Faculty Bibliography

PURPOSE:Only limited information on the effect of implant surface hydrophilicity in conjunction with simultaneous bone augmentation is available. In this study, new bone growth around implants with a superhydrophilic modSLA (SLActive) and hydrophobic SLA (SLA) surface were compared in circumferential defects when grafted in conjunction with mineralized cancellous bone allograft (MCBA, maxgraft) or sintered bovine bone mineral (SBBM, cerabone). MATERIALS AND METHODS:The osseointegration and bone formation in circumferential defects in minipig mandibles around Straumann Roxolid, Ø 3.3 mm, length 8 mm; either SLA or SLActive, were evaluated. Following implant placement, the 2-mm circumferential defects around the implants were filled with MCBA or SBBM. Distance from implant shoulder to first bone-to-implant contact (f-BIC), percentage of bone-to-implant contact (BIC), and bone aggregate percentage (amount of new bone and remaining graft) within the defect area were evaluated after 8 weeks of healing. RESULTS:In the SBBM group, lingual fBIC and buccal BIC were significantly lower for SLA (mean -0.404 ± 0.579 mm for modSLA versus -1.191 ± 0.814 mm for SLA, P = .021 and mean 62.61% ± 9.49% for modSLA versus 34.67% ± 24.41% for SLA, P = .047, respectively). Bone aggregate percentage was significantly higher for modSLA versus SLA implants in SBBM (77.84% ± 6.93% versus 64.49% ± 13.12%; P = .045). The differences between implant surfaces in MCBA showed a similar trend but were less pronounced than in the SBBM group and did not reach a statistically significant level. CONCLUSION:The results suggest that implants with a superhydrophilic modSLA surface are more conducive to faster osseointegration even in conjunction with simultaneous bone grafting procedures.

A retrospective review of patient records was conducted in a single private practice to evaluate the efficacy of immediately placing a novel implant design in posterior jaw locations using a flapless technique. Forty-two patients (22 males, 20 females) with a mean (SD) age of 60.2 (7.6) years (range = 31-68) presented with 1-2 non-restorable molar (maxillary = 14; mandibular = 8) or premolar (maxillary = 20; mandibular = 1) teeth compromised by periodontal disease, endodontic failure, root resorption, root fracture or severe caries. Most patients (78.6%) had moderate (66.7%) or severe (11.9%) periodontitis. Other comorbidities included smoking (14.3%) and controlled diabetes mellitus (11.9%). After atraumatic extraction, teeth were immediately replaced with a total of 44 trabecular tantalum implants (Trabecular Metal Implants) (diameters = 3.7-4.7 mm; lengths = 10-13 mm). Sites requiring augmentation were treated with 3 types of small-particle (250-1000 AA(1/4)m), mineralized, solvent-dehydrated, allografts (Puros) based on location: cortical for crestal sinus grafts, cancellous for periimplant voids in thick tissue biotypes, or cortical-cancellous (70:30) mix for periimplant voids in thin tissue biotypes. Cortical particulate was used when slower resorption was needed to help maintain graft volume for esthetics or implant support. Grafts were covered with resorbable bovine pericardium membranes (CopiOs). One asymptomatic implant failed to osseointegrate. Cumulative implant survival and success rates were 97.7%, respectively, with a mean (AA+/-SD) follow-up time of 25.0AA+/-12.1 months (range = 4-48). Within the limitations of this study, implants achieved outcomes comparable to conventionally placed and restored single-tooth implants in anterior jaw locations.

OBJECTIVE: The purpose of the current study is to assess the thickness of the maxillary sinus lateral wall in dentate and edentulous patients using cone beam computed tomography (CBCT). This study also provides information about the diameter, prevalence, and course of the posterior superior alveolar artery (PSAA), and its relation to the maxillary sinus floor. MATERIALS AND METHODS: Four hundred and thirty CBCT scans of the maxillofacial complex (860 maxillary sinuses) were reviewed. Measurements of the lateral wall of the maxillary sinus and PSAA were performed on the CBCT images. RESULTS: Statistical analysis showed that dental status (edentulous, non-edentulous) of the patients had no significant effect on the lateral wall thickness. The mean thickness of the lateral wall of the maxillary sinus was 1.21 +/- 1.07 mm at the second molar (M2), 1.98 +/- 1.87 mm at the first molar (M1), 2.02 +/- 1.53 mm at the second premolar (P2) and 2.16 +/- 1.25 mm at the first premolar (P1). There was statistically significant difference between the left and right sides of the maxillary sinus only at P2 (p =.043). Detection rate of the PSAA on CBCT was reported as 60.58%. The mean diameter of the artery was 1.17 mm (range 0.4-2.8 mm). There was no significant correlation between age and the size of the PSAA. The most frequent path of the PSAA was intraosseous (69.6%), followed by intrasinusal (24.3%) and superficial (6.1%). The overall mean distance of the PSAA from the floor of the maxillary sinus is 8.16 mm. CONCLUSIONS: The results from this study suggest that using CBCT prior to the surgery provides valuable diagnostic information. However, undetected intraosseous canal in CBCT does not exclude its existence. Alteration in the lateral window design and the use of piezoelectric instruments are recommended if intraoperative complications are expected.

