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The objective of this study was to evaluate the benefit of repeated subgingival cleaning with a low-concentrated hypochlorite/amino acid gel in subjects in maintenance care with residual pockets ≥ 5 mm. Examiner masked, randomized two-arm parallel design. Thirty-two adult periodontal patients in maintenance phase, > 3 months after periodontal therapy, with at least one residual periodontal pocket ≥ 5 mm, were randomly assigned to treatment by subgingival ultrasonic debridement with the gel or ultrasonic debridement only. At months 0, 4, and 8, all sites presenting with a probing depth (PD) ≥ 5 mm were treated. Six sites were monitored on each tooth. The primary end point was the presence or absence of PD ≥ 5 mm after 12 months. Secondary clinical outcomes were oral tissue safety; patient acceptance; changes in PD; bleeding on probing; recession after 4, 8, and 12 months; and the presence or absence of six target microorganisms in treated pockets at baseline, after 7 days and 4 months. A total of 365 sites in 32 patients with PD ≥ 5 mm were treated at baseline. At the final evaluation at month 12, 47% of these sites in the test and 49% in the control group were still in this PD category. The difference between baseline and month 12 was significant in both groups (p

Objectives The aim of the present methodological study was to evaluate the discrepancies in the detection of a number of periodontally involved pathogenic bacteria obtained from clinical samples by two methods: the quantitative Polymerase Chain Reaction (qPCR) and the qPCR combined with pre‐treatment by Propidium Monoazide (PMA). Material and methods Plaque and saliva samples were obtained from 30 subjects: 20 subjects with chronic or aggressive periodontitis in need of periodontal therapy with or without antibiotics and 10 subjects in Supportive Periodontal Treatment (SPT). The clinical samples taken before treatment (BL) and 1 month later (M1), were divided in two aliquots: one was immediately treated with PMA while the other was left untreated. All samples were further analyzed with qPCR after DNA extraction, for the detection of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Parvimonas micra (Pm), and Prevotella intermedia (Pi). Results Large inter‐individual variations were observed in the concentration of the studied bacteria. At both instances (BL and M1) and for the three groups, significantly lower counts of bacteria were depicted when plaque and saliva samples were pre‐treated with PMA as compared to those without treatment. Treatment resulted in significant decreases in the number of bacteria, mainly in the plaque samples. However, these changes were almost similar in the three groups independently of the method of detection used (PMA‐qPCR vs. q‐PCR). Conclusion Removal of DNA from non‐viable cells with PMA treatment is an easily applied step added to the classical qPCR that could give accurate information on the presence of viable bacterial load and evaluate the response to periodontal treatment.

OBJECTIVES The aim of this prospective clinical trial was to present the 6-year outcomes of a two-piece yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) implant system in partially edentulous patients. MATERIAL AND METHODS Forty-nine two-piece zirconia implants were placed in 32 patients systemically healthy. Zirconia abutments were connected with adhesive resin cement. Single-unit full-ceramic crowns were cemented. The cases have been followed for an average of 82.2 ± 5.86 months after loading (range 74.93-92.26 months). RESULTS 24 participants with 39 implants were available for examination 6 years after loading. The cumulative implant survival rate was 83%. On an implant level, the cumulative mechanical complication rate was 17.5%, the cumulative technical complication rate was 13%, and the biological complication rate was 8%. After 6 years, subjects reported good satisfaction with the treatment: 3.7 ± 4.4 on a visual analog scale (VAS) from 0 to 100 mm. CONCLUSIONS Within the limitations of this prospective case series study, two-piece zirconia implants could offer an alternative for treatment of single edentulous spaces in the posterior region. The major complication on the long term of this pioneering system was the abutment fracture; however, due to the versatility of a two-piece implant system, replacement of the broken parts was possible.

OBJECTIVES: The task of this working group was to update the knowledge about the use of drugs and biologicals affecting healing of soft tissue and bone during implant treatment or procedures associated with it. Moreover, the impact of titanium particles and biocorrosion on complications and implant survival has been analysed. MATERIALS AND METHODS: The literature in the areas of interest (platelet concentrates, antiresorptive drugs as well as implant-host interaction) was screened using systematic reviews for the former two areas, whereas a narrative critical review was performed for the latter topic. Two manuscripts on platelet concentrates, one manuscript on antiresorptive drugs and one manuscript on the effects of biocorrosion, were presented for group analysis with subsequent discussion in the plenum and final consensus approval. RESULTS: Results and conclusions of the individual reviews of the three topics are presented in the respective papers. Conclusions of the group on strengths and weaknesses of available evidence as well as consensus statements and directions for further research are provided in this study. The following papers were subject to group discussions and formed the basis for the consensus statements: Stähli A, Strauss FJ, Gruber R. () The use of platelet-rich-plasma to enhance the outcomes of implant-related therapies: a systematic review Strauss FJ, Stähli A, Gruber R. (2018) The use of platelet-rich-fibrin to enhance the outcomes of implant-related therapies: a systematic review Mombelli A, Hashim D, Cionca N. () What is the impact of titanium particles and bio-corrosion on implant survival and complications? A critical review Stavropoulos A, Bertl K, Pietschmann P, Pandis N, Morten Schiødt, Klinge B. () The effect of antiresorptive drugs on implant therapy: a systematic review. ispartof: CLINICAL ORAL IMPLANTS RESEARCH vol:29 pages:93-99 ispartof: location:SWITZERLAND, Pfaffikon status: published

A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.

BACKGROUND Surface modification may yield enhanced soft tissue adhesion to transmucosal titanium implant necks. AIM To evaluate and compare changes in soft tissues around implants with a modified hydrophilic sandblasted and acid-etched neck (mSLA; test) to those with a machined neck (M; control). MATERIALS AND METHODS Implants with a diameter of 4.1 mm and a neck height of 1.8 mm were randomly inserted in healed sites with pristine bone of the posterior maxilla or mandible. The modified Sulcus Bleeding Index (mSBI) (primary outcome) was assessed at baseline (BL) and 6, 12 and 36 months. Secondary outcomes included the assessment of pocket probing depth (PPD), mucosal recession (REC) and clinical attachment level (CAL). Standardized radiographs were taken at time of implant placement, at BL and after 12 and 36 months. RESULTS Of the 43 randomized subjects, 38 (19 test and 19 controls) completed the 36-month follow-up. Implant survival rates amounted to 95.5% (test) and 100% (control) (p > .05). At 36 months, 77.6% of test implants and 78.9% of control implants were without any bleeding sites (mSBI = 0; p > .05). The 36-month success rate was 86.4% in the test and 85.7% in the control group, respectively (p > .05). At 36 months, the mean radiographic bone level change from BL was 0.33 ± 0.69 mm at test implants and 0.12 ± 0.3 mm at control implants (p > .05). CONCLUSION Tissue level implants with a hydrophilic mSLA transmucosal neck failed to yield clinical and radiographic benefits compared with implants with a machined neck up to 3 years.

Despite decades of titanium as the gold standard in oral implantology, the search for alternatives has been growing. High esthetic standards and increasing incidence of titanium allergies, along with a rising demand for metal-free reconstructions, have led to the proposal of ceramics as potential surrogates. Following numerous experimental studies, zirconium dioxide (zirconia) has earned its place as a potential substitute for titanium in implantology. Yet, despite zirconia's excellent biocompatibility and tissue integration, low affinity to plaque and favorable biomechanical properties, early failures were significantly higher for zirconia implants than for titanium implants. Technical failure as a result of fracture of the material is also a major concern. So far, zirconia implants have been mainly manufactured as one-piece implant systems because of the material's limitations. Nevertheless, various two-piece systems have been progressively emerging with promising results. Screw-retained abutments are desirable but present a major technical challenge. Innovation and technical advances will undoubtedly lead to further improvement in the reliability and strength of zirconia implants, allowing for novel designs, connections and reconstructions. Additional clinical studies are required to identify all relevant technical and biological factors affecting implant success and patients' satisfaction. However, the evidence for a final verdict is, at present, still incomplete.

