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Recently, new centrifugation protocols for the preparation of platelet-rich fibrin (PRF) have been introduced in an attempt to further improve the beneficial impact of these 2nd generation platelet concentrate membranes. This in-vitro study aimed to compare the biological and physical characteristics of three types of PRF membranes using two different centrifuges with adapted relative centrifugal forces (RCF): leucocyte- and platelet-rich fibrin, advanced platelet-rich fibrin, and advanced platelet-rich fibrin+. Release of growth factors, macroscopic dimensions, cellular content and mechanical properties of the respective membranes, prepared from blood of the same individual were explored. Furthermore, the impact of timing (blood draw-centrifugation and centrifugation-membrane preparation) was assessed morphologically as well as by electron microscopy scanning. No statistically significant differences amongst the three PRF modifications could be observed, neither in their release of growth factors or the cellular content, nor in clot/membrane dimensions. The difference between both centrifuges were negligible when the same g-force was used. A lower g-force, however, reduced membrane tensile strength. Timing in the preparation process had a significant impact. Adaptation of RCF only had a minimal impact on the final characteristics of PRF membranes.

Leucocyte- and platelet rich fibrin (L-PRF) is an autologous biomaterial used in regenerative procedures. It has an antimicrobial activity against P. gingivalis although the mechanism is not fully understood. It was hypothesized that L-PRF exudate releases hydrogen peroxide and antimicrobial peptides that inhibit P. gingivalis growth. Agar plate and planktonic culture experiments showed that the antimicrobial effect of L-PRF exudate against P. gingivalis was supressed by peroxidase or pepsin exposure. In developing multi-species biofilms, the antimicrobial effect of L-PRF exudate was blocked only by peroxidase, increasing P. gingivalis growth with 1.3 log genome equivalents. However, no effect was shown on other bacteria. Pre-formed multi-species biofilm trials showed no antimicrobial effect of L-PRF exudate against P. gingivalis or other species. Our findings showed that L-PRF exudate may release peroxide and peptides, which may be responsible for its antimicrobial effect against P. gingivalis. In addition, L-PRF exudate had an antimicrobial effect against P. gingivalis in an in vitro developing multi-species biofilm.

BACKGROUND: Platelet concentrates like leucocyte- and platelet-rich fibrin (L-PRF) have been widely evaluated in different oral surgical procedures to promote the healing process. However, liquid L-PRF products such as liquid fibrinogen have been poorly explored, especially in the biomimetic functionalization of dental implants. The aim of this in vitro study is to evaluate the interaction between 5 different dental implant surfaces and liquid fibrinogen. METHODS: Five commercially available dental implants with different surfaces (Osseospeed™, TiUnite™, SLActive®, Ossean®, and Plenum®) were immersed for 60 minutes in liquid fibrinogen obtained from healthy donors. After this period, the implants were removed and fixed for scanning electron microscopy (SEM). RESULTS: All dental implants were covered by a fibrin mesh. However, noticeable noncontact areas were observed for the Osseospeed™, TiUnite™, and SLActive® surfaces. On the other hand, Ossean® and Plenum® surfaces showed a dense and uniform layer of fibrin covering almost the entire implant surface. The Osseospeed™, TiUnite™, and SLActive® surfaces presented with lower blood cell numbers inside the fibrin mesh compared with the others. Moreover, at higher magnification, thicker fibrin fibers were observed in contact with Ossean® and Plenum® surfaces. The Plenum ®surface showed the thickest fibers which also inserted and interconnect to the microroughness. CONCLUSION: The initial contact between an implant surface and the fibrin network differs significantly among different implant brands. Further studies are necessary to explore the clinical impact of these observations in the osseointegration process of dental implants. ispartof: BIOMED RESEARCH INTERNATIONAL vol:2021 ispartof: location:United States status: published

Various studies have described the biological properties of the Leucocyte- and Platelet Rich Fibrin (L-PRF) such as the antimicrobial effect against wound bacteria, but less is known about the effect against periodontal pathogens. The aim of this study was to evaluate the antibacterial properties of the L-PRF membrane and L-PRF exudate against the main periopathogens cultured on agar plates and in planktonic solution. This study demonstrated the antibacterial effect of the L-PRF membrane against P. intermedia, F. nucleatum, and A. actinomycetemcomitans, but especially against P. gingivalis. The L-PRF exudate also showed a strong inhibition against P. gingivalis on agar plates. No inhibition could be observed for the other bacterial strains. Moreover, L-PRF exudate decreased the number of viable P.gingivalis in a planktonic solution in a dose-dependent way. However, A. actinomycetemcomitans showed an increased growth in planktonic solution when in contact with the L-PRF exudate.

Background: Modulation of the commensal oral microbiota constitutes a promising preventive/therapeutic approach in oral healthcare. The use of prebiotics for maintaining/restoring the health-associated homeostasis of the oral microbiota has become an important research topic. Aims: This study hypothesised that in vitro 14-species oral biofilms can be modulated by (in)direct stimulation of beneficial/commensal bacteria with new potential prebiotic substrates tested at 1 M and 1%((w/v)), resulting in more host-compatible biofilms with fewer pathogens, decreased virulence and less inflammatory potential. Methods: Established biofilms were repeatedly rinsed with N-acetyl-D-glucosamine, alpha-D-lactose, D-(+)-trehalose or D-(+)-raffinose at 1 M or 1%((w/v)). Biofilm composition, metabolic profile, virulence and inflammatory potential were eventually determined. Results: Repeated rinsing caused a shift towards a more health-associated microbiological composition, an altered metabolic profile, often downregulated virulence gene expression and decreased the inflammatory potential on oral keratinocytes. At 1 M, the substrates had pronounced effects on all biofilm aspects, whereas at 1%((w/v)) they had a pronounced effect on virulence gene expression and a limited effect on inflammatory potential. Conclusion: Overall, this study identified four new potential prebiotic substrates that exhibit different modulatory effects at two different concentrations that cause in vitro multi-species oral biofilms to become more host-compatible.

