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To evaluate clinical, radiographic, microbiologic, and biomechanical parameters related to bone remodeling around implants with external hexagon (EH) and Morse-taper (MT) connections.Twelve totally edentulous patients received four custom-made implants in the interforaminal region of the mandible. Two of those implants had the same macroscopic design, but different prosthetic connections. All patients received an immediate implant-supported prosthesis. Clinical parameters (periimplant probing pocket depth (PPD), modified gingival index (mGI), and mucosal thickness (MTh)) were evaluated at 12 months follow-up. The distance between the top of the implant and the first bone-to-implant contact (IT-FBIC) was evaluated on standardized digital peri-apical radiographs acquired at 1, 3, 6, and 12 months follow-up. Samples of the subgingival microbiota were collected 1, 3, and 6 months after implant loading and used for the quantification of Tanerella forsythia, Porphyromonas gingivalis, Aggragatibacter actinomycetemcomitans, Prevotella intermedia, and Fusobacterium nucleatum. Further, 36 computerized-tomography based finite element (FE) models were accomplished, simulating each patient under three loading conditions.The evaluated clinical parameters were equal for EH and MT implants. Mean IT-FBIC was significantly different between the tested connections (1.17 ± 0.44 mm for EH, and 0.17 ± 0.54 mm for MT, considering all evaluated time periods). No significant microbiological differences could be observed between tested connections. FE analysis showed a significantly higher peak of equivalent (EQV) strain (p = 0.005) for EH (mean 3,438.65 µε) compared to MT (mean 840.98 µε) connection.Radiographic periimplant bone loss depends on the implant connection type. MT connections showed less periimplant bone loss, compared to EH connections.

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

Bad breath (halitosis) is an important social complaint. In most cases (≥90%), the cause of halitosis can be found within the oral cavity. Under this circumstance, the term oral malodor applies. It affects both healthy and periodontally diseased individuals. Oral malodor is mainly caused by a microbial degradation of both sulfur-containing and nonsulfur-containing amino acids into volatile, bad-smelling gases. Anaerobic gram-negative bacteria, the same species that have been linked to periodontal diseases, are especially involved in this process, explaining why clinicians often associate oral malodor with periodontitis. Some volatile organic compounds render patients more susceptible to periodontitis and this supports the malodor-periodontitis link. This review investigates the interaction between oral malodor and periodontal diseases. Pro and con arguments regarding the mechanisms of halitosis and clinical implications will be presented. In general, however, the impact of tongue coatings has been found to be the dominant factor, besides gingivitis and periodontitis. The last part of this review discusses the treatment of bad breath, with different options. ispartof: Periodontology 2000 vol:71 issue:1 pages:213-227 ispartof: location:Denmark status: published

Introduction: Several surgical techniques and prosthetic devices have been developed in the last decades, aiming to improve aesthetic, hygienic and functional outcomes that may affect the peri-implant tissues, such as procedures of bone and soft tissue augmentation and the use of custom-made abutments of titanium and zirconium.Materials and methods: Three systematic reviews, based on randomized clinical trials and prospective studies covering the above reported topics were analysed, and the detected evidence was exposed to interactive experts' discussion during the group's and general assembly's meetings of the 4th EAO Consensus Conference. The results are reported using the following abbreviations: ST: short-term evidence, M-T: medium-term evidence; L-T: long-term evidence; LE: limited evidence.Results: Soft tissue augmentation procedures may be indicated for the increase of soft tissue thickness and keratinized tissue, the reduction of interproximal peri-implant bone loss, and the coverage of shallow peri-implant soft tissue recessions (S-T, LE), L-T is lacking. Guided bone regeneration approaches (GBR) showed efficacy when used for ridge reconstruction after the complete healing of the soft tissues (S-T & L-T), and the stability of the augmented bone may play a role in the maintenance of the soft tissue position and dimensions (LE). No significant differences were observed between titanium and zirconia abutments when evaluating probing pocket depth, bleeding on probing, marginal bone levels and mucosal recessions. Zirconia abutments were associated with more biological complications but demonstrated superiority in terms of achieving natural soft tissue colour (S-T).

To examine the existing evidence in identifying risk indicators in the etiology of peri-implantitis.A literature search was performed in MEDLINE via PubMed database of the US National Library of Medicine, for articles published until October 2014 using Medical Subject Heading search terms + free text terms and in different combinations.The microbiota associated with peri-implantitis is complex, demonstrating differences and similarities to the one seen at periodontitis sites. Plaque accumulation at dental implants triggers the inflammatory response leading to peri-implant mucositis/peri-implantitis. Individuals with a history of periodontal disease and smokers have an increased risk of developing peri-implantitis. There is some evidence to support the role of genetic polymorphism, diabetes, and excess cement as risk indicators for the development of peri-implantitis. There is also evidence to support that individuals on regular maintenance are less likely to develop peri-implantitis and that successful treatment of periodontitis prior to implant placement lowers the risk of peri-implantitis.Plaque accumulation at implants will result in the development of an inflammation at implants. A history of periodontal disease, smoking, excess cement, and lack of supportive therapy should be considered as risk indicators for the development of peri-implantitis.

Aim To give an overview of the workflow from examination to planning and execution, including possible errors and pitfalls, in order to justify the indications for guided surgery. Material and methods An electronic literature search of the PubMed database was performed with the intention of collecting relevant information on computer-supported implant planning and guided surgery. Results Currently, different computer-supported systems are available to optimize and facilitate implant surgery. The transfer of the implant planning (in a software program) to the operative field remains however the most difficult part. Guided implant surgery clearly reduces the inaccuracy, defined as the deviation between the planned and the final position of the implant in the mouth. It might be recommended for the following clinical indications: need for minimal invasive surgery, optimization of implant planning and positioning (i.e. aesthetic cases), and immediate restoration. Conclusions The digital technology rapidly evolves and new developments have resulted in further improvement of the accuracy. Future developments include the reduction of the number of steps needed from the preoperative examination of the patient to the actual execution of the guided surgery. The latter will become easier with the implementation of optical scans and 3D-printing.

