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Objective: This university-based retrospective study aimed to assess the performance of the implant disease risk assessment (IDRA) in predicting peri-implantitis., Material and Methods: Patients with implants loaded for at least 1 year were included. Peri-implantitis development was the outcome, while the IDRA score and its eight vectors were the predictors. The IDRA score was calculated using an online tool. Data were analyzed using Cox proportional hazards models and ROC curve (AUC)., Results: Among 480 implants in 235 patients, 7.9% of implants and 9.4% of patients developed peri-implantitis. Implants at high risk for the "number of sites with PD ≥ 5 mm" vector had an increased risk (HR = 9.8, p = 0.004) of peri-implantitis, compared to those at low risk for this parameter. Implants at moderate (HR = 4.8, p = 0.04) and high (HR = 10.0, p = 0.01) risk for the "distance from the restorative margin (RM) to bone crest (BC)" vector exhibited a higher risk of peri-implantitis than implants at low risk for this parameter. The IDRA tool demonstrated an AUC of 0.66 (sensitivity = 0.80; specificity = 0.24) when estimated at implant level and an AUC of 0.61 (sensitivity = 0.91; specificity = 0.32) when calculated at patient level. The mixed-effects Cox model did not reveal a significant association between the overall IDRA score and the development of peri-implantitis (HR = 7.2, p = 0.18)., Conclusion: IDRA demonstrates good sensitivity but low specificity and suboptimal discriminatory capacity in predicting peri-implantitis. The "number of sites with PD ≥ 5 mm" and "distance from RM to BC" emerged as the most effective predictors for peri-implantitis., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The aim of this study was to evaluate the incidence of preloading crestal bone loss (PLCBL) and to identify the patient-related and implant-related factors associated with PLCBL., Methods: This retrospective cohort examined the dental records of patients who received at least one dental implant. PLCBL was defined as a reduction ⩾0.5 mm and severe PLCBL (primary variable) as a reduction ⩾1.5 mm in mesial and/or distal bone level, measured from the day of implant placement to uncovering or abutment installation/crown delivery. The incidence of PLCBL and patient and implant variables were recorded. Bivariate analysis and binary logistic regression identified factors associated with PLCBL ⩾0.5 mm and ⩾1.5 mm., Results: A total of 746 dental implants placed in 361 patients from January 2011 to July 2021 was included in the analyses. Of the implants assessed, 24.4% (n = 182) exhibited PLCBL ⩾ 0.5 mm and 10.5% (n = 78) presented severe PLCBL (i.e., ⩾1.5 mm). Males (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.11-3.07), patients with diabetes (OR = 3.33, 95% CI = 1.73-6.42), and those allergic to penicillin (OR = 3.13, 95% CI = 1.57-6.22) were more likely to experience severe PLCBL (p < 0.05). Implants placed in the anterior area (OR = 2.08, 95% CI = 1.16-3.73), with bone-level platform-abutment connection (OR = 4.73, 95% CI = 1.94-11.49) and inserted supracrestally (OR = 3.77, 95% CI = 1.84-7.72), presented a greater risk of developing severe PLCBL (p < 0.05). Implants placed in a previously grafted area presented a lower likelihood of developing severe PLCBL (OR = 0.489, 95% CI = 0.28-0.84)., Conclusion: The incidence of PLCBL ⩾ 0.5 mm and ⩾1.5 mm was 24.4% and 10.5%, respectively. Male sex, diabetes, allergy to penicillin, anterior location, bone-level platform-abutment connection, and supracrestal implant placement are potential risk factors for severe PLCBL. A previously grafted area is a potential protective factor., (© 2024 American Academy of Periodontology.)

