Immediate vs. Delayed Implant Placement after Anterior Single Tooth Extraction: The Timing Randomised Controlled Clinical Trial.

to compare need for bone augmentation, surgical complications, periodontal, radiographic, aesthetic and patient reported outcomes in subjects receiving implant placement at the time of extraction (IMI) or 12 weeks thereafter. METHODS: Subjects requiring single tooth extraction in the anterior and premolar areas were recruited in 7 private practices. Implant position and choice of platform were restoratively driven. Measurements were performed by calibrated and masked examiners. RESULTS: IMI was unfeasible in 7.5% of cases. 124 subjects were randomized. One implant was lost in the IMI group. IMI required bone augmentation in 72% of cases compared with 43.9% for delayed (P=0.01), while wound failure occurred in 26.1% and 5.3% of cases, respectively (P=0.02). At 1 year, IMI had deeper probing depths (4.1±1.2 mm vs. 3.3±1.1 mm, P<0.01). A trend for greater radiographic bone loss was observed at IMI over the initial 3-year period (Ptrend<0.01). Inadequate pink aesthetic scores were obtained in 19% of delayed and in 42% of IMI implant cases (P=0.03). No differences in patient reported outcomes were observed. CONCLUSIONS: Immediate implant placement should not be recommended when aesthetics are important, IMI should be limited to selected cases. Longer follow-up is needed to assess differences in complication rates. This article is protected by copyright. All rights reserved

Microbial colonization patterns predict the outcomes of surgical treatment of intrabony defects

Aim: To explore the impact of bacterial load and microbial colonization patterns on the clinical outcomes of periodontal surgery at deep intrabony defects. Materials and Methods: One hundred and twenty-two patients with advanced chronic periodontitis and at least one intrabony defect of >3 mm were recruited in 10 centres. Before recruitment, the infection control phase of periodontal therapy was completed. After surgical access and debridement, the regenerative material was applied in the test subjects, and omitted in the controls. At baseline and 1 year following the interventions, clinical attachment levels (CAL), pocket probing depths (PPD), recession (REC), full-mouth plaque scores and full-mouth bleeding scores were assessed. Microbial colonization of the defect-associated pocket was assessed using a DNA-DNA checkerboard analysis. Results: Total bacterial load and counts of red complex bacteria were negatively associated with CAL gains 1 year following treatment. The probability of achieving above median CAL gains (>3 mm) was significantly decreased by higher total bacterial counts, higher red complex and T. forsythensis counts immediately before surgery. Conclusions: Presence of high bacterial load and specific periodontal pathogen complexes in deep periodontal pockets associated with intrabony defects had a significant negative impact on the 1 year outcome of surgical/regenerative treatment. © 2006 Blackwell Munksgaard.link_to_subscribed_fulltex

Healing, post-operative morbidity and patient perception of outcomes following regenerative therapy of deep intrabony defects

Aim: This prospective multicenter randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix derivatives (EMD). This article reports on early healing events, post-operative morbidity and patient perceptions of the surgical outcomes. Material and Methods: One hundred and seventy-two patients with advanced chronic periodontitis and at least one intrabony defect of ≥ 3 mm were recruited in 12 centres in seven countries (European Research Group on Periodontology (ERGOPERIO)). Papilla preservation flaps were used to obtain access and primary closure. After debridement, and root conditioning, EMD was applied in the test subjects, and omitted in the controls. Healing was monitored 1, 2, 3, 4, 6 and 12 weeks after surgery. During the first 12 weeks of healing, supracrestal soft-tissue density was evaluated with a computer-assisted densitometric image analysis system (CADIA) using underexposed radiographs taken on a subset of 34 patients. Patient perceptions were evaluated with a questionnaire immediately after the procedure, at suture removal 1 week later and at 1 year. Results: Subjects reported little intraoperative or post-operative pain or discomfort for both test and controls. Twenty-four percent of controls and 30% of tests (p = 0.64) reported a degree of interference with daily activities for an average of 3 and 3.5 days, respectively. Post-surgical edema was noted in 25% of tests and 28% of controls. Wound dehiscence in the interdental portion of the flap was uncommon (14% of tests and 12% of controls at week 1) and of limited size. Root sensitivity was the most frequent post-operative adverse event: it affected 45% of test and 35% of controls (p = 0.55). Up to 6 weeks post-operatively, soft-tissue densities were significantly higher in subjects treated with EMD with respect to controls. One year after completion of the surgery, patients reported high levels of satisfaction with the outcomes. The most frequently reported benefits included the ability to preserve a tooth/dentition and to maintain/improve chewing ability. The cost and need for frequent follow-ups were cited as significant drawbacks. Conclusions: This study portrayed the early healing events, pain, discomfort and adverse events of papilla preservation flap surgery and the 1-year patient perceptions of the benefits and disadvantages of periodontal surgery in intrabony defects. Earlier gains in soft-tissue density were observed following application of EMD. In terms of patient-centered outcomes, however, both procedures performed in a similar manner. © Blackwell Munksgaard, 2004.link_to_subscribed_fulltex

Treatment of intrabony defects with guided tissue regeneration in aggressive periodontitis: clinical outcomes at 6 and 12 months

Periodontal Research Fund of the Unit of Periodontology at the Eastman Dental Institute, University College London, UK and a Scholarship of The Royal Thai Government

The simplified papilla preservation flap in the regenerative treatment of deep intrabony defects: Clinical outcomes and postoperative morbidity

