Showing papers in "Journal of Periodontology in 2009"
TL;DR: All 45 anterior maxillary single-tooth implants fulfilled strict success criteria for dental implants with regard to osseointegration, including the absence of peri-implant radiolucency, implant mobility, suppuration, and pain.
Abstract: Background: To validate the concept of early implant placement for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria when assessing outcome parameters.Methods: In this cross-sectional, retrospective 2- to 4-year study involving 45 patients treated with maxillary anterior single-tooth implants according to the concept of early implant placement, a novel comprehensive index, comprising pink esthetic score and white esthetic score (PES/WES; the highest possible combined score is 20), was applied for the objective esthetic outcome assessment of anterior single-tooth implants.Results: All 45 anterior maxillary single-tooth implants fulfilled strict success criteria for dental implants with regard to osseointegration, including the absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 14.7 ± 1.18 (range: 11 to 18). The mean total PES of 7.8 ± 0.88 (range: 6 to 9) documents favorable overall p...
518 citations
TL;DR: Patients with RP presented a distinct microbial profile compared to patients in the GR and PH groups, as determined by HOMIM.
Abstract: Background: This study compared the subgingival microbiota of subjects with refractory periodontitis (RP) to those in subjects with treatable periodontitis (GRs = good responders) or periodontal health (PH) using the Human Oral Microbe Identification Microarray (HOMIM).Methods: At baseline, subgingival plaque samples were taken from 47 subjects with periodontitis and 20 individuals with PH and analyzed for the presence of 300 species by HOMIM. The subjects with periodontitis were classified as having RP (n = 17) based on mean attachment loss (AL) and/or more than three sites with AL ≥2.5 mm after scaling and root planing, surgery, and systemically administered amoxicillin and metronidazole or as GRs (n = 30) based on mean attachment gain and no sites with AL ≥2.5 mm after treatment. Significant differences in taxa among the groups were sought using the Kruskal-Wallis and χ2 tests.Results: More species were detected in patients with disease (GR or RP) than in those without disease (PH). Subjects with RP we...
493 citations
TL;DR: Excess dental cement was associated with signs of peri-implant disease in the majority (81%) of the cases and was absent in 74% of the test implants after the removal of excess cement.
Abstract: Background: Cement-retained restorations are commonly used on dental implants. Residual excess cement after placement of fixed partial dentures has been associated with clinical and radiographic signs of peri-implant disease. The purpose of this study was to explore the relationship between excess dental cement and peri-implant disease using the dental endoscope.Methods: Thirty-nine consecutive patients with implants exhibiting clinical and/or radiographic signs of peri-implant disease were studied. Patients were enrolled in the study during a 5-year period in a private periodontal practice. Twelve of these patients had similar implants without signs of inflammation; these implants served as controls. There were 20 controls and 42 test implants. All were evaluated using a dental endoscope initially, and all but one implant was evaluated at a 30-day follow-up. Results from both groups were assessed by two trained operators and recorded.Results: None of the controls and all 42 of the test implants had clini...
473 citations
TL;DR: This clinical study sought the ability of putative host- and microbially derived biomarkers to identify periodontal disease status from whole saliva and plaque biofilm to identify incipient disease and reduce health care costs.
Abstract: Background: Periodontitis is the major cause of tooth loss in adults and is linked to systemic illnesses, such as cardiovascular disease and stroke. The development of rapid point-of-care (POC) chairside diagnostics has the potential for the early detection of periodontal infection and progression to identify incipient disease and reduce health care costs. However, validation of effective diagnostics requires the identification and verification of biomarkers correlated with disease progression. This clinical study sought to determine the ability of putative host- and microbially derived biomarkers to identify periodontal disease status from whole saliva and plaque biofilm.Methods: One hundred human subjects were equally recruited into a healthy/gingivitis group or a periodontitis population. Whole saliva was collected from all subjects and analyzed using antibody arrays to measure the levels of multiple proinflammatory cytokines and bone resorptive/turnover markers.Results: Salivary biomarker data were co...
329 citations
TL;DR: From a radiologic and histologic point of view at 6 months after surgery, the use of PRF as the sole filling material during a simultaneous sinus lift and implantation stabilized a high volume of natural regenerated bone in the subsinus cavity up to the tip of the implants.
Abstract: Background: Sinus augmentation with simultaneous implant placement without bone graft material is a hotly debated technique. This technique could be improved and secured by the use of an autologous leukocyte- and platelet-rich fibrin (PRF) (Choukroun’s technique) concentrate. The objectives of this study were to assess the relevance of PRF clots and membranes as the sole filling material during a lateral sinus lift with immediate implantation using radiologic and histologic analyses in a case series. Methods: Twenty-five sinus elevations with simultaneous implantation were performed on 20 patients with Choukroun’s PRF as the sole filling biomaterial. For each patient, a presurgical exam and a 6-month postsurgical radiologic exam were performed with a panoramic x-ray and three-dimensional volumetric computed radiography (VCR) to evaluate the subsinus residual bone height and the final bone gain around the implants. In nine patients, 6 months after the sinus lift, bone biopsies were collected on the buccal wall of the alveolar ridge at the level of the osteotomy window, and evaluated by histomorphometry. Results: In this study, 41 implants from three different systems with different screw designs (Biomet 3I Nanotite, MIS Seven, Intra-Lock Ossean) were placed. All implants were inserted in residual bone height between 1.5 and 6 mm (mean – SD: 2.9 – 0.9 mm). The final bone gain was always very significant (between 7 and 13 mm [mean – SD: 10.1 – 0.9 mm]). No implant was lost. After radiologic analyses, the position of the final sinus floor was always in the continuation of the end of the implant. All biopsies showed well organized and vital bone. Conclusions: From a radiologic and histologic point of view at 6 months after surgery, the use of PRF as the sole filling material during a simultaneous sinus lift and implantation stabilized a high volume of natural regenerated bone in the subsinus cavity up to the tip of the implants. Choukroun’s PRF is a simple and inexpensive biomaterial, and its systematic use during a sinus lift seems a relevant option, particularly for the protection of the Schneiderian membrane. J Periodontol 2009;80:2056-2064.