To investigate dentist- as well as patient-centered outcomes of the implant-supported cone-anchored removable prosthesis in the edentulous maxilla over 5 years.Ten patients, edentulous in the maxilla, received six Ti implants after which they were delayed loaded through a cone-anchored removable prosthesis. Clinical parameters such as plaque and bleeding indices, PTV, implant success, marginal bone loss, device and prosthesis complications, and patient satisfaction (visual analogue scale) were collected at follow-up visits scheduled 1, 3, 6, 12, 24, 36, and 60 months postprosthesis delivery.After at least 5 years of follow-up (mean: 63.7 months), 53/59 implants were rated successful, while two of 59 failed and one implant was kept sleeping. Mean marginal bone loss from prosthesis delivery until 1, 3, and 5 years, respectively, was; 0.15 (SD: 0.87), 0.36 (SD: 1.07), and 0.60 mm (SD: 1.12). The mean Periotest® values at baseline and 5 years did not differ significantly. After 1 year, a significant improvement in patient satisfaction was recorded compared with the old denture, and this remained stable over the 5-year period.Cone-anchored removable dental prostheses retained by secondary splinted implants offer a safe alternative for patients with an edentulous maxilla in need of more comfort. Dentist- as well as patient-centered outcomes compete with reports using other prosthetic anchoring devices. Larger replica studies are encouraged to further validate this concept.

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

AIM: To assess the accuracy and patient-centered outcome of a novel guided surgery system for placing implants in an edentulous maxilla. MATERIAL AND METHODS: Fifteen consecutive patients with sufficient bone to place six implants in the maxilla were randomly assigned to the immediate loading (with delivery of the final prosthesis within 24 h) or the delayed loading treatment group. Accuracy was assessed by matching the planning CT with a postoperative CBCT. Patient-centered outcome measures were the Dutch version of the McGill Pain Questionnaire (MPQ-DLV), the health-related quality of life instrument (HRQOL), visual analog scales (VAS), the duration of the procedure, and the analgesic doses taken each day. RESULTS: A mean deviation was found at the entry point of 0.9 mm (range: 0.1-4.5, median 0.8) and of 1.2 mm (range: 0.2-4.9, median 1.1) at the apex, and an angular deviation of 2.7° (range: 0.0-6.6°, median 2.3) was observed. The mean vertical deviation was 0.5 mm (range: 0.0-3.2, median 0.4), and in a horizontal direction, this was 0.7 mm (range: 0.1-3.1, median 0.6). The mean deviation in mesio-distal direction was 0.5 mm (range: 0.0-2.3, median 0.4) and in bucco-lingual direction 0.5 mm ± 0.4 (range: 0.0-2.2, median 0.3). No statistical differences could be shown between treatment groups on pain response (MPQ-DLV), treatment perception (VAS), number or kind of pain killers, or for the HRQOLI instrument. CONCLUSION: The accuracy of a novel CT-based guide is comparable to the accuracy data of other systems. Within the limitations of this study, no difference could be found in patient-centered outcome variables after immediate or delayed loading. ispartof: Clinical Oral Implants Research vol:27 issue:4 pages:427-432 ispartof: location:Denmark status: published

FOCUSED QUESTION: What is the effect of a dentifrice (DF), a mouthwash (MW), tongue cleaning (TC), or any combination of these as adjunct to toothbrushing on intra-oral malodour and tongue coating as compared to toothbrushing alone in systemically healthy patients, when used for a minimum follow-up period of 2 weeks? MATERIAL AND METHODS: The MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE databases were searched up to August 2014. Measurements of Volatile Sulphur Compounds and organoleptic scores of oral malodour were selected as outcome variables. Data were extracted and a descriptive analysis was performed. RESULTS: Independent screening of 1054 unique papers resulted in 12 eligible clinical trials with a medium-term (≥2 weeks) duration. The majority of studies provided a significant reduction in oral malodour when evaluating products with an active ingredient (incorporated into a DF or a MW) used adjunctively to toothbrushing. The added value of tongue cleaning over a MW was evaluated in one study. CONCLUSION: Due to very limited evidence, the potential effect of a specifically formulated dentifrice, a mouthwash or a tongue scraper for treating oral malodour is, in general, unclear. For mouthwashes containing the active ingredients chlorhexidine + cetylpyridinium chloride + zinc (CHX + CPC + Zn) and zinc chloride + cetylpyridinium chloride (ZnCl + CPC) most evidence was available. The strength of a recommendation to use these products was graded to be 'weak'. ispartof: Journal of Clinical Periodontology vol:42 issue:S16 pages:S303-S316 ispartof: location:SPAIN status: published

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

ispartof: Clinical Oral Implants Research vol:26 pages:III-IV ispartof: location:Denmark status: published

