Impact of abutment material on peri-implant soft tissue color. An in vitro study.

OBJECTIVES: The objectives of the present study is to determine the differences in peri-implant soft tissue color with the utilization of titanium, titanium gold-plated, white zirconia, Vita Classical (VC) A4-shaded zirconia, and fluorescent white zirconia abutments and to establish the influence of gingival thickness on the resulting color. METHODS: Four implants were contralaterally inserted in 19 fresh pig mandibles, and the color of the peri-implant mucosa with the different abutments was spectrophotometrically measured at 1-, 2-, and 3-mm height from the margin. RESULTS: At 1-mm height, titanium significantly differed from all zirconia abutments in lightness (L*), chroma along red axis (a*), and chroma along yellow-blue axis (b*) parameters. At 2 mm, all zirconia abutments differed from titanium in b* but only fluorescent zirconia in a*. At 3 mm, titanium differed from VC A4-shaded and fluorescent zirconia abutments in b*. At soft tissue thicknesses <1 and 1-2 mm, titanium differed from fluorescent zirconia in a* and b* and from VC A4-shaded zirconia in b*; at thickness >2 mm, no differences were found among abutments. All abutments differed from natural teeth in a* and b* at all heights and thicknesses except for fluorescent zirconia at thickness >2 mm. The Euclidean distance (ΔΕ) differed between titanium abutments and gold, VC A4, and fluorescent zirconia at <1- and 1-2-mm thicknesses. CONCLUSION: The natural gingival color was not reproduced with any abutment at gingival thicknesses <2 mm. The worst color match was with titanium abutments and the best with fluorescent zirconia, followed by VC A4-shaded zirconia. At gingival thicknesses >2 mm, no differences were detected among abutments. CLINICAL RELEVANCE: This study demonstrates that the type of abutment and the gingival thickness affect the resulting peri-implant gingival color.

Factors involved in the spectrophotometric measurement of soft tissue: A clinical study of interrater and intrarater reliability.

STATEMENT OF PROBLEM: The reliability of spectrophotometric measurements of gingival color has not been tested. PURPOSE: The purpose of this study was to evaluate the repeatability and reproducibility of gingival color measurements with a digital spectrophotometer. Measurement error was estimated by determining the interrater agreement and by repeating measurements in different illumination environments with and without contact of the device with the gingiva. MATERIAL AND METHODS: Two trained examiners measured the gingival shade around 30 central incisors with a spectrophotometer with and without external illumination and with and without contact of the device with the gingiva. Color data obtained (CIELab color coordinates; L*, c*, h*, a*, b*) were analyzed with the intraclass correlation coefficient (ICC) and the Student t test for paired samples. RESULTS: Mean L*, c*, a*, and b* values differed significantly between measurements made with and without contact of the device with the tissue, but no difference was found in h* values. An ICC of >0.9 was obtained for interrater and intrarater agreements in all cases. Shade measurements did not differ between the presence and absence of stable ambient light. CONCLUSIONS: The repeatability and reproducibility of soft tissue shade measurements were almost perfect (ICC >0.9) under the examination conditions tested. The measurements were affected by pressure but not by ambient light.

Diabetes and periodontal disease. Review of the literature.

Diabetes mellitus (DM) is a metabolic disease characterized by an increased blood glucose level, while periodontal disease is mainly characterized by the destruction of tooth support tissues. Detailed investigation is warranted to consider these highly prevalent chronic diseases together and analyze their mutual influence. Over the years, various biologically plausible mechanisms have been established for a common inflammatory etiopathogenesis of these diseases. Numerous epidemiological studies have found a high degree of association between DM and periodontal disease, and periodontal disease has even been proposed as a sixth complication of DM. It has also been demonstrated that this relationship is bidirectional, with periodontitis exerting an effect on DM. These findings have diagnostic and therapeutic implications. Thus, the high prevalence of periodontal disease in DM indicates the need to evaluate glucose levels in periodontal patients. Conversely, intervention studies have demonstrated that the treatment of periodontal disease improves the glycemic control of DM patients.

Immunomodulatory drugs: oral and systemic adverse effects.

OBJECTIVE: The main objectives are to present the different adverse effects of the immunomodulatory drugs that can impair the quality of life of the immunosuppressed patients and study the impact of immunomodulation on oral diseases. Immunomodulatory drugs have changed the treatment protocols of many diseases where immune functions play a central role, such as rheumatic diseases. Their effect on oral health has not been systematically investigated, however. STUDY DESIGN: We review current data on the new immunomodulatory drugs from the oral health perspective based on open literature search of the topic. RESULTS: These target specific drugs appear to have less drug interactions than earlier immunomodulating medicines but have nevertheless potential side effects such as activating latent infections. There are some data showing that the new immunomodulatory drugs may also have a role in the treatment of certain oral diseases such as lichen planus or ameliorating symptoms in Sjögren's syndrome, but the results have not been overly promising. CONCLUSION: In general, data are sparse of the effect of these new drugs vs. oral diseases and there are no properly powered randomized controlled trials published on this topic.

