Associations of inflammatory polyarthritis with clinical and radiological findings of temporomandibular disorders.

OBJECTIVE: To evaluate the association of different forms of inflammatory polyarthritis with clinical signs of temporomandibular disorders (TMD) and radiological findings in temporomandibular joint (TMJ), based on a nationwide health survey in Finland. The aim was also to assess the presence of clinical and radiological TMD findings in subjects with increased risk for developing rheumatoid arthritis (RA). MATERIAL AND METHODS: A nationally representative sample included 6331 Finnish adults who participated in the Health 2000 Survey (BRIF8901). Subjects were examined for signs of TMD, findings in panoramic radiograph of TMJ, musculoskeletal health and serology (rheumatoid factor, RF, and anti-cyclic citrullinated peptide, aCCP). RESULTS: Sixty-four percent of seronegative RA and 60% of seropositive RA subjects had at least one sign of TMD. While adjusting for confounding factors (gender, age, dentures and smoking history), RA was significantly associated with crepitation and abnormal radiological findings in TMJ. Seronegative RA was also associated with restricted mouth opening. Systemic autoimmunity associated with RA ("at risk of RA") was not associated with clinical or radiological TMD findings. CONCLUSIONS: Clinical and radiological findings of TMD are more prevalent among subjects with inflammatory polyarthritis than among the population in general in the Finnish adult population.

Toll-like receptor-1, -2, and -6 genotypes in relation to salivary human beta-defensin-1, -2, -3 and human neutrophilic peptide-1.

AIM: To examine whether functional gene polymorphisms of toll-like receptor (TLR)1, TLR2, and TLR6 are related to the salivary concentrations of human beta-defensins (hBDs)-1, -2, -3, and human neutrophilic peptide (HNP)-1. MATERIALS AND METHODS: Polymorphisms of TLR1 (rs5743618), TLR2 (rs5743708), and TLR6 (rs5743810) were genotyped by PCR-based pyrosequencing from the salivary samples of 230 adults. Salivary hBD-1, -2, -3, and HNP-1 concentrations were measured using enzyme-linked immunosorbent assay. General and periodontal health examinations, including panoramic radiography, were available for all participants. RESULTS: The genotype frequencies for wild types and variant types were as follows: 66.5% and 33.5% for TLR1, 95.5% and 4.5% for TLR2, and 25.1% and 74.9% for TLR6, respectively. The TLR2 heterozygote variant group exhibited higher salivary hBD-2 concentrations than the TLR2 wild-type group (p = .038). On the contrary, elevated hBD-2 concentrations were detected in the TLR6 wild-type group compared with the TLR6 heterozygote and homozygote variant group (p = .028). The associations between TLR6 genotypes and salivary hBD-2 concentrations remained significant after adjusting them for periodontal status, age, and smoking. CONCLUSION: hBD-2 concentrations in saliva are related to TLR2 and TLR6 polymorphisms, but only the TLR6 genotype seems to exhibit an independent association with the salivary hBD-2 concentrations.

Retained dental roots of adults: A nationwide population study with panoramic radiographs.

The aim of this study was to assess the occurrence and nature of retained dental roots and their associations with demographics in the Finnish adult population. From the cross-sectional nationwide Health 2000 Survey of the Finnish population aged 30 years and older, 6005 participants with clinical oral examination and panoramic radiographs were included. Occurrence and characteristics of all retained dental roots were examined. Statistical analyses included χ2 , Kruskal-Wallis and Mann-Whitney U tests, and SAS-SUDAAN calculations. The mean age of the 6005 participants (46% men and 54% women) was 53 (SD 14.6) years. At least one retained dental root was observed in 13% (n = 754) of the participants. The 1350 retained roots included 461 (34%) roots retained entirely in bone and 889 (66%) partly in bone. The most common location of a retained dental root was the third molar region. Occurrence of retained roots partly in bone was associated with male sex and lower education. Occurrence of retained third molar roots entirely in bone was associated with female sex, younger age, higher education, and living in a city. Among all retained dental roots, the preponderance of third molars emphasized the demanding nature of extracting the third molar in women.

