Journal Club- January 2022
A randomized controlled trial evaluating hyaluronic acid gel as wound healing agent in alveolar ridge preservation. Célien E, Julie A, Maarten G, Jan C. J Clin Periodontol. 2021 Dec 27. doi: 10.1111/jcpe.13589
Food Intake, Masticatory Function, Tooth Mobility, Loss of Posterior Support and Diminished Quality of Life Are Associated with More Advanced Periodontitis Stage Diagnosis. Uy SNMR, Deng K, Fok CTC, Fok MR, Pelekos G, Tonetti MS. J Clin Periodontol. 2021 Dec 21. doi: 10.1111/jcpe.13588.
Minimally invasive treatment of gingival recession by vestibular incision subperiosteal tunnel access technique with collagen membrane and advanced platelet-rich fibrin: A 6-month comparative clinical study. Jain KS, Vaish S, Gupta SJ, Sharma N, Khare M, Nair MM. J Indian Soc Periodontol. 2021 Nov-Dec;25(6):496-503. DOI: 10.4103/jisp.jisp_590_20
Treatment of periodontal intrabony defects using bovine porous bone mineral and guided tissue regeneration with/without platelet-rich fibrin: A randomized controlled clinical trial. Liu K, Huang Z, Chen Z, Han B, Ouyang X. J Periodontol. 2021 Nov;92(11):1546-1553. DOI: 10.1002/JPER.20-0860
Leukocyte- and Platelet-Rich Fibrin Versus Connective Tissue Graft for a Coronally Advanced Flap in the Treatment of Miller Class I and II Localized Gingival Recessions: A Randomized Controlled Clinical Trial. Andrade CA, Ruiz AS, Messina DR, Quirynen M, Carrasco NP. Int J Periodontics Restorative Dent. 2021 Nov-Dec;41(6):e287-e296. doi: 10.11607/prd.5093. PMID: 34818400.
Preliminary Results of a Minimally Invasive Microsurgical Approach to Sinus Floor Elevation and Bone Reconstruction Using a Palatal Septum Window. Moreno Rodríguez JA, Pecci-Lloret M, Ortiz Ruiz E, Ortiz Ruiz AJ. Int J Periodontics Restorative Dent. 2021 Nov-Dec;41(6):e255-e263. doi: 10.11607/prd.4810. PMID: 34818393.
Immediate Implant Placement In Conjunction With Guided Bone Regeneration And/Or Connective Tissue Grafts: An Experimental Study In Canines. Lim H, et al. J Periodontal Implant Sci. 2021 Dec;51(6):e44. doi.org/10.5051/jpis.2104040202.
Effects Of Hyaluronic Acid And Deproteinized Bovine Bone Mineral With 10% Collagen For Ridge Preservation In Compromised Extraction Sockets. Lee J, et al. J Periodontol. 2021; 92;1564-1575. doi: 10.1002/JPER.20-0832.
Association Between metabolic biomarkers and localized stage II/III periodontitis in young adults: The CHIEF Oral Health study. Tsai, K.-Z., Su, F.-Y., Cheng, W.-C.,Huang, R.-Y., Lin, Y.-P., & Lin, G.-M. (2021). Journal of Clinical Periodontology, 48(12), 1549–1558. DOI: 10.1111/jcpe.135551558TSAIET AL.
Serum antibody response against periodontal bacteria and coronary heart disease: Systematic review and meta-analysis. Joshi, C., Bapat, R., Anderson, W.,Dawson, D., Cherukara, G., & Hijazi, K. (2021). Journal of Clinical Periodontology, 48(12), 1570–1586. Doi: 10.1111/jcpe.135501586JOSHIET AL.
The loss of molars in supportive periodontal care: a 10-year follow-up for tooth- and patient-related factors. Costa FO, Cortelli JR, Cortelli SC, Costa AA, Esteves Lima RP, Costa AM, Pereira GHM, Cota LOM. J Clin Periodontol. 2021 Dec 14. doi: 10.1111/jcpe.13585. Epub ahead of print. PMID: 34905803.
A randomised clinical trial to investigate the effect of dietary protein sources on periodontal health. Eberhard J, Ruiz K, Tan J, Jayasinghe TN, Khan S, Eroglu E, Adler C, Simpson SJ, Le Couteur DG, Raubenheimer D, Macia L, Gosby AK, Ribeiro RV. J Clin Periodontol. 2021 Dec 21. doi: 10.1111/jcpe.13587. Epub ahead of print. PMID: 34935176.
Use of transcortical miniscrews for alveolar ridge preservation following tooth extraction: A pilot study. Joseph S, Oh SL, Pae EK, Joshi S. Clin Oral Implants Res. 2021 Nov 5. doi: 10.1111/clr.13875. Epub ahead of print. PMID: 34741321.
Erythritol air polishing in the surgical treatment of peri-implantitis: A randomized controlled trial. Hentenaar DFM, De Waal YCM, Stewart RE, Van Winkelhoff AJ, Meijer HJA, Raghoebar GM. Clin Oral Implants Res. 2021 Nov 22. doi: 10.1111/clr.13881. Epub ahead of print. PMID: 34808006.
Keratinized mucosa changes around one-stage implants: A prospective case series. Mainas G, Ruiz Magaz V, Valles C, Mora J, Candiago J, Pascual A, Nart J. Clin Implant Dent Relat Res. 2021 Dec 22. doi: 10.1111/cid.13053. Epub ahead of print. PMID: 34939306.
