Implant success remains high despite grafting voids in the maxillary sinus

ObjectivesGiven that the nature and presence of voids present within grafted sinuses following maxillary sinus elevation procedures were not known, nor was the contribution of these factors to implant success, the purpose of this study was to investigate these parameters and their relationship to implant success.Materials and MethodsThis study evaluated data from 25 subjects who had a lateral window maxillary sinus augmentation procedure. Cone‐beam computed tomography (CBCT) was performed at baseline and 4 months after surgery. CBCT images were used to evaluate grafted sites prior to implant placement. Using CBCT images, three examiners independently measured bone‐grafted areas (BG), void areas (V), and percentage of void areas (V%) from six different sections within grafted sites. The six sections were defined as a cross‐sectional (CS) midpoint, CS mesial point, CS distal point, horizontal section (HS) low point, HS midpoint, and HS high point. Implant success was also determined.ResultsThe calculated V% (V/BG) for the CS midpoint, CS mesial point, CS distal point, HS low point, HS midpoint, and HS high point were 5.30 ± 6.67%, 5.79 ± 8.51%, 6.67 ± 7.12%, 2.07 ± 2.56%, 5.30 ± 6.62%, and 4.92 ± 5.17% respectively. Implant success after 6 months of follow‐up approximated 100%.ConclusionsAlthough voids within grafts varied in terms of distribution and size, the V% within the HS low point were significantly smaller compared to those within the CS midpoint and CS distal point, which had the most intra‐subject V%. Thus, more attention should be given to the distal aspect of the sinus when compacting graft materials in the lateral wall sinus augmentation procedure. Implant success was not influenced by the existence of voids as implant success remained high.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110843/1/clr12386.pd

Quantitative tooth mobility evaluation based on intraoral scanner measurements

BackgroundTooth mobility assessment is subjective and current techniques require the translation of a continuous variable to a categorical variable based on the perception of the examiner. The aim of this study was to evaluate the reliability of a novel technique to assess tooth mobility.MethodsThree experienced periodontists were asked to push tooth #16 into a buccal position to in a typodont model with different mobility (M1â M2). Tooth position was obtained using an intraoral scanner and files were compared in metrology software. Mobility was calculated at three reference points at the cervical (C), middle (M), and occlusal (O) regions of the buccal surface of the tooth to determine the linear deviation in the three axes (x, y, and z). Reliability was determined by intraclassâ correlation coefficient, differences between M1 and M2 determined by t test, and the analysis of variance (ANOVA) was used to compare the data at the Câ Mâ O regions.ResultsExcellent reliability was assessed by Cronbach alpha >0.9 on the xâ yâ z axes for both mobility tested, except for M1â C X (0.85), M1â M Y (0.89), and M2â M Z (0.89). The correlation between the examiners demonstrated excellent (Ë 0.90) or good (0.75Ë x Ë 0.90) consistency, except for M1â C Y (0.73; examiner 1 to 2) and M1â M X (0.69; examiners 1 to 3). Significant changes were detected in all axes at the three reference points comparing M1 and M2, and a similar proportional change was observed between Oâ Mâ C reference points for M1 and M2.ConclusionA novel technique to assess tooth mobility based on intraoral scanner measurements provided reliable data in an in vitro experiment.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154459/1/jper10409_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154459/2/jper10409.pd

Characterization of macrophages infiltrating periâ implantitis lesions

ObjectivesThe mechanisms involved in the initiation and progression of periâ implantitis lesions are poorly understood. It was the aim to determine the content and activation status of macrophages present in human periâ implantitis lesions and compare the current findings with the macrophage polarization associated with periodontitis lesions.Material and MethodsA total of 14 patients were studied in this investigation. Seven were soft tissue biopsies from dental implants affected by periâ implantitis that required explantation. Seven biopsies were from chronic periodontal disease. Immunofluorescence stains were performed using biomarkers to identify macrophages (CD68+) undergoing M1 polarization (iNOS+) and M2 polarization (CD206+), along with Hoechst 33,342 to identify DNA content. All samples were stained and photographed, and doubleâ positive cells for CD68 and iNOS or CD68 and CD206 were quantified.ResultsAll periâ implantitis biopsies examined revealed a mixed population of macrophages undergoing M1 polarization and M2 polarization. Further analysis demonstrated the coâ expression of iNOS and CD206, which indicates the presence of a heterogenic immune response on periâ implantitis lesions. Macrophage polarization in periâ implantitis lesions presents a distinct pattern than in periodontitis. We observed a significant increase in the population of M1 macrophages on periâ implantitis samples compared to periodontal disease samples.ConclusionOur results demonstrate that periâ implantitis has higher numbers of macrophages displaying a distinct macrophage M1 polarization signature compared to periodontitis lesions. This pattern may explain, in part, the distinct nature of periâ implantitis progression vs. periodontitis in humans.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154542/1/clr13568_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154542/2/clr13568.pd