Background: From an ecological viewpoint, the oral cavity, in fact the oro-pharynx, is an 'open growth system'. It undergoes an uninterrupted introduction and removal of both microorganisms and nutrients. In order to survive within the oro-pharyngeal area, bacteria need to adhere either to the soft or hard tissues in order to resist shear forces. The fast turn-over of the oral lining epithelia (shedding 3 x/day) is an efficient defence mechanism as it prevents the accumulation of large masses of microorganisms. Teeth, dentures, or endosseous implants, however, providing non-shedding surfaces, allow the formation of thick biofilms. In general, the established biofilm maintains an equilibrium with the host. An uncontrolled accumulation and/or metabolism of bacteria on the hard surfaces forms, however, the primary cause of dental caries, gingivitis, periodontitis, peri-implantitis, and stomatitis. Objectives: This systematic review aimed to evaluate critically the impact of surface characteristics (free energy, roughness, chemistry) on the de novo biofilm formation, especially in the supragingival and to a lesser extent in the subgingival areas. Methods: An electronic Medline search (from 1966 until July 2005) was conducted applying the following search items: 'biofilm formation and dental/oral implants/surface characteristics', 'surface characteristics and implants', 'biofilm formation and oral', 'plaque/biofilm and roughness', 'plaque/biofilm and surface free energy', and 'plaque formation and implants'. Only clinical studies within the oro-pharyngeal area were included. Results: From a series of split-mouth studies, it could be concluded that both an increase in surface roughness above the R(a) threshold of 0.2 mum and/or of the surface-free energy facilitates biofilm formation on restorative materials. When both surface characteristics interact with each other, surface roughness was found to be predominant. The biofilm formation is also influenced by the type (chemical composition) of biomaterial or the type of coating. Direct comparisons in biofilm formation on different transmucosal implant surfaces are scars. Conclusions: Extrapolation of data from studies on different restorative materials seems to indicate that transmucosal implant surfaces with a higher surface roughness/surface free energy facilitate biofilm formation. To cite this article: Teughels W, Van Assche N, Sliepen I, Quirynen M. Effect of material characteristics and/or surface topography on biofilm development. Clin. Oral Imp. Res. 17 (Suppl. 2), 2006; 68-81. ispartof: Clinical oral implants research vol:17 issue:S2 pages:68-81 ispartof: location:SWITZERLAND, Pfaffikon status: published

Oral implants pierce through the mucosa thus establishing a connection between the oral environment and underlying tissues. The soft-tissue connection to the transmucosal part is of crucial importance as it relates to the stability of the peri-implant tissues and the prevention of peri-implant infection with subsequent destruction of the peri-implant structures. The adhesion of soft tissue to the material surface is one prerequisite for the longterm success. This adhesion is depending upon the topography and chemical composition of the implanted biomaterial. As regards to surface topography of implants we refer to the definitions proposed by Albrektsson & Wennerberg (2004a, 2004b), where minimally rough surface has been defined in the range of Sa 0.5–1 mm (e.g., turned implants), moderately rough Sa 1–2 mm (e.g., acid etched, sandblasted or anodized) and rough Sa 42mm (e.g., plasma sprayed).

OBJECTIVES: The beneficial effects of the one-stage, full-mouth disinfection remain controversial in the scientific literature. This might be due to the fact that an entire mouth disinfection with the use of antiseptics has been confused with a full-mouth scaling and root planing. This parallel, single blind RCT study aimed to compare several full-mouth treatment strategies with each other. MATERIAL AND METHODS: Seventy-one patients with moderate periodontitis were randomly allocated to one of the following treatment strategies: scaling and root planing, quadrant by quadrant, at two-week intervals (negative control, NC), full-mouth scaling and root planing within 2 consecutive days (FRP), or three one-stage, full-mouth disinfection (FM) protocols within 2 consecutive days applying antiseptics to all intra-oral niches for periopathogens using as antiseptics: chlorhexidine (FMCHX) for 2 months, amine fluoride/stannous fluoride for 2 months (FMF), or chlorhexidine for 2 months followed by amine fluoride/stannous fluoride for another 6 months (FMCHX+F). At baseline and after 2, 4, and 8 a series of periodontal parameters were recorded. RESULTS: All treatment strategies resulted in significant (p

AIM: To define the role of neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers in root canal disinfection along with a minimally invasive treatment concept. METHODOLOGY: The hypothesis was tested ex vivo that Nd:YAG laser irradiation has a bactericidal effect on endodontic pathogens inoculated in root canals. Resultant colony-forming unit counts were associated with observations of bacterial cell structural changes using conventional scanning electron microscopy (CSEM) and environmental scanning electron microscopy (ESEM) on inoculated dentine surfaces, following indirect and direct Nd:YAG laser irradiation, respectively. RESULTS: The Nd:YAG laser irradiation (1.5 W, 15 Hz, four times for 5 s) of Enterococcus faecalis inoculated canals resulted in a significant reduction (P < 0.05, Wilcoxon signed rank test) of the bacterial load, meaning a 99.7% kill, but no sterilization. The CSEM procedure verified that the extent of radiation damage was in line with the total amount of laser energy applied. After 2 h of incubation and three cycles of indirect laser treatment (i.e. through a 1-mm-thick dentine disc), no morphologically intact bacteria of Actinomyces naeslundii or Streptococcus anginosus were discernible. However, when micro-colonies of S. anginosus and specially biofilms of E. faecalis were present after 2 days, the in situ experiment using ESEM and direct laser treatment showed that bacterial eradication was reduced in deep layers. CONCLUSIONS: The Nd:YAG laser irradiation is not an alternative but a possible supplement to existing protocols for canal disinfection as the properties of laser light may allow a bactericidal effect beyond 1 mm of dentine. Endodontic pathogens that grow as biofilms, however, are difficult to eradicate even upon direct laser exposure. ispartof: International endodontic journal vol:39 issue:7 pages:547-57 ispartof: location:England status: published

Background: Periodontitis and peri-implantitis are linked to the presence of several key pathogens. The treatment of these infectious processes therefore involves the reduction/eradication of bacteria associated with periodontitis. Methods: This prospective, split-mouth, single-blind study followed the colonization of ‘pristine’ sulci created in 42 partially edentulous patients during implant surgery (e.g. abutment connection). The hypothesis was that the composition of the maturing subgingival plaque in these ‘fresh’ peri-implant pockets would soon (within 2 weeks) be comparable to the subgingival microbiota of teeth with similar clinical parameters (reference sites), including the presence of bacteria associated with periodontitis. Per patient, four subgingival plaque samples were taken from shallow and medium pockets around implants (test sites), and teeth within the same quadrant (undisturbed microbiota as control sites), 1, 2, 4, 13, 26 and 78 weeks after abutment connection, respectively. The samples were analysed by either checkerboard DNA–DNA hybridization, or cultural techniques, or real-time polymerase chain reaction (PCR) for intra-subject comparisons (teeth vs. implant, for comparable probing depths). Results: Checkerboard DNA–DNA hybridization and real-time PCR revealed a complex microbiota (including several pathogenic species) in the peri-implant pockets within 2 weeks after abutment connection. After 7 days, the detection frequency for most species (including the bacteria associated with periodontitis) was already nearly identical in samples from the fresh peri-implant pockets (5% and 20% of the microbiota belonging to red and orange complex, respectively) when compared with samples from the reference teeth. Afterwards (e.g. between weeks 2 and 13), the number of bacteria in peri-implant pockets only slightly increased (±0.1 log value), with minor changes in the relative proportions of bacteria associated with periodontitis (8% and 33% of the microbiota belonging to red and orange complex, respectively). Although small differences were seen between teeth and implants at week 2 with cultural techniques, a striking similarity in subgingival microbiota was found with this technique from month 3 on, with nearly identical detection frequencies for bacteria associated with periodontitis for both abutment types. Conclusions: This study indicates that the initial colonization of peri-implant pockets with bacteria associated with periodontitis occurs within 2 weeks.

