Is measurement of the gingival biotype reliable? Agreement among different assessment methods

To determine agreement among the most commonly used methods for assessing the gingival biotype. An electronic survey was sent to a sample of dentists practicing in Spain. The questionnaire was based on the evaluation of 5 cases involving different gingival biotype assessment methods. Dentists were required to classify the cases as having a ?thin?, ?thick? or ?not able to classify? biotype. Each case was assessed using a frontal intraoral photo of the anterior teeth; an enlarged photo of the buccal aspect of the tooth with a periodontal probe inserted inside the sulcus; and the real thickness measured in mm with a calibrated needle. Agreement among the classifications was assessed using Cohen?s kappa coefficient. A total of 104 surveys were analyzed. The most commonly used assessment method was visual evaluation of the morphology of the gingiva and the teeth (62.5%). Concordance among the three different methods was weak (kappa = 0.278). Agreement among the classification methods was greater in extreme cases (thinner and thicker gingival thickness). The most commonly used methods for assessing gingival biotype are not reliable. The three tested methods show poor to weak agreement, which leads to non-reliable estimation of the gingival biotype

Influence of wound closure on the volume stability of particulate and non-particulate GBR materials: an in vitro cone-beam computed tomographic examination. Part II.

Objectives: to test whether GBR with an L-shaped soft-block bone substitute and particulate bone substitute differs from GBR with particulate bone substitute as regards the volume stability of the augmented region during flap closure. Materials and methods: twenty peri-implant box-shaped bone defects were created in 10 pig mandibles. Every bone defect was augmented with each of the following two GBR procedures in turn: control group - particulate xenograft applied buccally + collagen membrane + pins; test group - particulate xenograft applied buccally + L-shaped soft-block xenograft applied buccally and occlusally + collagen membrane + pins. Cone-beam computed tomography scans were obtained before and after wound closure. The horizontal thickness (HT) of the augmented region (bone substitute + membrane) was assessed at the implant shoulder (HT0 mm ) and at 1 mm to 5 mm apical to the implant shoulder (HT1 mm -HT5 mm ). In the test group, the vertical thickness (VT) and 45° thickness (45-T) of the augmented region were measured from the implant shoulder. The changes in HT during flap suturing were calculated as absolute (mm) and relative values (%). Repeated-measures ANOVAs were used for statistical analysis. Results: the reduction in HT0 mm was 20.5 ± 23.3% (SD) in the control group and 2.4 ± 9.2% (SD) in the test group (P = 0.014). There were no statistically significant differences in changes in HT1-5 mm between the groups (P > 0.05). In the test group, the reduction in VT amounted to 28.0 ± 11.9% (SD) and the reduction in 45-T amounted to 24.8 ± 10.2% (SD) (P < 0.001). Conclusion: the addition of an L-shaped soft-block bone substitute to a particulate xenograft, covered by a collagen membrane and fixed with pins, significantly improved the horizontal volume stability of the augmented region during wound closure

Fracture resistance after implantoplasty in three implant-abutment connection designs

To assess the effect of implantoplasty and implant-abutment design on the fracture resistance and macroscopic morphology of narrow-diameter (3.5 mm) dental implants. Screw-shaped titanium dental implants (n = 48) were studied in vitro. Three groups (n = 16) were established, based on implant-abutment connection type: external hexagon, internal hexagon and conical. Eight implants from each group were subjected to an implantoplasty procedure; the remaining 8 implants served as controls. Implant wall thickness was recorded. All samples were subjected to a static strength test. The mean wall thickness reductions varied between 106.46 and 153.75 µm. The mean fracture strengths for the control and test groups were, respectively, 1211.90±89.95 N and 873.11±92.37 N in the external hexagon implants; 918.41±97.19 N and 661.29±58.03 N in the internal hexagon implants; and 1058.67±114.05 N and 747.32±90.05 N in the conical connection implants. Implant wall thickness and fracture resistance (P < 0.001) showed a positive correlation. Fracture strength was influenced by both implantoplasty (P < 0.001) and connection type (P < 0.001). Implantoplasty in diameter-reduced implants decreases implant wall thickness and fracture resistance, and varies depending on the implant-abutment connection. Internal hexagon and conical connection implants seem to be more prone to fracture after implantoplasty

Antibiotic prescription for the prevention and treatment of postoperative complications after routine dental implant placement. A cross-sectional study performed in Spain

As there are no established guidelines for antibiotic prescription after dental implant placement a study was made to determine the current prescribing habits of several groups of practitioners regarding antibiotics to prevent and/or treat postoperative complications ? early failures and infections ? in relation to routine dental implant placement. An electronic survey was sent to postgraduate students and professionals with experience in routine dental implant placement who practice in Spain. The questions asked were related to whether antibiotics were routinely prescribed either pre- or postoperatively to prevent and/or treat postoperative complications during routine dental implant placement, and, if so, what antibiotics, dosage, frequency, and duration were used. Descriptive and bivariate analyses of the data were performed. Two hundred and forty-seven responses were obtained. Preventively, 17 respondents (6.9%) prescribed antibiotics only preoperatively (95% confidence interval (CI): 3.7 to 10.0%), 100 (40.5%) preferred to give them exclusively during the postoperative period (95%CI 34.4 to 46.6%) and 94 practitioners (38.1%) prescribed antibiotics both pre- and post-operatively (95%CI 32.0 to 44.1%). The most common preoperative regime was amoxicillin 2 g given orally 1 hour before the procedure (21.6%, n = 24) following amoxicillin 750 mg given orally 1 day prior to surgery (21.6%, n = 24). The most common routine postoperative regime was amoxicillin 750 mg given orally for 7 days (34.0%, n = 66). To treat postoperative infections during the osseointegration period, 233 respondents (93.2%) prescribed antibiotics (95%CI 91.4 to 97.2%). The most common regime used was amoxicillin and potassium clavulanate 875/125 mg, given orally for 7 days (51.9%, n = 121). There is no consensus among dental clinicians regarding antibiotic use during routine dental implant placement to prevent postoperative complications and/or early failures. Moreover, the most commonly-prescribed regimes differ from that recommend in the latest published studies