Objectives To compare in persons aged 70 years or older the clinical and inflammatory changes occurring around implants and natural teeth during and after a phase of undisturbed plaque accumulation. Material and methods Twenty partially edentulous participants with titanium implants refrained from oral hygiene practices while being clinically monitored in weekly intervals for 21 days. Teeth and implants were then cleaned, oral hygiene resumed, and the participants were further monitored for 3 weeks. Twelve biomarkers were assessed in gingival and peri‐implant crevicular fluid (GCF, PCF). Results During 3 weeks of oral hygiene abstention, the gingival index (GI) continuously increased. On day 21, there were significantly more sites with GI >1 at implants than at teeth. After restarting oral hygiene, the GI decreased markedly in both groups. Throughout the experiment, the plaque index was significantly higher on teeth than on implants. The different biomarkers reacted variably. IL‐1β increased significantly with plaque accumulation. IL‐1β, GM‐CSF, TNF‐α, and IFN‐γ were significantly higher in GCF compared to PCF at day 21. IL‐8 decreased significantly in GCF up to day 14. MIP‐1β decreased significantly in GCF, but not in PCF. At the 3‐week follow‐up, the levels of all biomarkers assessed in GCF and PCF had returned to baseline values. Conclusions In an elderly cohort, plaque accumulation induced an inflammatory reaction around both teeth and implants. Although there was less plaque accumulation on implants, the peri‐implant mucosa showed a stronger clinical response than gingiva.

Objective This systematic review was conducted to evaluate the outcome of dental implant therapy in elderly patients (≥65 years). Material and Methods Online database and hand searches were systematically performed to identify studies reporting on dental implants placed in the partially/completely edentulous jaws of elderly patients. Only prospective studies reporting on regular-diameter (≥3 mm), micro-rough surface implants were included in this review. Two investigators performed the search and data extraction. An inter-investigator reliability was verified using kappa statistics (κ). A meta-analysis was performed on implant survival rates, while the mean peri-implant marginal bone level changes (PI-MBL), technical/mechanical complications, and biological complications were reported descriptively. Results The systematic search yielded 2221 publications, of which 11 studies were included for statistical analyses. The calculated κ for the various parameters extracted was κ = 0.818–1.000. A meta-analysis was performed on the post-loading implant survival rates at 1, 3, 5, and 10 years. The random-effects model revealed an overall 1-year implant survival of 97.7% (95% CI: 95.8, 98.8; I2 = 0.00%, P = 0.968; n = 11 studies). The model further revealed an overall implant survival of 96.3% (95% CI: 92.8, 98.1; I2 = 0.00%, P = 0.618; n = 6 studies), 96.2% (95% CI: 93.0, 97.9; I2 = 0.00%, P = 0.850; n = 7 studies), and 91.2% (95% CI: 83.4, 95.6; I2 = 0.00%, P = 0.381; n = 3 studies) for 3, 5, and 10 years, respectively. The reported 1-year average PI-MBL ranged between 0.1 and 0.3 mm, while the reported 5- and 10-year PI-MBL were 0.7 and 1.5 mm, respectively. Information obtained pertaining to the technical and biological complications in the included studies was inadequate for statistical analysis. The frequent technical/mechanical complications reported were abutment screw loosening, fracture of the overdenture prostheses, activation of retentive clips, ceramic chipping, and fractures. The common biological complication reported included peri-implant mucositis, mucosal enlargement, bone loss, pain, and implant loss. Conclusions This review provides robust evidence favoring dental implant therapy in elderly patients as a predictable long-term treatment option, in terms of implant survival, clinically acceptable PI-MBL changes, and minimal complications. Therefore, age alone should not be a limiting factor for dental implant therapy.

OBJECTIVES: The aim of this study was to compare the expression of host-derived markers in peri-implant/gingival crevicular fluid (PCF/GCF) and clinical conditions at ceramic implants and contralateral natural teeth. As a secondary objective, we compared zirconia implants with titanium implants. METHODS: One zirconia implant (ZERAMEX(R) Implant System) and one contralateral natural tooth were examined in 36 systemically healthy subjects (21 males, 15 females, mean age 58). The levels of Il-1beta, Il-1RA, Il-6, Il-8, Il-17, b-FGF, G-CSF, GM-CSF, IFN, MIP-1beta, TNF-alpha, and VEGF were assessed in PCF/GCF using the Bio-Plex 200 Suspension Array System. The plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing (BOP) were assessed at six sites around each implant or tooth. Titanium implants were also assessed when present (n = 9). RESULTS: The zirconia implants were examined after a loading period of at least 1.2 years (average 2.2 years). The mean PI was significantly lower at zirconia implants compared to teeth (p = 0.003), while the mean GI, PD, and BOP were significantly higher (p < 0.001). A correlation was found in the expression of Il-1RA, Il-8, G-CSF, MIP-1beta, and TNF-alpha at zirconia implants and teeth. The levels of IL-1beta and TNF-alpha were significantly higher at zirconia implants than at teeth. No significant differences were found between zirconia and titanium implants. A correlation was found between the levels of IL-1RA, IL-8, GM-CSF, and MIP-1beta at zirconia and titanium implants. CONCLUSIONS: The correlation in the expression of five biomarkers at zirconia implants and teeth, and of four biomarkers at zirconia and titanium implants, is compatible with the existence of a patient-specific inflammatory response pattern. Higher mean GI, PD, and BOP around implants suggests that the peri-implant mucosa may be mechanically more fragile than the gingiva. CLINICAL RELEVANCE: Similar expression of selected biomarkers at zirconia implants and teeth and at zirconia and titanium implants reflects existence of patient-specific inflammatory response patterns.

To assess in persons aged 70 years or older the microbiological alterations occurring around implants and natural teeth during and after 3 weeks of undisturbed plaque accumulation. Furthermore, to test the predictive value of several markers at baseline for the extent of inflammation around implants and teeth after this period. Twenty partially edentulous participants with titanium implants refrained from oral hygiene practices while being clinically monitored in weekly intervals for 21 days. Teeth and implants were then cleaned, oral hygiene resumed, and the participants were further monitored. Levels of six subgingival plaque microorganisms, the plaque index (PI), and the gingival index (GI) were assessed before (baseline), during (days 0, 7, 14, 21), and after plaque accumulation (days 28, 42). Six microorganisms; demographic and clinical variables at day 0 were further evaluated as potential predictors for presence of GI > 1 at days 21 and 28. The detection frequency of the selected bacteria did not differ between implants and teeth at any time point. Bacteria counts decreased in the preparatory phase and increased in the plaque accumulation phase. Patterns observed at implants and teeth were similar. Only Parvimonas micra at day 21 reached significantly higher counts at implants than teeth. For the prediction of clinical outcome at day 21, in the multivariable model, only implant vs. tooth was significant indicator for the primary outcome (p = 0.01). Overall, the analysis of subgingival/submucosal samples revealed only minor differences between implants and teeth during the development and resolution of inflammation. Within the limitations of our study, with plaque accumulation, elders develop more inflammation around implants than around teeth, in spite of similar bacterial profiles.

