The Decontamination Effect of an Oscillating Chitosan Brush Compared With an Ultrasonic PEEK-Tip: An In Vitro Study Using a Dynamic Biofilm Model.

OBJECTIVES: This study aimed to assess the effect of an oscillating chitosan brush (OCB) compared with an ultrasonic device with PEEK tip (US-PEEK) for mechanical implant surface decontamination using an in vitro model combining 3D models and a validated dynamic multispecies biofilm. MATERIALS AND METHODS: A multispecies biofilm using six bacterial strains (Streptococcus oralis, Veillonella parvula, Actinomyces naeslundii, Fusobacterium nucleatum, Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans) was seeded on dental implants with machined and sandblasted, large-grit and acid-etched (SLA) surfaces. These were installed in 3D models depicting peri-implant defect. Mechanical decontamination was performed for 120 s using either an OCB or a US-PEEK. A negative control group received no treatment. Scanning electron microscopy (SEM) was used to evaluate the bacterial composition and quantitative PCR (qPCR) analyzed the number of each bacterial species [colony-forming units per milliliter (CFU/mL)]. RESULTS: Well-structured biofilms with a dense microbial distribution were observed on the negative control implants after 72 h. qPCR following mechanical decontamination showed a scarce bacterial reduction in the OCB group. The US-PEEK group exhibited a significant decrease in bacterial species compared to both OCB and control groups (p < 0.05). A biofilm removal effect was also observed in the OCB group for the machined implant surfaces. CONCLUSION: In vitro assessment using an anatomical 3D model showed that mechanical decontamination effectively reduced biofilm. The US-PEEK group demonstrated biofilm reduction on the SLA surface, while the OCB group showed a reduction on the machined implant surface. Additionally, the US-PEEK group demonstrated greater efficacy in reducing bacterial numbers.

Undiagnosed Celiac Disease and Periodontal Bone Loss: A Cross-Sectional Radiological Assessment from the HUNT Study.

Objective: The objective was to assess radiographic periodontal bone loss in a population with previously undiagnosed celiac disease, and to compare it to a reference group without celiac disease. Background: Periodontitis and celiac disease are chronic inflammatory diseases with possible similar features related to immune reactions and microbial dysbiosis. The relationship between these two diseases is not clear. Methods: Clinical variables, blood samples, and answers to questionnaires were collected from participants in the fourth Trøndelag Health Study (HUNT4). Celiac disease was determined based on transglutaminase 2 (TG2), immunoglobulin A (IgA), and G (IgG) in serum samples. Seropositive individuals were invited to endoscopic examination and tissue sampling. Radiographically assessed bone loss caused by periodontitis in two different levels of severity was applied as outcome, that is, ≥15% and >33% of root length. Bone loss was determined in panoramic images in participants that had attended radiographic examination in the HUNT4 Oral Health Study or in the HUNT4 Coeliac Disease Study. The association between previously undiagnosed celiac disease and radiographic bone loss was estimated by adjusted Poisson regression models. Results: Radiographic assessment was completed in 485 individuals with celiac disease determined by positive serology and in 4,727 individuals with negative serology (without celiac disease). Compared to nonceliacs, seropositive participants were less likely to present with ≥15% radiographic bone loss (prevalence ratio (PR) 0.89 (95% CI 0.84-0.96). A similar association was also observed after histopathological confirmation of celiac disease (PR 0.89 (95% CI 0.82-0.98). No association between undiagnosed celiac disease and periodontal bone loss was observed when analyses were limited to individuals with severe bone loss (>33%). Conclusion: In this study of previously undiagnosed celiac disease and periodontal bone loss, newly diagnosed celiac disease was associated with less likelihood of presenting with ≥15% radiographic bone loss compared to a nonceliac reference group.

Anatomical three-dimensional model with peri-implant defect for in vitro assessment of dental implant decontamination.

