1. Effects of Guided Bone Regeneration Around Commercially Pure Titanium and
Hydroxyapatite-Coated
     Dental Implants. I. Radiographic Analysis 

2. A Bone Regenerative Approach to Alveolar Ridge Maintenance Following Tooth
Extraction. Report of 10
     Cases 

3. A new antibiotic therapy using tetracycline-impregnated fibers 

4  The use of porcelain laminate veneers and a removable gingival
   prosthesis for a periodontally compromised patient: A clinical report 

5  Do traditional techniques produce better conventional complete
   dentures than simplified techniques? 

6  Effect of rotary or manual instrumentation, with or without a calcium
   hydroxide/1% chlorhexidine intracanal dressing, on the healing of    experimentally induced
   chronic periapical lesions  

7  Longevity of ceramic inlays and onlays luted with a solely
   light-curing composite resin 

8  Influence of force location in orthodontic shear bond strength testing

Effects of Guided Bone Regeneration Around Commercially Pure Titanium and
Hydroxyapatite-Coated Dental Implants. I. Radiographic Analysis 


William C. Stentz, Brian L. Mealey, Pirkka V. Nummikoski, John C.
Gunsolley, and Thomas C. Waldrop 


The purpose of this study was to determine which treatment of a large
osseous defect adjacent to an endosseous dental implant would produce the
greatest regeneration of bone and degree of osseointegration: barrier
membrane therapy plus demineralized freeze-dried bone allograft (DFDBA),
membrane therapy alone, or no treatment. The current study assessed
radiographic density changes in bone within the healed peri-implant osseous
defect. In a split-mouth design, 6 implants were placed in edentulous
mandibular ridges of 10 mongrel dogs after preparation of 6 cylindrical
mid-crestal defects, 5 mm in depth and 9.525 mm in diameter. An implant
site was then prepared in the center of each defect to a depth of 5 mm
beyond the apical extent of the defect. One mandibular quadrant received
three commercially pure titanium (Ti) screw implants (3.75 x 10 mm), while
the contralateral side received three hydroxyapatite (HA) coated root-form
implants (3.3 x 10 mm). Consequently, the coronal 5 mm of each implant was
surrounded by a circumferential defect approximately 3 mm wide and 5 mm
deep. The three dental implants in each quadrant received either DFDBA
(canine source) and an expanded polytetrafluoroethylene membrane (ePTFE),
ePTFE membrane alone, or no treatment (control). Standardized radiographs
were taken at 1 week and 4 months post-implant placement. Computer-assisted
densitometric image analysis (CADIA) was performed at 6 areas of interest
(coronal, middle, and apical defect areas mesial and distal to each
implant) for each of the implant sites. Significantly greater increase in
bone density was obtained using DFDBA/ePTFE compared to ePTFE alone or the
controls; likewise, ePTFE alone resulted in greater bone density change
than the controls. There were no significant differences in radiographic
bone density adjacent to Ti versus HA-coated implants. When 3 dogs having
postoperative membrane complications were eliminated from the analysis, the
results were similar with the exception that defects adjacent to Ti
implants had significantly less density gain when compared to HA-coated
implants. The results of this study indicate the use of DFDBA/ePTFE in
large surgically-created defects promotes a denser healing of bone adjacent
to implants when measured radiographically than either ePTFE alone or no
treatment. 

J Periodontol 1997;68:199-208. 


A Bone Regenerative Approach to Alveolar Ridge Maintenance Following Tooth
Extraction. Report of 10 Cases 


