Combination of a Hydraulic Device and Nanohydroxylapatite Paste for Minimally Invasive Transcrestal Sinus Floor Elevation: Procedure and 4-Year Results.

PURPOSE: The objectives of this retrospective study were to describe a transcrestal sinus floor elevation technique combining the use of a hydraulic device and a nanohydroxylapatite paste and to report on 4-year clinical and radiographic outcomes. MATERIALS AND METHODS: The sinus floor elevation procedure used a specially designed drill (SinusJet) to start sinus membrane unsticking and a nanohydroxylapatite paste (Ostim) for further sinus membrane elevation and bone augmentation. It was performed as a one-step procedure with immediate implant placement or a two-step procedure with delayed implant placement 9 months later. Implant survival rate, sinus membrane perforation, postoperative complications, and the level of intraoperative and postoperative patient comfort using a visual analog scale were analyzed retrospectively. A nonparametric Wilcoxon matched-pairs test and parametric paired t test were used to identify significant differences. RESULTS: One hundred thirty-six sinus floor elevations were performed in 110 patients at two dental clinics in Belgium with a mean follow-up period of 48 months. In the one-step procedure, the mean 6-month elevation was 8.5 ± 2.7 mm; 194 implants were placed. In the two-step procedure, the mean 9-month elevation was 9.5 ± 2.4 mm; 8 implants were placed. The osteotomy, sinus membrane elevation, and bone grafting typically took less than 3 minutes. Sinus membrane perforation was observed in 2.9% (n = 4/136). The 4-year implant survival rate was 97% (n = 196/202), with six early implant losses. 96.4% of patients reported either no or minimal discomfort. CONCLUSION: This minimally invasive transcrestal sinus floor elevation procedure that combines a hydraulic device and nanohydroxylapatite paste appears to be safe and predictable. However, further randomized controlled studies are needed to validate the results of this retrospective observational study.

Clinical and Microbiological Profiles of Aggressive and Chronic Periodontitis in Congolese Patients: A Cross-sectional Study.

BACKGROUND: Chronic and aggressive periodontitis were the main forms of periodontitis according to the 1999 classification of periodontal diseases and conditions. Their profile in Congolese patients is still undescribed. AIM: The aim of this study was to compare the profile of chronic periodontitis (ChP) with that of aggressive periodontitis (AgP) in Congolese patients. MATERIALS AND METHODS: Thirty-two patients with ChP and 20 with AgP who consulted the dental services at any of the four medical centers in Kinshasa, from April 2017 to April 2018, were enrolled in the cross-sectional study. All patients underwent a full mouth examination, including assessment of the probing pocket depth and clinical attachment level at six sites per tooth. Microbial samples were collected in the deepest pocket in the maxilla and the deepest pocket in the mandible. A deoxyribonucleic acid (DNA) analysis was performed using DNA strip technology. Fisher exact test, the chi-square test, the t test, and the Mann-Whitney test were used for the statistical analysis. RESULTS: Patients with AgP were significantly younger than those with ChP (P < 0.001). There was no significant difference in the prevalence of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, or Prevotella intermedia between the AgP and ChP groups (P > 0.05). Aggregatibacter actinomycetemcomitans was detected in 10% of cases in the AgP group and in none of those in the ChP group (P = 0.143). CONCLUSION: This study shows that the clinical profiles of ChP and AgP are similar in Congolese patients. There were no microbiological differences between these two forms of periodontitis.

Implantoplasty Versus Glycine Air Abrasion for the Surgical Treatment of Peri-implantitis: A Randomized Clinical Trial.

