Identification of oral bacteria on titanium implant surfaces by 16S rDNA sequencing.

OBJECTIVE: To characterize the profile of microbial communities colonizing titanium implants with different surface treatments after exposure to the oral environment at the genus or higher taxonomic level. MATERIAL AND METHODS: Sixteen titanium disks, machined or sandblasted large-grit and acid-etched (SLA), were mounted on removable intraoral splints worn by four patients. After 24 h of intraoral exposure, biofilm samples were collected from disks and supra/subgingival teeth areas. The 16S rDNA genes from each sample were amplified, sequenced with the Miseq Illumina instrument and analyzed. RESULTS: A total of 29 genera and seven more inclusive taxa, representing the phyla Firmicutes, Proteobacteria, Fusobacteria, Bacteroidetes, Actinobacteria and candidate division TM7 were identified in both titanium surfaces and teeth. No differences were found in relation to the operational taxonomic units (OTUs) and microbial diversity, assessed by Chao 1 and Shannon indices, when comparing SLA and machined titanium surfaces. CONCLUSIONS: Machined and SLA surfaces are colonized by similar numbers of prokaryotic OTUs after 24 h of exposure to the oral environment. Higher complexity of the titanium surface topography in the initial phase of biofilm maturation does not seem to significantly influence the colonizing microbiota.

Profile of bacteria colonizing the exposed bone of patients with anti-osteoclastic drug-related osteonecrosis of the jaws.

Microbial etiology for anti-osteoclastic drug-related osteonecrosis of the jaw (ARONJ) was suggested. This study investigates any link between bacteria colonizing ARONJ sites and other oral cavity sites. Microbiota samples of 10 ARONJ patients were collected from the exposed bone, adjacent teeth, contralateral teeth, and tongue. DNA checkerboard hybridization was used for microbiota analysis with 43 genomic DNA probes prepared from human oral bacterial (38) and candida (5) species, using Socransky's bacterial complexes as a guide. The frequency and the mean proportion of each bacterial species were used. Eikenella corrodens, Streptococcus constellatus, and Fusobacterium nucleatum were dominant in the ARONJ sites and detected in most teeth samples. Staphylococcus aureus was also dominant in the ARONJ sites and tongue. Significant correlations were found between the mean proportions of bacterial species colonizing adjacent teeth, contralateral teeth, and tongue (p < 0.001, R(2) > 0.69). No significant correlation (p > 0.05, R(2) < 0.025) was found between bacteria colonizing ARONJ sites and other evaluated sites. Within the study limitations, it was concluded that the primary sources of microorganisms colonizing ARONJ sites could be other sites such as teeth and tongue. The microbial profile of the necrotic bone is predominantly colonized with bacteria from Socransky's green and orange complexes, as well as with species associated with bone infections.

Wear of matrix overdenture attachments after one to eight years of clinical use.

STATEMENT OF PROBLEM: Matrices of unsplinted attachment systems are generally reported to be the weak component of implant overdentures, often requiring frequent maintenance. Clinical wear results in reduced retention of the prosthesis, requiring activation or renewal of the matrix to restore the initial level of retention. PURPOSE: The purpose of this retrospective study was to measure the wear of the matrix of a ball attachment after various periods of clinical wear. MATERIAL AND METHODS: Seventy specimens of 3 groups of matrices of ball attachments that had been in use for mean periods of 12.3 months (1Y group, n=26), 39.0 months (3Y group, n=28) and 95.6 months (8Y group, n=16) were retrieved from 35 patients (2 specimens per patient) and measured on a coordinate measuring machine equipped with a touch trigger probe. Ten unused matrices were used as controls (CTRL group). The external and internal matrix diameters and deviations from circularity were measured. For the various time periods, the decreases in matrix thickness were calculated and compared with controls. Kruskal-Wallis 1-way ANOVA by ranks, followed by the Mann-Whitney post hoc tests, were conducted to test for differences in median values among groups (α =.05). RESULTS: For the internal upper diameter of the matrices tested, the Kruskal-Wallis and Mann-Whitney tests revealed significant differences for the 3 groups compared to the controls. For group 1Y, a significant difference (P<.001) of the internal upper diameter was found compared to the CTRL group. Compared to the controls, the nonparametric analyses for groups 3Y and 8Y showed significant differences for the internal upper diameter (P<.001) and deviations from circularity (P<.001). For groups 1Y, 3Y and 8Y, matrix thickness losses were 07, 47 and 70 µm, respectively. CONCLUSIONS: Within the limitations of this study, it was observed that one year of clinical wear had limited effect on the ball attachment matrices. Three to 8 years of clinical use resulted in a significant decrease of matrix thickness, especially at the tip of the retentive lamellae.

