Periotest

dynamically diagnosing the human periodontium and the dental implant-bone interface

periotest deviceabout Periotest device
 

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2003:
Bone density: its influence on implant stability after uncovering.
MORRIS HE, OCHI S, CRUM P, ORENSTEIN I, PLEZIA R.
J Oral Implantol.  2003;29(6):263-9.
Primary implant stability and bone density are variables that have long beenconsidered to be essential to achieving predictable osseointegration andlong-term clinical survival. Although the dentist can control most factorsassociated with implant survival, bone density is the one factor that cannot becontrolled. Measuring implant stability would assist in determining if animplant has integrated and is ready for the fabrication of the final prosthesis.Changes in implant stability in each type of Bone Quality (BQ-1, -2, -3, and-4), which may occur with time, have not been studied. Such information couldhelp identify well-integrated implants and identify changes associated withimpending implant failure. Several studies have used the Periotest instrument tostudy implant stability. Use of the Periotest implant stability will be studiedduring each phase of implant treatment for each bone density, and a range forclinically satisfactory integration will be suggested. Implant stability changesover time, and the changes are different for each bone density as the bonesurrounding the nonhydroxyapatite implant becomes denser. This is clearlydemonstrated in a postmortem histological specimen. The changes in implantstability (Periotest Values [PTVs]) are more apparent in BQ-1 and BQ-2 bone andless apparent in BQ-3 and BQ-4 bone. The Periotest is capable of providingvaluable information concerning favorable or unfavorable changes in thebone-implant interface after uncovering. In addition, it can help identify whenan implant is ready to be loaded. A new range of PTVs (-5 to -2) is suggestedfor monitoring the status of implants. Implants with PTVs more positive than -2would indicate a bone-implant complex that may be marginal.
DVA Dental Clinical Research Center, Ann Arbor, MI 48105, USA.
Rotational panoramic versus intraoral rectangular radiographs for evaluation ofperi-implant bone loss in the anterior atrophic mandible.
ZECHNER W, WATZAK G, GAHLEITNER A, BUSENLECHNER D, TEPPER G, WATZEK G.
Int J Oral Maxillofac Implants.  2003 Nov-Dec;18(6):873-8.
PURPOSE: In patients with atrophic mandibles, elevation of the floor of themouth often prevents intraoral rectangular radiography for longitudinalfollow-up studies, while extraoral techniques such as panoramic radiographs tendto produce distorted views of the interforaminal region. In this study,intraoral rectangular radiographs and panoramic radiographs were compared fortheir accuracy in evaluating peri-implant bone loss. MATERIALS AND METHODS: In arecall program, 22 patients with 88 screw-type implants (44 MKII and 44 Frios)were followed. Interforaminal marginal bone loss was evaluated by extraoralorthopantomograms and by intraoral rectangular radiographs. In addition, pocketdepth, Periotest readings, and bleeding on probing were recorded. Forstatistical analysis, the Spearman coefficient of correlation was used. Theeffects on bone loss and clinical variables were computed with a mixed model andthe Bland and Altman method. RESULTS: Computed as least square means, the meandifference between panoramic radiographs (2.4 + 0.2 mm for MKII implants and1.6 + 0.2 mm for Frios implants) and intraoral radiographs (2.6 + 0.2 mm and1.4 + 0.2 mm, respectively) was 0.2 mm (range, 0.1 to 0.8 mm). DISCUSSION: Inthis study, the 2 imaging techniques were comparable clinically in terms of theprecision with which they could be used to measure marginal bone loss.CONCLUSION: For highly atrophic mandibles with unfavorable imaging conditions,rotational panoramic radiographs can be a useful alternative to intraoralsmall-format radiographs for evaluating peri-implant bone loss.
Department of Oral Surgery, Dental School, University of Vienna, LudwigBoltzmann Institute of Oral Implantology, Vienna, Austria.werner.zechner@univie.ac.at
Four-year follow-up of larger-diameter implants placed in fresh extractionsockets using a resorbable membrane or a resorbable alloplastic material.
PROSPER L, GHERLONE EF, REDAELLI S, QUARANTA M.
Int J Oral Maxillofac Implants.  2003 Nov-Dec;18(6):856-64.