314 citations
TL;DR: Using this two-principle safe protocol, the use of PRF in periodontal surgery leads to a significant improvement during the early healing phase and to a thick and stable final remodeled gingiva.
Abstract: Background: The aim of this study was to determine whether the addition of an autologous platelet-rich fibrin clot (PRF) to a modified coronally advanced flap (MCAF) (test group) would improve the clinical outcome compared to an MCAF alone (control group) for the treatment of multiple gingival recessions.Methods: Twenty subjects, presenting three adjacent Miller Class I or II multiple gingival recessions of similar extent on both sides of the mouth, were enrolled in the study. The mean recession value at baseline was 2.9 ± 1.1 mm for test sites and 2.5 ± 0.9 mm for control sites. Each patient was treated on both sides by an MCAF technique; the combination treatment (with a PRF membrane) was applied on the test side. Probing depth (PD), recession width, clinical attachment level (CAL), keratinized gingival width, and gingival/mucosal thickness (GTH) were measured at baseline and at 6 months post-surgery. Gingival recession was measured at baseline and at 1, 3, and 6 months post-surgery.Results: Mean root c...
292 citations
TL;DR: Non-surgical periodontal therapy had a beneficial effect on the signs and symptoms of RA, regardless of the medications used to treat this condition.
Abstract: Background: Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions Recent studies showed a beneficial effect of periodontal treatment on the severity of active RA This study was undertaken to further examine the effect of non-surgical periodontal treatment on the signs and symptoms of RA in patients treated with or without anti-tumor necrosis factor-alpha (anti-TNF-α) medications The effect of anti-TNF-α therapy on periodontitis also was assessedMethods: Forty participants diagnosed with moderate/severe RA (under treatment for RA) and severe periodontitis were randomly assigned to receive initial non-surgical periodontal therapy with scaling/root planing and oral hygiene instructions (n = 20) or no periodontal therapy (n = 20) To control RA, all participants had been using disease-modifying anti-rheumatic drugs, and 20 had also been using anti-TNF-α before randomization Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI)
290 citations
TL;DR: This Editors' Consensus is supported by an educational grant from Colgate-Palmolive, Inc., New York, New Jersey, and is based on a meeting of the authors held in Boston, Massachusetts, on January 9, 2009.
Abstract: Acknowledgment: This Editors' Consensus is supported by an educational grant from Colgate-Palmolive, Inc., New York, New York, and is based on a meeting of the authors held in Boston, Massachusetts, on January 9, 2009.Disclosure: Dr. Friedewald has received honoraria for speaking from Novartis, East Hanover, New Jersey. Dr. Kornman is a full-time employee and shareholder of Interleukin Genetics, Waltham, Massachusetts, which owns patents on genetic biomarkers for chronic inflammatory diseases. Dr. Genco is a consultant to Merck, Whitehouse Station, New Jersey. Dr. Ridker has received research support from AstraZeneca, Wilmington, Delaware; Novartis; Pfizer, New York, New York; Roche, Nutley, New Jersey; Sanofi-Aventis, Bridgewater, New Jersey; and Abbott Laboratories, Abbott Park, Illinois. Dr. Ridker has received non-financial research support from Amgen, Thousand Oaks, California. Dr. Ridker is a co-inventor on patents held by Brigham and Women's Hospital that relate to the use of inflammatory biomarker...
281 citations
TL;DR: A successful dental implant osseointegration can be accomplished in subjects with diabetes with good metabolic control in a similar manner as in subjects without diabetes.
