Abstract This review discusses the role of diagnostic measures in the lifelong management of periodontal disease and peri‐implant complications. After active treatment, these conditions require ...regular monitoring of the supporting structures of teeth and dental implants to assess bone and soft tissue health over time. Several clinical measures have been developed for the routine assessment of periodontal and peri‐implant tissues, including periodontal and peri‐implant probing, bleeding on probing, intraoral radiography, biomarker analysis, and microbiological testing. This review highlights the evolution of diagnostic practices, integrating traditional methods with emerging technologies such as resonance frequency analysis and ultrasound imaging to provide a holistic view of peri‐implant health assessment. In addition to objective measurements, patient risk factors are considered. The goals of periodontal and peri‐implant maintenance are to control disease activity and stabilize tissues through supportive care, which includes diagnostic measures at follow‐up visits. This enables clinicians to monitor treatment outcomes, assess health status, and detect recurrence or progression early through routine evaluation, allowing additional interventions, including adjustment of supportive therapy intervals, to further improve and maintain periodontal and peri‐implant stability over time.
Objectives
To assess long‐term attachment and periodontitis‐related tooth loss (PTL) in untreated periodontal disease over 40 years.
Material and Methods
Data originated from the natural history of ...periodontitis study in Sri Lankan tea labourers first examined in 1970. In 2010, 75 subjects (15.6%) of the original cohort were re‐examined.
Results
PTL over 40 years varied between 0 and 28 teeth (mean 13.1). Four subjects presented with no PTL, while 12 were edentulous. Logistic regression revealed attachment loss as a statistically significant covariate for PTL (p < .004). Markov chain analysis showed that smoking and calculus were associated with disease initiation and that calculus, plaque, and gingivitis were associated with loss of attachment and progression to advanced disease. Mean attachment loss <1.81 mm at the age of 30 yielded highest sensitivity and specificity (0.71) to allocate subjects into a cohort with a dentition of at least 20 teeth at 60 years of age.
Conclusions
These results highlight the importance of treating early periodontitis along with smoking cessation, in those under 30 years of age. They further show that calculus removal, plaque control, and the control of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss.
Aim
To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non‐surgical mechanical instrumentation alone in untreated periodontitis patients.
Materials and ...Methods
Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, (a) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non‐surgical instrumentation alone? and (b) does application of aPDT provide adjunctive effects on PPD changes compared with non‐surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta‐analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines.
Results
Out of 1,202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta‐analysis including 2 articles (total n = 42; split‐mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI: −0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650–700 nm). In terms of adjunctive laser application, a high variability of clinical outcomes at 6 months was noted. Two articles included patient‐reported outcomes and 10 reported on the presence/absence of harms/adverse effects.
Conclusions
Available evidence on adjunctive therapy with lasers and aPDT is limited by (a) the low number of controlled studies and (b) the heterogeneity of study designs. Patient‐reported benefits remain to be demonstrated.
Reconstructive therapies to promote the regeneration of lost periodontal support have been investigated through both preclinical and clinical studies. Advanced regenerative technologies using new ...barrier‐membrane techniques, cell‐growth‐stimulating proteins or gene‐delivery applications have entered the clinical arena. Wound‐healing approaches using growth factors to target the restoration of tooth‐supporting bone, periodontal ligament and cementum are shown to significantly advance the field of periodontal‐regenerative medicine. Topical delivery of growth factors, such as platelet‐derived growth factor, fibroblast growth factor or bone morphogenetic proteins, to periodontal wounds has demonstrated promising results. Future directions in the delivery of growth factors or other signaling models involve the development of innovative scaffolding matrices, cell therapy and gene transfer, and these issues are discussed in this paper.
Aim
Assess the ability of a panel of gingival crevicular fluid (GCF) biomarkers as predictors of periodontal disease progression (PDP).
Materials and methods
In this study, 100 individuals ...participated in a 12‐month longitudinal investigation and were categorized into four groups according to their periodontal status. GCF, clinical parameters and saliva were collected bi‐monthly. Subgingival plaque and serum were collected bi‐annually. For 6 months, no periodontal treatment was provided. At 6 months, patients received periodontal therapy and continued participation from 6 to 12 months. GCF samples were analysed by ELISA for MMP‐8, MMP‐9, Osteoprotegerin, C‐reactive Protein and IL‐1β. Differences in median levels of GCF biomarkers were compared between stable and progressing participants using Wilcoxon Rank Sum test (p = 0.05). Clustering algorithm was used to evaluate the ability of oral biomarkers to classify patients as either stable or progressing.
Results
Eighty‐three individuals completed the 6‐month monitoring phase. With the exception of GCF C‐reactive protein, all biomarkers were significantly higher in the PDP group compared to stable patients. Clustering analysis showed highest sensitivity levels when biofilm pathogens and GCF biomarkers were combined with clinical measures, 74% (95% CI = 61, 86).
Conclusions
Signature of GCF fluid‐derived biomarkers combined with pathogens and clinical measures provides a sensitive measure for discrimination of PDP (ClinicalTrials.gov NCT00277745).
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Aim
This systematic review investigates the impact of specific interventions aiming at promoting behavioural changes to improve oral hygiene (OH) in patients with periodontal diseases.
Methods
A ...literature search was performed on different databases up to March 2019. Randomized and non‐randomized controlled trials evaluating the effects of behavioural interventions on plaque and bleeding scores in patients with gingivitis or periodontitis were considered. Pooled data analysis was conducted by estimating standardized mean difference between groups.
