Clinical characteristics at implants with a history of progressive bone loss

OBJECTIVE: The aim of the present study was to describe the clinical characteristics at implants with a history of progressive bone loss. MATERIAL AND METHODS: Eighty-two out of 184 previously identified subjects with a history of progressive bone loss volunteered for the study. Clinical assessments of plaque, bleeding on probing (BoP), probing pocket depth (PPD), suppuration following probing (Pus), presence of calculus on implants surfaces (Calc) and 'recession' i.e. the mucosal margin in level with or apical of the fixture/abutment junction were performed at the mesial, distal, buccal and lingual aspects of each implant and without removing the bridge constructions. RESULTS: It was demonstrated that the frequencies of BoP, Pus, 'recession' and PPD > or = 6 mm were higher at implants with than without 'progressive' bone loss. In addition, smokers had larger numbers of affected implants than non-smokers, and the proportion of affected implants that exhibited Pus and PPD > or = 6 mm was higher in smokers than in non-smokers. The logistic regression analysis revealed that the findings of Pus, 'recession' and PPD > or = 6 mm at an implant in a smoking subject had a 69% accuracy in identifying the history of progressive bone loss. CONCLUSION: The results from this study demonstrate an association between clinical signs of pathology and bone loss at implants. It is recommended to include clinical assessments in the evaluation of implant therapy.     

Immediate functional loading of implants in single tooth replacement: a prospective clinical multicenter study

Objectives: The aim of the present study was to evaluate the outcome of immediate functional loading of implants in single-tooth replacement using two different installation procedures.
Material and Methods: One hundred and fifty-one subjects, who required single-tooth rehabilitation in the area of 15–25 and 35–45, were enrolled in eight private clinics in Italy. The implant sites were randomly allocated to one of the following treatment groups. In the control group, in which a standard preparation procedure for implant placement and submerged healing of the implant was used, abutment connection and loading of the implants were performed 3 months after installation. In the test group 1, a standard preparation procedure for the implant placement and immediate functional loading of implant was carried out. In the test 2 group, however, a modified implant installation procedure (osteotome technique) was used followed by immediate functional loading of the implant. Clinical and radiographic examinations were performed at 3 and 12 months of follow-up at all sites.
Results: Three implants (5.5%) from the test 2 group (osteotome preparation) and one (2%) from the test 1 group (conventional drill preparation) failed to integrate and were removed one and three months after implant installation. The mean marginal bone loss assessed at 12 months was 0.31 mm (test 1), 0.25 mm (test 2) and 0.38 mm (control) (no statistically significant differences were found between the three treatment groups.)
Conclusion: It is suggested that immediate functional loading of implants that are placed with a conventional installation technique and with sufficient primary stability may be considered as a valid treatment alternative in a single-tooth replacement.     

Magnetic resonance imaging identifies early effects of sunitinib treatment in human melanoma xenografts

Background

Antiangiogenic treatment may change the tumor microenvironment and hence influence the effect of conventional therapies. The potential of diffusion weighted magnetic resonance imaging (DW-MRI) and dynamic contrast enhanced MRI (DCE-MRI) in assessing microenvironmental effects of sunitinib treatment was investigated in this preclinical study.

Methods

Sunitinib-treated and untreated A-07 tumors were subjected to DW-MRI and DCE-MRI, and parametric images of ADC and K^trans were produced. Microvascular density, hypoxic fraction, and necrotic fraction were assessed from immunohistochemical preparations, and tumor interstitial fluid pressure (IFP) was assessed with probe measurement.

Results

Sunitinib-treated tumors showed reduced microvascular density, increased hypoxic fraction, increased necrotic fraction, increased ADC, and reduced K^trans, but did not differ from untreated tumors in growth rate and IFP.

Conclusions

Sunitinib treatment affected the tumor microenvironment without affecting tumor size. DW-MRI and DCE-MRI were sensitive to the sunitinib-induced changes in the tumor microenvironment.

     

Association of the -1087 IL 10 gene polymorphism with severe chronic periodontitis in Swedish Caucasians

BACKGROUND: Severe forms of periodontitis are suggested to have a genetic basis. OBJECTIVE: The aim of the present investigation was to study association of an IL10 gene polymorphism (G to A transition at the -1087 position) with severe chronic periodontitis. MATERIALS AND METHODS: Two groups of Swedish Caucasian subjects were included. One group consisted of 60 patients (aged 36-74 years; mean 54.5+/-8.5) with severe and generalized chronic periodontitis. The patients exhibited bone loss >50% at all teeth. Thirty-nine periodontally healthy subjects between 35-78 years of age (mean 51.0+/-10.9) were also recruited. DNA was isolated from peripheral blood cells and genotyping was performed by combination of PCR with restriction endonuclease mapping. RESULTS: The proportion of subjects that exhibited the GG genotype was significantly larger in the group with severe periodontitis than in the periodontally healthy group. The difference regarding the occurrence of the GG genotype between the two groups was more conspicuous in non-smokers and yielded an odds ratio of 6.1. The G allele carriage in non-smokers was >90 % in the periodontitis group and was significantly higher than in the healthy controls. CONCLUSION: It is suggested that the -1087 IL10 polymorphism in Caucasian subjects of a north European origin is associated with severe chronic periodontitis.     

