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Background: The aim of this study was to analyze the correlation between the dental plaque indices measured using quantitative light-induced fluorescence-digital (QLF-D) and conventional clinical indices that assess gingival status., Methods: From among the patients who visited Ewha Womans University Mokdong Hospital, 33 adults in their 20s who had relatively even teeth were selected for full-mouth QLF-D imaging. The images were used to analyze the QLF-D score and the QLF-D ΔR score. As clinical indices, the gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and patient hygiene performance (PHP) index were measured. The correlations between the QLF-D score and QLF-D ΔR score and each clinical index were analyzed. Analyses were performed comparing the indices of maxillary and mandibular teeth, the teeth on right and left sides of the mouth, anterior and posterior teeth, and buccal and lingual surfaces of each tooth. Pearson's correlation analysis was conducted (p < 0.05)., Results: The mean full-mouth QLF-D score was highly correlated with the GI, BOP, PPD, PHP index (p < 0.01). The mean full-mouth QLF-D score showed the highest correlation with GI (r = 0.749) and the lowest correlation with PPD (r = 0.683). The correlations between the QLF-D score were higher in the mandible than in the maxilla and in the anterior teeth than in the posterior teeth, while no significant differences were seen between the buccal and lingual surfaces of tooth., Conclusions: This study concluded that the correlations between the plaque indices measured for each tooth surface area using QLF-D and the clinical indices assessed were significantly high, and it allowed objective determination of the gingival status. Therefore, the plaque index measured using QLF-D may be used as an alternative to supplement the shortcomings of conventional clinical indices for educating patients about plaque control and continued patient oral care.

The aim of this randomized-controlled, single-blinded study was to compare the effects of mechanical tooth cleaning (MTC) and ultrasonic debridement (UD) on oral hygiene status in healthy young adults. Thirty-seven participants (mean age: 20.3±0.62 years) were divided into 3 groups after pre-examination: group A, receiving MTC; B, receiving MTC+UD using a universal insert (UDUI); and C, receiving MTC+UD using a probe-shaped insert (UDPI). All participants were required to abstain from oral hygiene for 24 hours after the allocated intervention, after which they were examined. A masked examiner determined the Quigley-Hein plaque index (PlI) and Silness and Löe gingival index (GI) scores before the interventions and after 24 hours of non-brushing. A significant increase in the PlI score was observed in group A (p<0.001) in comparison with that in group B (A: 0.311±0.26; B: -0.01±0.33; C: 0.13±0.27; p<0.05). A significant decrease in the GI score was observed in groups B and C (p<0.05), and the change in this score in group C significantly differed from that in group A or B (A: -0.04±0.25; B: -0.13±0.17; C: -0.33±0.2; p<0.05). Only MTC was insufficient to prevent plaque formation over a 24-hour period of non-brushing and decrease the GI score. Ultrasonic debridement was more effective in preventing plaque formation and decreasing the GI score, regardless of the type of insert used. The present results suggest that UD should be included as an important procedure in the provision of professional oral prophylaxis and that UDPI is as efficient for cleaning as UDUI.

Unlabelled: Periodontal disease ranges from gingival inflammation (gingivitis) to the inflammation and loss of tooth-supporting tissues (periodontitis). Previous research has focused mainly on subgingival plaque, but supragingival plaque composition is also known to be associated with disease. Quantitative modeling of bacterial abundances across the natural range of periodontal severities can distinguish which features of disease are associated with particular changes in composition. We assessed a cross-sectional cohort of 962 Malawian women for periodontal disease and used 16S rRNA gene amplicon sequencing (V5 to V7 region) to characterize the bacterial compositions of supragingival plaque samples. Associations between bacterial relative abundances and gingivitis/periodontitis were investigated by using negative binomial models, adjusting for epidemiological factors. We also examined bacterial cooccurrence networks to assess community structure. The main differences in supragingival plaque compositions were associated more with gingivitis than periodontitis, including higher bacterial diversity and a greater abundance of particular species. However, even after controlling for gingivitis, the presence of subgingival periodontitis was associated with an altered supragingival plaque. A small number of species were associated with periodontitis but not gingivitis, including members of Prevotella, Treponema, and Selenomonas, supporting a more complex disease model than a linear progression following gingivitis. Cooccurrence networks of periodontitis-associated taxa clustered according to periodontitis across all gingivitis severities. Species including Filifactor alocis and Fusobacterium nucleatum were central to this network, which supports their role in the coaggregation of periodontal biofilms during disease progression. Our findings confirm that periodontitis cannot be considered simply an advanced stage of gingivitis even when only considering supragingival plaque., Importance: Periodontal disease is a major public health problem associated with oral bacteria. While earlier studies focused on a small number of periodontal pathogens, it is now accepted that the whole bacterial community may be important. However, previous high-throughput marker gene sequencing studies of supragingival plaque have largely focused on high-income populations with good oral hygiene without including a range of periodontal disease severities. Our study includes a large number of low-income participants with poor oral hygiene and a wide range of severities, and we were therefore able to quantitatively model bacterial abundances as functions of both gingivitis and periodontitis. A signal associated with periodontitis remains after controlling for gingivitis severity, which supports the concept that, even when only considering supragingival plaque, periodontitis is not simply an advanced stage of gingivitis. This suggests the future possibility of diagnosing periodontitis based on bacterial occurrences in supragingival plaque., (Copyright © 2016 Shaw et al.)

The aim of this study was to investigate the effect of a daily intake of probiotic lactobacilli on the prevalence and counts of oral Candida in frail elderly patients living in nursing homes. The study had a double-blind randomized placebo-controlled design with 2 parallel arms. The study group consisted of 215 older adults (range, 60 to 102 y) who were enrolled after informed consent. After baseline examination and randomization, the subjects were given 1 lozenge containing 2 strains of the probiotic bacterium Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) or placebo twice daily (morning and evening). The intervention period was 12 wk, and saliva and plaque samples were collected at baseline and follow-up. The primary end point was prevalence of high Candida counts assessed from chairside tests. Secondary end points were levels of dental plaque and gingival inflammation. The groups were balanced at baseline. The attrition rate to follow-up was 19%. There was a statistically significant reduction in the prevalence of high Candida counts in the probiotic group but not in the placebo group, and the difference was statistically significant in both saliva and plaque (P < 0.05). No significant differences between the groups were noted concerning the levels of supragingival plaque or bleeding on probing. Thus, daily use of probiotic lozenges may reduce the prevalence of high oral Candida counts in frail elderly nursing homes residents (ClinicalTrials.gov NCT02391532)., (© International & American Associations for Dental Research.)

Objective: The main aim of this study was to develop a simplified quantitative denture plaque index that could help dentists to motivate denture patients to maintain optimal oral hygiene. The secondary aim was to assess specific areas of dentures more prone to accumulate plaque and subjects' oral hygiene habits related to their dentures., Methods: One hundred subjects who wore maxillary and/or mandibular complete dentures for at least one year were included in the study as a powered sample. Fifteen females and 85 males, age range 45-75 years, were recruited. The study was carried out at King Saud University (KSU), College of Dentistry. A plaque disclosing solution was used to assess the plaque covered areas of denture. A quantitative percentage (10 x 10%) score index was developed by assessing plaque scores from digital images of intaglio surfaces of the dentures. The weighted kappa method was used to assess inter-examiner agreement in the main study., Results: The new denture plaque index was identified as ASKD-DPI (Almas, Salameh, Kutkut, and Doubali-Denture Plaque Index). It ranged from 0 - 100%, and reflected the percentage of the intaglio surfaces of maxillary and mandibular complete dentures that contained plaque. It also classified quantitative percentages: 30 subjects ranged from 0 - 30% (low DPI), 50 subjects ranged from 31 - 70% (moderate DPI), and 20 subjects ranged from 71 - 100% (high DPI) denture plaque score., Conclusions: A simplified denture plaque index (ASKD-DPI) technique was developed and tested in this study. ASKD-DPI may be used for evaluating denture plaque scores, monitoring denture hygiene, and measuring compliance of patients regarding plaque control for complete dentures.