Survival rates of ultra-short (<6 mm) compared with short locking-taper implants supporting single crowns in posterior areas: A 5-year retrospective study. Lombardo G, Signoriello A, Marincola M, Liboni P, Bonfante EA, Nocini PF. Clin Implant Dent Relat Res. 2021 Dec;23(6):904-919. doi: 10.1111/cid.13054. Epub 2021 Nov 18. PMID: 34796619.
Topic: Wound Healing
Authors: Célien E, Julie A, Maarten G, Jan C
Title: A randomized controlled trial evaluating hyaluronic acid gel as wound healing agent in alveolar ridge preservation
Source: J Clin Periodontol. 2021 Dec 27
DOI: 10.1111/jcpe.13589
Type: RCT
Keywords: alveolar ridge preservation, bovine bone mineral, collagen matrix, dental implant, extraction, hyaluronic acid, single tooth
Background: Hyaluronic acid gel has many properties believed to benefit wound healing such as bacteriostatic, anti-inflammatory and immunosuppressive.
Purpose: To investigate the use of hyaluronic acid gel to improve healing of ridge preservations
Methods: Patients were included in this randomized clinical trial study that needed tooth extractions in the aesthetic bone. All sites must have >50% of buccal bone to be present following extraction. Smokers, systemic disease, unstable perio and caries were excluded. Buccal soft tissues were never elevated. Groups were randomly assigned. Test groups were treated with Hyaluronic acid gel and control groups were not. Both groups had ridge preservation following extraction treated with Bio-Oss Collagen (C-DBBM) and were filled to the level of lingual bone crest. Mucograft seal were sutured on top with 4-6 single sutures. Test groups then had application of 0.8% HA gel. Patients were instructed to apply HA gel onto collagen matrix 3x a day for 7 days. Patients were amoxicillin 2g and ibuprofen 600mg before surgery and for 4 days after.
Primary outcomes were changes in wound dimensions. Secondary outcomes were patient compliance, amount of analgesic used, self-report pain and socket wound healing score. Immediate outcomes were evaluated at 1 week, 3 weeks and secondary outcomes 4-months. Changes in bone dimensions, changes in buccal soft tissue. Soft tissue height at center and mucosal scarring. Digital surface models were taken, and statistical analysis completed.
Results: Twenty- three sites were included for both the control and test groups each. There were no significant difference in wound dimensions from baseline to three weeks post-op between groups. HA gel group did show most sites completely healed at 3 weeks. More horizontal bone loss was seen at coronal aspect found in test group (HA gel group). No difference between groups for analgesic use, patient reports outcomes, soft tissue change, mucosal scaring.
Conclusion: Hyaluronic acid gel did not show improved wound healing after ridge preservation surgeries.
Topic: Mastication
Authors: Uy SNMR, Deng K, Fok CTC, Fok MR, Pelekos G, Tonetti MS.
Title: Food Intake, Masticatory Function, Tooth Mobility, Loss of Posterior Support and Diminished Quality of Life Are Associated with More Advanced Periodontitis Stage Diagnosis
Source: J Clin Periodontol. 2021 Dec 21
DOI: 10.1111/jcpe.13588.
Type: Cross sectional study
Keywords: periodontitis, stage IV, masticatory dysfunction, tooth loss, oral health related quality of life, diet
Purpose: associate measures of masticatory function with periodontitis clinical parameters and Stage and Grade diagnosis.
Methods: Two-hundred and fourteen subjects were included in this study. Subjects were evaluated with an intraoral exam and perio charting. Each patient was given a periodontal stage diagnosis. Subjects were then given a masticatory dysfunction questionnaire and quantitative test. Patients were given chewing gum with two different colors and were evaluated on ability to mix colors after 20 chewing cycles. The chewing gum’s hue was evaluated.
Results: Subjects with Stage IV perio had most self-reported impairments relating to quality of life, reduced their foot intake and altered food types due to chewing difficulties. Chewing gum test also determined similar findings of more masticatory dysfunction with more advanced stages of periodontal disease. More variation of hue of gum was found in patients with higher stages of periodontal disease. A positive association was found between mean CAL and variation of hue of gum. Loss of functional tooth units, the number of hypermobile teeth and the mean CAL were the variables with the largest effect. No association was found between presence of a removable partial denture and variation of hue of gum.
Conclusion: Subjects with more advanced periodontal diagnosis reported and had more trouble with mastication. Subjects diagnosed with Stage IV had the most self-reported masticatory dysfunction and presented with the most difficulty when chewing effectiveness was evaluated.
Topic: Root Coverage
Authors: Jain KS, Vaish S, Gupta SJ, Sharma N, Khare M, Nair MM.
Title: Minimally invasive treatment of gingival recession by vestibular incision subperiosteal tunnel access technique with collagen membrane and advanced platelet-rich fibrin: A 6-month comparative clinical study.Source: J Indian Soc Periodontol. 2021 Nov-Dec;25(6):496-503.
DOI: 10.4103/jisp.jisp_590_20
Type: Comparative clinical study
Keywords: advanced platelet-rich fibrin, collagen, healiguide, minimally invasive, root coverage, vestibular incision subperiosteal tunnel access
Purpose: To assess the vestibular incision subperiosteal tunnel access (VISTA) technique for the treatment of Miller Class I or 2 recession defects, and to compare the effectiveness of a bioresorbable collagen membrane or platelet-rich fibrin (A-PRF).
Methods: A total of 20 sites in patients were utilized in this study. Each patient presented with a minimum of 2 sites with either a Miller Class I or II buccal gingival recession. All patients underwent phase 1 therapy prior to surgical intervention. Group 1 consisted of 10 sites and these sites were treated via VISTA with A-PRF. Group 2 consisted of 10 sites and these sites were treated via VISTA with bioresorbable collagen membrane (Healiguide®). All clinical parameters were recorded at baseline, 3-months, and 6-months post-surgery. Stents were used when measurements were taken. VISTA technique was done as described by Dr. Zadeh. A specialized coronally anchored suturing technique was also used to coronally position the flap. Midline sutures were removed after 1 week and after 3 weeks the specialized sutures were removed.