BACKGROUND/AIMS: The development of an electro-transformation system and the construction of shuttle plasmids for Actinobacillus actinomycetemcomitans have enhanced the molecular analysis of virulence factors. However, inefficient transformation is frequently encountered. This study investigated the efficiency of electro-transformation and expression of Green Fluorescent Protein (GFP) in 12 different A. actinomycetemcomitans strains. The influence of the plasmid vector, serotype, and phenotype were the major factors taken into consideration. MATERIAL AND METHODS: Twelve serotyped A. actinomycetemcomitans strains were independently electro-transformed with two different Escherichia coli-A. actinomycetemcomitans shuttle plasmids (pVT1303 and pVT1304), both containing an identical ltx-GFPmut2 gene construct but a different backbone (pDMG4 and pPK1, respectively). The transformation efficiency, transformation frequency, and electro-transformation survival rate were determined by culture techniques. GFP expression was observed at the colony level by fluorescence microscopy. RESULTS: All strains could be transformed with both plasmids. However, major differences were observed for the transformation efficiency, transformation frequency, and electro-transformation survival rate between strains. The data demonstrated that plasmid vector, serotype, and phenotype are key players for obtaining a successful transformation. An inverted relationship between the electro-transformation survival rate and tranformation frequency was also observed. GFP expression was also influenced by phenotype, serotype and plasmid vector. CONCLUSIONS: The serotype of A. actinomycetemcomitans has an important influence on its survival after electro-transformation and on transformation frequency. The expression of GFP is strain and plasmid vector dependent. ispartof: Oral microbiology and immunology vol:20 issue:5 pages:274-81 ispartof: location:Denmark status: published

Background: Recent case reports introduced the term retrograde peri-implantitis as a lesion (radiolucency) around the most apical part of an osseointegrated implant. It develops within the first months after insertion. This retrospective study aimed to find predisposing conditions for such peri-apical lesions and to evaluate treatment strategies. Methods: All single implants (426 in the upper, 113 in the lower jaw, all Branemark system® type) placed at the department of Periodontology of the University Hospital (Catholic University Leuven) were included in this retrospective evaluation to check the incidence of retrograde peri-implantitis. Eventual predisposing factors such as patient characteristics (age, medical history), recipient site (local bone quality and quantity, cause of tooth loss), periodontal and endodontic conditions of neighboring teeth, implant characteristics (length, surface characteristics), and surgical aspects (guided bone regeneration, osseous fenestration, or dehiscency) were considered. Moreover, implants with retrograde peri-implantitis were followed longitudinally to verify their treatment outcome by means of different parameters (Periotest® values (PTV), marginal bone level, radiological size of peri-apical defect). Results: Seven implants in the upper (1.6%) and 3 in the lower jaw (2.7%) showed retrograde peri-implantitis, before or at abutment connection. In comparison with successful implants, such peri-apical lesions occurred preferably at sites with a history of an obvious endodontic pathology of the extracted tooth to be replaced. The incidence of retrograde peri-implantitis was significantly higher (P

The treatment of periodontitis/peri-implantitis involves the reduction/eradication of periopathogens. After therapy, beneficial and pathogenic species recolonize the subgingival area. The dynamics of recolonization and especially the role of the supragingival environment in this process are still not well-understood. This prospective, split-mouth study followed the early colonization of 'pristine' pockets created during implant surgery (16 partially edentulous patients), to record the time needed before a complex subgingival flora could be established with the supragingival area as the single source. Four subgingival plaque samples were taken from shallow and medium pockets around implants (test), and neighboring teeth (undisturbed microbiota as reference) 1, 2, and 4 wks after abutment connection. Checkerboard DNA-DNA hybridization and culture data revealed a complex microbiota (including several pathogenic species) in the pristine pockets within a wk, with a minimal increase in counts up to 4 wks. Analysis of these data demonstrated that, even with the supragingival environment as the single source for colonizing bacteria, a complex subgingival microbiota can develop within 1 wk. ispartof: Journal of Dental Research vol:84 issue:4 pages:340-4 ispartof: location:United States status: published

Background: Chlorhexidine (CHX) mouth rinse/spray can still be considered the gold standard in the chemical prevention of plaque formation and development of gingivitis. The product unfortunately has some side effects, such as extrinsic tooth staining, poor taste, taste disturbance, sensitivity changes in tongue, pain and irritation because of the alcohol content. These side effects led to the search of new formulations. Methods: In this double-blind, randomized, long-term, parallel study, 48 moderate periodontitis patients rinsed for 6 months (starting immediately after a “one-stage, full-mouth” disinfection) with one of the following products: CHX 0.2%+alcohol (Corsodyl®), CHX 0.05%+ cetyl pyridinium chloride (CPC) 0.05% and no alcohol (Perio-Aid Maintenance®, a new formulation), or the placebo of the latter. After 1, 3 and 6 months a series of clinical and microbiological parameters were recorded for the supra- and subgingival area as well as for saliva. Results: Although there was a significant treatment impact (mechanical debridement) in all groups, both CHX solutions further decreased both plaque and gingivitis indices (p