Objectives To compile the current evidence regarding the association between the release of titanium particles and biologic complications of dental implants. Material and methods This is a critical review. We searched the literature using the terms "corrosion," "allergy," "hypersensitivity," or "particles" together with "titanium," "Ti," "TiO2. " The bibliographies of identified publications and previously published review articles were scanned to find additional related articles. We included clinical studies, in vivo and in vitro experiments. Results Titanium particles and degradation products of titanium have been detected in oral and nonoral tissues. Particles are released from surfaces of dental implants because of material degradation in a process called tribocorrosion. It involves mechanical wear and environmental factors, notably contact to chemical agents and interaction with substances produced by adherent biofilm and inflammatory cells. In vitro, titanium particles can interfere with cell function and promote inflammation. A temporal association between exposure to titanium and occurrence of tissue reactions suggested hypersensitivity in a limited number of cases. However, there is poor specificity as the observed reactions could be initiated by other factors associated with the placement of implants. Titanium particles are commonly detected in healthy and diseased peri-implant mucosa alike, at low levels even in gingiva of individuals without titanium implants. Rather than being the trigger of disease, higher concentrations of titanium in peri-implantitis lesions could be the consequence of the presence of biofilms and inflammation. Conclusion There is an association between biocorrosion, presence of titanium particles, and biological implant complications, but there is insufficient evidence to prove a unidirectional causal relationship.

Objectives: The aim of Working Group 4 was to address topics related to biologicrisks and complications associated with implant dentistry. Focused questions on (a) diagnosis of peri‐implantitis, (b) complications associated with implants in augmented sites, (c) outcomes following treatment of peri‐implantitis, and (d) implant therapy in geriatric patients and/or patients with systemic diseases were addressed.Materials and methods: Four systematic reviews formed the basis for discussion in Group 4. Participants developed statements and recommendations determined by group consensus based on the findings of the systematic reviews. These were then presented and accepted following further discussion and modifications as required by the plenary.Results: Bleeding on probing (BOP) alone is insufficient for the diagnosis of peri‐implantitis. The positive predictive value of BOP alone for the diagnosis of peri‐implantitis varies and is dependent on the prevalence of peri‐implantitis within the population. For patients with implants in augmented sites, the prevalence of peri‐implantitis and implant loss is low over the medium to long term. Peri‐implantitis treatment protocols which include individualized supportive care result in high survival of implants after 5 years with about three‐quarters of implants still present. Advanced age alone is not a contraindication for implant therapy. Implant placement in patients with cancer receiving high‐dose antiresorptive therapy is contraindicated due to the associated high risk for complications.Conclusions: Diagnosis of peri‐implantitis requires the presence of BOP as well as progressive bone loss. Prevalence of peri‐implantitis for implants in augmented sites is low. Peri‐implantitis treatment should be followed by individualized supportive care. Implant therapy for geriatric patients is not contraindicated; however, comorbidities and autonomy should be considered.

BACKGROUND: This study assesses the microbiologic effects of a two-phase antimicrobial periodontal therapy and tested microbiologic, clinical, and biologic markers as prognostic indicators for clinical success. METHODS: Eighty patients with chronic or aggressive periodontitis received periodontal treatment supplemented with 375 mg amoxicillin plus 500 mg metronidazole, three times daily for 7 days. In group A, antibiotics were given during the first non-surgical phase (T1); in group B, antibiotics were given during the second surgical phase (T2). Six microorganisms, group assignment, demographic and clinical variables, peak values of 15 cytokines, and nine acute-phase proteins in serum were evaluated as potential predictors of at least one site with probing depth (PD) >4 mm and bleeding on probing (BOP) at 12 months post-therapy. RESULTS: T1 decreased the counts of Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia (Pi), and Treponema denticola significantly more in group A than group B. Aggregatibacter actinomycetemcomitans and Parvimonas micra (Pm) showed a significant decrease only if the treatment was supplemented with antibiotics, i.e., T1 in group A, or T2 in group B. After T2, differences between groups were no longer significant. A multivariable model including four parameters revealed a predictive value of Pm (odds ratio [OR] = 4.38, P = 0.02) and Pi (OR = 3.44, P = 0.049) and yielded moderate accuracy for predicting the treatment outcome (area under the curve = 0.72). Host-derived factors and treatment sequence were not significantly associated with the outcome. CONCLUSIONS: Long-term microbiologic outcomes of periodontal therapy with adjunctive antibiotics either in T1 or T2 were similar. Detection of Pm before therapy was a predictor for persistence of sites with PD >4 mm and BOP at 12 months post-treatment.

Background Previous studies have suggested that acute necrotising gingivitis precedes noma disease and that noma clusters in some villages in certain regions of low- and middle-income countries. We sought to assess the prevalence of gingivitis with bleeding in young children from villages with or without a history of noma and to analyse epidemiological differences related to sociodemographic characteristics, nutritional status and oral hygiene practices. Methods We conducted a cross-sectional study in 440 children aged between 2 and 6 years from four villages in the Zinder region of southeast Niger in Africa. In two villages, cases of noma have repeatedly been detected; in the other two, noma has never been identified. We randomly selected 110 participants from each village. Results The prevalence of acute necrotising gingivitis was significantly higher in the noma villages compared with the non-noma villages (6.8% vs 0.9%; p=0.001). We found differences between the four villages regarding socioeconomic factors, stunting, undernourishment and oral hygiene practices. The type of oral hygiene procedures influenced the amount of dental plaque and gingival inflammation. Children using sand, coal or other abrasive products instead of a toothbrush had a significantly increased likelihood to be diagnosed with acute necrotising gingivitis (p=0.041). Conclusions Our data suggest that efforts to prevent noma should focus on populations with a high prevalence of acute necrotising gingivitis and include nutritional support and attempts to introduce safe and efficient oral hygiene practices to improve gingival health.

Objectives To evaluate repeated subgingival air-polishing in residual pockets with a new erythritol powder containing 0.3% chlorhexidine. Material and methods Single-centre, examiner masked, randomized clinical trial of 12 months with a two-arm, within-subject parallel design. Fifty patients in periodontal maintenance were monitored in 3-month intervals. At months 0, 3, 6 and 9, all sites presenting with a probing depth (PD) >4 mm were subject to subgingival air-polishing (test side) or ultrasonic debridement (control side). The primary endpoint was presence/absence of PD >4 mm after 12 months. Results Totally 6918 sites were monitored at baseline, 457 of them had a PD >4 mm (range 5-9 mm). The number of pockets >4 mm per subject, PD and bleeding on probing were significantly lower at month 12. Differences between test and control were not significant. There was a significant difference in favour of air-polishing for the perception of pain/discomfort. Differences of frequencies at >1000 and >100,000 cells/ml of six microorganisms between baseline and month 12 were not significant. At month 12, test sites were less frequently positive for Aggregatibacter actinomycetemcomitans at >1000 cells/ml than controls, and counts never exceeded 100,000 cells/ml. Conclusions Repeated subgingival air-polishing reduced the number of pockets >4 mm similar to ultrasonic debridement. It was safe and induced less pain.

Objectives: The aim of this prospective clinical study is to evaluate the safety and efficacy of a new all-ceramic implant system to replace missing teeth in partially edentulous patients. Material and methods: Thirty-two partially edentulous, systemically healthy patients were treated with 49 two-piece zirconia implants (ZERAMEX" T Implant System). Zirconia abutments were connected with adhesive resin cement. Single-unit full-ceramic crowns were cemented. The cases have been followed for 588`174 days after loading (range 369–889 days). All patients have been re-evaluated 1 year after loading. Results: The cumulative survival rate 1 year after loading was 87% implants. All failures were the result of aseptic loosening, and no implants were lost after the first year. The results of the other cases were good, and the patients were very satisfied. The cumulative soft tissue complication rate was 0%, the cumulative technical complication rate was 4% implants, the cumulative complication rate for bone loss >2 mm was 0%, and the cumulative esthetic complication rate was 0%. Including the data from 20 patients treated with an earlier version of the system, an over-all 2-year cumulative survival rate of 86% was calculated for a total of 76 two-piece zirconia implants supporting all-ceramic crowns in 52 patients. Conclusions: Replacement of single teeth in the posterior area was possible with this new full- ceramic implant system. Failures were due to aseptic loosening.