This study aimed to assess the dosage and types of antibiotics prescribed in oral implant surgery, compare them among the different subpopulations (country and prescription regimens) and against the evidence-based recommended dosage: a 2-gram single preoperative dose of amoxicillin. A meta-analysis of cross-sectional surveys was conducted, which reports the overall dosage (and type) of antibiotics prescribed in combination with implant placement. PubMed, Cochrane, Science, Direct, and EMBASE via OVID were searched until April 2019. Three reviewers independently undertook data extraction and risk of bias assessment. The outcome variable was set on the average of prophylactic antibiotics prescribed per oral implant surgery. Overall, 726 participants from five cross-sectional surveys, representing five different countries were finally included. Amoxicillin was the most prescribed antibiotic. On average, 10,724 mg of antibiotics were prescribed per implant surgery. This average was significantly (p

The oral use of antimicrobial agents embedded in toothpastes and mouth rinses results in an oral microbial massacre with high amounts of dead bacteria in close proximity to few surviving bacteria. It was hypothesized that this provides the surviving pathogenic bacteria a large amount of dead microbial biomass as a nutritional source for growth (necrotrophy). This study demonstrated the necrotrophic growth of periodontal pathogens in the presence of different dead oral species. In addition, the presence of dead bacteria resulted in an outgrowth of several periodontal pathogens in complex multi-species biofilms. Additionally, upon contact with dead oral bacteria, virulence genes of P. intermedia and P. gingivalis were up-regulated (necrovirulence). This resulted in a more pronounced epithelial cytotoxicity (necrotoxicity). These findings indicate that presence of dead bacteria induce necrotrophy, necrovirulence and necrotoxicity in several oral pathogens.

Background and Aims: The scope of this working group was to review (1) ecological interactions at the dental biofilm in health and disease, (2) the role of microbial communities in the pathogenesis of periodontitis and caries, and (3) the innate host response in caries and periodontal diseases. Results and Conclusions: A health-associated biofilm includes genera such as Neisseria, Streptococcus, Actinomyces, Veillonella and Granulicatella. Microorganisms associated with both caries and periodontal diseases are metabolically highly specialized and organized as multispecies microbial biofilms. Progression of these diseases involves multiple microbial interactions driven by different stressors. In caries, the exposure of dental biofilms to dietary sugars and their fermentation to organic acids results in increasing proportions of acidogenic and aciduric species. In gingivitis, plaque accumulation at the gingival margin leads to inflammation and increasing proportions of proteolytic and often obligately anaerobic species. The natural mucosal barriers and saliva are the main innate defence mechanisms against soft tissue bacterial invasion. Similarly, enamel and dentin are important hard tissue barriers to the caries process. Given that the present state of knowledge suggests that the aetiologies of caries and periodontal diseases are mutually independent, the elements of innate immunity that appear to contribute to resistance to both are somewhat coincidental.

OBJECTIVES: Examine the clinical and microbiological benefits of a dual-strain Lactobacillus reuteri probiotic on the non-surgical therapy of initial peri-implantitis. MATERIALS AND METHODS: This randomized, double-blind study targeted patients with initial peri-implantitis, that is peri-implantitis with a maximum mean probing pocket depth of 6 mm and maximum 3 mm bone loss compared with loading. A full-mouth prophylaxis was performed and the peri-implantitis sites were debrided. Subsequently, local application of the study drops was carried out at the peri-implantitis sites and the study lozenges were handed out. The patients in the probiotic group received drops and lozenges containing L. reuteri (ATCC PTA 5289 & DSM 17938), those in the control group received placebo products. At the implant level the measurements of interest were bleeding, probing pocket depth and plaque. Full-mouth bleeding and plaque scores were also recorded. Microbiological samples were taken from the tongue, saliva and subgingivally around the implants. RESULTS: All clinical parameters were significantly decreased after 12 and 24 weeks. At the implant level the only statistically significant difference was a greater decrease in plaque levels in the probiotic versus the control group (p = .002 at 24 weeks). At the full-mouth level, the only intergroup difference was the greater decrease in full-mouth bleeding on probing sites in the probiotic group compared with the control group (p

AIM: To examine the adjunctive effect of a Lactobacillus reuteri probiotic (ATCC PTA 5289 & DSM 17938) on the re-instrumentation of residual pockets. MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled study included 39 previously non-surgically treated periodontitis patients. A re-instrumentation was carried out, and probiotic and/or placebo drops were applied according to the study protocoll. Patients afterwards received lozenges to use 2×/day for 12 weeks. Probing pocket depth (PPD), recession, bleeding on probing and plaque levels were analysed, next to the microbiological impact. RESULTS: No effects of the probiotic drops could be found. However, after 24 weeks, the overall PPD in the probiotic lozenges group (2.64 ± 0.33 mm) was significantly lower compared to the control lozenges (2.92 ± 0.42 mm). This difference was even more pronounced in moderate (4-6 mm) and deep (≥7 mm) pockets. In the probiotic lozenges group, there were also significantly more pockets converting from ≥4 mm at baseline to ≤3 mm at 24 weeks (67 ± 18% versus 54 ± 17%) and less sites in need for surgery (4 ± 4% versus 8 ± 6%). However, the probiotic products did not influence the microbiological counts of the periodontopathogens. CONCLUSION: The adjunctive consumption of L. reuteri lozenges after re-instrumentation improved the PPD reduction, without an impact on pocket colonization with periodontopathogens. ispartof: JOURNAL OF CLINICAL PERIODONTOLOGY vol:47 issue:1 pages:43-53 ispartof: location:United States status: published

PURPOSE: The leukocyte- and platelet-rich fibrin block (L-PRF block) is a composite graft that combines a xenograft that is acting as a scaffold with L-PRF membranes that serve as a bioactive nodule with osteoinductive capacity. This study evaluated the properties of the L-PRF block and its components in terms of release of growth factors, cellular content, and structure. MATERIALS AND METHODS: The concentration of transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor (VEGF), platelet-derived growth factor-AB (PDGF-AB) and bone morphogenetic protein-1 (BMP-1) released by a L-PRF membrane (mb) and a L-PRF block were examined with ELISA for five time intervals (0 to 4 hours, 4 hours to 1 day, 1 to 3 days, 3 to 7 days, 7 to 14 days). Those levels in L-PRF exudate and liquid fibrinogen were also evaluated. The cellular content of the liquid fibrinogen, L-PRF membrane and exudate was calculated. The L-PRF block was also analyzed by means of a microCT scan and scanning electron microscopy (SEM). RESULTS: TGF-β1 was the most released growth factor after 14 days, followed by PDGF-AB, VEGF, and BMP-1. All L-PRF blocks constantly released the four growth factors up to 14 days. L-PRF membrane and liquid fibrinogen presented high concentration of leukocytes and platelets. The microCT and SEM images revealed the bone substitute particles surrounded by platelets and leukocytes, embedded in a dens fibrin network. CONCLUSION: The L-PRF block consists of deproteinized bovine bone mineral particles surrounded by platelets and leukocytes, embedded in a fibrin network that releases growth factors up to 14 days. ispartof: INTERNATIONAL JOURNAL OF ORAL & MAXILLOFACIAL IMPLANTS vol:34 issue:4 pages:855-864 ispartof: location:United States status: published