Characterization of macrophage polarization in periodontal disease

AimTo explore the M1/M2 status of macrophage polarization from healthy, gingivitis, and periodontitis patient samples.Materials and methodsGingival biopsies were collected from 42 individuals (14 gingivitis, 18 periodontitis, and 10 healthy samples) receiving periodontal therapy. Histomorphology analysis was performed with haematoxylin and eosin staining. Immunofluorescence was performed using a combination of CD68 (macrophages), iNOS (M1), and CD206 (M2) in order to acquire changes in macrophage polarization at a singleâ cell resolution. Macrophages were quantified under microscopy using narrow wavelength filters to detect Alexa 488, Alexa 568, Alexa 633 fluorophores, and Hoechst 33342 to identify cellular DNA content.ResultsGingivitis and periodontitis samples showed higher levels of macrophages compared with healthy samples. Unexpectedly, periodontitis samples displayed lower levels of macrophages dispersed in the stromal tissues compared with gingivitis samples; however, it remained higher than healthy tissues. The polarization of macrophages appears to be reduced in periodontitis and showed similar levels to those observed in healthy tissues.ConclusionsOur study found that gingivitis and periodontitis differ from each other by the levels of macrophage infiltrate, but not by changes in macrophage polarization.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150506/1/jcpe13156_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150506/2/jcpe13156.pd

The Root Complex in Posterior Teeth: A Direct Digital Analysis.

The aim of this morphometric study was to precisely determine the three-dimensional characteristics of the root complex of the posterior dentition. Extracted and well-preserved permanent posterior teeth were included in this analysis and grouped based on tooth type and arch location. All teeth were digitally scanned. Morphological and dimensional features of the root complex were assessed, including length and surface area of the root trunk and individual roots, width of root concavities (RC), and furcation entrance, when present. A total of 240 posterior teeth constituted the sample of this study. The root complex of multi-rooted maxillary first premolars presented with a long root trunk (10.49mm), representing 65.52% of the surface area, and two short roots comprising the remaining 34.8% of the surface area. Root trunks of mandibular molars were on average 0.8mm shorter compared to their maxillary counterparts. Class III furcation involvement is expected in all maxillary and mandibular molars as well as multi-rooted maxillary first premolars after 4.80mm and 10.49mm of clinical attachment loss (CAL), respectively. Root concavities were a common finding among the evaluated dentitions. The root complex morphology varies among the maxillary and mandibular posterior dentition. Particularly, the multi-rooted maxillary first premolar presents with unique features exhibiting a long root trunk that encompasses 65% of the root surface area. Root concavities are highly prevalent on both maxillary and mandibular dentition. The findings derived from this study can be utilized in daily clinical practice for the adequate management of posterior dentition and serve as a reference for future investigations in dental anatomy and digital technology. Also, these findings can guide the industry into creating and redefining tools that adequately adapt to the anatomical characteristics and variations of the specific tooth type

Implant success remains high despite grafting voids in the maxillary sinus.