OBJECTIVES: Access to the implant surface plays a significant role in effective mechanical biofilm removal in peri-implantitis treatment. Mechanical decontamination may also alter the surface topography of the implant, potentially increasing susceptibility to bacterial recolonization. This in vitro study aimed to evaluate a newly developed, anatomically realistic, and adaptable three-dimensional (3D)printed model with a peri-implant bone defect to evaluate the accessibility and changes of dental implant surfaces after mechanical decontamination treatment. MATERIAL AND METHODS: A split model of an advanced peri-implant bone defect was prepared using 3D printing. The function of the model was tested by mechanical decontamination of the exposed surface of dental implants (Standard Implant Straumann AG) coated with a thin layer of colored occlusion spray. Two different instruments for mechanical decontamination were used. Following decontamination, the implants were removed from the split model and photographed. Image analysis and fluorescence spectroscopy were used to quantify the remaining occlusion spray both in terms of area and total amount, while scanning electron microscopy and optical profilometry were used to analyze alteration in the implant surface morphology. RESULTS: The 3D model allowed easy placement and removal of the dental implants without disturbing the implant surfaces. Qualitative and quantitative assessment of removal of the occlusion spray revealed differences in the mechanism of action and access to the implant surface between tested instruments. The model permitted surface topography analysis following the decontamination procedure. CONCLUSION: The developed 3D model allowed a realistic simulation of decontamination of implant surfaces with colored occlusion spray in an advanced peri-implant defect. 3D printing allows easy adaptation of the model in terms of the shape and location of the defect. The model presents a valuable tool for in vitro investigation of the accessibility and changes of the implant surface after mechanical and chemical decontamination.

Association between periodontitis stages and self-reported diseases in a Norwegian population: the HUNT study.

BACKGROUND: The relationships between periodontitis and non-communicable diseases (NCDs) have been investigated through several different case-definitions. The differences in methodology may have hindered the basis of comparison between these studies. The classification from the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions offers a unison platform that may facilitate future comparison of such research. The present study aimed to reproduce associations between periodontitis and other NCDs using the 2017 Classification, in the Trøndelag Health Study (HUNT). MATERIAL AND METHODS: The fourth HUNT-survey was carried out between 2017 and 2019. Clinical variables, blood samples and answers to questionnaires were collected from 4933 participants. Periodontal status was assessed based on the latest staging system, and its associations with NCDs were estimated by logistic regression models adjusted for potential confounders. RESULTS: Compared to no or Stage I periodontitis, participants with Stage III/IV periodontitis (radiographic bone loss exceeding 33%) were associated with cardiovascular disease, hyperglycemia in participants with diabetes and chronic obstructive pulmonary disease (COPD)/emphysema. Associations with hyperglycemia in participants with diabetes and COPD/emphysema were also observed in participants with Stage II periodontitis. The only observed association when considering never-smokers alone, was with COPD/emphysema. CONCLUSION: Periodontitis Stage II and III/IV were associated with major NCDs. Effect sizes increased with increasing periodontitis stages, which implies greater occurrence of coincident comorbidities in patients with severe periodontitis.

Non-surgical treatment of mild to moderate peri-implantitis with an oscillating chitosan brush or a titanium curette-12-month follow-up of a multicenter randomized clinical trial.

OBJECTIVES: To study clinical and radiographic outcomes after non-surgical treatment of peri-implantitis using either an oscillating chitosan brush (OCB) or titanium curette (TC) and to observe changes in clinical signs of inflammation after repeated treatment. METHODS: Thirty-nine patients with dental implants (n = 39) presented with radiographic bone level (RBL) of 2-4 mm, bleeding index (BI) ≥ 2, and probing pocket depth (PPD) ≥ 4 mm were randomly assigned to mechanical debridement with OCB (test) or TC (control). Treatment was performed at baseline and repeated at 3, 6, and 9 months in cases with > 1 implant site with BI ≥ 1 and PPD≥4 mm. Blinded examiners recorded PPD, BI, pus, and plaque. The radiographic bone level change between baseline and 12 months was calculated. A multistate model was used to calculate transitions of BI. RESULTS: Thirty-one patients completed the study. Both groups exhibited a significant reduction in PPD, BI, and pus at 12 months compared to baseline. Radiographic analysis showed stable mean RBL in both groups at 12 months. There was no statistically significant difference in any of the parameters between the groups. CONCLUSIONS: Within the limitations of this 12-month multicenter randomized clinical trial, non-surgical treatment of peri-implantitis with OCB or TC showed no statistically significant differences between the groups. Clinical improvements and, in some cases, disease resolution, was observed in both groups. However, persistent inflammation was a common finding which further puts emphasis on the need for further treatment.

The anti-plaque effect of high concentration sodium bicarbonate dentifrice on plaque formation and gingival inflammation, irrespective to individual polishing technique and plaque quality.