Clinical Trial    Randomized Controlled Trial
PURPOSE: The aim of this randomized study was to evaluate and compare thelong-term success rates of cylindric, screw-type titanium implants with a largerdiameter (5.9 mm) that were placed in fresh extraction sockets in associationwith resorbable bone substitutes or a resorbable membrane. MATERIALS ANDMETHODS: Eighty-three partially edentulous adult patients, selected from amongthose treated in 1997 and 1998 at the San Raffaele Institute in whom 1 or moreimplants had been placed into fresh posterior mandibular or maxillary sockets,were included in the study. A total of 111 implants were placed, 36 in mandiblesand 75 in maxillae. Fifty-six implants were placed in combination withresorbable hydroxyapatite (HA group) and 55 with a resorbable membrane (MRgroup). Intraoral radiographs and follow-up examinations, including verificationof implant stability via the Periotest, were carried out at second-stage surgery3, 6, 9, and 12 months later; and then annually up to 4 years after placement ofthe definitive restoration. The radiographic examination was conducted by meansof a standardized procedure to verify osseointegration. RESULTS: There was 100%attendance at the follow-up examination after 4 years. At second-stage surgery,which was performed after 4 to 6 months' healing time, none of the implantsshowed any signs of mobility, peri-implantitis, or bone loss. Two implantsfailed in the MR group, one at 3 months and one at 9 months after placement; 1implant failed in the HA group at 4 months after placement. After 4 years, theimplant success rate was 97.3% (108 of 111 implants were considered successful).The success rate did not differ significantly between the HA group (98.2%) andthe MR group (96.4%). DISCUSSION: The use of larger-diameter implants served tominimize the anatomic discrepancies that would have evolved when substituting amolar with a standard-diameter implant. According to the accepted criteria forsuccess, the 5-year success rate should be at least 85%; therefore both methodsmay be considered satisfactory. CONCLUSION: Implants placed in combination witha resorbable allogeneic material or with a resorbable membrane providedpredictable long-term results when restored with a fixed partial denture.
Oral Rehabilitation Department, University Vita e Salute, Scientific Institute,San Raffaele Hospital, Milan, Italy. lorisprosper@tin.it
Randomized multicenter comparison of 2 IMZ and 4 TPS screw implants supportingbar-retained overdentures in 425 edentulous mandibles.
MAU J, BEHNEKE A, BEHNEKE N, FRITZEMEIER CU, GOMEZ-ROMAN G, D'HOEDT B,SPIEKERMANN H, STRUNZ V, YONG M.
Int J Oral Maxillofac Implants.  2003 Nov-Dec;18(6):835-47.
Clinical Trial    Multicenter Study    Randomized Controlled Trial
PURPOSE: Two treatment concepts for implant-supported bar retention ofmandibular overdentures-2 intramobile cylinder (IMZ) implants and a Dolder barand 4 titanium plasma-sprayed (TPS) screw implants and an angulated bar-werecompared in a randomized controlled clinical trial with respect topostprosthetic efficacy and safety. MATERIALS AND METHODS: Four hundredtwenty-five patients with edentulous mandibles were enrolled; 212 wererandomized to TPS implants (control group) and 213 to IMZ implants (test group).Endpoints were occurrences of postprosthetic integration deficiency (ID),functional deficiency (FD), and complications. The trial was sized to detect a10% difference in 5-year ID-free postprosthetic system lifetime with a power of80%. RESULTS: With 340 protocol-completed cases, the trial achieved itspredetermined power. The 2 systems did not show statistically significantdifferences in occurrences of postprosthetic ID and FD; 5-year occurrence-freepostprosthetic system lifetime probabilities were estimated as 42.5% with IMZand 42.8% with TPS, for ID; and as 82.6% with IMZ and 87.2% with TPS, for FD.However, at 3 to 6 months after surgery, mean Periotest values weresignificantly higher (P = .0001 without adjustment) with IMZ implants (5.6, SD4.2) than with TPS implants (0.8, SD 4.3). TPS implants showed a higherincidence of inflammation and recession, while IMZ implants had a higherincidence of implant fracture after functional loading. DISCUSSION: Thesystem-wise approach overcomes potential bias with implant-wise analyses. Acombination of radiographic and clinical criteria distinguishes betweendesirable integration and functional anchorage. The in situ survival rates at 5years in this study (95% for IMZ, 92% for TPS) match rates reported in theliterature. CONCLUSION: This study demonstrated equivalent efficacy of 2 IMZcylinders and 4 TPS screws in implant-supported, bar-retained mandibularoverdentures and indicated a higher rate of complications with the TPS screwimplants.