INTRODUCTION/BACKGROUND:Malignant melanoma is an aggressive form of cancer that commonly affects skin and rarely affects the oral cavity. With poorly understood risk factors and an often-asymptomatic presentation, oral melanoma is difficult to detect until advanced stages of disease. Treatment for oral melanomas has been primarily surgical, and survival rates have been low. However, in recent years, immunotherapy has shown much promise with increased patient survival. CASE PRESENTATION/METHODS:A 49-year-old male was referred by his primary dentist to a periodontal clinic for management of an alleged unresolved periodontal abscess. The patient had completed full-mouth scaling and root planing and consequently developed a large mass in the left posterior maxilla. Incisional biopsies were performed in multiple locations in the maxillary gingivae, and interpretation revealed atypical melanocytic proliferation and primary melanoma. After appropriate work-up, the patient was treated with two different immunotherapy agents: 1) ipilimumab and 2) pembrolizumab. Results after immunotherapy were favorable, and the tumor significantly decreased in size with no major adverse effects. The response was so strikingly positive that the need for surgical removal was almost eliminated. At the present time, it is unknown whether the patient will receive any surgical treatment barring a recurrence. CONCLUSIONS:Oral mucosal pigmentation is a finding commonly encountered by dentists during clinical patient examinations. However, proper diagnosis of pigmented lesions, especially those associated with malignancy, requires investigations that go beyond clinical examination.

Localized ridge resorption, the consequence of socket collapse, following tooth extraction in the anterior maxilla can adversely affect esthetics, function, and future implant placement. Immediate grafting of extraction sockets may help preserve natural ridge contours, but a lack of available soft tissue can compromise the final esthetic outcome. The presented modified rotated palatal pedicle connective tissue flap is a useful technique for simultaneous soft tissue coverage and augmentation of grafted sockets to improve esthetic outcome. This article delineates its advantages through the presentation of a four-case series using this new technique.

PURPOSE: The present, randomized, controlled clinical trial compared the histologic and histomorphometric results from maxillary sinus augmentation with either biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% beta-tricalcium phosphate) or autogenous bone (AB) as bone-grafting materials. MATERIAL AND METHODS: Ten patients received bilateral sinus elevation surgery with intraoral AB chips (control group) on one side and BCP (test group) on the contralateral side. After a healing period of 6 to 8 months, implant sites were created and trephine cores were harvested for histological and histomorphometric analysis of the grafted areas. RESULTS: The histological examination of biopsies showed BCP particles interconnected by bridges of a vital newly formed bone. Histomorphometry demonstrated that the amount of newly formed bone in the control group (36.8%) was significantly greater than that in the BCP (28.2%) group (P = 0.0032). BCP and AB cores revealed an average of residual graft particles of 32.9% and 4.8%, respectively. The average percentage of soft tissue components was 38.9% in the BCP cores and 58.4% in the AB cores. CONCLUSIONS: Based on our findings, the amount of vital bone formation was significantly higher for AB than that for BCP. However, BCP seemed to be a biocompatible and osteoconductive material that can be used with success as a bone substitute in maxillary sinus procedures.

BACKGROUND: The aim of this pilot study was to test whether diagnostic agreement of aggressive and chronic periodontitis amongst Board Certified Periodontists, is influenced by knowledge of a patient's age. In 1999 at the International World Workshop age was removed as a diagnostic criteria for aggressive periodontitis. The impact of this change on the diagnostic reliability amongst clinicians has not yet been assessed. METHODS: Nine periodontal case reports were twice presented to sixteen board certified periodontists, once with age withheld and again with patient age provided. Participants were instructed to choose a diagnosis of Chronic Periodontitis or Aggressive Periodontitis. Diagnostic agreement was calculated using the Fleiss Kappa test. RESULTS: Including the patients' age in case report information increased diagnostic agreement (the kappa statistic) from 0.49 (moderate agreement) to 0.61 (substantial agreement). CONCLUSION: These results suggest that knowledge of a patients' age influenced clinical diagnosis, when distinguishing between aggressive periodontitis and chronic periodontitis, which may in turn impact treatment decision-making.

INTRODUCTION: A case series was used to evaluate the efficacy and predictability of a ceramic matrix in a putty-like collagen carrier in immediate extraction sockets. METHODS: A single failing tooth was atraumatically extracted from each of 10 subjects. The sockets were debrided and grafted with ceramic matrix in a putty-like collagen carrier (15% hydroxyapatite, 85% beta-tricalcium phosphate complex). A bovine pericardium membrane was draped over the graft site and a tension-free primary closure was obtained. After 6 months of healing, a trephine biopsy was taken from the center of each graft and a dental implant was placed. Two subjects were withdrawn from the study and were considered treatment failures. One of them moved to another state and the second exhibited delayed healing that required debridement of the grafting material from the socket. RESULTS: After 6 months follow-up, there was a mean reduction of ridge width of 1.667 mm and mean reduction of ridge height of 0.483 mm after graft healing and integration. Over a 24-month follow-up, mean new bone fill was 40.25% and implant osseointegration was 100%. CONCLUSION: Ceramic matrix in a putty-like collagen carrier maintained ridge dimensions and, despite ongoing bone turnover, produced adequate mineralized tissue that enabled implant placement at 6 months.