Cytokines are thought to play an important role in the pathogenesis of periodontal disease. Because periodontal disease is known for its inhomogeneous distribution within the dentition, it is unclear to what extent the detection of various cytokines at different sites correlates with presence of disease. We evaluated whether levels of 12 cytokines in gingival crevicular fluid (GCF) discriminated periodontally diseased sites from healthy ones, or periodontally diseased persons from healthy ones, and assessed the impact of nonsurgical periodontal therapy on these readings. This study included 20 periodontally healthy persons (H) and 24 patients with chronic periodontitis (P). In every participant, we measured the plaque index, gingival index, probing pocket depth (PD), bleeding on probing, and recession at six sites of every tooth. GCF was collected with Durapore® filter strips from two healthy sites (PD

Background: There is an ongoing controversy on the bene- fits of treatment protocols, including dental lasers and photo- dynamic therapy (PDT). The purpose of this study is to compare the local biologic effects of PDT, diode soft laser (DSL) therapy, and conventional deep scaling and root plan- ing (SRP) in residual pockets. Methods: Thirty-two individuals were included based on a his- tory of previous treatment for periodontitis and the persistence of sites with probing depths >4 mm and bleeding on probing. Resid- ual pockets were debrided with an ultrasonic device and then ran- domly assigned either to PDT, DSL, or SRP. Gingival crevicular fluid was collected before treatment, after 14 days, and at 2 and 6 months. Levels of 13 cytokines and nine acute-phase proteins were measured using a bead-based multiplexing analysis system. Results: Treatment with PDT, DSL, or SRP led to significant changes in several cytokines and acute-phase proteins: Com- pared with baseline, levels of interleukin-17, basic fibroblast growth factor, granulocyte colony-stimulating factor, granulocyte macrophage colony-stimulating factor, and macrophage inflam- matory protein 1-a were lower 14 days and 2 months after treat- ment. Except for granulocyte colony-stimulating factor, these differences remained significant throughout the observation pe- riod. The levels of five acute-phase proteins (a-2 macroglobulin, haptoglobin, serum amyloid P, procalcitonin, and tissue plas- minogen activator) were significantly higher at 6 months than at baseline. No significant differences were observed among the three treatment modalities at any time point for any bio- chemical parameter. Conclusions: Levels of several cytokines and acute-phase proteins significantly changed after treatment regardless of treatment modality. There was no evidence for a specific DSL- or PDT-enhanced expression of inflammatory media- tors. J Periodontol 2012;83:1018-1027.

The objective of this work was to compare the effects of antimicrobial photodynamic therapy (PDT), diode soft laser therapy (DSL), and thorough deep scaling and root planing (SRP) for treatment of residual pockets. Thirty-two subjects with a history of non-surgical treatment for chronic periodontitis were included. Residual pockets >4 mm and bleeding upon probing were debrided with an ultrasonic device and then subjected to either PDT, DSL, or SRP. Pocket probing depth (PPD), bleeding on probing (BOP), and gingival recession were monitored over 6 months. Counts of four microorganisms were determined by direct hybridization with RNA probes. PPD decreased from 5.6 ± 1.0 to 3.8 ± 1.1 in 6 months (p < 0.001), and BOP decreased from 100% to 52% (p4 mm with BOP depended on initial PPD (p = 0.036) and was higher if treated with DSL (p = 0.034). Frequencies of three microorganisms were significantly lower in PDT- and SRP-treated than in DSL-treated quadrants (p = 0.02) after 14 days, but not at months 2 and 6. All three treatments resulted in a significant clinical improvement. PDT and SRP suppressed Porphyr- omonas gingivalis, Tannerella forsythia, and Treponema denticola stronger, and resulted in fewer persisting pockets after 6 months, than DSL application.

It has been suggested that use of systemic antibiotics should be limited to patients with specific microbiologic profiles. The main purpose of the present analysis was to study whether microbiologic testing before therapy was of value in predicting which patients would specifically benefit from adjunctive amoxicillin and metronidazole, given in the context of full-mouth scaling and root planing (SRP) within 48 hours.This was a 6-month, single-center, double-masked, placebo-controlled, randomized longitudinal study. Fifty-one patients received full-mouth periodontal debridement, performed within 48 hours; then, 25 subjects received metronidazole, 500 mg, and amoxicillin, 375 mg, three times a day for 7 days, and 26 received a placebo (control group). Pooled microbiologic samples were taken from the deepest pocket at baseline in each quadrant before and 6 months after treatment. Six periodontal pathogens were quantified by real-time polymerase chain reaction.Forty-seven patients were followed for 6 months. After treatment, test subjects had a substantially lower mean number of persisting sites with probing depth4 mm and bleeding on probing than did control subjects (0.4 versus 3.0; P = 0.005; month 6). Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) could not be detected in the antibiotic group after treatment. However, in the placebo group, three of six subjects positive for A. actinomycetemcomitans continued to be positive. Lower frequencies were also noted in the test group for Porphyromonas gingivalis (P = 0.013) and Tannerella forsythia (previously T. forsythensis) (P = 0.007). However, even subjects testing negative for A. actinomycetemcomitans at baseline had a significantly better primary clinical outcome if they received the active drugs. The presence of six putative periodontal pathogens (A. actinomycetemcomitans, Fusobacterium nucleatum spp., P. gingivalis, Prevotella intermedia, Treponema denticola, and T. forsythia) quantified prior to therapy was not correlated with the outcome of full-mouth SRP with or without amoxicillin and metronidazole.Excellent clinical results in the antibiotics group were obtained regardless of the presence or absence of six classic periodontal periopathogens prior to treatment.

Aim The aim of the present study was to test the presumptive therapeutic effect of chlorhexidine digluconate in a population with untreated gingivitis and presence of abundant calculus. SETTING AND STUDY DESIGN: Sixty subjects (approximately mean age of 23.4) were recruited from a knitting factory in the Province of Guangdong, People's Republic of China. By applying a double-blind clinical trial design the participants were divided into two groups (Test and Control) and matched according to their mean GI scores. The Test group (n = 20) was assigned to two daily mouthrinses for 6 days per week using 0.12% chlorhexidine digluconate (Peridex). The Control group (n = 40) rinsed twice daily with a placebo solution. All the rinsings were supervised and timed for 45 s. No attempt was made to influence the oral hygiene habits of the participants. Prior to and after 3 months of the supervised rinsing, plaque was scored using the Plaque Index system (PII), and gingivitis was assessed using the criteria of the Gingival Index system (GI). Calculus was scored according to the Calculus Surface Severity Index system (CSSI), and stain was also graded by the Discoloration Index system (DI). Results After 3 months, the Test group (n = 13) showed significant reduction in mean PII, GI and percentage of gingival bleeding (GB%), while significant increases in mean DI were observed. The improvement in gingival health was observed at all regions with marked reduction in mean GI (from GI = 1.40 to 1.08) and GB% reduction by 24-52%. The proportion of GI = 2 was also reduced significantly from 50-36%. The Control group (n = 23) also showed a decrease in mean PII but significant increases in the mean GI and GB%. Intergroup comparison showed statistically significant differences between mean GI, percentage of gingival bleeding (GB%) and mean DI for the test and control groups after 3 months of supervised rinsing. However, there were no significant intergroup differences for mean PII. Conclusion In conclusion, there was a significant effect of chlorhexidine on gingivitis, although the effect may be too limited to assure prognostic benefits in the prevention of future disease progression.