AIM: To assess the anti-plaque effect of a high concentration sodium bicarbonate dentifrice on plaque formation, and gingivitis, as compared to a control toothpaste, irrespective of individual brushing technique and plaque quality. METHODS: The experimental gingivitis model, with a split-mouth design was used to assess the anti-plaque effect of a high concentration sodium bicarbonate dentifrice on plaque formation. By producing individual fitted trays, the toothpaste was applied in the test quadrant and a control dentifrice in the contralateral. The participants used the individual fitted trays for 1 min every morning and evening, for 21 days. In this period, the participants was only allowed to brush the teeth in the opposite jaw, as usual. Twenty healthy individuals successfully completed the study. RESULTS: At 21 days, there was no statistically significant difference between test quadrant and control quadrant with regard to plaque indices, gingival index and number of bleeding sites. CONCLUSION: This study demonstrated that the high concentration sodium bicarbonate dentifrice used did not produce statistically significant anti-plaque effect compared to the control dentifrice, in terms of Plaque- and Gingival Indices, number of bleeding sites or by Quigely and Hein, the Turesky modification Plaque Index, irrespective of brushing technique and individual plaque quality. TRIAL REGISTRATION: Regional Committee for Medical Research and Ethics, South-East Norway in 2021 (REK.2021/370116). CLINICAL TRIAL REGISTRATION: NCT05441371 (First registered 09/06/2022, First posted 01/07/2022) ( http://www. CLINICALTRIALS: gov ). (Retrospectively registered).

Non-surgical therapy of peri-implant mucositis-Mechanical/physical approaches: A systematic review.

AIM: To study in humans with peri-implant mucositis the efficacy of (Q1) mechanical/physical instrumentation over oral hygiene instructions alone; (Q2) any single mode of mechanical/physical instrumentation over others; (Q3) combinations of mechanical/physical instrumentation over single modes; and (Q4) repetitions of mechanical/physical instrumentation over single administration. MATERIALS AND METHODS: Randomized clinical trials (RCTs) fulfilling specific inclusion criteria established to answer the four PICOS questions were included. A single search strategy encompassing the four questions was applied to four electronic databases. Two review authors independently screened the titles and abstracts, carried out full-text analysis, extracted the data from the published reports and performed the risk of bias assessment through the RoB2 tool of the Cochrane Collaboration. In case of disagreement, a third review author took the final decision. Treatment success (i.e., absence of bleeding on probing [BoP]), BoP extent and BoP severity were considered as the implant-level outcomes of critical importance for the present review. RESULTS: A total of five papers reporting on five RCTs, involving 364 participants and 383 implants, were included. Overall, treatment success rates after mechanical/physical instrumentation ranged from 30.9% to 34.5% at 3 months and from 8.3% to 16.7% at 6 months. Reduction in BoP extent was 19.4%-28.6% at 3 months, 27.2%-30.5% at 6 months and 31.8%-35.1% at 12 months. Reduction in BoP severity was 0.3-0.5 at 3 months and 0.6-0.8 at 6 months. Q2 was addressed in two RCTs, which reported no differences between glycine powder air-polishing and ultrasonic cleaning, as well as between chitosan rotating brush and titanium curettes. Q3 was addressed by three RCTs, which showed no added effect of glycine powder air-polishing over the use of ultrasonic and of diode laser over ultrasonic/curettes. No RCTs were identified that answered Q1 and Q4. CONCLUSIONS: Several mechanical/physical instrumentation procedures including curettes, ultrasonics, lasers, rotating brushes and air-polishing are documented; however, a beneficial effect over oral hygiene instructions alone or superiority over other procedures could not be demonstrated. Moreover, it remains unclear whether combinations of different procedures or their repetition over time may provide additional benefits. (CRD42022324382).

Periodontitis in a 65-year-old population: risk indicators and impact on oral health-related quality of life.

