Journal Club- April 2022
Study on the immunopathological effect of titanium particles in peri-implantitis granulation tissue: a case-control study. Rakic.M, Radunovic.M, Petkovic-curcin.A. Clinical oral implants research March 28, 2022. DOI: https://doi.org/10.1111/clr.13928
Immediate implant placement vs early implant treatment in the aesthetic area. A 1 year randomized clinical trial. Puisys.A, Auzbikaviciute. V, Vindasiute-Narbute. E. Clinical oral implants research March 23, 2022. DOI: https://doi.org/10.1111/clr.13924
Volumetric assessment of changes in the alveolar ridge dimension following guided bone regeneration using a combination freeze-dried bone allograft with collagen membrane or novel resorbable scaffold: A prospective two-center clinical trial. Dowlatshahi, S, Chen, CY, Zigdon-Giladi, H, et al. J Periodontol. 2022; 93: 343– 353. DOI: 10.1002/JPER.21-0006
Efficacy of a harvest graft substitute for recession coverage and soft tissue volume augmentation: A randomized controlled trial. McGuire, MK, Janakievski, J, Scheyer, ET, et al. J Periodontol. 2022; 93: 333– 342. DOI: 10.1002/JPER.21-0131
The flat and step (F and S) pontics. Novel pontic designs for periodontally reconstructed sites. Gomez-Meda R, Esquivel J. J Esthet Restor Dent. 2022 Mar 18. doi: 10.1111/jerd.12905. Epub ahead of print. PMID: 35302708.
Treatment of Peri-implantitis Caused by Malpositioning and an Extra Implant: A Case Report. Shiba T, Katagiri S, Komatsu K, Nemoto T, Takeuchi Y, Chen B, Zhou Y, Iwata T. Int J Periodontics Restorative Dent. 2022 Jan-Feb;42(1):e15-e20. doi: 10.11607/prd.4800. PMID: 35060974.
Evaluation of failed implants and reimplantation at sites of previous dental implant failure: survival rates and risk factors. Park Y, et al. J Periodontal Implant Sci. 2022 Feb; 52(1): e4. doi.org/10.5051/jpis.2105020251
Survival of surface-modified short versus long implants in complete or partially edentulous patients with a follow-up of 1 year or more: a systematic review and meta-analysis. Medikeri R, Pereira M, Waingade N, Navale S. J Periodontal Implant Sci. 2022 Apr; 52(2): e7. doi.org/10.5051/jpis.2007340367
The prospective association between periodontal disease and brain imaging outcomes: The Atherosclerosis Risk in Communities study. Adam, H. S., Lakshminarayan, K.,Wang, W., Norby, F. L., Mosley, T., Walker, K. A., Gottesman, R. F., Meyer, K., Hughes, T. M., Pankow, J. S., Wong, D. F.,Jack, C. R. Jr., Sen, S., Lutsey, P. L., Beck, J., & Demmer, R. T. (2022). Journal of Clinical Periodontology, 49(4), 322–334. https://doi.org/10.1111/jcpe.13586334ADAMET AL.
A person-centered, theory-based, behavioral intervention programme for improved oral hygiene in adolescents: A randomized clinical field study. Dimenäs, S. L., Jönsson, B.,Andersson, J. S., Lundgren, J., Petzold, M., Abrahamsson, I., & Abrahamsson, K. H. (2022). Journal of Clinical Periodontology, 49(4), 378–387. https://doi.org/10.1111/jcpe.13601DIMENÄSET AL.387
Outcome measures and methods of assessment of soft tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years. Avila-Ortiz G, Couso-Queiruga E, Pirc M, Chambrone L, Thoma DS. J Clin Periodontol. 2022 Jan 27. doi: 10.1111/jcpe.13597.
Effect of photobiomodulation therapy on patient morbidity and wound healing at donor site after free gingival graft harvesting: a triple-blind randomized-controlled clinical trial. Valentim Bitencourt F, Cardoso De David S, Schutz JDS, Otto Kirst Neto A, Visioli F, Fiorini T. Clin Oral Implants Res. 2022 Mar 19. doi: 10.1111/clr.13923. Epub ahead of print. PMID: 35305280.
Overview of Systematic Reviews and Meta-analyses Investigating the Efficacy of Different Nonsurgical Therapies for the Treatment of Peri-implant Diseases. Joshi AA, Gaikwad AM, Padhye AM, Nadgere JB. Int J Oral Maxillofac Implants. 2022 Jan-Feb;37(1):e13-e27. doi: 10.11607/jomi.9088. PMID: 35235624.
Titanium Surface Decontamination: A Systematic Review of In Vitro Comparative Studies. Francis S, Iaculli F, Perrotti V, Piattelli A, Quaranta A. Int J Oral Maxillofac Implants. 2022 Jan-Feb;37(1):76-84. doi: 10.11607/jomi.8969. PMID: 35235623.
The Association Between Oral Health and Skin Disease. Macklis P, Adams K, Kaffenberger J, Kumar P, Krispinsky A, Kaffenberger B. J Clin Aesthet Dermatol. 2020 Jun;13(6):48-53. Epub 2020 Jun 1. PMID: 32884621; PMCID: PMC7442307.
The role of keratinized mucosa width as a risk factor for peri-implant disease: A systematic review, meta-analysis, and trial sequential analysis. Ravidà A, Arena C, Tattan M, Caponio VCA, Saleh MHA, Wang HL, Troiano G. Clin Implant Dent Relat Res. 2022 Mar 17. doi: 10.1111/cid.13080. Epub ahead of print. PMID: 35298862.