Is the technical quality of root fillings associated with socioeconomic status? A cross-sectional study among Finnish adults.

We investigated differences in the technical quality of root fillings according to socioeconomic status. In the Finnish Health 2000 Survey, which comprised a sample of 8,028 adults aged over 29 yr, 6,115 underwent panoramic radiography. A total of 7,986 endodontically treated teeth were detected among 3,095 participants. The criterion for a technically inadequate root filling was a distance from the root filling to the root apex of over 3 mm or a filling extruding beyond the apex. Educational level, employment status, and income were the measures of socioeconomic status. Differences in the frequency of inadequate root fillings according to socioeconomic status were investigated using a multilevel logistic mixed-effects model taking into account age, gender, number of teeth, and type of root filled tooth. Almost half (46%) of the root fillings were inadequate. Among the over 64-yr-olds, higher education and higher income were associated with a higher probability of having an inadequate root filling. Among the under 65-yr-olds, socioeconomic status was not associated with root filling quality. Contrary to expectation, lower socioeconomic status was not associated with poorer endodontic treatment quality; however, higher income and higher education was associated with higher odds for inadequate root fillings among the over 64-yr-olds.

How many third molars remain unnoticed in a population survey without panoramic radiographs?

OBJECTIVE: The aim of the study was to compare the findings of clinical examination and panoramic radiograph regarding the occurrence of third molars in a population survey to find out how many third molars remain clinically unnoticed. MATERIALS AND METHODS: A two-staged stratified cluster-sampling method was used to select 8028 participants representing the adult population aged 30 years and older. Clinical oral examinations and panoramic radiographs were carried out for 5989 subjects (46% men, 54% women; mean age 52.5, SD 14.6; range 30-97 years). Clinical recordings of the presence of third molars were compared with the radiographs. Statistics included chi-squared, Fisher's, Wilcoxon's, and Kruskal-Wallis tests. RESULTS: In the 5989 subjects, 3742 third molars were recorded in the clinical examination, and 5912 were observed in the panoramic images, a difference of 2170 teeth. Furthermore, related to 3668 (61%) of the third molars, both clinical and radiographic recordings were attributed to the same third molar, while 2244 third molars were observed only in the panoramic image, and 74 only in the clinical examination. In every age group, the mean number of third molars per subject was larger radiographically compared with the clinical recordings (means for all 0.99 vs. 0.62; P < 0.001). CONCLUSION: Numbers of third molars, recorded in clinical examination alone, are underreported by approximately one-third compared with radiographic findings. CLINICAL RELEVANCE: The numbers of third molars in a population survey without a panoramic radiograph do not reflect the total number of third molars in a population.

Genetic variation on the BAT1-NFKBIL1-LTA region of major histocompatibility complex class III associates with periodontitis.

Periodontitis is a chronic inflammatory disease with a multifactorial etiology. We investigated whether human major histocompatibility complex (MHC) polymorphisms (6p21.3) are associated with periodontal parameters. Parogene 1 population samples (n = 169) were analyzed with 13,245 single nucleotide polymorphisms (SNPs) of the MHC region. Eighteen selected SNPs (P ≤ 0.001) were replicated in Parogene 2 population samples (n = 339) and the Health 2000 Survey (n = 1,420). All subjects had a detailed clinical and radiographic oral health examination. Serum lymphotoxin-α (LTA) concentrations were measured in the Parogene populations, and the protein was detected in inflamed periodontal tissue. In the Parogene 1 population, 10 SNPs were associated with periodontal parameters. The strongest associations emerged from the parameters bleeding on probing (BOP) and a probing pocket depth (PPD) of ≥6 mm with the genes BAT1, NFKBIL1, and LTA. Six SNPs, rs11796, rs3130059, rs2239527, rs2071591, rs909253, and rs1041981 (r(2), ≥0.92), constituted a risk haplotype. In the Parogene 1 population, the haplotype had the strongest association with the parameter BOP, a PPD of ≥6 mm, and severe periodontitis with odds ratios (95% confidence intervals) of 2.63 (2.21 to 3.20), 2.90 (2.37 to 3.52), and 3.10 (1.63 to 5.98), respectively. These results were replicated in the other two populations. High serum LTA concentrations in the Parogene population were associated with the periodontitis risk alleles of the LTA SNPs (rs909253 and rs1041981) of the haplotype. In addition, the protein was expressed in inflamed gingival connective tissue. We identified a novel BAT1-NFKBIL1-LTA haplotype as a significant contributor to the risk of periodontitis. The genetic polymorphisms in the MHC class III region may be functionally important in periodontitis susceptibility.

