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- Paulander, Jörgen, 1942, et al.
(author)
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Intra-oral pattern of tooth and periodontal bone loss between the age of 50 and 60 years. A longitudinal prospective study.
- 2004
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In: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 62:4, s. 214-22
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Journal article (peer-reviewed)abstract
- OBJECTIVE: In a 10-year prospective study we analyzed (i) the intra-oral pattern of and (ii) potential risk factors for tooth and periodontal bone loss in 50-year-old individuals. METHODS: A randomized subject sample of 50-year-old inhabitants in the County of Varmland, Sweden, was examined at baseline and after 10 years. Data from full-mouth clinical and radiographic examinations and questionnaire surveys of 309 (72%) of the individuals who were dentate at baseline were available for analysis. Non-parametric tests and binary logistic multiple regression models were used for statistical analysis of the data. RESULTS: 4.1% of the 7,101 teeth present at baseline, distributed among 39% of the subjects, were lost during the 10-year interval. The incidence of tooth loss was highest among mandibular molars (7.5%) and lowest among canines (1.8%). The relative risk (RR) for tooth loss for endodontically compromised teeth was 4.1 and for furcation-involved molars 2.4-6.5, depending on tooth position. Logistic regression analysis identified baseline alveolar bone level (ABL), endodontic conditions, CPITN score (Community Periodontal Index of Treatment Needs), tooth position, caries, and educational level as risk factors for tooth loss. The overall mean 10-year ABL change was -0.54 mm (S.E. 0.01). On a tooth level the ABL change varied between -0.35 mm (mandibular molars) and -0.79 mm (mandibular incisors). Smokers experienced a greater (20-131% depending on tooth type) mean bone loss than non-smokers. The logistic regression model revealed that tooth position, smoking, and probing pocket depth > or =4 mm were risk factors for bone loss of >1 mm. No pertinent differences were observed with respect to risk factors for ABL change in the subgroup of non-smokers compared to the results of the analysis based on the entire subject sample. CONCLUSION: Tooth loss was more common in the molar than in the anterior tooth regions, while periodontal bone loss had a random distribution in the dentition. The predominant risk factors identified with regard to further radiographic bone loss were "probing pocket depth > or =6 mm" and "smoking".
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| 2. |
- Paulander, Jörgen, 1942, et al.
(author)
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Some characteristics of 50/55-year-old individuals with various experience of destructive periodontal disease: a cross-sectional study.
- 2004
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In: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 62:4, s. 199-206
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To analyze the association between subject characteristics and degree of destructive periodontal disease in a randomly selected sample of 50/55-year-old individuals. METHODS: A randomized and geographically stratified (urban/rural districts) subject sample composed of dentate 50-year-old (n = 190) and 55-year-old individuals (n = 359) from the county of Varmland, Sweden were examined. Data were collected through full mouth clinical and radiographic examinations and by the use of questionnaires. Based on the cumulative distribution of the individuals with respect to mean probing attachment loss (PAL), subgroups of subjects with the lowest (L20%) and highest (H20%) experience of PAL were identified. Similar classifications were made for never-smokers and current smokers. Correlation analyses and forward stepwise logistic regression models were performed. RESULTS: The subgroup with the most extensive PAL loss (H20%) included a significantly higher proportion of (i) males (60 vs 33%), (ii) subjects with low educational level (65 vs 41%), (iii) smokers (49 vs 15%), and had (iv) less favorable lifestyle characteristics than the subgroup with minimal experience of PAL loss (L20%). The same pattern of differences was observed when the analysis was restricted to never-smokers, with the addition of a significantly lower proportion of subjects living in urban areas (40 vs 69%) in the H20% compared to the L20% subgroup. The stepwise logistic regression analysis revealed that number of teeth and smoking habits were significant factors in the identification of individuals in the L20% subgroup. For the H20% subgroup, number of teeth, gender, number of cigarettes/day and lifestyle index were significant explanatory variables. CONCLUSION: Number of remaining teeth and smoking habits were identified as the main discriminating factors for classification of subjects with regard to degree of destructive periodontal disease.
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| 3. |
- Paulander, Jörgen, 1942, et al.
