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Abstracts-6

Special thanks to Dr B Praveen for compiling this abstract
 1. Burning Mouth Syndrome
 2. A Clinical Model of Trigeminal Neuropathic Pain
 3. Systemic Health Consequences of Alloplastic Implants of the TMJ
 4. Human Periodontal Defects Treated with Bio-Oss and Bio-Gide
 5. Evaluation of Demineralized Freeze-dried bone Allograft
 6. Localized Ridge Augmentation with Chin Grafts and Resorbable Pins
 7. Maintaining or Increasing the Width of Masticatory Mucosa Around Submerged Implants
 8. New Bioresorbable Guided Tissue Regeneration Device
 9. The Use of a Soft Tissue Expander in an Alveolar Bone Ridge Augmentation
10. Mechanisms of Endosseous Integration
11. Surgical Determinants of Clinical Success of Osseointegrated Oral Implants
12. The Implant-Mucosal Interface and Its Role in the Long-Term Success of Endosseous Oral Implants:
13. Imaging Techniques and Image Interpretation for Dental Implant Treatment
14. The Effects of Age, Jaw Site, and Bone Condition on Oral Implant Outcomes
15. Treatment Outcomes in the Field of Osseointegrated Implants: Prosthodontic Determinants

A Possible Therapeutic Solution for Stomatodynia (Burning Mouth Syndrome)The Journal of Orofacial Pain Vol. 12, No. 4 1998 Page: 272 Author(s): Woda/Navez/Picard/Pichard-Leandri
Abstract: Stomatodynia is a difficult disease for both patients and clinicians. When facing true stomatodynia, ie, idiopathic burning mouth, patients are offered poorly effective treatment. This open study reports the results of local application of clonazepam (0.5 or 1 mg) two or three times daily in 25 subjects who suffered from idiopathic stomatodynia. At the first evaluation, 4 weeks after the beginning of treatment, a visual analogue scale (VAS)that represented the intensity of pain decreased significantly from 6.2 +- 0.3 to 3.0 +- 0.5. At the second evaluation, 3 to 29 months after the first consultation, the VAS scores dropped significantly further to 2.6 +- 0.5. Analysis of the individual results showed that 10 patients were totally cured and needed no further treatment, 6 patients had no benefit at all, and the remaining 9 patients had some improvement but were not considered to be cured since they did not wish to stop the treatment. Blood level tests that were performed 1 and 3 hours after the topical application revealed the presence of small amounts of the drug (3.3 ng/mL +- 0.66 and 3.3 ng/mL +- 0.52, respectively). The hypothesis that clonazepam acts locally to disrupt the neuropathologic mechanism that underlies stomatodynia is proposed. The risk factors that are recognized for this condition could decrease the density and/or ligand affinity of peripheral benzodiazapine receptors. This, in turn, could cause spontaneous pain from the tissues concerned.
Posttraumatic Gustatory Neuralgia: A Clinical Model of Trigeminal Neuropathic Pain Vol. 12, No. 4 1998 Page: 287 The Journal of Orofacial Pain Author(s): Scrivani/Keith/Kulich/Mehta/Maciewicz
Abstract: Six cases are reported in which the primary complaint was episodic, recurrent facial pain that was triggered by a taste stimulus. The pain first occurred days to weeks after head and neck surgery. Patients reported that a food stimulus placed in the mouth evoked episodic, electric shock-like pain in a preauricular location on the surgical side. The smell of food or, less reliably,emotional excitement could also trigger pain. Mandibular movement did not evoke the pain, and between lancinating attacks there was either no pain or only mild discomfort. Following an episode of pain, there was a refractory period during which the pain could not be elicited. Physical examination demonstrated a preauricular sensory loss of variable distribution. No abnormal sweating or vasomotor findings were clinically apparent. No odontogenic, muscular, salivary gland, neurologic, or psychologic pathology was found to explain the clinical symptoms. The pain was not relieved with standard doses of anticonvulsants that are commonly used to treat trigeminal neuralgia. The duration of the recurrent pain symptoms in this group was 8 to 132 months without remission. Gustatory neuralgia may be a discrete syndrome that results from abnormal interactions between salivary efferent fibers and trigeminal sensory afferent fibers in the injured auriculotemporal nerve. The unique features of the disorder make it a potentially useful clinical model for the investigation of autonomic/sensory interactions in neuropathic pain.