Salivary type I collagen degradation end-products and related matrix metalloproteinases in periodontitis.

AIM: Type I collagen degradation end-products and related matrix metalloproteinases (MMPs) were examined aiming to detect potential markers of periodontitis in saliva, with high sensitivity and specificity. MATERIALS AND METHODS: The salivary concentrations of MMP-8, MMP-9 and MMP-13, tartrate-resistant acid phosphatase serum type 5b, C-terminal cross-linked telopeptide of type I collagen (CTx), N-terminal cross-linked telopeptide of type I collagen (NTx) and cross-linked carboxyterminal telopeptide of type I collagen were analysed in 230 subjects. Oral health examination included panoramic radiography. RESULTS: The concentrations of MMP-8, MMP-9 and MMP-13 in saliva were higher in subjects with generalized periodontitis than in controls. Of the tested salivary markers, MMP-8 was the only marker capable of differentiating subjects with severe alveolar bone loss from those with slight bone loss (p < 0.001). The association between the salivary MMP-8 levels and periodontitis remained significant after the adjustment with age, gender and smoking. In addition, significant correlations were found between the tested markers and periodontal parameters. CONCLUSION: Enzymes and end-products of type I collagen degradation have different associations with each other and with periodontal status that may reflect their roles in the cascade leading to alveolar bone loss. MMP-8 is a strong biomarker candidate for detecting alveolar bone destruction.

Radiographic follow-up of periapical status after endodontic treatment of teeth with and without apical periodontitis.

OBJECTIVES: The aim was to assess objectively the rate of changes in periapical status after endodontic treatment in relation to preoperative radiographic status (Periapical Index Score, PAI) and to tooth type. MATERIAL AND METHODS: Radiographic data from a total of 1,410 teeth in seven prospective clinical studies was pooled. The periapical status was evaluated blindly using the PAI scoring system. The longest follow-up period was 4 years; intervals between controls varied from 3 months to 1 year. RESULTS: Teeth with preoperative PAI score 1 maintained excellent periapical health throughout. Teeth with preoperative PAI score 2 showed some impairment in health over the first 6 months, but improved to approach 95 % healthy teeth at 2 years of observation. Teeth with PAI 3-5 at the start showed significant improvement at 3 months; 27 % were considered healthy (PAI 1 or 2) increasing to 41 % after 1 year. Improvement of periapical status was slower in PAI groups 4 and 5 compared with PAI 3 during the first year. After 2 years, improvement continued similarly in all preoperative PAI 3-5 groups of teeth. Upper lateral incisors showed the poorest healing rate. CONCLUSIONS: Healing of pre-existing periapical lesions is most pronounced from 3 months to 2 years. Teeth with initially healthy periapical structures predictably maintain good periapical health. Maxillary teeth, especially lateral incisors, showed poorer healing rates than mandibular teeth. CLINICAL RELEVANCE: Radiographic healing rates may vary among tooth groups within the dentition. Periapically healthy teeth that are root filled may not need postoperative controls.

Radiological signs indicating infection of dental origin in elderly Finns.