Background: Whether, and to what extent, diabetes mellitus (DM) can affect the subgingival biofilm composition remains controversial. Thus, the aim of this study was to compare the composition of the subgingival microbiota of non-diabetic and type 2 diabetic patients with periodontitis using 40 "biomarker bacterial species.", Methods: Biofilm samples of shallow (probing depth [PD] and clinical attachment level [CAL] ≤3 mm without bleeding) and deep sites (PD and CAL ≥5 mm with bleeding) of patients with or without type 2 DM were evaluated for levels/proportions of 40 bacterial species by checkerboard DNA-DNA hybridization., Results: A total of 828 subgingival biofilm samples from 207 patients with periodontitis (118 normoglycemic and 89 with type 2 DM) were analyzed. The levels of most of the bacterial species evaluated were reduced in the diabetic compared with the normoglycemic group, both in shallow and in deep sites. The shallow and deep sites of patients with type 2 DM presented higher proportions of Actinomyces species, purple and green complexes, and lower proportions of red complex pathogens than those of normoglycemic patients (P < 0.05)., Conclusions: Patients with type 2 DM have a less dysbiotic subgingival microbial profile than normoglycemic patients, including lower levels/proportions of pathogens and higher levels/proportions of host-compatible species. Thus, type 2 diabetic patients seem to require less remarkable changes in biofilm composition than non-diabetic patients to develop the same pattern of periodontitis., (© 2023 American Academy of Periodontology.)

Primary stability is an important factor for dental implant success. In the past years, a new method for bone site preparation was introduced, named osseodensification (OD). OD produces a condensation of the trabecular portion of the bone, increasing bone-to-implant contact and primary stability. This study aims to compare the effect of OD in cylindrical and conical implants to conventional instrumentation. A total of forty implants, divided into four groups, were placed in porcine tibia: cylindrical conventional (1a), cylindrical OD (1b), conical conventional (2a) and conical OD (2b). Each implant was measured for implant stability quotient (ISQ), insertion torque (IT) and removal torque (RT). Group 2b showed the higher values for each of the evaluated parameters; groups 1b and 2b showed better results than 1a and 2a, respectively. Regarding the IT and RT, group 1b achieved higher values than group 2a, but not for ISQ. The inter-group comparison showed significant difference between groups 1a vs 2a, 1a vs 2b and 1b vs 2b for ISQ and 1a vs 1b and 1a vs 2b for RT analysis. OD resulted in improved ISQ, IT and RT of both cylindrical and conical implants.

Introduction: The correction of maxillary transverse discrepancy is achieved by means of rapid maxillary expansion, which may be performed by conventional or surgically-assisted rapid maxillary expansion, and more recently, by miniscrew-assisted rapid palatal expansion (MARPE). This study assessed the bone thickness of the palate on cone-beam computed tomography (CBCT) images for placement of mini-implants and anchorage of MARPE., Methods: The sample consisted of 223 CBCT scans from patients of both genders (137 females and 86 males) aged ≥18 years. By using the Image Studio software (Anne Solutions, São Paulo, Brazil), measurements of the bone thickness of the palate were performed bilaterally, as follows: in the axial plane, the bone thicknesses were determined in the anterior region (distal face of the first premolars) and the posterior region (distal face of the first molars), at 3 mm and 6 mm laterally to the midpalatal suture. So in the sagittal plane, the bone thicknesses of the palate were measured in these placements from the palatal cortical to the nasal floor cortical in the anterior region at 30°, 45°, and 90°. In the posterior region, the bone thickness was determined only at 90°. The statistical tests used were the Kruskal-Wallis H test (analysis of variance on ranks) with Dunn's post-hoc test and Mann-Whitney U test (P <0.05)., Results: The bone thickness of the palate in the anterior region varied from 8.57 mm in women to 11.28 mm in men at 3 mm from the midpalatal suture and from 7.99 mm in women to 10.47 mm in men at 6 mm for 30°; from 6.35 mm in women to 9.28 mm in men at 3 mm from the midpalatal suture and from 6.20 mm in women to 8.88 mm in men at 6 mm for 45°; from 4.51 mm in women to 6.85 mm in men at 3 mm from the midpalatal suture and from 4.29 mm in women to 6.64 mm in men at 6 mm for 90°. In the posterior region, the bone thickness varied from 2.93 mm (3 mm from the suture) to 1.78 mm (6 mm from the suture) for women and from 3.24 mm (3 mm from the suture) to 1.99 mm (6 mm from the suture) for men. In general, the bone thickness of the palate is greater in the anterior region at 3 mm from the midpalatal suture at 30°., Conclusions: There was high variability in the bone thickness of the palate among patients and in different areas. Therefore, it is necessary to make an individualized diagnosis of the patient and manufacture the MARPE appliance carefully by performing a prior evaluation of the palatal bone thickness by means of CBCT to determine the ideal sites and inclinations for placement of mini-implants., (Copyright © 2022. Published by Elsevier Inc.)