Department of Statistics in Medicine, Heinrich Heine University, Duesseldorf,Germany. ismmau@uni-duesseldorf.de
Dental implants in reconstructed jaws: implant longevity and peri-implant tissueoutcomes.
CHEUNG LK, LEUNG AC.
J Oral Maxillofac Surg.  2003 Nov;61(11):1263-74.
PURPOSE: The study aimed to evaluate the clinical status and survival of dentalimplants inserted in reconstructed jaws, with particular reference to theperi-implant tissues. MATERIALS AND METHODS: We conducted a clinical follow-upstudy based on 29 rehabilitated patients after oral tumor surgery, who receivedautogenous bone grafts from the ilium and endosseous implants (14 maxillary and15 mandibular cases; 140 implants) for functional jaw reconstruction between1988 and 1999. Clinical records of the patients were reviewed retrospectively.Clinical parameters of plaque index, probing pocket depth, and bleeding onprobing were assessed around the implants and control teeth at 4 locations(mesiobuccal, distobuccal, mesiolingual, and distolingual). Implant mobility wasassessed clinically and objectively using a Periotest (Gulden; Siemens,Bensheim, Germany [www.med-gulden.com]) equipment for those implants supporting removable prostheses.Radiographically, the proportion of implant length remained osseointegrated wasmeasured. RESULTS: With a mean follow-up time of 50 months, 90.7% of the 140implants placed were functional in supporting dental prostheses; 4.3% ofimplants failed in osseointegration and the remaining 5.0% implants wereosseointegrated but nonfunctional. A total of 493 sites of 127 functionalimplants and 392 sites of 98 control teeth were assessed. No significantdifference was found between the implants and control teeth parameters, excepton the probing pocket depth. The mean peri-implant probing depth was 3.5 mm, and52.7% of the measured sites were 3 mm or less. More than one third of theimplants (35.9%) presented with increased probing depth (> or =4 mm), and thiswas significantly higher than in the control teeth (P <.001, chi(2) test).Bleeding on probing was found in 19.3% of the measured peri-implant sites,corresponding to 42.2% of the dental implants. Of the implants, 28.9% werecompletely free from plaque and 9.4% show visible plaque accumulation. Mobilityassessment was feasible on 32 implants and no mobility was detected.Radiographically, the mean implant length remained in bone was 81.1%, with 82.6%in the maxilla and 79.4% in the mandible. Implant survival rate calculated usingthe Kaplan-Meier method was 86.9% for 5 years. Based on the defined criteria,the success rate of implants placed in reconstructed jaws in this study was90.7%. CONCLUSION: Endosseous implants can be successfully placed inreconstructed jaws for oral rehabilitation with maintenance of reasonable healthstatus of the peri-implant tissues in the long-term.
Oral and Maxillofacial Surgery, Prince Philip Dental Hospital, 34 Hospital Road,Hong Kong SAR, China. lkcheung@hkucc.hku.hk
Implant stability and histomorphometry: a correlation study in human cadavers using stepped cylinder implants
NKENKE E, HAHN M, WEINZIERL K, RADESPIEL-TROGER M, NEUKAM FW, ENGELKE K
Clin Oral Implants Res 14(5):601-609 (2003)
The aim of the present study was to determine the correlation between the primary stability of dental implants placed in edentulous maxillae and mandibles, the bone mineral density and different histomorphometric parameters. After assessing the bone mineral density of the implant sites by computed tomography, 48 stepped cylinder screw implants were installed in four unfixed human maxillae and mandibles of recently deceased people who had bequeathed their bodies to the Anatomic Institute I of the University of Erlangen-Nuremberg for medical-scientific research. Peak insertion torque, Periotest values and resonance frequency analysis were assessed. Subsequently, histologic specimens were prepared, and bone-to-implant contact, the trabecular bone pattern factor (TBPf), the density of trabecular bone (BV/TV) and the height of the cortical passage of the implants were determined. The correlation between the different parameters was calculated statistically. The mean resonance frequency analysis values (maxilla 6130.4+363.2 Hz, mandible 6424.5+236.2 Hz) did not correlate with the Periotest measurements (maxilla 13.1+7.2, mandible -7.9+2.1) and peak insertion torque values (maxilla 23.8+2.2 N cm, mandible 45.0+7.9 N cm) (P=0.280 and 0.193, respectively). Again, no correlations could be found between the resonance frequency analysis, the bone mineral density (maxilla 259.2+124.8 mg/cm3, mandible 349.8+113.3 mg/cm3), BV/TV (maxilla 19.7+8.8%, mandible 34.3+6.0%) and the TBPf (maxilla 2.39+1.46 mm-1, mandible -0.84+3.27 mm-1) (P=0.140 and 0.602, respectively). However, the resonance frequency analysis values did correlate with bone-to-implant contact of the oral aspect of the specimens (maxilla 12.6+/6.0%, mandible 35.1+5.1%) and with the height of the crestal cortical bone penetrated by the implants in the oral aspect of the implant sites (maxilla 2.1+0.7 mm, mandible 5.1+3.7 mm) (P=0.024 and 0.002, respectively). The Periotest values showed a correlation with the height of the crestal cortical bone penetrated by the implants in the buccal aspect of the implant sites (maxilla 2.5+1.2 mm, mandible 5.4+1.2 mm) (P=0.015). The resonance frequency analysis revealed more correlations to the histomorphometric parameters than the Periotest measurements. However, it seems that the noninvasive determination of implant stability has to be improved in order to give a more comprehensive prediction of the bone characteristics of the implant site.

