Treatment of peri-implant mucositis with a chitosan brush-A pilot randomized clinical trial.

OBJECTIVE: This aim of this study was to evaluate a chitosan brush for the treatment of peri-implant mucositis. MATERIALS AND METHODS: A total of 11 patients with a combined total of 24 dental implants and who were diagnosed with peri-implant mucositis were included in this 6-month, split mouth, pilot clinical trial. Implants were randomly assigned to either treatment with a chitosan brush using an oscillating dental hand piece or treatment with titanium curettes. Supportive treatment was provided at 3 months. Two calibrated periodontists, blinded to treatment group, performed all examinations, including probing pocket depths (PPD) and bleeding on probing (mBoP). The changes in clinical parameters were compared between groups at 2 weeks, 4 weeks and 6 months. A Mann-Whitney U test with an alpha level of 0.05 was used for the statistical analyses. RESULTS: Both groups demonstrated significant reductions in mBoP between baseline and 6 months. The test implants treated with the chitosan brush had a better improvement in mBoP at 2 weeks and 4 weeks compared to the implants treated with the titanium curettes. The reduction in PPD was significantly better in the test group at 4 weeks. All implants had stable bone levels, as seen on radiographs between baseline and 6 months. CONCLUSION: Reduced signs of inflammation were seen in both groups 6 months after the baseline treatment and 3 months after maintenance. A chitosan brush seems to be a safe and efficient device for debridement of dental implants.

Surgical treatment of peri-implantitis: Prognostic indicators of short-term results.

AIM: To evaluate the clinical and radiographic short-term (6 months) effect of surgical treatment of peri-implantitis, and to identify prognostic indicators affecting the outcome using a multilevel statistical model. MATERIALS & METHODS: A total of 143 implants (45 patients) with a diagnosis of progressive peri-implantitis (progressive bone loss (PBL) ≥2.0 mm and bleeding on probing (BoP)/suppuration) received surgical treatment. Clinical and radiographic parameters were assessed 6 months postoperatively. Potential prognostic indicators on subject, implant and site level prior to surgery were analysed to evaluate the effect on individual and composite outcomes using multilevel logistic regression analysis. RESULTS: At the 6-month evaluation, none of the implants demonstrated PBL and 14% of the implants were registered with the absence of bleeding and no pocket probing depth ≥6 mm. Multilevel regression analysis identified, among others, suppuration, pocket probing depth >8 mm, bone loss >7 mm and the presence of plaque as criteria associated with the outcome. CONCLUSION: Resective peri-implantitis surgery seemed to reduce the amount of peri-implant inflammation. However, most of the sites continued to have BoP/suppuration. Thus, long-term maintenance and evaluation is warranted. The effect of treatment was reduced by some prognostic indicators such as the presence of suppuration prior to interception and peri-implant bone loss exceeding 7 mm.

Sulcus fluid bone marker levels and the outcome of surgical treatment of peri-implantitis.

AIM: To analyse change in selected bone markers in peri-implant sulcus fluid (PISF) sampled before treatment and after 12 months and test correlation with change in disease progression. MATERIALS AND METHODS: Peri-implant sulcus fluid was sampled from 32 patients in a randomized, clinical study comparing peri-implant defect re-construction with or without porous titanium granules. Matrix metalloproteinase 8 levels were measured using the Quantikine Human Total MMP-8 (DMP800) ELISA. Multianalyte profiling of the level of bone markers [interleukin-6, osteprotegerin (OPG), osteocalcin, leptin, osteopontin, parathyroid hormone, tumour necrosis factor-α, adiponectin and insulin] was performed by Luminex using Human Bone Panel IB. Changes in bone marker levels were compared and correlation with clinical findings was tested. RESULTS: No differences in clinical parameter or bone marker levels between test and control group were found. When comparing bone marker levels irrespective of treatment allocation between baseline and 12 months, a significant reduction in total protein, matrix metalloproteinase -8, interleukin-6, OPG, leptin and adiponectin were demonstrated. Positive correlations were found between the reduction in interleukin-6 (r = 0.43), insulin (r = 0.38) and matrix metalloproteinase-8 (r = 0.47) concentration, and probing pocket depth reduction. CONCLUSION: Peri-implantitis surgical treatment induced some reduction of the studied bone markers. Conclusive evidence for correlation between change in bone marker concentrations with disease resolution was not found.

Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial.

OBJECTIVE: This randomized controlled clinical trial was carried out to assess the effect of comprehensive nonsurgical periodontal treatment and strict plaque control performed during pregnancy on the reduction of preterm and/or low birth weight rates (PTLBW). MATERIAL AND METHODS: Three hundred and three women were randomly allocated to receive periodontal treatment either during pregnancy (n = 147, test group) or after delivery (n = 156, control group). During pregnancy, the control group received only one session of supragingival scaling and oral hygiene instruction. In contrast, the test group received comprehensive periodontal treatment including multiple sessions of scaling and root planing, oral hygiene instructions, and frequent maintenance visits. RESULTS: At baseline, periodontal inflammation was observed in approximately 50% of sites and attachment loss affected <15% of sites. Compared to controls, women in the test group had significant reductions in the percentage of sites with plaque (48.5% vs. 10.3%, p < 0.001), gingival bleeding (23.3% vs. 2.5%, p < 0.001), calculus (21.3% vs. 4.1%, p < 0.001), bleeding on probing (38.1% vs. 2.6%, p < 0.001) and probing depth ≥3 mm (19.97% vs. −2.45%, p < 0.001). No significant differences were observed between the groups in the occurrence of PT (11.7% vs. 9.1%, p = 0.57), LBW (5.6 % vs. 4.1%, p = 0.59), and PTLBW (4.15% vs. 2.60%, p = 0.53). CONCLUSIONS: Comprehensive periodontal treatment and strict plaque control significantly improved periodontal health; however, no reduction of PTLBW rates was observed. Thus, remaining periodontal inflammation posttreatment cannot explain the lack of effect of periodontal treatment on PTLBW. Clinical relevance This study demonstrated that periodontal diseases may be successfully treated during pregnancy. Our results do not support a potential beneficial effect of periodontal treatment on PTLBW.

A randomized, single-blind, parallel-group clinical study to evaluate the effect of soluble beta-1,3/1,6-glucan on experimental gingivitis in man.

BACKGROUND: Gingivitis is an inflammatory disorder of the periodontium induced by dental plaque bacteria. Soluble beta-1,3/1,6-glucan (SBG) is known to enhance infection defense by preventing excessive inflammatory responses caused by bacterial endotoxins. AIM: The aim of the present study was to investigate the effect of SBG on experimental gingivitis in man. MATERIAL AND METHODS: Experimental gingivitis was induced over a period of 24 days in 30 healthy volunteers who were simultaneously treated with SBG. Two groups (n=10/group) rinsed twice daily with an SBG mouthwash that was either swallowed or expectorated. A third group (n=10) received a water rinse as a control. Plaque index (Pl.I), gingival index (GI), and amount of gingival crevicular fluid (GCF) were assessed at baseline and at six times during the study. RESULTS: The results showed that in the SBG groups, GCF decreased significantly during the study. The swallow group experienced a significant increase in GCF during the first week. The control group followed the expected pattern of experimental gingivitis, with a significant increase in the gingival fluid secretion during the test period. There was a significant increase in GI and Pl.I during the study for all groups, with no significant differences between them. No adverse effects of SBG were recorded. CONCLUSIONS: In this 24-day experimental gingivitis study of subjects who used either a SBG or a control mouthrinse: (1) all subjects had increased plaque and gingivitis, (2) GCF increased in control-rinse subjects and GCF decreased in SBG-rinse subjects. The only statistically significant difference between the SBG-rinse and control-rinse subjects was an increase in GCF at day 7 for subjects who rinsed and swallowed SBG.

EMD in periodontal regenerative surgery modulates cytokine profiles: A randomised controlled clinical trial.

