Objectives
Retrospectively, we assessed the likelihood that peri‐implantitis was associated with a history of systemic disease, periodontitis, and smoking habits.
Methods
Data on probing pocket depth ...(PPD), bleeding on probing (BOP), and radiographic bone levels were obtained from individuals with dental implants. Peri‐implantitis was defined as described by Sanz & Chapple 2012. Control individuals had healthy conditions or peri‐implant mucositis. Information on past history of periodontitis, systemic diseases, and on smoking habits was obtained.
Results
One hundred and seventy‐two individuals had peri‐implantitis (mean age: 68.2 years, SD ± 8.7), and 98 individuals (mean age: 44.7 years, SD ± 15.9) had implant health/peri‐implant mucositis. The mean difference in bone level at implants between groups was 3.5 mm (SE mean ± 0.4, 95% CI: 2.8, 4.3, P < 0.001). A history of cardiovascular disease was found in 27.3% of individuals with peri‐implantitis and in 3.0% of individuals in the implant health/peri‐implant mucositis group. When adjusting for age, smoking, and gender, odds ratio (OR) of having peri‐implantitis and a history of cardiovascular disease was 8.7 (95% CI: 1.9, 40.3 P < 0.006), and odds ratio of having a history of periodontitis was 4.5 (95% CI 2.1, 9.7, P < 0.001). Smoking or gender did not significantly contribute to the outcome.
Conclusions
In relation to a diagnosis of peri‐implantitis, a high likelihood of comorbidity was expressed by a history of periodontitis and a history of cardiovascular disease.
Aims
To investigate clinical, radiographic and microbiological outcome over 12 months following open flap debridement of peri‐implantitis with or without antibiotics.
Materials and methods
...Peri‐implantitis was surgically treated with or without Zithromax® in 19 control and 20 test individuals. Probing pocket depth (PPD), gingival inflammation (BOP), intra‐oral radiographs and microbial samples were studied. Per protocol and intent‐to‐treat analyses were performed.
Results
The mean difference (reduction) in PPD values between baseline and month 12 in the test and control groups was 1.7 mm (SD ± 1.1, 95% CI: 1.1, 2.3, p < .001) and 1.6 mm (SD ± 1.5, 95% CI: 0.8, 2,4, p < .001), respectively. Data analysis failed to show study group differences for BOP, PPD, radiographic bone level and microbial load. Successful treatment (per protocol: PPD ≤ 5 mm, no BOP, no suppuration and no bone loss ≥0.5 mm) at 12 months in test and control groups was 7/15 (46.7%) and 4/16 (25.0%). Bacterial load reduction was similar in study groups with a temporary reduction following treatment.
Conclusions
Surgical treatment of peri‐implantitis with adjunctive systemic azithromycin did not provide 1‐year clinical benefits in comparison with those only receiving open flap debridement.
Background
This RCT compared non‐surgical treatment of peri‐implant mucositis with or without systemic antibiotics.
Materials and Methods
Forty‐eight subjects received non‐surgical debridement with ...or without systemic Azithromax ® (4 days), and were followed during 6 months. The checkerboard DNA‐DNA hybridization method was used to analyse the microbiological material.
Results
Five subjects were excluded due to antibiotic medication during follow‐up. At baseline,1 and 3 months no group differences were found. Statistical analysis failed to demonstrate differences in probing pocket depths (PPD) values at 6 months (Mean diff PPD: 0.5 mm, SE: ±0.4 mm, 95% CI: −0.2, 1.3, p = 0.16). Mean% implant bleeding decreased between baseline and month 6 from 82.6% to 27.3% in the test, and from 80.0% to 47.5% in the control group (p < 0.02). Throughout the study, no study group differences in bacterial counts were found.
Conclusion
No short‐term differences were found between study groups. The clinical improvements observed at 6 months may be attributed to improvements in oral hygiene. The present study does not provide evidence for the use of systemic antibiotics in treatment of peri‐implant mucositis.