OBJECTIVES: To assess the relationship between periodontal parameters and cervical root resorption in orthodontically moved teeth. MATERIAL AND METHODS: In a standardized experimental tooth movement in 16 periodontally healthy subjects, 29 pre-molars were tipped buccally for 8 weeks. Eighteen contralateral pre-molars not subjected to orthodontic movement served as controls. Plaque Index (PI), Gingival Index (GI), probing depth and bleeding on probing were assessed three times before and six times during the experimental phase. Teeth were extracted and scanned in a micro-computed tomography scanner. The presence or absence, and the severity of cervical root resorption were evaluated on the three-dimensional reconstruction of the scans by two calibrated examiners. RESULTS: Overall, periodontal parameters were not different between the test and the control teeth. Clear signs of buccal cervical resorption were detected on 27 of 29 orthodontically moved teeth and on one control tooth. Ten subjects had perfect oral hygiene and no gingivitis, whereas six subjects showed a moderate level of plaque and gingivitis (>20% occurrences of PI or GI with >0). No relationship could be demonstrated between resorption and periodontal parameters. CONCLUSIONS: Nearly all orthodontically moved teeth showed signs of cervical resorption. Periodontal parameters were unrelated to this important side effect of orthodontic treatment.

OBJECTIVE: To study the expression of IL-1beta, IL-4, and IL-8 in the gingival crevicular fluid (GCF) of children, adolescents, and young adults with and without fixed orthodontic appliances. MATERIAL AND METHODS: Eighty systemically healthy children and adolescents participated in the study: 56 aged between 8 and 16 years without any orthodontic appliance (Group A) and 24 aged between 10 and 20 years having worn fixed orthodontic appliances for at least 12 months (Group B). Clinical examination included presence or absence of plaque, probing depth, bleeding on probing, and gingival overgrowth. GCF was collected by means of Durapore strips from four randomly selected sites per subject. The contents of interleukin-1 beta (IL-1beta), interleukin-4 (IL-4), and interleukin-8 (IL-8) were detected by ELISA, measured as total amounts (pg/30s) and expressed in log scale. RESULTS: Statistically significant differences were noted for the mean log IL-1beta, IL-4, and IL-8 between the two groups: Group B showed significantly higher mean levels in log IL-1beta and log IL-8 compared to Group A. Mean levels of log IL-4 were lower in Group B, although they did not reach statistical significance. Furthermore, mean levels of log IL-1beta and log IL-8 were associated with bleeding sites (p

The aim of this study was to evaluate whether the application of tension or compression forces exerted on the periodontium during the early phase of orthodontic tooth movement is reflected by differences in the composition of the gingival crevicular fluid (GCF), at the level of interleukin-1beta (IL-1beta), substance P (SP), and prostaglandin E(2) (PGE(2)). Eighteen children (mean age 10.8 yr) starting orthodontic treatment were included in the study. Molar elastic separators were inserted mesially to two first upper or lower molars. One of the antagonist molars served as the control. GCF was collected from the mesial and distal sites of each molar, before (-7 d, 0 d) and immediately after (1 min, 1 h, 1 d, and 7 d) the placement of separators. The levels of IL-1beta, SP, and PGE(2) were determined by enzme-linked immunosorbent assay. At the orthodontically moved teeth, the GCF levels of IL-1beta, SP, and PGE(2) were significantly higher than at the control teeth in both tension and compression sides, and at almost all occasions after insertion of separators. The increase, relative to baseline values, was generally higher in tension sides. For the control teeth, the three mediators remained at baseline levels throughout the experiment. The results suggest that IL-1beta, SP, and PGE(2) levels in the GCF reflect the biologic activity in the periodontium during orthodontic tooth movement.

The purpose of this study was to determine the presence of suspected periodontal pathogens in the peri-implant microflora of osseointegrated implants exposed 3 and 6 months to the oral environment of patients previously treated for periodontal disease. Subgingival microbial samples were taken in the deepest residual pocket of each quadrant in 10 patients before placement of ITI implants and in 10 patients before abutment connection of Brånemark implants. The samples were cultured using continuous anaerobic techniques. 4 patients were positive for P. gingivalis, 13 for P. intermedia, 2 for A. actinomycetemcomitans, 16 for Fusobacterium, 7 for C. rectus and 12 showed microscopic evidence of spirochetes. After 3 and 6 months exposure of the implants to the oral environment, one sample was obtained from the peri-implant sulcus in each patient. P. gingivalis was found in 2 patients in the peri-implant samples after 3 and 6 months. 6 peri-implant samples were positive for P. intermedia after 3 months, 7 after 6 months. Fusobacterium was present in 13 peri-implant samples after 3, and in 12 samples after 6 months. 4 patients showed evidence of for C. rectus after 3 months, 2 after 6 months. Spirochetes were seen in 3 peri-implant samples after 3 and in 5 after 6 months. None of the implants were found to be colonized by A. actinomycetemcomitans, although the organism was detected on teeth in 1 individual. Similar distribution patterns were noted for ITI and Brånemark type implants.(ABSTRACT TRUNCATED AT 250 WORDS)

In a previous study, it was shown that professional tooth cleaning 3x a week had a significant influence on the subgingival microbiota of shallow pockets. The purpose of this investigation was to study the effect of a single episode of full-mouth supragingival cleaning and oral hygiene instructions in subjects with minimal periodontal disease but high prevalence of putative periodontal pathogens. 10 subjects from Arabic countries, aged between 22 and 48 years, which had previously not been exposed to any dental care other than extractions and fillings, were selected for this trial. DNA probe analysis of subgingival samples, taken in the deepest pocket of each quadrant, showed presence of Porphyromonas gingivalis and Prevotella intermedia in all patients, and presence of Actinobacillus actinomycetemcomitans in 5 individuals. 85% of all samples were P. gingivalis-positive, 83% were positive for P. intermedia and 43% were A. actinomycetemcomitans-positive. 4 weeks after treatment, subgingival microbiological samples were again taken in the same sites. In 8 patients, P. gingivalis could still be detected after treatment. However, the number of P. gingivalis positive samples was reduced from 85% to 38%, and the bacterial counts in positive samples were markedly lower than at baseline. P. intermedia-positive samples were obtained from 7 patients after treatment. 33% of all samples were still positive, but showed markedly reduced bacterial counts. 4 patients still yielded A. actinomycetem comitans-positive samples after treatment. Here, the number of positive samples was reduced to 15%, and the bacterial counts were barely exceeding the detection limit.(ABSTRACT TRUNCATED AT 250 WORDS)

To compare the clinical and microbiological outcome of non-surgical periodontal therapy after 6 months with data obtained after hygienic phase or 6 weeks after completion of non-surgical therapy, in order to evaluate the value of clinical and microbiological parameters to predict treatment success.Clinical and microbiological data were available from 271 sites in 10 systemically healthy non-smokers with moderate-to-advanced chronic periodontal disease (24-32 sites per individual). Subgingival plaque samples were tested for the presence of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Tannerella forsythensis and Treponema denticola using RNA probes.Stepwise multiple linear regression analysis revealed a significant impact of the number of sites with visible plaque index1 after hygienic phase on the bleeding tendency of a subject at month 6 (p0.01). Furthermore, an association could be demonstrated between the number of residual pockets (PD3 mm) 6 months after therapy and the number of bleeding sites and suppurating sites after hygienic phase (p=0.016). Six weeks after therapy, the mean total bacterial loads had a significant impact on the bleeding tendency of a subject at month 6 (p0.01). Although the average numbers of sites with persisting P. gingivalis, A. actinomycetemcomitans, T. forsythensis and T. denticola seemed to be very similar 6 weeks and 6 months after therapy, large variations were noted between subjects, and therefore the microbiological status of a subject at week 6 could not predict the status at month 6.The present study showed a limited potential of microbiological tests, performed after hygienic phase or shortly after non-surgical periodontal therapy, to predict the clinical outcome 6 months later, but confirmed the importance of an establishment of perfect oral hygiene before non-surgical therapy.