Results: Pocket depth reduction was observed in both Group 1 (0.9mm to 0.7mm) and 2 (0.9mm to 0.5mm). Group 1 displayed a keratinized gingiva width gain of 4.4mm to 5.0mm, and Group 2 displayed a gain of 4.3mm to 5.15mm. However, at the 3-month and 6-month period the difference between Group 1 and 2 were determined not to be significantly different. At baseline, the recession height for Group 1 was 2.05mm and Group 2 was 2.00mm, and at the end of the study the recession height was 0.35mm (Group 1) and 0.80mm (Group 2).
Conclusion: The results of this study suggest that the VISTA technique can be used to accomplish root coverage in Miller Class I and II recession defects. Both the A-PRF and the collagen membrane groups yielded good clinical outcomes. Authors report that more long-term studies are needed to evaluate the stability of the VISTA technique.
Topic: Periodontal Regeneration
Authors: Liu K, Huang Z, Chen Z, Han B, Ouyang X.
Title: Treatment of periodontal intrabony defects using bovine porous bone mineral and guided tissue regeneration with/without platelet-rich fibrin: A randomized controlled clinical trial.
Source: J Periodontol. 2021 Nov;92(11):1546-1553.
DOI: 10.1002/JPER.20-0860
Type: Randomized clinical trial
Keywords: guided tissue regeneration, periodontal, platelet-rich fibrin, randomized controlled trials
Purpose: To analyze the clinical differences of grafting with bovine porous bone mineral– platelet-rich fibrin (BPBM-PRF) or bovine porous bone mineral (BPBM) alone for periodontal regeneration in intrabony defects.
Methods: A total of 15 patients were utilized in this study. Each patient included were diagnosed with Stage IV Grade C periodontitis. Each patient had at least one intrabony defect >3mm located on either side of the mouth. All patients underwent initial periodontal therapy. Smokers were not included. One patient did withdraw, so a total of 65 intrabony defects in 14 patients were analyzed. Test group consisted of the BPBM-PRF complex and control group consisted of BPBM alone. A resorbable collagen membrane was used in both groups. Periodontal surgery was always done first on the left side and blood was always collected even if PRF was not going to be used. Patients were all given antibiotics and chlorhexidine post-operatively. Sutures were removed after 2 weeks. All patients were evaluated at 6, 12, and 24 months. Boney defects were also analyzed radiographically.
Results: The time for bone grafting was significantly shorter for the test group (23.9 secs) when compared to the control group 144 secs). At the 12 and 24-month periods the mean difference between the probing depths for both groups were 0.6-0.7mm. The difference in CAL gain between the 2 groups was observed to be 0.9-1.1mm.
Conclusion: The results of this study suggest that BPBM combined with PRF used for guided tissue regeneration results in better clinical outcomes when compared to BPBM alone. Authors report that more long-term studies are necessary.
Topic: Treatment of gingival recessions
Author: Andrade Catherine, et al.
Title: Leukocyte- and Platelet-Rich Fibrin Versus Connective Tissue Graft for a Coronally Advanced Flap in the Treatment of Miller Class I and II Localized Gingival Recessions: A Randomized Controlled Clinical Trial.
Source: Int J Periodontics Restorative Dent. Nov-Dec 2021;41(6):e287-e296
DOI: 10.11607/prd.5093
Type: Randomized controlled clinical trial
Keywords: Connective Tissue, Gingival Recession, surgery, Platelet-Rich Fibrin, Tooth Root, Treatment Outcome
Purpose: To compare leukocyte and platelet rich fibrin (L-PRF) with connective tissue graft (CTG) during a coronally advanced flap (CAF) procedure to treat Miller Class I or II localized gingival recessions.
Methods: Thirteen patients participated in the randomized controlled clinical trial. Control group: 17 sites that received CAF +CTG. Test group: 17 sites CAF +L-PRF. The inclusion criteria: systemically healthy patients, with Miller Class I or II gingival recession of 3mm at the buccal aspect of anterior and premolars, an identifiable CEJ.
Clinical parameters were assessed at baseline and 1,3-, and 6-months posttreatment: gingival recession depth (RD), gingival recession width (RW), probing depth (PD), clinical attachment level (CAL), keratinized tissue height (KTH), gingival thickness (GT) at 3 mm for the gingival margin, root coverage (RC). Additionally, postoperative morbidity and esthetics were evaluated.
Patients enrolled received initial therapy (prophylaxis session) and had <20% of plaque according to O’Leary index. Surgical technique: local anesthetic delivered, root was planed and treated with Tetracycline HCL for 3 minutes, then rinsed for 60s. CAF was performed following the technique described by de Sanctis and Zucchelli (trapezoidal-shaped flap, split-full-split), the papillae were deepithelialized. Once the flap was passively extended coronal to the CEJ, a CTG from the palate or a double L-PRF membrane was utilized over the recession, up to the level of the CEJ, and fixed with resorbable sutures. The two L-PRF membranes were attached with a resorbable suture to obtain one thick and more stable membrane. Finally, the flap was coronally advanced and stabilized. Flowable composite was applied at the interproximal sites to anchor the suture. Postoperative instructions: ketoprofen 100mg was prescribed, liquid diet and do not sports activity for 2 weeks, do not brush the area and just to rinse with chlorhexidine 0.12% three times a day for 1 minute.