Objective: Our study aimed to determine the relationship of antidepressant medicine use with periodontal diseases, exploring the association of different pharmacological classes of antidepressant with observations of clinical attachment loss (CAL) and alveolar bone level (BL) in patients with periodontitis., Background: Existing evidence on the impact of antidepressant medication on periodontal tissues has focused on some classes only and is still unclear. Therefore, this retrospective study evaluated the association of different antidepressant classes with clinical attachment loss (CAL) and alveolar bone level (BL)., Methods: This study was carried out in a population of patients aged ≥ 30 years old with periodontitis who sought treatment at the University of Florida from 2014 to 2018. The following variables were obtained from patients' records; usage of antidepressant medications and their pharmacological classes (selective serotonin reuptake inhibitors [SSRI], serotonin-norepinephrine reuptake inhibitors [SNRI], tricyclic, atypical, and monoamine oxidase inhibitors [MAO]), age, gender, smoking habit, mild systemic diseases, CAL, and cement-enamel junction (CEJ) and alveolar bone crest (BC) distance, defined as BL, in the Ramfjord index teeth., Results: Five hundred and eighty-two periodontitis patients were evaluated, of which 113 (19.4%) were antidepressant users. Antidepressant users exhibited significantly lower BL and fewer sites with severe CAL (≥5 mm), than non-users (p < .05). Among all single-class antidepressant users, the SSRI users showed significantly less CAL and lower BL than non-users (p < .05). Patients taking combinations of the different classes of antidepressants also showed better CAL and BL than non-users. Generalized linear models, including variables such as gender, age, systemic diseases, and smoking, demonstrated that antidepressant users were more likely to have lower mean BL and fewer sites with severe bone loss (i.e. BL > 3 and >5 mm) than non-users (p < .05)., Conclusions: Antidepressant medications were associated with higher alveolar bone level and less clinical attachment loss in patients with periodontitis. When the different classes of antidepressants were analyzed individually, only the SSRI class users and the multiple-class users showed significantly less periodontal breakdown than non-users., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The aim of this study was to perform a 5-year follow-up analysis of a previously-published randomized trial (RCT) evaluating the 2-years effects of metronidazole (MTZ) plus amoxicillin (AMX) as adjuncts to scaling and root planing (SRP) in the treatment of periodontitis in type 2 diabetic patients., Methods: Volunteers who received periodontal treatment in the aforementioned RCT were selected for clinical and microbiological evaluation. Patients did not receive regular supportive periodontal therapy (SPT) from 2 to 5 years post-treatment., Results: Of the patients enrolled in the RCT, 43% entered this study (n = 10/control and 15/test group). Most of clinical parameter values, including the number of sites with probing depth ≥ 5 mm (primary outcome variable), were reduced at 5 years post-therapy when compared with baseline in the antibiotic-treated group (P < 0.05), but presented higher values than those at 2 years (P < 0.05). The mean proportions of microbial complexes did not differ between MTZ+AMX+SRP and SRP-only groups at 5 years post-treatment (P > 0.05)., Conclusion: Diabetic patients treated with adjunctive MTZ+AMX were better maintained over a period of 5 years than those treated with SRP only. However, the clinical and microbiological benefits obtained up to 2 years post-treatment were not fully sustained in these patients who did not receive SPT between 2 and 5 years post-treatment., (© 2020 American Academy of Periodontology.)