Background: The aims of the present multi-center, randomized, controlled clinical trial were: 1) to compare the efficacy of the simplified papilla preservation flap with and without a barrier membrane in deep intrabony defects; 2) to evaluate the postoperative morbidity and surgical complications; and 3) to preliminarily test the impact of baseline tooth mobility on clinical outcomes. Methods: This parallel group, randomized, multi-center, controlled clinical trial involved 112 patients in 8 periodontal practices in 4 countries. A deep intrabony defect in each patient was accessed with the simplified papilla preservation flap. In the test defects, a bioabsorbable membrane was positioned. Patients' experiences with the surgical procedure and postoperative period were evaluated with a questionnaire. Clinical outcomes included clinical attachment level (CAL) and probing depth (PD) changes. Results: Complete observations were available for 55 test and 54 control defects. CAL gains at 1 year were 3.5 ± 2.1 mm in the guided tissue regeneration (GTR) group and 2.6 ± 1.8 mm in the control group (P= 0.0117). CAL gains ≥4 mm were observed in 50.9% of GTR sites and 33.3% of control sites. A significant center effect of 2.1 mm was observed (P = 0.01). Initial PD (P = 0.01) and baseline tooth mobility (P = 0.036) were significant covariates. During the procedure, 30.4% of test and 28.6% of controls reported feeling moderate pain, and subjects estimated the hardship of the procedure at 24 ± 25 visual analog scale (VAS) units in the test group, and at 22 ± 23 VAS in controls. In terms of the investigated outcomes, differences between test and control groups were not statistically significant. Among the postoperative complications, edema was most prevalent at week 1, and more frequently associated with the test treatment (P = 0.01). In the test group, 53.6% of membranes were exposed at week 3. Conclusions: The present study further supports the added benefits of guided tissue regeneration with respect to access flap alone in the treatment of deep intrabony defects, as well as the general efficacy of GTR in different clinical settings. Furthermore, our study indicates a possible influence of baseline tooth mobility on clinical outcomes.link_to_subscribed_fulltex

Effects of a single topical doxycycline administration adjunctive to mechanical debridement in patients with persistent/recurrent periodontitis but acceptable oral hygiene during supportive periodontal therapy

OBJECTIVES: To evaluate the efficacy of a slow release doxycycline gel (SRD) adjunctively administered to non-surgical therapy in subjects with recurrent or persistent periodontitis but acceptable oral hygiene during supportive periodontal care. MATERIAL and METHODS: In this single blind, parallel group, multicentre study, 202 of 203 recruited periodontal maintenance subjects with recurrent or persistent periodontitis were randomly assigned to subgingival ultrasonic/sonic instrumentation (USI) with (test) or without (control) subsequent administration of SRD in all residual periodontal pockets >/=4 mm. Intergroup differences in probing depth, BOP reductions, treatment time, probing attachment levels were evaluated at 3, 6 and 12 months. The primary outcome was the inter-group difference in absolute change of probing pocket depth (PPD) 3, 6 and 12 months after intervention. RESULTS: At baseline, the two groups were comparable. At 3 months, the test group showed a significantly higher decrease in mean probing depth than the control group at 3 months (mean difference = 0.11 mm, 95% CI 0.03-0.19 mm, p = 0.003). Administration of SRD resulted in significantly greater odds of transition of bleeding pockets >/=5 mm to a category of non bleeding sites with PPD /=2 mm) and were exited from the study. No difference in the incidence of adverse events was observed between groups. CONCLUSION: The trial results show that topically administered SRD may provide short-term benefit in controlling inflammation and deep pockets in treated periodontal patients participating in a secondary prevention programme and able to maintain a satisfactory level of oral hygiene.link_to_subscribed_fulltex

Clinical outcomes following treatment of human intrabony defects with GTR/bone replacement material or access flap alone: A multicenter randomized controlled clinical trial

Aim: This prospective multicenter randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of a guided tissue regeneration (GTR)/bone replacement material. Materials and Methods: One hundred and twenty-four patients with advanced chronic periodontitis were recruited in 10 centers in seven countries. All patients had at least one intrabony defect of ≥ 3 mm. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, the regenerative material was applied in the test subjects, and omitted in the controls. At baseline and 1 year following the interventions, clinical attachment levels (CALs), probing pocket depths (PPDs), recession, full-mouth plaque scores and full-mouth bleeding scores (FMBS) were assessed. Results: One year after treatment, the test defects gained 3.3 ± 1.7mm of CAL, while the control defects yielded a significantly lower CAL gain of 2.5 ± 1.5 mm. Pocket reduction was also significantly higher in the test group (3.7 ± 1.8 mm) when compared with the controls (3.2 ± 1.5 mm). A multivariate analysis indicated that the treatment, the clinical centers, baseline PPD and baseline FMBS significantly influenced CAL gains. Odds ratios (ORs) of achieving above-median CAL gains were significantly improved by the test procedure (OR = 2.6, 95% CI 1.2-5.4) and by starting with deeper PPD (OR = 1.7, 1.3-2.2) but were decreased by receiving treatment at the worst-performing clinical center (OR = 0.9, 0.76-0.99). Conclusions: The results of this trial indicated that regenerative periodontal surgery with a GTR/bone replacement material offers an additional benefit in terms of CAL gains, PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone. © Blackwell Munksgaard, 2004.link_to_subscribed_fulltex