The safety, efficacy and acceptability of an oscillating/rotating powered toothbrush was assessed in patients rehabilitated with fixed prostheses on implants. One hundred consecutive patients (aged 18-80; mean 56.3; 51 females), who met the inclusion/exclusion criteria and who participated in a regular annual recall scheme, were enrolled. They were instructed on how to use the powered toothbrush, as well as on classical interdental plaque control. The electric toothbrush had to be used twice daily for 2 min. The following periodontal parameters were measured at baseline and at 3 months, 6 months and 12 months: presence/absence of gingival and/or mucosal ulceration/desquamation; sulcus bleeding index; probing pocket depth; periodontal pocket-bleeding index and gingival recession. At 3 months and at the end of the study, patients completed a questionnaire concerning the overall acceptability and convenience of the powered toothbrush, as compared with their habitual manual toothbrush. A total of 80 patients completed the study. No dropouts were related to the use of the powered toothbrush. All parameters improved over the course of the study. The mean overall pocket depth decreased from 3.3 mm at baseline to 3.0 mm at 12 months, while the mean decrease in recession was 0.1 mm at 12 months. During the 1-year observation, there was a slight gain in periodontal attachment level. Gingival ulcerations were not observed at any point in the study. High scores for convenience and comfort of the powered toothbrush were reported, and the majority (95%) said that they would continue to use it for habitual oral hygiene. It is concluded that the powered toothbrush investigated is effective, safe and comfortable for patients rehabilitated by means of oral implant-supported prostheses. ispartof: Clinical oral investigations vol:8 issue:4 pages:206-10 ispartof: location:Germany status: published

Although a two-stage procedure with symphyseal oral implants can lead to a long-term (15 years) 99% cumulative survival rate, a one-stage approach with immediate loading via prefabricated elements seems to offer a short-term acceptable outcome with significantly lower costs. A series of 50 consecutive patients, not eliminated for any systemic or smoking condition, received at the department of periodontology three implants in the symphyseal area, connected by a very rigid horse shoe-shaped titanium bar. A final screw retained prosthetic framework was placed on top of it at the department of prosthetic dentistry within 2 days after surgery (44) or after a delay, due to purely external factors, of up to 10 days (6). Forty-five patients were followed for 1 year. In one patient, all three implants failed and another four patients were lost to follow-up. The cumulative failure rates for implants and prostheses at 1 year were, respectively, 7.3% and 5%. The mean marginal bone loss at 1 year was 1.08 mm (SD: 1.62; range −5.68 to +2.55). This study shows that stable marginal bone levels can be maintained around immediately loaded implants in the lower jaw in an average patient population for at least 1 year. The survival rate is, however, lower than for a staged approach.

Background: The anterior mandible is generally considered a rather safe surgical area, involving few risks of damage to vital anatomic structures. Nevertheless, both neurosensory disturbances and hemorrhages have been reported after implant surgery in that particular area. Purpose: With the increasing demand for oral implant placement, the anatomy of the anterior mandible should receive more attention. This review will focus on the anatomic peculiarities of the anterior mandible and the related clinical implications. Methods: The scientific evidence on the anatomic, histologic, physiologic, and clinical aspects of the neurovascularization of the anterior mandible will be reviewed. Results: Surgical complications may be attributed to the existence of a mandibular incisive canal with a true neurovascular supply. Potential risks may also be related to the presence of the lingual foramen and anatomic variations, such as an anterior looping of the mental nerve. Conclusions: Preoperative radiographic planning for oral implant placement in the anterior mandible should therefore not only consider all esthetic and functional demands but should also pay particular attention to the anatomic peculiarities of this region to avoid any neurovascular complications.

Adhesion of bacteria to epithelial cells might be influenced by the degree of cell differentiation, as observed in the multi-layering process of epithelial cells. In the present study, the adhesion of a large group of clinical Porphyromonas gingivalis strains (n=11) to in vitro cultured mono- and multi-layers of epithelial cells was examined and compared. The tissue samples originated from 6 patients with chronic adult periodontitis. Porphyromonas gingivalis bacteria adhered more to mono-layers as opposed to the more differentiated multi-layers. Differences between the clinical P. gingivalis strains, however, became obvious only on multi-layers. These partially differentiated cells may also better represent the individual subject variations. Mono-layer cultures, which are simpler to obtain, seem to be less precise. The importance of cell differentiation on bacterial adhesion needs more attention.

Antibiotics have played a major role in the improvement of life expectancy in the last 50 years and have led many to believe that bacterial infections were about to vanish as a disease entity of any importance. Emerging problems resulting from a widespread use of antibiotics have modified the general perception of the capabilities of antimicrobial agents. Over the years, bacteria have become increasingly resistant to formerly potent antimicrobial agents, including some antiseptics. The use of antimicrobials may also disturb the delicate ecological equilibrium of the body, allowing the proliferation of resistant bacteria or non-bacterial micro-organisms. This shift may initiate new infections that are worse than the ones originally treated. No antimicrobial drug is absolutely non-toxic and the use of an agent carries accompanying risks. This paper discusses the development and occurrence of antimicrobial resistance in the subgingival flora towards antiseptics and local or systemic antibiotics and is focussed on the question: how can the outcome of periodontal therapy with/without antimicrobials be improved?

This study aimed to analyse variations in the mandibular interforaminal morphology in an attempt to identify potential risks or contraindications for surgery, especially implant installation, in this particular region. A total of 210 spiral computer tomography (CT) examinations of patients requiring endosseous implant installation in the lower jaw were re-evaluated to explore anatomical variations in bone morphology (shape and contour), and to measure parameters concerning height, width and inclination of the bone in the symphyseal atrea. All measurements were performed on the cross-sectional reformatted images mesial to the mental foramina. A lingual concavity (with a depth of 6 +/- 2.6 mm) was observed in 2.4% of the jaws, with a remaining bone height in that area ranging from 4.2 to 11.9 mm. A clearly lingual tilted/inclined morphology was seen in 28.1% of jaws with a mean angle of 67.6 +/- 6.5 degrees, but a relatively constant width (> 8.8 mm). The remaining jaws (69.5%) showed a slight broadening in the caudal direction. The morphologic parameters were influenced neither by age nor by gender. In conclusion, mandibles with a lingual concavity or a severe slope of the lingual cortex might confer increased risks of lingual perforations during trepanation surgery or graft harvesting as well as fenestrations during implant installation. The detection frequency of such variations within the lower jaw seems to advocate a profound dissection of the lingual site and, in the case of some special treatment strategies, additional cross-sectional radiography.