Background: Previous studies have suggested an association between taking antidepressants and dental implant failure. This study aimed to investigate the association of different antidepressant classes with dental implant failure., Methods: This retrospective study included patients that received dental implants at the University of Florida from 2011 to 2016. The variables of implant failure, antidepressant use and classes (selective serotonin reuptake inhibitors [SSRI], serotonin-norepinephrine reuptake inhibitors [SNRI], tricyclic antidepressants [TCA], atypical antidepressants [AA], and monoamine oxidase inhibitors [MAOI]), age, sex, smoking, mild systemic diseases, and implant location were obtained from patients' records. Odds ratio (OR) and confidence interval (CI) of implant failure in patients taking different antidepressant classes, in relationship to non-antidepressant users, were estimated, and the influence of multiple variables on implant failure were investigated., Results: A total of 771 patients and 1,820 implants were evaluated. The statistically significant predictors for implant failure included smoking (OR = 5.221), use of antidepressants (OR = 4.285), posterior maxilla location (OR = 2.911), mild systemic disease (OR = 2.648), and age (OR = 1.037) (P <0.05). The frequency of implant failure was 33.3% in TCA users, 31.3% in SNRI users, 6.3% in SSRI users, 5.2% in Atypical antidepressant users, and 3.9% in non-users. Significant associations were observed between the use of SNRI (OR: 11.07; 95% CI: 3.265 to 33.82) and TCA (OR: 12.16; 95% CI: 1.503 to 71.58) and implant failure (P <0.05)., Conclusions: Users of antidepressants were at higher risk of implant failure than non-users. Patients taking SNRI and TCA were at the highest risk of implant loss, when compared with non-users. Conclusions about TCA, however, are based on a limited number of cases., (© 2020 American Academy of Periodontology.)

A recently developed orthodontic wire alloy known as GUMMETAL® is claimed to deliver more physiological forces to correct dental mispositioning. However, its mechanical characteristics have not been fully characterized yet. This study aimed to determine and compare the elastic properties of different wire alloys, such as nickel-titanium (NiTi), stainless steel (SS), and GUMMETAL®, and assess their unloading forces when combined with either conventional or self-ligating brackets (CL and SL) when correcting dental crowding. All wires had a 0.016″ cross-section diameter. A three-point bending test was performed to assess the maximum deflection of each wire. Then, a subsequent analysis measured the unloading force for each wire/bracket system in a dental crowding clinical simulation device. The test was carried out in a universal testing machine with a cross-speed displacement of 0.5 mm/min. Data were recorded in different ranges and statistically evaluated using two-way analysis of variance. GUMMETAL® displayed higher unloading mean forces in SL brackets (2228.78 cN) than CL brackets (1967.38 cN) for the 1.6-3.0 deflection interval (p = 0.018). Within this interval, NiTi showed higher forces when used with CL brackets (2683.06 cN) than with SL brackets (1179.66 cN) (p < 0.0001). For the CL bracket systems, SS wires showed higher forces (2125.31 cN) in the 1.0-1.6 deflection interval than the other two wire alloys (NiTi, 1541.52 cN and GUMMETAL®, 852.65 cN) (p < 0.0001). SS wires also displayed lower forces with SL brackets (1844.01 cN) than in CL brackets (2125.31 cN) (p = 0.049). Thus, only GUMMETAL® revealed to be an optimal choice for SL brackets, whereas NiTi for CL brackets.

This study investigated the effects of Brazilian Red Propolis (BRP) extract on seven-day-old multispecies subgingival biofilms. Mixed biofilm cultures containing 31 species associated with periodontal health or disease were grown for six days on a Calgary device. Then, mature biofilms were treated for 24 h with BRP extract at different concentrations (200-1600 µg/mL), amoxicillin (AMOXI) at 54 µg/mL (positive control) or vehicle (negative control). Biofilm metabolic activity was determined by colorimetry, and bacterial counts/proportions were determined by DNA-DNA hybridization. Data were analyzed by Kruskal-Wallis and Dunn's tests. Treatment with BRP at 1600, 800 and 400 μg/mL reduced biofilm metabolic activity by 56%, 56% and 57%, respectively, as compared to 65% reduction obtained with AMOXI. Mean total cell counts were significantly reduced in all test groups (~50-55%). Lower proportions of red, green and yellow complex species were observed upon treatment with BRP (400 µg/mL) and AMOXI, but only AMOXI reduced the proportions of Actinomyces species. In conclusion, BRP extract was as effective as AMOXI in killing seven-day-old multispecies biofilm pathogens and did not affect the levels of the host-compatible Actinomyces species. These data suggest that BRP may be an alternative to AMOXI as an adjunct in periodontal therapy. In vivo studies are needed to validate these results.