A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis.

AIMS: To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis. MATERIAL AND METHODS: Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth (PPD) and clinical attachment level (CAL) and most in plaque index (PlI) and/or bleeding on probing (BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria. RESULTS: The overall effect of the subgingival application of antimicrobials was statistically significant (p = 0.000) for both changes in PPD and CAL with a weighted mean difference (WMD) of -0.407 and -0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4 mm). CONCLUSIONS: The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial.

Evaluation of p53, caspase-3, Bcl-2, and Ki-67 markers in oral squamous cell carcinoma and premalignant epithelium in a sample from Alava Province (Spain).

OBJECTIVE: The objective of this study was to determine whether alterations in the expression of p53, caspase-3 Bcl-2, and ki-67 appear early in premalignant oral epithelium and show clonal behavior. STUDY DESIGN: Samples from 41 tumors with their adjacent non-tumor epithelia were immunohistochemically analyzed using monoclonal antibodies that recognize p53, caspase-3, Bcl-2, and Ki-67 RESULTS: A statistically significant association was found between the expression in tumor and adjacent epithelium of p53, caspase-3, and Bcl-2 but not of k-67. A significant association was observed between the expression of ki-67 and p53 in both localizations. In non-tumor (premalignant) epithelium samples, there was a significant inverse relationship between the expressions of p53 and caspase-3 and a significant direct relationship between the expressions of p53 and Bcl-2. CONCLUSIONS: Alterations in these proteins appear to operate in combination with premalignant epithelia to create hyperproliferative cell states that favor the acquisition of summative oncogenic errors that confer invasive capacity.

Gingival changes during pregnancy: III. Impact of clinical, microbiological, immunological and socio-demographic factors on gingival inflammation.

AIMS: To identify predictor variables involved in exacerbated gingival inflammation associated with pregnancy. MATERIAL AND METHODS: In this cohort study, 48 pregnant and 28 non-pregnant women without periodontitis were included. The pregnant women were evaluated in the first, second and third trimester and at 3 months postpartum, whilst the non-pregnant women were evaluated twice, with a 6-month interval. At each visit, clinical [plaque index (PlI) and gingival index (GI)], hormonal (salivary progesterone and estradiol), immunological [gingival crevicular fluid interleukin-1ß, interleukin-6, tumour necrosis factor-α (TNF-α) and prostaglandin-E(2) ] and microbiological (periodontal pathogens culture) evaluations were performed. Statistical analysis was undertaken using exhaustive chi-square automatic interaction detection (exhaustive CHAID) to analyse the predictive value of the independent outcomes to develop pregnancy GI. RESULTS: PlI was the strongest predictor implicated in the GI throughout pregnancy and after delivery. During the second and third trimesters the presence of Porphyromonas gingivalis significantly contributed to the worsening of gingival inflammation. When compared with the non-pregnant group, significant differences were found in TNF-α amounts and concentrations and in the third trimester site-specific GI. CONCLUSIONS: Bacterial challenge to the gingival tissues, both quantitatively (PlI) and qualitatively (harbouring P. gingivalis) appears to affect the level of gingival inflammation observed during pregnancy.

New perspectives on the dynamic behaviour of oral lichen planus.

Lichen planus, a chronic inflammatory disease that affects the skin and mucous membranes, is one of the most frequent dermatological disorders of the oral cavity. The prevalence of oral lichen planus ranges from 0.2% to 4%. The triggering factors remain unknown. Oral lichen planus can be considered to be a chronic disease of long duration with a dynamic evolution and frequent changes in clinical appearance. Three successive active stages can be distinguished, without sharp limits between them: an initial stage; a protracted intermediate stage with alternate periods of variable activity and quiescence, which carries a progressively increasing risk of malignant transformation; and a late stage that often ends in a clinically little-known, inactive cicatricial post-lichen stage, which does not respond to steroid treatment but retains the same risk.

Periodontal disease and diabetes.