It has already been shown that occlusive titanium barriers have osteoconductive properties. These barriers, however, cover only a limited surface area and have only been used in animal experiments. The aim of this study was to evaluate bone neogenesis under a pre-shaped titanium barrier placed over the top of the rabbit skull and the top of highly resorbed edentulous upper-jaw bone in patients. Computed tomography (CT) scans made it possible to pre-shape the titanium barrier according to individual bone shape in human experiments. On the rabbit skull, tissue augmentation of up to 6 mm 1 year after barrier placement was observed, while the original thickness of skull bone was on average between 1.5 and 2.5 mm. The bone, which remained histologically immature for 1 year, grew systematically along the titanium surface, illustrating its osteoconductivity. Even after removal of the barrier, on average, 75.3 and 59.4% of the newly created tissue volume was maintained after 3 and 9 months, respectively. Clinical observations on 10 consecutive patients showed that, in those (5/10) in which the barrier remained unexposed for several months, an increase of the jawbone height and width of up to 16 mm could be observed when the barrier was removed after 12-18 months. As in the rabbits at barrier removal, the bone demonstrated a limited degree of mineralization as ascertained from biopsies. This newly formed osteoid tissue allowed the insertion of 33 screw-shaped titanium implants which in most cases (30/33) successfully osseointegrated to support a fixed prosthesis. The surrounding marginal bone level remained stable even up to 5 years after implant placement. Both animal and clinical data demonstrate that guided bone neogenesis under a subperiosteally placed titanium barrier can reach large volumes.

Contexte: La fente labio-palatine complete unilateral (UCLP) est une malformation hereditaire ou multifactorielle qui peut etre corrigee avec succes par un traitement combine d'orthodontie, de chirurgie etde dentisterie restauratrice. Une telle approche multidisciplinaire dure de longues annees et reclame beaucoup de precautions vis a vis des dents et du parodonte du patient. Objectifs: Cette etude en bouche divisee avait pour but de comparer la sante parodontale et les parametres microbiologiques entre les regions des fentes et les autres. Materiel et methodes: 75 patients (52 hommes, 23 femmes) âges de 8 a 20 ans, et presentant une fente labio-palatine unilaterale complete (avant (n = 30), pendant (n = 34) et apres (n=11) le traitement orthodontique actif) se sont portes volontaires pour cette etude. Quatre regions ont ete determinees pour la comparaison en bouche divisee: les dents au voisinage de la fente (site 1), la dent dans la fente (site 2), et les dents contra-laterales correspondantes, respectivement, dans les quadrants non atteints (sites 3 et 4). Sur chaque site, les parametres parodontaux suivants ont ete releves: indices de plaque et de gingivite, profondeur de poche et perte d'attache, saignement au sondage, mobilite dentaire, (determinee a la vue et au Periotest), la perte osseuse radiographique et l'epaisseur de la gencive. En outre, trois echantillons de plaque sous gingivale groupes furent preleves (autour de la dent de la fente, sur les dents regardant la fente et sur les dents contra-laterales de cette derniere). Resultats: Les differences entre les dents voisines de la fente et les dents contra-laterales correspondantes etaient a la limite de la signification statistique (P≤0.05) pour l'indice de plaque, les profondeurs au sondage proximales et la perte d'attache (Les dents en regard de la fente ayant toujours des valeurs des parametres legerement plus forte). Lorsque la dent dans la fente etait comparee a la dent contra-laterale, les differences ne se rencontraient plus que pour les profondeurs de poches au sondage proximales, la perte d'attache et la perte osseuse, qui etaient significativement plus importantes pour la dent de la fente. L'analyse microbiologique ne revele aucune difference entre les differents sites, ni pour la proportion de bacteries aerobies et anaerobies (differences

The aim of the present study was to assess the influence of endogenous and local factors on the occurrence of implant failure up to the abutment stage. The study comprised a group of 399 consecutive patients, which represented the total of patients who had been treated from 1995 to 1997 (with a total of 1263 Branemark Bran-system implants) at the Department of Periodontology of the University Hospital, Catholic University Leuven. For each patient, the medical history was carefully examined. Data collection and analysis were mainly focused on endogenous factors such as hypertension, osteoporosis, hypo- or hyperthyroid function, chemotherapy, diabetes type I or II, Crohn's disease, some local factors (e.g. bone quality, reason for tooth loss) and breach of sterility during surgery. The reason for tooth loss, smoking habits, radiotherapy and other local bone factors (bone quality and quantity) were also recorded. Implant failures were recorded up to the abutment connection. The present study indicated a success rate until this stage of 97.8%. General factors such as heavy smoking, chemotherapy plus poor bone quality increased implant failure rate. Radiotherapy, limited bone volume and claustrophobia, which led to breaching the strict preoperative rules of asepsis, appeared to be the most relevant local factors for early implant failures.

