Replacement of missing lateral incisors for patients with cleft lip and palate: A decision-making tree based on a systematic review of the literature.

STATEMENT OF PROBLEM: Cleft lip and palate are the most frequent congenital anomalies of the face and are often linked with lateral incisor agenesis. The therapeutic decision on whether and how to replace the lateral incisors is not straightforward, and a decision-making tree is needed. PURPOSE: The purpose of this systematic review was to evaluate the available literature reporting on treatments for the replacement of missing lateral incisors in cleft areas. By analyzing the success and survival rates of these treatments, a decision-making tree was developed. MATERIAL AND METHODS: The literature search was performed on the PubMed (MEDLINE), Web of Science, Cochrane, EMBASE, Dentistry of Oral and Science Source, and Google Scholar databases and was based on the question: Which treatment for patients with lateral incisor agenesis and cleft lip and palate has a good success rate? RESULTS: Twenty-six articles were included in this systematic review. A meta-analysis was performed on 14 articles (20 case series, 6 case controls). The estimated overall 5-year survival rates were 96.4% for implant-supported prostheses. CONCLUSIONS: Different treatment options are available, depending on the clinical situation. If the patient meets the conditions for implant placement, this treatment remains a preferred solution. If the prosthetic space is reduced, orthodontic space closure and composite resin restorations are possible. When these options are not possible, a resin-bonded fixed partial denture is the preferred option. If the teeth adjacent to the edentulous area require extensive restorations, a fixed partial denture may be a suitable alternative.

Self-reported periodontal health and incident hypertension: longitudinal evidence from the NutriNet-Santé e-cohort.

OBJECTIVE: An association between periodontitis and arterial hypertension has been suggested recently. This study aimed at investigating the hypothesis that periodontal health is linked to incident arterial hypertension. METHODS: We analyzed data from the French population-based e-cohort NutriNet-Santé, selecting participants who had completed two oral health questionnaires in 2011-2012. Pregnant women, participants with diabetes, cancer, arterial hypertension and cardiovascular diseases at inclusion were excluded. Incident cases of arterial hypertension were self-reported and/or based on the use of antihypertensive therapy. Periodontal health was evaluated by estimating the modified and validated PEriodontal Screening Score (mPESS), with mPESS at least 5 corresponding to a high probability of severe periodontitis. Descriptive statistics and Cox proportional hazards regression models, taking into account sociodemographic and lifestyle confounders, were used. RESULTS: The study population consisted of 32 285 participants (mean age: 45.79 ±â€Š13.87 years); 78.5% were women. Two thousand one hundred and sixteen incident cases of arterial hypertension were identified during a median follow-up of 8 years (April 2012--December 2019). In the fully adjusted model, an mPESS at least 5 [hazard ratio: 1.84; 95% confidence interval (CI): 1.66-2.03] and the presence of nonreplaced missing teeth (hazard ratio: 1.13; 95% CI: 1.03-1.23) were significantly associated with a greater risk of incident arterial hypertension, whereas a regular annual visit to the dentist was associated with a lower risk (hazard ratio: 0.88; 95% CI: 0.80-0.97). CONCLUSION: Self-reported assessed periodontitis was associated with incident arterial hypertension over an 8-year period. The present results highlight the importance of considering periodontal health when assessing an individual's risk of arterial hypertension. TRIAL REGISTRATION: # NCT03335644.

Alcoholic beverage consumption, smoking habits, and periodontitis: A cross-sectional investigation of the NutriNet-Santé study.

BACKGROUND: Recent evidence suggests that dietary habits influence the development and severity of periodontitis. The present cross-sectional study evaluated the association between different types and quantity of alcoholic beverage consumption (alone and interacting with smoking) and the probability to suffer from severe periodontitis in the French e-cohort NutriNet-Santé. METHODS: The study population consisted of 35,390 adults (mean age: 49.04 ± 13.94 years), who filled oral health questionnaires and completed at least three non-consecutive 24-hour dietary records. Data on type and frequency of alcoholic beverage consumption were obtained from a semi-quantitative self-reported alcohol frequency questionnaire; the daily quantity (g/day) was estimated from the 24-hour dietary records. The probability of severe periodontitis (main dependent variable) was assessed by calculating the modified periodontal screening score (mPESS) from selected questions. RESULTS: A total of 7263 individuals (20.5%) presented a high probability of suffering from severe periodontitis (high-mPESS). After adjusting for confounding factors, the frequency of alcoholic beverage consumption was significantly higher among high-mPESS group than their low-mPESS counterparts, especially for hard liquor/spirits (1.9 ± 1.4 days/week for high-PESS versus 1.6 ± 1.1 days/week the low-PESS [P < 0.0001]). The mean daily quantity of ethanol was also higher in high-mPESS versus low-mPESS individuals (11.2 ± 15.6 versus 7.9 ± 12.3 g/day; P = 0.011). A stronger association with self-report severe periodontitis was noted when alcohol consumption exceeding > 20 g/day for women and > 30 g/day for men was combined with smoking habit (OR = 7.30 [95% CI: 6.1-8.73]). CONCLUSION: The present results support an association between alcoholic beverage consumption and self-report severe periodontitis, particularly when it is associated with current smoking.

Impact of risk factor control interventions for smoking cessation and promotion of healthy lifestyles in patients with periodontitis: A systematic review.

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.

Promoting behavioural changes to improve oral hygiene in patients with periodontal diseases: A systematic review.

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.

The relationship between dental implant papilla and dental implant mucosa around single-tooth implant in the esthetic area: A retrospective study.