STATEMENT OF PROBLEM: Implant-based prosthetic solutions can be time consuming. If implants can be placed successfully with a guide, surgery time can be reduced. PURPOSE: The purpose of this randomized controlled clinical trial was to assess implant outcomes, both clinical and radiological, comparing guided with nonguided implant placement after 3 years of follow-up. MATERIAL AND METHODS: A total of 314 implants were placed in 72 jaws (60 participants). The jaws were randomly assigned to 1 of the 6 treatment groups: Materialise Universal/mucosa (Mat Mu), Materialise Universal/bone (Mat Bo), Facilitate/mucosa (Fac Mu), Facilitate/bone (Fac Bo), freehand navigation (Freehand), and a pilot-drill template (Templ). Radiographic and clinical parameters (bone loss, pocket probing depth, bleeding on probing, and plaque scores) were recorded at the time of implant placement, prosthesis installment (baseline), and 1-year, 2-year, and 3-year follow-up. Analysis was performed using a linear mixed model, and correction for simultaneous hypothesis was made according to Sidak (α=.05). RESULTS: Three participants left the study before the 3-year follow-up; hence, 302 implants in 69 jaws were included in this study. None of the implants failed. The mean marginal bone loss after the third year of loading was 0.7 ±1.3 mm for the guided surgery group and 0.5 ±0.6 mm for the control group. No significant intergroup or follow-up period differences were observed (P>.05). In the guided surgery groups, the mean number of surfaces with bleeding on probing and plaque at 3-year follow-up was 1.7 ±1.5 and 1.7 ±1.7, respectively; for the control groups, this was 1.6 ±1.4 and 1.6 ±1.6, respectively. The mean pocket probing depth was 3.0 ±1.3 mm for the guided group and 2.6 ±1.0 mm for the control group. No significant differences were found (P>.1). CONCLUSIONS: Within the limitation of this study, no statistically significant differences could be found between the guided group and the control group at the 3-year follow-up. ispartof: JOURNAL OF PROSTHETIC DENTISTRY vol:121 issue:6 pages:904-910 ispartof: location:United States status: published

ispartof: JOURNAL OF PERIODONTOLOGY vol:90 issue:2 pages:119-121 ispartof: location:United States status: published

Objective To examine the effect of tongue cleaning with a tongue scraper (TS) or toothbrush (TB) in patients with periodontitis. Background The tongue is a possible reservoir for bacterial (re)colonization of the periodontal tissues in patients with periodontitis. To date, it is not known what the influence of tongue cleaning is on the tongue coating of patients with periodontitis. Material and Methods Eighteen systemically healthy, untreated moderate to severe adult patients with periodontitis with some degree of tongue coating were randomly assigned to the use of a TS or TB for cleaning the tongue. Microbial load of the saliva and tongue dorsum, amount of tongue coating and patient perception about tongue cleaning were studied at baseline and 2 weeks later. Results Two weeks of tongue cleaning with either a TB or a TS, did not influence the microbiological counts, neither in the saliva, nor in the tongue coating, even though tongue coating was significantly less. The patients themselves experienced no differences in breath odour or taste sensation after 2 weeks of tongue cleaning; however, they felt that their tongue was cleaner at the end of the study compared to baseline. No differences could be detected between the uses of a TS vs a TB. Conclusion In patients with periodontitis, tongue cleaning does not influence the bacterial load in the saliva or on the tongue dorsum.

BACKGROUND AND PURPOSE: Implant stability is one of the most important factors influencing osseointegration. Using stereolithographical guides for maximizing precision, this study aimed at investigating the relationship between implant stability and bone density derived from computerized tomography analysis. MATERIALS AND METHODS: One hundred ninety-five implants were placed in 48 patients using digitally designed stereolithographical surgical guides. Ninety-five implants were placed using a mucosa supported guide and 100 implants were placed using a bone supported guide. Implant stability was measured by means of resonance frequency analysis (RFA) and damping capacity assessment (Periotest, PTV). Bone density (Hounsfield units) was measured at different regions of interest (ROI) and cortex thickness was measured around each implant. RESULTS: Implant stability correlated significantly with the different ROI. The best correlation for RFA was obtained for the spongious bone ROI (r = .64) and PTV best correlated with the coronal cortex density (r = -.41). Shorter implants (9 mm) had a significantly lower primary stability than longer implants (11, 13, 15 mm). Primary stability was also significantly higher in 4 mm diameter implants than in 3.5 mm diameter implants. A formula for the prediction of primary stability based on the different variables investigated was developed. CONCLUSIONS: Bone density and cortex thickness have a significant influence on implant primary stability. Longer and wider implants reached higher primary stability than shorter and narrower implants. These correlations lose their significance after osseointegration has taken place. Implant stability can be predicted based on an preoperative analysis of bone characteristics. ispartof: CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH vol:20 issue:1 pages:50-57 ispartof: location:United States status: published