Effect of crown to implant ratio and implantoplasty on the fracture resistance of narrow dental implants with marginal bone loss: an in vitro study

Background: Peri-implantitis is a biological complication that affects soft and hard tissues around dental implants. Implantoplasty (IP) polishes the exposed implant surface, to decontaminate it and make it less prone to bacterial colonization. This study investigates whether a higher clinical crown-to-implant-ratio (CIR) reduces implant fracture resistance and whether implants are more fracture-prone after IP in the presence of 50% of bone loss. Methods: Forty-eight narrow platform (3.5 mm) 15 mm long titanium dental implants with a rough surface and hexagonal external connection were placed in standardized bone-like resin casts leaving 7.5 mm exposed. Half were selected for IP. The IP and control groups were each divided into 3 subgroups with different clinical CIRs (2:1, 2.5:1 and 3:1). The implant wall width measurements were calculated using the software ImageJ v.1.51 through the analysis of plain x-ray examination of all the samples using standardized mounts. A fracture test was performed and scanning electron microscopy was used to evaluate maximum compression force (Fmax) and implant fractures. Results: IP significantly reduced the implant wall width (P < 0.001) in all reference points of each subgroup. Fmax was significantly higher in the 2:1 subgroup (control = 1276.16 N ± 169.75; IP = 1211.70 N ± 281.64) compared with the 2.5:1 (control = 815.22 N ± 185.58, P < 0.001; IP = 621.68 N ± 186.28, P < 0.001) and the 3:1 subgroup (control = 606.55 N ± 111.48, P < 0.001; IP = 465.95 N ± 68.57, P < 0.001). Only the 2.5:1 subgroup showed a significant reduction (P = 0.037) of the Fmax between the controls and the IP implants. Most fractures were located in the platform area. Only 5 implants with IP of the 2:1 CIR subgroup had a different fracture location (4 fractures in the implant body and 1 in the prosthetic screw). Conclusions: IP significantly reduces the fracture resistance of implants with a 2.5:1 CIR. The results also suggest that the CIR seems to be a more relevant variable when considering the resistance to fracture of implants, since significant reductions were observed when unfavorable CIR subgroups (2.5:1 and 3:1 CIR) were compared with the 2:1 CIR samples

Influence of wound closure on the volume stability of particulate and non-particulate GBR materials: an in vitro cone-beam computed tomographic examination. Part II

OBJECTIVES To test whether GBR with an L-shaped soft-block bone substitute and particulate bone substitute differs from GBR with particulate bone substitute as regards the volume stability of the augmented region during flap closure. MATERIALS AND METHODS Twenty peri-implant box-shaped bone defects were created in 10 pig mandibles. Every bone defect was augmented with each of the following two GBR procedures in turn: control group - particulate xenograft applied buccally + collagen membrane + pins; test group - particulate xenograft applied buccally + L-shaped soft-block xenograft applied buccally and occlusally + collagen membrane + pins. Cone-beam computed tomography scans were obtained before and after wound closure. The horizontal thickness (HT) of the augmented region (bone substitute + membrane) was assessed at the implant shoulder (HT0 mm ) and at 1 mm to 5 mm apical to the implant shoulder (HT1 mm -HT5 mm ). In the test group, the vertical thickness (VT) and 45° thickness (45-T) of the augmented region were measured from the implant shoulder. The changes in HT during flap suturing were calculated as absolute (mm) and relative values (%). Repeated-measures ANOVAs were used for statistical analysis. RESULTS The reduction in HT0 mm was 20.5 ± 23.3% (SD) in the control group and 2.4 ± 9.2% (SD) in the test group (P = 0.014). There were no statistically significant differences in changes in HT1-5 mm between the groups (P > 0.05). In the test group, the reduction in VT amounted to 28.0 ± 11.9% (SD) and the reduction in 45-T amounted to 24.8 ± 10.2% (SD) (P < 0.001). CONCLUSION The addition of an L-shaped soft-block bone substitute to a particulate xenograft, covered by a collagen membrane and fixed with pins, significantly improved the horizontal volume stability of the augmented region during wound closure

Revisión bibliográfica de implantología bucofacial del año 2009. 1ª parte

Debido al amplio número de publicaciones que existen sobre Implantología Bucofacial, resultadifícil para el odontólogo seleccionar y leer de forma crítica una cantidad suficiente de artículos que puedan aportarle una información útil para su praxis diaria. En este artículo se pretende sintetizar la información más relevante que se encuentra en las revistas indexadas de la especialidad publicadas durante el año 2009

Revisión bibliográfica de implantología bucofacial del año 2009. 2ª parte

Debido al amplio número de publicaciones que existen sobre Implantología Bucofacial, resulta difícil para el odontólogo seleccionar y leer de forma crítica una cantidad suficiente de artículos que puedan aportarle una información útil para su praxis diaria. En este artículo pretendemos sintetizar la información más relevante que se encuentra en las revistas indexadas de la especialidad publicadas el año 2009

Revisión bibliográfica de implantología bucofacial del año 2009. 2ª parte

Debido al amplio número de publicaciones que existen sobre Implantología Bucofacial, resulta difícil para el odontólogo seleccionar y leer de forma crítica una cantidad suficiente de artículos que puedan aportarle una información útil para su praxis diaria. En este artículo pretendemos sintetizar la información más relevante que se encuentra en las revistas indexadas de la especialidad publicadas el año 2009