Background/Objectives: Controlled tightening force of implant prosthetic screws is achieved using dental torque wrenches. Beam-type wrenches are prone to a parallax error, where different viewing angles can unintentionally alter the applied force, potentially leading to screw loosening and fracture. The objective of this study was to determine the effect of different viewing angles of the operator relative to the wrench’s reading scale and the actual force applied on the prosthetic screw. Methods: Two types of beam torque wrenches (Institut Straumann AG, Switzerland; MIS Implant Technologies, Israel) were used. Five wrenches for each group were connected to a torque meter mounted on a custom 3D printed apparatus, allowing torque read at different viewing angles. Each wrench was tightened according to manufacturer recommendations at angles ranging between ±60 degrees from center position. A camera mounted on a tripod provided magnification and consistency in recordings. For each measurement, a comparison was made between intended tightening force and actual force exerted on the torque meter. Data were analyzed to determine the effect on clinical settings. Results: Both wrenches exhibited a parallax effect with its resulting impact on force delivery by the wrench. When the operator was positioned at a negative angle relative to the wrench, while applying tightening force, the actual force delivered by the wrench was amplified. The greater the angle, the greater the force amplification was. The opposite effect took place when the wrench was viewed from a positive angle relative to the operator. Force alteration reached up to 8.72 Ncm, which can account for as much as 25% from intended force. This effect was notable and statistically significant for both types of wrenches. Conclusions: The tested beam-type torque wrenches present an inherent potential deficiency in which oblique viewing angles lead to either amplification or attenuation of the actual force that is applied. This phenomenon might be associated with a variety of prosthetic failures. Operators are recommended to adopt a viewing strategy that minimizes undesired outcomes.

Objectives: This study aimed to describe implant survival rates and associated risk factors in patients treated with two sinus augmentation techniques—Lateral Window (LW) and Transcrestal (TC)—at a single center. Methods: A retrospective cohort analysis was performed using medical records of patients who underwent maxillary sinus augmentation and subsequent dental implant placement between 2015 and 2019 at the Rambam Healthcare Center. Data on demographic variables, surgical approach, graft materials, implant characteristics, and clinical outcomes were collected from electronic medical records. Results: A total of 135 patients met the inclusion criteria, contributing 144 TC procedures (with 144 implants) and 46 LW procedures (90 implants) to the final analysis. The overall implant failure rate was 7.7%, with a significantly higher failure rate for TC (11.11%) compared to LW (2.22%). Procedure type was a significant predictor of implant survival (OR 1.62); however, as residual bone height (RBH) data were unavailable, confounding by indication cannot be excluded and this finding should be interpreted with caution. Implant length demonstrated a significant influence on outcomes (OR 1.28 per mm increase); shorter implants (8 mm) exhibited lower survival rates (81.3%) compared to 10 mm implants (92.3%). Smoking status was identified as a negative predictor of implant survival (OR 0.23). Schneiderian membrane ruptures occurred in nine cases, seven of which were LW procedures. Smoking was the only factor affecting graft survival (OR 0.29). Conclusions: In this retrospective cohort, implant survival rates were higher in the LW group than in the TC group; however, given that individual residual bone height data were unavailable and case assignment, although governed by standardized departmental criteria, was not randomized, the possibility of confounding by indication cannot be excluded. Smoking and shorter implants were significant risk factors for implant failure. Smoking was also associated with graft failure.