Objectives:Porphyromonas gingivalis, one of the key pathogens in the development of periodontitis, produces a number of virulence factors that might explain its pathogenicity. One of them is the ability to adhere and invade pocket epithelium. The aim of this study was to follow, over time, the association of P. gingivalis and consequent morphological changes of the pocket epithelium cells. Material and Methods: The association capacity of four P. gingivalis serotypes [K1, K2, K4, K- (nonencapsulated)] with in vitro cultured mono-layers from periodontal pocket epithelial cells of patients with periodontitis, was followed by fluorescence microscopy and bacterial culture. The contact time between bacteria and epithelium cells ranged from 45 min to 8 h. The microscopic evaluation allowed differentiation between dead and living cells (bacteria as well as epithelium) and description of the morphological changes after association. Results: A highly significant difference in the number of associating bacteria was found between dead and living epithelium cells, and between non-capsulated and capsulated strains. A significant increase in the proportion of dead pocket epithelium cells was found with prolonged association time. The morphological changes (rounding of the epithelial cell, detachment from the glass cover-slip and loss of intercellular contact) occurred faster for mono-layers inoculated with the non-encapsulated P. gingivalis strain. Conclusions: This study indicates that dead pocket epithelium cells harbor more P. gingivalis cells, and that a positive correlation exists between contact time and cell death. For the P. ginigvalis species, non-encapsulated strains associate in higher number. As a result, the damage they cause to the host cell seems to occur faster than occurs in encapsulated strains. As such, cell death can be seen as the end-result of bacterial association.

Background: Breath odour is a complaint encountered worldwide, often linked to microbial overload in the oral cavity. This double blind, crossover, randomised study assessed the efficacy of several antiseptic mouthrinses or slurry vs. a control solution in the prevention of morning bad breath during an experimental period of 7 days without mechanical plaque control. Methods: Sixteen dental students with a healthy periodontium abolished, after a thorough professional cleaning, all means of mechanical plaque control during five experimental periods of 7 days, interleaved by washout periods of at least 3 weeks. During each experimental period, as the only oral hygiene measure, the students rinsed twice a day with one of the following formulations (in a randomised order): a 0.2% chlorhexidine-alcohol mouthrinse (CHX-Alc), a 0.05% CHX + 0.05% cetylpyridinium chloride + 0.14% zinc lactate mouthrinse (CHX-CPC-Zn), an amine fluoride/stannous fluoride (125 ppm F–/125 ppm F–) containing mouthrinse (AmF/SnF2Mr), a slurry of a tooth paste (AmF/SnF2Sl) containing amine fluoride (350 ppm F–) and stannous fluoride (1050 ppm F–) and a placebo solution (placebo). At days 0, 3 and 7, morning breath was scored via VSC level measurements of the mouth air, and organoleptic ratings of the mouth air and tongue coating. At the same visits both the degree of gingival inflammation and the de novo plaque formation were rated. At the end of each period a questionnaire for subjective ratings was completed and microbiological samples were taken from the tongue dorsum, the saliva and the supragingival plaque for anaerobic and aerobic culturing. Results: Although oral hygiene during the experimental periods was limited to rinsing, bad breath parameters systematically improved (P

Background: As the use of oral implants for the treatment of partially as well as fully edentulous patients has increased the past two decades, more specialized radiographie techniques have become available for the preoperative planning of oral implant placement. Purpose: The goal of this article was to enable clinicians to select the appropriate imaging techniques when planning for oral implants. Materials and Methods: This article reviews the available literature about various imaging techniques and their indication for the preoperative planning of oral implants. The advantages and drawbacks of each technique are described. A dosimet-ric overview is given relative to different radiologie techniques used in various clinical situations. Results: For preoperative planning of implant placement, advantages and drawbacks of the available imaging techniques have been considered, which allows guidelines for image technique selection to be formulated based on the clinical situation provided, considering the diagnostic yield of each technique and the radiation doses involved. Conclusions: From the available literature, it can be stated that many clinical situations demand the use of cross-sectional imaging techniques for optimal preoperative planning of implant placement. Nevertheless, such techniques are not required in cases in which the clinical examination reveals sufficient bone width and where standard radiographie examinations, such as intraoral and panoramic radiography, reveal adequate bone height and space for implant placement.

The purpose of this study was to evaluate over time the marginal bone level changes around implants installed to treat partial edentulism and to investigate the possible effect of several confounding variables. Consecutive intraoral radiographs taken with the paralleling technique were used. In all, 660 partially edentulous patients ever treated in the departments (248 males; 15-83 years of age) with 1655 implants, which were successfully integrated at abutment connection, were loaded by means of fixed partial prostheses. The observation period starting at abutment connection reached 16 years (mean 5.1). Implants were divided into three groups: 235 implants supported single-tooth crowns, 398 supported implant-tooth connected and 1022 free-standing fixed partial prostheses. Implants were placed in maxilla and mandible, both anteriorly and posteriorly. No significant difference in bone level evolution was predicted between the three groups of implants, either for posterior or for anterior sites. The estimated marginal bone loss for the first 6 months is 0.31 mm/year and after that 0.015 mm/year higher in the maxilla than in the mandible. More bone loss was predicted for the first 6 months when dehiscences existed, when a membrane or a bone graft were used, or when metal/ceramic prosthesis material was applied. Age and gender did not affect the change in bone level. The use of subsequently situated single-implant crowns to restore an edentulous space did not lead to more marginal bone loss than around splinted implants. Based on marginal bone height maintenance, the excellent prognosis of the presently used implants to support restorations in the treatment of partial edentulism was confirmed.

The increased concern for accountability and quality improvement is inducing universities throughout Europe to evaluate and control performance. The establishment of criteria for educational quality, a requirement for a successful evaluation, was studied as part of an evaluation of the dental education programme at the Catholic University of Leuven. Criteria suggested by different groups (members of the internal evaluation commission including graduate and postgraduate students; members of the academic staff of the School of Dentistry, Oral Pathology and Maxillo-facial Surgery, and other members of the academic staff, not directly belonging to the school), were analysed by means of ANOVA with Scheffe posthoc tests to identify intergroup differences. It was hypothesized that a closer connection to the dental curriculum or a higher responsibility in the evaluation process would result in stricter criteria. For 108 different questions (in the form of statements with a six point Likert-type scale), members of the three groups had to indicate the score below which the quality would be considered suboptimal. Except for one question, no significant differences were found between ratings given by the members of the internal evaluation commission and other members of the School. Significant differences were found between non-school members and school- and/or commission-members. This study indicates that agreement on educational quality may be presupposed within an academic faculty and between members of the internal evaluation commission. However, the study also indicated that some caution should be exercised when 'external' teachers are included in the evaluation process.