Results: Both approaches had significant improvements in recession depth, recession width, and clinical attachment level. CAF + CTG achieved higher root coverage at 1, 3 and 6 months and higher esthetic score at 6 months. CAF + L-PRP displayed significantly lower pain scores and fewer postoperative complications.
Parameters
| CAF +CTG | CAF + L-PRF | |
| Recession depth | Baseline 3.2mm
3 months -3.1mm 6 months -3.2mm |
Baseline 3.2mm
3 months -3.0mm 6 months -3.1mm |
| Recession width | Baseline 3.6mm
3 months -3.2mm 6 months -3.4mm |
Baseline 3.6mm
3 months -3.2mm 6 months -3.3mm |
| Root coverage % | 3 months 94.8
6 months 97.6 |
3 months 93.8
6 months 97.1 |
Conclusion: Overall, CAF +CTG and CAF +L-PRP demonstrated to be an effective treatment for Miller Class I or II localized gingival recession. CTG continues to be the gold standard, due to the higher percentage of root coverage and the best esthetic results obtained. Nevertheless, CAF + L-PRF represents a great alternative for posterior teeth or systemically compromised patients (older patients) since the technique demonstrated lower pain scores and fewer postoperative complications.
Topic: Sinus floor elevation
Title: Preliminary Results of a Minimally Invasive Microsurgical Approach to Sinus Floor Elevation and Bone Reconstruction Using a Palatal Septum Window.
Source: Int J Periodontics Restorative Dent. Nov-Dec 2021;41(6):e255-e263.
DOI: 10.11607/prd.4810
Type: Case reports
Keywords: Dental Implantation, Endosseous, Dental Implants, Maxillary Sinus / diagnostic imaging, Maxillary Sinus / surgery, Molar / surgery, Sinus Floor Augmentation.
Purpose: to present a new minimally invasive surgical approach to elevate the sinus floor for bone augmentation and implant placement.
Methods: The procedures were performed by the same surgeon under magnification (X6). Palatal septum window technique: maxillary molar was sectioned and extracted to avoid damage of intra-alveolar septum. And bony walls. Granulation tissue removed and socket was rinsed. If necessary osteoplasty was done to improve visibility. A micro-window was prepared on the palatal wall of the intra alveolar septum. To get access to the maxillary sinus, the window must cover at least two coronal thirds of the wall without damaging the fornix of the septum. Membrane raised together with the bone fragment (when it could be preserved). The membrane was elevated above the root processes along the access window in order to create the adequate space. The site was filled with xenograft/ (Bio-Oss) and covered with a non-resorbable membrane (Cytoplast). The soft tissue was approached utilizing a cross-sutured. The membrane was removed at 3 to 4 weeks. The implant was placed 6 months after the surgery, during the surgery and prior to place the implant, a biopsy was taken. Postoperative instructions: Ibuprofen 600mg + Amoxicillin 500mg, chlorhexidine 0.12% rinses three times a day for 4 weeks, nasal decongestants for at least 5 days.
Results: four patients participated. Maxillary molars had undergone root canal treatment, but lack of tooth structure made them non-restorable. After CBCT analysis, the sinus cavity extended between the molar roots and had a mean interradicular bone height of 2.4mm, and the cortical thickness of the palatal septum was 1.77mm. The mean gain in bone height was 7.87 with a mean reduction of 1.35mm of crestal width. The implant was placed without the need for additional bone reconstruction. Histologic analysis: presence of native bone in combination with bone marrow component, newly formed bone and residual particles from graft material. New bone was seen containing blood vessels and osteocytes. The newly formed bone was completely integrated and barely distinguished from the mature cortical bone. No inflammatory cells were observed.
| Baseline | 6 months | |
| Bone height | 2.4±0.58mm | 10.27±1.8mm |
| Crestal width | 12.4±1.1mm | 11.2±1.15mm |
Conclusion: The study shows that the palatal septum window for sinus floor elevation at the time of extraction provides several advantages. The area to be reconstructed is contained by several bony walls increasing the regenerative potential. Also, septum/ fornix maintenance favors the graft material’s stability in combination with the clot. The technique is indicated when reduced crestal height is present and when the maxillary sinus floor is invaginated between the roots of the molars (palatal root in close contact with the sinus). The technique is contraindicated when the root divergence is insufficient and cases with limited visibility.
Topic: Immediate implants
Title: Immediate Implant Placement In Conjunction With Guided Bone Regeneration And/Or Connective Tissue Grafts: An Experimental Study In Canines.
Source: J Periodontal Implant Sci. 2021 Dec;51(6):e44
DOI: 10.5051/jpis.2104040202
Type: Animal study
Keywords: alveolar ridge augmentation, animal experimentation, dental implantation
Purpose: To study the effects of bone and soft tissue grafting during immediate implant placement using a canine model.
Methods: Five mongrel dogs underwent hemi-sections of the maxillary premolars (P2 and P3) under general anesthesia. Sulcular incisions performed, buccolingual flaps were reflected, and then hemi-sections were carried out by extracting the distal roots and performing pulpectomies on the remaining mesial roots using CaOH. Next, 3.2x7mm NR line implants (Dentium) were immediately placed and healing abutments connected in the distal root sockets, leaving a buccal gap of 0.5-1mm between the implant and buccal wall. The sites received one of the 4 following treatment modalities: 1) guided bone regeneration (GBR) only using biphasic calcium phosphate (Osteon) and a cross-linked collagen membrane (Genoss) 2) subepithelial connective tissue grafting (SCTG) only using autogenous tissue harvested from the palate 3) GBR+SCTG 4) no additional treatment (control). In the sites that received GBR, bone graft was placed within the gap and used to overbulk to the buccal aspect, and membranes were tacked apically. Animals were sacrificed at 4 months post-operatively and maxillary segments underwent histologic and histomorphometric analysis.