OBJECTIVE: The aim was to assess the prevalence and background factors of signs of infection of dental origin in elderly Finns. MATERIALS AND METHODS: Every third birth cohort between 60-78 years of age (n = 1733) in a southern and a northern region in Finland were invited. Altogether, 1069 subjects attended radiographic examination. Of those, 660 were dentate and formed the study sample. In the analysis an index as a sum of points (scale per lesion 0-3, range 0-420) indicating the severity of infection from periapical lesions, furcal lesions, vertical bone pockets, horizontal bone loss and severe dental caries was used. RESULTS: The index ranged individually from 0-91. Horizontal bone loss was found in 94%, vertical bone loss in 19%, periapical lesions in 46%, furcal lesions in 19% and carious lesions in 39% of the subjects. Only 3% of the subjects were free of dental infections, while 2% had mild, 17% moderate and 78% severe risk of dentogenic infection. Statistically significant background factors were region, level of education, number of regular drugs in use, drugs reducing salivation, alcohol consumption, cardiovascular disease, asthma and rheumatoid arthritis. CONCLUSIONS: Elderly Finns have high a prevalence of signs of infections of dental origin, which is associated with several socio-demographic and health-related factors.

Zirconia implants interfere with the evaluation of peri-implant bone defects in cone beam computed tomography (CBCT) images even with artifact reduction, a pilot study.

OBJECTIVES: Three-dimensional cone beam computed tomography (CBCT) imaging can be considered, especially in patients with complicated peri-implantitis (PI). Artifacts induced by dense materials are the drawback of CBCT imaging and the peri-implant bone condition may not be assessed reliably because the artifacts are present in the same area. This pilot study investigates the performance of the artifact reduction algorithm (ARA) of the Planmeca Viso G7 CBCT device (Planmeca, Helsinki, Finland) with three different implant materials and imaging parameters. METHODS: Three pairs of dental implants consisting of titanium, zirconia, and fiber reinforced composite (FRC) were set into a pig mandible. A vertical defect simulating peri-implantitis bone loss was made on the buccal side of one of each implant. The defect was identified and measured by two observers and compared to the actual dimensions. In addition, the bone structure and the marginal cortex visibility between the implants were estimated visually. RESULTS: The bone defect and its dimensions with the zirconia implant could not be identified in any image with or without the metal artifact reduction algorithm. The bone defect of titanium and FRC implants were identified with all three imaging parameters or even without ARA. The interobserver agreement between the two observers was almost perfect for all categories analyzed. CONCLUSION: Peri-implantitis defect of the zirconia implant and the peri-implant bone structure of the zirconia implants cannot be recognized reliably with any ARA levels, or any imaging parameters used with the Planmeca Viso G7. The need for ARA when imaging the peri-implant bone condition of the titanium and FRC implants may be unnecessary.

Retrospective Analysis of Artifacts in Cone Beam Computed Tomography Images Used to Diagnose Chronic Rhinosinusitis.

BACKGROUND: Cone beam computed tomography (CBCT) is frequently used to corroborate the signs and symptoms of chronic rhinosinusitis (CRS). However, artifacts induced by dental restorations might complicate the diagnosis of CRS. Here, we assessed the frequency and location of artifacts in CBCT images taken to confirm the CRS. METHODS: All CBCT images of the patients referred to the Emergency Radiology unit, Turku University Hospital, with an indication of CRS in 2017 were re-examined. The prevalence of the artifacts was analyzed in three cross-sectional views and three horizontal levels delimited by anatomical landmarks. RESULTS: In total, 214 CBCT images of patients with CRS were evaluated. The diagnosis of apical periodontitis (AP) was impaired by artifacts present in 150/214 images (70%). The diagnosis of CRS was impaired in 5 of the 214 images (2.3%). The main origins of the artifacts were large dental fillings or crowns, and endodontic fillings were present in 95% (203/214) and 52% (111/214) of the images, respectively. CONCLUSIONS: AP as an etiology of CRS is possible to miss because of artifacts originating from dental and endodontic fillings in the CBCT images of the paranasal sinuses.

Radiographic assessments on prevalence and technical quality of endodontically-treated teeth in the Finnish population, aged 30 years and older.

OBJECTIVE: To assess the prevalence and technical quality of endodontic treatment (ET) in Finland by panoramic radiography. MATERIALS AND METHODS: As part of the Finnish nationwide Health 2000 Survey, panoramic radiographs of 5244 dentate subjects, aged 30-95 years, were analyzed. The criterion for a technically adequate ET was a distance from the root filling to the root apex of ≤3 mm. RESULTS: Sixty-one per cent of subjects had one or more teeth with ET. ET was more prevalent in older subjects and among women. Of all teeth (n = 120 250), 7% had had ET, the percentages being greatest for molars and premolars. Technical quality was adequate in 47% of all ET, in 71% of anterior teeth, in 51% of premolars and in 25% of molars. CONCLUSIONS: Prevalence and technical quality of endodontic treatment in Finland are comparable to that reported elsewhere, but are still calling for improvement in endodontic treatment, especially regarding molars.

