Clipping de Literatura Científica Julho-Agosto 2010

Nesta atual edição do clipping sugerido pela ITI, temos excelentes trabalhos, sempre de revistas científicas com alta penetração e qualidade onde há ratificação de algumas técnicas consagradas através de controles de longo prazo e "n" significante. Há ainda, outros promissores estudos com novas tecnologias que podem se tornar, em breve, a propedêutica adequada dentro do consultório de seu especialista. Confira os trabalhos selecionados. Atenção: para agilização da disponibilização, foram retirados os comentários da cada trabalho. Tais abstracts estão, por si só, bem explicativos, entretanto, será com grande prazer que comentaremos para crescimento conjunto, quaisquer observações dos leitores do blog. Mande seu recado!

Degidi M, Nardi D, Piattelli A. A comparison between immediate loading and immediate restoration in cases of partial posterior mandibular edentulism: a 3.year randomized clinical trial. Clin Oral Implants Res 2010;21(7):682-687. Either immediate loading or immediate restoration was performed in 50 patients with partial posterior mandibular edentulism (25 patients per group). A total of 100 implants were placed in healed sites. The prostheses in the restoration group were placed out of occlusal contact, and both groups received definitive restorations in occlusion after 6 months. Marginal bone loss was evaluated after 6, 12, 24 and 36 months. Mobility was detected in two implants, one in each group. Mean marginal bone loss after 3 years was 0.987 ± 0.375 mm and 0.947 ± 0.323 mm in the immediate restoration and immediate loading groups, respectively; there was no significant difference between the groups. Immediate rehabilitation was therefore predictable with both procedures.

Passeri G, Cacchioli A, Ravanetti F, Galli C, Elezi E, Macaluso GM. Adhesion pattern and growth of primary human osteoblastic cells on five commercially available titanium implant surfaces. Clin Oral Implants Res 2010;21(7):756-765. Human primary osteoblastic cells were cultured on five titanium surfaces: polished; machined; sandblasted/acid-etched; sandblasted/acid-etched and modified with H2O2 rinse; and, titanium plasma- sprayed. Cell growth was measured after 3, 7 and 9 days and the production of osteocalcin and osteoprotegerin was evaluated. Cell shape and anchorage was affected by surface topography, with large lamellipodia observed on the polished and machined surfaces and thin filopodia on both sandblasted/acid- etched surfaces. Cell proliferation was greater on the rough surfaces and focal adhesions were stronger on both sandblasted/acid-etched surfaces. Osteoprotegerin increased on all surfaces over time, but osteocalcin production was highest on the sandblastzed/acid-etched/H2O2 rinse surface.

Simonis P, Dufour T, Tenebaum H. Long-term implant survival and success: a 10-16-year follow-up of non- submerged dental implants. Clin Oral Implants Res 2010;21(7):772-777.n A total of 55 patients (from an original 76) who received 131 implants between 1990 and 1997 were available for a 10-16-year clinical and radiographic examination and a questionnaire on satisfaction. Cumulative implant survival up to 16 years was 82.94%, and the biological and technical complication rates were 16.94% and 31.09%, respectively. Most implant losses and biological complications were concentrated in a relatively small number of patients. Patients with a history of periodontitis were noted to have lower implant survival and were more prone to biological complications.

Payer M, Heschl A, Wimmer G, Wegscheider W, Kirmeier R, Lorenzoni M. Immediate provisional restoration of screw-type implants in the posterior mandible: results after 5 years of clinical function. Clin Oral Implants Res 2010;21(8):815-821. A total of 40 implants were placed in 24 patients to replace mandibular molars and premolars, and were immediately provisionalized after placement. Bone levels and implant survival/success were assessed after 12, 24, 36, 48 and 60 months. Significant bone loss was observed in the first year after final restoration, but no further significant increase occurred between 12 and 60 months. Two implants were lost, giving an implant survival rate of 95%; the corresponding implant success rate was 92.5% (two failures plus one implant with excessive bone loss). Careful patient selection appeared to be a key criterion for success.