Objective. The aim of this double-blind randomized placebo-controlled trial was to evaluate the effects of probiotic supplements in adjunct to conventional management of peri-implant mucositis. ...Materials and methods. Forty-nine adult patients with peri-implant mucositis were consecutively recruited after informed consent. After initial mechanical debridement and oral hygiene instructions, the patients received a topical oil application (active or placebo) followed by twice-daily intake of lozenges (active or placebo) for 3 months. The active products contained a mix of two strains of Lactobacillus reuteri. Patients were clinically monitored and sampled at baseline and after 1, 2, 4, 12 and 26 weeks. The clinical end-points were pocket-probing depth (PPD), plaque index (PI) and bleeding on probing (BOP). In addition, the subgingival microbiota was processed with checkerboard DNA-DNA hybridization and samples of gingival crevicular fluid (GCF) were analyzed for selected cytokines with the aid of multiplex immunoassays. Results. After 4 and 12 weeks, all clinical parameters were improved in both the test and the placebo group. PPD and BOP were significantly reduced compared with baseline (p < 0.05), but no significant differences were displayed between the groups. The clinical improvements persisted 3 months after the intervention. No major alterations of the subgingival microflora were disclosed and the levels of inflammatory mediators in GCF did not differ between the groups. Conclusions. Mechanical debridement and oral hygiene reinforcement resulted in clinical improvement of peri-implant mucositis and a reduction in cytokine levels. Probiotic supplements did not provide added benefit to placebo.
Abstract
Aim.
Probiotic bacteria have been introduced for prevention and treatment of periodontal diseases. The aim was to assess if daily oral administration of probiotic bacteria could influence ...the inflammatory response and the composition of supragingival plaque in an experimental gingivitis model.
Materials and methods.
Eighteen healthy female adults volunteered after informed consent. A double-blind randomized placebo-controlled cross-over design was used. The buccal surface of first molars was used as experimental sites. A mouth-guard covering the first premolar to second molar was used when brushing, preventing accidental cleaning during 3 weeks of plaque accumulation. Lozenges containing L. reuteri (ATCC55730 and ATCC PTA5289) or placebo were taken twice a day. During the run-in and washout periods, professional tooth cleaning was performed 5 days/week. At baseline and follow-up, plaque index, gingival index and bleeding on probing were recorded. Samples of gingival crevicular fluid (GCF) were analysed for concentration of seven inflammatory mediators. Bacterial samples were processed with checkerboard DNA/DNA-hybridization.
Results.
All subjects presented a local plaque accumulation and developed manifest gingivitis at the test sites during the intervention periods. The volume of GCF increased in both groups but was statistically significant only in the placebo group (p < 0.05). The concentrations of IL1-β and IL-18 increased significantly (p < 0.05), while IL-8 and MIP1-β decreased (p < 0.05). No differences were displayed between test and placebo. Likewise, the microbial composition did not differ between the groups.
Conclusion.
Daily intake of probiotic lozenges did not seem to significantly affect the plaque accumulation, inflammatory reaction or the composition of the biofilm during experimental gingivitis.
Background: The aim of this study was to compare ridge‐mapping measurement before surgical flap reflection and measurement using images from cone beam computerized tomography (CBCT) to direct caliper ...measurement following surgical exposure of the bone.
Methods: Sixteen subjects with 25 sites for planned implant placement or ridge augmentation were recruited. An acrylic stent was fabricated for each subject. The stent provided three buccal/lingual pairs of consistent measurement points for each implant site located 4, 7, and 10 mm from the summit of the alveolar soft tissue. Two independent examiners participated.
Results: Comparisons of bucco‐lingual ridge width using ridge‐mapping versus direct caliper measurements showed that 94% and 89% of the pairs of measurement deviations were within ± 1 mm for examiners 1 and 2, respectively. The corresponding comparison of CBCT images versus direct caliper measurements showed 70% and 55% agreement for examiners 1 and 2, respectively. CBCT image measurements provided lower levels of agreement than ridge‐mapping measurements because of the more frequent and larger magnitudes of deviations compared to direct caliper measurements.
Conclusions: Most often, ridge mapping provides measurements of the bucco‐lingual ridge width consistent with those obtained by direct caliper measurement following surgical exposure of the bone. As applied in this study, CBCT was less consistent compared to direct caliper measurements and did not provide any additional, significant diagnostic information.
To evaluate general dental practitioners' (GDPs) and dental hygienists' (DHs) assessment of prognosis, suggested treatment goals, and estimated number of treatment sessions in patients with varying ...severity of periodontal disease.
Seventy-seven GDPs and fifty DHs in a Swedish county participated in a questionnaire study, based on three patient cases: a patient with generalised bone loss but no clinical signs of inflammation (well-maintained); a patient with clinical signs of inflammation and generalised bone loss (periodontitis); and a patient with clinical signs of inflammation but no bone loss (gingivitis). In open-ended questions, the clinicians assessed the prognosis in case of no treatment and proposed treatment goals. Furthermore, based on given fixed-alternative options, they estimated the number of treatment sessions needed for successful management of the condition.