Aim: To develop a socio-dental impact locus of control scale (SILOC) and to study its relationship with oral health status as well as dental attendance., Study Design: Observational cross-sectional study design., Method: A seven-item SILOC scale based on locus of control and the WHO international classification of diseases' criteria for "Disability" in relation to oral health was developed. In the pilot study, 100 adolescent school children returned completed forms containing the multidimensional health locus of control (MHLC) and the (SILOC) scale. After confirmation of reliability and validity, 509 adolescent school children returned completed SILOC questionnaires and were examined for caries, plaque and gingivitis. A history of postponement of needed dental treatment was also elicited., Results: The SILOC scores were highly correlated with the MHLC scores. Factor analysis revealed a two-factor solution accounting for 59 % of the variance. A Cronbach's alpha of 0.75 showed its internal consistency. Those with higher SILOC scores had greater levels of caries, plaque, gingivitis, and a history of postponing needed dental visits. Multiple logistic regression analysis after adjusting for potential confounders showed that those with high SILOC scores were more likely to have caries (OR = 3.32, p < 0.001), plaque (OR = 1.83, p = 0.026), gingivitis (OR = 1.80, p = 0.012) and a history of 'Postponement of needed dental treatment' (OR = 4.5, p < 0.001) as compared with the others., Conclusions: The SILOC scale showed satisfactory reliability and validity in measuring locus of control orientation in an Indian adolescent population.

Research has demonstrated the validation of specific caries risk assessment (CRA) systems, but little is known about how dental practitioners assign a caries risk level to their patients. The aim of this study was to explore dental students' decision making in caries risk assignment when using the Caries Management By Risk Assessment (CAMBRA) system. Multiple correspondence analysis and chi-squared automated interaction detector analysis were performed on data collected retrospectively for a period of six years (2003-09) at the University of California, San Francisco predoctoral dental clinic. The study population consisted of 12,952 patients from six years of age through adult who received a baseline CRA during the period, were new to CAMBRA, and had not received any prior CAMBRA recommendations. The results showed variation in decision making and risk level assignment, illustrated by the range of percentages for the three scores (low, moderate, and high/extreme caries risk) when CRA was assigned for the first time. For those first-time CRAs, decision making was mainly based on four factors: cavities or caries lesions into dentin on radiograph, restorations during the last three years due to caries, visible heavy plaque, and interproximal lesions into enamel (by radiographs). This study's findings provide important data regarding one group of CAMBRA users and thus contribute to the development of knowledge about the implementation of caries risk assessment in contemporary dental practice.

Aim: To assess, in a randomized study, the implant (clinical and radiological) and patient outcomes of guided implant placement at 1-year follow-up, compared to conventional implant treatment., Material and Methods: A total of 314 were placed in 59 patients, randomly assigned to one of the treatment groups. Radiographic and clinical parameters were recorded at the time of implant placement, prosthesis instalment (baseline) and at 1-year follow-up. Patient satisfaction was measured with the oral health-related quality of life instrument (OHIP-49)., Results: No implants were lost. The mean marginal bone loss after the first year of loading was 0.04 mm (SD 0.34) for the guided surgery and 0.01 mm (SD 0.38) for the control groups. In the guided surgery groups, the mean number of surfaces with BOP and plaque at 1-year follow-up was 1.41 (SD 1.25) and 1.10 (SD 1.22), for the control groups this was, respectively, 1.37 (SD 1.25) and 1.77 (SD 1.64). The mean pocket probing depth was 2.81 mm (SD 1.1) for the guided, and 2.50 mm (SD 0.94) for the control groups. For all treatment groups, a significant improvement in quality of life was observed at 1-year follow-up (p ≤ 0.01), no differences between groups were observed., Conclusion: Within the limitations of this study, no difference could be found at 1-year follow-up between the implant and patient outcome variables of guided or conventional implant treatment., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Stress has an adverse effect on oral health and is a risk factor for plaque-associated diseases. The present study aims to assess the effect of academic stress on plaque and gingival health among dental students of Moradabad, India., Methods: Fifty eligible dental students (age 18 - 22 years) undergoing university examinations participated in the study. Students were examined for plaque index (PII) and gingival index (GI) scores during and after their examinations. Stress levels (using the DASS 21 questionnaire) and oral hygiene behavior were also assessed during and after university examinations and the data were subjected to statistical analysis., Results: The average PII and GI were 1.213 and 0.944, respectively, during examinations and 0.845 and 0.467, respectively, after examinations. The average stress scores were 15.66 and 9.94 during and after examinations, respectively. Eighty-eight percent of the students brushed once and 12% of the students brushed twice during the university examinations, whereas 76% brushed once and 24% of the students brushed twice after their examinations. Thirty-four percent of the subjects rated their thoroughness of brushing as good during university examinations whereas the percentage increased to 80% after the examinations. All the differences were found to be statistically significant., Conclusion: Students appearing for the university examinations showed increased stress levels. Moreover, under conditions of stress, the students generally neglected their oral health care and adverse effects on their plaque and gingival scores were observed. Thus, it might be concluded that academic stress has an adverse effect on plaque levels and gingival status in students.

Purpose: The aim of this randomised controlled trial was to assess the clinical performance of single crowns in the posterior maxilla supported by either 6-mm or 11-mm implants combined with maxillary sinus floor elevation., Materials and Methods: 41 consecutive patients with one missing premolar or molar in the posterior maxilla and with an estimated bone height of 6 to 8 mm in that area were included. Each patient was randomly allocated to one of the two treatment groups, namely to receive an 11-mm implant (Osseo Speed 4.0 S, Dentsply Implants, Mölndal, Sweden) in combination with maxillary sinus floor elevation surgery or to receive a 6-mm implant (Osseo Speed 4.0 S) without any grafting. After a 3-month osseointegration period, all implants were restored with custom-made titanium abutments and cemented zirconia-based porcelain crowns. Outcome measures were: implant survival; radiographic bone changes; plaque accumulation; bleeding tendency; peri-implant inflammation; presence of dental calculus; biological and technical complications; and patients' satisfaction. Clinical and radiographic examinations were performed at placement of the crown and 12 months thereafter. Patients' satisfaction was scored before treatment and after 12 months of functioning of the crown., Results: One patient of the 11 mm implant group died during the follow-up. No implant failed and no biological or technical complications occurred. From loading to the 12 months follow-up, no difference was found in mean marginal bone changes between the groups (bone resorption in both groups 0.1 ± 0.3 mm). Clinical items revealed very healthy peri-implant soft tissues in both groups. Patients' satisfaction scores were high in both groups., Conclusions: 6-mm implants and 11-mm implants combined with sinus floor elevation surgery are equally successful to support a single crown in the resorbed posterior maxilla after 1-year follow-up.

The goal of this quality assurance study was to explore the decision making of clinical faculty members at the University of California, San Francisco School of Dentistry predoctoral dental clinic in terms of caries risk level assignment using the caries risk assessment (CRA) as part of the Caries Management by Risk Assessment (CAMBRA) concept. This research was done in part to determine if additional training and calibration were needed for these faculty members. The study tested the reliability and reproducibility of the caries risk levels assigned by different clinical teachers who completed CRA forms for simulated patients. In the first step, five clinical teachers assigned caries risk levels for thirteen simulated patients. Six months later, the same five plus an additional nine faculty members assigned caries risk levels to the same thirteen simulated and nine additional cases. While the intra-examiner reliability with weighted kappa strength of agreement was very high, the inter-examiner agreements with a gold standard were on average only moderate. In total, 20 percent of the presented high caries risk cases were underestimated at caries levels too low, even when obvious caries disease indicators were present. This study suggests that more consistent training and calibration of clinical faculty members as well as students are needed.