Background and Objectives: Strontium ranelate is a medication indicated for the treatment of osteoporosis that presents concomitant anti-resorptive and osteoanabolic dual biological activity. However, the effects of strontium ranelate on alveolar bone have been poorly explored. Furthermore, to date, there are no data on the effects of this medication on alveolar bone loss (BL) during conditions of estrogen deficiency. Therefore, the aim of this study was to evaluate the effects of strontium ranelate on ligature-induced periodontitis in estrogen-deficient and estrogen-sufficient rats., Methods: Ninety-six rats were assigned to one of the following groups: sham-surgery + water (estrogen-sufficient; n = 24); ovariectomy + water (estrogen-deficient; n = 24), sham-surgery + strontium ranelate (ranelate/estrogen-sufficient; n = 24) and; ovariectomy + strontium ranelate (ranelate/estrogen-deficient; n = 24). The rats received strontium ranelate or water from the 14th day after ovariectomy until the end of the experiment. On the 21st day after ovariectomy, one first mandibular molar received a ligature, while the contralateral tooth was left unligated. Eight rats per group were killed at 10, 20, and 30 days after ligature placement. Bone loss (BL) and trabecular bone area (TBA) were analyzed in the furcation area of ligated and unligated teeth at all experimental times by histometry. Tartrate-resistant acid phosphatase (TRAP) positive cells and immunohistochemical staining for osteocalcin (OCN), osteopontin (OPN), osteoprotegerin (OPG), and receptor activator of NF-КB ligand (RANKL) were assessed in the ligated teeth at 30 days after ligature placement., Results: At 10 and 30 days, ligated teeth of the estrogen-deficient group exhibited higher BL, when compared to all other groups (P < .05). At 10 days, TBAs were higher in the unligated teeth of strontium ranelate-treated groups, when compared to those of untreated groups (P < .05). At 30 days, the ligated teeth of the estrogen-deficient group exhibited lower TBA than the other groups (P < .05). There were no differences among groups regarding the number of TRAP-stained cells (P < .05). The strontium ranelate-treated groups exhibited lower expressions of OCN and RANKL than the untreated groups (P < .05). The estrogen-sufficient group presented higher staining for OPG than both treated and untreated estrogen-deficient groups (P < .05)., Conclusions: Strontium ranelate prevented ligature-induced BL in an estrogen-deficiency condition and, to a certain extent, increased TBA in the presence and absence of periodontal collapse in states of estrogen deficiency and estrogen sufficiency. Furthermore, strontium ranelate also affected the expression of bone markers, appearing to have acted predominantly as an anti-resorptive agent., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This study evaluated the effects of type 2 diabetes mellitus (DM), smoking, and these two factors combined on gingival crevicular fluid levels and ratios of pro-/anti-inflammatory cytokines. Associations between cytokines with each other and with key periodontal pathogens in periodontal sites under the challenge of one or both of these risk factors were also assessed., Methods: A total of 102 subjects with periodontitis were included in this cross-sectional study and assigned to one of the following groups: non-diabetic non-smokers (control group, n = 25), non-smokers with DM (DM group, n = 30), non-diabetic smokers (S group, n = 26), and smokers with DM (S + DM group, n = 21). The levels of 13 pro-inflammatory (IFN-γ, TNF-α, MIP-1α, GM-CSF, IL-1β, IL-2, IL-6, IL-7, IL-8, IL-12, IL-17, IL-21, and IL-23) and 5 anti-inflammatory (IL-4, IL-5, IL-10, IL-13, and TGF-β) cytokines were assessed in healthy and diseased sites, using multiplex immunoassay. Ratios of pro-/anti-inflammatory cytokines were obtained in all possible permutations. The levels of 7 key periodontal pathogens were evaluated by qPCR., Results: Overall, the ratios of pro-/anti-inflammatory cytokines were higher in healthy and diseased sites of the DM group and in healthy sites of the S + DM group, and lower in diseased sites of the S group, compared