Abstract: Background: Implant treatment is an attractive substitute to traditional fixed/removable prosthetic appliances. In patients with diabetes, dental implant therapy has been considered a contraindication. Hyperglycemia augments the severity of periodontal disease, and glycemic control is an essential variable in determining the success of dental implants in subjects with diabetes. Subjects with well-controlled diabetes may not be significantly compromised and can have high dental implant success rates compared to individuals with poorly controlled diabetes. The focused questions addressed in this systematic review were as follows: Can patients with diabetes be good candidates for dental implant therapy? And how does hyperglycemia and glycemic control influence osseointegration? Methods: A systematic literature search of MEDLINE/PubMed articles published from 1982 up to and including July 2009 was independently performed by two investigators. In addition, reference lists of original and review articles were searched. The search strategy was to use the following terms in different combinations: dental implants, immediate implants, osseointegration, periodontal disease, diabetes, hyperglycemia, metabolic control, and glycemic control. The search included studies on humans and diabetes-induced animal models. The selection criteria included all levels of available evidence. Suitable variables included the implant survival rate among individuals with diabetes, effects of hyperglycemia and glycemic control on bone, and maintenance of dental implants in subjects with diabetes. Articles published only in the English language were considered, and unpublished data were not sought. Results: We initially identified 33 studies. Fifteen studies, which did not fulfill the selection criteria, were excluded. The included studies reported that poorly controlled diabetes negatively affects implant osseointegration; however, under optimal serum glycemic control, osseointegration can successfully occur in patients with diabetes. Animal studies have confirmed that osseointegration can be successfully achieved in insulincontrolled rats with diabetes, whereas in uncontrolled rats with diabetes, the bone-to-implant contact appears to decrease with time. The use of antiseptic mouthrinses and oral-hygiene maintenance helps in achieving a successful dental implant osseointegration in subjects with diabetes. Conclusion: A successful dental implant osseointegration can be accomplished in subjects with diabetes with good metabolic control (serum glycemic level and hemoglobin A1c in normal range) in a similar manner as in subjects without diabetes. J Periodontol 2009;80:1719-1730.
271 citations
TL;DR: This pilot study demonstrated the critical role of considering obesity as well as rigorous preventive and periodontal care in trials designed to reduce cardiovascular risk.
Abstract: Background- In the Periodontitis and Vascular Events (PAVE) pilot study periodontal therapy was provided as an intervention in a secondary cardiac event prevention model through five coordinated cardiac-dental centers. Methods- Subjects were randomized to either community care or protocol provided scaling and root planing to evaluate effects on periodontal status and systemic levels of high-sensitivity Creactive protein (hs-CRP). Results- After 6 months there was a significant reduction in mean probing depth and extent of 4- or 5-mm pockets. However there were no significant differences in attachment levels bleeding upon probing or extent of subgingival calculus comparing subjects assigned to protocol therapy (n = 151) to those assigned to community care (n = 152). Using intent-to-treat analyses there was no significant effect on serum hs-CRP levels at 6 months. However 48% of the subjects randomized to community care received preventive or periodontal treatments. Secondary analyses demonstrated that consideration of any preventive or periodontal care (i.e. any treatment) compared to no treatment showed a significant reduction in the percentage of people with elevated hs-CRP (values >3 mg/l)at 6 months. However obesity nullified the periodontal treatment effects on hs-CRP reduction. The adjusted odds ratio for hs-CRP levels >3 mg/l at 6 months for any treatment versus no treatment among non-obese individuals was 0.26 (95%confidence interval: 0.09 to 0.72) adjusting for smoking marital status and gender. Conclusion- This pilot study demonstrated the critical role of considering obesity as well as rigorous preventive and periodontal care in trials designed to reduce cardiovascular risk. Originally published Journal of Periodontology Vol. 80 No. 2 Feb 2009
224 citations
TL;DR: The root coverage esthetic score (RES) system may be a useful tool to assess the esthetic outcome following root-coverage procedures.
Abstract: Background: Generally, esthetic outcomes following root-coverage procedures are not assessed. This article proposes a score for evaluating the esthetic outcome following root-coverage surgery.Methods: Thirty-one patients with Miller Class I and II recession defects treated with root-coverage procedures were evaluated. Esthetic outcomes were assessed using the root coverage esthetic score (RES) 6 months after surgery. This score evaluates five variables: level of the gingival margin, marginal tissue contour, soft tissue texture, mucogingival junction alignment, and gingival color. Because complete root coverage was the primary treatment goal, and the other variables were considered secondary, the value assigned for root coverage was 60% of the total score, whereas 40% was assigned to the other four variables. With regard to assessment of the final position of the gingival margin, 3 points were given for partial root coverage, and 6 points were given for complete root coverage; 0 points were assigned when t...
TL;DR: Twenty consecutive patients treated with an implant-borne single crown were prospectively followed for 12 months, demonstrating ankylotic stability and healthy peri-implant soft tissues as documented by standard parameters.
Abstract: Background: Early implant placement is one of the treatment options in postextraction sites in the anterior maxilla. Implant placement is performed after a soft tissue healing period of 4 to 8 weeks. Implant placement is combined with a simultaneous guided bone regeneration (GBR) procedure to rebuild esthetic facial hard and soft tissue contours.Methods: In this prospective case-series study, 20 consecutive patients treated with an implant-borne single crown were prospectively followed for 12 months. Clinical, radiologic, and esthetic parameters were recorded to assess treatment outcomes.Results: At the 12-month examination, all 20 implants were successfully integrated, demonstrating ankylotic stability and healthy peri-implant soft tissues as documented by standard parameters. The esthetic outcomes assessed by a pink esthetic score (PES) and a white esthetic score (WES) demonstrated pleasing results overall. The WES values were slightly superior to the PES values. The periapical radiographs showed minima...
TL;DR: Stress, depression, and CORT were correlated with measures of periodontal disease, and oral care neglect during periods of stress and depression was associated with attachment loss and missing teeth.