Background: Von Willebrand disease (VWD) is the most common inherent bleeding disorder resulting in prolonged bleeding time. Gingival bleeding is a frequently reported symptom of VWD. However, gingival bleeding is also known as a leading symptom of plaque-induced gingivitis and untreated periodontal disease. Gingival bleeding in VWD patients (VWD) may be triggered by gingival inflammation and not a genuine symptom. Thus, this study evaluated whether type 1 VWD determines an increased susceptibility to gingival bleeding in response to the oral biofilm., Methods: Fifty cases and 40 controls were examined haematologically (VWF antigen, VWF Ristocetin cofactor, factor VIII activity) and periodontally [Gingival Bleeding Index (GBI), bleeding on probing (BOP), Plaque Control Record (PCR), periodontal inflamed surface area (PISA), vertical probing attachment level]., Results: GBI was significantly higher in controls (12.2%) than in VWD (10%). The study failed to find a significant difference regarding BOP between VWD (17%) and controls (17.2%). Multiple regressions identified PCR and PISA to be associated with GBI and BOP. VWD was negatively associated with GBI. Smoking and number of remaining teeth was negatively associated with BOP., Conclusion: VWD is not associated with a more pronounced inflammatory response to the oral biofilm in terms of GBI and BOP., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To assess the impact of hospitalization on the oral health status of individuals hospitalized for a short period of time., Material and Methods: This was an observational study of hospitalized patients. The plaque index (PI), gingival index (GI) was measured at baseline (T0 - first 24 h of hospital admission), and at 3 (T1), 7 (T2), 14 (T3) days., Results: One hundred and sixty-two patients were examined at baseline (T0), 35 examined at 3 days (T1), 23 at 7 days (T2) and 16 at 14 days (T3). The main reason for loss of patients was hospital discharge. The mean PI increased at T1 (0.97-1.21; p < 0.001), at T2 (1.06-1.30; p < 0.007) and at T3 (1.19-1.44; p < 0.03). Gingival index (GI) increased at T2 (0.74-0.96; p < 0.04) and at T3 (0.74-0.96; p < 0.02)., Conclusion: Oral health, assessed through PI and GI, deteriorates after a short period of hospitalization., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Osteocalcin, a protein secreted by osteoblasts during bone formation, is negatively associated with adult periodontal disease. Little is known about this association in children., Aim: To examine the extent to which plasma undercarboxylated osteocalcin (ucOC) is associated with gingival crevicular fluid tumour necrosis factor-alpha (GCF TNF-α) - a potential marker of gingival inflammation - in children., Methods: We used data from the Quebec Adipose and Lifestyle InvesTigation in Youth cohort, an ongoing longitudinal study on the natural history of obesity among Caucasian children with a family history of obesity in Quebec, Canada. This cross-sectional analysis from the baseline visit includes 120 children aged 8-10 years. Plasma ucOC and GCF TNF-α levels were determined by enzyme-linked immunosorbent assay. Linear regression analyses, adjusting for age, gender, family income, sexual maturity stage, daily physical activity, obesity, and fasting glucose were conducted, with TNF-α level as the dependent variable., Results: A 1-ng/ml increase in ucOC was associated with a 0.96% decrease (95% confidence interval (CI): -1.69, -0.23) in GCF TNF-α level., Conclusion: A negative association between a marker of bone formation and a marker of gingival inflammation was observed as early as childhood among Caucasian children with a family history of obesity., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The present study reports on a 3-year clinical and radiologic follow-up investigation of dental implants placed 3 and 6 months after sinus augmentation in 14 patients. Augmentation was performed with a synthetic bone substitute material composed of nanocrystalline hydroxyapatite. The aim of the study was to determine how the integration period of the bone substitute material, that is, 3 months or 6 months, influences implant integration within the patient's upper jaw. Therefore, the following clinical and radiologic parameters were investigated: implant being in situ; Periotest value; and presence of peri-implant osteolysis, bleeding on probing, plaque, and soft tissue recession around the implants. At the follow-up investigation 3 years after placement, 23 of 24 implants were in situ and suitable for prosthetic rehabilitation. No implants in either study group were mobile or showed peri-implant osteolysis. Only a few implants showed plaque or soft tissue variations. Within its limits, the present study showed comparable clinical performance of dental implants placed 3 months after sinus floor augmentation to implants placed 6 months after augmentation. The results of all investigated parameters were in accordance with results found in the literature. It can be concluded that augmentation with the applied synthetic bone substitute material already forms a sufficient implantation bed 3 months after augmentation, which enables long-term, stable, implant-retained restoration. These findings might contribute to a reduced healing time after augmentation, which would be favorable for patients and clinicians.

Purpose: To evaluate telescopic crown (TC), bar, and locator attachments used in removable four implant-supported overdentures for patients with edentulous maxillae., Materials and Methods: A total of 30 maxillary edentulous patients were enrolled in a 3-year prospective study. Ten patients (group A) were treated with overdentures supported by TCs, 10 patients (group B) with overdentures supported by bar attachments, and 10 patients (group C) with overdentures supported by locator attachments. A total of 120 implants were used to restore oral function. During the 3-year follow-up period, implant survival and success rates, biologic and mechanical complications, prosthodontic maintenance efforts, and patient satisfaction were evaluated., Results: All 30 patients were available for the 3-year follow-up and exhibited 100% implant survival and success rates. Peri-implant marginal bone resorption was not statistically significant for the three groups. There were lower plaque, bleeding, gingiva, and calculus indices in group C compared with groups A and B. The number of prosthodontic maintenance visits revealed eight complications in the TC group, seven complications in the bar group, and four complications in the locator group. However, there were no differences in the clinical effects of the overdentures in the three groups., Conclusion: Within the limits of this prospective study, it was concluded that the locator system produced superior clinical results compared with the TC and bar attachments in terms of peri-implant hygiene parameters, the frequency of prosthodontic maintenance measures, cost, and ease of denture preparation. However, longer-term prospective studies are required to confirm these results.

Even before dementia becomes apparent, cognitive decline may contribute to deterioration in oral health. This cohort study of middle-aged adults evaluated associations of six-year change in cognitive function with oral health behaviors and conditions in the Atherosclerosis Risk in Communities (ARIC) study. Cognitive function was measured at study visits in 1990-1992 and 1996-1998 with three tests: (a) Delayed Word Recall (DWR), (b) Digit Symbol Substitution (DSS), and (c) Word Fluency (WF). Cognitive decline scores were computed as 'studentized' residuals of 1996-1998 scores regressed against 1990-1992 scores. In 1996-1998, 10,050 participants answered dental screening questions, and 5,878 of 8,782 dentate participants received a comprehensive oral examination. Multiple regression models used cognitive change to predict oral health behaviors and conditions with adjustment for covariates. In the fully adjusted models, greater decline in all three measures of cognitive function was associated with increased odds of complete tooth loss. Greater decline in DSS and WF scores was associated with infrequent toothbrushing. Decline in WF scores was also associated with higher plaque levels. In these middle-aged adults, six-year cognitive decline was modestly associated with less frequent toothbrushing, plaque deposit, and greater odds of edentulism, but not with other oral behaviors or diseases.

Aim: The purpose of this prospective study was to evaluate radiographic, clinical and aesthetic outcomes and patient satisfaction of cases treated with platform-switched single implant restorations in the aesthetic region of the maxilla. Furthermore, the influence of an augmentation procedure 3 months before implant placement and the type of restoration (screw-retained vs. cement-retained) was evaluated., Material and Methods: Sixty patients with a missing anterior tooth in the maxilla were treated with a Straumann Bone Level Implant. Bone augmentation was performed in 29 patients at 3 months before implant placement. Implants were loaded after 3 months of submerged healing. Follow-up was conducted at 7 and 18 months after implant placement. Peri-implant mucosa and implant crown aesthetic outcomes were determined using the Implant Crown Aesthetic Index (ICAI) and the Pink Esthetic Score-White Esthetic Score (PES-WES)., Results: No implants were lost. At 18 months after implant placement, mean bone level change was -0.10 ± 0.27 mm and mean probing pocket depth was 2.57 mm. No differences were found between augmented and nonaugmented sites (P = 0.28). The ICAI indicated satisfactory mucosa and crown aesthetics in 67% and 75% of the cases, respectively, while the PES score was 14.4. ICAI mucosa (P = 0.004) and PES (P = 0.02) scores were significantly less favourable for augmented sites compared with nonaugmented sites. Patient satisfaction was high (8.9 ± 1.1 on VAS-score)., Conclusions: From the present prospective, clinical study, it can be concluded that the Straumann Bone Level Implant shows an excellent survival rate, marginal bone stability and good clinical and aesthetic results. Bone augmentation before implant placement does not lead to more marginal bone loss. However, less favourable pink aesthetic outcomes were found in augmented sites compared with nonaugmented sites, while no differences were found between cement-retained and screw-retained restorations., (© 2012 John Wiley & Sons A/S.)