V. Lekovic, E.B. Kenney, M. Weinlaender, T. Han, P. Klokkevold, M. Nedic,
and M. Orsini

Ten patients who required two or more anterior teeth extractions were
utilized in this study. Extraction procedures were carried out with a
full-thickness surgical flap approach. After flap reflection, teeth were
removed with a minimum of trauma to the surrounding bone. Following
extraction, silicone-based impression techniques were used to produce a
model of the alveolar process and small metal pins were placed in the
alveolus to be used as fixed points to make measurements of ridge
dimensions. One socket was covered with an expanded polytetrafluoroethylene
(ePTFE) barrier membrane (experimental site); the other socket was a
conventional control. The soft tissue flaps were then mobilized using
periosteal releasing incisions, and the wound closed with ePTFE mattress
sutures. Six months following extraction, patients were treated with flap
surgery to expose both extraction sites to remove the ePTFE membranes and
to measure ridge dimensions using the pins as fixed points. Clinical and
model measurements have shown statistically significant better ridge
dimensions at experimental sites than at control sites (P less than or
equal to 0.05). Three patients with exposed membranes had similar
dimensional changes as controls. Results from this study suggested that
this improved technique offers a predictable alveolar ridge maintenance
enhancing the bone quality for dental implant procedures and esthetic
restorative dentistry.
 J Periodontol 1997;68:563-570. 


Actisite

A new antibiotic therapy using tetracycline-impregnated fibers(trade name
Actisite) for treating localized periodontal infection has been cleared for
marketing by the U.S. Food and Drug Administration. These fibers offer new
options to help control subgingival microflora and bleeding in isolated
sites of periodontal disease. 

This first controlled local-antibiotic-delivery-system is supplied as a
nine-inch monofilament of ethylene/vinyl acetate copolymer 0.5mm in a
diameter containing 12.7mg of evenly-dispensed tetracycline. When placed in
a periodontal pocket, it provides continuous release of tetracycline with a
mean gingival fluid concentrations of 32 micrograms/ml. 250mg of oral
tetracycline generally produces about 10 micrograms/ml in the gingival
sulcus fluid. 

Studies have demonstrated that scaling and root planing followed by
tetracycline fiber placement was more effective than scaling alone and
reduced mean pocket depth by an additional 0.6mm and bleeding on probing by
an additional 13% after six months. Bacterial populations were also
reduced. The benefits of the fibers seem to increase over a six-month
period, possibly due to the fact that tetracycline is retained in the roots. 

Proctor & Gamble, which is marketing Actisite, recommends tha fibers be
used as an adjunct to therapy for recurrent periodontal disease in isolated
individual problem sites. The fibers can also be used in acute periodontal
abscesses, but should be loosely packed to allow for drainage. If the site
fails to respond to fiber therapy, then periodontal surgery may be indicated.

A single fiber is placed into a completely fill pocket to its base using a
cord packer. Cyanoacrylate adhesive is used to help secure the fiber in
place and the patient is instructed not to brush or floss the area for ten
days. Local analgesia is usually not required at placement and the fibers
are removed after ten days as they become a foreign body after about 14
days. The fibers should be placed by the doctor only. If stripping of the
epithelial attachment occurs and is kept open by the apical placement of
the fiber, a permanent increase in pocket depth may occur.
The development of tetracyline fibers is an important step in treating
localized periodontal infections by sustained high-dosage of local
antibiotic delivery. When multiple areas are infected, tetracycline fibers
are not the treatment of choice. Many other medications are currently being
tested, including metronidazole, doxycycline, minocycline and chlorhexidene
in chips, fibers, strips and gels. The obvious next step would be a
delivery system that is more time efficient at placement, biogrades in the
pocket so removal is not necessary, and is known to be effective against
the specific bacterial infection under treatment. 

Clinical studies indicate that some sites don't respond favorably to the
tetracycline fibers. This may be because tetracycline is a non-specific
antibiotic and some specific infections are resistant to tetracycline or
may be located too deep in the tissue to be affected. One tetracycline
fiber study reported that some patients infected with Actinobacillus
actinomycetemcomitnas, which is know to invade tissue, got worse or showed
no improvement. 

Tetracycline fibers are the first of an exciting new mode of therapy in our
continuing fight against periodontal disease.

"Updates": In Wilson's recent study pretaining to a five year investigation
of treating periodontal disease with scaling and root planing plus
tetracycline fibers a regression was noted from the original gains in the
previous parent study that lasted six months. It appears that the use of
the tetracycline fibers provided no significant advantage with regards to
probing depth reduction or clinical attachment gain in a five year period.
This underscores the need for long-term evaluations for these types of
therapy. 


