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JADA Specialty Scan - Radiology
Periodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Collagen matrix seal and collagen sponge combined with bone allograft reduce ridge resorption

The combination of a collagen matrix seal (CMS), collagen sponge (CS), and freeze-dried bone allograft (FDBA) sharply reduces ridge resorption in all dimensions and preserves buccal soft-tissue thickness in sockets with a buccal plate loss of less than 2 millimeters compared with tooth extraction without alveolar ridge preservation (ARP). The finding is from a study published in the June issue of Journal of Clinical Periodontology.

Researchers designed the study to measure the soft- and hard-tissue dimensional changes after ARP using either CMS or CS in combination with FDBA after 4 months of healing.

Twenty-eight patients from Tufts University School of Dental Medicine were evenly split between the CMS and the CS groups. The reasons for extraction were caries, endodontic complication, root fracture, or trauma with no evidence of acute infection such as severe swelling, suppuration, abscess, or spontaneous bleeding.

Researchers chose the flapless technique and left regenerative materials exposed during healing, noting that elevation and advancement of a full-thickness flap may cause postoperative bone resorption, marginal recession at the adjacent teeth, defective papillae, and loss of keratinized mucosa.

Researchers made stents for clinical measurements and sectional cone-beam computed tomography (CBCT) scans from a 1.5-mm thick plastic shell on the cast of each patient. They made 14 holes in the stent for reproducible clinical and radiographic measurements. They made 3 horizontal holes buccally and 3 lingually that corresponded to the teeth to be extracted at 4, 7, and 10 mm apical to the cementoenamel junction for horizontal clinical measurements of soft-tissue changes. They also made 1 vertical hole on the incisal or the occlusal edge for vertical measurements. They filled another 7 holes with diameters of less than 1 mm located adjacent to the reference holes with gutta-percha points as landmarks for measurements of hard-tissue changes on the CBCTs.

Researchers recorded measurements before extraction and 4 months after the ARP. They focused on width of alveolar ridge, vertical height to the buccal and palatal/lingual alveolar bone, and thickness of the buccal and palatal/lingual alveolar plates. They measured distances twice to 0.1 mm and recorded the mean distances.

Patients were seen after 1, 2, and 4 weeks. Sutures were removed during the 2-week postoperative visits.

Researchers noted a reduction in coronal ridge width (1.21 mm [14.91%] CMS and 1.47 mm [20.40%] CS), and vertical buccal bone resorption (0.30 mm CMS and 0.79 mm CS) were not significantly different. They also noted a slight increase in buccal gingival thickness at the coronal part in both groups (0.9 mm CMS and 0.5 mm CS). Horizontal bone loss in the coronal part was less, but not significantly different, in the CMS group (1.21 mm [14.91%]) compared with the CS group (1.47 mm [20.40%]).

Read the full article here.


Consulting Editor: Tapan Koticha, BDS
Diplomate, American Board of Periodontology
Director, Graduate Periodontics
University of Oklahoma Health Sciences Center, College of Dentistry

Air polishing effectiveness on titanium implant surfaces

The most effective air polishing should be applied with high pressure, deep insertion of the nozzle, enough water flow, and regular nozzle movement, according to a study published in the April issue of Journal of Periodontology.

Researchers designed the study to see how air polishing behaves on a titanium surface. They measured the size and shape of the cleaned area and the influence of different device settings, probing depths, and cleaning movements.

Titanium disks and 2 different subgingival models were used to mimic implant surface cleaning in vitro.

Disks were covered with a biomimetic calcium phosphate (CaP) coating to mimic a mineral-accumulated implant surface while enhancing visibility of the cleaning effect, placed in the subgingival model, and cleaned with a plastic nozzle under different settings.

The study was conducted in 2 steps. In step 1, researchers applied the treatment using a static nozzle and measured the shape and size of the cleaned area. In step 2, dynamic application of the nozzle mimicked clinical use. The best parameters discovered in step 1 were applied in step 2. The researchers tested different motions and calculated and compared the total cleaned surface area between test groups.