Purpose: The study evaluated 1-piece implants in daily clinical situations., Materials and Methods: One-piece implants restoring both single teeth and partially edentulous sites were included. A single-stage procedure was used with immediate provisionalization within 24 hours after surgery. The definitive prosthesis was delivered within 6 months of implant insertion., Results: One hundred fifteen implants have been placed in 84 patients at 4 centers. Two implants failed resulting in a cumulative survival rate of 98.3%. Normal periimplant mucosa and no visible plaque were observed in most of the implants. The soft tissue papilla scores improved considerably over time P < 0.001. Patient assessment improved significantly from implant insertion to the 3-year visit, P < 0.001. The mean bone level at implant insertion, 6-month, and 1-, 2-, and 3-year visits was 0.42, -0.58, -0.69, -0.80, and -0.66 mm, respectively. The mean change in bone level from implant insertion to 6 months and 1, 2, and 3 years was reported as -1.02, -1.12, -1.26, and -1.07 mm, respectively., Conclusions: The results indicate that this implant has the ability to preserve both hard and soft tissues' architecture.

Introduction: The aim of this prospective clinical trial was to examine the predictability of the protocol for premolar transplantation when applied by an inexperienced surgeon. Additional objectives were to examine the hard and soft tissues and to compare the findings with control premolars and also to record the patients' opinions of the treatment provided., Methods: The sample comprised 23 consecutively transplanted developing premolars in 19 patients. Their mean age at surgery was 12 years 8 months (range, 9 years 10 months-17 years). The mean observation time was 35 months (range, 6-78 months). Plaque accumulation, pocket depth, gingival recession, mobility, and pulp sensitivity were recorded for the transplanted and the control teeth. Standardized radiographs were used to examine hard tissues and crown-to-root ratios. Questionnaires were used to register each patient's opinion about the treatment and its outcome., Results: The survival rate was 100%, and the success rate was 91.3%. No significant differences were recorded between transplanted and control teeth. The patients' perceptions of the surgical management and the treatment outcome were favorable., Conclusions: The protocol for autotransplantation of developing premolars in growing patients was successfully adopted, regardless of lack of previous experience with this type of treatment., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

In the mid-nineties, 27 patients received 31 implant-supported crowns in the anterior maxillary region, and 12 to 15 years later, 18 patients (67%) with 22 implants (67%) participated in a retrospective study evaluating implant survival, bone loss, prosthetic complications, patient satisfaction, and patient and professional evaluation of esthetics. One implant was lost because of implant fracture after 10 years. Mean marginal bone loss was 1.53 mm (standard error ± 0.17 mm). In 6 patients, 6 crowns were replaced and 1 repaired. In 3 patients, 3 crowns had minor unrepaired porcelain fractures. Implant survival was 95.5%, and, despite the high frequency of prosthetic complications, patients were generally very satisfied with the long-term treatment outcome.

Aim: To obtain an overall quantitative estimate of the association between pregnancy and gingival inflammation., Material and Methods: Medline and EMBASE databases were searched through August 2011. Prospective cohort or cross-sectional studies assessing the effect of pregnancy on gingival inflammation evaluated by the gingival index (GI) and/or bleeding on probing were included. Meta-analyses were performed if possible., Results: Forty-four articles representing 33 studies (14 cohort and 19 cross-sectional) were included. Meta-analyses, performed whenever possible, revealed (1) a significantly lower GI in pregnant women in the first term compared with those in their second or third term of pregnancy; (2) a lower mean GI score in post-partum women compared with women in their second [WMD = 0.143; 95% CI (0.031; 0.255); p = 0.012] or third term [WMD = 0.256; 95% CI (0.151; 0.360); p < 0.001] of pregnancy, when considering cohort studies; (3) Non-pregnant women had lower mean GI values than women in their second or third term of pregnancy. Small changes in plaque levels were reported., Conclusion: Despite the limited number of studies included in the meta-analyses, the present systematic review confirms the existence of a significant increase in GI throughout pregnancy and between pregnant versus post-partum or non-pregnant women, without a concomitant increase in plaque levels., (© 2012 John Wiley & Sons A/S.)

Purpose: The aim of this 10 year retrospective study was to evaluate the crestal bone loss around immediate implant placed in tricalcium phosphate (TCP) grafted extraction sockets, Materials and Methods: Data were collected from files of 58 patients (33 females, 25 males, average age 54.78 years) undergoing immediate implant placement into fresh extraction socket with or without the use of TCP (Cerasorb, Curasan AG, Kleinostheim, Germany) grafting. After implant placement, horizontal gaps larger than 1.5 mm between the implant surface and the bony plate were grafted with TCP without the use of a membrane, while smaller gaps were not grafted. Two hundred fifty-four implants were inserted: 79 were placed immediately with the use of β-TCP as grafting material (group A), 175 were placed in healed extraction sites, with 61 implants placed with the use of β-TCP graft material (group B), and 114 implants were placed without any grafting material (group C). Bone loss recordings were performed using periapical radiography. Measurements were performed from the neck of the implant to level of the surrounding bone in the vertical dimension., Results: No implant was lost during the follow-up period. Statistical analysis showed no correlation between implant placement timing (delayed or immediate), the use of bone graft, and extent of bone loss., Conclusion: The use of TCP (Cerasorb) as a grafting material during immediate implant placement allowed no bone loss in 72.1% of the implants, which was very similar to the nongrafted cases for which implants were placed in favorable conditions., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to determine the plaque removal effectiveness of a new children's powered toothbrush and compare it to that of a manual brush., Methods: This examiner-blind, randomized study used a cross-over design. One-hundred and five qualifying male and female subjects (52 ages 8-12 and 53 ages 13-17) were randomly assigned either the powered brush (Spinbrush GLOBRUSH) or a manual toothbrush (Oral-B Indicator 30 Compact Soft Toothbrush) and instructed to brush at home with a standard fluoride toothpaste twice daily for two minutes during a one-week familiarization period. At the end of this period, the subjects returned to the study site after refraining from oral hygiene for twenty-four hours and from eating and drinking for four hours. Plaque was scored using the Rustogi Modification of the Navy Plaque Index, subjects brushed under supervision with their assigned toothbrush for two minutes, and plaque was rescored. They were then given the alternate toothbrush and the familiarization routine and evaluation process were repeated., Results: Within-group analysis showed that both toothbrushes produced statistically significant reductions from the pre-brushing baseline in whole mouth and regional plaque scores (p < 0.0001), with respective whole mouth reductions of 73.3% and 61.8% for the powered brush and the manual brush. Between-group analyses showed that the powered brush produced a statistically significantly greater plaque reduction than the manual brush, both whole mouth (12.8%, p < 0.0001) and at all subset sites, including difficult-to-reach areas such as the posterior lingual gingival region (74.9% greater plaque reduction, p < 0.0001)., Conclusion: The Spinbrush GLOBRUSH was significantly more effective in reducing plaque than the manual toothbrush when evaluated using this single-use clinical model.

The purpose of this systematic review was to assess the published data concerning zirconia dental implants from various aspects. To identify relevant literature an electronic search was performed of PubMed. Titles and abstracts were screened and articles that fulfilled the inclusion criteria were selected for a full-text reading. Articles were divided into four groups: 1) studies evaluating the mechanical properties of zirconia implants, 2) studies on osseointegration of zirconia, 3) studies on peri-implant tissue response to zirconia implant, and 4) studies on plaque accumulation with zirconia. Review of the selected articles showed that zirconia implants are reliable for placement in the jaw bone. Furthermore, zirconia implants present a material surface that is compatible with the peri-implant tissue and relatively less attractive to plaque. Based on the reviewed literature, it appears that zirconia has the potential to become the dental implant material of choice, especially for aesthetic restorations; however, some issues need to be studied further.