Results
Of 288 articles screened, 14 were included as follows: 4 studies evaluated the effect of motivational interviewing (MI) associated with OH instructions, 7 the impact of oral health educational programmes based on cognitive behavioural therapies, and 3 the use of self‐inspections/videotapes. Studies were heterogeneous and reported contrasting results. Meta‐analyses for psychological interventions showed no significant group difference for both plaque and bleeding scores. No effect was observed in studies applying self‐inspection/videotapes.
Conclusions
Within the limitations of the current evidence, OH may be reinforced in patients with periodontal diseases by psychological interventions based on cognitive constructs and MI principles provided by oral health professionals. However, no conclusion can be drawn on their specific clinical efficacy as measured by reduction of plaque and bleeding scores over time.
Susceptibility to periodontal disease depends on individual factors within the host response to the bacterial challenge. The study of these factors requires longitudinal studies of an undisturbed ...development of the disease process. On the basis of the original longitudinal studies on the natural histology of periodontal disease staged in Sri Lanka and Oslo/Norway, several analyses of periodontal parameters and tooth status have been performed. The main findings were that in the first 20 years of complete absence of oral hygiene practices or preventive services attachment was lost at various rates. Three groups of subjects could be identified: rapidly progressing (RP) (8%), moderately progressing (MP) (81%), and subjects with no disease progression (NP) (11%). In the second two decades, the RP subjects have lost most of their teeth and no NP patients were identified anymore. The progression rate in these two decades was much slower, and the tooth mortality decreased. It could be predicted that subjects who had lost more than 2 mm at age 30 would not maintain a functional dentition at age 60. The corresponding control population in Oslo was used to study the influence of gingival inflammation on the initiation and progression of periodontal disease. The pattern and rates of attachment loss were identified in a population that was exposed to optimal and regular preventive services from age 3 onward. In the observation period of 26 years, it could be demonstrated that gingival inflammation varied little throughout adult life and always bleeding sites occurred consistently in 10% to 20%. The role of ongoing gingivitis in the pathogenesis of attachment loss was identified and also reflected stability whenever it was absent. Tooth mortality was only found in subjects with ongoing gingivitis. After 50 years of tooth age, 63% of the teeth were still maintained, while 99.8% were maintained after 50 years when gingival inflammation had been absent. Consequently, continuous gingivitis represented a risk factor for tooth loss.
Aim
To systematically assess the efficacy of patient‐administered mechanical and/or chemical plaque control protocols in the management of peri‐implant mucositis (PM).
Material and Methods
Randomized ...(RCTs) and Controlled Clinical Trials (CCTs) were identified through an electronic search of three databases complemented by manual search. Identification, screening, eligibility and inclusion of studies was performed independently by two reviewers. Studies without professional intervention or with only mechanical debridement professionally administered were included. Quality assessment was performed by means of the Cochrane Collaboration's tool for assessing risk of bias.
Results
Eleven RCTs with a follow‐up from 3 to 24 months were included. Definition of PM was lacking or heterogeneously reported. Complete resolution of PM was not achieved in any study. One study reported 38% of patients with complete resolution of PM. Surrogate end‐point outcomes of PM therapy were often reported. The choice of control interventions showed great variability. The efficacy of powered toothbrushes, a triclosan‐containing toothpaste and adjunctive antiseptics remains to be established. High quality of methods and reporting was found in four studies.
Conclusions
Professionally‐ and patient‐administered mechanical plaque control alone should be considered the standard of care in the management of PM. Therapy of PM is a prerequisite for the prevention of peri‐implantitis.
Objective: To monitor clinical, microbiological and host‐derived alterations occurring around teeth and titanium implants during the development of experimental gingivitis/mucositis and their ...respective healing sequence in humans.
Material and methods: Fifteen subjects with healthy or treated periodontal conditions and restored with dental implants underwent an experimental 3‐week period of undisturbed plaque accumulation in the mandible. Subsequently, a 3‐week period with optimal plaque control was instituted. At Days 0, 7, 14, 21, 28, 35 and 42, the presence/absence of plaque deposits around teeth and implants was assessed, (plaque index PlI) and the gingival/mucosal conditions were evaluated (gingival indexGI). Subgingival/submucosal plaque samples and gingival/mucosal crevicular fluid (CF) samples were collected from two pre‐determined sites around each experimental unit. CF samples were analyzed for matrix‐metalloproteinase‐8 (MMP‐8) and interleukin‐1beta (IL‐1β). Microbial samples were analyzed using DNA–DNA hybridization for 40 species.
Results: During 3 weeks of plaque accumulation, the median PlI and GI increased significantly at implants and teeth. Implant sites yielded a greater increase in the median GI compared with tooth sites. Over the 6‐week experimental period, the CF levels of MMP‐8 were statistically significantly higher at implants compared with teeth (P<0.05). The CF IL‐1β levels did not differ statistically significantly between teeth and implants (P>0.05). No differences in the total DNA counts between implant and tooth sites were found at any time points. No differences in the detection frequency were found for putative periodontal pathogens between implant and tooth sites.
Conclusion: Peri‐implant soft tissues developed a stronger inflammatory response to experimental plaque accumulation when compared with that of their gingival counterparts. Experimental gingivitis and peri‐implant mucositis were reversible at the biomarker level. Clinically, however, 3 weeks of resumed plaque control did not yield pre‐experimental levels of gingival and peri‐implant mucosal health indicating that longer healing periods are needed.
To cite this article: Salvi GE, Aglietta M, Eick S, Sculean A, Lang NP & Ramseier CA. Reversibility of experimental peri‐implant mucositis compared with experimental gingivitis in humans. Clin. Oral Impl. Res. 23, 2012; 182–190. doi: 10.1111/j.1600‐0501.2011.02220.x
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.
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