Periodontal pathogen carriage, rather than periodontitis, determines the serum antibody levels.

AIM: We investigated in a nationally representative sample, how periodontitis modifies the association between the carriage of periodontal pathogens and serology. MATERIALS AND METHODS: The population comprised 1586 dentate subjects who participated in an interview, clinical and radiological oral health examination, and saliva collection. Serum immunoglobulin A (IgA)- and IgG-class antibody levels against Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis and their salivary occurrence were determined in the whole population. The quantity of the pathogens was measured in a subpopulation. RESULTS: In the univariate analyses, the corresponding antibody levels were higher in the pathogen carriers compared with the non-carriers, and clearly higher in the carriers with periodontal pockets compared with the carriers without. In the multi-variate analyses, however, all antibody levels associated strongly with age (p<0.001) and the carriage of the corresponding pathogen (p<0.001), but only weakly with the presence or number of teeth with periodontal pockets. In the subpopulation, the antibody levels and the numbers of corresponding bacteria in saliva had a positive association, which was not affected by the disease. CONCLUSIONS: The carriage of A. actinomycetemcomitans and P. gingivalis is the strongest determinant of the systemic antibody response to these pathogens, and the extent of periodontitis has at most a modest modifying effect.

Quality and Findings of Bitewing Radiographs among Twenty-Year-Old Conscripts in Finland.

OBJECTIVES: Bitewing radiographs are mainly used to confirm clinical findings in caries diagnostics. The objective here was to investigate the quality of bitewing radiographs after short brush-up training and additional findings besides caries in a low-caries population. METHODS: The material of this cross-sectional study comprised 377 pairs of bitewing radiographs of 19- to 20-year-olds taken by dentists. Radiography was considered indicated if one dentinal caries lesion was present on clinical examination. A senior oral radiologist evaluated quality and diagnosed the findings afterwards unaware of clinical status. The association between variables was analysed using cross tabulation and chi-squared testing. RESULTS: Almost half of the images were of compromised quality (44.1%). Dentinal caries lesions were detected in 82.3% and enamel lesions in 73.5% of the subjects. On average, the subjects had 1.7 (SD 0.52) dentinal lesions. Fillings were found in 81.8%, fractures/cracks in 11.7%, and attrition in 7.4% of the subjects. Signs of excessive bite force were recorded in 19.4%, whereas marginal bone loss was detected in 6.4%. No significant correlation was detected between fractures, attrition, and excessive bite forces. CONCLUSIONS: Effort must be taken to ensure high quality of bitewing radiographs. In addition to caries detection, bitewing radiographs offer additional value, such as detecting excessive bite forces, tooth wear, and marginal bone loss among young adults.

Prevalence of third molars determined by panoramic radiographs in a population-based survey of adult Finns.

OBJECTIVES: The aim of the study was to examine the prevalence of third molars in panoramic radiographs in a population-based study of adults aged ≥30 years. METHODS: Out of a sample of 8028 inhabitants of Finland, selected with two-staged stratified cluster-sampling method for the Health 2000 Survey, 5989 participated in clinical oral examination and panoramic radiography. Mean age was 52.5 years (SD 14.6; range 30-97 years). The following variables were included in the analysis: participant characteristics, clinical number of all teeth, and radiographic prevalence and characteristics of third molars. Statistics included chi-squared, Fisher's exact, and Kruskal-Wallis tests and SAS-SUDAAN calculations. RESULTS: A total of 5912 third molars in 47.8% of the study population were recorded from panoramic radiographs. At least one impacted third molar was found in 21.9% of the study population. More than half (57.3%) of the remaining third molars were located in the mandible. A preponderance of participants with all third molars missing were observed in the oldest age group, women, those with lower education and those living in the countryside. Third molars or remnants thereof were observed radiographically in 3.9% of clinically edentulous study population. CONCLUSIONS: The panoramic radiographs disclosed many remaining third molars in adult Finns aged ≥30 years. One-third of the third molars located impacted which may cause unexpected need for care.

