Immediate loading of dental implants supporting fixed partial dentures in the posterior mandible: A randomized controlled split-mouth study - Machined versus titanium oxide implant surface

PURPOSE: A split-mouth study was conducted to compare dental implants with either machined or titanium oxide (TiO) surfaces immediately loaded with fixed partial dentures in the posterior mandible. MATERIALS AND METHODS: Ten patients with bilateral partial edentulism in the posterior mandible received 42 implants; 20 on the test (TiO) and 22 on the control (machined) side. The implants were loaded within 24 hours postsurgery. At implant placement the maximum insertion torque (IT) was recorded. Implant stability quotient (ISQ) was also evaluated at baseline (day 0) and 1, 2, 4, 12, 24, and 52 weeks following implant placement. The radiographic bone level (RBL) change was measured on periapical radiographs at baseline and 12 months after loading. Means for the 2 groups were compared by paired t test. RESULTS: The overall implant success rate was 95%. No implants were lost in the test group; 2 failed in the control group. The difference between the groups in RBL change after 1 year of function was not statistically significant (P = .224). However, average RBL change for machined implants in distal positions was significantly higher than for TiO surface implants in the same position (post-hoc comparison; P = .048). ISQ and peak IT values did not differ between the groups (P = .414 and P = .762, respectively). The high IT necessary to insert the implants did not seem to affect the RBL change (P = .203). CONCLUSIONS: No significant difference was observed between machined and TiO implant surface in terms of RBL change or ISQ, although TiO implants may provide a lower RBL change compared to machined implants when utilized in the distal position. Immediate loading of implants using fixed partial dentures in posterior mandible may be considered as a treatment option if implants are inserted with IT > or = 20 Ncm and ISQ > or = 60 into nonaugmented bone and loaded with light centric occlusal contact

La GTR nei difetti di forcazione. Trattamento di molari mandibolari.

--

La Rigenerazione Tessutale Guidata nei difetti di forcazione. Trattamento di molari mandibolari

Scopo del presente studio clinico è stato valutare l’efficacia di una membrana riassorbibile in collagene nel trattamento di forcazioni di Grado II in molari mandibolari secondo i principi della rigenerazione guidata dei tessuti (GTR). Il gruppo di studio è risultato costituito da 6 forcazioni vestibolari con coinvolgimento di Grado II in molari mandibolari, trattate consecutivamente in 6 pazienti. La procedura chirurgica ha previsto l’esecuzione di un’incisione intrasulculare con una estensione tale da permettere agevole accesso al difetto. Se necessario, sono state effettuate incisioni verticali di rilascio. Dopo scollamento di un lembo a spessore misto e accurata detersione del difetto, una membrana in collagene Paroguide è stata posizionata a completa copertura della forcazione e dei circostanti margini ossei. Il lembo è stato poi posizionato il più coronalmente possibile e senza tensioni. I parametri clinici, misurati immediatamente prima della chirurgia e a distanza di 6 mesi postchirurgici, sono stati : indici di placca e gengivale difetto-specifici, profondità di sondaggio (PD), livello di attacco clinico verticale (CAL-v) e orizzontale (CAL-h), profondità di recessione (RD), e ampiezza di gengiva cheratinizzata (KT). I risultati a 6 mesi mostrano un guadagno medio del CAL-v pari a 1.8 mm, associato ad una diminuzione della PD e ad un aumento della copertura radicolare in corrispondenza delle forcazioni trattate. Il CAL-h ha mostrato una diminuzione da 4.3 mm prechirurgici a 3.2 mm dopo 6 mesi di guarigione. 4 forcazioni hanno mostrato un guadagno di CAL-h variabile da 1 a 3 mm. La KT ha mantenuto un’ampiezza pressochè costante durante il periodo di osservazione. I risultati del presente studio indicano che l’utilizzo della membrana in collagene Paroguide secondo i principi della GTR nel trattamento di forcazioni mandibolari di Classe II può migliorare la condizione clinica di tali difetti. Il collagene presenta caratteristiche di biocompatibilità e di integrazione tessutale che lo rendono particolarmente adatto come materiale-barriera nelle tecniche chirurgiche di tipo rigenerativo

Effect of pretreatment with ketorolac tromethamine on post-operative pain following periodontal surgery

A double-blind, randomized, single-dose clinical trial to evaluate the analgesic efficacy of preoperative ketorolac tromethamine administration on periodontal postoperative pain was designed. One group received 20 mg ketorolac immediately before periodontal flap surgery, and the other group received placebo. Naproxen sodium was allowed postoperatively as rescue medication. The visual analog scale was used to estimate pain. Postoperative pain was assessed hourly for the first 10 h on the day of surgery, and 4 x daily on the 1st and 2nd postsurgical days. Timing and dose of rescue analgesic remedication were also recorded. Results indicated that preoperative treatment with ketorolac significantly reduced initial pain intensity and delayed the onset of postoperative pain as compared to placebo. Incidence and amount of naproxen consumption was similarly small in both ketorolac- and placebo-treated groups. No adverse reactions related to preoperative medication were observed

Effects of a fibrin-fibronectin sealing system on proliferation and type I collagen synthesis of human PDL fibroblasts in vitro.

Fibrin glue (FG) is an agent widely used in many surgical disciplines for achieving hemostasis and tissue adhesion. The aim of this investigation was to determine the effectiveness of a highly concentrated FG (Tissucol) on the growth and phenotypic expression of human periodontal ligament (PDL) fibroblasts. PDL fibroblast strains were established from cells scraped from PDL, and cultured in the presence and absence of FG for 48 and 72 h. Cell proliferation was studied by counting cells and mitoses, and by immunocytochemical detection of the proliferation-associated Ki-67 nuclear antigen. Type-I collagen production was assessed by radioimmunological assay of the procollagen C-terminal peptide. Results showed that FG treatment was compatible with PDL fibroblast growth and type-I collagen synthesis, although a reduced trend in cell proliferation and collagen production was found in FG-supplemented cultures compared to control cultures. We conclude that FG may represent a suitable substrate for supporting PDL fibroblast growth and function