AIMS: The aims of the present study were to investigate socioeconomic and behavioral risk indicators for severe periodontitis in a 65-year-old Norwegian population, and to investigate how periodontitis impacts oral health-related quality of life. MATERIAL AND METHODS: A sample of 65-year-old residents in Oslo, born in 1954, was randomly selected for this study. The participants answered a questionnaire regarding country of birth, education, diabetes, smoking habits, dental attendance pattern, and tooth-brushing habits. In addition, oral health-related quality of life (OHRQoL) was assessed by the Oral Health Impact Profile-14 questionnaire (OHIP-14). Negative impact on OHRQoL was defined as responding "fairly often" or "very often" to at least one of the OHIP-14 items. The diagnosis of periodontitis was based on clinical and radiographic periodontal measurements and classified based on the consensus report from the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. RESULTS: Of 796 eligible participants, 460 individuals agreed to participate in the present study (response rate 58%). Seven participants were excluded from the analyses due to < 2 remaining teeth (n = 3) or missing questionnaire (n = 4), resulting in a study sample of 453 individuals (233 men and 220 women). An association was found between non-western country of birth, diabetes type 2, lower education, smoking, non-regular dental visits, and severe periodontitis (stage III or IV, n = 163) in bivariate analyses (Chi-square test). However, in the multiple logistic regression model, only non-western country of birth, diabetes type 2 and smoking (former and current), were associated with higher odds of severe periodontitis. The overall mean OHIP-14 total score was 3.6 (SD: 6.1). Participants with stage III or IV periodontitis reported a significantly higher OHIP-14 total score (mean: 4.7, SD: 7.4), indicating a lower OHRQoL, compared to non-periodontitis participants (mean: 2.9, SD: 4.9). CONCLUSIONS: In the present study, non-western birth country, diabetes type 2, and smoking were found as significant risk indicators for severe periodontitis. Overall, results indicate a good OHRQoL among 65-year-olds in Oslo, however, a tendency of reduced OHRQoL with increasing severity of periodontitis was observed.

Non-surgical treatment of mild to moderate peri-implantitis using an oscillating chitosan brush or a titanium curette-A randomized multicentre controlled clinical trial.

OBJECTIVES: This prospective, parallel-group, examiner-blinded, multicentre, randomized, controlled clinical trial aimed to assess the efficacy of an oscillating chitosan brush (OCB) versus titanium curettes (TC) on clinical parameters in the non-surgical treatment of peri-implantitis. MATERIAL AND METHODS: In five dental specialist clinics, 39 patients with one implant with mild to moderate peri-implantitis, defined as 2-4 mm radiographic reduced bone level, bleeding index (BI) ≥ 2, and probing pocket depth (PPD) ≥ 4 mm were randomly allocated to test and control groups, receiving OCB or TC debridement, respectively. Treatment was performed at baseline and three months. PPD, BI, and Plaque index (PI) were measured at six sites per implant and recorded by five blinded examiners at baseline, one, three, and six month(s). Pus was recorded as present/not present. Changes in PPD and BI were compared between groups and analysed using multilevel partial ordinal and linear regression. RESULTS: Thirty-eight patients completed the study. Both groups showed significant reductions in PPD and BI at six months compared with baseline (p < .05). There was no statistically significant difference in PPD and BI changes between the groups. Eradication of peri-implant disease as defined was observed in 9.5% of cases in the OCB group and 5.9% in the TC group. CONCLUSIONS: Within the limitations of this six-month multicentre clinical trial, non-surgical treatment of peri-implantitis with OCB and TC showed no difference between the interventions. Eradication of disease was not predictable for any of the groups.

Oral health-related quality of life following peri-implantitis surgery: A prospective study.

AIM: The aim of this prospective study was to describe long-term patient-reported outcomes following surgical treatment of peri-implantitis. METHODS: Oral health-related quality of life (OHRQoL) of 43 patients diagnosed with peri-implantitis was recorded using the short form of the Oral Health Impact Profile (OHIP-14), where low scores indicate low impact. A Norwegian version of the OHIP-14 form was filled out 1 week before and 6-, 18- and 36 months after the peri-implant surgery. The mean and median OHIP-14 scores were calculated for its seven domains (i.e., Functional limitation, Physical pain, Psychological discomfort, Physical disability, Psychological disability, Social disability, and Handicap) across four different time points. The dataset was analyzed to find correlations between independent variables and the OHIP-scores. RESULTS: The OHIP-14 scores were at a low level from baseline to 36 months post-surgery. The mean scores at specific time points were at baseline 7.2 (SD 7.3), 6 months post-surgery 6.0 (SD 6.9), 18 months post-surgery 6.8 (SD 9.7), and 3 years post-surgery 7.0 (SD 9.4). None of these changes were statistically significant. Specific domains of OHRQoL did not significantly differ across different time points (pre- and post-surgery) in males (except for domain "Handicap") or females (except for domain "Functional limitation"). CONCLUSIONS: The reported OHIP-14 measures were initially low and stayed low up to 3 years after peri-implant surgery. This may indicate that neither the disease nor the treatment deteriorated or improved the OHRQoL.