The enamel matrix derivative (EMD) contains hundreds of peptides in different levels of proteolytic processing that may provide a range of biological effects of importance in wound healing. The aim of the present study was to compare the effect of EMD and its fractions on the cytokine profiles from human gingival fibroblasts in vitro and in gingival crevicular fluid (GCF) in a randomized controlled split-mouth clinical study (n = 12). Levels of cytokines in cell culture medium and in GCF were measured by Luminex over a 2-week period. In the clinical study, levels of pro-inflammatory cytokines and chemokines were increased, whereas the levels of transforming growth factor-α (TGF-α) and platelet-derived growth factor-BB (PDGF-BB) were reduced. The in vitro study showed that EMD and its high and low molecular weight fractions reduced the secretion of pro-inflammatory cytokines and chemokines compared to untreated cells. EMD had an effect on levels of cytokines related to fibroplasia, angiogenesis, inflammation and chemotaxis both in vitro and in vivo, however, the anti-inflammatory effect induced by EMD observed in the in vitro study could not be confirmed clinically.

Clinical and radiographic effects of enamel matrix derivative in the treatment of intrabony periodontal defects: a 12-month longitudinal placebo-controlled clinical trial in adult periodontitis patients.

BACKGROUND: This randomized, double-masked, placebo-controlled clinical trial evaluated the effect of enamel matrix derivative (EMD) on clinical and radiographic parameters of periodontal intrabony defects. METHODS: A split-mouth design was used in 16 chronic periodontitis patients who had similar defects (> or =6 mm of probing depth). Both groups underwent scaling and root planing and were acid-etched with EDTA. The test sites received the EMD solution and the controls a placebo. Clinical examinations of all 16 patients and radiographs of 14 patients were available at baseline and 6 and 12 months after surgery. Clinical outcomes included probing depth (PD) and clinical attachment level (CAL); radiographic analysis was performed using computerized linear measurements. Intergroup comparisons were performed by paired samples t test, and over time comparisons were made by general linear model (alpha = 0.05). RESULTS: A statistically significant improvement over time for PD and CAL and a decrease of the vertical component of the defect was detected in both groups. Comparisons between groups revealed at baseline a mean+/-SD value of CAL of 12.93+/-2.00 and 13.47+/-2.93 for test and control groups, respectively. These values decreased to 10.92+/-1.92 and 11.31+/-1.86 after 12 months for test and control. No statistically significant differences could be observed between groups. PD displayed similar results from 7.57+/-1.02 and 7.38+/-1.16 for test and control groups at baseline to 3.40+/-1.82 and 2.99+/-1.07 after 12 months. If the data are divided into smokers and non-smokers, no differences are observed. CONCLUSION: Use of EMD did not result in more improvement in clinical and radiographic parameters compared to the placebo.

Microcomputed tomographic and histologic analysis of animal experimental degree II furcation defects treated with porous titanium granules or deproteinized bovine bone.

BACKGROUND: Titanium is an interesting material for osseous reconstruction given its thrombogenic properties. The aim of this study is to compare the potential of porous titanium granules (PTGs) with sham and deproteinized bovine bone mineral (DBBM) in the reconstructive treatment of surgically created buccal, degree II furcation defects in mini-pigs. METHODS: Buccal degree II furcation defects were surgically created in maxillary premolar teeth in adult, female, mini-pigs and filled with PTG or DBBM or were left empty (sham). After 6 weeks of healing, pigs were euthanized. Teeth with defects were excised en bloc and analyzed by microcomputed tomography (microCT) and histology. RESULTS: The histologic analysis showed significantly more vertical bone formation in both PTG and sham groups compared to DBBM-treated defects (P <0.01). The microCT analysis showed significantly more bucco-palatal bone formation in furcations treated with PTG compared to the DBBM and sham (P <0.05). Bucco-palatal cylindrical microCT cores demonstrated a median defect fill of 96.8% for PTG-implanted defects, which was significantly greater than sham (72.2%) and DBBM (62.0%) (P <0.001) treatments. Significantly more regenerated periodontal ligament was seen for sham than DBBM-treated defects (P <0.05). Root resorption lacunae were small and infrequent and did not differ among groups. CONCLUSIONS: The results of this study in mini-pigs suggest that PTG may integrate well in alveolar bone and supports osseous regrowth in degree II furcation defects. Moreover, PTG seems safe to use in close proximity to root surfaces. Clinical studies will be necessary to further explore these experimental animal findings.