Abstracts:
Topic: Titanium particles
Authors: Rakic. M, Radunovic.M, Petkovic-curcin.A
Title: Study on the immunopathological effect of titanium particles in peri-implantitis granulation tissue: a case-control study
Source: Clinical oral implants research March 28, 2022
DOI: https://doi.org/10.1111/clr.13928
Type: Case control
Keywords: Dental implant, biopsy, peri-implantitis; immunohistochemistry; granulation tissue; cd68; nf- kb; VEGF, titanium
Purpose: To identify titanium particles in peri-implant granulation tissue harvested from peri-implantitis and if it could induce an effect on the inflammatory patterns.
Methods: Patients were systemically healthy with a diagnosis of either peri-implantitis or severe periodontitis. Patients received phase 1 therapy followed by surgical therapy. Specimens represented peri-implant and periodontal granulation tissues harvested during standard surgical treatment. Exposure of the soft tissue pocket wall by elevation of full thickness mucoperiosteal flap and care was taken to avoid root surface. Biopsy placed in 3.5% buffered formalin for immediate transportation to the laboratory. In the peri-implantitis specimens, Ti-free instruments and blades were used for tissue harvesting and sectioning to prevent any false-positivity due to possible contamination. Histological analysis completed using dispersive X-ray spectrometry and HE stains for immunohistochemistry.
Results: Thirty-nine peri-implantitis and thirty-five periodontitis specimens were available for histological evaluation. Both peri-implantitis and periodontitis specimens, a chronic inflammatory infiltrate with focal presence of neutrophils comprised most of the tissue content. In peri-implantitis specimens, the inflammatory infiltrate was denser and richer in vascular networks and hyperaemic vessels. The presence of macrophages or multinucleated giant cells engulfing the titanium particles were not identified in any specimen.
Conclusion: No foreign body reaction associated with titanium particles in peri-implantitis patients. No presence of inflammatory response was seen around titanium particles. Peri-implantitis granulation tissue presented with increase infiltrate of plasma, neutrophils and macrophages.
Topic: Immediate implant placement
Authors: Puisys. A, Auzbikaviciute. V, Vindasiute-Narbute. E
Title: Immediate implant placement vs early implant treatment in the aesthetic area. A 1 year randomized clinical trial
Source: Clinical oral implants research March 23, 2022
DOI: https://doi.org/10.1111/clr.13924
Type: RCT
Keywords: Single implant; Immediate implant treatment; Early implant treatment, Connective tissue grafting; Immediate provisionalization; Implant esthetics; Soft tissue recession.
Purpose: To assess the esthetic outcomes of immediate temporization of immediately placed tapered implants in fresh extraction sockets with soft tissue and bone augmentation.
Methods: Patients presenting with failing maxillary anterior teeth were considered for inclusion. Patients had to be at least 18 years or older, must present with no recession, no periodontal bone loss of adjacent teeth, no adjacent implants, and had the presence of buccal wall to be included in study. Patients with diabetes, osteoporosis, heavy smokers and severe 2 class malocclusion were excluded. Control group had soft tissue augmentation with connective tissue grafting (CTG), early implant placement with simultaneous guided bone regeneration and delayed loading. Test Group had immediate implant placement with socket preservation (buccal augmentation using allogenic bone), connective tissue grafting (CTG) and immediate temporization. Patients were followed for 1 year after final restoration. Evaluated the pink esthetic score, mid buccal mucosal level and crestal bone changes.
Results: 25 patients were included in the control and 25 patients in the test groups. No implant failures were noted throughout the study. Test group had a gain of .2mm of mid buccal mucosal level at 1 year follow up and no change for the control group. Crestal bone changes at 1 year were from 0.1 – 0.2mm for test group and 0.2 – 0.3mm for control group. Chair times were recorded, and study showed that test group required half the chair time compared to the control group.
Conclusion: No significant clinical difference seen between immediate implant with immediate temporalization compared to early implant placement and delayed loading. Both groups showed excellent aesthetic outcomes.
Topic: Guided Bone Regeneration
Authors: Dowlatshahi, S, Chen, CY, Zigdon-Giladi, H, et al.
Title: Volumetric assessment of changes in the alveolar ridge dimension following guided bone regeneration using a combination freeze-dried bone allograft with collagen membrane or novel resorbable scaffold: A prospective two-center clinical trial.
Source: J Periodontol. 2022; 93: 343– 353.
DOI: 10.1002/JPER.21-0006
Type: Prospective two-center clinical trial
Keywords: biomaterial(s), bone graft(s), bone regeneration, clinical trial(s), collagen(s), osseous surgery, ridge augmentation, tissue engineering
Purpose: To examine lateral bone augmentation using the novel Ossix Volumax (OV), a thick and expandable multilayer sugar cross-linked collagen scaffold, as a monotherapy and to also compare it to combination therapy using freeze-dried bone allograft plus resorbable collagen membrane (FDBA/CM).
Methods: A total of 35 patients were included in this study. Patients included in this study required horizontal ridge augmentation prior to dental implant placement. Patients were divided into 2 groups, one group received underwent ridge augmentation via Ossix Volumax (OV) and the other group received freeze-dried bone allograft plus resorbable collagen membrane (FDBA/CM). Flaps were elevated and RegenerOss allograft was used, and a Bio-Gide membrane was used the other group received only the Ossix Volumax. Primary closure was achieved using 5-0 nylon sutures. Sutures were removed after 2 weeks and patients were seen for follow-up at 6,12, and 25 weeks. Implant placement was performed 9-months after ridge augmentation. During implant placement appointment, clinical measurements and a biopsy was taken of the OV group. CBCTs were taken at the initial exam and 9-months after horizontal augmentation. CBCTs were used to assess volumetric changes.
