Splinted and unsplinted overdenture attachment systems: A systematic review and meta-analysis.

Splinted and unsplinted overdenture attachment systems have unique advantages and disadvantages. The aim of the present systematic review was to determine the influence of splinted and unsplinted overdenture attachment systems on the marginal bone loss, prosthetic complications and implant survival rate. PubMed/MEDLINE, Scopus and Cochrane databases were searched for articles published up to October 2017, using the following search terms: "overdenture AND attachment OR overdenture AND bar OR overdenture splinted." The PICO question "Do splinted overdenture attachment systems promote better clinical results in comparison to unsplinted systems?" was evaluated. Eligible studies included randomized controlled clinical trials, prospective studies with at least 10 participants and a minimum follow-up of 6 months, and studies published in English that compared splinted and unsplinted attachment systems within the same study. The 95% confidence interval (CI) was considered for all outcomes analysed. After completion of the different steps in the article selection process, nine articles were included in the qualitative and quantitative analyses. A total of 984 implants were placed in 380 patients (mean age: 62.8 years). The meta-analysis demonstrated no statistically significant differences between splinted and unsplinted attachment systems with regard to marginal bone loss (P = .39; MD: -0.11; 95% CI: -0.37 to 0.14), complications (P = .31; RR: 1.26; CI: 0.80-1.99) and implant survival rate (P = .14; RR: 0.37% CI: 0.10-1.36). In addition, splinted and unsplinted overdenture attachment systems achieved similar results with regard to marginal bone loss, prosthetic complications and implant survival rate.

Periodontal treatment and HbA1c levels in subjects with diabetes mellitus.

It has earlier been reported that individuals with poorly controlled diabetes have severe periodontal disease (PD) compared to well-controlled diabetes. This longitudinal interventional study compared periodontal treatment outcomes with HbA1c level changes in four groups of diabetic and non-diabetic patients with or without PD, respectively. HbA1c, bleeding on probing (BOP), plaque index and periodontal pocket depth (PPD) 4 < 6 mm and ≥6 mm were recorded at baseline to 3 months after non-surgical treatment and 3-6 months for surgical treatment in subjects with or without T2D, and with or without PD. A total of 129 patients were followed from baseline to 6 months. Diabetics with PD and without PD showed reductions in HbA1c levels with a mean value of 0·3% after 3 months and mean values of 1% and 0·8%, respectively, after 6 months. Diabetics with PD showed higher levels of BOP versus non-diabetics without PD (P < 0·01) and versus diabetics without PD (P < 0·05) at baseline. After 6 months, diabetics with PD showed higher number of PPD 4 < 6 mm versus diabetics without PD (P < 0·01) and non-diabetics with PD (P < 0·01). Diabetics without PD showed higher levels of PPD 4 < 6 mm versus non-diabetics without PD (P < 0·01). Surgical and non-surgical periodontal treatment in all groups improved periodontal inflammatory conditions with a decrease in HbA1c levels in a period of three and 6 months. No change was seen in the number of pockets PPD 4 < 6 mm in diabetic subjects with PD after non-surgical and surgical treatment.

Risk factor assessment tools for the prevention of periodontitis progression a systematic review.

OBJECTIVES: (i) To identify characteristics of currently published patient-based tools used to assess levels of risk for periodontitis progression and (ii) systematically review the evidence documenting the use of patient-based risk assessment tools for predicting periodontitis progression. MATERIAL AND METHODS: A systematic review was prepared on the basis of an electronic search of the literature supplemented with manually searching the relevant journals of the latest 5 years. Prospective and retrospective cohort studies were included as no randomized controlled clinical trials were available. RESULTS: The search identified 336 titles, and 19 articles were included in this systematic review. The search identified five different risk assessment tools. Results of nine of 10 cohort studies reporting outcomes of 2110 patients indicate that risk assessment tools are able to identify subjects with different probability of periodontitis progression and/or tooth loss. Subjects with higher risk scores showed more progression of periodontitis and tooth loss. CONCLUSIONS: In treated populations, results of patient-based risk assessments, for example periodontal risk calculator (PRC) and periodontal risk assessment (PRA), predicted periodontitis progression and tooth loss in various populations. Additional research on the utility of risk assessment and results in improving patient management are needed.

Progression of attachment loss is strongly associated with presence of the JP2 genotype of Aggregatibacter actinomycetemcomitans: a prospective cohort study of a young adolescent population.

