Multicentre Withinperson Randomised Controlled Trial of 0.5 Mm Versus 1.5 Mm Subcrestal Placement of Dental Implants With Internal Conical Connection: Five-year Post-loading Results

PURPOSE. To assess whether there are any clinical benefits to placing single dental implants either 0.5 or 1.5 mm subcrestally in healed bone crests. MATERIALS AND METHODS. Sixty partially edentulous patients at six centres requiring two single implant-supported crowns had both sites randomly allocated according to a split-mouth design to either 0.5 mm or 1.5 mm subcrestal implant placement; implants in aesthetic areas were submerged for 3 months while those in non-aesthetic areas were not. Provisional acrylic crowns were fitted and replaced with definitive metal-ceramic crowns after 2 months. Patients were followed up to 5 years after loading. Outcome measures were: crown and implant failures, complications, aesthetics assessed using the pink esthetic score (PES), peri-implant marginal bone level changes, and patient prefe-rence, recorded by blinded assessors. RESULTS. Two patients dropped out. There were no statistically significant differences in failure rate (out of 58 patients, four implants failed in the 0.5 mm group versus one in the 1.5 mm group; difference =-5.17%; 95% CI-10.87% to 0.53%; P = 0.250) or complications (out of 58 patients eight complications occurred in eight patients from the 0.5 mm group versus five complications in five patients from the 1.5 mm group (difference =-5.17%; 95% CI-14.01% to 3.67%; P = 0.453) between groups. At 5 years after loading, the mean pink aesthetic scores were 10.89 ± 2.30 and 10.79 ± 2.41 in the 0.5 and 1.5 mm groups, respecti-vely, a difference that was not statistically significant (P = 0.943). Patients from the 0.5 mm group lost on average 0.53 ± 1.43 mm peri-implant marginal bone, and those in the 1.5 mm group lost 0.31 ± 0.98 mm, a statistically significant difference (0.26 mm; 95% CI 0.05 to 0.47; P = 0.016). Patients did not prefer any depth of implant placement over the other. There were no differences in outcomes between centres. CONCLUSIONS. No clinically appreciable differences were noted when placing implants surrounded by at least 1 mm of bone 0.5 mm or 1.5 mm subcrestally. Clinicians are therefore free to choose which strategy they prefer

Traps of multi-level governance. Lessons from the implementation of the Water Framework Directive in Italy

During recent decades, different patterns of multi-level governance (MLG) have spread across Europe as a consequence of Europeanisation of public policies, which have increasingly adopted decentralized and participatory procedures conceived as a tool of more effective and accountable policy-making. It appears, however, that the implementation of operational designs based on MLG may be rather problematic and it does not necessarily bring to the expected performance improvements. Referring to the case of the EU Water Framework Directive (2000/60/EC), which conceives the creation of new multi-level institutional settings as a key tool for enacting a new holistic approach to water management and protection, this article explores the difficulties that the implementation of such settings has brought in Italy, despite some favorable pre-conditions existing in the country. Evidence is provided that along with institutional and agency variables, the implementation effectiveness of MLG arrangements promoted by the EU can be challenged by their inherent characteristics

Beyond the post-political: Exploring the relational and situated dynamics of consensus and conflict in planning

This paper explores the problematique of the consensus and conflict binary that has emerged in the critical analysis of the post-political urban condition. Focusing on the interstitial spaces existing between consensus and conflict reveals a more relational dynamic that positions consensus and conflict as co-constitutive and continuously being shaped by the performance of politics by state and non-state actors. Critiques of the post-political tend to fail to engage with the conditions that lead to citizen actors acting in political ways beyond the formal processes of planning and decision-making, or when consensus or conflict is used by oppressive politics to produce exclusion and reproduce inequality. In addition to introducing the five papers appearing in this special issue, in this opening editorial, we argue the need to cast attention towards the new expressions of political participation generated by different citizen actors. Critically engaging with these varied expressions may reveal new ways of conceptualising participation that can create new informal spaces where injustices and inequalities are voiced and the structures and hegemonies created are exposed

Effect of laser- induced dentin modification on periodontal fibrobasts and osteoblasts: a new in vitro model

Background: The erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser has been shown to be a promising tool for root treatment in periodontitis, but little information is available regarding the surface characteristics after this treat- ment, mainly because it is difficult to obtain standardized den- tin samples for in vitro studies. Methods: Commercially available standardized dentin disks were treated with an Er:YAG laser at different settings and used as a substrate for human primary osteoblastic cells (hOBs) and periodontal ligament fibroblasts (PLFs). Cell proliferation on untreated dentin was measured by 3-(4,5-dimethylthiazol- 2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay after 3, 6, 12, 24, and 48 hours of culture. The effects of the laser on dentin and cell morphology on treated and untreated samples were investigated by scanning electron microscopy after 3, 6, 24, and 48 hours of culture. Results: Dentin samples supported proliferation for both cell types, although growth kinetics were different. The laser dra- matically affected the dentin profile, creating a rough and irreg- ular surface. Cells grew easily on untreated dentin, but fewer cells were present on treated areas, often displaying long filo- podes. hOBs showed poorer adhesion to treated dentin than PLFs. Conclusions: The dentin disks provide a standardized and useful tool to study dentin surface modifications in vitro. PLFs behaved differently from hOBs on dentin, possibly because of their different affinity to this tissue and/or their differentiation state. The changes induced by the laser produced a less favor- able environment for cell adhesion or growth, and treated den- tin seemed to be more suitable for PLF adhesion compared to hOB adhesion. J Periodontol 2009;80:1648-1654