Clinical Outcomes and Predictors of Satisfaction in Patients with Improved Lithium Disilicate All-Ceramic Crowns.

OBJECTIVES: The aim of this study was to determine the clinical outcomes and predictors of satisfaction in patients with lithium disilicate (LD) ceramic crowns. SUBJECTS AND METHODS: Clinical outcomes were assessed in 47 patients with 88 LD crowns using modified United States Public Health Service (USPHS) evaluation criteria and survival rates. The questionnaire for predictors included 3 aspects: (a) sociodemographic characteristics, (b) oral health habits (tooth brushing frequency, flossing frequency, and dental visits), and (c) satisfaction of the restorations (aesthetics, function, fit, cleansability, and chewing ability of the crowns, and overall satisfaction). Frequency distributions were computed using univariate and multivariate analysis. The Student t test and analysis of variance (ANOVA) were used to compare means across variables. Correlation analysis was done to assess the association between continuous variables. RESULTS: The age of crowns was 34.7 ± 9.7 months. The survival rate was 96.6% at 35.9 ± 9.2 months. There was a significant association between successful crown function and oral hygiene measures: tooth brushing (p˂ 0.001), dental visits (p = 0.006), and flossing (p = 0.009). A strong negative correlation was observed between aesthetic satisfaction (r = -0.717, p˂ 0.001) and chewing ability (r = -0.639, p˂ 0.001) with crown age. The linear regression model was significant for all predictors (p < 0.05) except overall satisfaction (p > 0.05). CONCLUSION: The LD crowns had long survival rates of 96.6% up to 35.9 ± 9.2 months and provided satisfactory clinical performance (low risk of failure). Oral hygiene habits such as brushing, flossing, and regular dental visits influenced patient satisfaction with LD crowns.

Impact of mandibular implant prostheses on the oral health-related quality of life in partially and completely edentulous patients.

OBJECTIVE: To assess the oral health-related quality of life (OHRQoL) of patients provided with mandibular implant fixed partial prostheses (IFPP) for rehabilitation of two adjacent missing posterior teeth and complete denture patients provided with mandibular implant-supported overdenture (ISOD). The response to change in OHRQoL with implant prostheses was additionally compared. MATERIAL AND METHODS: In this prospective study, 20 IFPP (mean age 47.0; SD 12.9 years) and 28 ISOD (mean age 61.5; SD 9.1 years) patients received 2 mandibular implants. Metal ceramic nonsplinted fixed prostheses were provided in IFPP group, while in ISOD group, the mandibular overdentures were retained by nonsplinted attachments. Patients rated their oral health-related quality of life using OHIP-14 Malaysian version at baseline (T0), 2-3 months (T1) and 1 year (T2) postimplant treatment. Mean OHIP-14 for total and domain scores between groups and intervals was analysed using repeated-measures ANOVA and t-test. Mann-Whitney and Wilcoxon signed-rank tests were used for the comparison of mean score change and effect size, while the association between pre- and post-treatment scores was determined using multivariate linear regression modelling. RESULTS: The total OHIP and domain scores before implant treatment were significantly higher (lower OHRQoL) in IFPP than in ISOD groups, except for physical pain where this domain showed similar impact in both groups. Postimplant scores between groups at T1 and T2 showed no significant difference. The mean score changes at T0-T1 and T0-T2 for total OHIP-14 and domains were significantly greater in IFPP except in the domains of physical pain and disability which showed no difference. Large effect size (ES) was observed for total OHIP-14 in IFPP while moderate in ISOD. Improved OHRQoL was dependent on the treatment group and pretreatment score. CONCLUSION: Improvement in OHRQoL occurred following both mandibular implant-supported overdentures and implant fixed partial prostheses.

Effect of nonsurgical periodontal therapy verses oral hygiene instructions on type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial.

BACKGROUND: 40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals. METHODS: 40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals. RESULTS: 15 subjects from NSPT group and 17 from OHI group completed the study. The difference in plaque index (PI) between NSPT and OHI groups were significant at 2 months recall (p = 0.013). There was no significant difference between NSPT and OHI group for all other clinical periodontal parameters, HbA1c and CRP levels. At 3 months post-therapy, periodontal parameters improved significantly in both groups with sites with probing pocket depth (PPD) < 4 mm reported as 98 ± 1.8% in NSPT group and 92 ± 14.9% in OHI group. Mean PPD and mean probing attachment loss (PAL) within the NSPT group reduced significantly from baseline (2.56 ± 0.57 mm, 3.35 ± 0.83 mm) to final visit (1.94 ± 0.26 mm, 2.92 ± 0.72 mm) (p = 0.003, p < 0.001). For OHI group, improvements in mean PPD and mean PAL were also seen from baseline (2.29 ± 0.69 mm, 2.79 ± 0.96 mm) to final visit (2.09 ± 0.72 mm, 2.62 ± 0.97 mm) (p < 0.001 for both). Similarly, HbA1c levels decreased in both groups with NSPT group recording statistically significant reduction (p = 0.038). Participants who demonstrated ≥ 50% reduction in PPD showed significant reductions of HbA1c and hs-CRP levels (p = 0.004 and p = 0.012). CONCLUSION: NSPT significantly reduced PI at 2 months post-therapy as compared to OHI. Both NSPT and OHI demonstrated improvements in other clinical parameters as well as HbA1c and CRP levels. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01951547.