Systemic Health Consequences of Alloplastic Implants of the TMJ: A Pilot Study - The International Journal of Periodontics and Restorative Dentistry Vol. 12, No. 4 1998 Page: 293 Author(s): Raphael/Marbach/Keller/Bartlett
Abstract: The aim of this study was to examine the relation between alloplastic temporomandibular joint (TMJ) implants and immune-associated systemic health problems. The authors compared 14 patients who received alloplastic TMJ implants with 31 TMJ patients who had never received surgery on the self-reported occurrence of symptoms and systemic disorders that are associated with problems of immunomodulation. Those with alloplastic jaw implants reported similar or lower rates of surveyed physical disorders than non-surgical TMJ participants. When the rates were summed across symptom categories and physical disorders, implant participants had significantly fewer symptoms and disorders than nonsurgical participants (P <0.01). This first report on systemic health problems in alloplastic TMJ implant patients found no evidence of elevated rates of systemic disorders that are associated with problems of immunomodulation.
Clinical, Radiographic, and Histologic Evaluation of Human Periodontal Defects Treated with Bio-Oss and Bio-Gide Vol. 18, No. 4 1998 Page: 321 The International Journal of Periodontics and Restorative Dentistry Author(s): Camelo/Nevins/Schenk/Simion/Rasperini/Lynch/Nevins
Abstract: This study evaluated the clinical, radiographic, and histologic response to Bio-Oss porous bone mineral when used alone or in combination with Bio-Gide bilayer collagen membrane in human periodontal defects. Four intrabony periodontal defects were treated: two received Bio-Oss alone and two were treated with a combination of Bio-Oss and Bio-Gide. Radiographs, clinical probing depths, and attachment levels were obtained preoperatively and 6 to 9 months postoperative, and teeth and surrounding tissues were biopsied. Both treatments significantly improved clinical probing depths and attachment levels,and the radiographic appearance suggested osseous fill. Histologic evaluation revealed that both treatments produced new cementum with inserting collagen fibers and new bone formation on the surface of the graft particles;this regenerative effect was more pronounced using the Bio-Oss/Bio-Gide combination, which resulted in 7 mm of new cementum and periodontal ligament and extensive new bone incorporating the graft. The membrane was intact at 7 months and partially degraded by 9 months after treatment.This human histologic study demonstrates that the porous bone mineral matrix used has the capacity to stimulate substantial new bone and cementum formation and that this capacity is further increased when the graft is used with a slowly resorbing collagen membrane.
Microscopic and Histochemical Evaluation of Demineralized Freeze-dried bone Allograft in Association with Implant Placement: A Case Report Vol. 18, No. 4 1998 Page: 355 The International Journal of Periodontics and Restorative Dentistry Author(s): Piattelli/Scarano/Piattelli
Abstract: A case report is presented in which a titanium implant was placed into a defect resulting from the extraction of an impacted tooth; the defect was filled with demineralized freeze-dried bone allograft particles without a membrane barrier. After a 6-month healing period the bone defect had completely healed and the tissue present had macroscopic features similar to mature bone. Histologic examination of this tissue showed that, in all demineralized freeze-dried bone allograft particles,mineralization nodules were scattered inside the demineralized bone; in the areas where the mineralization nodules were present, osteocyte lacunae could be observed.In the case presented, significant new vital bone formation was observed 6 months after placement of a demineralized freeze-dried bone allograft.