Results: A total of 30 patients completed the study, 16 in the FDBA/CM group and 14 in the OV group. 22 of these sites were in the maxilla and 8 sites were in the mandible. In the OV group, alveolar bone gain was not observed (-0.18mm) when measured 2mm from the bone crest. In the FDBA/CM group, alveolar bone gain was measured to be 0.38mm. When using the CBCT, the FDBA/CM group displayed a 0.95mm horizontal gain when measured 2mm from the bone crest, and the OV group was measured to be -0.62mm. Volumetric gain was determined to be 42mm3 for the FDBA/CM group, but no volumetric gain was observed in the OV group.
Conclusion: The results of this current study suggest that the use of freeze-dried bone allograft plus resorbable collagen membrane yielded better results, although moderate, when compared to Ossix Volumax. Authors reports that a volume increase was not observed clinically in the OV group.
Topic: Recession Treatment
Authors: McGuire, MK, Janakievski, J, Scheyer, ET, et al.
Title: Efficacy of a harvest graft substitute for recession coverage and soft tissue volume augmentation: A randomized controlled trial.
Source: J Periodontol. 2022; 93: 333– 342.
DOI: 10.1002/JPER.21-0131
Type: Randomized controlled trial
Keywords: collagen, connective tissue, esthetics, dental, gingival recession, personal satisfaction
Purpose: To examine non-inferiority in the efficacy of volume stable collagen matrix plus coronally-advanced flap (VCMX+CAF) compared with subepithelial connective tissue graft plus coronally-advanced flap (CTG+CAF) with respect to percent root coverage (%RC) at 24 weeks in the treatment of recession defects.
Methods: A total of 30 patients were utilized in this study. Patients had to present with 2 recession defects >3mm that were located contralaterally and classified as RT1 defects. Patients all received full-mouth cleanings prior to any surgical intervention. Recipient sites were prepared using a facial sulcular incision to join to vertical incisions. Flap was released using a combination of full and split thickness. Depending on the group, either a VCMX or CTG was placed in the recipient site. After surgery, patients were seen for dental cleanings at 4, 7, 12, and 24 weeks. Patients were assessed at 6-months and 1-year, postoperatively.
Results: At 6-months, the %RC was observed to favor the CTG+CAF by 19.81%. Root coverage of 100% was observed to occur in 10 (33%) of the VCMX group and in 20 (66%) of the CTG group. When comparing paired defects, VCMX accomplished 50% less root coverage and greater then 33% less recession coverage when compared to the CTG group. At 6-months and 1-year, the soft tissue volume was less in the VCMX group than in the CTG group.
Conclusion: The results of this study suggest that CTG is superior to the VCMX when attempting root coverage. However, the VCMX group did report less postoperative pain.
Topic: Pontic design for reconstructed sites
Author: Gomez-Meda, R; Equivel, J.
Title: The flat and step (F and S) pontics. Novel pontic designs for periodontally reconstructed sites
Source: J Esthet Restor Dent. 2022 Mar 18.
DOI: 10.1111/jerd.12905
Type: Clinical review
Keywords: dental implants; emergence profile; esthetic dentistry; fixed dental prosthesis; pontics
Background: ovate pontic sometimes forces the clinician to remove part of the gained tissue in order to seat the pontic without excessive pressure.
Purpose: Periodontal-prosthodontic approach to achieve functional and esthetics pontic site development in a predictable manner utilizing the flat (F) and step (S) pontics.
Discussion: The step (S) and flat (F) pontics are variations of the classic pontic approaches. These were designed aiming to get a wider contact area without exerting excessive pressure on it, thus reducing the chances of inflammation, ulceration and aiding oral home care for the patient.
After tooth extraction, 91% of the anterior sectors develop alveolar defects of different extents. Most common is Siebert Class III in which we have a vertical and horizontal soft and bone tissue deficiencies.
Defects should be periodontally reconstructed before pontic design, thus increasing the chances of a natural emergence profile of the final restoration.
Indications
| Flat Pontic |
| Sites that already received surgical reconstruction and adequate tissue is present. The flat design allows proper pontic adaptation without causing excessive pressure on the pontic site. The interim restoration is created with a flat surface and an acute angle between the palatal and facial surface (allows to soft tissue overcorrection).
Provisional restoration is delivered after surgery.
2 months later (25-45% soft tissue shrinkage) a reline of the basal area is necessary, important to keep a flat surface and highly polished provisional restoration In general, the restoration should be introduced at least 0.5-1mm into the overcorrected gingiva (blanching is expected but should disappear within 5’). In cases of a thick biotype and ischemia persists longer, a gingivoplasty needs to be done.
Recall should be done 2 months after interim restoration is delivered. Final impression can be made if prosthesis is not replacing teeth in the esthetic sector. Otherwise, 6-month waiting period is recommended before the final impression. Final restoration will be copy-milled from the interim restoration (easy to communicate with lab-technician)
|
| Step Pontic |
| In areas that a surgical reconstruction was performed but still soft tissue defect is present due to shrinkage (shallow vertical ridge defect <1mm, Seibert Class II)
This design has a 1-1.5mm concavity in the facial aspect of the pontic, allowing the soft tissue to migrate coronally, thus a shorter clinical crown with better stability of the gingival margin and a more natural emergence profile can be delivered.
After surgery interim prosthesis is delivered. For the final impression, same waiting period is recommended to ensure tissue stability. A pick-up impression or a digital intraoral scan can be made to precisely provide information to the laboratory. |
Conclusion: This Perio-Prosthodontic approach, is aimed to develop esthetic restorations with a proper emergence profile, phonetics, and to avoid biological complications as it promotes easier cleansability. At the time of tooth extraction, ridge reconstruction should be planned in order to have a proper soft-hard tissue availability to create the pontic design. Finally, these designs avoid a second surgical soft tissue reconstruction of the pontic site.