PURPOSE: Numerous approaches have been proposed for the treatment of peri-implantitis, but to date, none has been identified as the most effective. This study compared the efficacy of implantoplasty and glycine air polishing for the surgical treatment of peri-implantitis. MATERIALS AND METHODS: This prospective, randomized, parallel-group trial included 31 patients presenting with 42 implants with peri-implantitis. Patients underwent surgical treatment by implantoplasty (test group, n = 22) or glycine air polishing (control group, n = 20). Clinical parameters (Plaque Index), bleeding on probing (BOP), suppuration on probing (SOP), probing pocket depth (PPD), relative attachment level (RAL), and mucosal recession were assessed before surgery (baseline), and at 3 months and 6 months after surgery. Bone loss was recorded at baseline and 6 months. Two composite outcomes were also evaluated, according to the following definitions: (1) mean PPD reduction ≥ 0.5 mm + no further loss of bone; (2) PPD ≤ 5 mm, absence of BOP/SOP, and no additional mean bone loss ≥ 0.5 mm. RESULTS: Plaque Index remained low (< 0.5) in both groups for the duration of the study. Mean BOP, SOP, PPD, and RAL were greatly reduced at 3 months in both groups, and remained low between 3 months and 6 months. Bone loss was stable in the implantoplasty group, and slight bone gain (0.5 mm) was observed in the glycine air-polishing group. There were no significant differences between the two groups in any parameter, and composite treatment outcomes were similar in both groups, irrespective of the definition. CONCLUSION: Within the limitations of this 6-month follow-up study, implantoplasty is as effective as glycine air polishing for the surgical treatment of peri-implantitis.

Treatment of mandibular Class II furcations using bovine-derived bone xenograft with or without a collagen membrane: a randomized controlled trial.

OBJECTIVES: This randomized clinical trial aimed to compare the effects of a bovine-derived xenograft with (control group, CG) or without (test group, TG) a collagen membrane for the treatment of mandibular Class II furcations. METHOD AND MATERIALS: Nineteen patients presenting 32 furcations were included and randomly assigned to CG (n = 16) or TG (n = 16). At the 6-month follow-up (M6), 29 furcations were reevaluated. All clinical measurements were performed by the same investigator with a straight periodontal probe and a specially designed "modified Nabers probe" (both with 1-mm increments). The primary outcome was the improvement of the horizontal probing attachment level. According to the protocol, there was no re-entry at 6 months. RESULTS: Both vertical (at M6, CG: 2.4 ± 0.8 mm, TG: 2.7 ± 1.0 mm) and horizontal probing attachment levels, whether measured with a periodontal probe (at M6: CG: 3.4 ± 0.8 mm, TG: 3.2 ± 1.0 mm) or the "modified Nabers probe" (at M6: CG: 3.5 ± 1.1 mm, TG: 3.2 ± 1.0 mm), favorably evolved after 6 months. There was no significant difference for any of the measures performed (P > .05, unpaired t test). CONCLUSIONS: Both treatments were clinically effective with no statistically significant difference between them but as there was no histologic analysis, the amount of real regeneration could not be analyzed. This conclusion should be confirmed by longer follow-up periods.

Clinical Evaluation of Three Surgical Modalities in the Treatment of Peri-Implantitis: A Randomized Controlled Clinical Trial.

OBJECTIVES: To compare the efficacy of three mechanical procedures for surgically treating peri-implantitis. MATERIALS AND METHODS: In a randomized, prospective, parallel-group study, 47 patients with peri-implantitis were treated with (a) plastic curettes (n = 15 patients, 25 implants), (b) an air-abrasive device (Perio-Flow®, n = 16 patients,22 implants), or (c) a titanium brush (Ti-Brush®, n = 16 patients, 23 implants). Patients were assessed for the following measures at three timepoints (baseline, and three and six months after surgery): plaque index, bleeding on probing, gingival index, probing pocket depth (PPD), relative attachment level, and bone loss. Treatment outcome was considered successful when the implant was still present with PPD ≤ 5 mm, no bleeding on probing, and no further mean bone loss ≥ 0.5 mm. RESULTS: A greater reduction of gingival index and PPD was observed in the titanium brush group than in the other groups at six months (P < 0.001). Relative attachment level decreased from baseline in each group at three months but was more marked in the titanium brush group (P < 0.001). At six months, there was less bone loss in the titanium brush group than in the plastic curette group (P < 0.001; linear mixed model and Kruskal-Wallis). A successful outcome was observed in 22% of implants in the plastic curette group, 27% in the Perio-Flow® group, and 33% in the Ti-Brush® group. CONCLUSIONS: The titanium brush and glycine air-polishing device were more effective than the other methods, but treatment success remained low. Combining mechanical procedures with antimicrobials and/or antibiotics might be a more effective strategy and warrants careful investigation.