ObjectivesGiven that the nature and presence of voids present within grafted sinuses following maxillary sinus elevation procedures were not known, nor was the contribution of these factors to implant success, the purpose of this study was to investigate these parameters and their relationship to implant success.Materials and methodsThis study evaluated data from 25 subjects who had a lateral window maxillary sinus augmentation procedure. Cone-beam computed tomography (CBCT) was performed at baseline and 4 months after surgery. CBCT images were used to evaluate grafted sites prior to implant placement. Using CBCT images, three examiners independently measured bone-grafted areas (BG), void areas (V), and percentage of void areas (V%) from six different sections within grafted sites. The six sections were defined as a cross-sectional (CS) midpoint, CS mesial point, CS distal point, horizontal section (HS) low point, HS midpoint, and HS high point. Implant success was also determined.ResultsThe calculated V% (V/BG) for the CS midpoint, CS mesial point, CS distal point, HS low point, HS midpoint, and HS high point were 5.30 ± 6.67%, 5.79 ± 8.51%, 6.67 ± 7.12%, 2.07 ± 2.56%, 5.30 ± 6.62%, and 4.92 ± 5.17% respectively. Implant success after 6 months of follow-up approximated 100%.ConclusionsAlthough voids within grafts varied in terms of distribution and size, the V% within the HS low point were significantly smaller compared to those within the CS midpoint and CS distal point, which had the most intra-subject V%. Thus, more attention should be given to the distal aspect of the sinus when compacting graft materials in the lateral wall sinus augmentation procedure. Implant success was not influenced by the existence of voids as implant success remained high

Interproximal Soft Tissue Height Changes After Unassisted Socket Healing versus Alveolar Ridge Preservation Therapy.

The primary aim of this study was to evaluate the efficacy of alveolar ridge preservation (ARP) therapy compared with unassisted socket healing (USH) in attenuating interproximal soft tissue atrophy. Adult subjects that underwent maxillary single-tooth extraction with or without ARP therapy were included in this study. Surface scans and cone beam computed tomography were obtained to digitally assess interproximal soft tissue height changes and measure facial bone thickness (FBT), respectively. Logistic regression models were conducted to investigate the individual effect of demographic and clinical variables. Ninety-six subjects (USH=49; ARP=47) constituted the study population. Linear soft tissue assessments revealed a significant reduction of the interproximal soft tissue over time within and between groups (P1mm), independently of the treatment received (P<.0001). Nevertheless, ARP therapy resulted in better preservation of interproximal soft tissue height especially in thin bone phenotype by a factor of 2 for the mesial site (+1.3mm) and a factor of 1.6 (+0.9mm) for the distal site. This study demonstrated that ARP therapy largely attenuates interproximal soft tissue dimensional reduction after maxillary single-tooth extraction compared with USH

Protein biomarkers and microbial profiles in periâ implantitis

ObjectivesThe aim of the present investigation was to determine the profile of periâ implant crevicular fluid (PICF) biomarkers combined with microbial profiles from implants with healthy periâ implant tissues and periâ implantitis to assess realâ time disease activity.Material and methodsSixtyâ eight patients were included in this crossâ sectional study. They were divided into two groups: 34 patients with at least one healthy implant (control) and 34 with at least one periâ implantitis affected implant (test). Total DNA content and qPCR analysis for periodontal bacteria obtained from subgingival plaque samples (Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) and a PICF analysis for ILâ 1β, VEGF, MMPâ 8, TIMPâ 2, and OPG were performed. The individual and combined diagnostic ability of each biomarker for periâ implantitis and target bacterial species were analyzed.ResultsThe mean concentration of ILâ 1β (44.6 vs. 135.8 pg/ml; P < 0.001), TIMPâ 2 (5488.3 vs. 9771.8 pg/ml; P = 0.001), VEGF (59.1 vs. 129.0 pg/ml; P = 0.012), and OPG (66.5 vs. 111.7 pg/ml; P = 0.050) was increased in the periâ implantitis patients. The mean expression of MMPâ 8 (6029.2 vs. 5943.1 pg/ml; P = 0.454) and did not reveal a meaningful difference among groups. Total bacterial DNA of selected microorganisms was associated with a threefold or greater increase in periâ implantitis although no statistical significant difference. The ability to diagnose diseased sites was enhanced by T. denticola combined with ILâ 1β, VEGF, and TIMPâ 2 PICF levels.ConclusionThe present data suggest that the increased levels of the selected PICFâ derived biomarkers of periodontal tissue inflammation, matrix degradation/regulation, and alveolar bone turnover/resorption combined with siteâ specific microbial profiles may be associated with periâ implantitis and could have potential as predictors of periâ implant diseases.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134099/1/clr12708.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134099/2/clr12708_am.pd