BACKGROUND:This prospective cohort trial examines the effects of heavy smoking on peri-implant marginal bone loss (MBL) and implant survival rates over 15 months. METHODS:Thirty subjects, categorized as either smokers (more than 20 cigarettes daily for over 5 years) or non-smokers, were initially recruited with pocket depths ≤ 5 mm and at least one missing tooth. Urine cotinine assay was used to confirm smoking status. Implants were placed and restored after 4 months. Clinical, radiographic and stability variables were assessed at placement, 15, 24, and 67 weeks. Measurements included marginal bone height, peri-implant pocket depth, implant stability, bleeding on probing, and plaque index. Statistical analyses included Mann-Whitney tests for continuous variables, Fisher exact tests for categorical variables, and generalized estimating equations for longitudinal changes. RESULTS:Thirteen implants were installed in the smoker group (11 subjects) and 18 in the non-smoker group (18 subjects). Survival rates were lower in smokers (84.6%) compared with non-smokers (94.4%). Smokers experienced significantly greater marginal bone loss 12 months after final reconstruction (1.5 ± 0.3 mm versus 0.7 ± 0.6 mm; p = 0.008). Pocket depth was slightly greater in smokers but this did not reach statistical significance. CONCLUSIONS:Heavy smoking significantly increases marginal bone loss and decreases implant survival. Further research is needed to corroborate these findings and develop intervention programs. PLAIN LANGUAGE SUMMARY:Heavy smoking is a well-known risk factor for poor dental health, yet its effects on dental implants are less frequently examined. This study investigated how heavy smoking (more than 20 cigarettes daily for at least 5 years) impacts the success of dental implants. We monitored 29 patients, including both heavy smokers and non-smokers, over 15 months after implant placement and restoration. We evaluated bone loss, implant stability, and success rates. Our results showed that heavy smokers experienced significantly more bone loss-twice as much as non-smokers-along with slightly reduced implant stability and survival. These adverse outcomes likely relate to smoking's negative effects on bone healing and immune function. Our findings underscore the importance of addressing smoking before implant procedures and suggest that quitting smoking could greatly improve long-term outcomes. Further research is needed to develop strategies for mitigating the risks of smoking in implant dentistry.

Background: The aim of this study was to examine publication bias associated with a failure to report research results of studies that were initially posted on the ClinicalTrials.gov registry and to examine factors associated with this phenomenon. Methods: A search was conducted in the ClinicalTrials.gov registry using six dental-related topics. Corresponding publications for trials completed between 2016 and 2019 were then searched using PUBMED, EMBASE and Google Scholar. For studies lacking matching publications, we emailed the primary investigator and received some additional data. For included studies, we recorded additional variables: industry funding, site setting (academic, private research facilities or private practice), design (single or multi-center), geographical location and commencement date vis a vis registration and publication dates. Results: A total of 744 entries were found, of which 7 duplicates were removed; an additional 67 entries just recently completed were removed. An additional 7 studies were in different fields and thus removed. Thus, 663 trials were included; of these, only 337 studies (50.8%) were published. The mean registration to publication interval was 29.01 ± 25.7 months, ranging from +142 to −34 months (post factum registration). Less than 1/3 of the studies were posted prior to commencement, of which much smaller proportions were published (37.3%). Studies that were posted after commencement (n = 462) had a much higher publication rate (56.7%), p < 0.001. Multi-center studies and those conducted in commercial facilities had much higher, though non-significant, publication rates (56.5% and 58.3%, respectively). Conclusions: With only half of the studies registered being published, a major source for publication bias is imminent.

To identify, quantify, and characterize leukocyte populations in PI and periodontitis using flow cytometry. Fresh biopsies from human PI and periodontitis lesions were processed to a single-cell suspension. The immune cell types were identified using flow cytometry. Twenty-one biopsies were obtained and analyzed corresponding to fourteen PI and seven periodontitis samples. Participants’ average age was 63.95 ± 14.77 years without a significant difference between PI and periodontitis patients, the female/male ratio was 8/12, and mean PD was 8.5 ± 2.17. High similarity was found between periodontitis and PI in the main immune cell types. Out of the leukocytes, the PMN proportion was 40