Background and Objective: To the best of our knowledge, the healing time for toothbrush-induced gingival abrasions in humans has not yet been explored. The aim of this study was to evaluate the time needed to heal for toothbrush-induced abrasions of the keratinized mucosa of the palate. Material and Methods: In patients without, with mild periodontitis or with periodontitis, gingival abrasion lesions were induced at the keratinized mucosa of the palate by brushing up to 2 minutes. Healing as observed clinically was followed via calibrated digital photographs of the lesion after staining, every 24 hours until the lesion had resolved. In patients without or with only mild periodontitis, the healing time of lesions caused by 30 seconds and 1 minute of brushing was also recorded. Results: Thirty-one participants (11 without or with mild periodontitis, 20 with periodontitis) met the inclusion criteria. In patients without or with mild periodontitis, the lesions induced by brushing for 2 minutes diminished by 48.7% of their original surface area within 24 hours. In patients with periodontitis the respective outcome was 45.4% (P =.87). Abrasions caused by 2 minutes of brushing needed more than 24 hours to heal completely. When decreasing the time exposed to trauma, fewer lesions were visible at baseline and the time needed to heal decreased. The subgroup of smokers was too small to evaluate any effect. Conclusion: The longer the exposure time of the keratinized mucosa of the palate to trauma, the more lesions were visible, the larger the abrasions were and the more time they needed to heal completely. More studies are needed to investigate the role of smoking, gingival biotype and to link these findings with gingival recessions.

BACKGROUND AND AIMS: The scope of this working group was to review: (1) the effect of professional mechanical plaque removal (PMPR) on secondary prevention of periodontitis; (2) the occurrence of gingival recessions and non-carious cervical lesions (NCCL) secondary to traumatic tooth brushing; (3) the management of hypersensitivity, through professionally and self administered agents and (4) the management of oral malodour, through mechanical and/or chemical agents. RESULTS AND CONCLUSIONS: Patients undergoing supportive periodontal therapy including PMPR showed mean tooth loss rates of 0.15 ± 0.14 teeth/year for 5-year follow-up and 0.09 ± 0.08 teeth/year (corresponding to a mean number of teeth lost ranging between 1.1 and 1.3) for 12-14 year follow-up. There is no direct evidence to confirm tooth brushing as the sole factor causing gingival recession or NCCLs. Similarly, there is no conclusive evidence from intervention studies regarding the impact of manual versus powered toothbrushes on development of gingival recession or NCCLs, or on the treatment of gingival recessions. Local and patient-related factors can be highly relevant in the development and progression of these lesions. Two modes of action are used in the treatment of dentine hypersensitivity: dentine tubule occlusion and/or modification or blocking of pulpal nerve response. Dentifrices containing arginine, calcium sodium phosphosilicate, stannous fluoride and strontium have shown an effect on pain reduction. Similarly, professionally applied prophylaxis pastes containing arginine and calcium sodium phosphosilicate have shown efficacy. There is currently evidence from short-term studies that tongue cleaning has an effect in reducing intra-oral halitosis caused by tongue coating. Similarly, mouthrinses and dentifrices with active ingredients based on Chlorhexidine, Cetylpyridinium chloride and Zinc combinations have a significant beneficial effect. ispartof: Journal of Clinical Periodontology vol:42 issue:S16 pages:S214-S220 ispartof: location:SPAIN status: published

Subgingival debridement is the part of nonsurgical therapy which aims to remove the biofilm without intentionally removing the cementum or subgingival calculus. The objective of this review was to describe the end point of this therapy, the different methods used and how often it should be carried out. The literature shows that several methods are currently available for subgingival debridement, namely hand instrumentation, (ultra)sonic instrumentation, laser, photodynamic therapy and air-polishing. None of these methods seems superior to any other regarding clinical benefits or microbiological differences. However, less treatment discomfort is reported using laser, photodynamic therapy or air-polishing compared with hand- and/or (ultra)sonic instrumentation. Subgingival debridement can be carried out when, during supportive periodontal therapy, pockets of 5 mm or deeper are detected. ispartof: Periodontology 2000 vol:75 issue:1 pages:189-204 ispartof: location:Denmark status: published

Chronic wounds (VLU: venous leg ulcer, DFU: diabetic foot ulcer, PU: pressure ulcer, or complex wounds) affect a significant proportion of the population. Despite appropriate standard wound care, such ulcers unfortunately may remain open for months or even years. The use of leukocyte- and platelet-rich fibrin (L-PRF) to cure skin ulcers is a simple and inexpensive method, widely used in some countries but unknown or neglected in most others. This auto-controlled prospective cohort study explored and quantified accurately for the first time the adjunctive benefits of topical applications of L-PRF in the management of such refractory ulcers in a diverse group of patients. Forty-four consecutive patients with VLUs (n = 28, 32 wounds: 17 ≤ 10 cm(2) and 15 > 10 cm(2)), DPUs (n = 9, 10 wounds), PUs (n = 5), or complex wounds (n = 2), all refractory to standard treatment for ≥3 months, received a weekly application of L-PRF membranes. L-PRF was prepared following the original L-PRF method developed more than 15 years ago (400g, 12 minutes) using the Intra-Spin L-PRF centrifuge/system and the XPression box kit (Intra-Lock, Boca Raton, FL, USA; the only CE/FDA cleared system for the preparation of L-PRF). Changes in wound area were recorded longitudinally via digital planimetry. Adverse events and pain levels were also registered. All wounds showed significant improvements after the L-PRF therapy. All VLUs ≤ 10 cm(2), all DFUs, as well as the two complex wounds showed full closure within a 3-month period. All wounds of patients with VLUs > 10 cm(2) who continued therapy (10 wounds) could be closed, whereas in the five patients who discontinued therapy improvement of wound size was observed. Two out of the five PUs were closed, with improvement in the remaining three patients who again interrupted therapy (surface evolution from 7.35 ± 4.31 cm(2) to 5.78 ± 3.81 cm(2)). No adverse events were observed. A topical application of L-PRF on chronic ulcers, recalcitrant to standard wound care, promotes healing and wound closure in all patients following the treatment. This new therapy is simple, safe and inexpensive, and should be considered a relevant therapeutic option for all refractory skin ulcers. ispartof: Platelets vol:29 issue:5 pages:1-8 ispartof: location:England status: published