Provisional implants for anchoring removable interim prostheses in edentulous jaws: a clinical study.
KRENNMAIR G, WEINLANDER M, SCHMIDINGER S (Vienna, Austria)
Int J Oral Maxillofac Implants 18(4):582-8 (2003)
Dental Implants, Dental Prosthesis, Dental Restoration, Follow-Up Studies, Human, Middle Age, Patient Satisfaction
PURPOSE: The behavior of provisional implants in edentulous maxillae/mandibles used for anchoring removable interim overdentures was followed for the time of the intended healing of the definitive implants. MATERIALS AND METHODS: Twenty-eight edentulous arches (19 maxillae, 9 mandibles) were provided with 77 provisional implants (2 to 4 in maxillae; 2 or 3 in mandibles) for anchoring removable interim prostheses (overdentures). The provisional implants were to be maintained until final restoration (6 to 9 months in the maxilla and 3 months in the mandible). The loss rate of provisional implants and handling and behavior of the anchored overdenture were monitored until the definitive prosthetic restoration was placed. RESULTS: Twenty-three (29.8%) of the 77 provisional implants were lost prematurely. The loss rate of maxillary provisional implants (21/58; 36.2%) was significantly higher than that of mandibular implants (2/19; 10.5%) (P < .01). Determination of terminal stability (by means of the Periotest) of the provisional implants showed higher stability in the mandible (+3.8 +2.3) than in the maxilla (+8.6 + 3.9) (P < .05). In obvious contrast to mandibular interim overdentures, handling of maxillary interim overdentures was found to improve significantly during the follow-up period (P < .01). DISCUSSION AND CONCLUSION: With both the low loss rate in the mandible and the higher loss rate seen in the maxilla, placement of provisional implants fulfills the requirements for initiating immediate prosthetic rehabilitation. The removable interim overdenture can be adequately stabilized and provides for added patient comfort and satisfaction as compared to a conventional complete denture. An important aspect of the continued use of provisional implants concerns the expectations placed in these implants by both clinician and patient, which are quite different than those for definitive implants.

Restoration of partially edentulous patients using dental implants with a microtextured surface: a prospective comparison of delayed and immediate full occlusal loading
CANNIZZARO G, LEONE M (Italy)
Int J Oral Maxillofac Implants 18(4):512-22 (2003)
Comparative Study, Crowns, Dental Implants, Dental Prosthesis, Follow-Up Studies, Human, Middle Age, Radiography, Time Factors, Treatment Outcome
PURPOSE: The aim of this study was to determine the clinical effectiveness of placing dental implants with microtextured surfaces into full occlusal loading at the time of placement in partially edentulous patients. MATERIALS AND METHODS: Two demographically similar groups of 14 patients each were treated with a total of 92 Spline Twist Implants (Centerpulse Dental, Carlsbad, CA). Test implants were placed into immediate full occlusal loading, and control implants were restored using a conventional delayed loading procedure. Otherwise, both groups of patients received similar therapy from the same treatment team. Radiographs, periodontal indices, and Periotest values were recorded every 6 months during routine clinical follow-up appointments. The mean loading time for all prostheses was 24 months at the time of this report. RESULTS: No implants failed in the test group, and 1 implant failed before loading in the control group. Cumulative implant success was 98.9% for all implants placed (test group = 100%; control group = 92.9%). Periodontal measurements indicated no significant clinical differences between implants placed into immediate full occlusal loading and those loaded via a conventional delayed protocol. DISCUSSION: Immediate full occlusal loading of partial prostheses supported by microtextured implants in partially edentulous patients demonstrated excellent clinical results, with no adverse periodontal effects after 24 months of function. Additional follow-up will provide invaluable information on the long-term effects of this technique. CONCLUSION: Immediate full occlusal loading of partial prostheses supported by microtextured implants can be successfully achieved for 24 months in highly motivated patients with excellent oral hygiene.

