External cervical root resorption : determinants and treatment outcomes

Objectives: The objectives of this study were to assess if any systemic condition could be a potential predisposing factor for external cervical root resorption (ECRR), and to assess the long-term ECRR treatment outcome and its determinants. Methods: This study contains data from 76 patients (98 teeth) diagnosed with ECRR at the UBC Graduate Endodontics clinic, from 2008 to 2018. Data regarding the medical and dental history were retrospectively collected from the charts of the ECRR group and an equivalent group of patients without ECRR (control group). Subsequently, the ECRR patients were approached for a follow-up appointment, during which a clinical examination was conducted and intraoral photos were taken. Periapical radiographs, and CBCT if indicated, were taken for the radiographic evaluation. Chi Square test or Fisher’s Exact test were used for statistical comparisons at two levels, patient-based and tooth-based level. The Kaplan Meier curves method was used in order to evaluate the overall ECRR survival/failure rates, and how various treatment-related and local predisposing determinants were associated with the ECRR treatment outcome. Results: Overall, 67 patients were evaluated. The mean follow-up was 3.9 years with the minimum follow-up being one year. The majority of the patients were older than 40 years old (72.4%). The most frequently affected teeth were the maxillary anteriors (31.7%) with the most common diagnosis being Class 2 (38.8%). Half of the cases survived for eight years. Twenty-four teeth failed (i.e. 19 extracted, 5 not functional). The only influencing factor that proved to be statistically significant among the systemic conditions was diabetes, and it was more frequently present in the ECRR group than in the control group. Determinants with statistically significant influence were: the root canal treatment (RCT) and the resorption repair combined with RCT as local determinants; and the tooth location and the Heithersay classification as treatment-related determinants. Conclusions: Diabetes may be a potential systemic predisposing factor for ECRR. RCT and the ECRR repair combined with RCT are associated with lower failure rates. Higher failure rates are associated with posterior teeth and higher classes in the Heithersay classification.Dentistry, Faculty ofGraduat

Treatment outcome of the graduate periodontics clinic at the University of British Columbia : short term and long term results

The active treatment and maintenance for 100 periodontal patients (2,512 teeth) in the graduate periodontics clinic at the University of British Columbia was surveyed. All patients were in maintenance for at least 2 years and had an average duration of maintenance of 5.2 years. A subgroup of patients that were maintained for an average of 11 years was also investigated (19 patients). Patients and teeth were evaluated separately in order to determine the effectiveness of our treatment and maintenance program in terms of probing depth (PD) reduction, attachment level (AL) changes and tooth loss. Pockets were further divided into moderate (4-6 mm) and deep (Si7 mm), while teeth were grouped into molars and nonmolars. Additionally, prognosis of individual teeth and their long-term survivability were investigated. It was found that PD improved significantly during active therapy for all pockets, i.e. 2.1 mm in deep pockets and 0.7 mm in moderate pockets. This improvement continued for the duration of maintenance. Attachment levels improved during initial treatment but slightly deteriorated during maintenance. However, clinically all attachment levels were stable for the duration of our study. Smokers showed similar initial attachment gain and probing depth improvement with nonsmokers. During maintenance though, both AL and PD measurements were better for nonsmokers. Smoking didn't result in significantly greater tooth loss compared to nonsmoking patients in our study. Furthermore, if a patient was assigned in the severe periodontitis group it was likely that he/she would show a better response in PD reduction (1.38 mm vs. 0.34 mm; p<0.01) and attachment gain (0.64 mm vs. -0.48 mm; pO.Ol) compared to moderate periodontitis patients. Pretreatment prognosis and its association with tooth survivability was also studied and the results indicate that although at 5 years the prognoses of "good" and "fair" seem to overlap, by the 11 -year mark they are well separated in terms of percentage of survivability. At 5 years the percent of surviving "good" teeth is 99.4% and that of "fair" teeth is 95.6%. However, at 11 years these numbers change to 99.1% and 89.3% respectively. Notably, the "poor" teeth still have a 79% chance of surviving for 5 years. This number was similar even when evaluating the "poor" molars, alone which showed a 77%) survivability. With molars though we also showed a direct association between survivability and the clinical parameters of increased mobility and furcation involvement. These results seem to indicate that the effectiveness of the UBC graduate periodontics clinic in maintaining its patients is comparable with other studies. Tooth loss appears to be well controlled even for smokers. However, it is likely that a more aggressive smoking cessation protocol would be advantageous to our patients especially during maintenance. When assigning a prognosis we found our criteria to be reasonable and well founded. Our suggestion of using only 4 categories of prognoses instead of the usual 5, was proven to be valid and well supported at 11 years but not at 5 years. It seems that perhaps this modified prognosis assignment (with 4 categories) that we implemented may be more reasonable and effective in terms of communication with patients and with other colleagues.Dentistry, Faculty ofGraduat