Koizumi H, Sur J, Seki K, Nakajima K, Sano T, Okano T. Effects of dose reduction on multi-detector computed tomographic images in evaluating the maxilla and mandible for pre-implant surgical planning: a cadaveric study. Clin Oral Implants Res 2010;21(8):830-834. Micro-detector CT with variable tube currents of 80, 40, 20 and 10 mA was used to evaluate the maxillae and mandibles in six cadaver specimens. Multi-planar images were created and assessed by five oral radiologists for visibility of various anatomical landmarks, and the quality of the images was compared to the 80 mA images. The results indicated that anatomical landmarks could be visualized on 40 mA images to almost the same quality as 80 mA images, and 20 mA images were acceptable for diagnostic purposes, but with substantial deterioration of image quality. Significant dose reduction is therefore possible for pre-surgical implant planning with CT.

Widmann G, Zangeri A, Keiler M, Stoffner R, Bale R, Puelacher W. Flapless implant surgery in the edentulous jaw based on three fixed intraoral reference points and image-guided surgical templates: accuracy in human cadavers. Clin Oral Implants Res 2010;21(8):835-841. Implant planning was performed on the basis of CT scans of edentulous cadaver specimens. Surgical templates were fabricated, and the registration mouthpiece and surgical template were supported via three fixed reference points. Implants were inserted through the guide sleeves and the accuracy was evaluated via post-surgical CT. A total of 51 implants were placed in five maxillary and three mandibular edentulous specimens. Mean (± SE) total and lateral error was 1.1 ± 0.6 mm and 0.7 ± 0.5 mm, respectively, at the implant base, and 1.2 ± 0.7 mm and 0.9 ± 0.7 mm at the implant tip and the mean angular error was 2.8° ± 2.2°. Similar accuracy to tooth-supported surgical templates or surgical navigation was therefore found.

von See C, Gellrich N-C, Jachmann U, Laschke MW, Bormann K-H, Rücker M. Bone augmentation after soft-tissue expansion using hydrogel expanders: effects on microcirculation and osseointegration. Clin Oral Implants Res 2010;21(8):842-847. Bone grafts from eight isogenic rats and were implanted in eight rats without tissue expansion and eight rats after tissue expansion. Hydrogel expanders were inserted subperiostally in the tissue expansion group at the augmentation sites. Microcirculation was monitored for 19 days and histological samples were evaluated. Microvessel density was significantly higher in the region above the augmentation material in the tissue expansion group over the whole study, but physiological microcirculation was observed in both groups. Osseointegration of the graft was observed in the tissue expansion group, while connective and granulation tissue was observed in the group without tissue expansion. Hydrogel expanders may therefore increase the probability of success in bone augmentation.

Klinger A, Asad R, Shapira L, Zubery Y. In vivo degradation of collagen membranes exposed to the oral cavity. Clin Oral Implants Res 2010;21(8):873-876. Collagen membranes of three different types (ribose cross-linked, glutaraldehyde cross-linked or non-cross- linked) were placed over the buccal mucosa in the premolar and molar region in 20 subjects. A periodontal dressing was placed over the membrane, which was removed after 10 days to assess membrane integrity. Discomfort, pain or dislodging of the pack led eight subjects to withdraw from the study. Marked differences in membrane integrity between the three types were observed. The results indicated that the ribose cross- linked membrane appeared to be more resistant to degradation.

European Journal of Oral implantology

Vol. 3 No. 2 (June 2010)

Esposito M, Grusovin MG, Loli V, Coulthard P, Worthington HV. Does antibiotic prophylaxis at implant placement decrease early implant failures? A Cochrane systematic review. Eur J Oral Implantol 2010,3(2):101-110. The authors performed a literature search for randomized controlled trials comparing the outcomes of prophylactic regimens versus no antibiotics in implant placement. Four trials were identified; three compared 2 g amoxicillin preoperatively versus placebo (927 patients) and one compared 1 g amoxicillin preoperatively plus 500 mg four times daily versus no antibiotics (80 patients). Significantly more patients experienced implant failures in the groups not receiving antibiotics, but other outcomes were not statistically significantly different. Some evidence therefore suggests that prophylactic amoxicillin may reduce implant failures in ordinary conditions.

Cairo F, Nieri M, Gori AM, Tonelli P, Branchi R, Castellani S, Abbate R, Pini-Prato GP. Markers of systemic inflammation in periodontal patients: chronic versus aggressive periodontitis. An explorative cross-sectional study. Eur J Oral Implantol 2010,3(2):147-153. Blood samples from 45 systemically healthy patients with either chronic (21 patients) or aggressive (24 patients) periodontitis were evaluated for high-sensitivity CRP, cytokine and chemokine levels. No significant differences were found between the groups for periodontal parameters or inflammatory markers, indicating a similar inflammatory profile for chronic and aggressive periodontitis.