Abstract: Background: Stress and depression may affect the onset and progression of periodontal disease. However, to the best of our knowledge, no published study has established whether the mechanisms by which stress and depression influence periodontal disease are physiologic, behavioral, or both. This cross-sectional pilot study explored the associations between psychologic factors, markers of periodontal disease, psychoneuroimmunologic variables, and behavior.Methods: This study included 45 periodontal patients referred by three dentists. Participants completed composite health, chronic stress, depression, and demographic questions, and salivary cortisol (CORT) was measured. A hygienist assessed the magnitude of periodontal disease.Results: Stress, depression, and CORT were correlated with measures of periodontal disease. In addition, oral care neglect during periods of stress and depression was associated with attachment loss and missing teeth. After controlling for age, family history, and brushing frequency,...
TL;DR: Assessment of soft tissue and esthetic outcomes at single-tooth immediate implants placed without flap elevation in maxillary central and lateral incisor sites found recession was greater for implants placed facially within the extraction socket compared to those placed lingually.
Abstract: Background: The aim of this retrospective study was to assess soft tissue and esthetic outcomes at single-tooth immediate implants placed without flap elevation in maxillary central and lateral incisor sites.Methods: Photographic records of 85 consecutive patients with immediate single-tooth implants in maxillary central and lateral incisors that were placed without elevation of surgical flaps were selected. The change in mucosal level was expressed as a percentage of the length of the reference central incisor.Results: Significant recession of the mesial papilla (−6.2% ± 6.8%), distal papilla (−7.4% ± 7.5%), and facial mucosa (−4.6% ± 6.6%) between surgical placement and 1 year was observed (P <0.001). Recession was greater for implants placed facially within the extraction socket compared to those placed lingually (P = 0.009). Sites with gingival margins initially coronal achieved mucosal levels close to the line of symmetry with the contralateral tooth. Sites initially level or apical failed to reach t...
TL;DR: The envelope type of CAF was associated with an increased probability of achieving complete root coverage and with a better postoperative course and Keloid formation along the vertical releasing incisions was responsible for the worst esthetic evaluation made by an independent expert periodontist.
Abstract: Background: Vertical releasing incisions might damage the blood supply to the flap and result in unesthetic visible white scars. The aim of the present study was to compare root coverage and esthetic outcomes of the coronally advanced flap (CAF) with and without vertical releasing incisions in the treatment of multiple gingival recessions. Methods: Thirty-two systemically and periodontally healthy subjects with esthetic complaints due to the exposure of Miller Class I and II multiple (at least two) gingival recession defects (‡1 mm) affecting adjacent teeth of the same quadrant of the upper jaw were enrolled in the study. Sixteen patients (with 45 gingival recessions) were randomly assigned to the control group, and the other 16 patients (with 47 recession defects) were assigned to the test group. All recessions were treated with a CAF; vertical releasing incisions were performed in the control group, whereas an envelope-type flap was used in the test group. The patient’s postoperative morbidity was assessed 1 week after the surgery, whereas the esthetic evaluation, made by the patient and independent periodontist, and the clinical evaluation were made 1 year later. Results: Surgical time was significantly shorter in the envelope-type CAF group. No statistically significant difference was demonstrated between the two groups in terms of recession reduction and clinical attachment level gain. A statistically greater probability of complete root coverage (adjusted odds ratio, 3.76; 95% confidence interval: 0.92 to 15.33; P <0.05) and a greater increase in buccal keratinized tissue height were observed with the envelope type of CAF. Patient satisfaction with esthetics was very high in both treatment groups, with no statistically significant differences between them. A better postoperative course and better results in the esthetic evaluation made by an independent periodontist were demonstrated in patients treated with the envelope type of CAF. Conclusions: Both CAF techniques were effective in reducing recession depth. The envelope type of CAF was associated with an increased probability of achieving complete root coverage and with a better postoperative course. Keloid formation along the vertical releasing incisions was responsible for the worst esthetic evaluation made by an independent expert periodontist. J Periodontol 2009;80:1083-1094.
TL;DR: Non-surgicalperiodontal therapy was effective in improving periodontal clinical data and in reducing the plasma levels of IL-6, CRP, and fibrinogen in hypertensive patients with severe periodontitis.
Abstract: Background: Recent epidemiologic studies suggest that inflammation is the link between periodontal diseases and cardiovascular complications. This study aimed to evaluate the effects of non-surgical periodontal treatment on plasma levels of inflammatory markers (interleukin [IL]-6, C-reactive protein [CRP], and fibrinogen) in patients with severe periodontitis and refractory arterial hypertension. Methods: Twenty-two patients were examined and randomly divided into two groups. The test group was composed of 11 patients (mean age, 48.9 – 3.9 years) who received periodontal treatment, whereas the control group had 11 patients (mean age, 49.7 – 6.0 years) whose treatment was delayed for 3 months. Demographic and clinical periodontal data were collected, and blood tests were performed to measure the levels of IL-6, CRP, and fibrinogen at baseline and 3 months later. Results: The clinical results showed that the mean percentages of sites with bleeding on probing, probing depth (PD) 4 to 5 mm, PD ‡6 mm, clinical attachment loss (CAL) 4 to 5 mm, and CAL ‡6 mm were significantly reduced in the test group 3 months after periodontal treatment. There were no significant differences between the data at baseline and 3 months in the control group. Periodontal treatment significantly reduced the blood levels of fibrinogen, CRP, and IL-6 in the test group. Conclusion: Non-surgical periodontal therapy was effective in improving periodontal clinical data and in reducing the plasma levels of IL-6, CRP, and fibrinogen in hypertensive patients with severe periodontitis. J Periodontol 2009;80:786791.