Serum High-Sensitive C-reactive Protein May Reflect Periodontitis in Patients With Stroke.

BACKGROUND/AIM: Chronic infectious diseases are believed to increase the risk of stroke. We aimed to evaluate the prevalence of periodontal disease and its association with systemic inflammatory processes in patients suffering an acute stroke/transient ischemic attack (TIA). PATIENTS AND METHODS: Altogether 36 acute stroke/TIA patients underwent clinical, laboratory and radiological examinations. The level of systemic inflammation was analyzed both with routine measurements of plasma C-reactive protein (p-CRP) and serum high-sensitivity CRP (s-hsCRP) to analyze their associations with periodontitis. The diagnostic criteria for periodontitis included increased probing depth (>4 mm) measured from four different sites, bleeding on probing, and horizontal (>1 mm), vertical (>1 mm) or apical bone loss observed on orthopantomography. RESULTS: Twenty-six (72.2%) patients were diagnosed with periodontitis. Only five of the patients with periodontitis (19.2%) had elevated p-CRP values whereas the majority, (17/26; 65.4%) had elevated s-hsCRP values (p<0.01). Absolute s-hsCRP values in patients with periodontitis (8.9±12.5 mg/l) were significantly higher than in patients without periodontitis (2.3±3.0 mg/l; p<0.05). Absolute p-CRP concentrations did not differ (2.3±5.8 vs. 2.4±5.1 mg/l; p=not significant). The total number of periodontitis findings was significantly associated with s-hsCRP values (r=1.83) but not with p-CRP values. Conversely, seventeen of the nineteen patients with elevated s-hsCRP (89.5%) indicative of systemic inflammation had periodontitis. CONCLUSION: Periodontitis is a common finding among patients with acute stroke/TIA as over 80% of patients with cryptogenic stroke/TIA had periodontitis. S-hsCRP is a useful tool for detecting subclinical systemic inflammation.

Intensity of artefacts in cone beam CT examinations caused by titanium and glass fibre-reinforced composite implants.

OBJECTIVES:: The aim was to compare titanium and glass fibre-reinforced composite (FRC) orbital floor implants using cone beam CT (CBCT). FRC implants are nonmetallic and these implants have not been analysed in CBCT images before. The purpose of this study is to compare the artefact formation of the titanium and the FRC orbital floor implants in CBCT images. METHODS:: One commercially pure titanium and one S-glass FRC with bioactive glass particles implant were imaged with CBCT using the same imaging values (80 kV, 1 mA, FOV 60 × 60 mm). CBCT images were analysed in axial slices from three areas to determine the magnitude of the artefacts in the vicinity of the implants. Quantified results based on the gray values of images were analysed using analysis-of-variance. RESULTS:: Compared to the reference the gray values of the titanium implant are more negative in every region of interest in all slices (p < 0.05) whereas the gray values of the FRC implant differ statistically significantly in less than half of the examined areas. CONCLUSIONS:: The titanium implant caused artefacts in all of the analysed CBCT slices. Compared to the reference the gray values of the FRC implant changed only slightly and this feature enables to use wider imaging options postoperatively.

Computed tomography (CT) in the selection of treatment for root-filled maxillary molars with apical periodontitis.