Topic: Peri-implantitis/ treatment
Author: Shiba, Takahiko. Et al.
Title: Treatment of Peri-implantitis Caused by Malpositioning and an Extra Implant: A Case Report
Source: Int J Periodontics Restorative Dent. Jan-Feb 2022;42(1):e15-e20
DOI: 10.11607/prd.4800
Type: Case Report
Keywords: Dental Implants/ adverse effects, Peri-Implantitis / diagnostic imaging, Peri-Implantitis / etiology, Peri-Implantitis / surgery, Tooth Loss.
Purpose: Peri-implantitis treatment due to implant malpositioned and plaque accumulation at the maxillary arch.
Case: 64 y/o patients presented with pain and discomfort in the right maxillary quadrant: non-smoker and good plaque control (O’Leary 9.3%). Severe periodontitis on the 2nd molar and peri-implantitis was observed in implants placed on the buccal/palatal 1st molar and 2nd bicuspid. Tissue level Straumann implants were placed 16 years ago on a site that received sinus floor elevation with an autogenous bone graft. Clinically, swelling, bleeding, and probing depths of 6-7mm were observed on two right first molar implants. The second premolar area had slight inflammation with BOP and 4mm probing depth and no bone loss. No mobility was observed. It was observed that plaque accumulation was due to implant proximity even though the patient had proper oral hygiene.
Treatment. 2nd maxillary molar was extracted. Eight months later, Er:YAG laser, plastic curette, and subgingival irrigation with 0.2% benzethonium chloride solution were used to treat implant surfaces. One month later, the first molar palatal implant was removed, while the maxillary first molar buccal implant was debrided using ER: YAG laser. Spongel was used to fill the extraction socket, and the flap was repositioned using 4-0 Nylon sutures. The patient was prescribed amoxicillin for three days. At the 2-month postop evaluation, no periodontal complications were noted, and a provisional crown was cemented. The final restoration was delivered, and after six months of follow-up, no functional or periodontal problems were observed. The patient was followed up once every three months.
Conclusion: The case report demonstrated that extracting one implant and exchanging the prosthodontic component to allow proper hygiene can be a viable treatment without major surgery, including placement of a new implant and extra costs for the patient.
Topic: Dental implant failures
Title: Evaluation of failed implants and reimplantation at sites of previous dental implant failure: survival rates and risk factors
Source: J Periodontal Implant Sci. 2022 Feb; 52(1): e4.
DOI: 10.5051/jpis.2105020251
Type: Retrospective char review
Keywords: dental implants, risk factors, survival rate
Purpose: To evaluate failed implants and the survival of reimplants.
Methods: A chart review including 91 failed implants in 61 patients was performed. The inclusion criteria included: 1) adult pts 20-80yrs old who agreed to reimplantation, 2) no previous implant placement into site where initial implant was placed, and 3) both initial and reimplantation were performed at the Korean clinic site (location of study). The following data was collected from the chart review: patient’s medical history, surgical factors, implant, site, and prosthodontic details. An early failure referred to implant failure prior to prosthesis connection vs. a late failure referred to implant failure after prosthesis connection. The timing of reimplantation was categorized into immediate, early, and late reimplantation. Immediate referred to reimplantation immediately following the removal of the initial implant, whereas early was within 16 wks and late reimplantation occurred later than 16 wks of initial implant removal. Of the 91 failed implants studied, 69 were reimplanted—of which, 8 reimplants failed again in 7 patients. The reimplants that failed were compared to the previously failed implants and statistical analysis was performed.
Results: Eight out of 69 reimplants failed again and when patient factors were analyzed, a significant association was found with the older age at reimplantation (HR= 1.09) and smoking (HR=4.789), whereas a history of taking antithrombotic agents was negatively associated with reimplant failure (HR=0.172). Failure rates for initial implants were 3.7% at implant-level vs. failure rates for reimplants were significantly higher (11.6%). Only 3 failed reimplants received a second reimplantation, and to date all second reimplants survived. The one-year survival rate for reimplants (n=69) was 88.4% (vs. 96.3% for initial implantation). For the failed implants, 66% of them were early failures, whereas 34% were late failures. All reimplant failures were early failures. Time of reimplantation (immediate, early, late) was not significantly associated with reimplant failure, nor was the submerged or nonsubmerged approach. The most frequent site of initial implant failure was the maxillary first molar region (34%), however NS association was found between location and reimplant failure.
Conclusion: The failure rate for reimplants was significantly higher than initial implantation, with a one-year survival rate of 89.4% for reimplants. Older age at reimplantation and smoking SS increased risk of reimplant failure, whereas a history of taking anti-thrombotic agents had a SS negative association with reimplant failure.
Topic: Short vs. long implants
Authors: Medikeri R, Pereira M, Waingade N, Navale S.
Title: Survival of surface-modified short versus long implants in complete or partially edentulous patients with a follow-up of 1 year or more: a systematic review and meta-analysis
Source: J Periodontal Implant Sci. 2022 Apr; 52(2): e7
DOI: 10.5051/jpis.2007340367
Type: Systematic review and meta-analysis
Keywords: dental implants, marginal bone loss, short dental implants, survival
Purpose: To compare the survival rates of different surface-treated short implants with long implants with similar surfaces.
Methods: Systematic review and meta-analysis conducted according to PRISMA protocol. The following PICO question was used: P- partially or completely edentulous patients receiving ≥1 implant, I- short implants (≤8mm) with a modified surface, C- long implants (>8mm) with a modified surface, O- effect of surface modification on implant survival/failure rate. 22 studies met the inclusion criteria and were included in qualitative and quantitative analysis.