TL;DR: Alveolar bone regeneration in surgically created peri-implant saddle-like defects was more effective in test groups than the control group, and the feasibility of using stem cell-mediated bone regeneration to treat peri -implant defects was demonstrated.
Abstract: Background: The present study was undertaken to evaluate the potential of periodontal ligament stem cells (PDLSCs) and bone marrow SCs (BMSCs) on alveolar bone regeneration in a canine peri-implant defect model.Methods: Four adult, male beagle dogs were used in this study. Autologous BMSCs from the iliac crests and PDLSCs from extracted teeth were cultured. Three months after extraction, BMSC- and PDLSC-loaded hydroxyapatite/β-tricalcium phosphate (HA/TCP) (test groups) and cell-free HA/TCP (control group) were implanted in three rectangular, saddle-like peri-implant defects, respectively. The left side of the mandible was initially prepared, and after 8 weeks, the right side was also prepared. The animals were sacrificed after an 8-week healing period. Undecalcified ground sections were prepared. New bone formation and bone-to-implant contact (BIC) were measured histomorphometrically. BMSCs and PDLSCs were fluorescently labeled and traced.Results: Alveolar bone regeneration in surgically created peri-imp...
TL;DR: The lack of an accepted definition and classification of ankyloglossia makes comparisons between studies almost impossible and it also remains controversial which tongue-ties need to be surgically removed and which can be left to observation.
Abstract: Background: The objective of this study was to systematically review the diagnostic criteria, indications, and need for treatment of ankyloglossia (tongue-tie), as well as the various treatment options for patients in different age groups.Methods: The MEDLINE databases and the Cochrane Library were searched according to well-defined criteria, resulting in 64 included articles. The evidence regarding the classifications of tongue-tie, epidemiologic data, inheritance, breastfeeding problems, impaired tongue mobility, speech disorders, malocclusion, gingival recessions, therapy, and complications due to surgery was analyzed in detail.Results: Different classifications for ankyloglossia have been proposed but not uniformly accepted. Breastfeeding problems in neonates could be associated with a tongue-tie, but not enough controlled trials have been performed to identify an ideal treatment option. In children and adults with ankyloglossia, limitations in tongue mobility are present, but the individual degree of...
TL;DR: Systemic metronidazole and amoxicillin significantly improved the 6-month clinical outcomes of fullmouth non-surgical periodontal debridement, thus significantly reducing the need for additional therapy.
Abstract: Background: It has been suggested that scaling and root planing of all pockets within a few hours and chlorhexidine treatments (full-mouth disinfection) may reduce the need forsupplementarytherapies.Theaimofthisstudywastoevaluate the clinical benefit of amoxicillin and metronidazole administered immediately after completion of full-mouth periodontal debridement in patients with chronic periodontitis. Methods: This was a single-center, double-masked, placebo-controlled, randomized longitudinal study of 6 months’ duration. Fifty-one patients received full-mouth periodontal debridement,performedwithin48hours.Twenty-five subjects received metronidazole, 500 mg, and amoxicillin, 375 mg, three times a day for 7 days; 26 subjects received a placebo. Results: Forty-seven patients could be followed up to month 6. No differences in clinical parameters were noted before treatment. The overall mean probing depth decreased from 4.3 – 0.4 mm to 3.0 – 0.2 mm in the test group and from 4.4 – 0.4 mm to 3.1 – 0.3 mm in the control group (P = 0.05, difference between groups). More importantly, test subjects had a significantly lower mean number of persisting pockets >4 mm and bleeding on probing that required further treatment (P = 0.005): 6 months after full-mouth debridement plus antibiotics, only 0.4 – 0.8 persisting pockets were still present,whereas3.0 –4.3persistingpocketswerestillpresent in the control group. The protective risk of the antibiotics for having more than one pocket deeper than 4 mm and bleeding on probing per subject after 6 months was 8.85. Conclusion: Systemic metronidazole and amoxicillin significantly improved the 6-month clinical outcomes of fullmouth non-surgical periodontal debridement, thus significantly reducing the need for additional therapy. J Periodontol 2009;80:364-371.
TL;DR: Compared to subjects who did not take vitamin D and calcium supplementation, supplement takers had shallower probing depths, fewer bleeding sites, lower gingival index values, fewer furcation involvements, less attachment loss, and less alveolar crest height loss.
Abstract: Background: A low dietary intake of vitamin D and calcium hastens bone loss and osteoporosis. Because vitamin D metabolites may also alter the inflammatory response and have antimicrobial effects, we studied whether the use of vitamin D and calcium supplements affects periodontal disease status.Methods: A cohort of 51 subjects receiving periodontal maintenance therapy was recruited from two dental clinics; 23 were taking vitamin D (≥400 IU/day) and calcium (≥1,000 mg/day) supplementation, and 28 were not taking such supplementation. All subjects had at least two interproximal sites with ≥3 mm clinical attachment loss. Daily calcium and vitamin D intake (from food and supplements) were estimated by nutritional analysis. The following clinical parameters of periodontal disease were recorded for the mandibular posterior teeth: gingival index, probing depth, cemento-enamel junction–gingival margin distance (attachment loss), bleeding on probing, and furcation involvement. Posterior photostimulable-phosphor bi...
