Purpose: No information is available on the perception of the quality of care in patients treated for periodontitis. The purpose of this article was to assess how periodontitis-affected patients perceive the quality of periodontal treatment (PT) and to measure the factors which may influence it. Materials and Methods: 306 subjects who completed PT were invited to participate. Questionnaires and visual analogic scales (VAS) evaluating perception of quality of care, symptoms, and oral health related quality of life (OHRQoL) were handed out. Oral and periodontal indicators were collected before and after treatment. The impact of different factors on perception of quality was assessed with a regression model. Results: Quality evaluation was high yet unrelated for both patients and clinicians (p = 0.983). Quality was negatively influenced by the number of residual oral infections (p < 0.001), patient's age (p = 0.07) and presence of residual pain at completion of PT (p = 0.02). Professionalism, kindness of the staff and communication skills were the characteristics mostly appreciated. The OHRQoL was influenced by the number of residual teeth (p < 0.001), increasing age of patients (p = 0.08), number of residual infections (p < 0.01) and pain (p = 0.04). Conclusions: Patients' quality perception appeared to be influenced by clinical and emotional aspects. Oral care providers should be aware of the impact of non-clinical factors in patients' appreciation of quality of treatment. Keywords: oral health related quality of life, periodontitis, quality of care

Purpose: Sinus elevation via the lateral approach for implant rehabilitation of atrophic posterior maxillae is considered a safe and predictable therapy. Several xenogeneic biomaterials of different biologic origin have been used as valid and predictable alternatives to autogenous bone. This multicenter randomized controlled double-blind prospective clinical trial aimed to compare histomorphometrically two xenogeneic grafting materials used for sinus elevation with simultaneous implant placement. Materials and Methods: Seven private practices in Italy were involved. Patients presenting at least one site with a residual bone crest height between 2 and 4 mm were treated. Control sites were grafted with 100% deproteinated particulated bovine bone (DPBB), while test sites were grafted with prehydrated corticocancellous porcine bone (PCPB). Root-form implants were placed simultaneously. Insertion torque and clinical stability were assessed and recorded. At 6 months, a biopsy specimen was harvested from each site, and histomorphometric analyses were performed. Results: Thirty-seven patients received 42 sinus elevations (24 test and 18 control). Eighty-two implants with adequate primary stability were placed. Fifty-five implants were placed in residual bone crests greater than 2 mm but less than 4 mm (average 2.7 mm) and achieved an average insertion torque of 22.8 ± 11.3 N/cm. Nineteen implants were placed in ridges greater than 3 mm but less than 5 mm, and eight were placed in ridges with more than 5 mm remaining. After 6 months, three implants had failed to integrate, leading to a survival rate of 96.34%. Forty-two specimens were analyzed histomorphometrically. No significant differences in total bone volume (PCPB 37.43%, DPBB 37.52%) or residual grafting material (PCPB 13.55%, DPBB 16.44%) were detected. Conclusions: In this study, PCPB compared well with DPBB as a grafting material for lateral sinus elevation.

A titanium implant with an acid-etched surface was placed simultaneously with sinus floor elevation in a severely resorbed ridge of a 52-year-old man. The height of the residual crest was less than 3 mm, and no bone substitute was used to graft the sinus cavity. Six months after placement, the implants were uncovered, and no signs of mobility were recorded. The implant at the second molar site and surrounding bone were removed for prosthetic convenience. The specimen was harvested and processed for undecalcified histologic analysis. Poor bone quality around the implant was evident, characterized by large marrow spaces and scarce trabeculation. Signs of osseointegration could be seen mainly toward the apical third of the implant. A cortical wall was present apical to the implant, suggesting the formation of a new sinus floor. The relationship between the histologic evidence and possible clinical implications are discussed.

Restoration of non-carious cervical lesions (NCCLs) represents a major challenge for resin materials due to the different adhesive properties of the tooth structure, the biomechanical aspects of the cervical area, and the difficulties in the access and isolation of the operative field. Furthermore, NCCLs should be approached with a complete understanding of the role played by the marginal periodontal tissue. Whenever a cervical lesion is associated with a gingival recession, the interplay between restorative dentistry and periodontology is decisive for full esthetic and long-term success. A case report is presented dealing with the treatment of NCCLs associated with multiple gingival recessions using a combined restorative and periodontal treatment with a 12-month follow-up.

