A prospective, controlled clinical trial evaluating the clinical radiological and aesthetic outcome after 5 years of immediately placed implants in sockets exhibiting periapical pathology

OBJECTIVE: The aim was to compare the clinical, aesthetic and radiological outcome of immediately placed implants in sockets with or without periapical pathology 5 years after placement. MATERIALS AND METHODS: Twenty-seven patients were followed 5 years after immediate implant placement (test-group: 12 patients with periapical pathologies; control-group: 15 patients without periapical pathology). Clinical (FMBS, FMPS, CAL, keratinized mucosa), aesthetical (length of clinical crown, Papilla index), and radiological (vertical distance implant shoulder to first bone to implant contact (IS-BIC)) parameters were assessed. Both 95% confidence intervals, as well as results of statistical tests (one-sample, two-sample, paired t-test) were provided. RESULTS: After 5 years the implant survival rate was 100% for all 27 implants. In the test group the width of the keratinized mucosa increased significantly over the observation period (0.8 ± 1.0 mm). Concerning aesthetic parameters at the 3-month as well as at the 5-year examination no statistically significant difference could be found between the two groups. In the control-group the papilla mesial and distal to the implant increased statistically significant during the observation period by 0.5 ± 0.5 and 0.4 ± 0.6 index score points, respectively. The position of the gingival margin at the implant site and the two neighboring teeth remained stable. At the 5-year visit IS-BIC measured between 1.4 ± 0.5 mm (mesial, control) and 1.7 ± 0.7 mm (distal, test), no significant difference could be found between the two groups. Over the observation period no statistically significant change of IS-BIC could be found in the test- as well as in the control-group. None of the examined radiographs revealed any signs of retrograde peri-implantitis. CONCLUSION: The replacement of teeth exhibiting periapical pathologies by implants placed immediately after tooth extraction can be a successful treatment modality with no disadvantages in clinical, aesthetical and radiological parameters to immediately placed implants into healthy sockets

Improving Scaling and root planing over the past 40 years: A meta-analysis

Aim: To screen whether or not classical non-surgical periodontal therapy improved over the last four decades and how adjunctive local or systemic measures influenced its clinical outcome. Methodology: Starting from the year 1970, the entire annual sets of publications of every 5th year of the “Journal of Clinical Periodontology” and the “Journal of Periodontology” were hand searched for articles dealing with nonsurgical periodontal therapy, i.e. scaling and root planing either alone (SRP) or in combination with adjunctive local (SRPloc) or systemic (SRPsyst) treatment. Mean pocket reduction was computed for each of the three treatment modalities. Where applicable, a meta-analysis and a meta-regression as well as linear regression were performed. Results: A total of 52 articles were found. Twenty-six thereof were randomized clinical trials. The meta-analysis revealed a standardized mean difference of pocket reduction of 0.77 mm (95% CI=0.283; 1.255) and 0.90 mm (95% CI 0.210; 1.593 for SRPloc–SRP and SRPsyst–SRP, respectively (P<0.0001). Meta regression showed significantly more mean pocket reduction for SRPloc (p=0.011) and SRPsyst (p=0.001) than for SRP. In addition, a negative correlation between time to re-evaluation and mean pocket reduction could be found (p=0.015). None of the treatment modalities improved over the past 40 years. Conclusion: Adjunctive local or systemic measures seem to improve the classic non-surgical periodontitis therapy, i.e. scaling and root planing. None of the three analyzed treatment modalities improved over the past 40 years