Aim To investigate the influence of various surgical techniques for sinus augmentation on the volumetric changes of graft, membrane and the post-operative discomfort. Materials and Methods Eighteen patients in need of bilateral sinus floor elevation (SFE) were assigned to lateral SFE, transcrestal SFE and intralift procedures. CBCT images taken at baseline, 1 week and 6 weeks were analysed for volumetric changes in graft and Schneiderian membrane. Questionnaires were used to analyse post-op discomfort. Results The overall average graft volume obtained after 1 week was 1.87 cm3 (range 0.12–4.72 cm3). Volumes decreased after 6 weeks to an overall mean volume of 1.33 cm3 (range 0.10–4.29 cm3 – average decrease of 27.6%). After 6 weeks, the amount of graft volume decreased in every treatment option, ranging from −23.13% for the tSFE, over −24.55% for the lSFE, to −33.71% for the IL. Although all treatment options correspond in an increase in Schneiderian membrane volume, no statistically significant correlation between this increase and loss of graft volume could be obtained for all treatments (p = 0.97). Conclusion All SFE techniques provided sufficient graft volume for implant treatment. All techniques provoke a partially transient swelling of the Schneiderian membrane. All techniques resulted in a decrease in graft volume after 6 weeks; however, no significant differences were obtained between treatments. Furthermore, no statistical significant correlation between the post-operative swelling of the Schneiderian membrane and reduction in graft volume at 6 weeks could be obtained.

More insight into the biological fundamentals of leukocyte platelet-rich fibrin (L-PRF) guided healing is necessary to recommend its application, in particular in deficient bone sites that need to support implants. This study investigated the short-term bone healing effect of L-PRF treatment in cylindrical non-critical sized bone defects with 3 mm diameter and 6 mm depth in tibiae of 18 adult male New Zealand White rabbits. After a randomization process, 96 bone defects were prepared and half of them were filled with a L-PRF membrane, while untreated defects in the opposite tibia served as control group. The rabbits were euthanized after 7, 14 or 28 days of healing. The bone healing of the cortical and medullary areas was investigated by micro-CT, while the expression of molecular markers (RUNX2, VEGFA, COL1A2 and BMP2) was assessed by qRT-PCR. Treatment with L-PRF did not affect the micro-structural bone characteristics of the repaired bone tissue, except for a decrease in the trabecular connectivity at the cortical level after 14 days of healing. At this time, RUNX2 and VEGFA mRNA levels were significantly lower in the treated defects. L-PRF membranes thus had a temporary negative influence on the bone microarchitecture (Tb.Pf) and on the RUNX2 and VEGFA expression during early bone healing. Overall, L-PRF treatment did not enhance bone regeneration in these non-critical size defects after 28 days. ispartof: Scientific Reports vol:7 ispartof: location:England status: published

Introduction and aim Buccal bone thickness is considered to be an important factor during implant surgery. Its resorption might have an effect on the soft tissue stability and eventually on implant survival. This study aimed to investigate the resorption of the buccal bone over the first 12 months after implant loading. Materials and methods Twenty-four subjects (47 implants) were included. The buccal bone thickness was measured during implant surgery at several distances from the implant shoulder using a specifically designed device which allows buccal bone thickness measurements without the elevation of a muco-periostal flap. These measurements were repeated after 12 months of loading. Sixteen implants were placed flapless and 31 with the elevation of a flap. Of the latter, 19 were placed following a one-stage protocol and 12 following a two-stage protocol. Results The mean reduction in buccal bone thickness, when all groups pooled, was 0.26, 0.36, 0.35 and 0.27 mm at the shoulder and 2, 4 and 6 mm apically. Implants with initial bone thickness

Background Osteoporosis has been called a potential risk factor for bone healing around implants. Aim The aim of this multicentre study was to verify the clinical performance of fluoridated implants in the maxilla of subjects with diagnosed systemic primary osteoporosis/osteopenia. Material and Methods Postmenopausal women in need of 2–8 splinted implants in maxilla underwent bone mineral density measurements in the hip and spine, using dual-energy X-ray absorptiometry scans. Based on their T-scores, they were divided into two study groups: Group O (osteoporosis/osteopenia group) subjects had a T-score ≤−2, Group C (control group) had a T-score of ≥−1, and subjects with a T-score −2 were excluded. Implants were placed with a two-stage procedure and loaded 4–8 weeks after abutment surgery. At 6 months and 1 year after functional loading, clinical parameters (including peri-apical radiographs) were assessed. Results One hundred and forty-eight implants were placed in 48 subjects (mean age: 67 years (range [59–83]). Sixty-three implants were placed in 20 osteoporosis subjects (Group O, mean age: 69 years; range [59–83]), and 85 were placed in control subjects (Group C, mean age: 65 years; range [60–74]). The cumulative survival rate, on an implant level, was 99.3% (Group O: 98.4%; Group C: 100.0%). The cumulative survival rate, on a subject level, was 97.9% (Group O: 94.7%; Group C: 100.0%). Marginal bone level (MBL) alterations from functional loading to the 1-year follow-up visit were measured on an implant level and a subject level. The overall MBL alteration on an implant level was −0.01 ± 0.51 mm (Group O: −0.11 ± 0.49 mm; Group C: 0.05 ± 0.52 mm). The overall MBL alteration on a subject level was −0.04 ± 0.27 mm (Group O: −0.17 ± 0.30 mm; Group C: 0.04 ± 0.23 mm). Conclusion Within the limitations of this prospective, non-randomized, controlled, multicentre study, it can be concluded that oral implant therapy in patients suffering from osteoporosis/osteopenia is a reliable treatment option with comparable integration rates as in healthy patients. Long-term follow of the study groups is necessary to compare marginal bone alterations and treatment outcomes.

Introduction Universities are developing and implementing implant dentistry training to prepare dental professionals for the growing treatment needs. This study describes how implant dentistry is taught at the KU Leuven and focuses on implant-related clinical outcomes. Perspectives of participating undergraduate students are analysed with a view to improve oral implant dentistry training. Materials and methods Implant dentistry training at the KU Leuven consists of theoretical lectures, pre-clinical hands-on workshops and clinical (surgical/prosthetic) experience. Questionnaires were used to investigate the perceptions of students on the educational programme. Radiographs were taken at implant insertion, at healing abutment connection, at restoration/prosthesis insertion and after 1 and 2 years of functional loading. The marginal bone level was measured from the implant–abutment connection to the first visible bone-to-implant contact. Results One hundred and twelve implants were placed by 56 undergraduate students (61.5% of the total students) in 56 patients. After a follow-up time of 3 years, the cumulative implant survival rate, at implant level, was 97.1%. The mean marginal bone loss after 1 and 2 years in function was 0.35 mm and 0.39 mm, respectively. Eighty percentage of students were satisfied with the training, and they considered this sufficient preparation to perform implant placement under close supervision. Conclusions The clinical outcome of implant treatment performed by undergraduate students under close supervision is similar to that reported by experienced clinicians/research teams. Clinical, surgical as well as restorative experience in addition to theoretical and pre-clinical training seems beneficial when implementing implant dentistry in the undergraduate programmes.