Periodontal conditions in a 65-year-old population and prevalence of periodontitis according to three different bone level thresholds.

AIMS: The aims of this cross-sectional study were to describe the prevalence and severity of periodontal disease in a 65-year-old population in Oslo, Norway, and to investigate to what extent the radiographic bone level threshold for periodontitis case definition influences the prevalence. MATERIALS AND METHODS: A random sample of 454 subjects underwent a clinical and radiographic examination and answered a questionnaire regarding general health, medications, and smoking habits. Clinical periodontal parameters (periodontal pocket depths, bleeding on probing, mobility, and furcation involvement) and radiographic bone loss were used to identify periodontitis cases and to assess periodontal stage and grade. RESULTS: Of the 454 participants, 52.6% were defined as "periodontitis cases". Of the total study population "unstable cases of recurrent periodontitis" were present in 38.1%, 16.5% of the participants were assigned to stage II, 32.8% to stage III, and 3.3% to stage IV. When lowering the radiographic bone loss cutoff from > 3 mm to > 2 mm or > 1 mm the prevalence of periodontitis increased to 91.9% and 99.6%. CONCLUSIONS: Periodontitis was common among 65 year-olds living in Oslo, and in the majority of those with periodontitis, the disease was recurrent and unstable. This study also shows that the choice of bone loss cutoff for defining a periodontitis case affects the prevalence estimates to a large extent. In addition, this study addresses weaknesses in the use of the consensus report of the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions for epidemiologic studies in its current form.

Prevalence of periodontitis based on the 2017 classification in a Norwegian population: The HUNT study.

AIM: This cross-sectional study assesses the prevalence of periodontitis in a large Norwegian population, based on the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. The prevalence of periodontitis was determined by bone loss recorded on radiographs (orthopantomogram [OPG] and bitewing [BW]) and by clinical examination. MATERIALS AND METHODS: As part of a large population health study (The HUNT Study), 7347 participants aged 19 years and older were invited to the HUNT4 Oral Health Study. Radiographic bone loss (RBL) and periodontal stage and grade were assessed in 4863 participants. RESULTS: Periodontal examination was performed in 4863 participants. RBL and clinical registrations corresponding to periodontitis as defined were observed in 72.4%. The prevalence of periodontitis increased after 40 years of age, with severe forms occurring primarily after 60 years of age. Stage I was observed in 13.8%, Stage II in 41.1%, Stage III in 15.3%, and Stage IV in 2.3% of the population. Grade A, B, and C was observed in 5.7%, 60.2%, and 6.2%, respectively. CONCLUSION: Periodontitis was frequently observed in the investigated population. The prevalence of periodontitis Stage III and Stage IV combined was observed in 17.6% of the study population.

Periodontal status in long-term orthodontic retention patients up to 10 years after treatment - a cross-sectional study.

OBJECTIVE: To assess periodontal status in long-term orthodontic retention patients and investigate possible risk indicators. MATERIALS AND METHODS: Plaque index (PI), gingival index (GI), probing pocket depth (PPD), gingival recessions (GR) and calculus were recorded in 211 patients with or without fixed retainers. RESULTS: Periodontal parameters were within the limits of clinically healthy periodontium. The use of fixed retainers was associated with higher PI in the maxilla (ß = 1.10 [0.37]; p <.05). Older age was associated with higher PI in the mandible (ß = 0.27 [0.11]; p <.05). Smoking was associated with gingival bleeding on both palatal (ß = 0.63 [0.16]; p < .01) and labial sides in the maxilla (ß = 0.46 [0.20]; p <.05). Smoking was also associated with increased prevalence of GR in the mandible (ß = 0.24 [0.07]; p <.01), while use of snuff had similar effect on the labial side in the maxilla (ß = 0.35 [0.08]; p <.01). Higher age (ß = 0.05 [0.02]; p <.05) and the presence of a retainer (ß = 0.23 [0.07]; p < .05) were associated with calculus accumulation on the lingual side in the mandible. CONCLUSION: The present observational study suggest that long-term fixed retainers alone have no detrimental effect on the periodontium. Additional factors may increase the risk of plaque deposits and increased probing pocket depths. Further prosepective studies are needed to confirm the present outcome.

Development and initial testing of an in vitro model simulating class II furcation defects.