Localized Ridge Augmentation with Chin Grafts and Resorbable Pins: Case Reports Vol. 18, No. 4 1998 Page: 363 The International Journal of Periodontics and Restorative Dentistry Author(s): Urbani/Lombardo/Santi/Tarnow
Abstract: Six block grafts harvested from the mandibular symphysis were used to augment partially atrophied ridges. Three maxillary defects and three mandibular defects were treated in five patients. Autologous bone grafts from the chin were stabilized in the recipient sites with resorbable pins and no membranes were used over the grafts. Healing proceeded without complciations. At 3 to 4 months the external cortical surface of the grafts progressively resorbed and the profiles of the pins protruded from underneath the buccal tissue that covered the a ugmented areas. However, the pins never perforated the tissue and they were resorbed macroscopically within 4 to 6 months. At 6 months the areas treated showed successful ridge augmentation and, when exposed for stage 2 surgery, remnants of the pin holes on the external surface of the repaired defects were detected. Radiographic evaluation of the block grafts was performed at 3 and 6 months and histologic specimens were obtained at 6 months; the specimens demonstrated incomplete pin resorption and encapsulation. A severe foreign-body reaction was detected in one case. The presence of an acellular bone matrix in certain sections and a normal bone pa ttern with a cellular component in others was a consistant finding. ITI endosseous implants were placed with excellent primary stability in all treated cases.
A Protocol for Maintaining or Increasing the Width of Masticatory Mucosa Around Submerged Implants: A 1-year Prospective Study on 53 Patients Vol. 18, No. 4 1998 Page: 377 The International Journal of Periodontics and Restorative Dentistry Author(s): Barone/Clauser/Grassi/Merli/Pini Prato
Abstract: Masticatory mucosa around implants may be useful to enhance esthetics and/or plaque control. This study proposes simplified guidelines for maintaining or obtaining a minimal amount of masticatory mucosa around submerged implants in cases of partial edentulism, and for keeping the need for additional surgery to a minimum. Free gingival grafts were used in the mandibular arch when the width of buccal masticatory mucosa was less than 2 mm. The width of masticatory mucosa expected to be available for attachment to the bone surface buccal to implants was estimated by measuring the distance between the emergence of the implant from bone and the mucogingival junction.When this distance was 3 mm or less, the use of an apically positioned flap for implant exposure was preferred over gingivectomy. The amount of masticastory mucosa buccal to implants was measured 2 weeks, 6 months,and 12 months after implant exposure. In no case was the width of masticatory mucosa less than 2 mm at 1 year.Therefore, this protocol is recommended for the treatment of cases where the presence of an adequate amount of masticatory mucosa is necessary to ensure a satisfying appearance or is useful for facilitating oral hygiene.
Clinical Application of a New Bioresorbable Guided Tissue Regeneration Device: Case Reports Vol. 18, No. 4 1998 Page: 389 The International Journal of Periodontics and Restorative Dentistry Author(s): Parashis/Andronikaki-Faldami/Tsiklakis/van der Stelt
Abstract: Bioresorbable barriers have been recently introduced in clinical practice for guided tissue regeneration therapy.One of these is the Guidor matrix barrier, which is made of amorphous polylactic acid softened with a citric acid ester to increase malleability and facilitate clinical handling. The advantages of the bioresorbable barrier include: the elimination of second surgery; better handling and adaptation around the totoh and over the bone; and integration of the connective tissue of the flap with the barrier, preventing epithelial migration,gingival recession, and pocket formation. In the case of matrix exposure the material disappears within 6 to 8 weeks. The purpose of this report is to present the clinical application of the Guidor matrix barrier in the treatment of two- or three-wall intrabony defects that were followed up for more than 1 year. The evaluation included soft tissue changes using clinical parameters and hard tissue changes using non standardized digital subtraction radiography. In the authors' opinion, the incorporation of a bioresorbable barrier in guided tissue regeneration therapy represents a significant improvement in the treatment of intrabony defects.