Puig CP. A retrospective study of edentulous patients rehabilitated according to the ‘all-on-four’ od the ‘all- on-six’ immediate function concept using flapless computer-guided implant surgery. Eur J Oral Implantol 2010,3(2):155-163. A total of 195 implants were placed and immediately loaded in 30 patients to support 25 maxillary (128 implants) and 17 mandibular (67 implants) full-arch prostheses via the ‘all-on-four’ or ‘all-on-six’ protocols; provisional prostheses were placed immediately with definitive prostheses after 6-12 months. Implant positioning and guided flapless implant placement was by means of Procera software. There were four implant failures in three patients (two each in the maxilla and mandible), three of which were successfully replaced. No definitive prostheses failed and no patients dropped out of the study, but three patients were surgically and antibiotically treated for apically infected implants. Both surgical protocols appeared to be viable and predictable, but may be sensitive to the clinician’s experience.

European Journal of Oral Sciences

Vol. 118 No. 4 (August 2010)

Taylor B, Tofler G, Morel-Kopp M-C, Carey H, Carter T, Elliott M, Dailey C, Villata L, Ward C, Woodward M, Schenck K. The effect of initial treatment of periodontitis on systemic markers of inflammation and cardiovascular risk: a randomized controlled trial. Eur J Oral Sci 2010;118(4):350-356. A total of 136 patients with chronic periodontitis were randomized to receive initial periodontal treatment (test) or no treatment (control) in a 3-month study. Cardiovascular risk factors and hematological, inflammatory and metabolic markers were measured at the start and end of the study. Data were available for 51 test and 64 control patients, and the results showed a non-significant trend towards lower fibrinogen levels in the test group and a significant increase in hemoglobin and hematocrit after intervention. Systemic effects of periodontal treatment were therefore observed.

Implant Dentistry

Vol. 19 No. 3 (June 2010)

Acocella A, Bertolai R, Sacco R. Modified insertion technique for immediate implant placement into fresh extraction socket in the first maxillary molar sites: a 3-year prospective study. Implant Dent 2010;19(3):220- 228. Each of 68 patients scheduled for extraction of a first maxillary molar immediately received an implant in the fresh extraction socket. Regenerative therapy was simultaneously performed, if necessary. Single crowns were placed after 3 months. After 3 years, there were three implant failures, giving a cumulative survival rate of 97.96%. Immediate implant placement in the maxillary first molar position, with appropriate regenerative material, is therefore a valid treatment option.

Bilhan H, Mumcu E, Erol S, Kutay Ö. Influence of platform-switching on marginal bone levels for implants with mandibular overdentures: a retrospective clinical study. Implant Dent 2010;19(3):250-258. A total of 51 patients with 126 implants supporting mandibular overdentures appeared for routine recall visits after 6, 12, 24 and 36 months and were included in the study group. Mean marginal bone level change was assessed from successive radiographs. Significantly lower bone loss was observed for platform-switched implants after 36 months, although rates of mesial and distal bone loss differed at 6, 12 and 24 months.

International Journal of Oral and Maxillofacial Implants

Vol. 25 No. 3 (May/June 2010)

Waasdorp J, Reynolds MA. Allogeneic bone onlay grafts for alveolar ridge augmentation: a systematic review. Int J Oral Maxillofac Implants 2010;25(3):525-531. A literature search was performed for clinical studies using allogeneic bone grafts for alveolar bone augmentation. From an initial 35 publications identified, nine were included in the review (six case series, one prospective multicenter case series and two case reports). High graft incorporation and implant survival were found in observational studies, but most articles involved selected defects in the anterior region with < 3 years follow-up. Clinical evidence therefore differed in terms of defects, treatment and therapeutic endpoints. The potential for allogeneic block grafts was shown, but there is insufficient evidence to establish treatment efficacy.

Valderrama P, Jones AA, Wilson TG Jr, Higginbottom F, Schoolfield JD, Jung RE, Noujeim M, Cochran DL.