Researchers treated 48 titanium sandblasted large-grit acid-etched surface film-coated disks with an air abrasive system using a subgingival plastic nozzle. Two subgingival models were used: open-ended (step 1) and defined-size (step 2). In step 2, the best settings were used for dynamic application to test influence of different movements (up-down, slowly up, rotation). For both steps, researchers calculated powder and water consumption and total cleaned area.

Air pressure was the main factor with the strongest effect on cleaning. Increasing air pressure extended cleaning area. Nozzle depth and excessive powder flow amount had weak influences. Cleaning effect reached deeper than the nozzle physically reached. Step 2 showed that there was no significant difference between different nozzle movements; however, cleaning efficiency decreased greatly without movement.

The average total cleaned surface area of the groups with high pressure was 8 square millimeters, and for groups with low pressure it was 3.5 mm2.

Step 1 (static application) showed that the main factor influencing cleaning efficiency was air pressure. The higher the pressure applied, the better the cleaning. The size of the cleaned area was increased and cleaning became deeper with high pressure. Higher powder flow than the standard chamber allows was not required for better cleaning.

Study limitations included specimen type and the use of a CaP coating on titanium disks. Although the type of material and microsurface properties of the disks were the same as those of dental implants, the threaded shape of implants was different from the flat shape of the disks. In vitro biofilm was not chosen because it is less sticky than real peri-implantitis biofilm and can be sonicated easily. The researchers could not measure the cleaning path or difference in cleaning efficiency of different movements.

Read the full article here.


AAP 2017 Annual Meeting in Boston: meet the speakers
Hear directly from the world-class experts presenting at the 103rd Annual Meeting of the American Academy of Periodontology, held Sept. 9-12, 2017, in Boston. Don’t forget to register today! For more information, visit or e-mail


Higher levels of dissolved titanium associated with peri-implantitis


Higher levels of dissolved titanium were found in submucosal plaque around implants with peri-implantitis compared with healthy implants, suggesting a link between titanium dissolution and peri-implantitis. The findings are from a study published in the May issue of Journal of Periodontology.

Researchers designed a study to compare levels of dissolved titanium in submucosal plaque collected from healthy implants and implants with peri-implantitis.

Researchers recruited 30 patients aged 41 through 91 years for the study from the graduate periodontics clinic at the University of Washington. Inclusion criteria consisted of 1 healthy implant, 1 implant with peri-implantitis, or both; implant loaded with restorative components for at least 2 years; and presence of a baseline or current radiograph of the implant restored.

Clinical parameters recorded for each implant included probing depth (PD) at 6 sites, bleeding on probing (BOP) or suppuration, plaque index (PI) score, gingival index (GI) score, and number of years of implant in function after loading.

Peri-implantitis was diagnosed for implants with PDs greater than or equal to 5 mm, BOP or suppuration, and bone loss greater than or equal to 2 mm.

The authors collected submucosal plaque from 20 implants with peri-implantitis and 20 healthy implants with sterile curets, taking care not to contact or scratch the implant surface. They measured titanium levels using inductively coupled plasma mass spectrometry and normalized for mass of bacterial DNA per sample to exclude confounding by varying amounts of plaque per site.

One-half of implants in the healthy group were placed in females compared with 80% of implants in the peri-implantitis group. The number of years implants were functional was 8.12 through 4.33 in the healthy group and 7.95 through 4.59 in the peri-implantitis group. PDs, PI, and GI were significantly greater in the peri-implantitis group (P = .001, .04, and .001, respectively).

The amounts of plaque collected were significantly higher in the peri-implantitis group (48.73-67.16) than in the healthy group (23.87-14.06) (P = .01). In implant-level analysis, mean titanium levels were significantly higher in implants with peri-implantitis (0.85-2.47) than in healthy implants (0.07-0.19) after adjusting for amount collected per site.

“The importance of developing implant-specific treatment protocols that factor in titanium cytocompatibility has only recently been realized,” the authors noted. “The present findings corroborate the need to consider titanium material properties and its biocompatibility for establishing peri-implantitis treatment strategies that will bode for long-term success.”