TL;DR: Patients with rheumatoid arthritis receiving anti-TNF-alpha medication had lower periodontal indices and GCF TNF- alpha levels, suggesting suppression of proinflammatory cytokines might prove beneficial in suppressingperiodontal diseases.
Abstract: Background: The aim of this study was to evaluate the influence of anti-tumor necrosis factor-alpha (TNF-a) therapy on the clinical and immunologic parameters of the periodontium. Methods: Ten patients with rheumatoid arthritis (RA) who routinely received infusions of infliximab, 200 mg (RA+), 10 patients with RA without anti-TNF-a therapy (RA-), and 10 healthy controls (C) were included. Clinical parameters, including the plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (AL), and bleeding on probing (BOP), were assessed, and total gingival crevicular fluid (GCF) TNF-a level was determined using enzyme-linked immunosorbent assay. Analysis of variance with Scheffe modification and the Pearson correlation test were used for statistical analysis. Results: The ages of the patients ranged from 22 to 76 years (mean, 50.73 – 9.1 years). The mean PI was similar among the groups. However, mean inflammatory parameters in the three groups varied significantly; GI was greater in the RA- group compared to RA+ and C groups (P = 0.0042). The RA+ group exhibited less BOP than RA- and C groups (21.1% – 3.0%, 45.9% – 6.2%, and 39.1% – 7.2%, respectively; P = 0.0146). The mean PD in the RA+ group was shallower than in RA- and C groups (3.22 – 0.13 mm, 3.85 – 0.22 mm, and 3.77 – 0.20 mm, respectively; P = 0.055). Clinical AL in the RA+ group was lower than in RA- and C groups (3.68 – 0.11 mm, 4.52 – 0.26 mm, and 4.35 – 0.24 mm, respectively; P = 0.0273). TNF-a levels in the GCF of the RA+ group were the lowest compared to RA- and C groups (0.663, 1.23, and 0.949 ng/site, respectively; P = 0.0401). A significant positive correlation was found between TNF-a levels in the GCF and clinical AL (r = 0.448; P = 0.0283). Conclusions: Patients with RA receiving anti-TNF-a medication had lower periodontal indices and GCF TNF-a levels. Thus, suppression of proinflammatory cytokines might prove beneficial in suppressing periodontal diseases. J Periodontol 2009;80:1414-1420.
TL;DR: It is indicated that differences in implant designs may affect the potential risk for invasion of oral microorganisms into the FAI microgap of dental implants with different characteristics of the connection between the fixture and abutment.
Abstract: Background: The geometry of the fixture–abutment interface (FAI) might influence the risk of bacterial invasion of the internal part of the implant. The aim of this study was to use an in vitro model to assess the potential risk for invasion of oral microorganisms into the FAI microgap of dental implants with different characteristics of the connection between the fixture and abutment. Methods: Thirty implants were divided into three groups (n = 10 per group) based on their microgap dynamics. Groups 1 and 2 were comprised of fixtures with internal Morse-taper connections that connected to standard abutments and the same abutments with a 0.5-mm groove modification, respectively. Group 3 was comprised of implants with a tri-channel internal connection. Fixtures and abutments were assembled and allowed to incubate in a bacterial solution of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) and Porphyromonas gingivalis. Two standard abutments were either exposed to bacterial culture or left sterile to serve as positive and negative controls. After disconnection of fixtures and abutments, microbial samples were taken from the threaded portion of the abutment, plated, and allowed to culture under appropriate conditions. Results: Three of the 10 samples in group 1 developed one colony forming unit (CFU) for A. actinomycetemcomitans, whereas zero of 10 samples developed CFUs for P. gingivalis. Ten of 10 and nine of 10 samples from groups 2 and 3, respectively, developed multiple CFUs for A. actinomycetemcomitans and P. gingivalis. Conclusion: This study indicated that differences in implant designs may affect the potential risk for invasion of oral microorganisms into the FAI microgap. J Periodontol 2009;80:19911997.
TL;DR: In apparently otherwise healthy patients,periodontal disease is associated with increased circulating concentrations of IL-6 and hs-CRP, which decreased 3 months after non-surgical periodontal therapy.