Bone changes around early loaded chemically modified sandblasted and acid-etched surface implants with and without a machined collar: a radiographic and resonance frequency analysis in the canine mandible. Int J Oral Maxillofac Implants 2010;25(3):548-557. A total of 72 implants, 36 with a 2.8 mm machined collar and 36 without a machined collar, were placed in six dogs. Implant stability (by resonance frequency analysis) was measured weekly for 3 weeks, and the implants were loaded after 21 days. Periapical radiographs were taken at 3 weeks and 3, 6, 9 and 12 months. Implant stability increased by 5 ISQs for implants with a machined collar and by 7 ISQs for implants without a machined collar from implant placement to week 3. After 12 months, a mean bone loss of 1.0 mm was observed for the machined collar implants, compared to mean bone gain of 0.11 mm for implants without a machined collar. Coronal bone apposition was attributed to the properties of the chemically modified implant surface.

Weinländer M, Piehslinger E, Krennmair G. Removable implant-prosthodontic anchorage of the edentulous mandible: five-year results of different prosthetic anchorage concepts. Int J Oral Maxillofac Implants 2010;25(3):589-597. Different bar retention designs were evaluated in 76 patients: 39 patients received an overdenture with an ovoid bar supported on two implants (design 1) or multiple ovoid bars on four implants (design 2), and 27 patients received a rigid implant-supported prosthesis with a milled bar. Implant survival, peri-implant parameters and prosthodontic maintenance were assessed over 5 years. Implant survival was 100% and there was no difference in peri-implant parameters between the groups. Prosthodontic maintenance was not significantly different between the overdenture groups, but was significantly lower for the group with rigid prostheses and milled bars. High patient satisfaction was noted for all designs.

Garcia-Bellosta S, Bravo M, Subirá C, Echeverría JJ. Retrospective study of the long-term survival of 980 implants placed in a periodontal practice. Int J Oral Maxillofac Implants 2010;25(3):613-619. Clinical records of 323 patients with 980 implants were retrospectively reviewed; 71.1% of implants were placed in patients undergoing periodontal maintenance care and 38.8% were placed in smokers. The cumulative implant survival rate was 96.2%, and most implant failures occurred before implant loading. The risk of failure was not increased with periodontitis or smoking, but the risk of failure was increased in individuals with many implants and with implants placed in sinus elevation. Implant placement is therefore reliable long-term, even in smokers or patients with periodontitis.

International Journal of Periodontics and Restorative Dentistry

Vol.30 No. 3 (May/June 2010)

Kan JYK, Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival biotype assessment in the esthetic zone: visual versus direct measurement. Int J Periodontics Restorative Dent 2010;30(3):237-243. The gingival biotype of an anterior maxillary failing tooth in 48 patients was assessed by three different methods: visual, periodontal probing or direct measurement; for direct measurements, ≤ 1.0 mm was considered thin and > 1.0 mm was considered thick. Mean gingival thickness was 1.06 ± 0.27 mm, and thick and thin biotypes were evenly distributed. There was a significant difference between visual assessment and assessment with a periodontal probe or direct measurement, but there was no significant difference between periodontal probing and direct measurement. Periodontal probing for assessment of gingival biotype is therefore adequately reliable, but visual assessment alone is not.

Tymstra N, Meijer HJA, Stellingsma K, Raghoebar GM, Vissink A. Treatment outcome and patient satisfaction with two adjacent implant-supported restorations in the esthetic zone. Int J Periodontics Restorative Dent 2010;30(3):307-316. Ten patients with two adjacent implants in the anterior maxilla, and who previously received augmentation with autogenous bone, were included in this study. Clinical and esthetic parameters were evaluated. No implants were lost. Bone crest level between the implants was significantly more apical than that between an implant and the adjacent tooth, and complete filling of the interproximal space was observed was observed in only one patient, but the papilla between implant and neighboring tooth was seen in seven patients. The esthetic outcome of the implant-supported was rated as ‘acceptable’ in all cases by the patients, but clinicians rated six as ‘acceptable’ and four as ‘unacceptable’. Esthetic results were therefore difficult to achieve.

