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Aim: This study evaluated the reliability of a new rapid biological spore test (BST) for determining the sterilization efficacy of dental steam autoclaves within 20 minutes, as compared to a conventional BST requiring 2 days of incubation after autoclave exposure.Materials and methods: A total of 177 pairs of BST, each composed of a rapid test (Celerity™ 20 Steam Biologic Indicator, Steris) and a conventional BST (Attest™ 1262 Biological Indicator, 3M), both containing Geobacillus stearothermophilus spores, were placed into steam autoclaves loaded with instruments, and subjected to either sterilizing (157 pairs) or non-sterilizing conditions (20 pairs). Celerity™ BST was then incubated for 20 minutes at 57°C, with the growth medium evaluated spectrophotometrically for fluorescent α-glucosidase signal changes (no change with successful sterilization; increased fluorescence after failed sterilization). Attest™ BST was incubated for 48 hours at 57°C, after which a pH-based color change in the culture broth was visually assessed (no change in purple color with successful sterilization; change to yellow color with failed sterilization).Results: Celerity™ and Attest™ BST both accurately identified successful sterilization, with no G. stearothermophilus spore growth from either BST after exposure to sterilizing steam autoclave conditions (100% agreement between 157 pairs of each BST). Both BST also accurately detected unsuccessful sterilization, with all tested ampoules positive for G. stearothermophilus spore germination after non-sterilizing steam autoclave time periods. Both BST exhibited 100% sensitivity, specificity, and accuracy for detection of sterilizing steam autoclave conditions.Conclusion: Celerity™ BST, after only 20 minutes incubation, performed equally as well as a BST requiring 48 hours incubation in determining the sterilization efficacy of dental steam autoclaves.Clinical significance: Rapid BST offer earlier detection of sterilization failure before potentially contaminated dental instruments are used in clinical patient care.

OBJECTIVES: To compare erythritol air-polishing with piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis.MATERIAL AND METHODS: Eighty patients (n=139 implants) with peri-implantitis (probing pocket depth (PPD) ≥5mm, marginal bone loss (MBL) ≥2mm as compared to bone level at implant placement, bleeding and/or suppuration on probing (BoP/SoP)) were randomly allocated to air-polishing or ultrasonic treatment. The primary outcome was mean BoP (%) at 3 months after therapy (T3). Secondary outcomes were mean SoP (%), plaque score (Plq) (%), PPD (mm), MBL (mm), full mouth periodontal scores (FMPS) (%), levels of 8 classical periodontal pathogens and treatment pain/discomfort (Visual Analog Scale, VAS). Patients who were considered successful at T3 were additionally assessed at 6, 9 and 12 months. Differences between both groups were analysed using multilevel statistics.RESULTS: Three months after therapy, no significant difference in mean BoP (%) between the air-polishing and ultrasonic therapy was found (crude analysis β (95% CI) -0.037 (-0.147; 0.073), p = 0.380). Neither secondary outcomes SoP (%), Plq (%), PPD (mm), MBL (mm), FMPS (%) and periodontal pathogens showed significant differences. Treatment pain/discomfort was low in both groups (VAS score air-polishing group 2.1 (±1.9), ultrasonic 2.6 (±1.9); p = 0.222). All successfully treated patients at T3 (18.4%) were still considered successful at 12 months follow-up.CONCLUSIONS: Erythritol air-polishing seems as effective as piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis, in terms of clinical, radiographical and microbiological parameters. However, neither of the proposed therapies effectively resolved peri-implantits. Hence, the majority of patients required further surgical treatment.

Aim The aim of this single-blind RCT was to evaluate the adjunctive clinical and microbiological effect of systemic amoxicillin (AMX) plus metronidazole (MTZ) to non-surgical treatment of peri-implantitis.Material and methods Patients (N = 62) with peri-implantitis were randomly assigned to receive full-mouth mechanical debridement and decontamination and use of chlorhexidine (control group) or combined with antibiotic therapy of AMX/MTZ (test group). Primary outcome was change in bleeding score from baseline (T-0) to 3-month follow-up (T-3). Secondary parameters were plaque, suppuration, PPD, CAL, bone level, microbiology, adverse events and need for additional surgery. Data were analysed with linear multiple regression analysis.Results 57 patients with 122 implants completed 3-month follow-up. Both groups showed major clinical improvements at T-3 in both peri-implant and periodontal parameters. However, no significant differences were observed between both groups for any of the primary or secondary parameters.Conclusions Systemic antibiotic therapy of AMX/MTZ does not improve clinical and microbiological outcomes of non-surgical peri-implantitis treatment and should not be routinely recommended. Although complete disease resolution may be difficult to achieve, meticulously performed full-mouth non-surgical treatment, achieving a high level of daily oral hygiene and healthy periodontal tissues, can significantly improve the starting position of the subsequent (surgical) peri-implantitis treatment phase.

Aim To compare biomarker levels in peri-implant crevicular fluid (PICF) of healthy implants with levels in PICF of implants with peri-implantitis (before and after non-surgical treatment).Materials and methods Samples were taken from 20 healthy implants (n = 17 patients) and from 20 implants with peri-implantitis (n = 19 patients) before and 3 months after non-surgical treatment using the Airflow Master Piezon(R) (EMS). A Luminex (TM) assay was used to evaluate pro-inflammatory and anti-inflammatory cytokines IL-1 beta, TNF-alpha, IL-6 and G-CSF, collagen degradation enzyme MMP-8, chemokines MCP-1 & MIP-1 alpha/CCL3, bone markers OPG and sRANKL and interferon-gamma. Clinical and radiographical characteristics were assessed. A Mann-Whitney U and Wilcoxon signed-rank test analysed between- and within-group differences.Results IL-1 beta and MMP-8 levels were found significantly elevated in implants with peri-implantitis (p = .007; p =Conclusion Implants diagnosed with peri-implantitis have higher levels of IL-1 beta and MMP-8 in PICF compared to healthy implants. Non-surgical therapy did not influence the inflammatory immune response.