OBJECTIVE: To compare surface topography of porcine and human root dentin and to develop a new in vitro model for class II furcation defects. The hypothesis for this study was that porcine mandible blocks can function as a model for class II furcation defects. BACKGROUND: Treatment of mandibular class II furcation defects is unpredictable. There is a need for in vitro models to investigate new treatment methods. METHODS: A model to investigate the surface topography of porcine and human root dentin was developed and the two tissues compared by SEM imaging and profilometer. A novel method for studying class II furcation defects was then tested. Blocks of porcine mandibles with molar 3 were prepared. Buccal class II furcation defects were created. The furcation area was isolated and bioluminescent Staphylococcus epidermidis Xen43 was used to form a biofilm in the furcation area to test the functionality of the novel furcation model. RESULTS: Micromechanical damage caused by debridement on porcine and human root dentin showed similar pattern. No significant difference in the surface morphological parameters was observed between the corresponding porcine and human samples. The model allowed for assessment of the root surface inside the furcation area. While the number of viable bacteria in the furcation following debridement could be quantified, no significant difference between the treatment groups was detected, likely due to bacterial colonization within the periodontal ligament space. CONCLUSION: Porcine and human root dentin show similar surface topography following surface debridement. Porcine mandible blocks can function as a model for class II furcation defects. However, further development and refinement of the novel in vitro model is warranted.

Supportive treatment following peri-implantitis surgery: An RCT using titanium curettes or chitosan brushes.

AIMS: The aim of this randomized controlled trial was to assess the effect of two maintenance programmes when treatments were performed every third month from six to 18 months following surgical treatment of peri-implantitis. MATERIALS AND METHODS: At the 6-month post-surgical evaluation, 44 subjects were randomized into groups receiving supportive peri-implant treatment either by the use of titanium curettes or chitosan brushes at implants registered with BoP and PPD >3 mm. Follow-up examinations and supportive therapy were performed 6, 9, 12, 15 and 18 months post-surgically. Clinical and radiographic assessments were made. RESULTS: The percentage of implants registered with inflammation was high at the 6-month baseline examination (>80% bleeding on probing in both test and control group) and remained high throughout the observation period. Similar observations were made for all clinical parameters, and no significant difference was found between test and control groups. CONCLUSIONS: In the present study, no statistical significant difference was found when supportive peri-implant treatment was performed with either titanium curettes or chitosan brushes. Within the limits of the study, the results might indicate the need of more effective submucosal cleaning procedures following peri-implant surgery.

Pain and morbidity after non-surgical and surgical treatment of peri-implantitis.

Objective: Not much information exists on post-treatment pain related to peri-implantitis. The purpose of this study was to evaluate intensity and quality of pain after non-surgical and surgical treatment of peri-implantitis. Material and methods: A total of 30 patients with a diagnosis of peri-implantitis were included in the study. The patients registered pain using a VAS scale after non-surgical and surgical treatment of peri-implantitis. The data were registered for one week after each treatment. The patients also recorded quality of pain and if analgesics were taken. Factors included in the study were number of implants, severity of peri-implantitis (millimetre bone loss at most severely affected implant), implant localization, smoking and gender. Results: Statistically significant difference in intensity of pain was found between day zero and day one for both non-surgical and surgical treatment of peri-implantitis (p < .05). Number of implants, severity of peri-implantitis, implant localization, smoking and gender were not statistically significant related to intensity of pain post-treatment. The most frequently reported quality of pain was throbbing/soreness and numbness for both non-surgical and surgical treatment. Conclusion: Levels of pain are found to be low to moderate for most patients after treatment of peri-implantitis. The pain was most pronounced on the first two days post-treatment. Throbbing/soreness and numbness were the most frequently reported quality of pain.

Surgical treatment of peri-implantitis: Prognostic indicators of short-term results.

AIM: To evaluate the clinical and radiographic short-term (6 months) effect of surgical treatment of peri-implantitis, and to identify prognostic indicators affecting the outcome using a multilevel statistical model. MATERIALS & METHODS: A total of 143 implants (45 patients) with a diagnosis of progressive peri-implantitis (progressive bone loss (PBL) ≥2.0 mm and bleeding on probing (BoP)/suppuration) received surgical treatment. Clinical and radiographic parameters were assessed 6 months postoperatively. Potential prognostic indicators on subject, implant and site level prior to surgery were analysed to evaluate the effect on individual and composite outcomes using multilevel logistic regression analysis. RESULTS: At the 6-month evaluation, none of the implants demonstrated PBL and 14% of the implants were registered with the absence of bleeding and no pocket probing depth ≥6 mm. Multilevel regression analysis identified, among others, suppuration, pocket probing depth >8 mm, bone loss >7 mm and the presence of plaque as criteria associated with the outcome. CONCLUSION: Resective peri-implantitis surgery seemed to reduce the amount of peri-implant inflammation. However, most of the sites continued to have BoP/suppuration. Thus, long-term maintenance and evaluation is warranted. The effect of treatment was reduced by some prognostic indicators such as the presence of suppuration prior to interception and peri-implant bone loss exceeding 7 mm.