Clinical wear of overdenture ball attachments after 1, 3 and 8 years.

OBJECTIVES: Implant-supported overdentures have become the treatment of choice in restoring complete edentulism, but the types of attachment to assure durable retention are a subject of debate. Ball attachments were reported as a simple treatment, but wear of components was responsible for a decrease in retention. The aim of this retrospective study was to measure the wear of the ball abutment or patrix after three different periods of clinical wear. MATERIAL AND METHODS: Sixty-nine specimens of three groups of patrix that were in use for a mean of 12.3 months (group A), 39 months (group B) and 95.6 months (group C) were retrieved from 35 patients and measured on a coordinate measuring machine equipped with a touch trigger probe. Ten unused ball abutments were added as a control (group D). The patrix diameters and any deviation from circularity in different axes were measured. RESULTS: The diameters of groups A, B and C were significantly different from that of group D (control). No statistically significant differences were found between diameter and circularity variations between groups B and C. The maximal amount of diameter reduction was limited to approximately 30 µm, and 90% of diameter loss at the equator due to wear was reached in group B. CONCLUSION: One, 3 and 8 years of clinical wear reduced significantly the diameters of the ball abutments tested, and the maximal amount of wear was reached after 3 years of clinical use.

A 3-year longitudinal prospective study assessing microbial profile and clinical outcomes of single-unit cement-retained implant restorations: Zirconia versus titanium abutments.

PURPOSE: The aim of this study was to assess the microbiological and clinical outcomes of implant-supported restorations on zirconia or titanium abutments after 3 years in function. MATERIALS AND METHODS: Twenty two-part dental implants were placed in 20 healthy individuals in need of single-tooth replacement. Ceramic-based reconstructions were cemented in either zirconia or titanium abutments. Clinical, radiographic, and microbiological outcomes were examined at implant loading and then yearly up to 3 years post-loading. RESULTS: Cumulative survival/success implant rates were 95% after 3 years. Mean total marginal bone loss was 0.76 ± 0.21 mm for zirconia and 0.99 ± 0.41 mm for titanium, with no significant differences (P > .05). Overall, titanium and zirconia abutments presented similar values of probing depth, gingival recession, and bleeding on probing over time (P < .05). Microbial profile of implants restored with titanium or zirconia is quite similar to that found in the remaining teeth. CONCLUSIONS: Zirconia and titanium presented different microbial profile and genome counts. Clinical findings for both zirconia and titanium abutments were similar and consistent with a healthy condition, reflecting a high survival rate and low bone loss. Microbiota did not impact the clinical outcomes after 3 years of function.

A Qualitative Study on Patients' Perceptions of Two Types of Attachments for Implant Overdentures.

The aim of this qualitative study was to gain a deeper understanding of patient perceptions of wearing implant-retained overdentures with ball-shaped or cylindrical attachment systems. Twenty-two wearers of implant-supported overdentures participated in this qualitative study based on a randomized crossover clinical trial that aimed to compare a cylindrical attachment and a ball attachment. In phase I of the study, group A experienced ball attachments (n = 11) and group B Locator attachments (n = 11) for 1 year. Afterward, in phase II, the attachments were changed; group A received Locator attachments and group B received ball attachments. One week after the attachment's replacement, semistructured individual interviews were conducted. All interviews were audiotaped and transcribed. The analysis was guided by thematic content analysis. Most of the patients from both groups preferred the attachment they received in phase II, regardless the type. A major theme raised by the participants to justify their preference between the attachment types was prosthesis retention/stability, sometimes considered as a positive and other times as a negative factor. Other themes were also explored: oral function, pain, hygiene, previous experiences, confidence on the dentist's work, and esthetic. Aspects related to the retention/stability of the overdentures are the main concerns associated with the perceptions of most patients treated with implant overdentures regardless of the type of attachment. Adequate retention level should be identified and adjusted on an individual basis and maintained overtime as possible. Therefore, follow-up appointments should be planned for readjustment of the attachment's retention. Overretention should be avoided.