Diabetes is considered to be a genetically and environmentally based chronic metabolic and vascular syndrome caused by a partial or total insulin deficiency with alteration in the metabolism of lipids, carbohydrates and proteins culminating with different manifestations in different organisms. In humans hyperglycemia is the main consequence of defects in the secretion and/or action of insulin, and its deregulation can produce secondary lesions in various organs, especially kidneys, eyes, nerves, blood vessels and immune systems. Periodontal disease is an entity of localized infection that involves tooth-supporting tissues. The first clinical manifestation of periodontal disease is the appearance of periodontal pockets, which offer a favorable niche for bacterial colonization. The etiology of periodontal disease is multifactorial, being caused by interactions between multiple micro-organisms (necessary but not sufficient primary etiologic factors), a host with some degree of susceptibility and environmental factors. According to current scientific evidence, there is a symbiotic relationship between diabetes and periodontitis, such that diabetes is associated with an increased incidence and progression of periodontitis, and periodontal infection is associated with poor glycaemic control in diabetes due to poor immune systems. Hence, for a good periodontal control it is necessary to treat both periodontal disease and glycaemic control.

Local and systemic antimicrobial therapy in periodontics.

CONTEXT: This review aimed to update the current evidence on the efficacy of the adjunctive use of local and systemic antimicrobials in the treatment of periodontitis and to assess whether it might improve the clinical limitations and shortcomings of standard nonsurgical treatment in the management of periodontitis. EVIDENCE ACQUISITION: Relevant randomized clinical trials (RCT) with more than 3 months of follow-up, published from 2010 to 2012 for systemic antimicrobials and from 2008 to 2012 for local antimicrobials, were searched in Medline and critically analyzed. Scientific evidence evaluated in different systematic reviews and reviews presented at European and World Workshops were also included. Only adjunctive therapies were considered in the present review: articles comparing debridement alone or plus placebo, versus debridement plus systemic or local antimicrobials were included. EVIDENCE SYNTHESIS: Adjunctive systemic antimicrobials have been evaluated both in aggressive and chronic periodontitis: in aggressive periodontitis, amoxicillin and metronidazole have been extensively studied, reporting clinical and microbiological benefits; in chronic periodontitis, different products are under scrutiny, such as azithromycin. The clinical efficacy of local antimicrobials, although extensively demonstrated, is still surrounded by a constant debate on the cost-effectiveness evaluation and on its adequate indications. CONCLUSIONS: Despite the clinical efficacy of the adjunctive use of local and systemic antimicrobials, demonstrated in RCTs and in systematic reviews, there is a lack of evidence to support well-defined clinical protocols, including products and dosages.

Case report of necrotizing sialometaplasia.

INTRODUCTION: Necrotizing sialometaplasia is a rare inflammatory necrotizing reactive process that can involve minor and major salivary glands. Gland tissue ischaemia has been proposed as the aetiology. CASE REPORT: A 21-year-old woman was referred with a 1-week history of bilateral painful swelling of the palate, with the development of two deep ulcers after the first 3 days. Ulcer edges were elevated but not indurated, and the bases had a necrotic appearance. An incisional biopsy of the margin of one ulcer confirmed the diagnosis of necrotizing sialometaplasia. The ulcers spontaneously healed within 8 weeks without treatment. DISCUSSION: The clinical and histological similarity between this entity and a malignant lesion implies a risk of unnecessary or inadequate treatment. This case illustrates the need for an incisional biopsy to be analyzed by an experienced pathologist to establish a correct diagnosis.

Periodontal disease and diabetes-Review of the Literature.

AIMS: To provide updated knowledge on the relationship between periodontal disease and diabetes from an oral health perspective. METHODS: A review of the English-language literature was performed, gathering articles on the two diseases published over the past 10 years. RESULTS: Both diseases result from the confluence of various triggering and modifying factors, and there are inter-individual differences in the risk of their development. Recent research has shown that diabetes may increase the risk of periodontitis, and it has been proposed that chronic periodontal disease may influence the natural course of diabetes. There appears to be an association among oral infections, impaired sugar metabolism, and atherosclerosis, indicating a theoretical link between metabolic syndrome and periodontal disease. CLINICAL IMPLICATIONS: Control of periodontal disease may enhance glycemic control in patients with type 2 diabetes. In turn, improved glycemic control may contribute to a better control of periodontal disease.

Oral Infections and Systemic Health - More than Just Links to Cardiovascular Diseases.