This 3-year prospective randomized controlled trial compared the clinical, microbiological and biochemical outcome of minimally (Turned, Tur) and moderately rough (TiUnite®, TiU) implant surfaces in a split-mouth design.The study population included 14 subjects: nine fully edentulous and five partially edentulous subjects with a history of periodontitis. Implants (n = 78, 39 Tur and 39 TiU) were installed randomly in each patient. Peri-implant clinical parameters and intra-oral radiographs were recorded after 3 years of loading. Subgingival plaque and peri-implant crevicular fluid samples were collected and analysed using culture and quantitative polymerase chain reaction for the biofilm, and enzyme-linked immunosorbent assay for the concentration of osteoprotegerin and receptor activator of nuclear factor kappa-B ligand, respectivelyNo statistically significant differences in clinical, microbiological and biochemical parameters could be observed when comparing the Tur and TiU implant surfaces.After 3 years of loading, in periodontitis susceptible patients, the moderately rough, TiU implants demonstrated a similar clinical outcome compared with the smoother, turned implants. Longer follow-up and studies using different implant types are needed to confirm the statement that minimally and moderately rough implant surfaces perform similar, both from a clinical and from a microbiological point of view.

Aim This study envisaged to explain early marginal bone loss (first years of function) around implants in the posterior area of the mandible by the local bone quality (ratio cortical vs. cancellous bone). Material and methods Four hundred and twenty-three Brånemark MKIII® implants inserted in the posterior region of the mandible were examined, retrospectively, on intra-oral radiographs taken at abutment connection, and 1 and 3–4 years after loading. The quality of the bone was assessed on cone beam or multi-slice CTs. The bone quality was determined by the relative proportions of cortical and trabecular bone at the insertion site. Cortical bone was defined as a clearly white structure without a trabecular pattern. Trabecular bone was defined as the structure between the two cortical plates. The width of both structures was measured at 1, 3, 5, and 7 mm away from the crest of the alveolar bone and converted in to relative proportions. Other parameters (smoking, history of periodontitis, dehiscence, pre-tapping, submerged healing, etc.) were retrieved from the patients record. Results At abutment connection, the mesial and distal marginal bone level was located 0.7 (±0.7) and 0.8 (±0.7) mm apically to the implant–abutment junction. At 1 year and 3–4 years of loading implants placed in a mandible consisting of

AIM The dimension of the alveolar bone reduces significantly after tooth loss. Clinicians consider a 1-2 mm buccal and lingual bone width mandatory around the implant at placement. This prospective study analysed the outcome of implants inserted in jaws with narrow (≤4.5 mm) buccal bone dimensions. MATERIAL AND METHODS Twenty-eight patients (mean age 63, 89% female) with a narrow alveolar crest (≤4.5 mm in width on CBCT) received 100 implants (3.5 mm) via a two-stage procedure. Intra-oral radiographs were taken at placement, functional loading and after 1, 2 and 3-years of follow-up. Peri-implant bone level alterations were recorded by two calibrated, periodontologists. RESULTS All implants integrated and the cumulative survival rate after 3 years was 100%. The implants were inserted 0.81 mm ± 0.83 subcrestal. At functional loading the bone was located 0.65 mm ± 0.6 apical of the implant shoulder. During 3 years of loading the amount of annual marginal bone loss was 0.17 ± 0.4, 0.05 ± 0.4 and - 0.06 ± 0.1 mm, respectively. CONCLUSION Based on these data and within the limitations of this study it became clear that implants, placed in sites with limited dimensions (≤4.5 mm width), showed minimal amounts of marginal bone loss during the first 3 years of functional loading.

BACKGROUND The aim of this study was to compare the 5-year survival and success rates of 3.3 mm dental implants either made from titanium-zirconium (TiZr) alloy or from Grade IV titanium (Ti Grade IV) in mandibular implant-based removable overdentures. METHODS The core study had a follow-up period of 36 months and was designed as a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann Bone Level implants (diameter 3.3 mm, SLActive®), one of TiZr (test) and one of Ti Grade IV (control), in the interforaminal region. This follow-up study recruited patients from the core study and evaluated the plaque and sulcus bleeding indices, radiographic crestal bone level, as well as implant survival and success 60 months after implant placement. RESULTS Of the 91 patients who initially received implants, 75 completed the 36 month follow-up and 49 were available for the 60 month examination. Two patients were excluded so that a total of 47 patients with an average age of 72 ± 8 years were analysed. The characteristics and 36-month performance of the present study cohort did not differ from the non-included initial participants (p > 0.05). In the period since the 36-month follow-up examination, no implant was lost. The cumulative implant survival rate was 98.9 % for the TiZr group and 97.8 % for the Ti Grade IV group. Crestal bone level changes at 60 months were not different in the test and control group (TiZr -0.60 ± 0.69 mm and Ti Grade IV -0.61 ± 0.83 mm; p = 0.96). The cumulative implant success rate after 60 months was 95.8 and 92.6 % for TiZr and Ti Grade IV, respectively. CONCLUSIONS After 60 months, the positive outcomes of the 36 month results for TiZr and Ti Grade IV implants were confirmed, with no significant differences with regard to crestal bone level change, clinical parameters and survival or success rates. TiZr implants performed equally well compared to conventional Ti Grade IV 3.3 mm diameter-reduced implants for mandibular removable overdentures. TRIAL REGISTRATION Registered on www.clinicaltrials.gov: NCT01878331.