Introduction: The use of immediate implant loading protocols delivers obvious benefits to the patient. When applied in healed sites, this has not only been well documented in the totally edentolous mandible but has also been documented and reported to be predictable in the upper jaw, and in cases of partial edentoulism, as well. A further application of immediate loading protocol, although still controversial, especially when replacing single maxillary teeth in the anterior zone, is the immediate implant placement and provisionalization in postextractive sockets. In consideration of the oxidized surface promoting bone healing and the tapered shape of the implant body, the Replace Select Tapered TiUnite implants have been used for many years in our clinic when facing these clinical situations. This article will report about our long-term clinical experience with such implants and the relevant role of a correct surgical and prosthetic treatment planning., Purpose: The aim of this retrospective study was to report on the 5-year clinical and radiologic outcome of patients treated with Replace Select Tapered TiUnite implants when used according to an immediate loading protocol in postextraction sites., Method and Materials: In routine practice, 56 consecutive patients were treated with 79 implants. The patients, 23 males and 33 females, had a mean age of 50.9 years, range 21-76 years, at implant placement. Forty-seven implants were placed in the maxilla and 32 implants were placed in the mandible. All implants were placed in postextraction sites and were immediately loaded. Provisional restorations were delivered within 2 hours from surgery and all were in occlusion. Forty-three patients received a single implant while in the remaining 13 patients the implants were splinted. Definitive prosthetic restoration was delivered within 1 to 4 months following implant placement. Evaluations of soft tissue health and marginal bone remodeling were conducted. An independent radiologist performed the radiographic evaluation using the top of the implant as the reference point with negative values indicating a level below the reference point., Results: Forty-eight patients, accounting for 66 implants, have passed the 5-year follow-up. No implants have failed resulting in a 5-year cumulative implant survival rate of 100%. Three patients, with six implants, withdrew during the course of the follow-up; one patient passed away and two patients moved. Five patients with seven implants did not show up at 5 years recall. At the 5-year follow-up, majority of the implants that were followed demonstrated normal periimplant mucosa and no visible plaque. The mean bone level at 5-year follow-up was -2.45mm (SD 1.29, n=63) demonstrating a level in line with the first thread. Mean marginal bone loss from implant inserting to 5 years was 0.56 mm (SD 1.98, n=63). In regard with complications, a fracture of the ceramic crown was reported 5 years after implant insertion in a patient who developed bruxism. No other biologic nor mechanical complications were reported., Conclusion: This retrospective 5-year follow-up study of 56 patients treated with implants immediately placed in postextraction sockets and immediately loaded demonstrates good treatment outcome with regard to implant survival, soft tissue condition, and marginal bone response., (© 2010 Wiley Periodicals, Inc.)

The aim of this study was to investigate the effects of two commonly used flap designs (envelope and triangular) used for the removal of mandibular third molars (M3) on postoperative morbidity. 19 patients with bilateral symmetrically impacted mandibular M3 were studied using a split mouth design. Swelling, pain and trismus measures were recorded on days 2, 7 and 14; periodontal indices were recorded on days 7 and 14, one final measure of probing depth on the distal aspect of the mandibular second molar (M2) was taken at the last follow up appointment. Data were analysed using the χ(2) test, the Mann-Whitney U-test and Pearson's correlations. The mean age of the patients was 21.4 ± 2.3 years (± SD). Facial swelling and the reduction in mouth opening were significantly greater in the early postoperative period (P<0.05) with pyramidal flap designs. There was no significant difference in pain scores, plaque accumulation and bleeding on probing indices between the two flap designs (P>0.05). Probing depth was significantly greater with envelope flaps in the early postoperative period (P<0.005). In conclusion, flap design in mandibular M3 surgery has an effect on postoperative recovery., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Aim: The aim of this study was to evaluate the utility of a simple colorimetric chair side test detecting amines in saliva as an adjunct test in the oral malodour diagnosis., Material and Methods: Non-stimulated saliva samples were collected from 100 volunteers with different degrees of oral malodour. The amount of amines detected by the test was estimated clinically (colorimetric test), confirmed semi quantitatively in the laboratory (standard addition method) and consequently compared with (i) the organoleptic score (OLS); (ii) the volatile sulphur compounds (VSCs) levels (OralChroma(™)) and (iii) the amount of amines detected by means of gas chromatography - mass spectroscopy., Results: The chair side test correlated well (Spearman correlation coefficient: 0.46-0.77), with the OLS, the level of VSCs, and the amines determined by using gas chromatography - mass spectroscopy. The results of the new test for patients with and without oral malodour were significantly different (Mann-Whitney U-test, p < 0.0001). The sensitivity, specificity, and positive and negative predictive value of this chair side test were similar to those of the VSCs evaluations., Conclusions: These results support the "fit for purpose" of the new chair side test as adjunctive diagnostic tool for oral malodour., (© 2012 John Wiley & Sons A/S.)

Objective: To evaluate the literature on different methods of scoring plaque in patients with fixed orthodontic appliances., Materials and Methods: A systematic electronic and hand search using MEDLINE and PubMed was conducted., Results: Most orthodontic trials have used the original Silness and Löe plaque index. Indices vary in several potentially important aspects. Only two papers have reported reproducibility of methods of plaque scoring in orthodontic patients., Conclusion: Some plaque indices are inappropriate for orthodontic patients. Newer digital planimetric methods are promising if more complex. There is a need to further assess the reproducibility and practicability of the advocated methods.

Objective: To explore the effectiveness of oral hygiene care on plaque and gingival status of residents with dementia., Background: Oral hygiene and oral hygiene care has been reported to be poor among the institutionalised elderly with dementia. The severity of oral diseases has been shown to increase with the severity of physical and cognitive impairment related with dementia. Little research has been carried out on plaque and gingival status of elderly with dementia and the impact of disability related with dementia on oral health in residential aged care facilities (RACF)., Materials and Methods: A cross-sectional study of 205 elderly residing in RACF in Perth., Results: Forty-one percent of the residents in RACF had dementia. Sixty percent of the residents with dementia and 75% of the residents with an Activities of Daily Living Oral Health score of D were assisted with oral care. Mean plaques scores and extent of gingival inflammation were higher for residents in the DD and D subgroups and resident with dementia. Residents assisted with brushing had higher mean plaque score and more moderate gingival inflammation., Conclusion: Oral hygiene care status in residents with dementia was poor despite the fact that oral care assistance was being provided., (© 2011 The Gerodontology Society and John Wiley & Sons A/S.)

The purpose of this investigation was to test the safety and clinical effect of a new material for the treatment of proximal caries. In 50 patients with two proximal initial lesions, one of the lesions was randomly chosen and sealed with a thin polyurethane-dimethacrylate foil using bonding. The other lesion received oral home care and was left as the control. In clinical follow-ups after 6 and 12 months and X-ray evaluation after 2 and 3 years, the sealants showed good retention, marginal adaptation, and color. No relevant significant differences in plaque accumulation or gingival status were found between sealed and control teeth. On the radiographs, almost all sealed and control lesions appeared stable, indicating an arrest of the lesion. In conclusion, sealing initial proximal lesions showed no clinical problems and mostly arrest of caries on bitewing radiographs.

Unlabelled: There is significant evidence to support the regular review of patients with chronic periodontitis. There is, however, comparatively little evidence to demonstrate how often such reviews should take place. This paper looks at the periodontal healing period, the risks of periodontal progression and current thinking about maintenance programmes. It thus attempts to establish some guidelines that practitioners may use when calculating recall intervals., Clinical Relevance: The choice of individual, patient-focused recall intervals is essential to limit disease progression and maintain healthy periodontal tissues.

Aim: The effect of Ocimum gratissimum (Og) on the reduction of dental plaque and gingivitis was evaluated in a randomized, parallel and double-blind clinical trial., Materials and Methods: Subjects were randomly allocated to the control group (n=10)-mouth rinse with no antiseptic agents; CLX group (n=10)-mouth rinse containing chlorhexidine digluconate or Og group (n=10)-mouth rinse containing Ocimum gratissimum. Plaque (PLI) and bleeding (BI) indexes were assessed at days 0 and after 3 months. Subjects were asked to brush their teeth with a fluoridated dentifrice, three times a day, during a 90-day period. After each brushing they rinsed with one of the three mouth rinses during 1 minute., Results: There was a significant reduction on plaque and gingivitis in tests groups (p < 0.05), but no statistically significant difference was observed among them (p > 0.05)., Conclusion: Mouth rinse containing Og was effective as antiplaque and antigingivitis agent, in a similar manner that chlorhexidine digluconate., Clinical Significance: Research in treatment of chronic oral diseases using natural agents must be encouraged to verify which would be a useful addition to the current range of chemotherapeutic treatment options.