The aim of this article was to compare baseline residual ridge height using Cone-beam Computed Tomography (CBCT) and panoramic radiographs. A secondary aim was to examine the magnitude of vertical bone gain 6 months after trans-crestal sinus augmentation and compare it between operators. Thirty patients, who underwent trans-crestal sinus augmentation simultaneously with dental implant placement, were included in this retrospective analysis. Surgeries were done by 2 experienced surgeons (EM and EG) using the same surgical protocol and materials. Preoperative residual ridge height was measured on panoramic and CBCT images. The final bone height and the magnitude of the vertical augmentation were measured on panoramic X ray taken 6 months after surgery. Mean residual ridge height measured preoperatively using CBCT was 6.07 ± 1.38 mm, whereas these same measurements on the panoramic radiographs yielded similar results (6.08 ± 1.43 mm), which were statistically insignificant (P = .535). Postoperative healing was uneventful in all cases. All 30 implants were successfully osseointegrated at 6 months. The mean overall final bone height was 12.87 ± 1.39 mm (12.61 ± 1.21 and 13.39 ± 1.63 mm for operators EM and EG, respectively; P = .19). Likewise, mean postoperative bone height gain was 6.78 ± 1.57 mm, which was 6.68 ± 1.32 and 6.99 ± 2.06 mm for operators EM and EG, respectively (P = .66). A moderate positive correlation was found between residual bone height and final bone height (r = 0.43, P = .002). A moderate negative correlation was found between residual bone height and augmented bone height (r = -0.53, P = .002). Sinus augmentation performed trans-crestally produce consistent results with minimal interoperator differences between experienced clinicians. Both CBCT and panoramic radiographs produced similar assessment of the preoperative residual bone height.

Purposes: 1. to measure Gingival Thickness (GT) both directly and with CBCT using various exposure times, and compare them. 2. to compare hard tissue measurements between different exposure times within each CBCT system. The study hypothesis was that accuracy of CBCT GT measurement is impaired when reducing exposure time. Methods: 8 fresh pig maxillae were utilized for each of two CBCT scan systems (SysA and SysB). Eight disposable dental needles were inserted into the gingival tissue of each jaw until reaching resistance from the underlying bone. A mark on each needle at its entrance point into the soft tissue was created using a permanent marker. Jaws were scanned twice, using low (RadL) and high (RadH) exposure times. The needles were extruded, and an electronic caliper was used to measure the length of the penetrated portion of the needle in mm (Cli). Radiographic GT was measured on cross sectional images, produced in the axial direcion of the 3D location of the needles (Rad) in two software systems (R and I). Descriptive statistics, t-test and ANOVA were performed. Significance was set at 5%. Results: Software I mean Cli was 2.22mm ± 0.54mm, RadL and RadH were 2.34mm ± 0.47mm and 2.34mm ± 0.52mm. Software R RadL and RadH were 2.16mm ± 0.50mm and 2.23mm ± 0.49mm, respectively. Using pairwise comparisons, both soft and hard tissue RadL and RadH were not statistically different. There was a good correlation between clinical and radiographic measurements of gingival thickness and essentially no significant difference between higher and lower radiation doses. Conclusions: Reducing CBCT radiation may be possible without affecting accuracy of radiographic gingival thickness measurements , thus opening the way to a wider utilization of CBCT in dentistry. Clinical relevance: Reducing radiation dose may enable a wider utilization of CBCT in dentistry.

BACKGROUND:Previous studies focused on the influence of buccal mucosa thickness on peri-implant bone loss and inflammation, with inconclusive results. We observed substantially thicker palatal mucosal tissues at peri-implantitis sites. Therefore, we hypothesize that thick palatal peri-implant mucosa may be associated with deeper pockets and disease severity.PURPOSE:To compare the thickness of the palatal tissue between natural teeth and implants in periodontal health and disease.METHODS:Adult, non-smoker, healthy patients who visited our department for periodontal examination or treatment with restored implants in the posterior maxilla were recruited. Probing depth (PD), plaque index (PI), gingival index (GI) and radiographic measurements were recorded around implant and the contralateral tooth. Palatal tissue thickness was measured using a 30G needle that was inserted perpendicular into the mucosa at the bottom of the periodontal/peri-implant pocket and 3 mm coronally. Differences in the palatal tissue thickness between teeth and implants (in the same patient) was performed using t-test; as well as between peri-implantitis and non-peri-implantitis sites (among patients).RESULTS:Sixty patients were included. Thirty-four implants were diagnosed with peri-implantitis and 26 healthy/mucositis implants with corresponding 24 healthy/gingivitis teeth and 36 teeth with attachment loss. Mean PD was higher around implants (4.47 ± 1.57 mm) than teeth (3.61 ± 1.23 mm, p = 0.001). The thickness of implants' palatal mucosa was higher than in teeth, at the base of the pocket and 3 mm coronally (4.58 ± 1.38 mm vs. 3.01 ± 1.11, p = 0.000; 3.58 ± 2.15 vs. 1.89 ± 1.11, p = 0.000, respectively). Mean palatal tissue thickness was 4.32 ± 2.35 mm for the peri-implantitis group while only 2.61 ± 1.39 in healthy implants, 3 mm coronal to the base of the pocket (p = 0.001). Palatal thickness at peri-implantitis sites was higher (4.32 ± 2.35) compared to periodontitis sites (2.23 ± 0.93), p = 0.000. Implant sites with palatal mucosa >4 mm (n = 32) had deeper mean pockets (5.58 ± 1.98) compared with thinner (≤4 mm) sites (n = 28) (4.48 ± 1.18, p = 0.018).CONCLUSION:Thicker palatal tissue around implants is associated with deeper palatal pockets. Thick palatal tissue was found around implants diagnosed with peri-implantitis.