In Vitro Comparison of the Efficacy of Peri-Implantitis Treatments on the Removal and Recolonization of Streptococcus gordonii Biofilm on Titanium Disks.

Objective: To compare the efficacy of four commonly used clinical procedures in removing Streptococcus gordonii biofilms from titanium disks, and the recolonization of the treated surfaces. Background: Successful peri-implantitis treatment depends on the removal of the dental biofilm. Biofilm that forms after implant debridement may threaten the success of the treatment and the long-term stability of the implants. Methods: S. gordonii biofilms were grown on titanium disks for 48 h and removed using a plastic curette, air-abrasive device (Perio-Flow®), titanium brush (TiBrush®), or implantoplasty. The remaining biofilm and the recolonization of the treated disks were observed using scanning electron microscopy and quantified after staining with crystal violet. Surface roughness (Ra and Rz) was measured using a profilometer. Results: S. gordonii biofilm biomass was reduced after treatment with Perio-Flow®, TiBrush®, and implantoplasty (all p < 0.05), but not plastic curette (p > 0.05), compared to the control group. Recolonization of S. gordonii after treatment was lowest after Perio-Flow®, TiBrush®, and implantoplasty (all p < 0.05 vs. control), but there was no difference between the plastic curette and the control group (p > 0.05). Ra and Rz values ranged from 1⁻6 µm to 1⁻2 µm and did not differ statistically between the control, plastic curette, Perio-Flow, and TiBrush groups. However, the implantoplasty group showed a Ra value below 1 µm (p < 0.01, ANOVA, Tukey). Conclusions: Perio-Flow®, TiBrush®, and implantoplasty were more effective than the plastic curette at removing the S. gordonii biofilm and preventing recolonization. These results should influence the surgical management of peri-implantitis.

Oral Microbes, Biofilms and Their Role in Periodontal and Peri-Implant Diseases.

Despite many discoveries over the past 20 years regarding the etio-pathogenesis of periodontal and peri-implant diseases, as well as significant advances in our understanding of microbial biofilms, the incidence of these pathologies still continues to rise. This review presents a general overview of the main protagonists and phenomena involved in oral health and disease. A special emphasis on the role of certain keystone pathogens in periodontitis and peri-implantitis is underlined. Their capacity to bring a dysregulation of the homeostasis with their host and the microbial biofilm lifestyle are also discussed. Finally, the current treatment principles of periodontitis and peri-implantitis are presented and their limits exposed. This leads to realize that new strategies must be developed and studied to overcome the shortcomings of existing approaches.

Cowden Syndrome Associated with Severe Periodontal Disease: A Short Literature Review and a Case Report.

PURPOSE: The aim of this literature review and case report was to point out the relationship between Cowden Syndrome (CS) and severe periodontitis. CS is a rare autosomal dominant disorder characterised by skin and oral hamartomas, and is associated with an increased risk of cancer development. CASE REPORT: The case of a 43-year old male patient affected by Cowden syndrome and presenting severe periodontitis was reported. RESULTS: It can be suggested that the specific gingival morphology of the patient with CS might be a risk factor for the development of periodontal disease, as described in the present case report. CONCLUSION: Early diagnosis is crucial in patients affected by CS. The dentist may be the first to notice any atypical changes in the oral cavity and refer the patient for further examinations. Moreover, the mucosal and skin changes have a tendency to appear prior to the malignancies associated with the syndrome. This highlights the responsibility of the dentist in the early diagnosis of this progressive pathological syndrome.