AIM: To assess the progression of attachment loss (AL) during a 2-year period according to the presence of JP2 and non-JP2 genotypes of Aggregatibacter actinomycetemcomitans in a Ghanaian adolescent population. METHODS: A total of 500 adolescents (mean age 13.2 years, SD ± 1.5) were enrolled in the study. After 2 years, 397 (79.4%) returned for a periodontal re-examination, including the measurement of AL. The carrier status of the JP2 and non-JP2 genotypes of A. actinomycetemcomitans was evaluated in a baseline examination 2 years earlier. RESULTS: Individuals who carried the JP2 genotype of A. actinomycetemcomitans had a significantly increased risk [relative risk (RR) = 7.3] of developing AL ≥ 3 mm. The mean AL at the follow-up and the mean 2-year progression of AL were significantly higher in the JP2 genotype-positive group (n = 38) compared with the group positive for the non-JP2 genotypes of A. actinomycetemcomitans (n = 169), and the group of A. actinomycetemcomitans-negative individuals (n = 190). The JP2 genotype was strongly associated with the progression of AL ≥ 3 mm (OR = 14.3). The non-JP2 genotypes of A. actinomycetemcomitans were also, however, less pronounced, associated with the progression of AL ≥ 3 mm (OR = 3.4). CONCLUSION: The JP2 genotype of A. actinomycetemcomitans is strongly associated with the progression of AL.

The role of physiological markers of health in the association between demographic factors and periodontal disease.

BACKGROUND AND OBJECTIVE: Age is highly related to oral health status. The higher prevalence of oral disease within subgroups of the population may reflect a tendency towards "early aging" and dysregulation of multiple physiological systems. This study examines whether the association between periodontal disease and demographic factors is mediated by physiological measures of health. MATERIAL AND METHODS: Logistic regression was used to examine whether biomarkers and demographic factors, such as socio-economic status (SES) and race/ethnicity, were associated with periodontal disease, and then whether the strength of these relationships could be attributed to associations between demographic variables and physiological measures of systemic health. RESULTS: Periodontal disease was associated with measures of SES and race/ethnicity. Furthermore, 1-unit increases in cytomegalovirus (CMV), optical density, C-reactive protein (CRP) and glycated hemoglobin (HbA1c) were associated with a 25% [odds ratio (OR) = 1.25; 95% confidence interval (CI): 1.14-1.36], 13% (OR = 1.13; 95% CI = 1.03-1.24) and 19% (OR = 1.19; 95% CI = 1.12-1.27) increased likelihood of periodontal disease, respectively. However, when biomarkers and socio-demographic variables were both included in the model, their associations with periodontal disease were significantly reduced or eliminated. CONCLUSIONS: The risk of periodontal disease is higher among black and/or low-income individuals; however, these associations appear to be partly due to the greater probability of elevated levels of CRP, CMV or HbA1c among these groups.

The natural history of periodontal attachment loss during the third and fourth decades of life.

AIM: To describe changes in the occurrence of periodontal attachment loss (AL) through ages 26, 32 and 38 in a complete birth cohort. MATERIALS AND METHODS: Systematic periodontal examinations conducted at ages 26, 32 and 38 in a longstanding New Zealand cohort study (N = 1037). Periodontitis extent data were used to assign participants to periodontitis trajectories using group-based trajectory analysis. RESULTS: Eight hundred and thirty-one individuals were periodontally examined at all three ages; the prevalence and extent of AL increased as the cohort aged. Between 26 and 32, one in nine participants had 1+ sites showing new or progressing AL; that proportion almost doubled between ages 32 and 38. Four periodontitis trajectory groups were identified, comprising 55.2%, 31.5%, 10.7% and 2.5% of the cohort; these were termed the "Very low", "Low", "Moderately increasing" and "Markedly increasing" trajectory groups respectively. Those who had smoked tobacco at all ages from 15 through 38 were at higher risk of being in the "Moderately increasing" or "Markedly increasing" trajectory groups. There was a similar risk gradient for those who were in the highest 20% of cannabis usage. CONCLUSIONS: Periodontitis commences relatively early in adulthood, and its progression accelerates with age, particularly among smokers.

Changes in molar position associated with missing opposed and/or adjacent tooth: a 12-year study in women.

The aim of this study was to radiographically analyse long-term changes in (i) overeruption of unopposed molars and (ii) tipping of molars with a mesial edentulous space, and whether there is an interaction between the two events. A further aim was to analyse if loss of alveolar bone height might influence overeruption and tipping. The sample consisted of panoramic radiographs taken at an interval of 12 years of 292 subjects from a prospective population study of women. The panoramic radiographs were scanned and analysed. Changes in tipping, overeruption and alveolar bone height of molars and control teeth were measured. The results showed that unopposed molars were more commonly found in the upper jaw and that unopposed molars showed 4·9 times higher risk of overeruption of ≥2 mm (95% CI 1·5-15·3) than opposed molars during the 12-year observation period. The average overeruption for the unopposed molars was 4·5% (s.d. 7·6), which corresponds to approximately 0·9 mm. The degree of overeruption increased with decreased bone support. Molars with a mesial edentulous space were most prevalent in the lower jaw, but neither an edentulous space nor alveolar bone level/bone level change were found to have a significant effect on tipping of the molars. The average mesial tipping was 0·8° (s.d. 5·6). In conclusion, unopposed molars showed a significantly increased risk for overeruption. Molars facing a mesial edentulous space showed a low risk for mesial tipping, but a significant interaction between overeruption and tipping was identified.