Results: 22 studies included, for a total of 1,472 patients with 1,100 short and 1,118 long-implants analyzed. Overall, there was a SS lower survival rate for short implants compared to long implants (RR=2.28), and irrespective of surface modifications the failure rate of all short implants was 2.1% greater than that of long implants. Amongst the different surface modifications, the only treatments that showed SS differences in survival rates between long- and short- implants were the hydrophilic sandblasted acid-etched (SAE) and Fl2-modified TiO2 surfaces. The hydrophilic SAE short implants failed 3 times more frequently than long implants with the same surface, and likewise short implants with TiO2 Fl2-modified surfaces failed 3.54 times more frequently than their long implant counterpart. In contrast there was NSSD in survival rates between long and short implants with the following surfaces: nanostructured calcium phosphate-modified surfaces, conventional sandblasted acid-etched surfaces, and dual acid-etched surfaces coated with nanometer-scale calcium phosphate crystals. Overall, there SS less marginal bone loss observed in the short implant group compared to the long. When surface treatments were analyzed this SS difference held true for nanostructured calcium phosphate-modified, hydrophilic sandblasted acid-etched, and dual acid-etched surface coated with nanometer-scale calcium phosphate crystals surface treatments (-0.23 to -0.78mm less MBL).
Conclusion: The findings from this meta-analysis suggest that surface alterations influenced the impact that implant length (short vs. long) had on implant survival and marginal bone loss. For implants that have Fl2-modified or hydrophilic SAE surfaces, long implants (>8mm) have better survival rates than short implants (≤8mm). Additionally, SS less MBL is observed with short implants that have nanostructured calcium-incorporated titanium surfaces, hydrophilic SAE surfaces, and dual acid-etched surfaces coated with nanometer-scale calcium phosphate crystals compared to long implants with the same surface treatment.
Topic: Atherosclerosis
Author: Adam, H. S., Lakshminarayan, K., Wang, W., Norby, F. L., Mosley, T., Walker, K. A., Gottesman, R. F., Meyer, K., Hughes, T. M., Pankow, J. S., Wong, D. F., Jack, C. R. Jr., Sen, S., Lutsey, P. L., Beck, J., & Demmer, R. T.
Title: The prospective association between periodontal disease and brain imaging outcomes: The Atherosclerosis Risk in Communities study.
Source: Journal of Clinical Periodontology, 49(4), 322–334.
DOI: 10.1111/jcpe.13586334ADAMET AL.
Type: Prospective study
Keywords: cohort studies, dementia, magnetic resonance imaging, periodontal diseases, positron-emission tomography
Background: Systemic inflammation is a component of mild cognitive impairment and dementia in older adults. As periodontal disease also contributes to systemic inflammation, periodontal conditions may be linked to neurodegeneration and other brain issues.
Purpose: To investigate if periodontal disease is prospectively associated with cerebrovascular and neurodegenerative markers of dementia and Alzheimer’s pathology.
Methods: A total of 1306 patients (mean age 76.5) were included from the Atherosclerosis Risk in Communities study, an ongoing prospective study evaluating the etiologic factors and clinical outcomes of atherosclerosis. Patients had dental exams and brain magnetic resonance imaging scans performed. Patients were divided into groups for tooth status: edentulous or seven groups based on periodontal condition (PPC) which integrates CAL, PD, BOP, GI, PI, and number of teeth present. The seven stages of PPC include healthy (no disease), mild disease, high gingival inflammation, tooth loss, posterior disease, severe tooth loss, and severe disease. For this study, the PPC was consolidated into healthy, “mild to posterior disease,” “severe tooth loss to severe disease,” and edentulism. Cerebrovascular measures and beta-amyloid positivity were measured and analyzed.
Results: No association was seen between various stages of periodontal disease and brain volumes, micro-hemorrhages, or elevated beta-amyloid. However, edentulous patients and those with severe tooth loss had lower odds ratios for infarcts (0.56 and 0.37 OR respectively). Severe tooth loss, edentulism, and mild periodontal disease appeared to protect against subcortical and lacunar infarct subtypes.
Conclusion: Periodontal disease did not appear to be associated with altered brain volumes, microhemorrhages, or beta-amyloid positivity, but tooth loss was associated with lower odds of cerebral infarcts. Advanced and complete tooth loss was also linked to a reduced risk of ischaemic stroke. More research is needed.
Topic: Oral hygiene
Author: Dimenäs, S. L., Jönsson, B., Andersson, J. S., Lundgren, J., Petzold, M., Abrahamsson, I., & Abrahamsson, K. H.
Title: A person-centered, theory-based, behavioral intervention programme for improved oral hygiene in adolescents: A randomized clinical field study.
Source: Journal of Clinical Periodontology, (2022) 49(4), 378–387
DOI: 10.1111/jcpe.13601DIMENÄSET AL.387
Type: RCT
Keywords: adolescents, behavioral intervention, gingivitis, oral hygiene, prevention
Background: Cognitive behavioral therapy is a form of therapy based on changing and improving ways of thinking, recognizing patterns of unhelpful behavior, and providing coping strategies. The main goal is to help change thinking patterns long-term with collaborative work from both the practitioner and patient. This strategy can also be applied to learning new habits, such as improving oral hygiene.
Purpose: To test the effectiveness of a person-centered and theory-based educational intervention to increase oral hygiene performance in adolescents.
Methods: Data was collected from a prospective, multi-centered, two-arm, quasi randomized field study performed by dental hygienists in Sweden. Cognitive behavioral theory and motivational interviewing were used to develop a collaborative communication strategy for the test group, while the control group received conventional information and instruction. Teenagers 16-17 years old with gingival bleeding and/or plaque scores ≥ 50% were included. Clinical indices were recorded at baseline and six months, including marginal bleeding and plaque. The intervention for the test group included CBT and conversations such as goal setting, planning, and self-monitoring. The collaborative communication approach was designed to elicit and strengthen the teenagers’ motivation to change their behavior and guide their development of appropriate and effective oral hygiene. The intervention consisted of three 45-60 min conversational treatment sessions over 10-12 weeks. The control group received conventional oral hygiene instructions at one or more occasions described as “business as usual.”