Periopathogenic bacteria in dental plaque of Congolese patients with periodontitis: A pilot study.

BACKGROUND: Periopathogenic bacteria play an important role in the etiology of periodontal disease. At present, no study screening for periopathogens in the DR Congo was carried out. The aim of this pilot study was to investigate the prevalence of five periopathogens in Congolese patients with periodontitis and to determine the association between these bacteria. MATERIAL AND METHODS: Twelve patients (eight women and four men) with a mean age of 45 ± 19 years from those consulted in dental services of two medical centers of Kinshasa from April 2017 to October 2017 were included. Full mouth examination was registered, the probing pocket depth and clinical attachment level were assessed at six sites per tooth. Dental subgingival plaque samples were taken in the deepest pocket per arch in the maxilla and mandible. DNA analysis was performed using DNA-strip technology. The Fisher Exact test and Pearson correlation were used for statistical analysis. RESULTS: Porphyromonas gingivalis and Tannerella forsythia were detected at high level of 92%, Prevotella intermedia at a rate of 75% whereas Treponema denticola was detected in all patients. Aggregatibacter actinomycetemcomitans was not detected. Strong associations were found between three bacteria of the red complex and between T. denticola and P. intermedia (r=1). CONCLUSIONS: This first study investigating periopathogens in subgingival plaque of Congolese with periodontitis demonstrated a high prevalence of the red complex (P. gingivalis, T. forsythia and T. denticola). Associations between different bacteria of this complex were strong. Key words:Association, bacteria, periopathogen, periodontitis, prevalence.

Evaluation of Emdogain® antimicrobial effectiveness against biofilms containing the keystone pathogen Porphyromonas gingivalis.

This study aimed to evaluate the antimicrobial activity of Emdogain® (EMD) against biofilms containing the periopathogen Porphyromonas gingivalis. A brain-Heart infusion broth inoculated with S. gordonii and P. gingivalis was perfused (7-d, anaerobiosis) through a closed circuit containing two Robbins devices as to form biofilms. The latter were then treated for 2 min with various antimicrobials (Chlorhexidine (CHX) 0.2%, Povidone iodine (PVI) 5%, PVI 10%, essential oils (EO), EO ZeroTM or EMD) (n=8) and cell densities were calculated and compared. In the present in vitro model, Emdogain® was not statistically effective (p>0.05) in killing biofilm bacteria unlike the other tested molecules.

Periodontal treatment and maintenance of molars affected with severe periodontitis (DPSI = 4): An up to 27-year retrospective study in a private practice.

OBJECTIVE: This retrospective study aimed to evaluate the long-term response of molars affected with severe periodontitis to periodontal treatment, to analyze the differences in response between molars with and without furcation involvement (FI) and to reevaluate the usefulness of the existing classification of FI in determining the prognosis. METHOD AND MATERIALS: A total of 402 patients from a single private practice were included. The observation period was 27 years (mean 16.5 years). The average frequency of the supportive periodontal therapy (SPT) visits was 1.76 ± 0.57 per year (median 1.95/ year). Inclusion criteria were: at least 10 years of periodontal follow-up, at least one tooth with probing depth ≥ 6 mm, level 4 of the Dutch Periodontal Screening Index (DPSI). RESULTS: Of the 2,559 molars present at the initial examination, 125 were extracted immediately. Degrees III or II FI were found in 37.2% molars, while 62.8% exhibited degree I or had no FI. The performed periodontal treatments were: nonsurgical therapy of scaling and root planing (77.6%), eventually repeated scaling and root planing (11.6%), access flap (7.8%), tunnellization (0.2%), and root resection (2.8%). The survival rate was 83.9% (77.5% molars with FI; 87.8% without FI). The presence or absence of FI did not exhibit a significant effect in any of the treatments provided. CONCLUSION: Simple treatments can successfully be applied to treat molars affected with severe periodontitis, even with FI, yielding good long-term survival rates. The classification of FI was not of great use in determining the prognosis except in case of degree III FI.

