Periimplant tissue stability around modified Sand-blasted Large-grid Acid-etched (SLActive) implant surface in augmented bone

Peter Toth, Peter Szatmári  Balint Molnár, Péter Windisch Department of Periodontology, Semmelweis University

Aim: The aim of this retrospective study was to evaluate the safety and efficacy of implants with modified Sand-blasted Large-grid Acid-etched (SLActive) surface, inserted into augmented alveolar ridges.
Materials and methods: 17 patients were included presenting a total of 30 implants. Sites were treated with simultaneous or staged augmentation in X and Y cases, respectively. 29 implants were integrated and successfully loaded with fixed partial dentures. At the time of loading, and 6 and 12 months later clinical parameters were recorded: bleeding on probing (BOP), periimplant probing depth (PPD), mucosal recession (MR), implant mobility, presence of inflammation or suppuration and patients' complaints. To assess crestal bone changes, intraoral radiographs were taken at baseline, 6 and 12 months post loading. Distance between implant shoulder and crestal bone was measured on digitized images at mesial and distal aspects of fixtures. Digital images were examined under 8-fold magnification. Implant height was used for calibration.
Result: One implant failed before loading. All loaded implants survived and were successful according to criteria by Albrektsson et al. BOP averaged 5,1%, 6,8%, 4,3%; PPD averaged 3,12±0,45mm, 3,24±0,36mm, 3,41±0,52mm; MR averaged 0,34±0,26mm, 0,46±0,22mm, 0,49±0,61mm; marginal bone loss averaged 0,73±0,29mm, 0,78±0,31mm, 0,98±0,5mm at loading, 6 and 12 months post loading, respectively. No implant showed periimplant inflammation.
Conclusion: Our results confirm that SLActive implants present high survival and success rates in augmented bone. Follow-up marginal bone loss and clinical parameters were comparable to implants inserted to pristine sites.
Szerzõk: Tóth Péter (petertothdr@gmail.com), Szatmári Péter (szatmaripeter@gmail.com), Molnár Bálint, Török Bálint, Windisch Péter

Treatment of Miller Class I-II multiple gingival recessions with the modified coronally advanced tunnel technique by means of a bioresorbable collagen matrix (Mucograft®) or a connective tissue graft:
A prospective, randomized, controlled split-mouth clinical trial

S.Aroca1, B.Molnar2, T. Keglevich2, I. Gera2, P.Windisch2, A. Sculean1
1 Department of Periodontology, University of Berne
2 Department of Periodontology, Semmelweis University

Aim: The aim of this prospective, randomized, controlled split-mouth clinical trial was to compare the treatment of Miller-Class I, II multiple recessions using the modified coronally advanced tunnel (MCAT) technique either with a bioresorbable collagen matrix or a connective tissue graft (CTG).
Materials and methods: Twenty-two subjects exhibiting multiple Miller-Class I, II recessions were treated using the MCAT by either a bioresorbable collagen matrix (Mucograft®, Geistlich, Wolhusen, Switzerland) (test) or a CTG (control). Following parameters were assessed at baseline, 1, 3, and 6 months postoperatively: recession depth and width, width and thickness of keratinized tissue, percent of 100% root coverage.
Results: No allergic reactions, tissue irritations or matrix exfoliations occurred. At 6 months, root coverage averaged 1,28 ± 0,82 mm vs. 1,64 ± 0,93 mm; increase in keratinized tissue width averaged 0,29 ± 0,91 mm vs. 0,53 ± 1,0 mm at test vs. control sites, respectively. Differences were statistically not significant. Increase in keratinised tissue thickness averaged 0,13 ± 0,28 mm vs. 0,37 ± 0,37 mm; complete root coverage was found in 50% vs. 78% at test vs. control sites, respectively. Differences were statistically significant. Duration of surgery and patient morbidity were lower on test sites compared to control.
Conclusions: i) treatment of Miller-Class I, II multiple recessions using the MCAT combined with either Mucograft® or CTG may result in substantial mean root coverage, but lower complete root coverage with Mucograft® and ii) Mucograft® may represent a valuable alternative to CTG, resulting in lower patient morbidity and duration of surgery.