Objectives: The color is a major factor in determining inflammation status in most gingival indices. Current indices have limitations mainly due to subjective nature. Digital color analysis can provide objective and ac-curate measurements. Thus, the present study aimed to assess by digital tool the gingival color in the different stages of an active periodontal treatment.Methods: Forty patients (19 males and 21 females) diagnosed with periodontitis (stage III/ IV, grade C) and treated surgically were included in the study. Clinical data (probing depth, bleeding on probing, clinical attachment level, gingival index, and gingival recession) and photographs by digital single-lens-reflex (DSLR) camera were recorded before initial periodontal treatment, which included scaling and root surface debridement (T0); the same parameters were then re-evaluated 6-8 weeks (T1) and 3 months after periodontal surgery (regenerative/resective) (T2). Differences between clinical parameters were calculated. The color space defined by the International Commission on Illumination (CIELab) was used to analyze gingival color.Results: In 56 periodontal surgical sites, 168 photographs were taken. The a*-value of the CIELab color system (higher a*-value translate to a stronger red color) was significantly reduced between T0 to T1 and further decreased at T2 (32.01, 29.28, and 27.45 respectively). Significant improvement in clinical parameters were found between T0 to T1 and T1 to T2. Sub-analysis of two distinct surgical interventions revealed that only regenerative procedure improved the a*-value, which was significantly correlated with pocket depth reduction.Conclusions: Photometric analysis can be used to assess gingival color change during periodontal treatment of patients with periodontitis. Clinical significance: Gingival inflammation is a major factor in periodontal assessment; nevertheless, all current gingival inflammation indices are partially subjective and only semi-quantitative. The digital photometric analysis may allow for accurate and objective gingival color assessment during periodontal treatment.

OBJECTIVES To examine whether a surgeons' position affects the axial angulation of dental implants placed freehand. METHOD AND MATERIALS Implants' axial angulation was assessed on digital panoramic radiographs. An occlusal line was plotted based on the neighboring teeth/crowns. The mesial angle between the long axis of the implant and the occlusal line was measured. In addition, post-hoc ideal implant-positioning planning was done on the panoramic digital image, and the angle of the intersection between the long axis of the actual and post-hoc ideal implant was measured. Student t test for unpaired observations and the Kolmogorov-Smirnov nonparametric tests were utilized to compare the ipsi- and contralateral sides and between clinicians. RESULTS Seventy-seven patients (149 implants) were eligible for the study. Implants had slight mesial inclination (mean 97.7 ± 8.7 degrees) which was similar for both the ipsi- (98.2 ± 8.4 degrees) and contralateral sides (97.2 ± 9.1 degrees), P = .491. For the post-hoc planning versus actual placement comparison, the overall median (interquartile range) of implant angular deviation was minimal (-0.25 degrees [-2.98, +3.47]). This was true for both the ipsilateral (-0.5 degrees [-2.9, +2.9]) and contralateral (-0.2 [-4.2, +5.4]) sides, P = .55. For the actual versus post-hoc planning, most observations clustered around the midline (zero to minimal deviation), while for the implant to occlusal plane angle, a tendency towards slight mesial angulation was observed. CONCLUSIONS Dental implants placed freehand by experienced clinicians have only slight axial deviation as measured from post-hoc optimal position. Implants placed in ipsilateral and contralateral sides and by left- and right-dominant-hand clinicians had similar angulations.