Evaluation of a unique subgingival irrigation with 10% povidone-iodine after scaling and root planing: A randomized clinical trial.

OBJECTIVE: The beneficial effects of antiseptics in the treatment of periodontitis are still controversial. The goal of this randomized split-mouth study was to evaluate the clinical and microbiologic results of a unique subgingival irrigation of 10% povidone-iodine in addition to a full-mouth scaling and root planing for the treatment of chronic periodontitis. METHOD AND MATERIALS: Twenty patients with chronic periodontitis took part in this investigation. In each patient, four initially untreated pockets ≥ 4 mm were randomly selected for one subgingival irrigation. After a one-session full-mouth treatment with scaling and root planing (SRP), two pockets of a split mouth received one unique irrigation with 10 mL 0.9% NaCl solution (control group, CG). Two pockets on the other side received 10 mL of povidone-iodine 10% (test group, PIG). Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) parameters were assessed at baseline and after 1, 3, and 6 months (M). Bacterial samplings with sterile paper points were taken at M0 and after M1, M3, and M6. These samplings were separately cultured under aerobic and anaerobic conditions before CFU evaluation. RESULTS: Pl, GI, PPD, and CAL were significantly improved in both groups after 6 months. The major difference was seen between M0 and M3 (P < .001). No significant differences were seen between the groups, except for deep pockets (> 6 mm) where a statistical difference was observed in favor of PIG after 6 months; in these subgroups the mean probing reduction was 2.68 ± 0.37 mm for CG versus 3.93 ± 0.23 mm in PIG (P < .001). No significant differences were seen between CG and PIG regarding the microbiologic results after 6 months. CONCLUSION: One single irrigation of 10% povidone-iodine associated with full-mouth SRP would bring a small additional benefit in deep pockets. More studies are needed to yield additional results.

In vitro evaluation of peri-implantitis treatment modalities on Saos-2osteoblasts.

OBJECTIVES: Mechanical treatment of the implant surface through surgical approach is recommended to control peri-implantitis. Few conclusive data exist about the physical and chemical properties of treated titanium surfaces and their biocompatibility towards osteoblasts. This in vitro study aimed to evaluate four clinical procedures: plastic curette, air-abrasive device (Perio-Flow(®) ), titanium brush (Ti-Brush(®) ) and implantoplasty in terms of biocompatibility and osteogenic effect when cultured with Saos2. MATERIALS AND METHODS: Titanium disks were treated with plastic curette, air-abrasive device (Perio-Flow(®) ), titanium brush (Ti-Brush(®) ) and implantoplasty. Their surface microtopography (SEM), chemical composition (EDX) and wettability were evaluated. After seeding with Saos-2, cell morphology (1 h, 24 h), viability (three and 6 days) and alkaline phosphatase (ALP), osteoprotegerin (OPG) and osteocalcin (OCN) production (7 days) were analyzed. RESULTS: Control, plastic curette, Perio-Flow(®) and Ti-Brush(®) groups presented complex microstructures including craters and micropits, whereas the implantoplasty group appeared much smoother (SEM). Titanium, oxygen, aluminium and carbon were identified as the main components in all disks with a decrease in the percentage of oxygen, carbon and an increase in the percentage of titanium in the implantoplasty group (EDX). Implantoplasty disks were also significantly more hydrophilic than the other ones, whose surfaces appeared hydrophobic. Saos-2 showed no morphological difference at 1 h. At 24 h, they appeared round shaped in all groups, except the implantoplasty group where the cells appeared stretched and elongated. Viability was similar in all groups, but significantly higher in the Perio-Flow(®) than the control group at day six. ALP, OPG and OCN protein expression at 7 days was similar in all groups. CONCLUSIONS: Although implantoplasty was the only modality to modify the titanium surface morphology, composition and wettability, all treatment modalities promoted ALP, OPG and OCN production and appeared as valid approaches in terms of biocompatibility.