References: 

1. Listgarten M: Effect of Tetracycline and /or scaling on human
periodontal disease. J. Clin Perio 1978 5:246-71. 

2. Newman MG, Kornman KS, Doherty FM: A 6-month multi-center evaluation of
adjunctive tetracycline fiber therapy used in conjunction with scaling and
root planing in mainternace patients: J Periodontl 1994 Jul;65(7):685-91. 

3. Kerry G: Tetracycline-loaded fibers as adjunctive treatment in
periodontal disease. JADA 1994 Sep;125(9):1199-1203. 

4. Tonetti MS, Pini-Prato G, Cortellini P: Principles and clinical
applications of periodontal controoled drug delivery with tetracycline
fibers. Int. J. Periodontics Restorative Dent 1994 Oct;14(5):421-435. 

5. Wilson T. Long-Term Results of Tetracycline Therapy. J Perio
1997;68:1029-1032.



4  The use of porcelain laminate veneers and a removable gingival
   prosthesis for a periodontally compromised patient: A clinical report 

The Journal of Prosthetic Dentistry, Volume 93, Issue 4, April 2005,
Pages 315-317

Classic Article

Waldimir Carvalho CDa, , , Eliane P. Barboza CD, MScD, DScDb and
Cresus Vinicius Gouvea CDc

aGraduate Student, Federal Fluminense University
bVice-Chairwoman, Master of Science in Dentistry Program, School of
Dentistry, Federal Fluminense University and Director, Brazilian
Institute of Periodontology
cChairman, Master of Science in Dentistry Program, School of
Dentistry, Federal Fluminense University

School of Dentistry, Federal Fluminense University, Rio de Janeiro,
Brazil; Brazilian Institute of Periodontology, Rio de Janeiro, Brazil.
Available online 28 March 2005.

Periodontal disease may lead to tooth and tissue loss that can result
in esthetic problems. Combined periodontal/prosthodontic treatment for
patients with advanced periodontal disease is well documented. This
clinical report illustrates a method of treatment for advanced tissue
loss in an esthetic area using porcelain laminate veneers and a
removable gingival prosthesis.

5  Do traditional techniques produce better conventional complete
   dentures than simplified techniques? 

Journal of Dentistry, In Press, Corrected Proof, Available online 9 March 2005,
Yasuhiko Kawai, Hiroshi Murakami, Batoul Shariati, Esa Klemetti, John
V Blomfield, Lucie Billette, James P Lund and Jocelyne S Feine

a Nihon University School of Dentistry at Matsudo, Chiba, Japan
b Faculty of Dentistry, McGill University, Montreal, Canada
c Community Medicine Department, Tehran University of Medical
Sciences, Tehran, Iran
d Department of Restorative Sciences, Faculty of Dentistry, Kuwait
University, Kuwait
e Division of Prosthodontics, McGill University, Faculty of Dentistry,
Montréal, Canada
f Private practice, Montréal, Canada
g Centre de recherche en sciences neurologiques, Université de
Montréal, Montréal, Quebec
h Faculty of Dentistry, and Associate Member, Department of
Epidemiology and Biostatistics and Occupational Health, and Department
of Oncology, Faculty of Medicine, McGill University, Montréal, Canada

Received 2 September 2004;  revised 4 October 2004;  accepted 7
January 2005.  Available online 9 March 2005.

Summary
Objectives
To compare the quality of conventional complete dentures fabricated
with two different techniques. A randomized controlled clinical trial
was conducted to compare traditional (T) and simplified (S) methods of
making complete conventional dentures on patients' ratings of
satisfaction, comfort and function at 3 and 6 months following
delivery. The quality of the prostheses was rated by prosthodontists
at 6 months.

Materials and methods
One hundred twenty-two male and female edentulous individuals, aged
45–75 years, were randomly allocated into groups that received
dentures made with either T or S methods. Following delivery,
patients' ratings of several denture-related factors were measured
using 100 mm visual analogue scales, and denture quality was assessed
by blinded prosthodontists using ratings on a validated quantitative
scale.

