Get a load of this

Now comes a study that challenges these principles and explores early "loading" of dental implants.

In a multi-center study, Lazzara et al^* evaluated the loading of 429 Osseotite⁺ dental implants (3-I-Implant Innovations Inc., Palm Beach Gardens, FL) in 155 patients. Implants were placed using conventional surgical protocols with the exception that the implants were not submerged under the surgical flaps. Instead, healing abutments were placed on the implants at the time of implant surgery. Then, approximately 2.1+ 0.7 months after implant and abutment placement, prosthetics were commenced. A host of parameters were evaluated including bone density, implant position, type of prosthesis, screw-retained vs. cemented restoration, and more. Each dentist in this study decided what type of restoration would be fabricated and how it was to be retained.

Only seven of the 429 implants evaluated did not integrate. This translated into a 98.5% survival rate at 12.6 months.

In our opinion, this study should be viewed with cautious optimism. Though the new restorations in this study not have been battle-tested very long, the high success rate is quite encouraging. It should be noted that early-loading of implants cannot be tried in every case. Bone density and length of the implant can affect success. So can location. What is clear is that the lengthy treatment times associated with conventional approaches to implant treatment can be revisited and may be altered in some instances.

^* Lazzara R.G., Porter S.S., Testori T., Glante J., and Zetterqvist L.: "A prospective study evaluating loading of Osseotite implants two months after placement: one –year results." J Esthetic Dent 1999; 10:281-289.

⁺ Osseotite. This implant is acid-etched which yields a higher bone-to-metal contact surface. The inference is that early-loading is predicated on this implant type due to its increased surface area.

It's no Watergate, but still a cover up worth mentioning

Twenty-three healthy patients – ten males, thirteen females - were studied in three clinical centers. Their mean age was 41.5 + 11.6 years. Each patient had advanced periodontal disease, including two osseous defects of similar depth and shape located in the same jaw. Attachment loss had to be -> 6mm, with at least a 2mm infrabony defect.

Treatment consisted of elevating a full thickness buccal and lingual flap in all cases, debriding the roots by hand and mechanical instrumentation, then randomly covering one defect with a polylactic-acid barrier membrane (Guidor AB, Sweden) or leaving the defect to heal on its own. No root conditioning was performed. In all cases – the control and the experimental - primary flap closure was achieved.

The results were consistent: at one year, pocket depths were shallower in the test group than in the controls (3.0+1.5mm in test group vs. 3.7+1.3mm in controls). When it came to gain in clinical attachment levels, the improvements were similar for both groups, yet more defects completely healed – both shallow and deep – when the bioresorbable membrane was used. As expected and noted in other studies, deeper defects had greater healing responses than shallower ones.

Though limited by the small number of defects studied, the consistent results reported here should not be overlooked. Greater healing and reduction occurred with the bioresorbable membranes, indicating that this is one time cover-ups may be the right thing to do!

^** Cortellini P., Carnevale G., Sanz M., and Tonetti M.S..: "Treatment of shallow and intrabony defects: A multi-center randomized controlled clinical trial." J Clin Perio 1998; 25:981-987.

Gum Disease: No big deal--right? Wrong!

Let's first talk about how the gums relate to the heart. If you have a healthy heart, this doesn't pertain to you. Getting your teeth cleaned or having a gum abscess does matter if you have a weakened heart valve, as in mitral valve prolapse or aortic stenosis. Why? Bacteria from the mouth find their way into the circulatory system. They may be introduced when your teeth are cleaned or can arise from an infection. In either case, these "circulating" bacteria are normally gobbled up by the white blood cells before they do any damage. Should they pass through the body and make it to the heart unscathed, the chance exists that they will colonize on a weakened valve and cause a severe problem (bacterial endocarditis). For this reason, patients with any of the above conditions are suggested to pre-medicate with antibiotics when receiving dental care.

Circulating bacteria can also impact on coronary artery disease. The walls of the coronary arteries can thicken due to the build-up of fatty proteins. Often blood clots form in these narrowed coronary arteries and normal blood flow activity is obstructed. This depletes the heart of the nutrients and oxygen it needs to function properly. Scientists now believe that bacteria found in the oral cavity can attach to these fatty plaques once they enter the bloodstream. Clinging to the heart walls, these bacteria may contribute to clot formation.

When it comes to diabetes, gum disease cannot be ignored. The link between the two has been well-documented. We have always known that diabetics are prone to more infections and heal slowly. Now studies find that periodontal disease may make a pre-existing diabetic condition worse. It has been shown that diabetics require less insulin once their gum condition has been treated. Since periodontal disease is a risk factor for the progression of diabetes, physicians should consider the periodontal status of their diabetic patients who have difficulty with glycemic control.

In the next newsletter, we discuss the medical aspects of how gum disease relates to chronic pulmonary disease and estrogen replacement therapy.

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