Influence of low direct electric currents and chlorhexidine upon human dental biofilms.

Dental biofilms have been widely associated with biological complications of oral implants. Currently, no consensus exists regarding the most reliable anti-infective approach to treat peri-implantitis. This study aimed to investigate whether low direct electric currents (DC) could influence chlorhexidine (CHX) 0.2% antimicrobial efficacy against human dental biofilms. To support biofilm accumulation, discs made with machined titanium (Ti) or hydroxyapatite (HA) were used. Five volunteers wore during 24 h an intraoral thermoformed splint on which ten specimens were bonded. Biofilms were then collected and treated ex vivo. During each antimicrobial experiment (N = 20 replicates), two modalities of treatment (CHX/PBS = control groups and CHX/PBS+5mA = test groups) were tested (n = 5 discs each) and the number of viable bacteria evaluated in LogCFU/mL at baseline, 0.5, 1, 2 and 5 min. The proportion of killed bacteria was also estimated and compared statistically at each time point between control and test groups. CHX+/-5mA induced a mean viability reduction around 90-95% after 5 min of treatment whatever the surface considered (Ti/HA). A significant difference regarding the bactericidal effect was noted on Ti surfaces after 0.5, 1 and 2 min in favor of the CHX+5mA modality when compared to CHX alone (p < 0.05). PBS+5mA also had a certain antimicrobial effect (58%) after 5 min on Ti surfaces. This effect was significantly higher than that observed with PBS (25%) (p < 0.05). This study showed that low DC (5mA) can have an antibiofilm effect and are also able to enhance chlorhexidine 0.2% efficacy against human dental biofilms grown on titanium surfaces.

Electrical enhancement of chlorhexidine efficacy against the periodontal pathogen Porphyromonas gingivalis within a biofilm.

Electric currents have been shown to promote the antimicrobial effectiveness of several biocides against microbial biofilms. Therefore, the objective of this work was to test the null hypothesis that low electric direct currents (DC) do not influence chlorhexidine (CHX) efficacy against the periodontal pathogen Porphyromonas gingivalis within a biofilm. A brain heart infusion medium inoculated with Streptococcus gordonii and P. gingivalis was perfused for 7 days in anaerobiosis through two modified Robbins devices (MRD) assembled in parallel. Biofilms grew on hydroxyapatite discs placed at the bottom of the MRD plugs, and were then treated for 10 min with either CHX or CHX/DC (1.5 mA or 10 mA). The bactericidal effect against biofilms was then evaluated by comparing the mean proportions of P. gingivalis killed. In the first series of experiments (CHX ± 1.5mA), the proportions of P. gingivalis killed were 81.1% for biofilms undergoing CHX and 79.1% when they were additionally treated with 1.5mA (p>0.05). In the second series (CHX ± 10mA), the viability of P.gingivalis was reduced by 87.3% with CHX and 98.9% when CHX was supplemented with 10mA (p<0.01). The null hypothesis was rejected, since a significant enhancement of the chlorhexidine 0.2% efficacy against P.gingivalis was observed when applying 10mA currents.

The modified coronally advanced tunnel combined with an enamel matrix derivative and subepithelial connective tissue graft for the treatment of isolated mandibular Miller Class I and II gingival recessions: a report of 16 cases.