Results
There were no significant differences between the two groups in
patient ratings for overall satisfaction (3 months: mean T=83 mm, mean
S=83 mm, P=0.97; 6 months: mean T=79 mm, mean S=79 mm, P=0.96 ) or in
prosthodontists' ratings of denture quality (T=66, S=63; P=0.38).

Conclusion
These results show that the quality of complete dentures does not
suffer when manufacturing techniques are simplified to save time and
materials. Dental educators should consider these findings when
re-designing prosthodontic training programs.

Keywords: Randomized controlled trial; Complete dentures; Denture
quality; Patient satisfaction; Education

6  Effect of rotary or manual instrumentation,
   with or without a calcium hydroxide/1% chlorhexidine intracanal dressing,
   on the healing of    experimentally induced chronic periapical lesions

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and
Endodontology, Volume 99, Issue 5, May 2005, Pages 628-636

Endodontology

Andiara De Rossi DDS, MSca, , , Léa A.B. Silva DDS, PhDb, Mario R.
Leonardo DDS, PhDc, Lenaldo B. Rocha DDS, MScd and Marcos A. Rossi MD,
PhDe

aPostgraduate student of Experimental Pathology, Department of
Pathology, Ribeirão Preto School of Medicine, University of São Paulo.
Recipient of a Scholarship from FAPESP (01/04732-9)
bProfessor, Department of Pediatric Dentistry, Ribeirão Preto School
of Dentistry, University of São Paulo
cProfessor, Department of Endodontics, Araraquara School of Dentistry,
State University of São Paulo
dPostgraduate student of Experimental Pathology, Department of
Pathology, Ribeirão Preto School of Medicine, University of São Paulo
eProfessor, Department of Pathology, Ribeirão Preto School of
Medicine, University of São Paulo

Received 3 May 2004;  revised 17 June 2004;  accepted 18 July 2004.
Ribeirão Preto and Araraquara, Brazil
UNIVERSITY OF SÃO PAULO AND STATE UNIVERSITY OF SÃO PAULO.  Available
online 8 December 2004.

Objective
To evaluate the healing of experimentally induced chronic periapical
lesions in dogs at 30, 75, and 120 days after root canal
instrumentation with rotary NiTi files or manual K-files, with or
without a calcium hydroxide/1% chlorhexidine paste intracanal
dressing.

Study design
The second, third, and fourth mandibular premolars and the second and
third maxillary premolars of 5 dogs (12 to 18 months of age, weighing
8 to 15 kg) were selected for treatment (a total of 82 root canals).
After pulp removal, the root canals were left exposed to the oral
cavity for 7 days to allow microbial contamination, after which the
root canals were sealed with ZOE cement until periapical lesions were
confirmed with radiography. Group I and II teeth were instrumented
with manual K-files using the crown-down technique. In group III and
IV teeth, NiTi rotary files were used. The apical delta was perforated
by using #20 to #30 K-files at the length of the tooth, thus creating
a standardized apical opening. The apical stop was enlarged to size
70, with 2.5% sodium hypochlorite irrigation at each file change.
Teeth in groups II and IV were dressed with calcium hydroxide
(Ca(OH)2)/1% chlorhexidine (CHX) paste for 15 days before root
filling. Group I and III teeth did not receive an intracanal dressing.
The access openings of the teeth were permanently restored with silver
amalgam condensed on a glass ionomer cement base. Pairs of
standardized periapical radiographs were taken at the beginning of the
treatment (0 days) and at 30, 75, and 120 days after filling.

Results
There was no significant difference in the rate of radiographic
healing of the periapical lesions between manual and rotary
instrumentation. Radiographs taken at 120 days showed that the
treatment with Ca(OH)2/1% CHX paste resulted in a significant
reduction in mean size of the periapical lesions in comparison to
single-session treatment. These findings were also true for histologic
observations.

Conclusion
The findings support the hypothesis that, regardless of the
instrumentation technique (manual or rotary), the use of an intracanal
dressing is important in the endodontic treatment of dog's teeth with
experimentally induced chronic periapical lesions.