Objectives: The purpose of this study was to evaluate the views, knowledge and preferences of a large sample of practising dentists in periodontics, focusing specifically on the treatment of gingival recessions, and to compare the findings with the current evidence available in the dental literature. Methods: We conducted a cross-sectional postal survey of 3780 dentists, representing the majority of all dentists working in Switzerland. The questionnaire consisted of 17 questions, most of them giving the possibility of multiple choices of answers. The demographic profile, interests and satisfaction in periodontics were associated with the choice of treatment options offered for the management of six clinical situations. Results: One thousand two hundred and one dentists sent back the questionnaire within three months and were thus included in the analysis. In general, the interest and the satisfaction in periodontics were moderate to high (6–7 on an analogue scale from 1 to 10). Specialists in periodontics indicated a significantly higher interest and satisfaction in periodontics than the general dentists (p

Objectives: The purpose of the present study was to evaluate the clinical effects of non-surgical periodontal treatment, supplemented with enamel matrix derivative (EMD) and/or systemic antibiotics, in deep periodontal pockets of patients with chronic periodontitis. Methods: This was a randomized, placebo-controlled longitudinal clinical trial of 12 months duration. Using a split-mouth design, 16 subjects were randomly assigned to scaling and root planing (SRP) with EMD or placebo in contra-lateral dentition areas. One half of the subjects received 250 mg metronidazole and 375 mg amoxicillin three times a day for 7 days and the other half received a placebo. One inter-proximal periodontal lesion was chosen as study site in each of the contra-lateral quadrants. Results: Subjects treated with systemic antibiotics yielded significantly better clinical results than those treated with placebo. In these cases, probing pocket depth was reduced significantly more after 6 months (3.0 ′ 2.1 mm versus 1.6 ′ 1.4 mm, p = 0.05), and the mean clinical attachment gain was significantly greater after 6 months (2.3 ′ 1.9 mm versus 0.7 ′ 1.6 mm, p = 0.02) and 12 months (2.3 ′ 3.5 mm versus 0.4 ′ 3.8 mm, p = 0.02). Sites treated with the antibiotics plus EMD gained the largest amount of clinical attachment. There was no significant benefit of EMD adjunctive to SRP in subjects not treated with antibiotics. Conclusions: The present study supports the notion that optimal repair and regeneration of the periodontium requires suppression of the microbiota causing periodontal disease.

The number of immunocompromised patients is increasing as a consequence of successful organ transplantation. Placing dental implants in these patients has been questioned because of their increased risk for infections. The 10-year follow-up data of a 71-year-old liver transplant recipient with long-term immunosuppressive therapy is reported. Six months after liver transplantation, two interforaminal implants were inserted in the edentulous mandible, and an overdenture using non-rigid telescopic attachments was fabricated 3 months later.Oral clinical parameters included the modified plaque index, sulcus fluid flow rate, modified bleeding index, probing depth, distance implant mucosa, attachment level, width of the keratinized mucosa and mobility values. The distance implant bone (DIB) was determined on digital panoramic radiographs. The levels of eight periodontal marker organisms were established using DNA probe technology. Additionally, swabs of the edentulous oral mucosa were taken for microbiological culture and antimicrobial resistance testing.The peri-implant parameters were within normal ranges indicating a stable osseointegration with moderate vertical bone loss. Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Campylobacter rectus, and Treponema denticola were not detected. Low levels of Porphyromonas gingivalis, Fusobacterium nucleatum, and Eikenella corrodens were found. Prevotella intermedia was the only bacterium with a level higher than 10(4). The mucosal swabs indicated the presence of an abundant normal oral flora, including Escherichia coli and Candida albicans. The antibiogram revealed multiple resistance to antibiotics.This case report suggests that immunocompromised patients can be successfully rehabilitated with dental implants.

The semisolid consistency of poly(ortho esters) (POEs) containing tetracycline free base allows direct injection in the periodontal pocket and shows sustained and almost constant in vitro release in phosphate buffer, pH 7.4 at 37 degrees C, for up to 14 days. Total polymer degradation concomitant with drug release was obtained. Formulations containing 10% or 20% (wt/wt) tetracycline were evaluated in a panel of 12 patients suffering from severe and recurrent periodontitis. In the first trial including 6 patients, single-rooted teeth and molar teeth with furcations were treated immediately after scaling and root planing. Patients tolerated both formulations well, experienced no pain during application, and showed no signs of irritation or discomfort during the observation period. However, retention of the formulation was minimal in this first study. An improved clinical protocol followed in the second study (stopping bleeding after scaling and root planning) prolonged the retention of the formulations in the inflamed periodontal pockets. For up to 11 days, tetracycline concentrations in the gingival crevicular fluid were higher than the minimum inhibitory concentration of tetracycline against most periodontal pathogens.

Aim: The aim of this single-blind, randomized, parallel-designed clinical trial (RCT) was to evaluate the clinical and microbiological effects of three sustained-release biodegradable polymers delivered into periodontal pockets following initial periodontal therapy.Methods: Forty-seven patients (28 females and 19 males) with a mean age of 51 years (range 29-71) underwent a periodontal examination at baseline (i.e. Week 0) and after 18 weeks. This included the assessment of the Plaque Index (PlI), Bleeding on Probing (BOP), Pocket Probing Depths (PPD) and Probing Attachment Levels (PAL) at six sites per tooth. Two to 4 months prior to baseline, all subjects had received initial periodontal therapy including motivation, instruction in oral hygiene practices and full-mouth scaling and root planing. At the treatment appointment (i.e. Week 2), the patients were randomly assigned to receive either Atridox(TM), Elyzol(R) Dental Gel or PerioChip(R) at all residual periodontal pockets with a probing depth greater than or equal to 5 mm and concomitant BOP. In accordance with the manufacturer's recommendations, Elyzol(R) Dental Gel was applied for a second time 7 days later. In addition to the clinical evaluation, subgingival microbiological samples were collected prior to treatment (i.e. Week 2) and at Weeks 4 and 18. Analysis of variance/covariance was used to evaluate changes from baseline to Week 18 for the clinical parameters.Results: Between the baseline and 18-week examinations, subjects treated with Atridox showed a significantly greater gain in mean PAL of 0.33 mm +/- 0.09 (SD) than subjects treated with Elyzol(R) Dental Gel [0.03 mm +/- 0.09 (SD)](p=0.03). However, the gain in PAL of 0.16 mm +/- 0.10 (SD) found after PerioChip(R) application did not differ significantly from that obtained following the application of Atridox(TM) (p=0.27). Of the sites treated with Atridox(TM) , 42% gained greater than or equal to 1 mm PAL and 9% greater than or equal to 2 mm PAL as opposed to the sites treated with Elyzol(R) Dental Gel, in which 34% gained greater than or equal to 1 mm PAL and 8% gained greater than or equal to 2 mm PAL. Of the sites treated with PerioChip(R), 36% gained greater than or equal to 1 mm and 6% gained greater than or equal to 2 mm PAL following a completed initial periodontal therapy.Conclusions: The application of the three biodegradable sustained release devices tested following initial periodontal therapy resulted in a statistically significant gain in mean PAL for Atridox(TM) and a significant reduction in PPD for all three devices during the study period. Furthermore, when sites treated with Atridox(TM) were compared with sites treated with Elyzol(R) , a significant difference in mean PAL gain (0.3 mm) was observed.