Reduction of salivary S. aureus and mutans group streptococci by a preprocedural chlorhexidine rinse and maximal inhibitory dilutions of chlorhexidine and cetylpyridinium.

OBJECTIVES: Staphylococcus aureus and mutans group streptococci can cause, among many other diseases, infective endocarditis and postoperative infections. The reduction of the number of these microorganisms in the oral cavity prior to surgical procedures has been related to a decreased incidence of such occurrences. The aim of this study was to evaluate the effect of a single preprocedural rinse with 0.12% chlorhexidine solution (Periogard) on the salivary counts of S aureus and mutans group streptococci and determine maximal inhibitory dilutions (MID) of this and 0.05% cetylpyridinium chloride solution (Cepacol). METHOD AND MATERIALS: Saliva was collected from 60 patients before and after 30-second mouthrinses with chlorhexidine and cultured in appropriate media. The number of microorganisms was calculated based on the colony-forming units (CFUs). For the in vitro MID determination, 25 strains of S aureus were seeded in the media containing one of the sequential dilutions of both antiseptics. RESULTS: S aureus, Streptococcus mutans, and Streptococcus sobrinus were initially isolated from 45%, 63%, and 28% of the patients, respectively. After rinsing with chlorhexidine, the reductions in the CFUs were above 99% for all the studied microorganisms. In the MID determination, all isolates were inhibited with 1/20 and 1/80 dilutions of cetylpyridinium and chlorhexidine, respectively. Dose-response curves were obtained for both antiseptics. CONCLUSION: Single preprocedural chlorhexidine mouthrinse is effective in reducing salivary microorganisms to levels currently considered safe to perform invasive procedures, and it is still effective in a 1:80 dilution.

Bisphosphonates inhibit bone remodeling in the jaw bones of rats and delay healing following tooth extractions.

OBJECTIVE: This study aimed to evaluate the impact of concurrent administration of clinically relevant doses of zoledronic acid (ZA) and dexamethasone (DX) on bone healing after tooth extraction (EXO). MATERIALS AND METHODS: Forty-four Sprague-Dawley rats (6-8 month old) were randomized into five groups: ZA + DX = weekly injection of ZA with DX for 7 weeks; WD = ZA with DX for 3 weeks then DX alone for 4 weeks; C = control saline for 7 weeks; ZA = ZA alone for 7 weeks and DX = DX alone for 7 weeks. ZA was administered at 0.13 mg/kg/week and DX at 3.8 mg/kg/week and body weights recorded at the time of injection. All rats underwent extraction (EXO) of the mandibular and maxillary first molars at 3 weeks and were euthanized at 7 weeks. The extracted and non-extracted sides of both jaws were harvested for micro-CT analyses. RESULTS: All rats, particularly those injected with ZA, exhibited weight gain till EXO followed by decline then recovery. ZA + DX group demonstrated highest fractional bone to tissue volume (BV/TV) in the non-extracted side. ZA + DX rats exhibited also highest volume and surface of sequestra. Only sequestra volume was statistically higher in the WD group compared to C group. CONCLUSION: Combined treatment with ZA and DX over a prolonged period inhibits bone remodeling and increased sequestra formation to a greater extent than either drug alone. Trauma caused by these sequestra cutting through the mucosa could play a key role in the development of BRONJ by potentially facilitating infection. ZA withdrawal may promote bone-remodeling reactivation following EXO.

Wear of ball attachments after 1 to 8 years of clinical use: a qualitative analysis.