Sample session topics: explore and analyze health beliefs, knowledge, needs; explore willingness for behavioral change; mutual agreement + summary; oral hygiene instructions; individual goal setting for next session; write diary for self-monitoring of oral hygiene behavior.
Results: A total of 312 teenagers were included with 274 following the program for 6 months. The 38 patients who dropped out were more likely to be smokers or snuff users but otherwise had similar baseline status. The test group had a mean of 3 interventions and 123 min long initial intervention, while the control group had on average 1 exam at 41 min. Both groups had significant improvements in GI and plaque scores at six months. However, the test group had significantly better results with the students brushing and using interdental cleaning aids more frequently than the control group.
Conclusion: The oral health education program that centered on individuals and theory discussed in this study was more effective in improving teens’ oral hygiene behavior and perio infection control than conventional oral health education.
Topic: Soft tissue augmentation
Title: Outcome measures and methods of assessment of soft tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years
Source: Clinical Oral Implants Research
DOI: 10.1111/clr.13927
Type: Systematic review
Keywords: dental implants, outcome measures, outcome assessment, soft tissue therapy
Purpose: To examine the outcome measures and methods of assessing peri-implant soft tissue augmentation techniques
Material and methods: Electronic and hand search of articles pertaining to outcome measures, specific methods and timing of assessment of soft tissue augmentation of dental implants was completed by 2 reviewers. Qualitative analysis, categorization of outcome measures, primary outcomes, risk of bias assessment and frequency of reporting was then calculated.
Results: Overall, 92 articles were included in the study including 39 randomized controlled trails, 20 non-randomized controlled trials and 33 case series. Outcome measures were categorized into patient reported outcome measures and investigator-evaluated outcome measured including clinical, esthetic, digital imaging, biomarker, safety and histologic measures. It was found that 22.83% of primary outcomes was assessed using clinical facial mucosa thickness. 19.57% of primary outcomes was assessed using clinical facial keratinized mucosa width. 18.48% of primary outcomes was assessed using clinical facial mucosal margin position (Recession). 11.96% of primary outcomes was assessed using digital imaging of facial mucosa thickness. 9.78% of primary outcomes was assessed using digital imaging of facial soft tissue volume. Lastly, 9.78% of primary outcome was assessed using clinical supracrestal tissue height No association was found between the quality or type of clinical studies and the method used determined the primary outcome.
Conclusions: This review found that in the last 10 years, clinical outcome measures were most frequently used to assess peri-implant soft tissue augmentation interventions. The most frequent primary outcome was assessed using clinical methods to determine the facial mucosa thickness. Randomized controlled trials are the most common type of study and there is currently a trend increasing use digital technology to aid in establishing the primary outcome.
Topic: Photobiomodulation therapy
Title: Effect of photobiomodulation therapy on patient morbidity and wound healing at donor site after free gingival graft harvesting: a triple-blind randomized controlled clinical trial
Source: Clinical oral Implant Research
DOI: 10.1111/clr.13923
Type: Randomized controlled clinical trial
Keywords: acute pain, gingival recession, low level light therapy, outcome measures, dental implant, wound healing
Purpose: To assess the effectiveness of photobiomodulation therapy (PBMT) on donor site healing and patient morbidity following a free gingival graft.
Material and methods: This study included 44 patients that were treatment planned for a free gingival graft. 22 patients were randomly assigned to each of the control group and test group. The test group received PBMT (660 nm red wavelength, near-infrared at 808nm wavelength) immediately after, 24 and 48 hours after the surgery The control group received the same treatment with no laser emission. Visual Analogue Scale was used to determine the post-operative pain at the donor site immediately after surgery, 6, 24, 48, and 72 hours after the harvesting the free gingival graft from the palate. Patient-reported outcome measures, medication consumption, and percent of wound closures were also assessed as secondary outcomes.
Results: The control had significantly higher post-operative rescue analgesic requirement compared to the test group. Patients receiving PBMT had 2.43 times less rescue analgesic intake compared to the control group. The test group has a non-statistically significant lower post-operative visual analogue scale value (VASLog Value) compared to the control group. There was significant difference in post-operative pain (VASlog value) in the test group at 6, 48 and 72 hours unlike the control group. Significantly less morbidity, greater ability to open their mouth wide, food consumption, chewing, bleeding and swelling was reported by patients that received PBMT. Patients in the control group reported more difficulty sleeping, working, performing daily functions. Both groups presented with statistically significant wound closure when comparing the amount of epithelium from day 7 to day 14. The test group presented with significantly more wound closure at day 7 compared to the placebo group. However, at day 14 and 28 there was similar wound closure between both groups
Conclusions: Photobiomodulation following a free gingival graft can improve patient morbidity, reduce post-operative pain and the use of rescue medication, improves wound healing and patient satisfaction.
Topic: Non-surgical treatment of peri-implantitis
Authors: Joshi AA, Gaikwad AM, Padhye AM, Nadgere JB
Title: Overview of Systematic Reviews and Meta-analyses Investigating the Efficacy of Different Nonsurgical Therapies for the Treatment of Peri-implant Diseases.