The Use of a Soft Tissue Expander in an Alveolar Bone Ridge Augmentation for Implant Placement Vol. 18, No. 4 1998 Page: 403 The International Journal of Periodontics and Restorative Dentistry Author(s): Zeiter/Ries/Weir/Mishkin/Hendley/Sanders
Abstract: A narrow mandibular posterior alveolar ridge was modified by the use of a soft tissue expander to generate adequate tissue for graft coverage. The principles of osteoperiosteal flaps were combined with guided bone regeneration techniques for an optimum amount of bone at the site.
Mechanisms of Endosseous Integration Vol. 11, No. 5 1998 Page: 391 Author(s): Davies The International Journal of Prosthodontics
Abstract: Purpose: Although the clinical term osseointegration describes the anchorage of endosseous implants to withstand functional loading, it provides no insight into the mechanisms of bony healing around such implants. Nevertheless, an understanding of the sequence of bone healing events around endosseous implants is believed to be critical in developing biologic design criteria for implant surfaces. Results and Discussion: This discussion paper shows that peri-implant bone healing, which results in contact osteogenesis (bone growth on the implant surface), can be addressed experimentally. The first, osteoconduction, relies on the migration of differentiating osteogenic cells to the implant surface, through a temporary connective tissue scaffold. Anchorage of this scaffold to the implant surface is a function of implant surface design. The second, de novo bone formation, results in a mineralized interfacial matrix, equivalent to that seen in cement lines in natural bone tissue, being laid down on the implant surface. Implant surface topography will determine if the interfacial bone formed is bonded to the implant. A third tissue response, that of bone remodeling, will also, at discrete sites, create a bone-implant interface comprising de novo bone formation. Conclusion: Treatment outcomes in dental implantology will be critically dependent on implant surface designs that optimize the biologic response during each of these three distinct integration mechanisms.
Surgical Determinants of Clinical Success of Osseointegrated Oral Implants: A Review of the Literature Vol. 11, No. 5 1998 Page: 408 The International Journal of Prosthodontics Author(s): Sennerby/Roos
Abstract: Purpose: This article reviews the current knowledge about the influence of surgical factors on implant failure in routine cases and in those where implants have been used in conjunction with bone augmentation procedures.
Materials and Methods: Clinical reports published in major scientific journals served as the basis for this review.
Results: With few exceptions, most clinical reports were on screw-shaped titanium implants. High failure rates are associated with poor bone quality and the use of short implants in the athrophic maxilla, irradiation, and bone-grafting procedures of the athrophic maxilla. Evidence for high long-term failure rates of press-fit cylinders was found. Moreover, limited clinical experience, lack of preoperative antibiotics, and smoking may lead to higher failure rates. Conclusion: There is a need for further research to increase the success rates in the severely resorbed maxilla. Because of a lack of proper documentation with respect to the great majority of currently used oral implant designs, the influence of different factors and their long-term results remain unknown.

The Implant-Mucosal Interface and Its Role in the Long-Term Success of Endosseous Oral Implants: A Review of the Literature Vol. 11, No. 5 1998 Page: 421 The International Journal of Prosthodontics Author(s): Koka
Abstract: Purpose: This article reviews the literature on the anatomy and the role of the implant-mucosal interface in the long-term success of oral endosseous implants.
Materials and Methods: In vitro, in vivo animal, and in vivo human studies are reviewed and discussed.
Results: The anatomy of the implant-mucosal interface is described. The interface shares many features with periodontal mucosa. A clinically healthy implant-mucosal interface is a routine and predictable occurrence. The validity of using traditional clinical periodontal parameters to indicate or predict changes in peri-implant marginal bone height is unproven, especially if inflamed mucosal tissues are present.
Conclusion: In general, the human host response of peri-implant mucosa to long-term functional challenges if favorable.