The dome technique: a new surgical technique to enhance soft-tissue margins and emergence profiles around implants placed in the esthetic zone

Tassos Irinakis,1 Salwa Aldahlawi1,2 1Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada; 2Faculty of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia Abstract: Achieving symmetry of the soft-tissue margins between anterior maxillary dental-implant restorations and adjacent teeth is a therapeutic challenge for both the implant surgeon and the restorative dentist. This article describes a modified procedure utilizing autogenous connective-tissue grafts to improve primarily buccal soft-tissue margins and secondarily interproximal tissues around tooth-bound single dental implants. This technique has the advantage of allowing for coronal augmentation of the peri-implant soft tissue while maximizing the blood supply to the area by using tunneling-technique principles. A detailed description of the technique and a case with a stable result over 24 months after crown placement is presented. Keywords: esthetic dental treatment, peri-implant soft tissue, autogenous connective-tissue grafts, dental implants, soft tissue augmentation, tunnel technique&nbsp

The effect of implant placement torque on crestal bone remodeling after 1 year of loading

Salwa Aldahlawi,1 Angela Demeter,2 Tassos Irinakis3 1Department of Basic and Clinical Oral Sciences, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia; 2Private Practice, Calgary, Alberta, Canada; 3Graduate Periodontic Program, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada Purpose: The aim of this study was to evaluate and compare crestal bone levels (CBLs) after 1 year of loading of self-tapping bone condensing implants placed with high insertion torque (IT) compared to those placed with lower IT. Materials and methods: A retrospective chart review of 66 consecutive patients who received at least one self-tapping bone condensing implant and were in function for at least 1 year was conducted. On the basis of intrasurgical notes documenting the implant IT, the patient population was divided into group A (implant IT, &gt;55 Ncm) and group B (IT, &lt;55 Ncm). Radiographs taken immediately after insertion and during annual follow-up appointments were evaluated for detecting crestal bone loss. The relationship between IT and crestal bone loss, bone density, and jaw location were analyzed, and a P-value of 0.05 was considered to be statistically significant. Results: A total of 113 self-tapping bone condensing NobelActiveTM implants were placed. The average follow-up period from the placement of the implant restoration was 12.87 (&plusmn;4.83) months. Six implants were classified as failures resulting in overall survival rate of 94.6%. Implants in group A had a mean IT of 67.35 &plusmn; 4.0 Ncm, whereas implants in the group B had a mean IT of 37.9 &plusmn; 12.62 Ncm. Implants in group A had statistically significant crestal bone loss compared to implants in group B (0.95 &plusmn; 1.60 and 0.18 &plusmn; 0.68 mm, respectively). Group A implants placed in the mandible showed significantly more pronounced crestal bone loss (2.12 &plusmn; 1.99 mm) compared to those placed in the maxilla (0.25 &plusmn; 0.65 mm; P&lt;0.05); however, this was not the case in group B implants. Conclusion: Implants inserted with high IT (&gt;55 Ncm) showed more peri-implant bone remodeling than implants inserted with a less assertive IT (&lt;55 Ncm). Bone density and jaw location affect IT and CBLs. Keywords: dental implant, nobelactive, insertion torque, torque, crestal bone level, marginal bone leve