Aim
To report the clinical and radiographic outcomes of implant‐supported fixed dental prostheses with cantilever extensions (FDPCs) after a function time ≥10 years.
Material and methods
Patients ...with FDPCs in posterior areas were clinically and radiographically re‐evaluated. Mesial and distal radiographic marginal bone levels (mBLs) from baseline (i.e. delivery of FDPC) to the follow‐up examination were calculated and compared between implant surfaces adjacent to and distant from the cantilever extension. Implant survival rate, pocket probing depth (PPD), presence/absence of bleeding on probing (BoP) and presence/absence of mechanical/technical and biological complications were recorded.
Results
Twenty‐six patients with 30 FDPCs supported by 60 implants were re‐evaluated after a mean loading time of 13.3 ± 2.7 years (range: 10–18.6 years). One diameter‐reduced implant carrying a cantilever extension fractured, yielding a patient‐based survival rate of 96.2% (95% CI: 0.95/1.0). The mean marginal bone level change was not statistically significantly different from baseline to follow‐up (1.2 mm ± 0.9 to 1.6 mm ± 1.7; 95% CI: −0.1/0.9; p > .05). The mean PPD changed statistically significantly from 3.4 mm ± 0.7 to 3.7 mm ± 0.7 (95% CI: 0.04/0.6; p = .02). Loss of retention occurred ≥ 1x in 9 patients (34.6%, 95% CI: 0.44/0.83). At follow‐up, peri‐implant health was diagnosed in 12 (46.2%), peri‐implant mucositis in 7 (26.9%) and peri‐implantitis in 7 (26.9%) patients, respectively.
Conclusion
Despite a high rate of loss of retention, the use of implant‐supported FDPCs in posterior areas represents a reliable long‐term treatment option with a high implant survival rate and minimal peri‐implant bone level changes irrespective of the location of the cantilever extension.
Aim
The aim of this systematic review was to identify the most recent widely accepted guidelines for risk factor control interventions and to assess their impact in patients with periodontitis.
...Materials and methods
The electronic search strategy included a first systematic search to identify guidelines for interventions for smoking cessation, diabetes control, physical exercise (activity), change of diet, carbohydrate (dietary sugar) reduction and weight loss in the general population and a second systematic search to identify the studies evaluating these interventions in periodontitis patients.
Results
A total of 13 guidelines and 25 studies were selected. Most guidelines included recommendations for all healthcare providers to provide interventions and follow‐up counselling with the risk factors considered in the present review. In patients with periodontitis, interventions for smoking cessation and diabetes control were shown to improve periodontal health while the impact of dietary interventions and the promotion of other healthy lifestyles were moderate or limited.
Conclusions
While aiming to improve treatment outcomes and the maintenance of periodontal health, current evidence suggests that interventions for smoking cessation and diabetes control are effective, thus emphasizing the need of behavioural support in periodontal care.
Aim
To relate the time between recall visits and residual periodontal probing depths (PPDs) to periodontal stability in patients enrolled in supportive periodontal therapy (SPT).
Materials and ...methods
Retrospective data on residual PPDs from 11,842 SPT visits were evaluated in SPT patients at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland, 1985–2011. A residual PPD‐based algorithm was developed to compute SPT intervals with no expected change of residual PPD.
Results
A total of 883 patients aged 43.9 (±13.0) years and 55.4% (n = 489) being females were identified. Linear mixed model analysis yielded highest statistically significant impact on PPD change with time between SPT visits, presence of residual PPD ≥4 mm, and bleeding on probing (p < 0.0001). Patients returning for SPT five times consecutively earlier than computed presented mean % PPDs ≥4 mm of 5.8% (±3.9) compared with patients returning later (19.2%, ±7.6) (p < 0.0001). Additionally, patients attending >50% of their SPT visits earlier versus later demonstrated increased periodontal stability after 5 years (p = 0.0002) and a reduced frequency of tooth loss (0.60, ±0.93 versus 1.45, ±2.07) after 20 years (p < 0.0001).