The purpose of this study was to analyze and compare scanning electron microscopy (SEM) observations of ball attachments that had been worn by patients during three periods of clinical use. One hundred forty-four specimens of ball anchor attachments (gold alloy matrix and titanium patrix) were studied by SEM after periods of approximately 1, 3.5, and 8 years of clinical use. Twenty new attachment components were examined as controls. SEM images revealed signs of mechanical wear for the ball attachments studied. The surfaces of the titanium patrix were associated primarily with roughening after short-term use, whereas surfaces of the gold alloy matrix showed wear, roughening, and loss of microscopic material in the form of flakes. Severe mechanical wear on both surfaces was noted after longer periods of use. The mechanical changes were not correlated with patient-mediated observations regarding the time-dependent retentive efficacy of the attachments. One year of clinical wear appeared to have limited effect on the ball attachment tested. Conversely, longer periods of use led to marked modifications in shape of the matrix and patrix components.

The role of enamel crystallography on tooth shade.

OBJECTIVES: Tooth shade is influenced by a combination of extrinsic-stains that are adsorbed to the enamel surface and by its intrinsic-shade resulting from the interaction of light with tooth structures. This study was designed to investigate how the variations in enamel ultrastructure may affect tooth optical properties. METHODS: One-hundred extracted teeth were collected from adult patients attending McGill-Undergraduate Dental Clinics. Shade-spectrophotometry, FTIR and XRD were used to assess tooth shade, enamel chemical composition and crystallography. The data obtained was analysed for Pearson correlation analysis and multiple linear regression analysis. The statistical significance was set at P < 0.05. RESULTS: Tooth shade parameters varied dramatically within the studied population. Pearson correlation analysis demonstrated that tooth hue was associated with enamel hydroxyapatite (HA) crystal size (R = -0.358; B = -0.866; P = 0.007), tooth chroma was associated with enamel HA carbonization (R = -0.419; B = -99.06; P = 0.005), and tooth lightness was associated with both enamel HA crystal size (R = -0.313; B = -1.052; P = 0.019) and the degree of HA carbonization (R = -0.265; B=-57.95; P = 0.033). Multiple linear regression analysis demonstrated that the size of enamel HA crystals and the relative content of mineral carbonate were the most important predictors for tooth shade lightness (P = 0.018) and chroma (P=0.008), respectively. In contrast, enamel organic content had no correlation with tooth shade. CONCLUSIONS: In the present study we have revealed that the tooth shade is regulated by the size of their HA enamel crystals. On the other hand, variation in the degree of enamel HA carbonization can also affect the tooth shade. These findings are of great relevance in dentistry since it provides better understanding of tooth aesthetics.

Within-subject comparisons of maxillary fixed and removable implant prostheses: Patient satisfaction and choice of prosthesis.

Dental implants provide patients with restorative options for the edentulous maxilla. Both fixed and removable prostheses can be attached to the edentulous maxilla, but the efficacy of different designs has not been determined. In this two-session within-subject crossover trial we compared maxillary implant retained fixed prostheses with removable implant overdentures opposed by mandibular implant-supported overdentures. Sixteen patients, who had previously received mandibular implants, entered the study and received four to six maxillary implants. After dropouts as a consequence of a lack of osseointegration and general health problems, 13 remained. Of these, five received the removable prosthesis first and eight the fixed prosthesis. After 2 months, the prostheses were exchanged and the second was also worn for 2 months. Psychometric measurements of general satisfaction with the prostheses as well as comfort, ability to speak, stability, esthetics, ease of cleaning and occlusion were obtained once each prosthesis had been worn for 2 months. Chewing ability was assessed for seven types of food. Removable long-bar overdentures received significantly higher ratings of general satisfaction than fixed prostheses (P = 0.003). Patients also rated their ability to speak and ease of cleaning significantly better with the removable overdentures. Nine patients chose to keep the removable prosthesis and four preferred to keep the fixed prosthesis. The results suggest that maxillary removable overdentures on multiple implants may provide patients with better function than fixed prostheses.