PURPOSE: During the past 20 years, a plethora of research reports has been published showing a statistical association between poor oral health and cardiovascular diseases. The aim of this narrative review was to focus on associations between oral infections and non-atherosclerosis-related systemic diseases. MATERIALS AND METHODS: An open literature search and evaluation of articles were conducted on Medline and Cochrane databases with the key words 'oral infection', 'periodontitis', 'pneumonia', 'osteoarthritis', 'rheumatic diseases', 'inflammatory bowel disease', 'kidney disease', 'liver diseases', 'metabolic syndrome', 'diabetes', 'cancer', 'Alzheimer's disease'. Cardiovascular diseases were excluded from the analysis. RESULTS: The scarcity of controlled studies did not allow conducting a systematic review with meta-analysis on the topics, but dental infections have been shown be associated with several general diseases also beyond the atherosclerosis paradigm. However, there is no causal evidence of the role of dental infections in this regard. Poor oral health has nevertheless often been observed to be associated with worsening of the diseases and may also affect treatments. CONCLUSIONS: Maintaining good oral health is imperative regarding many diseases, and its importance in the daily life of any patient group cannot be over emphasised.

Gingival changes during pregnancy: II. Influence of hormonal variations on the subgingival biofilm.

AIM: To determine whether the exacerbated gingival inflammation that develops in pregnant women is related to a change in the subgingival biofilm induced by the increase in hormone levels during pregnancy. MATERIAL AND METHODS: This open cohort study included 48 pregnant and 28 non-pregnant women without periodontitis. Pregnant women were evaluated in the first, second and third trimester and at 3 months after delivery. Non-pregnant women were evaluated twice, with a 6-month interval, assessing microbiological, clinical and hormonal variables at each visit. Total anaerobic counts and frequency of detection and proportions were calculated. The Friedman test with the Bonferroni correction was used for intra-group comparisons and Mann-Whitney U-tests for inter-group assessment. Correlations were analysed by means of Spearman's rank correlation coefficient. RESULTS: Proportions of the subgingival periodontal pathogens did not differ throughout pregnancy, although significant differences were found for all the pathogens after delivery. Porphyromonas gingivalis-positive patients presented an increase in gingival inflammation (p<0.001) that was not related to plaque. Correlations were found between maternal hormone levels and P. gingivalis and Prevotella intermedia. CONCLUSION: Qualitative differences in periodontal pathogens were found from pregnancy to post-partum. Patients harbouring P. gingivalis presented and increased gingival inflammatory status.

Gingival changes during pregnancy: I. Influence of hormonal variations on clinical and immunological parameters.

AIM: To test whether exacerbated gingival inflammation in pregnancy is associated with increased salivary hormone levels and changes in gingival crevicular fluid (GCF) interleukin-1beta (IL-1beta) and prostaglandin-E2 (PGE2) levels. MATERIAL AND METHODS: In this cohort study, 48 pregnant women without periodontitis were evaluated in the first, second, and third trimesters and at 3 months postpartum. Twenty-eight non-periodontitis non-pregnant women were evaluated twice, with a 6-month interval. Plaque and gingival indices (PlI, GI), salivary progesterone and estradiol and GCF IL-1beta and PGE2 levels were determined. anova for repeated measures or Friedman's test were used for intragroup analyses. Inter-group comparisons were analysed with t-test or Mann-Whitney U-test. Correlations were evaluated with Pearson's and Spearman's test. RESULTS: Pregnant women showed an increase in GI (p<0.05) despite maintaining low PlI values. No changes in IL-1beta and PGE2 levels were observed during pregnancy. No significant correlation was found between the GI increase and salivary hormone levels. GI (p<0.05) and IL-1beta levels (p<0.001) were lower in non-pregnant than in pregnant women. CONCLUSIONS: This study confirms the presence of an exacerbated gingival inflammation during pregnancy, but this phenomenon could not be associated with an increase in progesterone or estradiol or with changes in PGE2 or IL-1beta.

Analysis of new diagnostic methods in suspicious lesions of the oral mucosa.

OBJECTIVE: The objective of this study was to analyse publications related to examination techniques that might improve the visualisation of suspicious lesions of the oral mucosa (ViziLite system and VELscope system) or that might facilitate the cytological identification of suspicious lesions (OralCDx). METHODS: A literature search was performed, using the PubMed database and the key words "brush biopsy", "OralCDx", "ViziLite" and "Velscope", limiting the search to papers in English or Spanish published from 2002 to 2008. RESULTS: According to the results of studies identified, the ViziLite system has a sensitivity of 100% and specificity ranging from 0-14.2%, the VELscope system has a sensitivity of 98-100% and specificity of 94-100% and the Oral CDx system has a sensitivity of 71.4-100% and specificity of 32-100%. CONCLUSION: Clinical examination and histopathological confirmation with biopsy remain the gold standard for the detection of oral cancer. More randomised controlled studies are needed to confirm the positive cost-benefit relationship and the true usefulness of these "new diagnostic methods" in oral mucosal pathology.

Host defence mechanisms against bacterial aggression in periodontal disease: Basic mechanisms.