(author)
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Some risk factors for periodontal bone loss in 50-year-old individuals. A 10-year cohort study
- 2004
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In: Journal Of Clinical Periodontology. ; 31:7, s. 489-96
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The aim of this 10-year prospective study of 50-year-old individuals was to analyze the incidence of periodontal bone loss and potential risk factors for periodontal bone loss. METHODS: The subject sample was generated from an epidemiological survey performed in 1988 of subjects living in the County of Varmland, Sweden. A randomized sample of 15% of the 50-year-old inhabitants in the county was drawn. At the 10-year follow-up in 1998, 320 (75%) of the 449 individuals examined at baseline were available for re-examination, out of which 4 had become edentulous. Full-mouth clinical and radiographic examinations and questionnaire surveys were performed in 1988 and 1998. Two hundred and ninety-five individuals (69%) had complete data for inclusion in the analysis of radiographic bone changes over 10 years. Non-parametric tests, correlations and stepwise multiple regression models were used for statistical analysis of the data. RESULTS: The mean alveolar bone level (ABL) in 1988 was 2.2 mm (0.05) and a further 0.4 mm (0.57) (p=0.000) was lost over the 10 years. Eight percent of the subject sample showed no loss, while 5% experienced a mean bone loss of >/=1 mm. Smoking was found to be the strongest individual risk predictor (RR=3.2; 95% CI 2.03-5.15). When including as smokers only those individuals who had continued with the habit during the entire 10-year follow-up period, the relative risk was slightly increased (3.6; 95% CI 2.32-5.57). Subjects who had quit smoking before the baseline examination did not demonstrate a significantly increased risk for disease progression (RR=1.3; 95% CI 0.57-2.96). Stepwise multiple regression analysis revealed that smoking, % approximal sites with probing pocket depth >/=4 mm, number of teeth and systemic disease were significant explanatory factors for 10-year ABL loss (R(2)=0.12). For never smokers, statistically significant predictors were number of teeth, mean ABL, % periodontally healthy approximal sites and educational level (R(2)=0.20). CONCLUSION: The inclusion of smokers in risk analysis for periodontal diseases may obstruct the possibility to detect other true risk factors and risk indicators.
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| 4. |
- Wennström, Jan, 1947, et al.
(author)
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Bone level change at implant-supported fixed partial dentures with and without cantilever extension after 5 years in function.
- 2004
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In: Journal of clinical periodontology. - 0303-6979. ; 31:12, s. 1077-83
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The aim of this study was to retrospectively analyze whether the inclusion of cantilever extensions increased the amount of marginal bone loss at free-standing, implant-supported, fixed partial dentures (FPDs) over a 5-year period of functional loading. MATERIAL AND METHODS: The patient material comprised 45 periodontally treated, partially dentate patients with a total of 50 free-standing FPDs supported by implants of the Astra Tech System. Following FPD placement (baseline) the patients were enrolled in an individually designed supportive care program. A set of criteria was collected at baseline to characterize the FPDs. The primary outcome variable was change in peri-implant bone level from the time of FPD placement to the 5-year follow-up examination. The comparison between FPDs with and without cantilevers was performed at three levels: FPD level, implant level, and surface level. Bivariate analysis was performed by the use of the Mann-Whitney U-test and stepwise regression analysis was utilized to evaluate the potential influence of confounding factors on the change in peri-implant bone level. RESULTS: The overall mean marginal bone loss for the implant-supported FPDs after 5 years in function was 0.4 mm (SD, 0.76). The bone level change at FPDs placed in the maxilla was significantly greater than that for FPDs in the mandible (0.6 versus 0.2 mm; p<0.05). No statistically significant differences were found with regard to peri-implant bone level change over the 5 years between FPDs with and without cantilevers at any of the levels of comparisons. The multivariate analysis revealed that the variables jaw of treatment and smoking had a significant influence on peri-implant bone level change on the FPD level, but not on the implant or surface levels. The model explained only 10% of the observed variance in the bone level change. CONCLUSION: The study failed to demonstrate that the presence of cantilever extensions in an FPD had an effect on peri-implant bone loss.
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| 5. |
- Wennström, Jan, 1947, et al.
(author)
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Oral rehabilitation with implant-supported fixed partial dentures in periodontitis-susceptible subjects. A 5-year prospective study.