Re-osseointegration after treatment of peri-implantitis at different implant surfaces

Peri-implantitis is a condition that includes soft tissue inflammation and rapid loss of bone. Treatment of peri-implantitis includes both antimicrobial and bone augmenting methods. The question of whether true re-osseointegration may occur following treatment of peri-implantitis is controversial. The aim of this study was to investigate whether the character of the implant surface was of importance for the occurrence of re-osseointegration following treatment of peri-implantitis. Four beagle dogs were used. The mandibular premolars were extracted. After 12 months, 3 ITI(R) solid screw dental implants were placed in each side of the mandible. In the left side, implants with a turned surface (Turned sites) were used, while in the right side implants with a SLA surface (SLA sites) were placed. After 3 months of healing, peri-implantitis was induced by ligature placement and plaque accumulation. When about 50% of the initial bone support was lost, the ligatures were removed. Five weeks later, treatment was initiated. Each animal received tablets of Amoxicillin and Metronidazole for a period of 17 days. Three days after the start of the antibiotic regimen, one implant site (experimental site) in each quadrant was exposed to local therapy. Following flap elevation, the exposed titanium surface was cleaned with the use of cotton pellets soaked in saline. The implants were submerged. Six months later, biopsies were obtained. Treatment resulted in a 72% bone fill of the bone defects at Turned sites and 76% at SLA sites. The amount of re-osseointegration was 22% at Turned sites and 84% at SLA sites. A treatment regimen that included (i) systemic administration of antibiotics combined with (ii) granulation tissue removal and implant surface cleaning resulted in resolution of peri-implantitis and bone fill in adjacent bone defects. Further, while substantial "re-osseointegration" occurred to an implant with a rough surface (SLA), bone growth on a previously exposed smooth surface (Turned) was minimal.     

Tooth mobility and resolution of experimental periodontitis

Abstract The aim of the present experiment was to study alterations in the mobility of teeth that occurred during resolution of experimentally induced periodontitis lesions in the dog. 5, 1-year-old, beagle dogs were used in the study. The left and right 4th, 3rd, and 2nd mandibular premolars (₄P₄, ₃P₃, ₂P₂) served as experimental teeth. Periodontal tissue breakdown was initiated by placing plaque-collecting cotton-floss ligatures around the neck of the experimental teeth. The ligatures were replaced to the level of the receding gingival margin 1 × every month. On Day 120, the ligatures were removed and debridement was performed. A groove, parallel to the long axis of the mesial root, was prepared in the mesio-buccal surface of the crowns of ₂P and P₂. Guided by the groove and with a probing force of 0.5 N, a probe was inserted into the buccal gingival pocket of the mesial root and was attached to the buccal surface. Biopsies including both the mesial and distal root of ₂P and P₂ and the surrounding hard and soft tissues were harvested. The biopsy procedure was repeated in a similar manner 15 days (i.e. Day 135) and 3 months (i.e. Day 225) after ligature removal in the 4th (₄P₄) and 3rd (₃P₃) premolar regions. After fixation, decalcification and sectioning, the biopsy material was exposed to histometric and morphometric measurements. Assessment of the mobility of the experimental teeth was performed on Days 120, 135 and 225 using the Periotest system. The amount of remaining bone at the experimental teeth was evaluated in radiographs obtained in a standardized manner. The findings of the present experiment disclosed that in dogs allowed to form plaque, the placement of cotton-floss ligatures at the neck of mandibular premolars initiated a process that resulted in (i) the formation of an inflammatory lesion which extended deep into the supracrestal connective tissue; (ii) extensive loss of alveolar bone; (iii) markedly increased tooth mobility. It was also observed that, within a 4-month period the removal of the ligature and, as a consequence, a substantial portion of the subgingival microbiota, reduced the size and the apical extension of the inflammatory lesion in the supracrestal connective tissue. The alterations in the soft supracrestal tissue were accompanied by a marked decrease in the mobility of the experimental teeth and a reduced probing pocket depth. It was suggested that the reduced penetration of the probe was the result of the change in the size and position of the infiltrate as well as of a reduced mobility of the experimental teeth.     