Source: Int J Oral Maxillofac Implants. 2022 Jan-Feb;37(1):e13-e27
DOI: 10.11607/jomi.9088
Type: Overview of Systematic Reviews and Meta-analyses
Reviewer: Erin Schwoegl
Keywords: AMSTAR, dental implant, evidence-based dentistry, Glenny, nonsurgical therapy, peri-implantitis, systematic review
Purpose: To evaluate the systematic reviews and meta-analyses regarding different non-surgical therapy (NST) techniques as treatment of peri-implant disease
Methods: Two focus questions were used to guide the search: 1) “What is the efficacy of different NSTs in improving the outcomes in the treatment of peri-implant diseases?” and 2) “What is the quality of evidence from the systematic reviews and meta-analyses evaluating the efficacy of NSTs for the treatment of peri-implant diseases?” Animal and in vitro studies were excluded.
Results: A total of 27 articles were included for assessment of methodologic quality and outcomes. Thirteen studies included a meta-analysis, two had a network meta-analysis, and one study was a Cochran review. In the single review assessing growth factors, a positive effect was found in treatment of peri-implant mucositis, but an effect on peri-implantitis was not established. Three reviews discussed antimicrobial photodynamic therapy, two of which were inconclusive while the last found a positive effect in the reduction of microbial overload. Three reviews evaluated photodynamic therapy as adjunctive treatment to mechanical debridement. One of these found significant improvements, while the other two were inconclusive. Adjunctive glycine powder to mechanical debridement was studied in one review which showed it has positive clinical outcomes. Of the eight reviews evaluating lasers, five studies found positive results, one was not in favor of laser treatment, and two were inconclusive. There were 13 reviews assessing NSTs and surgical therapy. Seven of these favored surgical treatment for peri-implantitis, three found NST efficacious for peri-implant mucositis, and the remaining three were inconclusive.
Conclusion: Overall, the reviews found NST to be effective in reducing clinical signs of peri-implant disease, however surgical therapy may be favored in treatment of peri-implantitis. NST should be part of phase 1 therapy in treatment of peri-implant diseases to reduce inflammation and microbial overload.
Topic: Titanium surface decontamination
Authors: Francis S, Laculli F, Perrotti V, Piattelli A, Quaranta A.
Title: Titanium Surface Decontamination: A Systematic Review of In Vitro Comparative Studies
Source: Int J Oral Maxillofac Implants. 2022 Jan-Feb;37(1):76-84
DOI: 10.11607/jomi.8969
Type: Systematic review
Keywords: chemical decontamination, cleaning efficacy, dental implants, laser decontamination, mechanical decontamination
Purpose: To systematically assess in vitro studies which use different therapies to decontaminate titanium surfaces of dental implants
Methods: The focus question “Is mechanical, chemical, or laser decontamination the most effective modality in removing the biofilm formed on titanium surfaces?” was used to guide the search. In vitro, and comparative studies were included. Excluded were in vivo studies, review articles, and those reporting only one treatment modality.
Results: A total of 38 studies met the inclusion criteria. Of the four articles that compared chemical agents, none reported an agent more effective than chlorhexidine (CHX) and no comparable alternative agents were suggested. Jet plasma followed by 1% CHX was shown to have a better effective than either treatment on its own. There were three studies comparing lasers to chemical treatments. One found no significant difference between photodynamic therapy (PDT) and CHX, two reported CHX was more effective than PDT in eliminating A. actinomycetemcomitans, and two reported LED was superior compared to the diode laser in PDT. There were five studies comparing chemical and mechanical procedures. It was found that air-powered abrasion (AA) was more effective than curettes and 0.12% CHX in cleaning and removing lipopolysaccharide, and AA was also more effective than distilled deionized water, citric acid, or CHX in removing endotoxin. In the five articles comparing different lasers, favorable results were found with diode soft laser irradiation followed by exposure to toluidine blue solution and PDT with methylene blue, activated with a diode laser. Differing results were found in the articles comparing lasers and mechanical treatments. One study found greater bacterial reduction with Er:YAG laser than titanium curettes and/or PDT, while others found better results with mechanical treatment over lasers. Fourteen studies reviewed mechanical vs. mechanical therapies. Titanium brushes were found to reduce more plaque than curettes. Significantly different results were reported regarding the effectiveness of different powder formulations in AA. However, AA systems were found to be superior to other mechanical methods. Some studies compared mechanical, chemical, and laser treatments. While results greatly differed, mechanical methods, or mechanical in combination with chemical performed better than laser treatments.
Conclusion: While all treatment modalities achieved good results, mechanical debridement, especially AA, lead to better outcomes than with chemical or laser treatment. Combinations of different therapies may play a large role in treatment outcomes, and the authors recommend randomized controlled trials with appropriate sample sizes and standardized treatments.
Topic: Oral Health and Skin Disease
Authors: Macklis, P., Adams, K., Kaffenberger, J., Kumar, P., Krispinsky, A., Kaffenberger, B.
Title: The Association Between Oral Health and Skin Disease.
Source: J Clin Aesthet Dermatol. 2020 Jun;13(6):48-53. Epub 2020 Jun 1.
DOI: 10.1111/jcpe.13603
Type: Review
Keywords: N/A
Purpose: To summarize findings which correlate oral health, oral care practices, and skin disease.
Background: Periodontal disease destruction cause a release of inflammatory mediators- TNF alpha, Interleukin-1, IL-2, IL-8, and prostaglandins, which can enter the circulatory system and be a factor for systemic inflammation. Evidence of systemic inflammation is seen with elevation of C-reactive protein in acute and chronic periodontitis. The most important contributing factor can is plaque due to poor oral hygiene. Many studies have determined a link between oral hygiene, presence of specific bacterial species, and many different autoimmune skin diseases. Leading to the thought that oral care is a modifiable factor for these conditions.