International Journal of Prosthodontics

Vol. 23 No. 3 (May/June 2010)

Andreiotelli M, Att W, Strub J-R. Prosthodontic complications with implant overdentures: a systematic literature review. Int J Prosthodont 2010;23(3):195-203. A literature search was performed for clinical studies with data regarding prosthetic complications with follow- up periods of at least 5 years. Only a limited number of randomized controlled trials were identified, and very few prospectively compared prosthetic complications for over 5 years. Predictable results were observed with implant-supported overdentures in terms of stability, retention and patient satisfaction, but lower implant survival and a higher prosthetic complication rate is observed for maxillary overdentures. Considerable information on complications can be found, but analysis is difficult due to variations in study design. Well designed longitudinal studies are therefore required.

Journal of Clinical Periodontology

Vol. 37 No. 7 (July 2010)

Vol. 37 No. 8 (August 2010)

Benguigui C, Bongard V, Ruidavets J-B, Chamontin B, Sixou M, Ferrières J, Amar J. Metabolic syndrome, insulin resistance, and periodontitis: a cross-sectional study in a middle-aged French population. J Clin Periodontol 2010;37(7):601-608. A cross-sectional survey on cardiovascular risk factors included 276 subjects, 21 of whom were excluded due to edentulism or infectious risk. Periodontal parameters were recorded and periodontitis was classified as moderate or severe. Moderate or severe periodontitis was identified in 41% and 39% of subjects, respectively, and periodontitis was found to be associated with metabolic syndrome, most of its components, and the homeostasis model assessment of insulin resistance (HOMA) index. The association between HOMA index and severe periodontitis remained after adjusting for confounders, and HOMA was also associated with the number of periodontal sites with clinical attachment level ≥ 4 or 5 mm, or probing depth ≥ 4 mm, but there was no such relationship in patients who had never smoked.

Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P. Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol 2010;37(7):644-650. In 13 patients, a total of 93 Miller class I, II and III gingival recessions were treated with coronally advanced flap (CAF) alone or combined with connective tissue graft (CTG) and assessed after 6 months and 1 and 5 years. After 6 months, there was no difference in the number of sites with complete root coverage between the groups, but the prevalence of complete root coverage was significantly greater in the CAF+CTG group after 5 years. Between 6 months and 5 years, the gingival margins showed an apical relapse in the CAF group but a coronal improvement in the CAF+CTG group.

Ronaldo B, Mattos CML, Dibart S. A clinical comparison of two flap designs for coronal advancement of the gingival margin: semilunar versus coronally advanced flap. J Clin Periodontol 2010;37(7):651-658. In this investigation the semilunar coronally re-positioned flap (SLCRF) technique, one of the variants of the semilunar incision was evaluated versus coronally advanced flap (CAF) in 22 patients with 22 contralateral Miller class I gingival recessions. Clinical parameters were recorded at baseline and after 6 months. Coronal displacement of the gingival margin was effective with both techniques, but significantly greater root coverage, frequency of complete root coverage and gain in clinical attachment level was found with CAF. Root coverage obtained immediately following SLCRF surgery was not maintained.

Pires ILO, Cota LOM, Oliveira OCB, Costa JE, Costa FO. Association between periodontal condition and use of tongue piercing: a case-control study. J Clin Periodontol 2010;37(8):712-718. Oral health records of 60 patients with tongue piercings and 120 without tongue piercings were evaluated, including periodontal parameters and tooth fracture, and risk variables for gingival recession were identified. The presence and severity of gingival recession was much higher for those with tongue piercings than for those without, and the risk of gingival recession in the anterior lingual region was 11 times greater. Use of piercings, age, male gender and bleeding on probing were associated with gingival recession in the anterior lingual region.

Zucchelli G, Mele M, Stefanini M, Mazzotti C, Marzadori M, Montebugnoli L, de Sanctis M. Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: a comparative randomized-controlled clinical trial. J Clin Periodontol 2010;37(8):728-738. Recessions in 50 patients were treated with coronally advanced flap (CAF) combined with connective tissue graft (CTG) or de-epithelialized gingival graft (DGG). No significant differences in painkiller consumption, post-operative discomfort or bleeding were observed between the groups, but consumption of painkillers increased with the height of the graft and with primary flap dehiscence/necrosis. A negative correlation was found between pain and residual thickness of soft tissue over the palatal bone, and the DGG group showed significantly greater buccal soft tissue thickness.

