 11 mm to achieve maximum adaptation to the treated surface, and the width of the working end should be less than 1 mm to allow sufficient interdental instrumentation.     

Morphometric analysis of the furcation anatomy of mandibular molars

BACKGROUND: Successful treatment of molar furcation defects remains a challenge in clinical practice. Knowledge of anatomic factors facilitates predictable management of furcation involvement lesions. The degree of success in managing furcation involvement is inversely related to the horizontal probing depth. The depth of the horizontal component of attachment loss can vary depending on the external tooth-surface reference points used. However, the anatomical factors affecting horizontal component of attachment loss have not been previously assessed. Therefore, this study determined the bucco-lingual measurements of the cemento-enamel junction and the mesial and distal roots and at the level of root separation. METHODS: One hundred extracted permanent human mandibular first (N = 50) and second (N = 50) molars were studied. Four horizontal bucco-lingual widths were measured with calibrated calipers: 1) furcation entrance/roof (FE); 2) cemento-enamel junction level (CEJ); 3) mesial root width (MRW); and 4) distal root width (DRW). RESULTS: The mean widths at FE, CEJ, MRW, and DRW were, respectively, 5.53 +/- 0.45 mm, 8.71 +/- 0.54 mm, 8.57 +/- 0.54 mm, and 7.97 +/- 0.65 mm in the first molars and 5.61 +/- 0.65 mm, 8.40 +/- 0.65 mm, 7.95 +/- 0.88 mm, and 7.16 +/- 0.84 mm in the second molars. Analysis of variance revealed significant differences between FE and the other variables tested. The results showed that the bucco-lingual width of the furcation roof is considerably shorter than the MRW and DRW. The difference in the mean bucco-lingual dimension between FE and the other measurements occurred in all teeth evaluated and varied between 0.7 and 4.30 mm. CONCLUSIONS: Our findings demonstrate that clinical measurements of horizontal probing depth that use the external surfaces of roots as reference points overestimate the true anatomical component of furcation involvement in mandibular molars. Conversely, positive treatment outcomes in these teeth may be underestimated. This has implications not only for clinical practice but also for clinical research studies evaluating treatment outcomes.     

A randomized-controlled clinical trial evaluating clinical and radiological outcomes after 3 and 5 years of dental implants placed in bone regenerated by means of GBR techniques with or without the addition of BMP-2

Objective: The aim of this randomized-controlled clinical trial was to evaluate the long-term outcome of implants placed in bone augmented with a xenogenic bone substitute material and a collagen membrane with or without the addition of recombinant human bone morphogenetic protein-2 (rhBMP-2).
Material and methods: Eleven patients received a total of 34 implants placed into sites exhibiting lateral bone defects. In a split mouth design, the defects were randomly treated with the graft material and the collagen membrane either with (test) or without (control) rhBMP-2. The patients were examined 3 and 5 years after insertion of the prosthetic restoration. Student's paired t -test was performed to detect differences between the two groups.
Results: The survival rate at 3 and 5 years was 100% for both groups. The peri-implant soft tissues were stable and healthy without any difference between the two groups. The prosthetic reevaluation demonstrated four loose prosthetic screws during the first 3 years and seven ceramic chippings after 3 and 5 years. The mean distance between the first bone to implant contact to implant abutment junction at 3 years was 1.37 mm (test), 1.22 mm (control), and 1.38 mm (test), and 1.23 mm (control) at 5 years. The difference of <0.2 mm between test and control implants was not statistically significant. The mean change of the marginal bone level between baseline and 5 years ranged from −0.07 mm (mesial, test), −0.11 mm (distal, test), −0.03 mm (mesial, control), to +0.13 mm (distal, control). No statistically significant differences were observed between test and control sites.
Conclusion: Implants placed in bone augmented with and without rhBMP-2 revealed excellent clinical and radiological outcomes after 3 and 5 years.