Purpose: The objective of this prospective study was to assess the overall outcome of immediate single implant treatment in the anterior maxilla after a 3-year observation period., Material and Methods: Thirty consecutively treated patients with a thick gingival biotype, ideal gingival level/contour and intact socket walls at the time of tooth extraction were treated for single-tooth replacement in the aesthetic zone by two experienced clinicians. Treatment included minimal mucoperiosteal flap elevation, immediate implant placement (NobelReplace TiUnite(®)), insertion of a grafting material between the implant and the socket wall and connection of a screw-retained provisional restoration. The latter was replaced by a cemented crown 6 months thereafter. Patients were clinically and radiographically re-examined after 3 years to assess implant survival, complications and hard and soft tissue conditions. The aesthetic outcome was objectively rated using the Pink Esthetic Score (PES) and White Esthetic Score (WES) by a blinded clinician who had not been involved in the treatment., Results: Twenty-five patients could be re-evaluated after 3 years. One early implant failure had occurred resulting in an implant survival rate of 96%. Radiographic examination yielded on average 1.13 mm mesial, respectively 0.86 mm distal bone loss. The clinical conditions showed fairly low peri-implant plaque (18%) and bleeding (24%) and mean probing depth was 3.17 mm. Mean mesial/distal papilla shrinkage and midfacial soft tissue recession in reference to the pre-operative status accounted for 0.05, 0.08 and 0.34 mm, respectively. Between the 1- and 3-year reassessment mesial papillae showed significant re-growth (0.36 mm; p=0.015). Advanced midfacial recession (>1 mm) was found in 2/25 (8%) cases. Five (21%) cases were aesthetic failures (PES<8 and/or WES<6) and 5/24 (21%) showed an (almost) perfect outcome (PES≥12 and WES≥9). The remainder (14/24 or 58%) demonstrated acceptable aesthetics., Conclusions: The proposed strategy seems a valuable and predictable treatment option for well-selected patients in the mid-long term as shown by almost full papillary re-growth and a low risk for advanced midfacial recession., (© 2011 John Wiley & Sons A/S.)

Aims: To evaluate the associations between serum inflammatory biomarkers and periodontal inflammation in subjects with type 1 diabetes mellitus (T1DM). Our hypothesis was that local host responses may be modulated by the serum inflammatory mediators., Material and Methods: Plaque, bleeding on probing and probing pocket depth (PD) were examined in 80 T1DM subjects at the baseline and in 58 subjects 8 weeks after periodontal therapy. The levels of glycosylated haemoglobin, serum interleukin (IL)-6, ultrasensitive C-reactive protein and the lipid profile were measured at the baseline and after therapy. Stratification of the sample separately by smoking and body mass index (BMI) was performed. Adjusted associations between the levels of systemic biomarkers and periodontal parameters were studied using multiple regression models., Results: The level of serum IL-6 was associated with the extent of bleeding and PD≥4 mm at the baseline in non-smokers and in subjects with BMI≤26 kg/m(2). These associations were also evident after periodontal therapy. Subjects with a high after-therapy IL-6 level presented poorer periodontal healing than those with a low level., Conclusions: The observed associations may be considered to be suggestive of a modulatory effect of IL-6 on host responses in T1DM subjects., (© 2011 John Wiley & Sons A/S.)

The aim of this study was to evaluate and compare the efficacy of antiplaque mouthwashes. Plaque levels were determined by applying a plaque-disclosing solution using the Turesky et al modification of the Quigley Hein plaque index. The control group (n = 6) brushed twice per day with fluoride toothpaste for one minute and rinsed with water, while the study groups (n = 6) brushed once per day with fluoride toothpaste for one minute, followed by rinsing with 5.0 mL of mouthwash diluted with 10.0 mL of water for 30 seconds. The control group brushed and rinsed with water twice per day. The results indicated that cetylpyridinium chloride in combination with sodium fluoride offered maximum plaque inhibition, followed by chlorhexidine gluconate and sodium monofluorophosphate, while plaque levels increased in the control group and with the combination of chlorhexidine gluconate and sodium fluoride. The only antiplaque agents to demonstrate a statistically significant difference from the control were cetylpyridinium chloride in combination with sodium fluoride, and chlorhexidine gluconate. Increasing the fluoride concentration had no impact on antiplaque activity.

Objective: To analyse the relation of stimulated and unstimulated salivary flow rates to periodontal infection in home-dwelling elderly people aged 75 years or older., Subjects and Methods: This study was based on a subpopulation of 157 (111 women, 46 men) home-dwelling, dentate, non-smoking elderly people (mean age 79.8, SD 3.6 years) from the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly Study). The data were collected by interview and oral clinical examination., Results: Persons with very low (< 0.7 ml min⁻¹) and low stimulated salivary flow rates (0.7- < 1.0 ml min⁻¹) had a decreased likelihood of having teeth with deepened (≥ 4 mm) periodontal pockets, RR: 0.7, CI: 0.5-0.9 and RR: 0.7, CI: 0.5-0.9, respectively, when compared with those with normal stimulated salivary flow. Persons with a very low unstimulated salivary flow rate (< 0.1 ml min⁻¹) had a decreased likelihood of having teeth with deepened (≥ 4 mm) periodontal pockets, RR 0.8, CI: 0.6-1.0, when compared with subjects with low/normal unstimulated salivary flow., Conclusions: In a population of dentate, home-dwelling non-smokers, aged 75 years or older, low stimulated and unstimulated salivary flow rates were weakly associated with a decreased likelihood of having teeth with deep periodontal pockets., (© 2010 John Wiley & Sons A/S.)

Introduction: The objective of this study was to evaluate the effect of fixed appliances on oral malodor., Methods: Forty-one patients participated in this study. They were randomized into 2 groups: treated with fixed orthodontic appliances and untreated controls. Oral malodor measurements and the gingival and plaque indexes were recorded in each group by same periodontist. Measurements were taken from the study group before bonding, 1 week after bonding, and 4 weeks after bonding. The control group's measurements were made at the same time., Results: Oral malodor and the gingival and plaque indexes were significantly increased 1 week after bonding (P <0.05). Oral malodor was increased at 4 weeks after bonding (P >0.05). The comparison of the groups showed differences 1 week and 4 weeks after bonding., Conclusions: The oral malodor reached the critical level during fixed orthodontic treatment. Oral malodor could indicate a need to evaluate oral health and remind patients of the importance of maintaining ideal oral hygiene., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background: A common clinical finding is that many schoolchildren display a nonacceptable oral hygiene., Aim: To evaluate the tooth-brushing behaviour in children aged 6-12 years., Design: The study used a cross-sectional descriptive design. Children aged 6, 8, 10, and 12 years in an elementary school in a middle class area in Umeå, a city in northern Sweden, were invited and 82 (82%) consented. Visible plaque on buccal surfaces of incisors and canines was recorded from photographs of the participant's teeth before and after brushing using the scores of the Green and Vermillion Oral Hygiene Index. Brushing technique was recorded with a video camera. A questionnaire was used to collect data about oral hygiene habits at home., Results: The ratio between the sum of plaque scores after and before brushing was statistically significantly higher in the 6-year-old group compared with the 10-year olds, (P < 0.05). There was a negative correlation between time spent for brushing and the ratio between the sum of plaque scores after and before brushing (r = -0.31, P < 0.01). The lowest correlation was displayed in the youngest age group (r = 0.07, P > 0.05). Six-year olds spent statistically significantly less time for brushing than older children (P < 0.05)., Conclusion: Plaque removal from buccal surfaces from brushing was poor and averaged 19% for 6-year olds and 30% for older children. The results of brushing for children aged 8-12 years could benefit from increasing tooth-brushing time. Children could be given an increasing responsibility from 7 to 8 year of age but parental help is motivated up to 10 years of age., (© 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.)