7 Longevity of ceramic inlays and onlays luted with a solely
  light-curing composite resin 

Journal of Dentistry, Volume 33, Issue 5, May 2005, Pages 433-442
Andreas G. Schulte, Alexander Vöckler and Rüdiger Reinhardt

Longevity of ceramic inlays and onlays luted with a solely
light-curing composite resin

Andreas G. Schulte, , Alexander Vöckler and Rüdiger Reinhardt

Department of Conservative Dentistry, University of Heidelberg, Im
Neuenheimer Feld 400, 69120 Heidelberg, Germany

Received 30 July 2004;  revised 23 October 2004;  accepted 29 October
2004.  Available online 2 February 2005.

Summary
Objectives. To determine the longevity of heat-pressed glass ceramic
inlays and onlays luted with solely light-curing composite resin.

Methods. The records of patients who had received a ceramic inlay or
onlay at the Heidelberg University Department of Conservative
Dentistry from 1993 to 2002 were evaluated. The mean observation time
and the survival probability of the ceramic inlays and onlays was
calculated with the aid of the Kaplan–Meier algorithm. This was done
for the total number of all restorations as well as for various
subgroups (number of surfaces, tooth type, endodontic condition at the
time that the ceramic restoration was incorporated, experience of
operator). The log-rank test was used to compare groups and look for
significant differences, and p<0.05 was set to be statistically
significant. In addition, 95% confidence intervals of the survival
probability values were computed.

Results. At the time of the last observation, 783 (96.7%) of these
restorations were still in place. The mean observation period for all
ceramic restorations was 17.3 months (SD 20.2), with an observation
interval of between 0 and 116 months. The last loss of a ceramic
restoration was observed 45 months after it had been placed, so that
the survival probability of all ceramic restorations amounted to
p=0.90 (95% confidence interval 0.86–0.94) from this time onward.
Factors such as endodontic condition of tooth, type of tooth, position
of tooth, extent of restoration, experience of operator or gender of
patient had no significant influence on the survival probability of
the ceramic restorations.

Conclusions. Heat-pressed glass ceramic inlays and onlays can be used
successfully in routine clinical therapy. In addition, this type of
inlays and onlays can be placed successfully with solely light-curing
composite resin.

8  Influence of force location in orthodontic shear bond strength testing 

Influence of force location in orthodontic shear bond strength testing

Arndt Klocke ,  and Bärbel Kahl-Nieke

Department of Orthodontics, University Hospital Hamburg-Eppendorf,
Kieferorthopaedie, ZZMK, Pav. O 53, Martinistr. 52, D-20246 Hamburg, Germany

Received 4 May 2004;  accepted 15 July 2004.  Available online 22 October 2004.

Summary
Objective

The purpose of the present study was to analyze the influence of debonding force
location in shear bond strength testing of orthodontic brackets in vitro.

Methods
Ninety extracted permanent bovine mandibular incisors were randomly divided into
3 groups of 30 specimens each. Teeth were bonded with stainless steel orthodontic
brackets. Enamel surfaces were etched with 37% phosphoric acid for 30 s and bonded
with a composite adhesive. Debonding force measurements were performed with a universal
testing machine. Location of the debonding force was: bracket base (group A),
ligature groove (group B), occlusal bracket wings (group C).

Results
Mean shear bond strength measurements were as follows: 22.70(4.23) MPa (group A),
11.52(2.74) MPa (group B), 9.44(2.96) MPa (group C). Analysis of variance indicated
that there were significant differences in shear bond strength. Post-hoc Tukey tests
showed that bond strength measurements of group A were significantly different from
those of groups B and C. The adhesive remnant index also showed significant differences
and ranged from a mean of 1.53 in group A to a mean of 2.10 in group C.

Significance
Debonding force location had a significant influence on shear bond strength measurements
and bond failure pattern, indicating that this parameter needs to be taken into
consideration for interstudy comparison of in vitro results.

Keywords: Bond strength testing; Orthodontic ; Force location; Distance; In vitro; Adhesion