Die Versorgung von nicht kariösen zervikalen Läsionen (NCCL) mit Komposit ist relativ schwierig. Das liegt an den unterschiedlichen adhäsiven Eigenschaften der Zahnsubstanz, den biomechanischen Aspekten des Zervikalbereichs und den Schwierigkeiten beim Zugang zum Arbeitsbereich und dessen Isolierung. Außerdem ist bei NCCL die Rolle des marginalen Parodontalgewebes zu berücksichtigen, was genaue Kenntnisse dieses Bereichs erfordert. Bei einer zervikalen Läsion im Zusammenhang mit einer gingivalen Rezession ist der Austausch zwischen restaurativer Zahnmedizin und Parodontologie für den umfassenden ästhetischen und langfristigen Erfolg entscheidend. In dem folgenden Fallbericht geht es um die Behandlung von NCCL im Zusammenhang mit multiplen gingivalen Rezessionen mit einer kombinierten restaurativen und Parodontalbehandlung. Der Follow-up-Zeitraum betrug 12 Monate.

A modified ridge augmentation technique is introduced for augmenting deficient alveolar ridges in preparation for endosseous implant placement. The technique is based on the principles for guided bone regeneration, in which a created space is kept isolated from the surrounding soft tissues by a resorbable membrane with an excellent extended resorption profile, thus permitting the accrual of bone-formative elements into the graft site. The absorbable membrane is propped up by an autogenous mixture of native corticocancellous bone cores taken in the graft site and reduced to smaller particle sizes and osseous coagulum collected in bone traps and with a special bone scraper. The major advantage of this technique is that all the autogenous bone graft material is obtained from the actual graft site, avoiding second remote intra- or extraoral surgical sites and attendant morbidities. Ridges augmented with this technique permit optimal endosseous implant placement.

Two failing implants were removed for prosthetic reasons from the maxilla of a 60-year-old woman. The implants were clinically immobile but presented clear signs of peri-implant mucositis and bone destruction. One of the two implants was harvested together with the surrounding bone and analyzed histologically. The implant was threaded and consisted of three distinct components screwed together in a telescopic fashion. Histologically, bone loss reached the fourth thread, while apical to the fourth thread, osseointegration between the host bone and the implant surface was recognizable. The implant parts were not completely seated into each other, and the resulting gap was colonized by host bone. Newly formed alveolar bone penetrated deep into the implant body cavity and appeared similar in nature to the alveolar bone surrounding the implant. Histologic findings are discussed in reference to the ability of such an implant to withstand biomechanical loading over time.

A submerged hydroxyapatite (HA)-coated implant placed into a fresh extraction socket in conjunction with a nonresorbable HA graft was harvested after 6 years of unloaded healing. The implant and surrounding bone were processed for histologic analysis. The HA coating appeared to be stable and homogenous. An excellent bone-to-implant contact could be found along the entire implant length. No signs of HA resorption or detachment were found. The HA graft was still recognizable histologically around the apical third of the implant. Light microscopy revealed a good osteoconductive ability of the HA particles, which did not show any signs of remodeling or resorption. These findings suggest that HA-coated implants may be able to maintain optimal osseointegration over time, even in the absence of loading.

Removal of barrier membranes may complicate second-stage implant surgery, particularly in mandibular areas characterized by a shallow vestibule and minimal amount of keratinized tissue. A new surgical technique that permits implant exposure and membrane removal combined with a plastic procedure to improve soft tissue quality both buccally and lingually is presented. A midcrestal incision preserving the keratinized tissue available on the lingual side is designed. A double-layer flap is elevated, allowing membrane removal. The inner, full-thickness layer is then sutured back into place, thus protecting the regenerated bone and allowing a recipient bed for a free gingival graft. The outer, partial-thickness flap is sutured apically, thus deepening the vestibule. The advantages and technical aspects of the procedure are discussed.

The objective of the study was to determine the osteoconductive potential of bovine-derived porous hydroxyapatite (HA) in combination with demineralized freeze-dried bone allograft (DFDBA) as an alternative to autogenous grafting in the maxillary sinus. The study involved 5 patients treated with 2-stage sinus elevation procedures using a combination of DFDBA and Osteograf/N 300 and 700. The healing time before implant placement ranged from 6 to 13 months. At the time of reentry, a bone core was harvested from each patient and processed for histologic and histomorphometric analysis. Woven and lamellar bone formation was evident in all specimens. Mean trabecular bone volume was 27.92%. The amount of newly formed bone was positively correlated with healing time. The range of new bone formation was 5.36% (6 mo) to 43.68% (12 mo). Residual HA graft particles were evident in all specimens, and the amount was inversely correlated with time. HA particles were often surrounded by an intense inflammatory infiltrate. DFDBA particles, largely present in the 6-month biopsy, were not recognizable in the 10-, 12-, and 13-month specimens, suggesting complete replacement. The combination of Osteograf/N and DFDBA appears to be osteoconductive and may be considered a valid alternative to autogenous bone grafts in sinus lift procedures. Histomorphometric and histologic evaluation may also be used to monitor the status of the future implant site.