3D TECA hydrogel reduces cellular senescence and enhances fibroblasts migration in wound healing.

This study was designed to investigate the effect of 3D TECA hydrogel on the inflammatory-induced senescence marker, and to assess the influence of the gel on the periodontal ligament fibroblasts (PDLFs) migration in wound healing in vitro. PDLFs were cultured with 20 ng/ml TNF-α to induce inflammation in the presence and absence of 50 µM 3D TECA gel for 14 d. The gel effect on the senescence maker secretory associated-ß-galactosidase (SA-ß-gal) activity was measured by a histochemical staining. Chromatin condensation and DNA synthesis of the cells were assessed by 4',6-diamidino-2-phenylindole and 5-ethynyl-2'-deoxyuridine fluorescent staining respectively. For evaluating fibroblasts migration, scratch wound healing assay and Pro-Plus Imaging software were used. The activity of senescence marker, SA-ß-gal, was positive in the samples with TNF-α-induced inflammation. SA-ß-gal percentage is suppressed (>65%, P < 0.05) in the treated cells with TECA gel as compared to the non-treated cells. Chromatin foci were obvious in the non-treated samples. DNA synthesis was markedly recognized by the fluorescent staining in the treated compared to non-treated cultures. Scratch wound test indicated that the cells migration rate was significantly higher (14.9 µm2/h, P < 0.05) in the treated versus (11 µm2/h) for control PDLFs. The new formula of 3D TECA suppresses the inflammatory-mediated cellular senescence and enhanced fibroblasts proliferation and migration. Therefore, 3D TECA may be used as an adjunct to accelerate repair and healing of periodontal tissues.

Resistin as potential biomarker for chronic periodontitis: A systematic review and meta-analysis.

OBJECTIVES: To determine the serum and gingival crevicular fluid (GCF) levels of resistin between individuals with chronic periodontitis (CP) and those without CP, and to evaluate the role of resistin in CP. MATERIALS AND METHODS: The addressed focused question was "Is there a difference in the resistin levels between individuals with CP and those without CP?" four electronic databases: Medline, PubMed (National Institutes of Health, Bethesda), EMBASE, and Science direct databases from 1977 up to March 2016 for appropriate articles addressing the focused question. EMBASE and Medline were accessed using OVID interface which facilitated simultaneous search of text words, MeSH or Emtree. Unpublished studies (gray literature) were identified by searching the Open-GRAY database and references of the included studies (cross referencing) were performed to obtain new studies. In-vitro studies, animal studies, studies that reported levels of other cytokines but not resistin, letters to the editor and review papers were excluded. RESULTS: Ten studies were included. Nine studies compared resistin levels between CP and periodontally healthy (H) individuals and reported higher mean serum and GCF levels of resistin in CP patients than the H controls. Two studies showed comparable resistin levels from GCF and serum between diabetes mellitus with CP (DMCP) and CP groups. Three studies included obese subjects and showed comparable serum and GCF resistin levels between obese subjects with CP (OBCP) and CP subjects. CONCLUSIONS: CP patients were presented with elevated levels of GCF or serum resistin as compared with H individuals. Resistin modulates inflammation in chronic periodontal disease and may be used as surrogate measure to identify subjects at risk for periodontitis. Resistin levels in patients with CP and systemic inflammatory disorders such as diabetes, obesity, or rheumatoid arthritis was not significantly higher than the levels in patients with only CP.

Efficacy of 'Gamadent' toothpaste on the healing of gingival tissues: a preliminary report.