OBJECTIVES: The aims of this study were to evaluate whether the use of CT facilitates agreement among endodontists in selecting treatments for root-filled maxillary molars with apical periodontitis and to assess the efficacy of CT in choosing a treatment for such teeth. METHODS: 39 root-filled maxillary molars from 34 patients with suspected apical periodontitis were independently evaluated by 4 endodontists and 1 postgraduate student (decision-makers). Treatment decisions were made based on intra-oral radiographs and a fictive clinical history. After 1-3 months, the same decision-makers repeated the examination of the same teeth but with additional information from a CT examination. Agreement between decision-makers with or without the availability of the CT results was measured with Cohen's kappa coefficient. Differences in selected treatments with or without accessibility to the CT results were plotted for the same endodontists using descriptive statistics. RESULTS: The agreement in assessments among endodontists was slight or fair before the CT results were available (range: 0.081-0.535). No increase was observed after reviewing the CT results (range: 0.116-0.379). After the use of CT, the treatment plan was changed 38-76% of the time by all decision-makers, and the changes affected 57.8% of the cases in the study. CONCLUSIONS: The endodontists in this study exhibited a low degree of agreement when choosing a treatment for root-filled maxillary molars with apical periodontitis. A CT examination of the investigated teeth did not result in a significantly higher degree of agreement, and CT frequently contributed to a shift in the selected therapy.

Associations Between Salivary Bone Metabolism Markers and Periodontal Breakdown.

BACKGROUND: A dual relationship between glycemic status and bone remodeling was suggested recently. The present study aimed to 1) analyze salivary levels of receptor activator for nuclear factor κ-B ligand (RANKL), osteoprotegerin, osteocalcin, and osteopontin as potential biomarkers of alveolar bone loss and 2) determine whether the glycemic status affects the relationship between bone remodeling markers and periodontal status. METHODS: Salivary levels of RANKL, osteoprotegerin, osteocalcin, osteopontin, and serum glycosylated hemoglobin A1c, insulin, and glucose were analyzed in 220 participants divided into four groups according to their periodontal health status: 1) 79 participants had at least 14 teeth with probing depth (PD) ≥4 mm (generalized periodontitis [GP]); 2) 65 participants had either two or seven teeth with PD ≥4 mm (two groups of localized periodontitis [LP1 and LP2, respectively]); and 3) 76 participants had no teeth with PD ≥4 mm (non-periodontitis control group). RESULTS: Salivary concentrations of RANKL, osteocalcin, and osteopontin were higher, and osteoprotegerin was lower in females than in males. Salivary osteoprotegerin concentrations were higher in the GP and LP2 groups than in the control group, whereas RANKL, osteocalcin, and osteopontin were not related with periodontal status. Salivary osteopontin correlated positively with serum and salivary insulin. The association observed between increased osteoprotegerin concentrations and periodontitis was lost after salivary insulin was included into the analyses as a confounding factor. CONCLUSIONS: Salivary concentrations of bone markers are either affected by glycemic status or detected at very low levels. These factors hinder their use as salivary biomarkers of periodontitis.

Effect of display type, DICOM calibration and room illuminance in bitewing radiographs.

OBJECTIVES: To compare observer performance in the detection of both anatomical structures and caries in bitewing radiographs using consumer grade displays with and without digital imaging and communications in medicine (DICOM) calibration, tablets (third generation iPad; Apple, Cupertino, CA) and 6-megapixel (MP) displays under different lighting. METHODS: 30 bitewing radiographs were blindly evaluated on four displays under bright (510 lx) and dim (16 lx) ambient lighting by two observers. The dentinoenamel junction, enamel and dentinal caries, and the cortical border of the alveolar crests were evaluated. Consensus was considered as reference. Intraobserver agreement was determined. The proportion of equivalent ratings and weighted kappa were used to assess reliability. RESULTS: The proportion of equivalent ratings with consensus differed significantly between uncalibrated and DICOM-calibrated consumer grade display in enamel caries in upper and lower molars in bright (p = 0.013 and p = 0.003) lighting, and in dentinal caries in lower molars in both bright (p = 0.022) and dim (p = 0.004) lighting. The proportion also differed significantly between DICOM-calibrated consumer grade and 6-MP display in dentinal caries in lower molars in bright lighting (p = 0.039), tablet and consumer grade display in enamel caries in upper molars (p = 0.017) in bright lighting, tablet and 6-MP display in dentinal caries in lower molars (p = 0.003) in bright lighting and in enamel caries in lower molars (p = 0.012) in dim lighting. CONCLUSIONS: DICOM calibration improves the detection of enamel and dentinal caries in bitewing radiographs, particularly in bright lighting. Therefore, a calibrated consumer grade display can be recommended as a diagnostic tool for viewing bitewing radiographs.