OBJECTIVES: To clinically evaluate the healing of mandibular Miller Class I and II isolated gingival recessions treated with the modified coronally advanced tunnel (MCAT) in conjunction with an enamel matrix derivative (EMD) and subepithelial connective tissue graft (SCTG). METHOD AND MATERIALS: Sixteen healthy patients (13 women and 3 men) exhibiting one isolated mandibular Miller Class I and II gingival recessions of a depth of ≥ 3 mm, were consecutively treated with the MCAT in conjunction with EMD and SCTG. Treatment outcomes were assessed at baseline and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (eg, 100% root coverage). RESULTS: Postoperative pain and discomfort were low and no complications such as postoperative bleeding, allergic reactions, abscesses, or loss of SCTG were observed. At 12 months, statistically significant (P < .0001) root coverage was obtained in all 16 defects. CRC was measured in 12 out of the 16 cases (75%) while in the remaining 4 defects root coverage amounted to 90% (in two cases) and 80% (in two cases), respectively. Mean root coverage was 96.25%. Mean keratinized tissue width increased from 1.98 ± 0.8 mm at baseline to 2.5 ± 0.9 mm (P < .0001) at 12 months, while mean probing depth did not show any statistically significant changes (ie, 1.9 ± 0.3 mm at baseline vs 1.8 ± 0.2 mm at 12 months). CONCLUSION: Within their limits, the present results indicate that the described treatment approach may lead to predictable root coverage of isolated mandibular Miller Class I and II gingival recessions.

Evaluation of an air-abrasive device with amino acid glycine-powder during surgical treatment of peri-implantitis.

OBJECTIVE: The aim of this retrospective study was to analyze collected data concerning the effect of an air-abrasive device (Perio-Flow®) during surgical treatment of peri-implantitis without addition of any antimicrobials. METHOD AND MATERIALS: Data reports from 22 implants with peri-implantitis surgically treated using either an air-abrasive device (Perio- Flow) (test group), or plastic curettes and cotton pellets impregnated with saline (control group) were analyzed for the present study. Clinical and radiographic parameters plaque index (PI), gingival index (GI), probing pocket depth (PPD), and bone loss (BL) were previously assessed at baseline, 6 months, and 12 months after treatment. A repeated measures ANOVA test was used for each clinical and radiographic parameter (PI, GI, PPD, and BL). The implant and the patient were considered separately as the statistical unit. RESULTS: Regarding betweengroup comparisons, PI scores remained low during the entire study period (at implant and patient levels). At the end of the study, GI and PPD reductions were statistically higher (P < .05) in the Perio-Flow group (implant level), and no differences were observed between the two groups at patient level (P > .05) (repeated measures ANOVA test). It was also noted that BL analyses (implant and patient levels) revealed no differences between baseline and 12 months in both groups. Nevertheless, only 8% from each treatment group were considered stabilized after 12 months. CONCLUSION: Within the limitations of the present study, both groups (Perio-Flow and its control group) revealed a significant reduction of the clinical parameters. Moreover, the air-abrasive device group yielded better improvements regarding GI and PPD when the implant was considered as the statistical unit. However, if the stabilization of the disease was the final objective, these two treatments failed in resolving its activity. A longer follow-up and a larger number of patients would be needed to confirm these results and the benefit of adding this air-abrasive method of decontamination to the surgical procedure.

Prevalence and risk factors for peri-implant disease in Belgian adults.

OBJECTIVES: This study aimed to evaluate in a Belgian population the frequence of mucositis and peri-implantitis in patients with implants of at least 5 years of function. Another outcome was to access implants/patients characteristics as possible risk indicators for peri-implantitis. MATERIAL AND METHODS: One hundred and three patients (38 males/65 females) with a total of 266 implants were examined. Implants had been inserted in university hospitals as well as in private clinics and the mean time of implants in function was 8.5 years (±3.2). The average patients' age within the population was 62 years (±13.4). General health informations were recorded as well as habits regarding smoking, maintenance visits and oral hygiene. Full mouth clinical parameters (PlI, BoP, PPD) were assessed and radiographs taken to determine the periodontal status and implants diagnosis. RESULTS: Prevalences of mucositis and peri-implantitis at the patient's level were respectively 31% and 37%. They were 38% and 23% at the implant's level. Subjects older than 65 years (OR = 1.39) and those with active periodontitis (OR = 1.98) were prone to peri-implantitis. The association was stronger for hepatitis (OR = 2.92) and totally edentulous patients (OR = 5.56). Finally, at the implant's level, a significant correlation was found in the multi-level analyses between rough surfaces, overdentures and peri-implantitis. CONCLUSION: After 8.5 years an important proportion (±60%) of implants presented biological complications. Furthermore, a positive correlation was showed between age, periodontitis, absence of teeth, rough surfaces and peri-implantitis. Consequently, patients with such characteristics should be informed before implant placement and frequently re-called after for maintenance visits.