Expression of endothelial adhesion molecules in the alveolar ridge mucosa,gingiva and periimplant mucosa

OBJECTIVES: The purpose of this study was to analyze the expression of adhesion molecules on endothelial cells in the alveolar ridge mucosa, the gingiva and the periimplant mucosa in humans. MATERIAL AND METHODS: Twelve partially edentulous subjects were included in the study. In each subject, one soft tissue biopsy was harvested from the edentulous alveolar ridge mucosa, one from a tooth site and one from an implant site. After 3 weeks of undisturbed plaque accumulation, an additional biopsy was obtained from one tooth and one implant site in each subject. The tissue samples were snap frozen and prepared for immunohistochemical analysis. RESULTS: In the alveolar ridge mucosa, smaller proportions of endothelial cells expressing ICAM-1, ELAM-1 and VCAM-1 were observed than in the gingiva. ELAM-1-positive cells occurred in lower numbers than in periimplant mucosa. After 21 days of plaque accumulation, ELAM-1 was increased in tooth sites, but decreased in periimplant mucosa. CONCLUSION: The results of the present study indicated that the proportions of activated endothelial cells and the extravasation of leukocytes is larger in gingiva and periimplant mucosa than in alveolar ridge mucosa. This might be due to the less permeable keratinized epithelial layer in the edentulous ridge mucosa, which offers proper protection against microbial pathogens. The greater expression of endothelial cell adhesion molecules during experimental gingivitis, compared to periimplant mucositis, may reflect its longer history of repeated antigenic assaults.     

Periodontal tissue reactions to orthodontic extrusion

Orthodontic tooth extrusion is used at crown lengthening procedures or in conjunction with periodontal therapy aimed at eliminating or reducing angular bone defects. A technique for orthodontic extrusion combined with resection of the supracrestal attachment fibers (fiberotomy) was recently proposed as an adjunct to certain restorative procedures. The aim of the present investigation was to analyze reactions of the periodontal tissues to orthodontic extrusion when combined with fiberotomy. In 5 beagle dogs, the mesial roots of the 2nd, 3rd and 4th hemisected mandibular premolar were used as target roots while the distal roots served as reference units. After a baseline examination, an orthodontic extrusion device (stent) was installed and reactivated at 2-week intervals during an 8-week period of active tooth movement. Immediately following the installation of the stent and once every 2nd week, the target roots were exposed to fiberotomy. After the active period, the teeth were retained in their new position for a period of 8 weeks. Clinical, radiographical and histological measurements were performed. The results from the investigation demonstrated that orthodontic extrusion combined with supracrestal fiberotomy resulted in a coronal displacement of the tooth and was associated with pronounced recession of the gingival margin and extensive loss of connective tissue attachment. The degree of gingival recession and the amount of loss of connective tissue attachment were, however, less extensive than the amount of tooth extrusion. Thus, repeated fiberotomy obviously failed to entirely prevent coronal migration of the attachment apparatus. It was also observed that undesired attachment loss had occurred at the reference roots.     

The mucosal attachment to titanium implants with different surface characteristics: an experimental study in dogs

BACKGROUND: Findings from in vitro studies have indicated that the orientation and proliferation of cells on titanium surfaces may be influenced by the topography of the surface on which they are grown. It may be argued, therefore, that differences may occur in the mucosal attachment to titanium implants with different surface roughness. AIM: The present experiment was performed to study the composition of the soft tissue barrier that formed to implants prepared with well-defined smooth or rough surfaces. MATERIAL AND METHODS: Five beagle dogs were used. Four implants made of c.p. titanium were placed in the right edentulous mandibular premolar region. After 3 months, two different types of abutments were connected: one experimental (OA) with a dual, thermal acid-etched surface ('Osseotite'), and one regular (RA) abutment with a 'turned' surface. At the end of a 6-month period during which proper plaque control had been maintained, biopsies including the implant and the surrounding soft and hard tissues were obtained, decalcified and processed for light and electron microscopy. A confocal He-Ne laser profilometer was used to study the surface topography of the abutments. RESULTS: The attachment between the peri-implant mucosa and titanium abutments with either a turned (RA; 'smooth') or acid-etched (OA; 'rough') surface was similar from both a quantitative and a qualitative aspect. The attachment comprised a barrier epithelium and a zone of connective tissue attachment of similar dimension at RA and OA. It was further observed that the 'inner' zone of the connective tissue attachment at both types of abutment was composed of about 30-33% fibroblasts and 63-66% collagen. CONCLUSION: It was demonstrated that the soft tissue attachment that formed to implants made of c.p. titanium was not influenced by the roughness of the titanium surface.