Breath malodour, a significant social and/or psychological handicap, may be caused by several intra- and extraoral factors. Malodour of intraoral origin is the result of microbial putrefaction, during which volatile sulphur compounds (VSC) and other volatile compounds are produced. The treatment of oral malodour can therefore be focused on the reduction of the intraoral bacterial load and/or the conversion of VSC to nonvolatile substrates. This article outlines the efficacy and mechanisms of different antimalodour approaches. Most approaches were found to be inefficient and/or short lasting. The most successful treatment involves mechanical debridement (including toothbrushing, flossing, and tongue cleaning), possibly combined with the use of an antimicrobial mouthrinse.

The use of oral implants in the rehabilitation of partially and fully edentulous patients is widely accepted even though failures do occur. The chance for implants to integrate can for example be jeopardised by the intra-oral presence of bacteria and concomitant inflammatory reactions. The longevity of osseointegrated implants can be compromised by occlusal overload and/or plaque-induced peri-implantitis, depending on the implant geometry and surface characteristics. Animal studies, cross-sectional and longitudinal observations in man, as well as association studies indicate that peri-implantitis is characterised by a microbiota comparable to that of periodontitis (high proportion of anaerobic Gram-negative rods, motile organisms and spirochetes), but this does not necessarily prove a causal relationship. However, in order to prevent such a bacterial shift, the following measures can be considered: periodontal health in the remaining dentition (to prevent bacterial translocation), the avoidance of deepened peri-implant pockets, and the use of a relatively smooth abutment and implant surface. Finally, periodontitis enhancing factors such as smoking and poor oral hygiene also increase the risk for peri-implantitis. Whether the susceptibility for periodontitis is related to that for peri-implantitis may vary according to the implant type and especially its surface topography.

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

The aim of the present study was to describe nerve fibres around osseointegrated implants in humans.Twelve mechanically failed implants, retrieved from 10 patients were collected from three dental centres over a period of 5 years. After implant removal, decalcified semi-thin sections (0.5 μm) were stained with thionic methylene blue for light microscopic analysis. In addition, an ultrastructural analysis was performed on serial ultra-thin sections (0.06 μm) using transmission electron microscopy.Both myelinated and unmyelinated nerve fibres could be identified inside the Haversian canals of the osteonal bone near the implant threads. Myelinated fibres were also located at the woven bone around the implant. However, no differentiated nerve endings could be observed around the implants.This study shows the presence of nerve fibres in human peri-implant bone. Previous studies in animals showed that those fibres participate in the process of bone modelling and remodelling. Yet, the role of peri-implant bone innervation in the osseoperception phenomenon cannot be ruled out since the mechanism of mechanoreception in bone is not fully understood.

The predation of Bdellovibrio bacteriovorus on different periodontal pathogens has already been described. However, it is necessary to consider the polymicrobial nature of periodontal disease. The current study explores the predation of Bdellovibrio on oral pathogens organized in multispecies communities. The effect of the predator was evaluated on in vitro six species communities with microbial culturing. Additionally, the effect on ex vivo subgingival plaque and saliva samples from periodontitis patients was assessed. In the latter experiment results were examined with microbial culturing, quantitative polymerase chain reaction (qPCR) and denaturing gradient gel electrophoresis (DGGE). The latter technique was used to get an overview of the whole mixed microbial population. Results showed that even in more complex models, B. bacteriovorus was still able to predate on F. nucleatum and A. actinomycetemcomitans. However predation on P. intermedia and P. gingivalis could not be validated in multispecies models. The effect of Bdellovibrio was not restricted to the target bacteria. Changes in the overall ecology of the different models were evident. It could be concluded that the efficiency of predation decreased when complexity of the models increased. However, B. bacteriovorus was able to attack two important oral pathogens, F. nucleatum, and A. actinomycetemcomitans, even when present in ex vivo clinical samples. These effects still have to be validated in in vivo models to see the impact of Bdellovibrio on the whole bacterial ecology. publisher: Elsevier articletitle: Effect of Bdellovibrio bacteriovorus HD100 on multispecies oral communities journaltitle: Anaerobe articlelink: http://dx.doi.org/10.1016/j.anaerobe.2014.09.011 content_type: article copyright: Copyright © 2014 Elsevier Ltd. All rights reserved. ispartof: Anaerobe vol:35 issue:Pt A pages:45-53 ispartof: location:England status: published

Osteoporosis is a disease affecting more than 300 million people worldwide and is responsible for numerous medical complications. This study aimed to investigate the relation between skeletal and maxillary bone density.Seventy-three patients were recruited and divided between group A (osteoporosis), group B (healthy, control), and group C (osteopenia) on the basis of a dual-energy x-ray absorptiomery (DXA) scan. These patients also received a CT scan on which bone density measurements were performed at five sites: maxilla midline, retromolar tuberosities, incisor, premolars, and molar regions.The bone density was lower in osteoporotic patients compared with the control patients. The bone mineral density (BMD) of the tuberosities showed the strongest correlations with the BMD of the hip and the spine (respectively, r = 0.50 and r = 0.61). The midline region showed moderate correlations with the hip (r = 0.47) and the spine (r = 0.46). For potential implant sites, the correlations with the BMD of the hip and spine were, however, small to insignificant. Based on measurements of bone density of the maxilla, it was possible to predict if the patient was osteoporotic or not with a sensitivity of 65% and a specificity of 83%.The maxillary bone density of subjects with osteoporosis is significantly lower than that of healthy patients. Moreover, there is a direct correlation between the density of the skeleton and the density of some sites of the maxilla. Using measurements of maxillary bone density in order to predict skeletal bone density might be a useful tool for the screening of osteoporosis.

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

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