Objective: This study was designed to evaluate the clinical efficacy of an antiplaque alcohol-free mouthwash containing 0.075% cetylpyridinium chloride (CPC) and 0.05% sodium fluoride (NaF), as compared to a control mouthwash containing only 0.05% NaF, in controlling established dental plaque and gingivitis after three and six months of product use., Methods: This was a single-center, parallel-group, two-cell, double-blind, randomized clinical study. Prospective adult male and female subjects from San Jose, Costa Rica reported to the clinical facility having refrained from all oral hygiene procedures for 12 hours, and from eating, drinking, or smoking for four hours prior to their visit. Qualifying subjects who presented with Gingival Index scores (Löe and Silness Index) of at least 1.0 and Plaque Index scores (Turesky Modified Quigley-Hein Index) of at least 1.5 were allowed to participate in this study. Subjects were randomly assigned to one of two treatment groups according to their baseline gingival and plaque scores. In the first treatment group (Test), subjects used an alcohol-free mouthwash containing 0.075% CPC and 0.05% NaF, whereas in the second treatment group (Control), subjects used a mouthwash containing only 0.05% NaF. Gingivitis and plaque assessments, and examinations of oral hard and soft tissues were conducted after three months and six months of product use., Results: One-hundred and ten (110) subjects complied with the protocol and completed the six-month study. After six months of product use, the Test Mouthwash group exhibited statistically significant reductions from baseline with respect to Gingival (33.5%), Gingival Interproximal (34.5%), Gingival Severity (63.2%), Plaque (33.6%), Plaque Interproximal (30.0%), and Plaque Severity (73.6%) Index scores. After six months of product use, the Control Mouthwash group exhibited statistically significant increases from baseline with respect to Gingival (6.9%), Plaque Interproximal (7.2%), and Plaque Severity (32.7%) Index scores. Furthermore, after six months of product use, the Control Mouthwash group exhibited reductions from baseline with respect to Plaque (6.1%), Gingival Interproximal (3.6%), and Gingival Severity (1.1%) Index scores which were not statistically significant. After three months of product use, the Test Mouthwash group exhibited statistically significant reductions in Gingival (25.0%), Gingival Interproximal (22.3%), Gingival Severity (38.9%), Plaque (26.1%), Plaque Interproximal (22.4%), and Plaque Severity (75.0%) Index scores as compared to the Control Mouthwash group. After six months of product use, the Test Mouthwash group exhibited statistically significant reductions in Gingival (38.1%), Gingival Interproximal (37.1%), Gingival Severity (63.6%), Plaque (36.5%), Plaque Interproximal (33.2%), and Plaque Severity (78.5%) Index scores as compared to the Control Mouthwash group., Conclusion: The results of this double-blind clinical study support that 1) an alcohol-free mouthwash containing a combination of 0.075% CPC and 0.05% NaF produces statistically significant reductions in dental plaque and gingivitis after three and six months compared to baseline, and 2) the alcohol-free CPC mouthwash provides a statistically significantly greater level of efficacy in controlling established dental plaque and gingivitis after three and six months of product use as compared to the Control Mouthwash containing only NaF.

Background: The emergence of periodontal medicine has increased interest in defining the serologic profiles of inflammatory mediators in subjects with periodontitis. Thus, the aim of this pilot study is to evaluate the serum levels of tumor necrosis factor-alpha (TNF-alpha), interferon-gamma, and interleukin (IL)-4, -17, and -23 in subjects with generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP) before and after non-surgical periodontal therapy., Methods: Cytokines were measured by enzyme-linked immunosorbent assay in serum samples taken from 42 systemically healthy subjects divided according to periodontal status into subjects with GAgP (n = 14) and GCP (n = 14) and periodontally healthy (PH) subjects (n = 14). In addition, the levels of cytokines were reassessed at 6 months after periodontal therapy in the periodontitis groups. Clinical parameters were also evaluated at baseline and 6 months post-therapy., Results: After therapy, both periodontitis groups demonstrated a significant improvement in clinical periodontal status (P <0.05). At baseline, concentrations of TNF-alpha (P = 0.0006) and IL-17 (P = 0.02) were significantly higher in the GAgP group compared to the other groups. There was a significant decrease in serum concentrations of TNF-alpha (P = 0.03) and IL-17 (P = 0.04) at 6 months post-therapy in the GAgP group (P <0.05). The concentration of TNF-alpha remained elevated in the GAgP group compared to the PH group at 6 months post-therapy (P = 0.04)., Conclusions: Subjects with GAgP presented higher levels of TNF-alpha and IL-17 than subjects with GCP and PH subjects. In addition, although the serum levels of these cytokines improved significantly as a result of periodontal therapy, the levels of TNF-alpha remained higher in subjects with GAgP compared to PH subjects.

Background: Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions and share many pathologic features. A similar profile of cytokines is involved in the pathogenesis of the two diseases. The relationship between the disease activity of RA and the periodontal condition remains unclear. This study examines whether the disease activity of RA affects serum cytokine and periodontal profiles., Methods: The study subjects consisted of 84 Japanese adults with RA and 22 race-matched control individuals. After periodontal and rheumatologic examination, the disease activity of RA was determined with the Disease Activity Score including 28 joints using C-reactive protein (DAS28-CRP). Serum levels of cytokines including interleukin (IL)-1beta, IL-6, IL-12, IL-12 p40, IL-18, and tumor necrosis factor-alpha (TNF-alpha) were determined by an enzyme-linked immunosorbent assay. High-sensitive CRP was also measured with a latex particle-enhanced nephelometric method., Results: Of 84 patients with RA, 28 and 56 patients exhibited low and moderate to high disease activity, respectively. Serum levels of IL-6, TNF-alpha, and CRP were significantly different between the two groups (P <0.05). Additionally, a significant correlation was observed between DAS28-CRP and percentage of sites with bleeding on probing (BOP) (P = 0.008) and between serum TNF-alpha levels and percentage of sites with BOP (P = 0.01) in 56 patients with RA with moderate to high activity., Conclusion: These results suggest that the disease activity of RA correlated with serum levels of IL-6, TNF-alpha, and CRP, and it might influence BOP in the patients with moderate to high disease activity.

Objective: The aim of the present study was to investigate the effects of academic stress on periodontal health, in relation to inflammatory markers in gingival crevicular fluid (GCF) and cortisol in saliva., Materials and Methods: The study included 20 healthy dental hygienists (females: mean age 29.3 +/- 8.5 SD) and was conducted during a major exam period and 4 weeks later after the exams. A clinical examination was performed and GCF was collected from four sites in each subject on these two occasions. Interleukin (IL)-1beta, IL-4, IL-6, IL-10 levels were determined using Luminex 100 and cortisol amounts by radioimmunoassay (RIA (125)I). Students registered their perceived stress on a visual analogue scale (VAS). Significance of the findings was determined using paired t-test, Wilcoxon-matched pair and Spearman's rank correlations., Results: Students had higher amounts of dental plaque (P < 0.007) and gingival inflammation (P < 0.001) during the exam period compared with after the exams. The amounts of IL-6 and IL-10 in GCF were significantly increased during the time of examinations. The median level of cortisol in saliva was also significantly raised during the exam period compared with after the exams, 20.52 nmol/l (range: 11.91-27.34) and 16.41 nmol/l (range: 10.91-24.17) respectively, P < 001. The results from the VAS registration revealed a significant difference (P < 001) between the two occasions., Conclusion: Academic stress appears to affect periodontal health, shown by more plaque accumulation, gingival inflammation and increased amounts of IL-6, IL-10 in GCF and cortisol in saliva.

Purpose: Patients presenting with leukaemic blast crisis with acute myeloid leukaemia (AML) may have gingival enlargements that interfere with oral hygiene. Few large cohort studies of gingival lesions have been carried out on AML patients. The aim of the present study was to assess gingival and periodontal pathology at the time of presentation, prior to chemotherapy, in a cohort of adult patients presenting at a cancer hospital in Kerala, a region located in southern India., Materials and Methods: A total of 73 young adult patients (mean age 20.6 ± 2.3) who were diagnosed with AML were examined. These patients did not suffer from any other systemic disorder. The oral hygiene status, gingival overgrowth (GO) and periodontal status were assessed using traditional clinical indices., Results: Around three-quarters of the patients had either fair or poor oral hygiene. A statistically significant association between dental plaque levels and both GO and periodontal index (P < 0.001) was observed., Conclusions: Poor oral hygiene is a risk factor for leukaemic GO and for destructive periodontal disease. Both conditions add to the microbial burden these patients are exposed to. In patients showing high levels of oral hygiene, the GO tends to be mild and does not seem to be problematic, especially with respect to mechanical tooth cleaning.