To evaluate oral health conditions in pediatric liver transplant recipients, with special focus on caries, green staining of the teeth, gingival bleeding, and gingival overgrowth. 40 patients (mean age 11.6 years) were examined at a routine follow-up visit, 6 months to 16 years after liver transplantation at the Swiss Center for Liver Disease in Children. After the medical examination, participants were further examined for the presence of dental caries, periodontal disease, GE, and GTC. The mean decay, missing, and filled teeth (dmft/DMFT) score was 3.8. 45% of the participants presented at least one carious lesion. Two-third of the participants had more than 20% of sites with the presence of plaque and gingival inflammation. Signs of GE were found in 18% and GTC in 30% of the participants. A positive correlation was identified between GTC and peak serum bilirubin (P

Background, aim: Symmetry is a common feature of biological systems, and can be observed in multiple aspects of the human body. The purpose of this study was to estimate the impact of symmetry on variance observed in intraoral topographic distribution patterns of chronic periodontitis. Method: This analysis was performed on a data set from 56 subjects, including clinical and microbiological variables, recorded at the mesial and distal aspect of every tooth in the entire dentition. The impact of contralateral conditions was determined on the level of the site, the tooth, and the quadrant. Results: Significant correlations were detected between probing depths, recession, attachment levels, total cultivable bacterial counts and the plaque index recorded on the right and left side on all levels of analysis. The odds for bleeding on sampling, as well as for the presence of P. intermedia/nigrescens and A. actinomycetemcomitans increased significantly if the respective contralateral site was positive for the same parameter. In combining ipsilateral and contralateral parameters into the analysis it could be shown in several instances that this contralateral effect was stronger than the impact of other, ipsilateral factors. As an example, the odds for bleeding on sampling increased up to 10 fold if the contralateral site was bleeding, whereas the ipsilateral total cultivable count, determined at the same site, explained less than 30% of the variation in the bleeding tendency. Conclusion: These findings support the view that the development of periodontal disease in any site cannot be explained by the influence of local detrimental factors alone.

A new local delivery device (LDD) capable of releasing silver in periodontal pockets has been developed and tested pre-clinically. Silver has potent antimicrobial effects on Gram-negative periodontal pathogens with a mean in vitro minimum bactericidal concentration (MBC) or =5 mm. Serum, gingival fluid and subgingival plaque samples were evaluated before and at various time points after LDD placement for 21 days. At each time point, the concentration of silver in gingival crevicular fluid (GCF) was quantified with an Inductively Coupled Plasma-Mass Spectrometer. Subgingival plaque samples were processed for evaluation of total anaerobic and aerobic counts (CFU/ml). The maximum mean silver concentration in GCF was 1,493 +/- 709 microg/ml (range 589-2,245). It decayed exponentially with a half-life of 7.1 +/- 6.1 days (2.7-20.4). Average silver concentrations in excess of 10 microg/ml were detected in each patient for 14 days after LDD placement with the average concentration for all patients in excess of 25 microg/mL at day 21. Total anaerobic counts decreased an average of 1.7 +/- 1.9 x 10(6) CFU/ml (p= 0.0078) from baseline to day 7, indicating that the silver was biologically active. A mild increase in cervical root discoloration was observed at day 21:0.25 +/- 0.31 stain index units. Discoloration that did not resolve spontaneously could be removed at the end of the study with polishing. No systemic effects were observed. It is concluded that local silver concentrations above the MBC in serum were maintained for at least 21 days. A specific microbiologic effect was also observed.

An increasing number of studies point to the detrimental effect of plaque bacteria on periimplant tissue health. The purpose of this retrospective study was to explore a possible relationship between the clinical and microbiological periimplant conditions of osseointegrated oral implants after several years of service and the dental and medical history, as well as the conditions of the residual dentition. 45 partially edentulous patients (mean age: 51 years, range: 27-83 years), with a total of 64 implants participated in this retrospective analysis. The time between examination and the last dental visit ranged from 6 to 24 months (mean: 13 months) and the time since the last maintenance therapy appointment with a dental hygienist ranged between 3 and 24 months (mean 7 months). During 5 to 10 years between implant installation and examination, 9 implants experienced one episode and an additional 6 implants two episodes of periimplantitis. As a consequence of extensive bone loss associated with these infections, one of these implants, in a patient who had a history of diabetes, was lost. With this exception, the other episodes of periimplantitis were successfully treated employing the principles of the Cumulative Interceptive Supportive Therapy (CIST) protocol. At examination, 42 implants (66%) showed a probing pocket depth exceeding 4 mm. Of the periimplantitis sites, four implants showed cultural evidence for presence of Porphyromonas gingivalis, and 2 implants were positive for Actinobacillus actinomycetemcomitans. Statistical analysis revealed a significant relationship between periimplant probing depth and the total anaerobic cultivable microbiota as well as the frequency of detection of P. gingivalis.

The aim of this study was to determine the distribution patterns of Porphyromonas gingivalis, Prevotella intermedia/nigrescens, and Actinobacillus actinomycetemcomitans in periodontitis patients after standard mechanical periodontal therapy, and to determine factors increasing the odds to detect these target organisms in treated sites.Eight hundred fifty-two (852) separate subgingival microbial samples were taken from the mesial and distal aspects of every tooth in 17 patients. Target organisms were identified culturally.The 3 microorganisms showed different persistence patterns: P. gingivalis was detected in a high percentage of subjects (59%), but in a low proportion of sites (5.4%). P. intermedia/nigrescens was detected in all subjects except one, and in 40.6% of the tested sites. Only 5 subjects were A. actinomycetemcomitans positive, but 2 of them showed a very high number of positive sites (44% and 75%, respectively). A highly significant relationship was found between a subject's tendency to bleed upon sampling and the number of P. intermedia/nigrescens-positive sites. A significant portion of the variation in frequency of persisting P. gingivalis could be explained by the frequency of persisting pockets deeper than 4 mm. No similar relationship could be established between clinical parameters and A. actinomycetemcomitans. On a site level, the odds of detecting P. gingivalis increased by a factor of 2.47 (P= 0.0001) for every millimeter of residual probing depth; the odds of detecting P. intermedia/nigrescens increased by a factor of 1.84 (P= 0.0001).If, after standard mechanical periodontal therapy, a large number of sites continue to bleed, one may expect an increased number of sites positive for P. intermedia/ nigrescens. If many deep pockets persist, a greater number of P. gingivalis-positive sites can be expected.

In 1993, the 1st European Workshop on Periodontology explicitly recognized that there was insufficient knowledge to differentiate truly different forms of periodontal disease from differences in the presentation/severity of the same disease. In spite of recent progress in our understanding of periodontal diseases, the issue is far from having been resolved. Classification of periodontal diseases, therefore, remains based upon the definition of specific clinical syndromes. Early-onset periodontitis (EOP) is one such syndrome and comprises a group of pathological conditions leading to loss of periodontal tissues early in life. The notion that classifies periodontitis syndromes as "early-onset" or "adult" is primarily epidemiological in nature and is based on the observation that periodontitis is rather infrequent in children and young adults. Nevertheless, considerable epidemiological evidence indicates that periodontitis does affect children and young adults to a level of severity that may lead to premature exfoliation of primary and/or permanent teeth. Clinical presentation of periodontitis early in the life of an individual is thought to indicate that the etiologic agents have been able to cause considerable tissue damage over a relatively short period of time. It also implies either infection with highly virulent bacteria and/or a highly susceptible subject. The purpose of this review is to discuss the criteria generally utilized to classify EOP, provide the rationale to designate EOP as a distinct disease entity, and to review the evidence justifying a subclassification into particular subgroups of EOP.

The aim of this study was to explore the microbiological and clinical effects of an antiseptic dental varnish when applied to periodontally diseased teeth after mechanical therapy. 20 subjects participated in this placebo controlled, double blind prospective longitudinal study. 2 experimental sites with a pocket probing depth > or =5 mm were chosen in each subject. The control varnish, consisting of ethanol, ethylacetate and polyvinylbutyral, was applied to one of the selected teeth and the test varnish, containing 1% chlorhexidine and 1% thymol in addition, was applied to the other one. Clinical parameters were assessed, and microbiological samples were obtained from the two study sites at baseline (6-10 weeks after completion of conventional periodontal therapy), and 2, 4 and 12 weeks thereafter. The mean PLI at baseline was very low and, therefore, only a minimal potential for a further improvement existed. During the 12-week observation period, the mean PLI increased significantly at sites treated with the placebo varnish, while no similar trend for an increase in PLI was detected in the test sites. The bleeding tendency seemed to remain unaffected by the application of the varnish. On the microbiological level, no relevant differences could be detected between placebo and test sites at baseline, or during the follow-up period. In conclusion, the application of a dental varnish with antimicrobial properties after mechanical periodontal therapy had little effect in subjects with good oral hygiene.