Periodontal diseases are complex bacteria-induced infections characterised by an inflammatory host response to plaque microbiota and their by-products. Most of these microorganisms have virulence factors capable of causing massive tissue destruction both directly, through tissue invasion and the production of harmful substances, or indirectly, by activation of host defense mechanisms, creating an inflammatory infiltrate of potent catabolic activity that can interfere with normal host defense mechanisms. In response to the aggression, host defense mechanisms activate innate and adaptive immune responses. Our aim is to offer a general overview of the main mechanisms involved in the host response to bacterial aggression in periodontitis, such as lipopolysaccharide receptor CD14, complement system, polymorphonuclear neutrophils, antibodies and immunoglobulins.

Difference in the expression of inflammatory mediators in gingival crevicular fluid in postmenopausal patients with chronic periodontitis with and without menopausal hormone therapy.

OBJECTIVE: Hormonal changes experience by women produce significant changes in the periodontium. The aim of this study is to assess whether menopausal hormone therapy, in patients diagnosed with moderate chronic periodontitis and menopause presents a beneficial effect, in terms of clinical and immunological outcomes. STUDY DESIGN: Thirty subjects with moderate chronic periodontitis and menopause were selected and assigned to two groups in accordance to the presence of menopausal hormone therapy. Periodontal clinical parameters, microbiological samples and immunological variables were assessed in both groups. Inter-group differences were evaluated using non-paired Student t-tests and chi square tests. Also, Pearson coefficient correlation was performed to determine the correlation between variables. RESULTS: There were statistically significant differences between groups for clinical attachment level, probing pocket depth, interleukin 1ß and interleukin 6. Smoking habit, deeper PPD and higher Il-6 levels in non-menopausal hormone therapy users group, tend to increase the interleukin 1ß GCF levels. These findings were supported by serum estrogen levels. The variables levels were higher in the menopausal hormone therapy users group. CONCLUSION: Within the limitations of the present study, the hypothesis that menopausal hormone therapy user's women will show better periodontal status and differences in immunological variables respect to those being non-menopausal hormone therapy users was supported.

Cellular senescence in oral cancer and precancer and treatment implications: a review.

INTRODUCTION: Recent studies have demonstrated the capacity of the human organism to prevent the growth of potentially carcinogenic cells by paralyzing them. This antitumor mechanism is known as cellular senescence and is defined as an emergency defence system for cells on the way to becoming cancerous. RESULTS: This review of the literature suggests that oncogene-induced senescence may be a response to oncogenic activation, acting as a natural barrier against tumorigenesis at a premalignant stage. Thus, a large number of cells enter senescence in premalignant lesions but none do so in malignant tumors, due to the loss of senescent pathway effectors such as p16(INK4a) or ARF-p53. Potential senescence markers in oral precancerous lesions include p21(WAF1), p16(INK4a), pRb, Maspin, RAR-beta, G-actin, p15(INK4b), DCR2, and DEC1, some of which are currently under study. CONCLUSION: In the short term, the study of this mechanism may yield valuable data for the management of oral cancer and precancer, for which no effective diagnostic or prognostic markers are yet available.

Genotypic determination by PCR-RFLP of human papillomavirus in normal oral mucosa, oral leukoplakia and oral squamous cell carcinoma samples in Madrid (Spain).

BACKGROUND: Human papillomaviruses (HPVs), especially genotypes 16 and 18, are considered to be human carcinogens by the International Agency for Research on Cancer (IARC). They are the most important etiological agents of uterine cervix cancer but their true role in oral carcinogenesis is controversial. OBJECTIVES: To detect the presence of HPV genome genotypes in oral leukoplakia and oral squamous cell carcinoma (OSCC) and analyze their relationship with clinicopathological variables. MATERIALS AND METHODS: Presence of genome ofHPV types 6, 11, 16, 18, 31, 33, 39, 42, 45, and 52 was studied by polymerase chain reaction in samples of normal mucosa (30 controls), oral leukoplakia (35 cases) and OSCC (33 cases). Results were compared between groups and differences were examined in relation to clinical and histological variables. RESULTS: HPV genome was detected in 23.3% of controls, 45.7% of oral leukoplakias, and 39.4% of OSCCs. Only HPV-16 was significantly (p=0.0005) more frequently detected in leukoplakias (40%) and OSCCs (33.3%) versus controls (0%). No significant relationship was found between the presence of viral genome and the main clinicopathological variables. CONCLUSION: According to these findings, the presence of HPV-16 is significantly associated with oral leukoplakia and OSCC lesions, therefore in our setting this virus may be a carcinogenic element in this disease.