Four-year results following treatment of intrabony periodontal defects with an enamel matrix derivative alone or combined with a biphasic calcium phosphate.

The aim of this study was to evaluate the 4-year clinical outcomes following regenerative surgery in intrabony defects with either EMD + BCP or EMD. Twenty-four patients with advanced chronic periodontitis, displaying one-, two-, or three-walled intrabony defect with a probing depth of at least 6 mm, were randomly treated with either EMD + BCP (test) or EMD alone (control). The following clinical parameters were evaluated at baseline, at 1 year and at 4 years after regenerative surgery: plaque index, gingival index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. No differences in any of the investigated parameters were observed at baseline between the two groups. The test group demonstrated a mean CAL change from from 10.8 ± 1.6 mm to 7.4 ± 1.6 mm (p < 0.001) and to 7.6 ± 1.7 mm (p < 0.001) at 1 and 4 years, respectively. In the control group, mean CAL changed from 10.4 ± 1.3 at baseline to 6.9 ± 1.0 mm (p < 0.001) at 1 year and 7.2 ± 1.2 mm (p < 0.001) at 4 years. At 4 years, two defects in the test group and three defects in the control group have lost 1 mm of the CAL gained at 1 year. Compared to baseline, at 4 years, a CAL gain of ≥3 mm was measured in 67% of the defects (i.e., in 8 out of 12) in the test group and in 75% of the defects (i.e., in 9 out of 12) in the control group. There were no statistically significant differences in any of the investigated parameters at 1 and at 4 years between the two groups. Within their limits, the present results indicate that: (a) the clinical improvements obtained with both treatments can be maintained over a period of 4 years, and (b) in two- and three-walled intrabony defects, the addition of BCP did not additionally improve the outcomes obtained with EMD alone. In two- and three-walled intrabony defects, the combination of EMD + BCP did not show any advantage over the use of EMD alone.

Effect of xylitol/chlorhexidine versus xylitol or chlorhexidine as single rinses on initial biofilm formation of cariogenic streptococci.

OBJECTIVES: Oral bacteria implying a natural resistance may deteriorate the antibacterial efficacy of chlorhexidine on cariogenic microorganisms. Xylitol, mostly applied via chewing gum, is known to possess favorable plaque-reducing properties. The aim of this study was to investigate the effect of a xylitol rinse formulated as pure solution or combined with chlorhexidine on the viability of Streptococcus sanguis (early colonizer of human teeth) and Streptococcus mutans (the most causal strain for caries) during initial steps of biofilm formation. METHOD AND MATERIALS: After exposure to the test solutions, the bacteria suspended in human sterile saliva were allowed to attach to human enamel slides for 60 minutes in a preclinical flow chamber system. The bacterial vitality of suspended and attached cells was monitored using 2 fluorescent DNA stains by epifluorescence microscopy. Further parameters measured were the total bacterial cell counts on enamel slides and growth of suspended streptococci. RESULTS: The sensitivity of S mutans to pure chlorhexidine or in combination with xylitol is contrary to the natural resistance of S sanguis to chlorhexidine. The combination of xylitol/chlorhexidine showed a statistically significant antivital effect on S sanguis cells compared to the pure agents xylitol and chlorhexidine. The bacterial cell density on enamel and bacterial reproduction on agar plates were similarly affected by the combination of xylitol/chlorhexidine or the single substances. CONCLUSION: The newly discovered synergistic antivital effect of xylitol combined with chlorhexidine may contribute to the favorable potential of xylitol use for the improvement of new formulations of caries-preventive mouthrinses.