Read the full article here.


Environmental tobacco smoke and periodontitis in U.S. nonsmokers from 2009 through 2012

The odds of developing periodontitis for those with environmental tobacco smoke (ETS) exposure was 28% higher compared with that for those with no ETS exposure, according to a study published in the June issue of Journal of Periodontology.

The goals of the study were to estimate the prevalence of periodontitis among U.S. nonsmoking adults exposed to ETS, report the values of the improved methods for estimating disease prevalence, and evaluate the predictive contribution of ETS exposure to periodontitis.

Researchers designed the study to include updated data from the National Health and Nutrition Examination Survey (NHANES), including full-mouth, 6-site periodontal probing, and attachment loss assessment. The analyzed NHANES data were from 2009 through 2012.

The authors used a dataset of 4,329 people (1,645 men [weighted frequency, 34,139,566] and 2,684 women [weighted frequency, 52,155,980], aged 30 to 80 years; mean age, 52.3 years) to represent lifetime nonsmoking U.S. civilian, noninstitutionalized adults 30 years or older.

Researchers assigned moderate periodontitis to those with a clinical attachment level (CAL) of at least 4 millimeters (that is, at least 2 interproximal sites, not on the same tooth) and a probing depth (PD) of at least 5 mm (that is, at least 2 interproximal sites, not on the same tooth). Interproximal sites used for the CAL and PD criteria were disto-facial, mesiofacial, disto-lingual, and mesiolingual.

To account for the NHANES survey design, researchers used survey analysis techniques to account for stratum, cluster, and weighting. They conducted their analyses using a reputable statistical analysis package. Researchers used an examination weighting variable to adjust personal-level data to national estimates. Differences in exposure by each variable were determined using Wald c2 test statistic.

A total of 24% of adult nonsmokers in the dataset had moderate periodontitis. Researchers found that ETS exposure was greater for men than for women, those in the 30- to 49-year age group than in the older age group, for non-Hispanic black adults than for those in other race/ethnicity groups, and for those with less than a college education. ETS exposure prevalence ranged from 14% to 31% from highest to lowest income category. The differences were shown in the mean serum cotinine level for the race/ethnicity, education level, and annual family income-level categories.
The odds of moderate periodontitis were 28% higher for those who had any ETS exposure (serum cotinine level ≥ 0.05 nanograms per milliliter) compared with those who had no ETS exposure.

“Nicotine alone can impact the physiology of a nonsmoker in oral disease, but this is of further significance in dentistry due to the volatile nature of some of the smoke derivatives said to be left behind,” the authors wrote, noting that sources of second- and third-hand smoke include water pipes and electronic cigarettes.

Read the full article here.

AAP Announces first recipient of SUNSTAR Innovation Grant

Dr. Yvonne Kapila

The $30,000 research grant, a component of the American Academy of Periodontolgoy’s recent partnership with oral health and technology company SUNSTAR, provides support to an AAP member whose research endeavors show significant potential to advance the science and practice of periodontics. Dr. Yvonne Kapila’s research project, “Natural Bacteriocins as Pre/Pro-Biotics to Promote Oral Health and Prevent Periodontal Disease,” was selected out of 15 grant submissions. Click here to read more.

For your hygienists: diabetes and periodontal diseases

The relationship between oral health and overall health grants dental professionals (particularly dental hygienists who perform preventive and nonsurgical care) a responsibility to educate all patients about the bidirectional relationship of diabetes and periodontal diseases and what it means for their risk and treatment. In this article, educator and American Academy of Periodontology periodontist Marcelo Freire, DDS, PhD, DMSc, sheds light on the sweeping worldwide incidence of diabetes and its connection to periodontal disease, which affects one of every two United States adults older than 30. Click here to read more.


Available for download: clinical and scientific papers from the AAP
The American Academy of Periodontology has developed a suite of resources to be used as guidelines for dentists dealing with periodontal health issues. These resources include: disease classifications; AAP-commissioned reviews; parameters of care; position papers; consensus papers/clinical recommendations; and Academy statements. View and download these materials by clicking here.


JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.

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