Clinical effect of three glass ionomer cement restorative materials used in Class V cavities on the gingival tissue
A. Horvath, Zs. Papp, Dobo-Nagy Cs, I. Gera Semmelweis University, Dept. Periodontology Budapest

The restoration of cervical abrasions, erosions or class V. carious lesions is still challenging because of their unpredictable adhesion and possible negative effects on the marginal plaque accumulation and gingival health . Three Glass Ionomer cements (Fuji IX GP, GC Fuji IX GP EXTRA and GC G-Coat PLUS (Equia®) put paragingivally or partially subgingivally into class V cavities were studied. It was also investigated if GC G-Coat Plus cement with a light curing varnish has any additional effect on the gingival tissue.
Materials and methods A total number of 30 non-smokers with healthy gingiva having cervical abrasion/erosion defects were enrolled in this study. The cervical abrasion/erosion defects were restored by using one of the three glass ionomer cements. The parameters of the gingival recession and cervical defects as well as plaque scores (PlI), bleeding on probing (BOP), crevicular fluid flow (CFF) were recorded at baseline and after 3, 26 and 52 weeks.
Results: The dimensions of gingival recession did not change throughout the whole study. The plaque scores showed a slight but also not significant increase by the end of the study. The PPD, BOP and CFF did not change significantly throughout the one year observation period. The light curing varnish (Equia®) slightly improved the PlI in the cervical region compared to the others.
Conclusions: Over the observation period, the glass ionomer cements did not significantly affect the gingival health but the GIC coated with the new varnish resulted in less plaque accumulation and somewhat better gingival health.

10 Year Results Following Surgery with EMD, NBM and TCP


1Dept. of Periodontology, Semmelweis University of Medicine, Budapest, Hungary, 2Dept. of Periodontology, University of Marburg, Marburg, Germany, 3Dept. of Periodontology, University of Bern, Bern, Switzerland

Aim: To evaluate clinically the long-term results following treatment of deep intrabony defects with either EMD+NBM or EMD+β-TCP. Material and Methods: Twenty patients with advanced periodontal disease, each of whom displayed one intrabony defect, were randomly treated with a combination of either EMD+NBM or EMD+β-TCP. Clinical evaluation was performed at baseline, at 1 year and 10 years following therapy. Main clinical parameter was the clinical attachment level. Results: In the EMD+NBM group mean CAL changed from baseline 8.9 ± 1.6 mm to 5.3 ± 0.9 mm at 1 year and 5.9 ± 1.1 mm at 10 years, respectively. In the EMD+β-TCP group mean CAL changed from baseline 9.1 ± 1.8 mm to 5.3 ± 1.5 mm at 1 year to 5.9 ± 1.6 mm at 10 years. Compared to baseline, the PD and CAL values improved statistically significant at 1 year and at 10 years (p<0.001). The PD and CAL changes between 1 and 10 years did not present statistically significant differences in any of the 2 groups. Between the treatment groups no statistically significant differences were observed at 1 and at 10 years. Conclusion: The present results indicate that the clinical improvements obtained with both treatments were stable over a period of 10 years.

Complex rehabilitation of edentulous sites following advanced periodontal tissue loss
B Torok, B Molnar, I Gera, P Windisch
Dept. of Periodontology, Semmelweis University

Aim :Primary objective was to create sufficient periimplant hard and soft tissue conditions by reconstructing alveolar defects, originating from severe periodontitis. Secondary objective was to investigate the efficacy of the applied surgical protocol on the elimination of periodontal defects at adjacent teeth.
Materials and Methods :Twenty chronic periodontitis patients, with one tooth scheduled for extraction due to advanced attachment loss, with missing buccal bone were recruited. Patients underwent initial periodontal treatment, full mouth plaque- and bleeding scores were kept below 20% during the study. First stage surgery included tooth removal and extraction site development. After 6 months, at second stage surgery implants were placed with simultaneous ridge augmentation. After 9 months, abutment connection was performed. Probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL) of adjacent teeth was recorded at baseline and abutment connection. Intraoperative measurements were performed to assess vertical and horizontal dimensions of the alveolar ridge during second- stage surgery and abutment connection. Intraoral radiographs with additional CBCT scans were recorded at baseline and before surgeries.
Results:  abutment connection, vertical tissue gain at implants averaged 2,5±1,17mm, horizontal tissue gain averaged 1,58±1,16mm compared to second stage surgery. At abutment connection, compared to baseline, PPD, GR and CAL changed at adjacent teeth from 3,59±2,12mm to 2,38±0,64mm; 0,41±0,78mm to 1,1±1,46mm; 4±2,48mm to 3,49±1,67mm; respectively.
Conclusion: This stepwise surgical approach resulted in favourable soft- and hard tissue conditions, periimplant hard tissues were levelled off to adjacent proximal crestal bone. Residual PPD values measured less than 3mm on adjacent teeth.