Materials and Methods: A search was conducted using PubMed from summer 2017 through summer 2018. Articles looking at oral health vs. eczema, dermatitis, hidradenitis suppurativa, acne inversa, pyoderma gangrenosum, sweet’s syndrome, neutrophilic dermatosis, subcorneal pustular dermatosis, hives, urticarial, cutaneous lupus, pemphigoid, pemphigus, lichen planus and aphthous stomatitis were looked into. The review had an inclusion of 43 articles.
Results: Patients with aphthous stomatitis had worse oral health compared to healthy controls. Correlation of improved oral health and improved disease was seen. Recurrent aphthous stomatitis was associated with greater plaque index scores, decreased tooth brushing and oral infections. Porphyromonadaceae and Veillonellaxeae bacteria were seen at active lesion sites. Aphthous stomatitis was seen to be associated with plaque accumulation, oral infection and poor periodontal status.
Patients with dermatitis/eczema were largely seen to have a correlation to oral disease. One study showed patients with atopic dermatitis were resistant to conventional treatment also had periapical root infection in 30% of patients. Several studies have also showed following treatment of periodontitis or pulpitis, chronic pigmented purpura resistant to corticosteroids resolved. Amalgam fillings have also been linked to dermatitis, but other studies have disputed this link.
Prevalence of lichen planus and strong correlation to periodontitis has been observed. Although, strong correlation, one study determined that patients with oral lichen planus had no worse of a periodontal status than healthy controls, but increase in calculus deposit and greater plaque was observed for lichen planus patients. One study determined that worsening of liken planus was observed as a response to stress, spicy foods and poor oral hygiene. Oral hygiene improvement was seen to have an improvement in lichen planus
Mucous membrane pemphigoid patients were seen to have greater gingival index scores showing more gingival inflammation compared to healthy controls. One study determined that patients with MMP did not show an increase risk for development of progression of periodontal disease. Although many other studies contradict the above finding.
Pemphigus was correlated with indicators of poor periodontal health. Clinical severity score of pemphigus was associated with attachment loss and periodontal pocket depth in periodontitis patients. Diagnosis of pemphigus for longer than 5 years was related to increased severity of periodontal disease. One systematic review showed a bidirectional relationship between pemphigus and periodontal disease- meaning that an increase in periodontitis was seen with increased pemphigus severity and pemphigus patients were more susceptible to periodontal disease.
The strongest association for cutaneous disease and periodontitis was seen with psoriasis. A patient with psoriasis showed significant increase in odds of periodontitis. Another study showed that psoriasis patients were at risk for mild to severe bone loss compared to patients without periodontal bone loss. Patients with psoriasis also had increase in streptococcus infection.
Conclusion: Although mechanism of action is not defined, periodontal disease seems to play a role in many dermatologic diseases. These findings suggest that commensal bacteria correlates with periodontal health and can be a protective measure, whereas dysbiotic biofilm correlates by playing a direct role in dermatological diseases or an indirect role by stimulating immunoinflammatory pathways.
Topic: Keratinized Mucosa Width
Authors: Ravidà A, Arena C, Tattan M, Caponio VCA, Saleh MHA, Wang HL, Troiano G
Title: The role of keratinized mucosa width as a risk factor for peri-implant disease: A systematic review, meta-analysis, and trial sequential analysis
Source: Clin Implant Dent Relat Res. 2022 Mar 17
DOI: 10.1111/cid.13080
Type: Systematic review and Meta-analysis
Keywords: alveolar bone loss, dental implants, gingival recession, meta-analysis, oral mucosa
Purpose: To determine if the prespecified measurement of 2mm of keratinized mucosa width (KMW) is a risk factor for development of peri-implantitis.
Background: Keratinized mucosa width is used to show the measurement of the height of the soft tissue running apico-coronally from the gingival margin to the mucogingival junction. There is conflicting evidence with KMW necessary for health around an implant, with most studies showing a need for greater than or equal to 2mm to prevent soft tissue recession, bone resorption and facilitate adequate oral hygiene. KMW’s role in reaching and maintaining peri-implant health has yet to be determined.
Material and methods: PECO question was formed (Patient, Exposure, Comparison, Outcome). Population was systemically healthy adult human subjects needing implant therapy. Exposure was the existence of <2mm of KMW during implant placement. Comparison was the existence of >=2mm of KMW during implant placement. Outcomes were implant survival rate, changes in probing depth, soft tissue recession, clinical attachment level, mean gingival index, mean plaque index, incidence of peri-implantitis, marginal bone loss and patient reported assessment of brushing discomfort. MEDLINE via Pubmed, Scopus, Web of Science, and Medicine Grey Literature Reports were searched for articles. Manual search through several other journals took place. Nine studies were analyzed- five were prospective cohort studies, three were non randomized clinical trials and one was a randomized clinical trial.. Statistical analysis took place.
Results: Statistical significance was seen for meta-analysis of two studies, determining that a lower MBL rate was seen with higher KMW of >=2mm. In a meta-analysis of three studies for PD reduction, no significant difference was determined between KMW >=2mm or KMW <2mm. In a meta-analysis with two studies for increase in REC, no significant difference was determined between KMW >=2mm or KMW <2mm. Statistically significant difference was seen for mean plaque index when the presence of wider KMW (>=2mm) existed. Not enough evidence was available in order to have a meta-analysis for implant survival rate, CAL, GI, and incidence of peri-implantitis. One study determined that after 4 years, 51.4% of patients having a KM <2mm experienced some level of brushing discomfort.
Conclusions: This study determined that implants containing less than <2mm of keratinized mucosa width did not have increased marginal bone loss, recession, or probing depths compared to implants with >=2mm KMW. Implants having <2mm of keratinized mucosa width were associated with increased plaque index and more discomfort after brushing teeth. The study concluded that it is nonessential to have a presence of 2mm of keratinized mucosa width in order to obtain peri-implant health.