Prevalence of furcation involvements in patients referred for periodontal treatment

Abstract The aim of this study was to evaluate the prevalence of furcation-involved molars in a patient sample referred for periodontal treatment, A total of 222 patients aged, 14-73 years (mean age 45 years), and with signs of destructive periodontal disease in at least 2 quadrants of the dentition were included in the study. The clinical examination involved assessments of oral hygiene status, gingival conditions, probing pocket depth and presence/degree of furcation involvement. In addition, a full mouth intraoral radiographic examination was performed. The results revealed that 4% of the patients presented with all 12 molars, while 3% had lost all molars, 52% of the individuals had at least 8 molars; 95% of subjects < 30 years of age and 19% in the age 60 years. In patients aged ≥40 years, every 2nd molar showed advanced periodontal destruction in the furcation area. The prevalence of furcation involved molars was higher in the maxilla than in the mandible. From the age of 30 years, about 50% of the 1st and 2nd molars in the maxilla showed at least 1 furcation site with deep involvement, while in the mandible a similar prevalence was observed first after the age of 40 years. The highest frequency of furcation involvement was found at the distal site of the maxillary 1st molar (53%), and the mesial aspects of the maxillary 2nd molar showed the lowest frequency (20%), Furcation sites with a probeable trunk region were observed at a frequency of 17-22% at the various tooth sites. It was concluded that tooth morphology may be an important factor that accounts for the variability in prevalence of molar furcation involvement.     

Progression of Periodontitis and Tooth Loss Associated with Glycemic Control in Individuals Undergoing Periodontal Maintenance Therapy: A 5‐Year Follow‐Up Study

Background: Prospective studies that investigated the influence of glycemic control in the progression of periodontitis and tooth loss during periodontal maintenance therapy (PMT) programs have not previously been reported. The aim of the present study is to evaluate associations between glycemic control status and progression of periodontitis and tooth loss among individuals during PMT. Methods: A total of 92 individuals, all recruited from a prospective cohort with 238 participants undergoing PMT, participated in this study. Diabetes control was assessed according to percentage of glycated hemoglobin (HbA1c). Individuals were matched for sex and smoking and were divided into three groups: 23 individuals with diabetes and poor glycemic control (PGC), 23 individuals with diabetes and good glycemic control (GGC), and 46 controls with no diabetes (NDC). Full‐mouth periodontal examination, including bleeding on probing (BOP), probing depth (PD), and clinical attachment level, was performed at all PMT visits during a 5‐year interval. Results: Progression of periodontitis and tooth loss were significantly higher among PGC compared to GGC and NDC. The final logistic model in the final examination included: 1) for the progression of periodontitis, HbA1c ≥6.5% (odds ratio [OR] = 2.9), smoking (OR = 3.7), and BOP in >30% of sites (OR = 4.1); and 2) for tooth loss, HbA1c ≥6.5% (OR = 3.1), smoking (OR = 4.1), and PD 4 to 6 mm in ≤10% of sites (OR = 3.3). Conclusions: PGC individuals, especially smokers, presented with a higher progression of periodontitis and tooth loss compared to NDC and GGC individuals. This result highlights the influence of glycemic control in maintaining a good periodontal status.     

A 22‐year follow‐up of an endodontic implant

Root fractures in the middle and apical thirds of the root are treated by repositioning and for approximately 6 weeks of immobilization while those in the cervical third are immobilized for 3 months. Even though the results are good, some root‐fractured teeth are lost and replaced by dental implants or fixed partial dentures. One historic but effective treatment option for those root fractures with unfavorable crown to root ratios is an endodontic implant in middle and apical third root fractures. This method offers immediate stable fixation of a crown and its coronal root segment to the underlying alveolar bone. This report documents the long‐term survival of a tooth treated with an endodontic implant. A 25‐year‐old male patient presented following a bicycle accident with a dislocated unfavorable root fracture in the middle third. The crown with the coronal root segment was secured to the bone using a commercially available endodontic implant. The apical part of the root was removed. Although the clinical and radiological follow‐up results of the endodontic implant demonstrated a good clinical function and little bone loss, the implant ultimately had to be removed after 22 years of service due to pain and increasing mobility.     

Implants in fresh extraction sockets: a prospective 5‐year follow‐up clinical study

Objective: The aim of this prospective study was to evaluate the 5‐year clinical outcome of the ‘immediate implants.’ Material and methods: One week after the cementation of the prosthesis, a clinical baseline examination was carried out. Clinical measurements were performed of the following: plaque, mucositis, probing pocket depth, and soft tissue position. The height of the keratinized mucosa was measured at the buccal/lingual aspects. Standardized intra‐oral radiographs were taken. The marginal level of bone to implant contact [radiographic (Rx) bone level] was measured, and Rx bone level change over time was evaluated. The clinical/radiographic measurements were repeated on a yearly basis. The subjects were enrolled in a carefully supervised oral hygiene program. Results and conclusion: It was demonstrated that ‘immediate implants’ that were loaded after 5–7 months had a high success rate. During the 5‐year interval, no implant was lost, and the mean Rx bone level at the implants was maintained or even improved. The plaque and mucositis scores were low (<20%) at baseline and at all re‐examinations. Implant sites located adjacent to the teeth showed bone gain during the initial period while sites that were facing edentulous zones lost some bone.     

A prospective,multi‐center study assessing early loading with short implants in posterior regions. A 3‐year post‐loading follow‐up study

Background

Few prospective studies about early loading of short implant have been available and very little evidence exists on the outcomes longer than 3 years.

Purpose

To assess clinical and radiographic outcomes of 6 mm‐short implants placed in the posterior maxilla and mandible applying an early loading protocol.

Materials and methods

Ninety‐five short implants (6 mm‐short, Ø 4 mm) were placed in 45 subjects at 3 study sites, 2 or 3 implants per subject, using a one‐stage surgical procedure and loaded with a screw‐retained splinted fixed prosthesis 6 weeks later. Follow‐up took place at 6, 12, 24, and 36 months after loading. Marginal bone level changes, implant survival, clinical variables, and adverse events were assessed.

Results

The survival rate for all implants placed was 95.8%. From implant loading to 3 years follow‐up, mean marginal bone level changes were minimal (0.07 ± 0.49 mm) and the peri‐implant soft tissue status was healthy. No major technical or biological complications occurred except for the 4 early implant losses.

Conclusion

Three‐year data indicates that the use of splinted 6 mm‐short implants is a viable treatment in posterior regions with low marginal bone resorption. Early loading after 6 weeks should be taken cautiously in patients with known risk factors.