Abstract: Background: Periodontal disease has been associated with many chronic inflammatory systemic diseases, and a common chronic inflammation pathway has been suggested for these conditions. However, few studies have evaluated whether periodontal disease, in the absence of other known inflammatory conditions and smoking, affects circulating markers of chronic inflammation. This study compared chronic inflammation markers in control individuals and patients with periodontal disease and observed whether non-surgical periodontal therapy affected inflammatory disease markers after 3 months. Methods: Plasma and serum of 20 controls and 25 patients with periodontal disease were obtained prior to and 3 months after non-surgical periodontal therapy. All patients were non-smokers, they did not use any medication, and they had no history or detectable signs and symptoms of systemic diseases. Periodontal and systemic parameters included probing depth, bleeding on probing, clinical attachment level, hematologic parameters, as well as the following inflammatory markers: interleukin (IL)-6, high-sensitivity C-reactive protein (hs-CRP), CD40 ligand, monocyte chemoattractant protein (MCP)-1, soluble P-selectin (sP-selectin), soluble vascular adhesion molecule (sVCAM)-1, and soluble intercellular adhesion molecule (sICAM)-1. Results: There were no differences in the hematologic parameters of the patients in the control and periodontal disease groups. Among the tested inflammatory markers, IL-6 concentrations were higher in the periodontal disease group at baseline compared to the controls (P = 0.006). Therapy was highly effective (P <0.001 for all the analyzed clinical parameters), and a decrease in circulating IL-6 and hs-CRP concentrations was observed 3 months after therapy (P = 0.001 and P = 0.006, respectively). Our results also suggest that the CD40 ligand marker may have been different in the control and periodontal disease groups prior to the therapy (P = 0.009). Conclusions: In apparently otherwise healthy patients, periodontal disease is associated with increased circulating concentrations of IL-6 and hs-CRP, which decreased 3 months after non-surgical periodontal therapy. With regard to the CD40 ligand, MCP-1, sP-selectin, sVCAM-1, and sICAM-1, no changes were seen in the periodontal disease group between baseline and 3 months after therapy. J Periodontol 2009;80:594-602.
TL;DR: There was a modest inverse association between the intake of green tea and periodontal disease, and inversely correlated with the mean PD, mean clinical AL, and BOP.
Abstract: Background: Green tea is a very popular beverage, and in vitro studies have shown that green tea polyphenols inhibit the growth and cellular adherence of periodontal pathogens and their production of virulence factors. We investigated the epidemiologic relationship between the intake of green tea and periodontal disease. Methods: We analyzed 940 Japanese men aged 49 to 59 years as part of a comprehensive health examination. Probing depth (PD), clinical attachment loss (AL), and bleeding on probing (BOP) were used as the periodontal parameters. We examined the relationship between the intake of green tea and periodontal parameters. The intake of green tea was defined as the number of cups per day in a self-administered questionnaire. Results: The intake of green tea was inversely correlated with the mean PD, mean clinical AL, and BOP. In multivariate linear regression models, every one cup/day increment in green tea intake was associated with a 0.023-mm decrease in the mean PD (P <0.05), a 0.028-mm decrease in the mean clinical AL (P <0.05), and a 0.63% decrease in BOP (P <0.05), after adjusting for other confounding variables. Conclusion: There was a modest inverse association between the intake of green tea and periodontal disease. J Periodontol 2009;80:372-377.
TL;DR: Implant number and distribution along the edentulous maxilla seemed to influence the prosthodontic survival rate, and implants with rough surfaces showed a statistically higher survival rate than machined implants at all intervals.
Abstract: Background: This descriptive study reviewed the 1- to 15-year survival rates of fixed implant rehabilitations in the edentulous maxilla.Methods: An electronic search was conducted, and cohort studies with 1- to 15-year follow-ups were identified by two independent reviewers. The implant and prosthodontic survival rates were reviewed at 1-, 3-, 5-, 10-, and 15-year endpoints. Descriptive analysis includes surface characteristics, bone-augmentation procedure, prosthetic design, and implant number and distribution along the edentulous maxilla.Results: Thirty-three studies, including 1,320 patients and 8,376 implants, were selected for analysis. The overall calculated implant survival rates ranged from 94% (1 year) to 87.7% (15 years). The implant survival rates for rough-surface implants ranged from 97% (1 year) to 98% (15 years); machined implants showed survival rates of 92% to 87.7%; respectively. Implants placed in native bone had greater survival rates than those placed in augmented bone. The prosthodon...
TL;DR: Subgingival bacterial counts increased for several species not linked to periodontitis, whereas tongue bacterial samples decreased during the study period, and the experimental gingivitis protocol is not applicable if the diet does not include refined sugars.
Abstract: BACKGROUND: The objective of this study was to assess the oral microbiota and clinical data in subjects without access to traditional oral hygiene methods and who ate a diet available in the Stone Age. METHODS: Ten subjects living in an environment replicating the Stone Age for 4 weeks were enrolled in this study. Bleeding on probing (BOP), gingival and plaque indices, and probing depth (PD) were assessed at baseline and at 4 weeks. Microbiologic samples were collected at the mesio-buccal subgingival aspects of all teeth and from the dorsum of the tongue and were processed by checkerboard DNA-DNA hybridization methods. RESULTS: No subject had periodontitis. Mean BOP decreased from 34.8% to 12.6% (P <0.001). Mean gingival index scores changed from 0.38 to 0.43 (not statistically significant) and mean plaque scores increased from 0.68 to 1.47 (P <0.001). PD at sites of subgingival sampling decreased (mean difference: 0.2 mm; P <0.001). At week 4, the total bacterial count was higher (P <0.001) for 24 of 74 species, including Bacteroides ureolyticus, Eikenella corrodens, Lactobacillus acidophilus, Capnocytophaga ochracea, Escherichia coli, Fusobacterium nucleatum naviforme, Haemophilus influenzae, Helicobacter pylori, Porphyromonas endodontalis, Staphylococcus aureus (two strains), Streptococcus agalactiae, Streptococcus anginosis, and Streptococcus mitis. Bacterial counts from tongue samples were higher at baseline (P <0.001) for 20 species, including Tannerella forsythia (previously T. forsythensis), Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans; serotype a), and Streptococcus spp. CONCLUSIONS: The experimental gingivitis protocol is not applicable if the diet (e.g., Stone Age) does not include refined sugars. Although plaque levels increased, BOP and PD decreased. Subgingival bacterial counts increased for several species not linked to periodontitis, whereas tongue bacterial samples decreased during the study period.