Results: Histologically, majority of specimens demonstrated no BIC more coronal than the third implant thread. Histomorphometric analysis revealed that the median vertical distance of the buccal peri-implant marginal mucosa was coronal to the implant platform, with a range of 1.24-1.99mm, but NSSD was found between groups. The vertical distance of the marginal buccal mucosa to the site of first BIC was similar for the GBR only (4.06mm), SCTG (3.86mm), and control group (3.97mm)—while the GBR+SCTG exhibited the shortest distance (3.37mm), however NSSD was found between groups. Tissue thickness measurements favored greatest thickness with SCTG only group (0.78mm) and the least amount of thickness within the SCTG+GBR group (0.30mm)—however NSSD was found between any of the groups.
Conclusion: While NSSD were found between any of the groups, the use of SCTG only during immediate implant placement (IIP) tended to result in the best soft tissue outcomes (horizontal and vertical dimensions). Whereas, simultaneous hard and soft tissue grafting during IIP did not provide any additional benefit.
Topic: Ridge preservation
Title: Effects Of Hyaluronic Acid And Deproteinized Bovine Bone Mineral With 10% Collagen For Ridge Preservation In Compromised Extraction Sockets
Source: J Periodontol. 2021; 92;1564-1575
DOI: 10.1002/JPER.20-0832
Type: Animal study
Reviewer: Lauren Langlois
Keywords: alveolar bone grafting, bone regeneration, growth factors, hyaluronic acid, tooth extraction, tooth socket
Background: Hyaluronic acid (HA) is a high molecular weight glycosaminoglycan (GAG) that comprises a large component of the extracellular matrix within the periodontium. Previous study demonstrated a positive effect of HA in infected extraction sockets and also its ability to increase production of osteocalcin (marker for bone formation).
Purpose: To study the effectiveness of HA and deproteinized bovine bone mineral with 10% collagen (DBBM-C) when used for ridge preservation in compromised extraction sockets.
Methods: A combined endo-perio lesion was induced in 8 beagle dogs, involving hemi-section of the mandibular molars and the placement of a Porphyromonas gingivalis-soaked silk ligature at CEJ of the remaining mesial root. Four months following lesion induction, the mesial root was extracted, sockets were thoroughly debrided, and sites were assigned to one of the following four treatment groups: 1) absorbable collagen sponge (ACS), 2) ACS+ HA (ACS soaked with 1% of hyaluronic acid [HA] gel), 3) RP (ridge preservation with DBBM-C), 4) RP+HA (ridge preservation with DBBM-C mixed with HA). In sites where HA was placed (ACS+HA and RP+HA), the biomaterial was soaked for 15 min in 1%HA, placed to the level of the bone crest, and Mucograft was sutured on top of DBBM-C. Animals were sacrificed after 1 and 3 months, mandibles were processed, and dimensional ridge changes and bone formation were analyzed using microcomputed tomography, histology, and histomorphometry.
Results: At 3 months following tooth extraction, ridge width was significantly higher in RP (11.0mm) and RP+HA (9.39mm) than ACS (-1.92mm) and ACS+HA (-3.74mm). While, ACS+ HA and RP+HA treatment groups demonstrated the highest proportion of mineralized bone and bone volume density compared to ACS and RP. Both ACS+HA and RP+HA exhibited significantly more mineralized bone and newly formed bone than the other two groups, with NSSD between ACS+HA and RP+HA.
Conclusion: 1) ACS+HA enhanced bone formation but was unable to prevent loss of ridge dimensions, 2) RP treatment reduced ridge loss, but resulted in less bone formation, 3) RP+HA demonstrated both reduction of ridge loss and promotion of bone formation.
Ridge preservation with DBBM-C and HA enhanced bone formation while also minimizing ridge shrinkage in compromised extraction sockets at 1- and 3- months, suggesting that DBBM-C may be a suitable carrier for HA.
Topic: Metabolic Syndrome
Author: Tsai, K.-Z., Su, F.-Y., Cheng, W.-C.,Huang, R.-Y., Lin, Y.-P., & Lin, G.-M.
Title: Association Between metabolic biomarkers and localized stage II/IIIperiodontitis in young adults: The CHIEF Oral Health study.
Source: Journal of Clinical Periodontology, 48(12), 1549–1558
DOI: 10.1111/jcpe.135551558TSAIET AL.
Type: Cohort Study
Keywords: localized periodontitis, metabolic syndrome, young adults
Background: Metabolic syndrome (MetS) is a cluster of risk factors for atherosclerosis and predictor of future cardiovascular issues. MetS is a systemic condition involving at least three of the following abnormalities: dyslipidemia (high triglycerides or low HDL), hyperglycemia/insulin resistance, hypertension, and central obesity. In the United States, 21.6% of the population had MetS in 2003-2004. MetS may be related to periodontitis.
Purpose: To investigate the associations between metabolic risk factors (metabolic syndrome) and periodontitis in young adults.
Methods: Military members age 19-40 were divided into healthy (including stage I periodontitis) and localized stage II/III periodontitis. A total of 1123 patients were included (995 males, 128 females). Patients answered a questionnaire for demographics. The patients underwent a military health examination including physical and lab testing. Regression analysis was performed to adjust for sex, age, betel nut consumption, and smoking.