The Periotest in traumatology. Part II. The Periotest as a special test for assessing the periodontal status of teeth in children that have suffered trauma
ANDRESEN M, MACKIE I, WORTHINGTON H (Manchester, UK.)
Child, Comparative Study, Follow-Up Studies, Human, Incisor, Percussion, Periapical Diseases, Root Resorption, Sound/diagnostic use, Tooth Fractures, Tooth Mobility, radiography, Wound Healing
Dent Traumatol 19(4):218-20 (2003)
The research was carried out on the upper permanent incisor teeth of 101 children aged 8-12 years attending the trauma clinic at the University Dental Hospital, Manchester, UK. The double blind, cross-over study involved Periotest readings being taken by one examiner and traditional special tests being carried out by another examiner. The traditional special tests chosen were mobility testing, percussion sounds and radiographs. The Periotest readings and special tests were then repeated at the child's recall appointment. The results revealed that there was a significant difference (P < 0.001) between the number of abnormalities detected by the Periotest and those detected by the traditional special tests. There was also found to be a significant difference (P < 0.001) in the detection of undesirable sequelae between the Periotest and the traditional special tests.

The Periotest in traumatology. Part I. Does it have the properties necessary for use as a clinical device and can the measurements be interpreted?
ANDRESEN M, MACKIE I, WORTHINGTON H (Manchester, UK.)
Dent Traumatol 19(4):214-7 (2003)
Child, Cooperative Behavior, Human, Incisor, Observer Variation, Periodontics, Reproducibility of Results, Time Factors
The Periotest is a non-invasive, electronic device which provides an objective measurement of the reaction of the periodontium to a defined impact load applied to the tooth crown. In order for a clinician to interpret Periotest readings, normal physiological values must be known. In traumatology, using the contralateral tooth as a control is impractical, as it too may be affected by injury. The main purpose of this research project was to establish the normal physiological Periotest readings for upper permanent incisor teeth at an age when trauma to teeth is at a peak. This was achieved by taking Periotest readings on healthy upper permanent incisors of 250 children aged between 8-12 years. Test-retest reliability was investigated by taking repeated Periotest readings on the teeth of 13 dental nurses at timed intervals over a 2-h period. The practicality of using the device on children was examined by examiner observation and patient questionnaire. Results showed a wide variation of Periotest readings in healthy upper permanent incisor teeth in 8-12-year-olds, and thus it was felt that normal physiological measurements are best expressed as a range. The test-retest reliability of readings was good (R > 0.85) provided that the repeat reading was taken at least 15 min after the initial reading. The examiner found the equipment easy to use and taking measurement was readily acceptable by the sample group. It was concluded that Periotest could be utilised in traumatology, although the clinician needs to take into account the limitations of the device and the difficulty in interpreting the results.

In-patient comparison of immediately loaded and non-loaded implants within 6 months.