TL;DR: Investigating cytokine levels in the gingival crevicular fluid of patients with aggressive periodontitis found that non-surgical periodontal treatment with PDT or SRP led to statistically significant reductions in TNF-a level 30 days following treatment.
Abstract: Background: Aggressive periodontitis is a specific form of periodontal disease that is characterized by rapid attachment loss and bone destruction. Cytokine profiles are of considerable value when studying disease course during treatment. The aim of this trial was to investigate cytokine levels in the gingival crevicular fluid (GCF) of patients with aggressive periodontitis, after treatment with photodynamic therapy (PDT) or scaling and root planing (SRP), in a split-mouth design on -7, 0, +1, +7, +30, and +90 days. Methods: Ten patients were randomly treated with PDT using a laser source associated with a photosensitizer or SRP with hand instruments. GCF samples were collected, and the concentrations of tumor necrosis factor-alpha (TNF-a) and receptor activator of nuclear factor-kappa B ligand (RANKL) were determined by enzyme-linked immunosorbent assays. The data were analyzed using generalized estimating equations to test the associations among treatments, evaluated parameters, and experimental times (a = 0.05). Results: Non-surgical periodontal treatment with PDT or SRP led to statistically significant reductions in TNF-a level 30 days following treatment. There were similar levels of TNF-a and RANKL at the different time points in both groups, with no statistically significant differences. Conclusion: SRP and PDT had similar effects on crevicular TNF-a and RANKL levels in patients with aggressive periodontitis. J Periodontol 2009;80:98-105.
TL;DR: Intraoral radiographs provide a two-dimensional view of osseous structures, whereas cone-beam volumetric tomography images are viewable in three dimensions, and CBVT correlated strongly with surgical measurements, whereas IRs correlated less favorably.
Abstract: Background: Intraoral radiographs (IRs) provide a two-dimensional view of osseous structures, whereas cone-beam volumetric tomography (CBVT) images are viewable in three dimensions. The aim of this investigation was to compare the measurements from digital IR and CBVT images to direct surgical measurements for the evaluation of regenerative treatment outcomes.Methods: Digital IR and CBVT images were taken prior to initial bone grafting and at the 6-month reentry surgery for 35 intrabony defects. After defect debridement, direct bony defect measurements were made with a periodontal probe. These same measurements were made on the IR and CBVT images and then compared to the direct surgical values.Results: CBVT correlated strongly with surgical measurements (r = 0.89 to 0.95), whereas IRs correlated less favorably (r = 0.53 to 0.67). IR measurements were significantly less accurate compared to CBVT for all parameters investigated and underestimated surgical measurements from 0.6 ± 2.3 mm to 1.5 ± 2.3 mm. No s...
TL;DR: The placement of short rough-surface implants is not a less efficacious treatment modality compared to the placement of conventional rough- surface implants for the replacement of missing teeth in either totally or partially edentulous patients.
Abstract: Background: A meta-analysis on the survival of short implants compared to conventional implants has never been performed. Therefore, the aim of this study was to address the focused question “Is there a significant difference in survival between short (≤8 or <10 mm) and conventional (≥10 mm) rough-surface dental implants placed in 1) totally or 2) partially edentulous patients?” by conducting a systematic review and meta-analysis of prospective studies published in the dental literature in the English language up to and including August 2007.Methods: PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were scanned electronically, and seven journals were searched manually. In the first phase of selection, titles and abstracts, and in the second phase, full texts, were evaluated autonomously and in duplicate by two reviewers. Extensive contact with authors was carried out in search of missing, unclear, or unpublished data.Results: The electronic and manual search provided, resp...
TL;DR: The levels of cytokines in untreated and treated peri-implant diseased sites to healthy ones were compared and the effects of mechanical anti-infective therapies were assessed to clinically and immunologically assess the effects.
Abstract: Background: The objectives of this study were to clinically and immunologically assess the effects of mechanical anti-infective therapies for mucositis and peri-implantitis and to compare the levels of cytokines in untreated and treated peri-implant diseased sites to healthy ones.Methods: Titanium dental implants were assigned to one of the following groups: healthy (n = 10) = control; mucositis (n = 10) = mechanical debridement using abrasive sodium carbonate air-powder and resin curets; and peri-implantitis (n = 20) = open surgical debridement using abrasive sodium carbonate air-powder and resin curets. Visible plaque accumulation, marginal bleeding, bleeding on probing, suppuration, and probing depth were assessed at baseline for all groups and at 3 months after therapies for diseased groups. At these times, the total amounts of interleukin (IL)-4, -10, and -12, tumor necrosis factor-alpha (TNF-α), receptor activator of nuclear factor-kappa B ligand (RANKL), and osteoprotegerin (OPG) in the peri-implan...