Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions.

BACKGROUND: Treatment of periodontal (gum) disease may lessen the adverse consequences of some chronic systemic conditions. PURPOSE: To estimate the effects of periodontal therapy on medical costs and hospitalizations among individuals with diagnosed type 2 diabetes (T2D); coronary artery disease (CAD); cerebral vascular disease (CVD); rheumatoid arthritis (RA); and pregnancy in a retrospective observational cohort study. METHODS: Insurance claims data from 338,891 individuals with both medical and dental insurance coverage were analyzed in 2011-2013. Inclusion criteria were (1) a diagnosis of at least one of the five specified systemic conditions and (2) evidence of periodontal disease. Subjects were categorized according to whether they had completed treatment for periodontal disease in the baseline year, 2005. Outcomes were (1) total allowed medical costs and (2) number of hospitalizations, per subscriber per year, in 2005-2009. Except in the case of pregnancy, outcomes were aggregated without regard to reported cause. Individuals who were treated and untreated for periodontal disease were compared independently for the two outcomes and five systemic conditions using ANCOVA; age, gender, and T2D status were covariates. RESULTS: Statistically significant reductions in both outcomes (p<0.05) were found for T2D, CVD, CAD, and pregnancy, for which costs were lower by 40.2%, 40.9%, 10.7%, and 73.7%, respectively; results for hospital admissions were comparable. No treatment effect was observed in the RA cohorts. CONCLUSIONS: These cost-based results provide new, independent, and potentially valuable evidence that simple, noninvasive periodontal therapy may improve health outcomes in pregnancy and other systemic conditions.

Association of a common genetic factor, PTGER3, with outcome of periodontal therapy and preterm birth.

BACKGROUND: Clinical evidence suggests an association between preterm birth and periodontal disease. This study explores whether specific genetic polymorphisms are associated with success of periodontal therapy in pregnant women with periodontal disease and, further, whether any of these same polymorphisms are also associated with spontaneous preterm birth (sPTB). METHODS: One hundred sixty high-risk pregnant women (6 to 20 weeks of gestation) with periodontal disease (≥ 3 sites with attachment loss ≥ 4 mm) were studied. All women received scaling and root planing plus oral hygiene instruction. Periodontal examinations were performed before treatment and 20 weeks later. Participants were classified according to two study outcomes: 1) success or failure of periodontal treatment; and 2) presence or absence of sPTB. Maternal DNA samples from mucosal swabs were characterized using a 1536-SNP (single-nucleotide polymorphism) custom polymerase chain reaction chip. A probabilistic model of each dichotomous outcome, derived using a stepwise Bayesian procedure, was compared to respective null hypotheses on the basis of Monte Carlo simulations and significance estimates obtained using three measures (z-test, Welch t-test, and probability convolution). The models were further confirmed by logistic regression analyses. RESULTS: The models revealed a significant relation between a specific polymorphism of prostaglandin E receptor 3 (a gene associated with inflammatory response) and both periodontal treatment failure (odds ratio 11.09, P <0.0002) and sPTB (odds ratio 6.89, P < 0.0032). CONCLUSIONS: These results demonstrate that the risk of unsuccessful periodontal treatment is associated with tag SNPs in specific genes that regulate the inflammatory response, one of which is also associated with sPTB.

A meta-analytic approach to determine the state of the science on implant dentistry.

Meta-analyses have been widely used to estimate treatment effects in evidence-based dentistry. Few conferences, however, have used a systems approach to assure coherent data management and analysis. The purpose of this section is to describe the data management and statistical analysis for the State of the Science of Implant Dentistry (SSID) conference. This overview includes (a) a description of widely used clinical trial designs for implant dentistry, (b) a description of data management procedures specifically designed for the SSID conference, and (c) a description of the data analysis methodology, including descriptive analyses and meta-analyses. The use of the systems approach facilitated data abstraction and analysis.

Mandibular growth following implant restoration: does Wolff's law apply to residual ridge resorption?

This study measured bone height under a fixed detachable cantilever restoration supported by five or six endosseous implants in 60 consecutively treated patients. Panoramic films were made at surgery and 1, 2, 3, and 4 years postrestoration. A computer-enhanced method was used to measure mandibular height 5, 10, 15, and 20 mm distal to the last implant, which was used as a length. standard to correct for variation in film magnification. Implant restoration resulted in a significant growth of the mandible (baseline: 7.25 +/- 0.25 mm, 4 years: 8.18 +/- 0.18 mm; P = .05). The growth in dimension appears to occur during the first year of function.

Influence of implant geometry and surface characteristics on progressive osseointegration.

PURPOSE: Although no currently available technique for the measurement of osseointegration is entirely satisfactory, 3 clinical variables can be reasonably associated with the process: probing depth, micromobility, and crestal bone height. Micromobility can be quantified to some extent with the use of the Periotest, a commercially available instrument In this investigation, the influence of surface characteristics and geometry upon Periotest value (PTV) and probing depth measurements was studied. MATERIALS AND METHODS: In a multicenter trial, 120 healthy edentulous patients received 5 or 6 implants in the anterior mandible and were followed for 3 years. A total of 634 implants were placed. Every patient received at least 1 implant of each of 3 types: threaded titanium plasma-sprayed (TPS), threaded hydroxyapatite-coated (HA), and cylindric HA-coated. A randomization schedule assured that approximately equal numbers of each type of implant were placed and that they were uniformly distributed over the arch. RESULTS: Of the 4 tested combinations of dependent and independent variables, the only statistically significant (P < .05) effect was that of coating on PTV. At 1 year after prosthetic restoration, the mean PTV for HA-coated threaded implants was -5.36 +/- 1.24, compared with -4.86 +/- 1.70 for TPS implants. This difference steadily declined in magnitude and significance, until, after 3 years, the groups were indistinguishable. DISCUSSION: This study agrees with the previous observations that HA coating tends to accelerate the initial rate of osseointegration. The absence of a difference between threaded and cylindric implants confirms that the PTV responds to micromobility near the surface, on a scale much smaller than such gross geometric features. CONCLUSION: On the basis of these results, one may conclude that HA-coated implants exhibit a more rapid decrease in micromobility than do TPS implants of identical geometry.