OBJECTIVES To screen a sample of Moldavian schoolchildren to establish their periodontal condition using the Pathfinder study design of the World Health Organization (WHO). METHODS Two cohorts - 12- and 15-year schoolchildren - were screened in 12 schools around the country: four schools in the capital city; four more schools in two other larger cities (two schools in each city); and four village schools (one school in each village). In addition to demographic data, the periodontal parameters dental plaque, calculus and bleeding on probing (BOP) were collected. Periodontal pocket depth (PPD) was also measured but only in the cohort of 15-year-old schoolchildren. Measurements were recorded for the six Ramfjord index teeth. RESULTS In total, 720 children were surveyed: 365 (50.7%) were 12 years of age and 355 (49.3%) were 15 years of age; 351 (48.8%) were girls and 369 (51.2%) were boys; 490 (68%) lived in an urban area and 230 (32%) lived in a rural area. Only 4.5% of 15-year-old children presented with a pocket depth of ≥3.5 mm. Children who lived in rural areas had higher plaque scores than children who lived in urban areas (64.8% vs. 54.1%, P = 0.007). In addition, children who lived in urban areas had significantly less calculus (P = 0.047) and shallower PPDs (P = 0.019). Deeper PPD was associated with higher PI and calculus scores. CONCLUSIONS Moderate-to-deep periodontal pockets were not uncommon in children in the 15-year-old cohort. Periodontal status was worse in children from rural areas than in children from urban areas. It is therefore suggested that an educational programme, together with preventive and interceptive protocols, should be adopted in early adolescence and especially in rural regions.

BACKGROUND:Chlorhexidine (CHX) is a broad-spectrum antimicrobial agent commonly used in medicine. Application of (CHX) during abutment connection reduced the bacterial load at the implant-abutment interface. We hypothesize this treatment may consequently reduce peri-implant soft tissue inflammation and marginal bone loss.PURPOSE:To evaluate the effect of a single application of CHX gel inside the dental implant internal hexagon on peri-implant tissue.METHODS:Forty patients were recruited to this randomized, double-blinded, clinical trial. At the time of implant installation, a 4-mm healing abutment was connected to the implant. In the test group, chlorhexidine gel 1% was applied inside the implant hex, whereas control implants did not receive any gel. Clinical and radiographic measurements included soft tissue recession (REC), plaque index (PI), gingival index (GI), plaque index (PI), keratinized mucosa width (KM), probing depth (PD), and a peri-apical parallel x-ray. Peri-implant crevicular fluid (PICF) was collected for cytokine analysis. t-Test was used to compare changes from baseline to 3 months. Mann-Whitney U test and t test were used to compare test and control groups.RESULTS:Twenty patients in the test group and 17 in the control group completed the study. One implant in the control group failed to osteointegrate. There were no significant differences between the control and test groups for REC changes, bone loss, and PD. GI was significantly lower in the test group after 1 week (1.79 ± 0.24 vs 0.75 ± 0.18, respectively) and 3 months (1.18 ± 0.21 vs 0.25 ± 0.12, respectively) although PI was equal. At 3 months, interleukin 1-β (IL1-β) was higher in the control group (p < 0.01) and a positive correlation was found between GI and IL1-β (rs  = 0.60424, p = 0.00032).CONCLUSIONS:Application of chlorhexidine gel reduced inflammation and IL1-β levels in the peri-implant soft tissue.