The buccal bone plate is a component of the alveolar process tightly related to the tooth it supports. A plethora of physiological and pathological events can induce its remodeling. Understanding this remodeling process and its extent is of major importance for the practitioner as it can affect the functional and esthetic outcome of implant surgery at the involved sites. Bone remodeling and resorption of the buccal bone plate are inevitable after tooth loss or extraction. To limit resorption, several ridge-preservation techniques of varying efficacy have been described. Bone resorption is equally found to occur upon implant placement and is thought to be a result of the surgical trauma inflicted as well as an adaptation process of the tissues to the new foreign body. Because of the implications of bone resorption on the soft-tissue levels and the general esthetic outcome, it is of primary importance for the practitioner to be able to evaluate the hard tissues and the inherent resorption risks in an effort to optimize the treatment strategies. Based on limited short-term data, the present general opinion advises the need for a 2-mm-thick buccal bone plate in order to avoid vertical bone resorption. ispartof: Periodontology 2000 vol:66 issue:1 pages:97-105 ispartof: location:Denmark status: published

Clinical investigations on patients suffering from halitosis clearly reveal that in the vast majority of cases the source for an offensive breath odor can be found within the oral cavity (90%). Based on these studies, the main sources for intra-oral halitosis where tongue coating, gingivitis/periodontitis or a combination of the two. Thus, it is perfectly logical that general dental practitioners (GDPs) should be able to manage intra-oral halitosis under the conditions found in a normal dental practice. However, GDPs who are interested in diagnosing and treating halitosis are challenged to incorporate scientifically based strategies for use in their clinics. Therefore, the present paper summarizes the results of a consensus workshop of international authorities held with the aim to reach a consensus on general guidelines on how to assess and diagnose patients' breath odor concerns and general guidelines on regimens for the treatment of halitosis. ispartof: Journal of Breath Research vol:8 issue:1 pages:017101- ispartof: location:England status: published

At the moment there are no clear protocols for the assessment of bad breath. An organoleptic evaluation is still the reference. To date there are several tools available to detect and quantify specific compounds related to halitosis. This paper reviews the available information on three sulphur monitors (OralChroma™ (CHM-1), Halimeter® and Breathtron®), in order to suggest guidance for the general dental practitioner. All three devices showed an acceptable correlation with organoleptic scores. The Halimeter® and Breathtron® seem the most appropriate devices for a general dental practitioner, because they are easy to handle. Because of its capacity of distinguishing between different sulphur compounds and due to its time-consuming and complicated use, the OralChroma™ (CHM-1) seems more suitable in a research environment. ispartof: Journal of Breath Research vol:8 issue:1 pages:017103- ispartof: location:England status: published

This report described a case in which diagnostic radiographs showed irregular dense radiopaque strings and curved lines in the head and neck area. These artifacts could lead to misinterpretation since they may obscure anatomical structures and/or mask critical structures/pathologies. A more detailed history of the patient indicated that these strings originated from a facelift procedure in which a gold-wire technique was used. Considering that such intervention may cause a radiodiagnostic burden, it should be included in the anamnesis prior to radiography. ispartof: Imaging science in dentistry vol:44 issue:1 pages:81-4 ispartof: location:Korea (South) status: published

Aim To compare the clinical benefit of a periodontal dressing applied after a one-stage full-mouth disinfection (OSFMD) in patients with chronic periodontitis up to 3 months after therapy. Material and Methods This randomized, controlled split-mouth study included 24 patients. After OSFMD, a test and a control side were selected by means of a computer-generated randomization list. Test sides received a periodontal dressing (Coepak®) for 7 days and the control sides received no periodontal dressing. After 7 days the periodontal dressing was removed and the pain experience was recorded. After 3 months, the clinical periodontal parameters were recorded. Results The periodontal dressing group showed a significant (p

With a steadily increasing impact of oral implant placement in daily practice, the number of reported surgical complications has also been growing. Recent studies reveal significant variation in the occurrence and morphology of neurovascular canal structures in the jaw bone. All those structures contain a neurovascular bundle, the diameter of which may be large enough to cause clinically significant damage. Therefore, it has become obvious that presurgical radiographic planning of jaw-bone surgery should pay attention to the neurovascular structures and their likely variations, in addition to examining many other factors, such as jaw-bone morphology and volume, bone trabecular structure and the absence of bone or tooth pathology. A critical review is accomplished to explore the potential risks for neurovascular complications after implant placement, with evidence derived from histologic, anatomic, clinical and radiologic studies. In this respect, cross-sectional imaging can often be advocated, as it is obvious that the inherent three-dimensional nature of jaw-bone anatomy may clearly benefit from a detailed spatial image analysis. Although this could initially be realized by conventional computed tomography, in current practice, dentomaxillofacial cone beam computed tomography might be used, as it offers high-quality images at low radiation dose levels and costs. ispartof: Periodontology 2000 vol:66 issue:1 pages:188-202 ispartof: location:Denmark status: published

AIM: The scope of the discussions of this consensus report was to assess the strength of the scientific evidence and make clinical and research recommendations for surgical interventions to cover exposed root surfaces and enhance soft tissues at implants. METHODS: Discussions were informed by three systematic reviews covering single recessions, multiple recessions and soft-tissue deficiencies at implants. The strength of the evidence was assessed using a modification in GRADE. The group also emphasized the need to report the experience of the surgeon and the performance of the control intervention (CONSORT guidelines for non-pharmacological treatment). RESULTS: A moderate strength of evidence supported the following statements for single (moderately deep, mostly maxillary) recessions without inter-dental attachment loss: (i) The addition of a connective tissue graft (CTG) improved outcomes of coronally advanced flaps (CAF). (ii) The addition of enamel matrix derivative (EMD) improved the outcomes of CAF. For multiple recessions, preliminary data indicate that flaps specifically designed to treat this condition are worthy of additional attention. Emerging data indicate that it is possible to obtain complete root coverage at sites with some inter-dental attachment loss. With regards to soft-tissue deficiencies at implants, several procedures are available, but great heterogeneity among studies does not allow drawing conclusions at this time. CONCLUSIONS: The group highlighted that periodontal plastic procedures are complex, technique-sensitive interventions that require advanced skills and expertise. At single recessions, the addition of autologous CTG or EMD under CAF improves complete root coverage and may be considered the procedure of choice at maxillary anterior and premolar teeth. The adjunctive benefit needs to be put in the context of increased morbidity of the donor area or increased cost. Additional research is needed to: (i) assess the role of alternatives to autologous soft-tissue grafting in combination with CAF; (ii) identify the optimal surgical design and the need for additional soft-tissue grafting (or alternatives) at multiple recessions, recessions with inter-dental attachment loss and soft-tissue deficiencies at implants.