Based on a response rate of 94%, the majority of clinicians expected a worsening of the periodontal condition in all three patients (well-maintained: 80%; periodontitis: 94%; gingivitis: 60%). The most common treatment goal in all 3 cases was to improve oral health awareness. The majority of clinicians estimated that the periodontitis case needed slightly more treatment sessions (mean: 3.04, 95% CI: 2.83-3.24) compared to the gingivitis (mean: 1.93, 95% CI: 1.75-2.11) or well-maintained patient case (mean: 1.84, 95% CI: 1.60-2.07).
The majority of included clinicians did not perform an individualised risk assessment and did not individually match the number of appointments to the actual periodontal treatment needs of the patient. This may result in overtreatment in some cases and in undertreatment in others, and possibly in suboptimal use of resources.
Abstract
Objective.
To analyse how general dental practitioners (GDPs) and dental hygienists judge and plan to treat patients with different periodontal conditions.
Materials and methods.
...Seventy-seven GDPs and 50 dental hygienists in a Swedish county, Halland, participated in a questionnaire study. The response rate was 94%. The questionnaire consisted of four simulated patient cases and an attached answer sheet. The patient cases had different periodontal status, ranging from healthy to moderate bone loss with general inflammation. The clinicians judged the periodontal status as healthy or diseased. If judged as diseased the clinicians suggested a diagnosis, selected treatment options and estimated the number of treatment sessions for each patient case. The clinicians were compared to each other regarding their judgement, as healthy or diseased, diagnostics and treatment.
Results.
Three out of four patients were judged both as healthy and diseased by different clinicians. If judged as diseased the patients were diagnosed as having gingivitis or periodontitis. Regardless of the clinicians' former judgement and diagnostics there were no differences (p > 0.05) in the selected treatment options but there was a difference (p < 0.05) in the suggested number of treatment sessions.
Conclusions.
Clinicians' judgement of the same periodontal condition, as healthy or diseased, varies, which partly results in different treatment decisions considering the number of treatment sessions. The suggested number of treatment sessions varied also between clinicians even if they judged and diagnosed the condition likewise. The willingness to treat and suggested treatment options were not influenced by the variation in judgement and diagnostics.
Objective
The aim of the present study was to investigate the reproducibility of bacterial enumeration from subsequent subgingival samples collected from patients with peri-implant mucositis.
...Material and methods
Duplicate microbial samples from 222 unique implant sites in 45 adult subjects were collected with paper points and analyzed using the checkerboard DNA-DNA hybridization technique. Whole genomic probes of 74 preselected bacterial species were used. Based on the bacterial scores, Cohen’s kappa coefficient was used to calculate the inter-annotator agreement for categorical data. The percentage agreement was considered as “good” when the two samples showed the same score or differed by 1 to the power of 10.
Results
Moderate to fair kappa values were displayed for all bacterial species in the test panel (range 0.21–0.58). There were no significant differences between Gram-positive and Gram-negative species. The percentage of good agreement between the first and second samples averaged 74.7 % (
n
= 74; range 56–83 %), while the proportion of poor agreement ranged from 1 to 19 % for the various strains.
Conclusion
While an acceptable clinical agreement was obtained in most cases, diverging bacterial scores may appear in subgingival samples collected at the same time point from patients with peri-implant mucositis.
Clinical relevance
The broad bulky base of implant crowns may present an obstacle for the collection of reproducible subgingival samples with paper points.
Purpose This prospective study followed 61 patients who were partially dentulous and considered to have insufficient bone volume for routine implant treatment and consequently underwent sinus inlay ...bone grafting. Patients and Methods The patients were treated with maxillary sinus floor augmentation with particulated autogenous bone from the mandibular ramus/corpus. After a healing period, dental implants (n = 180) were installed. Results Radiographic examination revealed average residual vertical bone heights of 6.5 mm in the first premolar region, 3.8 mm in the second premolar region, 3.5 mm in the first molar region, and 2.6 mm in the second molar region. The average implant lengths were 12 mm in the first premolar region and 11 mm in the second premolar, first, and second molar regions. All patients received a fixed partial prosthesis. All bone grafts were stable, and the implant survival rate was 98.9%. There were few cases of minor complications postoperatively and no record of any injured teeth, heavy bruising, bleeding, or swelling in either the donor site or the recipient site. The present clinical study demonstrated a low failure rate of surface-modified dental implants when placed into the maxillary sinus an average of 7 months after augmentation with particulate mandibular bone grafts and followed up to delivery of the final fixed prosthesis. Conclusion The findings indicate that treatment with endosseous implants may be as predictable in patients with inadequate bone who underwent sinus floor augmentation as in patients with adequate bone volume.