Conclusions
To reach and maintain periodontal stability during SPT, individual quantitative data from comprehensive residual PPD profiles may contribute to the improved planning of SPT intervals.
Objective
To determine the microbiota at implants and adjacent teeth 10 years after placement of implants with a sandblasted and acid‐etched surface.
Material and methods
Plaque samples obtained from ...the deepest sites of 504 implants and of 493 adjacent teeth were analyzed for certain bacterial species associated with periodontitis, for staphylococci, for aerobic gram‐negative rods, and for yeasts using nucleic acid‐based methods.
Results
Species known to be associated with periodontitis were detectable at 6.2–78.4% of the implants. Significantly higher counts at implants in comparison with teeth were assessed for Tannerella forsythia, Parvimonas micra, Fusobacterium nucleatum/necrophorum, and Campylobacter rectus. Higher counts of periodontopathogenic species were detectable at implants of current smokers than at those of non‐smokers. In addition, those species were found in higher quantities at implants of subjects with periodontitis. The prevalence of Prevotella intermedia, Treponema denticola, C. rectus, and moreover of Staphylococcus warneri might be associated with peri‐implant inflammation. Selected staphylococcal species (not Staphylococcus aureus), aerobic gram‐negative rods, and yeasts were frequently detected, but with the exception of S. warneri, they did not show any association with periodontal or peri‐implant diseases.
Conclusions
Smoking and periodontal disease are risk factors for colonization of periodontopathic bacteria at implants. Those bacterial species may play a potential role in peri‐implant inflammation. The role of S. warneri needs further validation.
Dental anxiety is a prevalent concern in Western societies, affecting a broad demographic from children to the elderly, and posing a challenge to the delivery of oral health care. The Swiss Dental ...Association (SSO) has been conducting national surveys since 1980, with additional questions since 2010, to better understand the Swiss population's perception of the dental profession. Their 2010 and 2017 surveys aimed to gain more insight into dental anxiety across Switzerland, and to relate their findings to various demographic and socio-economic factors. A total of 2240 participants (1129 in 2010 and 1111 in 2017), demographically representative of Switzerland's socioeconomic distribution, were surveyed, with an even gender distribution (49.7% male and 50.3% female, p=0.7656). The mean age of the cohort was 43.5 ±16.0 years. The prevalence of dental anxiety decreased from 2010 to 2017. In 2010, 21.3% (CI: 19.0-23.7) reported higher levels of dental anxiety, which decreased to 13.3% (CI: 11.4-15.4) in 2017. Women consistently reported higher levels of dental anxiety than men in both years (2010: p<0.0001, 2017: p=0.0003). Logistic regression analysis revealed that higher levels of education (p<0.0001), trust in the dentist (p=0.0005) and satisfaction with the dentist (p=0.0489) significantly predicted lower levels of dental anxiety. In conclusion, these results highlight an overall decrease in dental anxiety from 2010 to 2017, but particularly among highly educated individuals and participants expressing satisfaction and trust in their dentist. While women consistently reported higher levels of anxiety, the overall results suggest promising trends in perceptions of oral health in Switzerland.
Background
Implant‐supported restorations with cantilever extension may display high rates of biological and technical complications.
Purpose
To report the outcomes of single‐unit crowns with ...cantilever extension (SCCs).
Materials and methods
Patients with SCCs were reevaluated after ≥10 years of loading. Radiographic marginal bone levels (mBLs) at baseline (ie, delivery of SCCs) and follow‐up were calculated and compared between implant surfaces adjacent to and distant from the cantilever extension. Implant survival and success rates were calculated.