Results: Localized stage II/III periodontitis risk was highly associated with greater waist circumference, serum triglycerides, and serum uric acid. Total cholesterol, HDL, and blood pressure were not associated with periodontal status. Fasting glucose had a non-linear association with localized stage II/III periodontitis. The turning point for fasting glucose was 105 mg/dl, with an odds ratio of 0.97 and 1.06 when levels were <105 and ≥ 105 mg/dl, respectively. LDL-C was seen to be a risk factor for periodontitis in women and correlated positively with PPD and CAL. The higher the MetS severity scores, the greater the risk of localized stage II/III periodontitis in young adults.\
Conclusion: Plasma glucose had a non-linear relationship with localized stage II/III periodontitis in young adults. Waist circumference, serum triglycerides, and serum uric acid all were risk factors in this population. Controlling these metabolic risk factors may help reduce severe periodontitis in young adults.
Topic: Antibodies and CHD
Author: Serum antibody response against periodontal bacteria and coronary heart disease: Systematic review and meta-analysis.
Title: Joshi, C., Bapat, R., Anderson, W.,Dawson, D., Cherukara, G., & Hijazi, K.
Source: Journal of Clinical Periodontology, 48(12), 1570–1586.
DOI: 10.1111/jcpe.135501586JOSHIET AL.
Type: Systematic review
Keywords: antibodies, coronary heart disease, periodontitis, P. gingivalis, A. actinomycetemcomitans
Purpose: To assess the reported association between elevated serum anti-periodontal bacterial antibody responses and coronary heart disease (CHD).
PICO: In the adult population (P), compared to the control participants (C), is elevated serum antibody response against periodontal bacteria (E) associated with an increased risk of coronary heart disease (O)?
Methods: Twenty studies of an initial 752 studies from five databases were included that compared serum anti-P. gingivalis and/or anti-A actinomycetemcomitans IgG antibody responses between CHD and control patients. Both serum sample positivity or elevated/high levels of antibody responses were considered exposures of interest. Endpoints included CHD, CAD, ischemic heart disease, cardiovascular disease leading to MI, acute coronary syndrome, and unstable angina pectoris.
Results: Ten studies compared anti-Pg responses and six recorded anti-Aa responses. The rest compared IgA. CHD was verified by either self-reported questionnaires or physician-verified clinical records. Nineteen of twenty studies used serum samples to measure periodontal antibody responses, with one measuring plasma samples. CHD was the major outcome of interest, so independent association of anti-Pg and anti-Aa responses could not be measured with angina, ACS, or MI. Serum IgG antibody responses were higher in CHD patients than controls in 61% of studies. Patients with elevated serum anti-Pg or anti-Aa IgG antibody levels were 1.2 times more likely to have CHD.
Conclusion: Serum antibodies for Pg and Aa may be used as potential biomarkers for CHD but more research is needed given the inconsistencies with the design and assay interpretation in this study.
Topic: Tooth loss
Title: The loss of molars in supportive periodontal care: a 10-year follow-up for tooth- and patient-related factors
Source: J Clin Periodontol.
DOI: 10.1111/jcpe.13585
Type: Retrospective cohort study
Keywords: molar, tooth loss, furcation defects, smoking, diabetes, periodontal maintenance, periodontitis
Purpose: The purpose of the study is the assess the impact of tooth related factors, patient related factors and furcation involvement on the loss of molars in patients undergoing supportive periodontal care.
Material and methods: This study included 222 individuals diagnosed with stage 2, 3 and 4 periodontitis resulting in 1, 329 molars evaluated throughout 10 years of supportive periodontal care. The patients underwent active periodontal therapy including non-surgical and or surgical treatment. Periodontal clinical parameters including probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), furcation involvement, pulp vitality, type of molar were collected at 50 days after periodontal therapy and after 10 years. Using the cox regression analysis, the association between tooth and patient related factors and loss of molars was evaluated.
Results: The study resulted in the extraction of 235 molars during the 12.4 years of supportive periodontal care with a total survival rate of 82.3%.161 molars (68.7%) molars were lost due to periodontal involvement with 80.7% of those were due to class 3 furcation involvement. All periodontal clinical parameters (PD, CAL, BOP) were found to significantly worsen compared to baseline and there was a significant increase in class 2 and 3 furcation involvement. Patient- related factors associated with the loss of molars during supportive periodontal care included males, diabetes, smoking, older than 50 years old and no compliance. Tooth related factors associated with the loss of molars include PD ≥ 5 MM, non-vital teeth, class 2 and 3 furcation and bleeding on probing.
Conclusions: Patient related factors and tooth related factors are significantly associated with loss of molar and therefore should be considered when treatment planning and deciding whether to keep or extract teeth. Tooth non-vitality, greater PD and BOP, class 3 furcation involvement, age, diabetes, smoking and male gender all greatly influences the prognosis of molars.
Topic: Factors affecting periodontal health
Title: A randomised clinical trial to investigate the effect of dietary protein sources on periodontal health
Source: J Clin Periodontol.
DOI: 10.1111/jcpe.13587
Type: Randomized clinical trial
Keywords: plant proteins, periodontal health, dietary fats, carbohydrates
Purpose: To determine the effects of macronutrients on oral health.
Material and methods: This study included 67 healthy individuals with a BMI between 20-35 kg/m ². Patients committed to one of four diets including omnivorous higher fat, omnivorous higher carbohydrates, semi-vegetarian higher fat or semi-vegetarian higher carbohydrate for 4 weeks. Before and after the trial, periodontal probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), oral plaque and gingival crevicular fluid was collected.