PURPOSE To describe the postoperative complications following lateral wall sinus augmentation using (poly L-lactideco-ε-caprolactone; PLCL) and natural polysaccharides polymers-coated bovine bone (PBB). The secondary aims were to examine histologic findings and to propose complication management alternatives. MATERIALS AND METHODS This retrospective study included 61 subjects who underwent 67 lateral wall sinus augmentation procedures using PBB in the standard protocol. In cases that presented complications, treatment included additional antibiotic therapy, implant removal, or sinus reentry and total removal of the grafting material. In three cases, biopsy specimens were taken from the sinuses, and histologic analyses were performed. RESULTS The prevalence of postoperative complications was 32.8% (22 of 67 cases) in 18 of the patients (29.5%). The most prevalent symptoms were persistent pain (68.2%), swelling (63.6%), and oroantral fistula (54.5%). Radiographic signs appeared in 45.5% of the complications. A total of 24 implants failed; thus, an overall 80.3% survival rate was established at 19 months. The vast majority of complications (86.4%) were treated eventually with reentry surgery and revealed that the sinus was full with granulation tissue surrounding pieces of a nonossified rubber-like material. In cases where implants were placed, nonosseointegrated implants were surrounded by soft tissue. The sinus was cleaned thoroughly; the graft material remnants were removed together with inflamed parts of the sinus membrane, followed by chlorhexidine and saline lavages. In the biopsy specimens taken from the sinus cavity, there were no histologic features of new bone formation around the grafted material. CONCLUSION Lateral wall maxillary sinus augmentation using PBB was associated with an acute sinus infection histologic appearance and with a 7-times-higher failure rate compared with previous reports. This serious adverse event suggests that PBB cannot be recommended for maxillary sinus augmentations.

In this narrated review, we shall study the commonality and discord in the anatomy, bacterial flora, immune response, rate of progression, and response to therapy. Finally, we shall explore the unique, periimplantitis-related risk factors. The absence of PDL around implants, combined with poor periimplant vascularization and weaker attachment apparatus, might account for the poor cellular response to bacterial implant in periimplantitis. Using 16S ribosomal gene sequencing, it has been recently shown that although certain known periodontal pathogens may also be found around dental implants with periimplantitis, apparently, the multiplicity of bacterial flora in this condition is great with some distinct microorganisms associated with periimplantitis. The inflammatory cell infiltrate is more pronounced than in periodontitis and extended more apically. Mean bone loss in periimplantitis is generally much greater than around natural teeth with periodontitis. Risk factors that are uniquely associated with dental implants include bone type, prosthetic and surgical variables, and implant surface characteristics. The role of titanium particles found in the periimplantitis lesion is yet unclear. Lastly, the possibility of foreign body reaction being the trigger for periimplantitis is plausible but as of yet requires further substantiation. The search to improve our treatment strategies in periimplantitis should first focus on establishing or declining the primary mode of breakdown. The results of such studies will help guide us to either improve our current anti-infective therapies targeting the unique characteristics of periimplantitis or else put us on a new road to understanding how to modify or restrict the natural immunological response as might be the case for a foreign body response.

BACKGROUND:Peri-implantitis is a challenging condition to manage and is frequently treated using non-surgical debridement. The local delivery of antimicrobial agents has demonstrated benefit in mild to moderate cases of peri-implantitis. This study compared the safety and efficacy of chlorhexidine gluconate 2.5 mg chip (CHX chips) as an adjunctive treatment to subgingival debridement in patients afflicted with peri-implantitis. METHODS:A multicenter, randomized, single-blind, two-arm, parallel Phase-3 study was conducted. Peri-implantitis patients with implant pocket depths (IPD) of 5-8 mm underwent subgingival implant surface debridement followed by repeated bi-weekly supragingival plaque removal and chlorhexidine chips application (ChxC group) for 12 weeks, or similar therapy but without application of ChxC (control group). All patients were followed for 24 weeks. Plaque and gingival indices were measured at every visit whereas IPD, recession, and bleeding on probing were assessed at 8, 12, 16, 24 week. RESULTS:A total of 290 patients were included: 146 in the ChxC group and 144 in the control. At 24 weeks, a significant reduction in IPD (P = 0.01) was measured in the ChxC group (1.76 ± 1.13 mm) compared with the control group (1.54 ± 1.13 mm). IPD reduction of ≥2 mm was found in 59% and 47.2% of the implants in the ChxC and control groups, respectively (P = 0.03). Changes in gingival recession (0.29 ± 0.68 mm versus 0.15 ± 0.55 mm, P = 0.015) and relative attachment gain (1.47 ± 1.32 mm and 1.39 ± 1.27 mm, P = 0.0017) were significantly larger in the ChxC group. Patients in the ChxC group that were < 65 years exhibited significantly better responses (P < 0.02); likewise, non-smokers had similarly better response (P < 0.02). Both protocols were well tolerated, and no severe treatment-related adverse events were recorded throughout the study. CONCLUSIONS:Patients with peri-implantitis that were treated with an intensive treatment protocol of bi-weekly supragingival plaque removal and local application of chlorhexidine chips had greater mean IPD reduction and greater percentile of sites with IPD reduction of ≥2 mm as compared with bi-weekly supra-gingival plaque removal.