Imaging Techniques and Image Interpretation for Dental Implant Treatment Vol. 11, No. 5 1998 Page: 442 The International Journal of Prosthodontics Author(s): Wyatt/Pharoah
Abstract: Purpose: This article reviews the literature on radiographic imaging techniques and image interpretation for dental implant treatment.
Materials and Methods: MEDLINE was used to identify published peer-reviewed literature for this report. Results: Radiographic images are indispensable in the evaluati on of osseous structures when planning treatment for dental implants. Potential bone sites for implant placement can be assessed clinically by means of palpation or probing through the mucosa; however, diagnostic imaging provides the best means for indirectly measuring bone dimensions. After healing of the implant site, the application of radiology is useful to verify the amount of bone adjacent to the implant and that the transmucosal abutments fit the implant. Upon completion of the implant prosthesis, radiology may be used to monitor initial and long-term success of implant treatment.
Conclusion: Recommendations for the application of radiology over the course of treatment are made for various implant cases ranging from the overdenture to the single-tooth implant.

The Effects of Age, Jaw Site, and Bone Condition on Oral Implant Outcomes Vol. 11, No. 5 1998 Page: 470 The International Journal of Prosthodontics Author(s): Bryant
Abstract: Purpose: This paper reviews literature on age and jaw site in relation to jawbone quantity and quality and the osseointegration of endosseous oral implants. Results and Discussion: The condition of jawbone is both age-and site-specific. However, increased age does not appear to affect the clinical potential for osseointegration or the rate of crestal bone resorption observed around oral implants. In contrast, jaw site is related significantly to osseointegration potential; mandibular sites tend to be more successful than maxillary sites. The reason for this may be that jawbone quality and quantity are often more compromised in maxillary than in mandi bular sites. However, evaluation of this relationship has been hampered by a lack of evidence to support the validity and reliability of methods used to assess jawbone condition preoperatively. Furthermore, short-term evidence suggests that high rates of implant success can be achieved in maxillary sites, even those with low trabecular density, if an adequate volume of bone exists to accommodate the implants. Although the rate of crestal bone resorption around oral implants is usually low and may not be site-specific, there is some evidence that it may be greater in sites with less preoperative resorption associated with shorter periods of edentulism.This pattern of bone loss could jeopardize long-term implant outcomes especially in younger implant patients.Another concern in young growing patients is that their prosthetic outcome may become compromised because osseointegra ted implants cannot keep pace with growth and development in surrounding structures. Conclusion: To improve our understanding of how the age-and site-specificity of jawbone condition affects oral implant outcomes, research needs to be aimed at establishing reliable and valid measures of preoperative jawbone condition, and at better documenting the effects of jawbone condition on oral implant outcomes.
Successful Long-Term Treatment Outcomes in the Field of Osseointegrated Implants: Prosthodontic Determinants Vol. 11, No. 5 1998 Page: 502 The International Journal of Prosthodontics Author(s): Carr
Abstract: Purpose: Because existing implant success criteria have not met with widespread use, consensus is needed among profess ionals working in the field as to what constitutes implant success. This article discusses implant success within the context of prosthesis success, and argues that successful use of implants cannot be judged without prosthesis consideration. Results and Discussion: A framework for evaluating clinical success of prosthodontic treatment is presented.A context for judging success by presenting related topics that that include contrasting process and outcome measures, and consideration of long-term outcomes that have a tangible meaning to the patient (ie, are patient-based), is argued for. A hierarchy of outcomes is proposed for a better understanding of the relative strengths associated with various outcomes. Emphasis is given to the concept of prosthodontic treatment being prescribed to reduce the patient-specific burden associated with the missing tooth condition. Conclusion: The challenge is to define the best applications of dental implants within the broad context of prosthodontic options through demonstrated advantages over more conventional options. A broad understanding of success from multiple outcome domains is most likely to give the truest measure for implant application within the context of possible prosthodontic options for all patients.


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