- 2004
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In: Journal of clinical periodontology. - 0303-6979. ; 31:9, s. 713-24
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Journal article (peer-reviewed)abstract
- BACKGROUND: Comparatively few studies with at least 5 years of follow-up are available that describe the use of implants in prosthetic rehabilitation of partially edentulous patients. Randomized, controlled clinical studies that evaluated the effect of different surface designs of screw-shaped implants on the outcome of treatment are also sparse. OBJECTIVE: To determine, in a prospective randomized, controlled clinical trial, the outcome of restorative therapy in periodontitis-susceptible patients who, following basic periodontal therapy, had been restored with implants with either a machined- or a rough-surface topography. MATERIAL AND METHODS: Fifty-one subjects (mean age, 59.5 years), 20 males and 31 females who, following treatment of moderate-to-advanced chronic periodontitis, required implant therapy for prosthetic rehabilitation were recruited. Seventeen of the patients were current smokers. Following the active treatment, all subjects were included in an individually designed maintenance program. A total of 56 fixed partial dentures (FPDs) and a total of 149 screw-shaped, and self-tapping implants (Astra Tech implants) -- 83 in the maxilla and 66 in the mandible -- were installed in a two-stage procedure. Each patient received a minimum of two implants and by randomization every second implant that was installed had been designed with a machined surface and the remaining with a roughened Tioblast surface. Abutment connection was performed 3-6 months after implant installation. Clinical and radiographical examinations were performed following FPD connection and once a year during a 5-year follow-up period. The analysis of peri-implant bone-level alterations was performed on subject, FPD and implant levels. RESULTS: Four patients and four FPDs were lost to the 5 years of monitoring. One implant (machined surface) did not properly integrate (early failure), and was removed at the time of abutment connection. Three implants were lost during function and a further eight implants could not be accounted for at the 5-year follow-up examination. The overall failure rate at 5 years was 5.9% (subject level), 5.3% (FPD level) and 2.7% (implant level). Radiographic signs of loss of osseointegration were not found at any of the implants during the 5-year observation period. During the first year in function there was on average 0.33 (SD, 0.61) mm loss of peri-implant marginal bone on the subject and FPD levels and 0.31 (0.81) mm on the implant level. During the subsequent 4 years, the peri-implant bone-level alterations were small. The calculated annual change in peri-implant bone level was -0.02 (0.15) on subject and FPD levels and -0.03 (0.20) on the implant level. Thus, the mean total bone-level change over the 5-year interval amounted to 0.41 mm on all three levels of analysis. In the interval between baseline and 5 years, the machined and the Tioblast implants lost on average 0.33 and 0.48 mm, respectively (p>0.05). CONCLUSION: The present randomized, controlled clinical trial that included partially edentulous periodontitis-susceptible subjects demonstrated that bone loss (i) during the first year of function as well as annually thereafter was small and (ii) did not vary between implants with machined- or rough-surface designs.
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| 7. |
- Abrahamsson, Ingemar, 1953, et al.
(author)
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Early bone formation adjacent to rough and turned endosseous implant surfaces. An experimental study in the dog
- 2004
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In: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 15:4, s. 381-92
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To validate a proposed model (Berglundh et al. 2003) and to evaluate the rate and degree of osseointegration at turned (T) and sand blasted and acid etched (SLA) implant surfaces during early phases of healing. MATERIAL AND METHODS: The devices used for the study of early healing had a geometry that corresponded to that of a solid screw implant with either a SLA or a T surface configuration. A circumferential trough had been prepared within the thread region (intra-osseous portion) that established a geometrically well-defined wound chamber. Twenty Labrador dogs received totally 160 experimental devices to allow the evaluation of healing between 2 h and 12 weeks. Both ground and decalcified sections were prepared from mesial/distal and buccal/lingual device sites. Histometric and morphometric analyses of the ground sections and morphometric analysis of the tissue components in decalcified sections were performed. RESULTS: The ground sections provided an overview of the various phases of tissue formation, while the decalcified, thin sections enabled a more detailed study of events involved in bone tissue modeling and remodeling for both SLA and T surfaces. The initially empty wound chamber became occupied with a coagulum and a granulation tissue that was replaced by a provisional matrix. The process of bone formation started already during the first week. The newly formed bone present at the lateral border of the cut bony bed appeared to be continuous with the parent bone, but on the SLA surface woven bone was also found at a distance from the parent bone. Parallel-fibered and/or lamellar bone as well as bone marrow replaced this primary bone after 4 weeks. In the SLA chambers, more bone-to-device contact, more initial woven bone and earlier lamellar bone formation was found than in the T chambers. CONCLUSION: Osseointegration represents a dynamic process both during its establishment and its maintenance. While healing showed similar characteristics with resorptive and appositional events for both SLA and T surfaces, the rate and degree of osseointegration were superior for the SLA compared with the T chambers.
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