Results
Twenty‐one patients with 25 SCs supported by 25 implants were reevaluated after a mean of 13.6 ± 3.8 years (range: 10–19 years). No implants were lost. The mean overall mBLs changed from 0.99 mm ± 0.95 at baseline to 0.95 mm ± 0.99 at follow‐up (p = 0.853). The mean pocket probing depths changed from 3.39 mm ± 0.62 at baseline to 3.34 mm ± 0.54 at follow‐up (p = 0.635). Loss of retention occurred 3× in 2 patients (14.3%). At follow‐up, peri‐implant health was diagnosed in 10 (48%) and peri‐implant mucositis in 11 (52%) patients, respectively.
Conclusions
Within the limitations of the present study, the use of implant‐supported SCs with cantilever extension in posterior areas represents a reliable long‐term treatment option with a 100% implant survival rate and minimal marginal bone level changes.
Objective
The objective of the study is to compare the clinical, microbiological and host‐derived effects in the non‐surgical treatment of initial peri‐implantitis with either adjunctive local drug ...delivery (LDD) or adjunctive photodynamic therapy (PDT) after 12 months.
Materials and Methods
Forty subjects with initial peri‐implantitis, that is, pocket probing depths (PPD) 4–6 mm with bleeding on probing (BoP) and radiographic bone loss ≤2 mm, were randomly assigned to two treatment groups. All implants were mechanically debrided with titanium curettes and with a glycine‐based powder airpolishing system. Implants in the test group (N = 20) received adjunctive PDT, whereas minocycline microspheres were locally delivered into the peri‐implant pockets of control implants (N = 20). At sites with residual BoP, treatment was repeated after 3, 6, 9 and 12 months. The primary outcome variable was the change in the number of peri‐implant sites with BoP. Secondary outcome variables included changes in PPD, clinical attachment level (CAL), mucosal recession (REC) and in bacterial counts and crevicular fluid (CF) levels of host‐derived biomarkers.
Results
After 12 months, the number of BoP‐positive sites decreased statistically significantly (P < 0.05) from baseline in both groups (PDT: 4.03 ± 1.66–1.74 ± 1.37, LDD: 4.41 ± 1.47–1.55 ± 1.26). A statistically significant (P < 0.05) decrease in PPD from baseline was observed at PDT‐treated sites up to 9 months (4.19 ± 0.55 mm to 3.89 ± 0.68 mm) and up to 12 months at LDD‐treated sites (4.39 ± 0.77 mm to 3.83 ± 0.85 mm). Counts of Porphyromonas gingivalis and Tannerella forsythia decreased statistically significantly (P < 0.05) from baseline to 6 months in the PDT and to 12 months in the LDD group, respectively. CF levels of IL‐1β decreased statistically significantly (P < 0.05) from baseline to 12 months in both groups. No statistically significant differences (P > 0.05) were observed between groups after 12 months with respect to clinical, microbiological and host‐derived parameters.
Conclusions
Non‐surgical mechanical debridement with adjunctive PDT was equally effective in the reduction of mucosal inflammation as with adjunctive delivery of minocycline microspheres up to 12 months. Adjunctive PDT may represent an alternative approach to LDD in the non‐surgical treatment of initial peri‐implantitis.
Objective
To compare the adjunctive clinical effects in the non‐surgical treatment of peri‐implantitis with either local drug delivery (LDD) or photodynamic therapy (PDT).
Material and methods
Forty ...subjects with initial peri‐implantitis, i.e. pocket probing depths (PPD) 4–6 mm with concomitant bleeding on probing (BoP) and marginal bone loss ranging from 0.5 to 2 mm between delivery of the reconstruction and pre‐screening appointment were randomly assigned to two treatment groups. All implants underwent mechanical debridement with titanium curettes, followed by a glycine‐based powder airpolishing. Implants in the test group (n = 20) received adjunctive PDT, whereas minocycline microspheres were locally delivered into the peri‐implant pockets of control implants (n = 20). At sites with residual BoP, treatment was repeated after 3 and 6 months. The primary outcome variable was the change in the number of sites with BoP. Secondary outcome variables were changes in PPD, in clinical attachment level (CAL), and in mucosal recession (REC).