The aim of this randomised, parallel, double-blind study, in which 28 adult patients diagnosed with chronic gingivitis or early stages of chronic periodontitis were recruited, was to evaluate the efficacy of 'Gamadent' toothpaste compared to a placebo toothpaste. 'Gamadent' toothpaste has all the basic constituents of a toothpaste with the addition of a sea cucumber extract (SCE) of the species Stichopus sp. 1 to improve the healing potential of tissues. The placebo has the same basic constituents minus the extract. Out of the 28 patients, 14 were placed in the test group who used the 'Gamadent' toothpaste, and 14 patients were placed in the control group (2 control subjects defaulted and were excluded), who brushed using the placebo toothpaste. The longitudinal study was carried out over a period of 3 months with assessments made at baseline, 1 month, 2 months and 3 months after conventional therapy at the baseline visit. The clinical parameters used during the trial were Plaque Index (PI), Gingival Index (GI), Papilla Bleeding Index (PBI) and Probing Pocket Depth (PPD). A predetermined number of sites on a molar, premolar, canine and an incisor were examined and evaluated in each quadrant. After the baseline assessment, the patients had full mouth scaling and debridement as well as oral hygiene instructions. Patients were instructed to brush their teeth twice a day with the toothbrush provided (Oral-B plus, size 35) and toothpaste (test or control), using the Bass technique. At the 1-month assessment, there were significant mean reductions to baseline mean values in PI (P < 0.005) and GI (P < 0.001) in the test group as compared to the control group. At the end of the 2-month interval, significant reductions were observed in PI, PBI and PPD (P < 0.001). By the end of 3 months, there were significant differences in the mean reduction of all the parameters i.e. PI, PBI, GI and PPD (P < 0.001), between the test and control sites. In conclusion, 'Gamadent' toothpaste provided noteworthy benefits, producing statistically significant improvement in all clinical parameters compared to the placebo during the healing phase after conventional initial therapy.

Short dental implants: an emerging concept in implant treatment.

OBJECTIVE: Short implants have been advocated as a treatment option in many clinical situations where the use of conventional implants is limited. This review outlines the effectiveness and clinical outcomes of using short implants as a valid treatment option in the rehabilitation of edentulous atrophic alveolar ridges. DATA SOURCES: Initially, an electronic search was performed on the following databases: Medline, PubMed, Embase, Cochrane Database of Systematic Reviews, and DARE using key words from January 1990 until May 2012. An additional hand search was included for the relevant articles in the following journals: International Journal of Oral and Maxillofacial Implants, Clinical Oral Implants Research, Journal of Clinical Periodontology, International Journal of Periodontics, Journal of Periodontology, and Clinical Implant Dentistry and Related Research. Any relevant papers from the journals' references were hand searched. Articles were included if they provided detailed data on implant length, reported survival rates, mentioned measures for implant failure, were in the English language, involved human subjects, and researched implants inserted in healed atrophic ridges with a follow-up period of at least 1 year after implant-prosthesis loading. CONCLUSION: Short implants demonstrated a high rate of success in the replacement of missing teeth in especially atrophic alveolar ridges. The advanced technology and improvement of the implant surfaces have encouraged the success of short implants to a comparable level to that of standard implants. However, further randomized controlled clinical trials and prospective studies with longer follow-up periods are needed.

Patient-based and clinical outcomes of implant telescopic attachment-retained mandibular overdentures: a 1-year longitudinal prospective study.

PURPOSE: The purpose of this study was to evaluate and compare Oral Health-Related Quality of Life (OHRQoL), denture satisfaction, and masticatory performance in edentulous patients provided with mandibular implant-supported overdentures (ISODs) retained with telescopic attachments and those of conventional complete dentures (CCDs). Peri-implant soft tissue changes were also evaluated at various intervals during a 1-year observation period. MATERIALS AND METHODS: Participating patients received new CCDs and later received two mandibular interforaminal implants and had their mandibular CCDs converted into ISODs with telescopic attachments. Questionnaires were used to assess OHRQoL (Shortened Oral Health Impact Profile-14, Malaysian version) and denture satisfaction at different stages of treatment with CCDs and ISODs. Objective masticatory performance with the CCDs and ISODs was recorded with a mixing ability test. Evaluations were carried out at 3 months with the new CCDs, 3 months after mandibular ISOD provision, and 1 year after receiving the ISOD. Peri-implant parameters were additionally assessed at specific intervals during the treatment period. The data obtained were statistically analyzed and compared. RESULTS: In the 17 patients who completed the protocol, significant improvements were observed in OHRQoL and patient satisfaction when CCDs were modified to ISODs, after 3 months, and at 1 year. Significantly better mixing ability with the ISOD was noted, with the highest values observed at 1 year. Statistically insignificant differences were observed for all the peri-implant parameters, except for gingival recession, for which significant changes were observed 6 months after ISOD delivery (values had stabilized by 1 year). CONCLUSION: Telescopic crown attachment-retained mandibular ISODs improved OHRQoL, dental prosthesis satisfaction, and masticatory performance compared to CCDs. Peri-implant soft tissue response and implant stability were found to be favorable after 1 year.