Journal of Oral Rehabilitation

Vol. 37 No. 7 (July 2010)

Vol. 37 No. 8 (August 2010)

Lee SY, Piao CM, Koak JY, Kim SK, Kim YS, Ku Y, Rhyu IC, Han CH, Heo SJ. A 3-year prospective radiographic evaluation of marginal bone level around different implant systems. J Oral Rehabil 2010;37(7):538-544. Three different types of implants (rough surface, hybrid smooth and rough surface, and rough surface with microthreads) were placed in 54 patients, with clinical and radiographic examinations performed at implant placement and after 1 and 3 years. A total of 135 implants were placed, of which 120 completed the study. After 3 years, mean bone loss was lower with the rough surface/microthread implants (0.59 ± 0.30 mm) compared to rough (0.95 ±0.27 mm) and hybrid surface (1.05 ± 0.34 mm) implants. The rough surface/microthread implants may therefore have a positive effect on maintenance of marginal bone level.

Journal of Periodontology

Vol. 81 No. 6 (June 2010)

Vol. 81 No. 7 (July 2010)

Waasdorp JA, Evian CI, Mandracchia M. Immediate placement of implants into infected sites: a systematic review of the literature. J Periodontol 2010;81(6):801-808. Infected sites have been considered a contraindication for implant placement, but data have shown similar success rates to implants placed in healthy sites. A literature review was therefore performed for studies where implants were immediately placed in infected sites. A total of 417 articles were identified, of which 12 met the inclusion criteria. Most studies were of sites with chronic periapical infection, but classification was vague and uncategorized in relation to outcome. High implant survival was observed in animal studies, although BIC may be impaired. High implant survival was also seen in clinical studies, but evidence was limited to small numbers of studies and patients. Thorough debridement of the site is required and guided bone regeneration is usually performed.

Bornstein MM, Wittneben J-G, Brägger U, Buser D. Early loading at 21 days of non-submerged titanium implants with a chemically modified sandblasted and acid-etched surface: 3-year results of a prospective study in the posterior mandible. J Periodontol 2010;81(6):809-818. In 39 partially edentulous patients, 56 implants with a chemically modified SLA surface were placed and loaded with provisional crowns after 21 days. Definitive restorations were placed after 6 months, and radiography and soft tissue analysis were performed for up to 36 months. There were no implant failures, but two implants were not osseointegrated after 21 days, so were subjected to a longer healing period. All implants showed favorable clinical and radiographic findings after 36 months, and the survival and success rate was 100%. Significantly lower probing depths and clinical attachment levels were observed compared to a historic control group. Implants with a chemically modified SLA surface can therefore achieve and maintain successful tissue integration over 3 years.

Anitua E, Orive G. Short implants in maxillae and mandibles: a retrospective study with 8 years of follow-up. J Periodontol 2010;81(6):819-826. A total of 1,287 short implants (< 8.5 mm) were placed in 661 patients over an 8-year period, and implant survival and the influence of demographic and clinical factors, surgery-dependent factors and prosthetic variables were analyzed. Overall implant- and subject-based survival rates were 99.3% and 98.8%, respectively (nine implants were lost), after a mean follow-up of 47.9 ± 24.46 months. Because of the low failure rate, none of the variables analyzed were associated with implant failure. Placement of short implants can therefore be safe and predictable.

Nickles K, Ratke-Krüger P, Neukranz E, Raetzke P, Eickholz P. Ten-year results after connective tissue grafts and guided tissue regeneration for root coverage. J Periodontol 2010;81(6):827-836. A total of 38 Miller class I and II recessions in 15 patients were treated using either connective tissue graft (CTG) or guided tissue regeneration (GTR), with clinical parameters measured at baseline and after 120 ± 12 months. After 120 months, nine patients were available for analysis. Significant root coverage from baseline was obtained with CTG after 6 and 120 months, while significantly greater root coverage from baseline was achieved only at 6 months with GTR. A significant loss in coverage occurred in both groups between 6 and 120 months, but the stability of root coverage was significantly better with CTG. More post- surgical discomfort was observed with CTG, but treatment outcomes were significantly better.