Results: This study found that there was no significant difference in PPD and CAL at baseline and at the 4 week follow up in patients undergoing an omnivorous high fat, omnivorous high carbohydrates, and semi- vegetarian high carbohydrate diet. Those eating a semi-vegetarian high fat diet had a significant increase in the number of sites with CAL < 5 mm and decrease in the amount of gingival crevicular fluid and number of sites with CAL ≥ 5 mm between base line and the 4 week follow up. A significant difference in PPD reduction > 1 mm was found between omnivorous high carbohydrate diet and semi vegetarian high fat diet and between omnivorous high fat diet and high carbohydrate diet. Significant difference between CAL gain > 1 mm between omnivorous high carbohydrate diet and semi vegetarian high fat diet and between omnivorous high fat diet and high carbohydrate diet was also found. Overall, the oral microbiota was not found to be associated with clinical parameters when comparing the alpha diversity for all 4 diets in supragingival and subgingival plaque pre-intervention and post-intervention. Lastly, no changes between oral health behavior were found at baseline and at the 4 week follow up.
Conclusions: This study provides evidence that a semi-vegetarian higher fat diet can be beneficial to periodontal health by improving the clinical parameters.
Topic: Transcortical miniscrews
Authors: Joseph S, Oh SL, Pae EK, Joshi S
Title: Use of transcortical miniscrews for alveolar ridge preservation following tooth extraction: A pilot study.
Source: Clin Oral Implants Res. 2021 Nov 5
DOI: 10.1111/clr.13875
Type: Pilot clinical study
Reviewer: Erin Schwoegl
Keywords: case report; extraction socket; ridge preservation; transcortical miniscrew; volumetric analysis.
Background: Transcortical miniscrews, most often used for temporary orthodontic anchorage, do not integrate completely, allowing for ease of removal. Previous studies have indicated that placing miniscrews in extraction sockets may prevent bone remodeling and have low risk of peri-implant inflammation.
Purpose: To observe the effects of placing transcortical miniscrews over the buccal plate of extraction sockets
Methods: Included six adult patients who required extraction of a left and right maxillary premolar. The left and right sides were randomly assigned to either the experimental group (placement of miniscrews), or the control group. Maxillary premolars were extracted atraumatically without a flap. There were no bone grafts or sutures used and no antibiotics were prescribed. Baseline CBCTs were taken 1 week postop to ensure all buccal plates were intact. A 1.4mm x 8mm miniscrew was placed 3mm below the crest of the buccal plate of the six experimental sockets. They were centered mesiodistally. An 8-month CBCT was taken immediately after miniscrews were removed.
Results: There was no inflammation, infection, of complications reported for any patient. The experimental sides displayed significantly less alveolar bone loss than the control sides, 0.7 ± 0.2mm vs. 1.3 ± 0.7mm, respectively.
Conclusion: The placement of miniscrews over the buccal plate of extraction sockets may lead to less bone resorption in the first 8 months post-extraction.
Topic: Peri-implantitis
Authors: Hentenaar DFM, De Waal YCM, Stewart RE, Van Winkelhoff AJ, Meijer HJA, Raghoebar GM
Title: Erythritol air polishing in the surgical treatment of peri-implantitis: A randomized controlled trial.
Source: Clin Oral Implants Res. 2021 Nov 22
DOI: 10.1111/clr.13881
Type: Randomized controlled trial
Keywords: dental implant; intervention study; peri-implantitis; randomized controlled trial; surgery.
Background: Erythritol can help to limit biofilm growth, displaying greater antimicrobial and antibiofilm effects than glycine. It also helps to improve cell attachment, viability, and proliferation pf osteoblasts. In vitro studies have shown support for erythritol air polishing in treatment of peri-implantitis.
Purpose: To compare the effect of erythritol air polishing to saline-soaked gauze as implant debridement methods.
Methods: All patients in this investigator-blind study previously underwent non-surgical treatment for perio-implantitis. Surgical treatment was indicated when inflammation did not subside after 3 months. Included patients had at least one implant with peri-implantitis: 5+ mm probing depth with bleeding, suppuration, and/or progressive marginal bone loss. Incisions were made to remove the inflamed tissue collar, then buccal and lingual full-thickness flaps were elevated. Granulation tissue and calculus were removed, then the peri-implant surfaces were debrided. The implant surfaces in test group were then air abraded with erythritol powder containing 0.3% chlorhexidine. The surfaces in the control group were cleaned with cotton gauze soaked in saline. The bone was recontoured as necessary and flaps were re-approximated with single interrupted sutures. Patients we re-assessed at 3-, 6-, 9-, and 12-month follow ups.
Results: A total of 27 test patients and 31 control patients completed the study. There was significant reduction of bleeding on probing in both groups, but no statistical significance between the groups. There were significant improvements in terms of suppuration and plaque levels were seen in both groups, but no difference between the control and test groups. There was no significant difference between baseline and 12-month follow ups for either groups in terms of probing depth or marginal bone loss. There were no significant peri-implant microbial changes after therapy in either group. However, the natural dentition in the control group had significant decreases in P. intermedia, T. denticola, and T. alocis 12 months after treatment.
Conclusion: Surfaces air abraded with erythritol-based powder had similar clinical, radiographical, and microbiological outcomes as the surfaces treated with saline-soaked gauze. The success of air abrasion as sole treatment is low, so further studies which investigate a combination of treatments are recommended.
Topic: Keratinized tissue
Authors: Mainas, G., Ruiz Magaz, V., Valles, C., Mora, J., Candiago, J., Pascual, A., Nart, J.
Title: Keratinized mucosa changes around one-stage implants: A prospective case series
Source: Clin Implant Dent Relat Res. 2021 Dec;23(6):904-919. Epub 2021 Nov 18.