This study aims to analyze the correlation between Solobacterium moorei (S. moorei), both on the tongue and in saliva, and several oral malodour- and clinical parameters. Data from 193 patients visiting a halitosis clinic were used for analysis. A questionnaire assessed their general health, allergies, medication, smoking habits and oral hygiene. Following halitosis parameters were recorded: organoleptic score (OLS) (0-5), total concentration of volatile sulfur compounds (VSC) (Halimeter®), individual concentrations of VSC (Oral Chroma®), tongue coating (MTCI, WTCI and mWTCI), salivary parameters (flow rate and pH), oral hygiene, tonsil health and periodontal health. In all subjects, microbiological samples were collected from the tongue coating and from the saliva, and a quantitative polymerase chain reaction was performed to detect S. moorei. A significant correlation could be established between S. moorei, from both tongue and saliva, and several breath parameters (OLS, H2S, CH3SH, (CH3)2S and total VSCs), tongue coating indices and periodontal indices (gingivitis, periodontitis and oral hygiene). This study suggests a strong association between the presence of S. moorei and oral malodour (s54747). ispartof: Journal of Breath Research vol:7 issue:4 pages:046006- ispartof: location:England status: published

OBJECTIVES: Recently, guided implant surgery has been introduced and several studies verified its accuracy. While those studies reported on the accuracy of the entire procedure, this experiment wanted to evaluate the degree of deviation that can occur during the drilling procedure alone, due to the tolerance of the drill in the sleeve insert. MATERIAL AND METHODS: Drilling was executed in a plexi-glass box with a maximal inclination of the drills within the sleeve insert. Different sleeve inserts, sleeve positions, sleeve heights, sleeve insert heights and diameters were evaluated. RESULTS: The two tested sleeve inserts gave a maximum deviation in angulation of 5.2° and a maximum horizontal deviation of 1.3 mm at the implant shoulder and 2.4 mm at the apex for a 13 mm implant. These deviations decreased if the distance of the sleeve above the plexi-glass box became smaller and hand hold sleeve inserts gave less deviation than drill hold sleeve inserts. The deviation increased by longer implant length, larger drill key diameter, shorter sleeves and/or drill key heights. CONCLUSIONS: For a minimal deviation during the surgery with a stereolithographic guide, it is very important to use the drill in a centric position, parallel to the cylinder. The use of longer drill keys and sleeves are critical for optimal accuracy. ispartof: Clinical oral implants research vol:24 issue:6 pages:630-634 ispartof: location:Denmark status: published

Background: The aim of the current study was to compare the prevalence of commensal bacteria, with beneficial properties, for healthy and diseased individuals and additionally to examine the inhibitory effect of some commercial dietary probiotics on periodontopathogens comparing this inhibitory effect with that of orally derived beneficial bacteria. Methods: Subgingival plaque samples from 35 patients (healthy and periodontitis patients), were analyzed. Growth inhibition of the periodontal pathogens Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Aggregatibacter actinomycetemcomitans was examined using the agar overlay technique and agar well diffusion method. The quantification of the inhibitory effect was checked with the agar well diffusion method. Results: Using the agar overlay technique the prevalence of strains antagonistic towards P. gingivalis, A. actinomycetemcomitans and F. nucleatum was found to be higher in healthy individuals than in individuals suffering from periodontitis, this could not be validated by the agar well diffusion assay. Compared with the antagonistic activity of the isolated strains, the probiotic strains overall showed a stronger inhibition of the periodontal pathogens. Conclusion: It was shown that some oral bacteria can cause antagonism towards periodontopathogens and these observations underline the therapeutic potential of applications that stimulate oral health by the application of beneficial effector strains. ispartof: Journal of periodontology vol:84 issue:6 pages:801-811 ispartof: location:United States status: published

The aim of this study was to assess the efficacy of mouthrinses formulations in oral malodour.This single-centre, double-blind, randomized, parallel group clinical trial compared the efficacy of Halita™ and meridol(®) with and without zinc lactate versus negative and positive control. Volunteers with confirmed oral malodour (18/group) rinsed with one mouthrinse during 7 days (15 ml, 2x/day for 1 min.). 15 min. after a first rinse (masking effect), and after 7 days (therapeutic effect) the change in organoleptic scores and level of sulphur compounds was recorded.All rinses showed a masking effect (OLS 1 to 2 values reduced), only the rinses with antimicrobial ingredients showed a therapeutic effect (OLS 1 to 1.5 value less). The addition of zinc resulted in a more pronounced masking effect. Halita™ and meridol(®) with zinc showed the best therapeutic effect.Although the masking effect of the rinses can be attributed partially to a dilution and the effect of aromas, the therapeutic effect should be linked to the anti-microbial action of active ingredients and counter action of zinc ions on VSC. A complete resolution of the unpleasant breath by additional mechanical intervention remains to be proven.

OBJECTIVE: The aim of this study was: (i) to evaluate whether an endodontic pathology on the extracted tooth or adjacent teeth of an implant site has an influence on the emergence of a periapical lesion, (ii) to retrospectively analyse the outcome of different treatment strategies, (iii) to determine which bacteria were present in periapical lesions. METHODS: The endodontic status of the tooth at the implant site and the adjacent teeth was explored and linked to the periapical status of the implant. For all the lesions treated since 2000, their survival was assessed. Finally, microbial samples (culturing) from the periapical lesions, were analysed. RESULTS: If an endodontic treatment or a periapical lesion at the apex of a tooth is present, a periapical lesion around the implant can be detected in 8.2% up to 13.6% (OR 7.2). For periapical pathology at the adjacent teeth, the percentage rises to 25% (OR 8.0). The best treatment option could not be found. Bacteria were found in 9/21 lesions. The most prominent species was P. gingivalis. CONCLUSIONS: When an endodontic pathology is present on the extracted or neighbouring teeth, it is significantly more likely that a periapical lesion will develop around a future implant. ispartof: Journal of clinical periodontology vol:40 issue:3 pages:296-302 ispartof: location:United States status: published