Results
After 3 months, implants of both groups yielded a statistically significant reduction (P < 0.0001) in the number of BoP‐positive sites compared with baseline (LDD: from 4.41 ± 1.47 to 2.20 ± 1.28, PDT: from 4.03 ± 1.66 to 2.26 ± 1.28). After 6 months, complete resolution of mucosal inflammation was obtained in 15% of the implants in the control group and in 30% of the implants in the test group (P = 0.16). After 3 months, changes in PPD, REC, and modified Plaque Index (mPlI) were statistically significantly different from baseline (P < 0.05). No statistically significant changes (P > 0.05) occurred between 3 and 6 months. CAL measurements did not yield statistically significant changes (P > 0.05) in both groups during the 6‐month observation time. Between‐group comparisons revealed no statistically significant differences (P > 0.05) at baseline, 3 and 6 months with the exception of the mPlI after 6 months.
Conclusions
In cases of initial peri‐implantitis, non‐surgical mechanical debridement with adjunctive use of PDT is equally effective in the reduction of mucosal inflammation as with the adjunctive use of minocycline microspheres up to 6 months. Adjunctive PDT may represent an alternative treatment modality in the non‐surgical management of initial peri‐implantitis. Complete resolution of inflammation, however, was not routinely achieved with either of the adjunctive therapies.
Aim
To systematically assess the efficacy of oral health behaviour change counselling for tobacco use cessation (TUC) and the promotion of healthy lifestyles.
Materials and Methods
Systematic ...Reviews, Randomized (RCTs), and Controlled Clinical Trials (CCTs) were identified through an electronic search of four databases complemented by manual search. Identification, screening, eligibility and inclusion of studies were performed independently by two reviewers. Quality assessment of the included publications was performed according to the AMSTAR tool for the assessment of the methodological quality of systematic reviews.
Results
A total of seven systematic reviews were included. With the exception of inadequate oral hygiene, the following unhealthy lifestyles related with periodontal diseases were investigated: tobacco use, unhealthy diets, harmful use of alcohol, physical inactivity, and stress. Brief interventions for TUC were shown to be effective when applied in the dental practice setting while evidence for dietary counselling and the promotion of other healthy lifestyles was limited or non‐existent.
Conclusions
While aiming to improve periodontal treatment outcomes and the maintenance of periodontal health current evidence suggests that tobacco use brief interventions conducted in the dental practice setting were effective thus underlining the rational for behavioural support.
ABSTRACT
Purpose: This retrospective study assessed the 10‐year outcomes of titanium implants with a sandblasted and acid‐etched (SLA) surface in a large cohort of partially edentulous patients.
...Materials and Methods: Records of patients treated with SLA implants between May 1997 and January 2001 were screened. Eligible patients were contacted and invited to undergo a clinical and radiologic examination. Each implant was classified according to strict success criteria.
Results: Three hundred three patients with 511 SLA implants were available for the examination. The mean age of the patients at implant surgery was 48 years. Over the 10‐year period, no implant fracture was noted, whereas six implants (1.2%) were lost. Two implants (0.4%) showed signs of suppuration at the 10‐year examination, whereas seven implants had a history of peri‐implantitis (1.4%) during the 10‐year period, but presented with healthy peri‐implant soft tissues at examination. The remaining 496 implants fulfilled the success criteria. The mean Plaque Index was 0.65 (±0.64), the mean Sulcus Bleeding Index 1.32 (±0.57), the mean Probing Depth 3.27 mm (±1.06), and the mean distance from the implant shoulder to the mucosal margin value −0.42 mm (±1.27). The radiologic mean distance from the implant shoulder to the first bone‐to‐implant contact was 3.32 mm (±0.73).
Conclusion: The present retrospective analysis resulted in a 10‐year implant survival rate of 98.8% and a success rate of 97.0%. In addition, the prevalence of peri‐implantitis in this large cohort of orally healthy patients was low with 1.8% during the 10‐year period.
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