Objective: This investigation assessed regional differences in dental plaque and gingivitis within the human dentition in conjunction with microbiological analyses of dental plaque., Methods: Forty-one adults (23 males and 18 females; age range 19-44 years) were enrolled, and a calibrated dental examiner completed whole mouth examinations for dental plaque (PI) and gingivitis (GI) using the Turesky modification of the Quigley-Hein Index (TMQH) and the L6e-Silness (LS) Index, respectively. Dental plaque samples were collected from the anterior surfaces and posterior teeth to determine viable anaerobic bacteria. During this visit, subjects underwent a whole mouth dental prophylaxis and were provided a marketed fluoride dentifrice for twice-daily oral hygiene. Subjects were recalled on day 15 and day 30 for whole mouth assessments of PI and GI, followed by the collection of dental plaque from the anterior and posterior teeth for microbiological analyses during these visits., Results: Low plaque and gingival scores were common on anterior surfaces, in contrast to greater frequencies of higher PI and GI scores on the posterior regions or the entire dentition. Correspondingly, mean scores for PI and GI were significantly lower among the anterior surfaces in comparison to all other regions of the mouth (posterior, Ramfjord surfaces, or the entire dentition) over each phase of the study (p < 0.0001). While prophylaxis resulted in lower clinical scores from baseline to the day-15 recall visit (p < 0.05), anterior surfaces demonstrated lower scores than posterior regions during this recall visit (p < 0.05). Although dental plaque scores increased from the day-15 to the day-30 evaluations, gingival scores maintained broad reductions, with anterior scores consistently lower than the corresponding posterior regions (p <0.05). Microbiological analyses indicated significantly lower numbers of viable bacteria from the anterior surfaces in comparison to posterior regions at both recall visits (p < 0.05)., Conclusion: Anterior surfaces routinely demonstrated lower levels of dental plaque scores than the other regions of the dentition. Higher gingival inflammation levels were also correlated with increased plaque deposits associated with posterior teeth. Microbiological analyses confirm clinical observations with significantly higher numbers of viable bacteria in the dental plaque collected from the posterior regions. The human dentition demonstrates significant regional differences in the prevalence of dental plaque, gingivitis, and corresponding anaerobic bacteria, with posterior surfaces consistently reporting higher scores than the anterior regions. These consistent differences should be taken into account in performing plaque and gingivitis studies when assessing the efficacy of oral health products for controlling dental health.

Purpose: Hyaluronan, commonly known as hyaluronic acid, has been shown to have anti-inflammatory action, bacteriostatic effect and antioxidant properties, thus making its use as a long-term anti-plaque and anti-gingivitis agent an appealing proposition. The aim of the present study was to evaluate the efficacy of 0.025% hyaluronan-containing mouthwash in comparison with 0.2% chlorhexidine and a water-based mouthwash and also to evaluate its antibacterial efficacy on isolated strains of periodontopathogens., Materials and Methods: Forty-five volunteers in a hospital setting were recruited. A single-blinded, parallel design, randomised controlled trial was carried out and the 4-day plaque re-growth model was used to study the efficacy of the three mouthwashes. Microbiological and clinical evaluation was performed by culturing and using dental indices, respectively. The three mouthwashes used in the present study were commercially available 0.025% sodium hyaluronate, 0.2% chlorhexidine and a water-based rinse (negative control). Effects of the three mouthwashes were tested on the growth of isolated strains of Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa) and Prevotella intermedia (Pi)., Results: In vitro, hyaluronan had a distinct effect on the growth of Aa and Pi with no effect on the growth of Pg. In vivo, the differences between the individual rinse solutions and the water-based solution showed significantly less plaque regrowth with respect to both chlorhexidine (P = 0.033) and hyaluronan (P = 0.045) when compared to the negative control. The difference between chlorhexidine and hyaluronan was not statistically significant (P = 0.69)., Conclusions: Hyaluronan (0.025%)-containing mouthwash was comparable to chlorhexidine (0.2%) in inhibiting plaque growth in vivo, and it significantly reduced the growth of Aa and Pi in vitro

Background: Measurement and assessment of denture plaque can provide valuable information regarding an individual's oral health status and assessment of new treatments or products. Current methods tend to rely on subjective indices or image analysis derived planimetric (area measurement) assessment of stained plaque on dentures. Plaque indices are most commonly used to assess plaque coverage without image capture. This is not ideal because the methods are subjective, examiner bias may occur, there is no reproducibility between studies, the methods have lower accuracy and sensitivity than image analysis, and there is no record. To the authors' knowledge, no standardised published method of denture plaque assessment is currently employed for product development and testing., Method: In this study visual and planimetric plaque assessment methods were compared using reference dentures. In addition, an in vivo study compared these methods for evaluating denture cleanser efficacy., Results and Conclusions: The results show that blinded image scoring is more representative of the true plaque area coverage than 'live' denture scoring, detecting significant decreases in plaque coverage. Planimetric analysis provides a more sensitive and less subjective technique with greater differentiation between treatments. However, analysis is very time consuming. Thus, a number of recommendations are made regarding quantification of denture plaque for the assessment of cleanser products.

Purpose: The aim of this study was to evaluate plaque accumulation and peri-implant tissue response adjacent to machined and dual acid-etched (DAE) titanium implant surfaces., Materials and Methods: Two types of implants were used-control implants with a DAE surface in their apical portion and a machined coronal part, and test implants with a DAE surface throughout their entire length. A total of 10 sets of implants were placed in the posterior quadrants of eight patients, with at least 2 implants (1 control and 1 test implant) placed in each site. Machined healing abutments were placed on the control implants and DAE-surfaced healing abutments on the test implants. Plaque Index and bleeding on probing (BOP) were recorded together with histologic and microbiologic analyses of the peri-implant tissues. The healing abutments underwent a scanning electron microscope scan at 5 months postsurgery. Standardized radiographs were also taken at the time of implant placement and 3, 6, and 12 months postsurgery., Results: DAE surfaces accumulated more plaque than machined surfaces (P < .0006) and the plaque was assessed as more difficult to remove (P < .0143). No histologic abnormalities were seen and the test implants showed significantly lower crestal bone resorption than the control (P < .0174)., Conclusion: DAE healing abutments showed an increased plaque accumulation, but no significant BOP differences or histologic analyses were found between test and control sites. The test implants showed less interproximal bone resorption than the control ones at the end of a 1-year follow-up evaluation.

Background and Objective: Periodontitis is a multifactorial disease in which environmental and genetic determinant factors contribute to individual subjects susceptibility. A DNA polymorphism in the regulating region of adhesion molecule genes is suggested to modulate the molecules physiological effects. The aim of this study was to investigate the genetic association between the E-selectin Ser128Arg and L-selectin Phe206Leu polymorphisms and periodontitis., Material and Methods: DNA was isolated from the whole blood of 88 patients with periodontitis and 139 healthy individuals. All samples were genotyped for the E-selectin Ser128Arg and L-selectin Phe206Leu polymorphisms using the polymerase chain reaction with sequence specific primers., Results: Our findings revealed a significant difference in the Ser128Arg polymorphism of E-selectin, but not in the L-selectin polymorphism, between periodontal patients and controls. The 128Arg allele was present more frequently in patients than in healthy individuals (31.25% vs. 12.2%, p < 0.0001). In addition, there was an association between the presence of the 128Arg allele and periodontitis (odds ratio 2.9; 95% confidence interval: 1.75-4.4, p < 0.0001). No significant association was found between the polymorphisms tested and the subgroups of periodontal disease (i.e. chronic periodontitis and aggressive periodontitis)., Conclusion: The findings of this study showed that the Ser128Arg polymorphism of E-selectin might contribute to the susceptibility of Iranian individuals to periodontitis.

Objectives: To determine the effect of magnetron-sputtered calcium phosphate coating of implants on the later stages of osseointegration in a non-human primate model., Material and Methods: Eighteen and 20 implants with a 0.1 microm amorphous calcium phosphate coating and a turned surface, respectively, were inserted in the anterior upper and lower jaw of adult non-human primates. Following a 7.5 months healing period, one part of the implants remained in the submerged position. The other part of implants was connected to healing abutments to allow peri-implant inflammation to occur. After another 20 months, histologic and histomorphometric analysis of the peri-implant area was performed., Results: Submerged implants with a calcium phosphate coating and a turned surface showed no signs of an inflammatory reaction. The histomorphometric parameters 'bone volume per tissue volume' (BV/TV) and 'bone-to-implant contacts' (BIC) were not affected by calcium phosphate coating. Non-submerged implants of both groups showed occasionally signs of inflammation at the implant-abutment junction. Histomorphometric analysis revealed that the distance between the implant-abutment junction and the most coronal level (where bone was attached to the implant) as well as BV/TV and BIC were independent from the surface modification., Conclusion: Our results show that dental implants with calcium phosphate coating behave similar to turned implants independently whether they are connected to healing abutments or remain submerged. Ultra-thin calcium phosphate coating can combine the positive effects of calcium phosphate during the early stage of osseointegration without causing impairment of the later stages.