Role of vestibuloplasty in the treatment of periimplantitis: a report of 3 cases
T Chikany, B Molnar, R Kemper, P Windisch
Dept. of Periodontology, Semmelweis University, Budapest

Introduction: The aim of this retrospective case report of 3 cases, presenting a total of 5 implants was to evaluate the effectiveness of a modified vestibuloplasty technique to create stable soft tissue conditions around ailing dental implants exhibiting compromised soft tissue conditions.
Case report: 3 patients exhibiting moderate periimplant bone loss,bleeding on probing (BOP) increased probing depths (PD) and lack of buccal attached periimplant mucosa were treated. Mechanical debridement and chemical disinfection of periimplant pockets were performed prior to surgery. After 3 months healing time a modified vestibuloplasty procedure was used to reestablish previously lost attached mucosa, with simultaneous deepening of the vestibule around implants. Following local anaesthesia, an apically oriented paramarginal bevelled incision was placed 3mm from the mucosal margin. A split thickness flap was elevated, and subsequently fixed with resorbable sutures (Coated Vicryl 6/0, Ethicon, East Brunswick NJ, USA) to the underlying periosteum, 3-5 mm apically from the incision line. The uncovered periosteal layer was left to heal by secondary epithelialisation. Periodontal dressing was used to cover the wound, if necessary, sutures were removed after 14 days.
Discussion: 3-5 mm gain of non-inflammatory attached mucosa was observed around treated implants. BOP and PD were reduced at each implant, reestablished mucogingival conditions were more conducive for oral hygiene.
Conclusion: The presented minimally invasive modified vestibuloplasty reestablished attached periimplant mucosa, which may improve the soft tissue environment around ailing implants. The present surgical approach may also serve for creating more appropriate soft tissue conditions for further periimplant hard tissue reconstructions.
modified vestibuloplasty, compromised soft tissue conditions for implants .

Implant therapy of edentulous sites originating from advanced horizonto-vertical periodontal defects after tooth extraction

Török B, Gera I. Windisch P.

Three cases of chronic periodontitis patients with one maxillary front tooth with hopeless prognosis are presented. The objectives was to create sufficient amount of periimplant hard and soft tissue at sites where tooth or teeth had to be removed due to advanced periodontal breakdown. It was also tested if this surgical correction had any regenerative effect on the periodontal defects at the neighbouring remaining teeth resulting in the reduction of postoperative pocket depth and the no deeper the 3 mm residual pocket depth can be achieved.
Materials and Methods 3 patients underwent a stepwise series of three consecutive surgical approaches to restore lost hard and soft tissues left after tooth extraction and to facilitate periodontal regeneration of the intrabony defects at the neighbouring teeth. Surgery one included tooth extraction, alveolar ridge preservation or extraction site development to regenerate alveolar ridge conditions. Surgery two served implant placement with simultaneous ridge augmentation. The periodontal defect and the edentulous ridge were overfilled vertically and horizontally with NBM (Bio- Oss®, particle size 0.25 to 1.0 mm, Geistlich AG,Wolhusen, Switzerland). Surgery three aimed at soft tissue augmentation with an appropriate-sized connective tissue graft.
Results Clinically and radiographically healthy periimplant conditions were achieved while the residual clinical probing pocket depth at the neighbouring teeth were no deeper than 3 mm and radiological bone fill could be detected in all cases.
Conclusion This stepwise series of surgical techniques could be successfully applied for correcting sever ridge deficiencies and also can facilitate the comprehensive regenerative therapy of periodontal defects at adjacent teeth.

 Treatment of Miller Class I-II multiple gingival recessions with the modified coronally advanced tunnel technique by means of a bioresorbable collagen matrix (Mucograft®): A prospective pilot case series

B.Molnar1, S.Aroca2, T. Keglevich1, I. Gera1, P.Windisch1, A. Sculean2
1 Department of Periodontology, Semmelweis University
2 Department of Periodontology, University of Berne


The aim of this prospective pilot case series was to clinically evaluate the treatment of Miller Class I, II multiple adjacent gingival recession defects (MARTD) using the modified coronally advanced tunneling technique (MCAT) in combination with a bioresorbable collagen matrix (Mucograft®).
Materials and methods
8 subjects in good general health exhibiting multiple Miller Class I, II MARTD (i.e. at least 3 adjacent recessions per site) were included. Recession sites were treated using the MCAT technique in combination with a bioresorbable collagen matrix (Mucograft®, Geistlich, Wolhusen, Switzerland). The following clinical parameters were assessed at baseline and at 1, 3, 6 and 12 months postoperatively: full mouth plaque score, full mouth bleeding score, probing pocket depth, gingival recession depth and width, thickness and width of keratinised gingiva,
No allergic reactions, soft tissue irritations or matrix exfoliations occurred at treated sites. Mean depth of gingival recession decreased from 1,98 ± 1,00 mm (baseline) to 0,33 ± 0,57 mm (12 months postoperatively). Mean width of keratinised gingiva increased from 2,98 ± 1,55 mm (baseline) to 3,48 ± 1,47 mm (12 months postoperatively). Complete root coverage was found in 71% of treated sites. Postoperative complaints were low, patient acceptance was generally high.
These outcomes indicate that: i) treatment of Miller Class I-II MARTD using the MCAT technique combined with a bioresorbable collagen matrix (Mucograft®) may result in substantial mean root coverage and ii) Mucograft® may represent a valuable alternative to connective tissue grafting, resulting in low patient morbidity and high patient acceptance. The present study was supported by Geistlich, Wolhusen, Switzerland.