LORENZONI M, PERTL C, ZHANG K, WEGSCHEIDER WA (Graz, Austria)
Clin Oral Implants Res 14(3):273-9(2003)
Alveolar Process, Bone Resorption, Comparative Study, Dental Abutments, Dental Implants, Follow-Up Studies, Human, Middle Age, Osseointegration, Prospective Studies, Time Factors, Treatment Outcome, Wound Healing
According to the Branemark protocol, a stress-free healing period is one of the most emphasised requirements for implant integration. Recent studies have encouraged a progressive shortening of the healing period and immediate loading has been proposed for the edentulous mandible. This prospective study evaluated the clinical outcomes of 14 immediately loaded FRIALIT-2(R) implants compared with 28 non-loaded controls in an in-patient study. The results were based on clinical stability and on changes of bone level from implant placement to abutment connection 6 months after insertion. In the course of our investigation, seven patients with edentulous mandibles have been treated with 43 implants following an immediate-loading protocol. Six FRIALIT-2(R) implants were placed in the interforaminal region located at positions 34, 33, 32, 42, 43, 44. Bone level in relation to implant margin was measured and recorded. In order to obtain an in-patient comparison of immediately loaded and non-loaded implants, the ones at 33 and 43 were chosen to be immediately loaded by a Dolder-bar retained overdenture. The implants in position 32, 34, 42 and 44 were covered and left to heal. After a healing period of 6 months, second stage surgery was carried out. The clinical criteria to be checked at this point were survival, Periotest values and marginal bone level at the loaded and non-loaded implants. The mean Periotest value was -2.7 for the loaded and -5.6 for the non-loaded implants. The Mann-Whitney U-test showed that the difference was highly significant (P < 0.001). The mean bone level changes at prosthetic delivery were 0.9 mm resorption for the loaded implants and 0.33 mm for non-loaded implants. The difference was highly significant (P < 0.001). No implant failures were observed up to the prosthetic restoration 6 months post insertion. The results of this investigation allowed for direct comparison of implant survival and clinical results between immediately loaded implants and standard implants. Clinical bone changes at the 6-month evaluation demonstrated significantly higher crestal resorption around loaded implants. This fact was confirmed by higher median Periotest values (-3 vs. -6) of immediately loaded implants. According to the outcome of this study, immediate loading of two interforaminal implants with a Dolder-bar resulted in an intimate bone apposition comparable with implants with submerged healing. Nevertheless, the coronal bone level as well as clinical stability (PTV) were significantly lower in the case of the immediately loaded implants. Future studies will be necessary to evaluate marginal bone resorption, Periotest values and clinical success rates of mandibular immediately loaded implants in the long-term.

A split-mouth study on periodontal and microbial parameters in children with complete unilateral cleft lip and palate.
QUIRYNEN M, DEWINTER G, HEIDBUCHEL K, VERDONCK A, CARELS C (Leuven, Belgium)
J Clin Periodontol 30(1):49-56(2003)
Alveolar Bone Loss, Child, Cleft Lip therapy, Comparative Study, Dental Plaque Index, Follow-Up Studies, Gingival Hemorrhage, Gingival Recession, Gram-Negative Bacteria, Human, Periodontal Diseases, Tooth Mobility
BACKGROUND: Complete unilateral cleft lip and palate (UCLP) is a hereditary or multifactorial malformation that can be corrected successfully with a combined orthodontic, surgical and restorative treatment. Such multidisciplinary treatment takes many years and demands a lot of attention to both patients' teeth and periodontium. OBJECTIVES: This split-mouth study aimed to compare the periodontal health as well as the microbial parameters between cleft and non-cleft region. MATERIAL AND METHODS: 75 patients (52 males, 23 females) between 8 and 20 years with a complete unilateral cleft lip and palate (before (n = 30), during (n = 34) and after (n = 11) the active orthodontic treatment) volunteered for this study. Four regions were defined for the split-mouth comparison: teeth neighbouring cleft (site 1), tooth in cleft (site 2), and the corresponding contra-lateral teeth, respectively, in the unaffected quadrants (sites 3 and 4). At all sites the following periodontal parameters were recorded: plaque and gingivitis indices, pocket depth, attachment loss, bleeding on probing, tooth mobility (visual and Periotest), radiographic bone loss and gingival width. In addition, three pooled subgingival plaque samples were taken (around tooth in cleft, teeth facing the cleft, and contra-lateral teeth of the latter). RESULTS: The differences between the teeth neighbouring the cleft and the corresponding contra-lateral opponents were of borderline significance (P <or= 0.05) for the plaque index, the approximal probing depths and the attachment loss (teeth facing the cleft always had slightly higher parameters). When the tooth in the cleft was compared to the contra-lateral tooth, differences were only found for both the approximal probing depths, attachment loss and bone loss, which were significantly higher for the tooth in the cleft. The microbial analysis did not reveal differences between the different sites, neither in the proportion of aerobic and anaerobic bacteria (differences < 0.5 log), nor in the detection frequency of periopathogens. CONCLUSIONS: These data indicate that the periodontium in UCLP patients can cope well with a long-term orthodontic treatment, even in unfavourable conditions (like absence of attached gingiva and poor oral hygiene).