The aims of the present study were to assess radiographically the effects of scaling/root planing combined with antibiotic therapy using tetracycline fibers (TCF): (II) on alveolar bone density and linear discriptors and (II) on supracrestal soft tissue density, 19 subjects with generalized adult periodontitis (with at least 20 teeth present, at least 4 teeth with pockets >4 mm and bleeding upon controlled force probing) and high cultural counts of Porphyromonas gingivalis were recruited from a pool of 57 patients. The full mouth treatment group (FT) consisted of 10 patients, who underwent a full mouth supra-gingival scaling and prophylaxis treatment and were instructed to rinse 2× daily with a 0.1% chlorhexidine solution. 1 week later, tetracycline-hydrochloride-containing fibers (Actisite® periodontal fiber) were applied around all teeth. After 7–12 days, the fibers were removed and all teeth were scaled and root planed under local anaesthesia. The chlorhexidine rinsing continued for another 2 months. In 9 subjects (local treatment group LT), 2 teeth with periodontal lesions with pocket probing pepth (PPD) ≥5 mm were treated by placement of tetracycline fibers, which remained in place for 7 to 12 days. Upon removal of the fibers, scaling and root planing was performed on these 2 teeth, while the rest of the dentition renamed untreated, and no chlorhexidine rinse was applied, 2 of the untreated teeth revealing similar periodontal lesions were chosen to represent sites affected by untreated periodontitis (NT). In this group, a limited local treatment was performed (2 teeth) with the inherent potential for recolonization from the untreated pocket sites. Standardized periapical radiographs were obtained from the 4 monitored sites within each patient at baseline (before treatment) and 2 and 6 months thereafter. One radiograph was exposed in a standard way for bone assessment. The second radiograph was underexposed, at about a 1/5 of the original exposure time to allow the evaluation of soft tissue. Mean changes in the near parameters and changes in density (CADIA) observed at multiple sites within each patient and treatment group were used as the best estimate of treatment outcome. Over the observation period of 6 months, a significant difference in bone height changes was found between the untreated sites (median loss –0.29 mm) and the sites from full-mouth treated patients (median gain 0.24 mm p=0.008). When comparing the baseline to the 6 months radiographs, a loss in bone density was observed for the untreated group (median=–2.13 CADIA), Both treatment groups revealed a gain in density (median= 1.58 and 2.43 CADIA for the locally and the full–mouth treated groups, respectively). Differences in density were significant, both between the nontreated and locally treated sites (p= 0.026) and between the nontreated sites and the sites from the full mouth treated patients (p=0.002). The analysis of the soft tissues showed a similar pattern of changes in density to those seen in the bone defect. At 2 months, there was a tendency for loss in density for the nontreated group (median=–0.17 CADIA) that continued over the 6 month period (median =–0.31 CADIA), A significant increase in density was observed for the full–mouth treated sites (median = 1.57 and 0.64 CADIA for the 2 and 6 months radiographs, respectively), A significant increase was also observed for the locally treated group when compared to the untreated sites (median=0.13 and 0.10 CADIA for the 2 and 6 months radiographs, respectively). Comparing untreated sites with full–mouth treated sites, a significant difference was observed for CADIA measurements (p

The aims of this study were to compare clinical and microbiological features in the peri-implant area of implants carrying either screw retained or cemented suprastructures, and to investigate the relationship between the peri-implant microflora, the microbiota on the inner surface of removable suprastructures, and the periodontal microflora within the same subject. In 15 partially edentulous patients with ITI implants used as abutments for crown and bridge reconstructions, microbial samples were taken i) from the deepest periodontal pocket of each quadrant, ii) from the sulcus of the implants and iii) from the internal surface of the screw retained suprastructures. The samples were cultured using continuous anaerobic techniques. Five patients were found with both screw retained (S) and cemented (C) suprastructures. In these subjects the mean total cultivable counts were significantly higher in peri-implant samples from group C than in samples from group S. Furthermore, peri-implant samples of group S yielded a higher proportion of coccoid cells in the darkfield microscope and demonstrated absence of large spirochetes. From the 15 patients, Porphyromas gingivalis was detected in 10% of the periodontal samples and in only one peri-implant sample. Prevotella intermedia was detected in 33% of the periodontal and in 30% of the peri-implant samples. Fusobacterium spp. had a prevalence of 58% in the periodontal samples and was recovered from 50% of the peri-implant samples. Actinobacillus actinomycetemcomitans was not detected in any dental or peri-implant sample. In 1 case, however, the organism was recovered from the internal surface of the suprastructure. Linear regression analysis showed a significant relationship between the frequency of micro-organisms in peri-implant samples of group S and in samples from the inner surface of the suprastructure. Furthermore, there was a significant correlation between the incidence of micro-organisms in dental samples and i) in peri-implant samples of group S and ii) in samples from the internal suprastructure surface. These findings indicate, that the microbial leakage through the gap between the suprastructure and the abutment plays an important role in the bacterial colonization of the internal part of screw retained crowns and bridges. The study furthermore confirms the impact of the dental microflora on the microbial colonization of implants. This factor appears to be more important than the mode of fixation of the suprastructure.

The purpose of this study was to compare the tissue resistance to probing and the accuracy of depth determination at different force levels around implants and teeth. In 11 subjects 1 implant and 1 tooth at a comparable location and with comparable probing depth were investigated. The sites were located on either the mesial or distal aspect of the tooth and the implant. A probing device was used which allowed simultaneous monitoring of probing force and probe penetration and which standardized the insertion pathway for repeated measurements. The probing instrument was fitted with an attachment for an aiming device to take a radiograph with the probe tip in the sulcus, using a standardized projection geometry. Probing depth values were determined at 0.25, 0.50, 0.75, 1.00 and 1.25 N probing force. The standard error of the individual measurement (Si), evaluated by comparison of repeated measurements in the same session, was 0.2 mm on implants and 0.1 mm on teeth. For implants there was a trend for slightly better reproducibility at higher force levels. Curve analysis of depth force patterns showed that a change in probing force had more impact on the depth reading in the peri-implant than in the periodontal situation. The mean distance between the probe tip and the peri-implant bone crest amounted to 0.75 +/- 0.60 mm at 0.25 N probing force. It is concluded that peri-implant probing depth measurements are more sensitive to force variation than periodontal pocket probing.

Peri-implant infections are pathological conditions which are normally localized in the soft tissues surrounding an oral implant. They may range from a rather localized mucositis lesion reflecting the host response to a bacterial challenge to a more advanced lesion "termed peri-implantitis" when previously osseointegrated oral implants have been partially disintegrated; i.e. have lost alveolar bone around the implant. Usually these lesions start as a result of plaque accumulation and show similar progression as observed around teeth. Muscositis seems to be a prerequisite for the following peri-implantitis. However, the factors involving the transition to a more advanced lesion are still not known. Logically, the therapy for peri-implant infection has to be related to antibacterial treatment prior to the attempt to surgically regenerate peri-implant alveolar bone lost as a result of the infection. In order to diagnose these lesions at an early stage frequent assessments of clinical parameters are needed during maintenance therapy. The anti-infective treatment may intercept the development of the lesion. Following mechanical debridement of plaque deposits the application of efficacious antiseptics (chlorhexidine) is a necessity. Following this, antibiotics may cumulatively be applied to control the infection. Only a few longitudinal studies have documented the efficacy of such treatment regimens, and controls have generally not been available for ethical reasons. In regenerating the lost jaw bone only case reports are available today. Controlled animal studies will have to be performed to document the possibility of re-osseointegration and the factors influencing predictability.