Aim The aim of this prospective cohort study was to assess the effect of a pocket irrigator/evacuator device (IED) in the non-surgical treatment of peri-implantitis. Material and Methods In total 24 patients having 38 implants diagnosed with peri-implantitis were included in this study. Peri-implant pockets were irrigated six times in three consecutive weeks. The primary outcome was bleeding on probing (BoP). Secondary outcome parameters included plaque index (Pl), suppuration on probing (SoP), probing pocket depth (PPD), marginal bone loss (MBL), presence and numbers of periodontal pathogens. Parameters were assessed at baseline and 3 months after the last treatment. Treatment pain perception was scored using the visual analog scale (VAS) after the first and last treatment. Results At 3 months, IED treatment revealed significant reduction of peri-implant BoP (71% [+/- 20] vs 57% [+/- 28] [P = .014]) and peri-implant plaque scores (10 [+/- 14] to 5 [+/- 9] [P = .039] [T0 vs T3 respectively]). Significant reduction in mean peri-implant PPD from 4.92 mm (SD +/- 1.28) to 4.66 mm (SD +/- 1.35) (P = .041) was observed. In addition, a reduction in VAS pain score between the first and the last (6th) treatment was found (P = .039). No reduction in SoP (P = .088) was found. No changes in mean periodontal full mouth plaque, BOP, SOP and PPD levels, MBL and microbiological outcomes were found. Conclusion Beneficial clinical effects in terms of BoP, PPD and PI were found at 3 months after IED treatment. However, the IED does not seem to effectively treat peri-implantitis in terms of disease resolution.

To evaluate the influence of the cervical crown contour on marginal bone loss and soft tissue health around platform-switched, posteriorly placed, two-piece implants. Materials and Methods: A dataset from two previously conducted studies was used. Patients with single two-piece, platform-switched implants in between two natural teeth or adjacent to one natural tooth were included. Clinical parameters and standardized periapical radiographs from 1 month and 5 years after final crown placement were assessed. A new measurement method was developed to analyze geometric values of the cervical crown contour. Interand intraexaminer reliability were assessed. Emergence angles were measured at 1, 2, and 3 mm above the implant shoulder. Linear correlations between variables were determined by calculating Pearson correlation coefficients. Results: A total of 64 patients with 67 posterior implants met the inclusion criteria. At 1, 2, and 3 mm above the implant shoulder, mean emergence angles at the mesial implant sites were 0.5 ± 2.8, 12.8 ± 12.8, and 18.0 ± 11.3 degrees, respectively. At the distal sites, the corresponding values were 2.8 ± 8.3, 16.2 ± 16.6, and 18.7 ± 13.8 degrees, respectively. Mean marginal bone loss between 1 month and the 5-year evaluations was 0.14 ± 0.34 mm at the mesial aspect and 0.26 ± 0.47 at the distal aspect of implants. No correlation with peri-implant bone loss or soft tissue health could be found. No implants showed signs of peri-implantitis. Conclusion: The cervical crown contour at platform-switched, posteriorly placed, two-piece implants showed no correlation with peri-implant marginal bone loss or soft tissue health up to 5 years after implant placement. Int J Prosthodont 2020;33:373-379. doi: 10.11607/ijp.6365.

Periodontitis, a bacterial-induced infection of the supporting soft and hard tissues of the teeth (the periodontium), is common in patients with rheumatoid arthritis (RA). As RA and periodontitis underlie common inflammatory pathways, targeting the progression of RA might mediate both periodontitis and RA. On the other hand, patients with RA on immunosuppressive medication have an increased risk of infection. Therefore, the objective of this longitudinal observation study was to assess the effect of methotrexate (MTX) and anti-tumor necrosis factor-α (anti-TNF, etanercept) treatment on the periodontal condition of RA patients. Overall, 14 dentate treatment-naive RA patients starting with MTX and 12 dentate RA patients starting with anti-TNF therapy in addition to MTX were included. Follow-up was scheduled matching the routine protocol for the respective treatments. Prior to the anti-rheumatic treatment with MTX or the anti-TNF therapy in addition to MTX, and during follow-up, i.e., 2 months for MTX, and 3 and 6 months for the anti-TNF therapy in addition to MTX, the periodontal inflamed surface area (PISA) was measured. The efficacy of the anti-rheumatic treatment was assessed by determining the change in RA disease activity (DAS28-ESR). Furthermore, the erythrocyte sedimentation rates were determined and the levels of C-reactive protein, IgM-rheumatoid factor, anti-cyclic citrullinated protein antibodies, and antibodies to the periodontal pathogen Porphyromonas gingivalis, were measured. Subgingival sampling and microbiological characterization of the subgingival microflora was done at baseline. MTX or anti-TNF treatment did not result in an improvement of the periodontal condition, while both treatments significantly improved DAS28 scores (both p &lt, 0.01), and reduced C-reactive protein levels and erythrocyte sedimentation rates (both p &lt, 0.05). It is concluded that anti-rheumatic treatment (MTX and anti-TNF) has negligible influence on the periodontal condition of RA patients.