OBJECTIVE: The aim of the present study was (a) to evaluate the relationship between dental implant mucosa and dental implant papilla levels; and (b) to identify the clinical parameters associated with peri-implant soft tissue stability over time. MATERIALS AND METHODS: This is a retrospective study on a cohort of patients seeking a single-tooth implant therapy in a private practice in the Paris area. Two independent examiners analyzed photographs and radiographs taken the day of definitive crown load (baseline) and the last follow-up visit (at least 12 months later) in order to measure four peri-implant soft and hard tissue parameters. RESULTS: Seventy-four patients corresponding to 90 implants were analyzed. During a mean follow-up of 53.88 months, five implants (5.6%) presented with an apical displacement of the mid-facial marginal mucosal level of at least 1 mm. Changes in the mid-facial mucosa level were explained by changes in (a) the keratinized tissue height over time (p < .0001); (b) changes in the papilla height (p < .0001); and (c) by the periodontal phenotype (p = .007). A significant difference between papillae that gain in height (n = 85) and papilla that lost height (n = 78) was observed concerning (a) the timing of the implant placement (p = .019); and (b) the presence of an incomplete papilla fill (distance from the top of the papilla to the contact point) at baseline (p = .004). CONCLUSIONS: The present findings indicate a dependent association between dental implant mucosa and dental implant papilla levels. Stability of peri-implant soft tissues depends on periodontal phenotype, keratinized tissue height and papilla height.

Soluble Forms of the Receptor for Advanced Glycation Endproducts (RAGE) in Periodontitis.

The receptor for advanced glycation endproducts (RAGE) is critically involved in the pathobiology of chronic inflammatory diseases. Soluble forms of RAGE have been proposed as biomarkers of severity in inflammatory and metabolic conditions, and in monitoring therapeutic responses. The aim of the present study was to determine circulating levels of the soluble forms of RAGE in periodontitis and to evaluate the expression of cell-bound, full-length RAGE and its antagonist AGER1 locally, in gingival tissues. Periodontitis patients and periodontally healthy, sex- and age-matched controls (50 per group) were included. Serum levels of total soluble RAGE and cleaved RAGE (cRAGE) were significantly lower in periodontitis patients. Levels of the endogenous secretory esRAGE were similar in the two groups. cRAGE remained significantly lower in the periodontitis group following multiple adjustments, and had a statistically significant inverse correlation with body mass index and all periodontal parameters. In periodontitis patients, gene expression of full-length RAGE and of AGER1 were significantly higher in periodontitis-affected gingival tissues compared to healthy gingiva. Soluble forms of RAGE, particularly cRAGE, may serve as biomarkers for the presence and severity/extent of periodontitis, and may be implicated in its pathogenesis and its role as a systemic inflammatory stressor.

Periodontal reconstruction by heparan sulfate mimetic-based matrix therapy in Porphyromonas gingivalis-infected mice.

BACKGROUND: Periodontitis is a set of chronic inflammatory diseases affecting the supporting structures of the teeth, during which a persistent release of lytic enzymes and inflammatory mediators causes a self-perpetuating vicious cycle of tissue destruction and repair. A matrix-based therapy using a heparan sulfate (HS) analogue called ReGeneraTing Agent (RGTA) replaces destroyed HS by binding to available heparin-binding sites of structural molecules, leading to restoration of tissue homeostasis in several inflammatory tissue injuries, including a hamster periodontitis model. METHODS: The ability of RGTA to restore the periodontium was tested in a model of Porphyromonas gingivalis-infected Balb/cByJ mice. After 12 weeks of disease induction, mice were treated weekly with saline or RGTA (1.5 mg/kg) for 8 weeks. Data were analyzed by histomorphometry. RESULTS: RGTA treatment restored macroscopic bone loss. This was related to (1) a significant reduction in gingival inflammation assessed by a decrease in infiltrated connective tissue, particularly in cells expressing interleukin 1ß, an inflammatory mediator selected as a marker of inflammation; (2) a normalization of bone resorption parameters, i.e. number, activation and activity of osteoclasts, and number of preosteoclasts; (3) a powerful bone formation reaction. The Sharpey's fibers of the periodontal ligament recovered their alkaline phosphatase coating. This was obtained while P. gingivalis infection was maintained throughout the treatment period. CONCLUSIONS: RGTA treatment was able to control the chronic inflammation characteristic of periodontitis and blocked destruction of periodontal structures. It ensured tissue regeneration with recovery of the periodontium's anatomy.

Increased levels of soluble CD163 in periodontitis patients.

AIM: Soluble CD163 (sCD163) has been implicated as a new biomarker in inflammatory conditions. The aim of this cross-sectional study was to assess CD163 levels systemically and locally in patients with chronic periodontitis. METHODS: sCD163 levels were measured by ELISA in serum samples from 70 periodontitis and 70 periodontally healthy subjects, and in saliva samples in a subset of the population. Two gingival biopsies were harvested per subject from 20 periodontitis patients: one from a periodontally affected site, the other from a healthy site, and the relative expression of CD163 mRNA was assessed by real-time PCR. RESULTS: Serum sCD163 was significantly higher in periodontitis patients compared to periodontally healthy subjects (720.0 ± 330.6 ng/ml versus 510.7 ± 219.6 ng/ml, respectively; p < .001). Similarly, sCD163 levels in saliva were significantly increased in periodontitis compared to healthy subjects (3.01 ± 5.07 ng/ml versus 1.98 ± 4.95 ng/ml, respectively; p = .009). Serum and saliva sCD163 levels showed a positive correlation (Kendall's tau .27, p = .018). Importantly, CD163 gene expression was significantly higher in affected sites compared to unaffected sites in periodontitis patients, with a mean fold upregulation of 9.9 (STD: 15.3, p = .010). CONCLUSION: Our findings suggest that CD163 may be involved in the pathogenesis of periodontitis and its link with systemic conditions.