Evaluation of distraction implants for prosthetic treatment after vertical alveolar ridge distraction: a clinical investigation.
FEICHTINGER M, GAGGL A, SCHULTES G, KARCHER H (Graz, Austria)
Int J Prosthodont 16(1):19-24 (2003)
Alveolar Bone Loss, Alveolar Ridge Augmentation, Dental Implants, Dental Prosthesis, Follow-Up Studies, Human, Middle Age, Osseointegration, Periodontal Pocket
PURPOSE: The purpose of this study was to clinically evaluate the mucosal condition and the esthetic and functional results of distraction implants loaded with fixed or removable implant-supported restorations. MATERIALS AND METHODS: A total of 35 patients were treated with 62 distraction implants for correction of alveolar ridge deficiency. The distraction implants were loaded with prosthetic superstructures 4 to 6 months after distraction. Nine patients were provided with single-crown restorations, 16 received metal-ceramic fixed partial dentures, and 10 received removable overdentures. Recall was scheduled before and 3, 6, and 9 months after implant loading. Periotest values, periimplant probing depths, and radiographic marginal bone levels were recorded, along with any biologic or mechanical complications. RESULTS: Patients were followed for 9 months after implant loading. Two distraction implants were lost before abutment connection. After fabrication and placement of individual abutments, all implants were loaded with prosthetic superstructures. The results showed a decrease of the Periotest values, and thus an increase of implant stability, during the following 9 months. Periimplant probing depths also decreased in the first months after implant loading. Soft tissue around the superstructures and adjacent teeth was healthy. CONCLUSION: The distraction implant system has a high potential for osseointegration. Because of the gentle distraction technique and the possibility of using individual abutments at almost any angulation, satisfying esthetic and functional results are possible. The rate of complications was low in this short-term study.

Immediate loading of single-tooth implants in the anterior maxilla. Preliminary results after one year.
LORENZONI M, PERTL C, WIMMER G, WEGSCHEIDER WA (Graz, Austria)
Clin Oral Implants Res 14(2):180-7 (2003)
Acrylic Resins, Adult, Alveolar Process, Bone Resorption, Crowns, Dental Abutments, Dental Implants, Single-Tooth, Dental Restoration, Temporary, Follow-Up Studies, Human, Incisor, Middle Age, Occlusal Splints, Osseointegration, Survival Analysis, Treatment Outcome, Wound Healing
According to the standard protocol, a load-free healing period is one of the most emphasized requirements for implant integration. Recent studies have encouraged a progressive shortening of the healing period for single-tooth implants and immediate loading has been proposed for the aesthetic zone in the maxilla. The present study evaluated clinical outcomes of immediately loaded FRIALIT-2 Synchro implants 12 months after placement in the maxillary incisal region. In the course of our investigation, nine patients have been treated following an immediate loading protocol. The stepped-screw type implants were inserted with an increasing torque up to 45 Ncm, thus measuring the primary stability of the implants. All implants were immediately restored with unsplinted acrylic resin provisional crowns and the patients provided with occlusal splints. Regular controls were performed at monthly intervals, intraoral radiographs were taken directly after implant placement, 6 and 12 months post insertion. The survival rate, clinical stability (Periotest) and radiographic coronal bone defects (CBD) were evaluated at delivery of the definitive superstructures (CBD 6) and 6 months later (CBD 12). Twelve FRIALIT-2 Synchro stepped screws of 3.8, 4.5 and 5.5 mm diameter and 13 and 15 mm length were placed in the incisal maxillary region. The median Periotest value 6 months post insertion was -2 with a minimum of -5 and a maximum of +2. The mean coronal bone level changes (CBD) at 6 and 12 months were 0.45 and 0.75 mm. No implant failed up to 12 months after insertion, resulting in a 100% survival rate. The presented results showed promising data for immediately loaded single-tooth implants in the anterior maxilla. Periotest values were within the range published for submerged implants. The radiographic coronal bone resorption after 6 and 12 months was even less than evaluated for implants placed in a standard two-stage procedure. It is evident that successful immediate loading protocols require a careful and strict patient selection aimed at achieving the best primary stability and avoiding any excessive functional or non-functional loading. Additional research needs to be done to provide data in situations where problems of poor bone quality, multiple implants or augmentation procedures must be overcome.

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update: 2004-VIII-21.