Holmlund A, Holm G, Lind L. Number of teeth as a predictor of cardiovascular mortality in a cohort of 7,674 subjects followed for 12 years. J Periodontol 2010;81(6):870-876. Between 1976 and 2002, 7,674 subjects received a dental examination by periodontal specialists, evaluating number of remaining teeth, severity of periodontal disease, number of deepened periodontal pockets and bleeding on probing in relation to cause of death. A total of 629 subjects died over a median follow-up period of 12 years; 299 died from cardiovascular disease (CVD; 167 from coronary heart disease, 83 from stroke, 49 from aortic aneurysm or congestive heart failure (CHD)). All-cause mortality and mortality in CVD and CHD was significantly predicted by number of remaining teeth, age, gender and smoking, but mortality from stroke was not. The risk of mortality from CHD was increased 7-fold for subjects with < 10 teeth compared to those with > 25 teeth. Severity of periodontal disease, number of deepened periodontal pockets and bleeding on probing were not found to be related to mortality. There appears to be a relationship, therefore, between oral health and CVD.

Saito A, Hosaka Y, Kikuchi M, Akamatsu M, Fukaya C, Matsumoto S, Ueshima F, Hayakawa H, Fujinami K, Nakagawa T. Effect of initial periodontal therapy on oral health-related quality of life in patients with periodontitis in Japan. J Periodontol 2010;81(7):1001-1009. A total of 58 patients with periodontitis completed initial periodontal therapy and were assessed for perceptions of oral health-related quality of life. An impact of oral health status on quality of life was perceived by 97% of patients at baseline, with pain, eating and chewing and psychologic function influenced. Oral health was initially rated as poor in over half the patients. Oral health-related quality of life was significantly improved by periodontal therapy, and significantly more patients reported never or rarely having problems with pain and eating/chewing.

Santamaria MP, Ambrosano GMB, Casati MZ, Nociti FH Jr, Sallum AW, Sallum EA. The influence of local anatomy on the outcome of treatment of gingival recession associated with non-carious cervical lesions. J Periodontol 2010;81(7):1027-1034. A total of 78 gingival recession defects in maxillary canines or premolars were treated with coronally advanced flap (CAF) alone or with restoration, or with subepithelial connective tissue graft (CTG) alone or with restoration. Relative reduction in gingival recession and gain in clinical attachment level were evaluated. For relative reduction in gingival recession, there was a significant association with cervical lesion height when CAF and CTG + restoration, and when overall data from both CTG groups, were analyzed, and there was a significant association with cervical lesion depth with CAF. Bone level was also significantly associated with relative reduction in gingival recession and with gain in clinical attachment level in the CTG group, and when considering overall data from the CAF groups.

Quintessence International

Vol. 41 No. 5 (May 2010) Vol. 41 No. 6 (June 2010) Vol. 41 No. 7 (July/August 2010)

Blus C, Szmukler-Moncler S, Vozza I, Rispoli L, Polastri C. Split-crest and immediate implant placement with ultrasonic bone surgery (Piezosurgery): 3-year follow-up of 180 treated implant sites. Quintessence Int 2010;41(6):463-469. A total of 61 split-crest procedures were performed with piezosurgery in 43 patients, and 180 implants were immediately placed. Mean initial ridge width was 3.3 ± 0.7 mm (range 1.5 to 5.0 mm). The mean split length was 14.8 ± 10.8/ mm and the mean final ridge width achieved was 6.0 ± 0.4 mm. Five implants failed to osseointegrate by second-stage surgery; the implant success rate was 97.2% (95.1% and 100% in the maxilla and mandible, respectively). No further implant failures occurred during the 3-year follow-up. Piezosurgery is therefore a predictable technique for split-crest procedures and reduced the risk of soft tissue alteration.

Deppe H, Hohlweg-Majert B, Hölzle F, Schneider KTM, Wagenpfeil S. Pilot study for periodontal treatment and pregnancy outcome: a clinical prospective study. Quintessence Int 2010;41(6):e101-e110. A total of 302 pregnant women were invited for periodontal examination, of whom 62 agreed to screening and 54 met the inclusion criteria. No periodontal treatment was indicated in 28 patients, while 12 patients consented to therapy (full-mouth disinfection) and 14 declined therapy. Gestational age at end of pregnancy, birth weight and growth restriction were evaluated. Periodontal measurements were improved in the periodontally treated group, but there were no significant differences in gestational age, birth weight or growth restrictions between patients who received periodontal therapy and those who did not, and there were no significant differences from the group not requiring periodontal therapy. Further studies are therefore required in this field.