DOI: 10.1111/cid.13054
Type: Prospective study
Keywords: dental implants; gingiva; software.
Purpose: To observe the changes of keratinized mucosa and soft tissue volume surrounding non- submerged implants before being restored prosthetically.
Background: Debate as to whether keratinized tissue is needed to maintain health around teeth has been ongoing and inconclusive. This review shows that lack of keratinized tissue may cause issues in some prosthetics and orthodontic procedures. Many articles have been released in support of needing KT around implants for health, as well as articles with the opposite opinion. An apically positioned flap design has been suggested in order to preserve keratinized mucosa around dental implants.
Materials and methods: 40 patients were included in the study who needed implants in the posterior mandible (premolar/molar region). 15 patients had thick biotype of tissue and 25 patients had thin biotype of tissue. The study included smokers and non-smokers. Each patient received a comprehensive periodontal evaluation. Periapical radiographs were taken, and oral hygiene instruction was given. All surgeries were performed by 3rd year periodontics residents. Keratinized mucosa was compared before (baseline) and after implant placement (at 3 months) on the buccal and lingual surfaces. The buccal and lingual widths of the keratinized tissue were measured. Intraoral scanning was used for impression at the time of implant placement and before restoring. Soft tissue volumes were measured at 1mm, 3mm, 5mm apical to healing abutment. T tests were performed for analyzation.
Results: At initial measurement keratinized mucosal width on the buccal was 4.54mm average and 5.04mm average on the lingual. At the 3-month evaluation the average width on the buccal was 3.15mm and on the lingual was 3.72mm. This was a statistically significant change for both surfaces. There was a statistically significant increase in tissue volume at all three points (1mm, 3mm, 5mm) measured, increase of 0.42mm, 0.22mm, and 0.12mm
Conclusion: This study determined that measuring from baseline to three months, keratinized mucosa undergoes a considerable amount of change in width around a one stage implant on buccal and lingual surfaces. Although there is a decrease in width, there is a significant increase in the volume of buccal soft tissue.
Topic: Utra short implant survival
Authors: Lombardo, G., Signoriello, A., Marincola, M., Liboni, P., Bonfante, E., Nocini, P.
Title: Survival rates of ultra-short (<6 mm) compared with short locking-taper implants supporting single crowns in posterior areas: A 5-year retrospective study
Source: Clin Implant Dent Relat Res. 2021 Dec;23(6):904-919. Epub 2021 Nov 18.
DOI: 10.1111/cid.13054
Type: Retrospective Study
Keywords: bone loss; crown-to-implant ratio; peri-implantitis; short; single crown; success; survival; ultra-short.
Purpose: To compare at 5 year follow up, locking-taper short implants (6-8mm) and ultra- short implants (5 mm length) in terms of survival of the implant, marginal bone loss, and peri-implant complications when the implant is restored with a single crown.
Background: Implant placement has proven to be a reliable method in restoring edentulous spaces. In absent of sufficient bone, restoring with short implants have been suggested instead of ridge augmentation. Success from short implants has led to development of ultra-short implants less than 6mm. Previous studies have controversy due to limitations of the study and short follow up periods with regards to ultra-short implants being restored with a single crown.
Material and methods: A retrospective study took place looking at patients from 2007-2005. 142 patients were examined in the study, in both smokers and nonsmokers. 333 implants were placed in the maxillary and mandibular posterior regions. At 5 year follow up appointments, radiographic and clinical examination took place. The locking taper implant system (Bicon dental implants) contained convergent crest module, platform switching, plateau root form design, and a surface that was hydroxyapatite treated and acid etched. All surgeries by one clinician. Maintenance performed every 4 months and clinical evaluation, and radiographs were taken 1 time per year during the 5 years. Post-surgical evaluation took place by 2 examiners who had not placed the implants. Implant lengths considered: 8.0mm, 6.0mm, and 5.0mm. Implant survival, marginal bone loss, and implant success were examined. Failure was deemed if implant removal was necessary before loading or after loading. Survival criteria: implant was symptom free, no mobility present, absence of radiolucency or bone loss so severe that it leads to implant removal. Implant success defined as absence of persistent pain, dysesthesia or paraesthesia in implant area, absence of peri-implant infection with or without suppuration, absence of perceptible mobility of the implant and absence of persistent peri-implant bone resorption greater than 1mm during the time interval from loading to 5 year follow- up. Implants without signs of peri-implantitis were considered a success. 127 implants were 8mm in length, 115 were 6mm in length, and 91 were 5mm in length.
Results: The average crown to implant ratio (CIR) was 1.94. There was statistically significant difference of the CIRs with 8mm implants average being 1.45, 6mm being 2.01, an 5mm being 2.57. At 5 years, the implant survival was 96.10%- 12 were lost and removed once functionally loaded. Crest bone level average at loading was 1.99mm, at 5 year follow up was 1.15mm. first bone in contact was 0.23mm on average and at 5 year follow up was 0.29mm. Change in crest of bone level was 0.69mm and change in first bone in contact was 0.01mm. change in crest bone level was statistically different in significance in those with a history of periodontal disease. Soft tissue conditions were stable at 5 year follow up in terms of pocket probing depth, mean bleeding index, mean plaque index, and mean keratinized tissue. At placement 19 implants experienced more than 1mm in loss of bone, and 9 of those were successfully treated. 42 implants presented with biological complications at 5 year follow up, with regards to perio-implant mucositis and peri- implantitis. Implant success was 94.06% (301/320).
Conclusions: Crest bone levels over time experience no statistically significant difference between survival and success with short and ultra-short implants. Restoring with a single crown restoration is a successful option in treatment of atrophy of the posterior jaws.