Comparing the effect of 0.06% -, 0.12% and 0.2% Chlorhexidine on plaque, bleeding and side effects in an experimental gingivitis model: a parallel group, double masked randomized clinical trial.

BACKGROUND: Chlorhexidine is the gold standard of dental plaque prevention. The aim of the present study was to compare the plaque and gingivitis inhibiting effect of commercial products containing 0.2%, 0.12% and 0.06% chlorhexidine in a modified experimental gingivitis model. METHODS: In three groups of healthy volunteers, experimental gingivitis was induced and monitored over 21 days and simultaneously treated with the commercial solutions containing 0.2%, 0.12% and 0.06% chlorhexidine. The maxillary right quadrant of each individual received mouthwash only, whereas the maxillary left quadrant was subject to both rinsing and mechanical oral hygiene. Compliance and side effects were monitored at days 7, 14, and 21. Plaque and gingivitis scores were obtained at baseline and day 21. RESULTS: The commercial mouthwash containing 0.2% chlorhexidine resulted in statistically significantly lower plaque scores than the 0.12 and 0.06% mouthwashes after 21 days use, whereas no statistically significant difference was found between the effects of the two latter. CONCLUSION: A commercially available mouthwash containing 0.2% chlorhexidine had statistically significant better effect in preventing dental plaque than the 0.12% and 0.06% solutions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02911766 . Registration date: September 9th 2016.

EMD in periodontal regenerative surgery modulates cytokine profiles: A randomised controlled clinical trial.

The enamel matrix derivative (EMD) contains hundreds of peptides in different levels of proteolytic processing that may provide a range of biological effects of importance in wound healing. The aim of the present study was to compare the effect of EMD and its fractions on the cytokine profiles from human gingival fibroblasts in vitro and in gingival crevicular fluid (GCF) in a randomized controlled split-mouth clinical study (n = 12). Levels of cytokines in cell culture medium and in GCF were measured by Luminex over a 2-week period. In the clinical study, levels of pro-inflammatory cytokines and chemokines were increased, whereas the levels of transforming growth factor-α (TGF-α) and platelet-derived growth factor-BB (PDGF-BB) were reduced. The in vitro study showed that EMD and its high and low molecular weight fractions reduced the secretion of pro-inflammatory cytokines and chemokines compared to untreated cells. EMD had an effect on levels of cytokines related to fibroplasia, angiogenesis, inflammation and chemotaxis both in vitro and in vivo, however, the anti-inflammatory effect induced by EMD observed in the in vitro study could not be confirmed clinically.

A new digital tool for radiographic bone level measurements in longitudinal studies.

BACKGROUND: The reproducibility of measurements on radiographs is influenced by the techniques by which the images as well as the measurements are obtained. Thus, bias resulting from errors in the image and/or image examinations at two points in time may result in wrongful registrations of true biological or pathological changes. The aim of the present study was to propose and evaluate an indirect radiological examination technique, by which bias, when measuring radiographic bone level, could be substantially reduced as compared to the technique using direct mm measurements. METHODS: A plugin to ImageJ was designed to reduce bias when measuring bone loss on radiographic images. In human dry mandibles, radiographic images of 20 teeth were obtained parallel with the tooth axis (alpha = 0) and at an angle of 30° deviation. The direct technique of measuring radiographic bone level (RBL) and the indirect, length-adjusted RBL were registered by four researchers in a double blinded fashion. RESULTS: When mean RBL measured at 0° angle was 7.0 mm, the corresponding mean RBL measured at 30° angle was 7.8 mm, signifying an 11.4% increase (p = 0.032), whereas the mean length-adjusted RBL increased by 0.6% (p = 0.9). CONCLUSIONS: This study showed that the use of the original, direct technique (ImageJ) resulted in markedly biased radiographic bone level at 30° angle, while the proposed indirect length-adjusted technique (ImageJ plugin) did not.