with the control (p < .05). The proportion of the pro-inflammatory cytokines in relation to the 18 cytokines studied was higher in the DM group and lower in the S group, whereas the proportion of the anti-inflammatory cytokines was lower in both diabetic groups and higher in the S group, compared to the control (p < .05). A cluster of six common cytokines (IL-4, IL-5, IL-12, IL-13, IL-21, and IL-23) was observed in the diseased sites of all groups studied. Eight common cytokines (IL-4, IL-5, IL-12, IL-13, IL-17, IL-21, IL-23, and IFN-γ) grouped closely in the healthy sites of both diabetic groups. Significant associations between pathogens and cytokines occurred mainly in the diseased sites of the S + DM group (p < .05)., Conclusion: Diabetes mellitus induced an overall pro-inflammatory state, while smoking mainly stimulated immunosuppression in periodontal sites. When the two risk factors overlapped, smoking seemed to partially assuage the hyperinflammatory effect of DM., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

Objective: This study assessed the impact of chronic periodontitis (CP) and CP associated with type 2 diabetes mellitus (DM) and/or smoking on the serum ratios of pro- to anti-inflammatory cytokines., Materials and Methods: Subjects were assigned into one of the following groups: control (n = 25, non-diabetic non-smokers with no history of periodontitis), CP (n = 26, non-diabetic non-smokers with CP), DMCP (n = 30, non-smokers with DM and CP), SCP (n = 27, non-diabetic smokers with CP), and SDMCP (n = 22, smokers with type 2 DM and CP). Serum levels of 18 cytokines were measured using multiplex immunoassays., Results: Six ratios of pro-inflammatory to anti-inflammatory cytokines were significantly higher in the CP group than in the control group (p < 0.05). Eleven, seventeen and nine ratios of pro-inflammatory to anti-inflammatory cytokines were significantly higher in the DMCP, SCP and SDMCP groups than in the control group, respectively (p < 0.05). The SCP group presented higher serum ratios of tumor necrosis factor (TNF)-α/interleukin (IL)-4, TNF-α/IL-5, IL-17/IL-13 and IL-6/IL-13 (p < 0.05) than the CP group. Cluster analysis revealed a relevant cluster composed of ten cytokines (IL-17, IL-23, interferon-γ, IL-12, IL-1β, IL-2, IL-21, IL-6, IL-4 and granulocyte-macrophage colony-stimulating factor [GM-CSF]) in the serum of subjects from the DMCP group., Conclusions: The ratios of pro- to anti-inflammatory cytokines shift to favor a pro-inflammatory status in the serum of patients with CP and even more when CP is associated with one or both risk factors., Clinical Relevance: CP and CP associated with hyperglycemia and/or smoking might contribute to a systemic inflammatory burden and increased risk of systemic complications.

Aim: This study evaluated the levels of sclerostin (SOST) and Dickkopf (DKK)-1 in the chronic periodontitis (CP) associated with type 2 diabetes (DM) and/or smoking. Relationships between SOST, DDK1, RANKL, OPG, IL-1ß, IL-6 and TNF-α, and pathogens were assessed., Material and Methods: The study population included non-diabetic non-smokers (control), non-smokers with DM (DM group), non-diabetic smokers (S group) and smokers with DM (SDM group), all with CP. Serum and gingival levels of SOST, DKK1, RANKL, OPG, IL-1ß, IL-6 and TNF-α were evaluated by multiplex immunoassay. Gene expressions of these biomarkers and subgingival levels of pathogens were assessed by qPCR., Results: Gingival protein and/or mRNA levels of DKK1 and SOST were higher in subjects with DM and/or smoking than in controls (p < .05). Serum levels of SOST were higher in the DM group than in controls (p < .05). DKK1 positively correlated with SOST in the DM, SDM and control groups (p < .05) at mRNA levels. DKK-1 and SOST correlated with pathogens, especially in both groups with DM., Conclusions: SOST and DKK1 were upregulated in patients with CP presenting DM and/or smoking. DM, alone or with smoking, particularly influenced the correlations of SOST and DKK1 with each other and with the other biomarkers mostly at mRNA levels, as well as with periodontal pathogens., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)