OBJECTIVES:In the present pilot, multicenter, randomized, single-blinded, controlled study, surgical treatment with or without the administration of D-PLEX500 (a biodegradable prolonged release local doxycycline formulated with β-tricalcium phosphate bone graft) was accessed for the treatment of peri-implantitis.METHOD AND MATERIALS:Subjects undergoing surgical treatment for intrabony peri-implantitis defects after flap elevation were randomly assigned, to adjunct D-PLEX500 placement group or to control group. Clinical and radiographic parameters were measured at 6 and 12 months.RESULTS:Twenty-seven subjects (average age: 64.81 ± 7.61 years) were enrolled; 14 patients (18 implants) were randomized to the test group and 13 (14 implants) to the control group. There was no difference in plaque scores between the groups. There was no difference in the changes of mean periodontal probing depth between the test and control groups between baseline and the 6-month follow-up, whereas statistically significant difference was observed after 12 months' follow-up when analyzed for all sites averaged. There was a statistically significant difference in the changes of clinical attachment levels and radiographic bone levels between the groups between baseline and 12 months. These improvements were demonstrated when analyzed at both implant and subject levels. Only D-PLEX500 treatment led to improved bone levels at both time points. The improvement in bone levels was significant in the D-PLEX500 treatment group already after 6 months, and further improved over the 12-month follow-up. Implants were lost only in the control group (14%).CONCLUSIONS:D-PLEX500 sustained release local antibiotic formulated with bone filler showed promising results in enabling healing of peri-implantitis lesions. The antibacterial component of the bone graft material might create favorable conditions that enable implant surface decontamination and soft and hard tissue healing over a prolonged period.

Osteonecrosis of the jaw (ONJ) is characterized by a chronic wound in the oral mucosa with exposed necrotic bone. This condition can occur after tooth extraction or other types of oral surgery; however, it can also develop spontaneously adjacent to infected teeth or an implant. The lesion can be symptomatic but is often asymptomatic. Both irradiation to the head and neck region (osteoradionecrosis) and bacterial infection, mainly Staphylococcus aureus (osteomyelitis), have long been known to cause this phenomenon.

Sinus pneumatization is a continuous physiological process that occurs naturally and causes an increase in the volume of paranasal sinuses. Pneumatization is also frequently observed following extraction of teeth in the posterior maxilla. This leads to an increase in the sinus volume and height at the expense of the edentulous alveolar ridge. These changes may affect treatment planning if dental implants are indicated to replace extracted teeth. Using a novel method to align and compare two panoramic radiographs taken before and after tooth extraction, we aimed to examine post-extraction dimensional changes in the maxillary sinus and alveolar ridge by superimposition of preand post-treatment panoramic radiographs. Twenty-two pairs of panoramic radiographs were analyzed retrospectively for changes in alveolar ridge and maxillary sinus dimensions following at least 6 months from tooth extraction. Pre- and post-extraction radiographs were matched and then superimposed using a fixed reference unit. Measurements included the distance from bone-crest to sinus-floor and to sinus-roof, as well as distance from sinus-floor to sinus-roof and maxillary-sinus sagittal circumference. The mean difference between pre- and post-extraction bone-crest to the sinus-floor radiographic measurements was statistically significant ( P = 0.001) with a mean change of 1.2 mm. The difference between pre- to post-extraction bone-crest to sinus-roof measurements was insignificant ( P = 0.094) with a mean change of 0.9 mm. The distance between pre- and post-extration sinus-floor to sinus-roof was significantly increased in an average of 1 mm ( P = 0.001) along with an increase in sinus sagittal circumference from 993.9 ± 295.7 mm to 1096.6 ± 312.5 mm ( P < 0.0001). In conclusion, a moderate increase in maxillary sinus dimensions concurrent with crestal resorption may be anticipated after extraction of maxillary posterior teeth, leading to an overall decrease in alveolar bone height.