Health insurance status is associated with periodontal disease progression among Gullah African-Americans with type 2 diabetes mellitus.

OBJECTIVES: Assess periodontal disease progression among GullahAfrican Americans with type 2 diabetes mellitus (T2DM) according to health insurance coverage. METHODS: From an ongoing clinical trial among T2DM Gullah, we extracted a cohort that was previously enrolled in a cross-sectional study (N=93). Comparing prior exam to trial initiation, total tooth sites/person with periodontal disease progression events [evaluated separately: 2+ mm of clinical attachment loss (CAL), 2+ mm increased periodontal probing depths (PPD), bleeding on probing (BOP) emergence] were evaluated according to health insurance coverage using regression techniques appropriate for data with different counts of potential events per subject (varying tooth sites available). We used negative binomial regression techniques to account for overdispersion and fit multivariable models that also included baseline glycemic control (poor: glycated hemoglobin > OR =7 percent, well: glycated hemoglobin <7 percent), history of established periodontitis, age, gender, body mass index, annual income, and oral hygiene behaviors. Final models included health insurance status, other significant predictors, and any observed confounders. RESULTS: Privately insured were most prevalent (41.94 percent), followed by uninsured (23.66 percent), Medicare (19.35 percent), and Medicaid (15.05 percent). Those with poor glycemic control (65.59 percent) were more prevalent than well-controlled (34.41 percent). CAL events ranged from 0 to 58.8 percent tooth sites/ person (11.83 +/- 12.44 percent), while PPD events ranged from 0 to 44.2 percent (8.66 +/- 10.97 percent) and BOP events ranged from 0 to 95.8 percent (23.65 +/- 17.21 percent). Rates of CAL events were increased among those who were uninsured [rate ratio (RR) = 1.75, P = 0.02], Medicare-insured (RR = 1.90, P = 0.03), and Medicaid-insured (RR = 1.89, P = 0.06). CONCLUSIONS: Increased access to health care, including dental services, may achieve reduction in chronic periodontal disease progression (as determined by CAL) for this study population. These results are very timely given the March 2010 passing of the US healthcare reform bills.

Relationship between the prognosis of periodontitis and occlusal force during the maintenance phase--a cohort study.

BACKGROUND AND OBJECTIVE: Few studies have longitudinally investigated the relationship between periodontal disease progression and occlusal factors in individual subjects during the maintenance phase of periodontal therapy. The aim of this cohort study was to investigate the relationship between biting ability and the progression of periodontal disease in the maintenance phase. MATERIAL AND METHODS: A total of 194 patients were monitored for 3 years during the maintenance phase of periodontal therapy. The subjects with disease progression (Progress group) were defined based on the presence of >or= 2 teeth demonstrating a longitudinal loss of proximal attachment of >or= 3 mm or tooth-loss experience as a result of periodontal disease during the study period. The subjects with high occlusal force were diagnosed as men who showed an occlusal force of more than 500 N and women who showed an occlusal force of more than 370 N. The association between biting ability and the progression of periodontitis was investigated using logistic regression analysis. RESULTS: There were 83 subjects in the Progress group and 111 subjects in the Non-progress group. A backward, stepwise logistic regression model showed that the progression of periodontal disease was significantly associated with the presence of one or more teeth with a high clinical attachment level (CAL) of >or= 7 mm (odds ratio: 2.397; 95% confidence interval: 1.306-4.399) ( p = 0.005) and low occlusal force (odds ratio: 2.352; 95% confidence interval: 1.273-4.346) ( p = 0.006). CONCLUSION: The presence of one or more teeth with a high CAL of >or= 7 mm and low occlusal force might be possible risk factors for periodontal progression in the maintenance phase of periodontal therapy.

Periodontal disease progression and glycaemic control among Gullah African Americans with type-2 diabetes.

AIM: To evaluate associations between glycaemic control and periodontitis progression among Gullah African Americans with type-2 diabetes mellitus (T2DM). MATERIALS AND METHODS: From an ongoing clinical trial among T2DM Gullah, we extracted a cohort previously in a cross-sectional study (N=88). Time from baseline (previous study) to follow-up (trial enrollment, before treatment interventions) ranged 1.93-4.08 years [mean=2.99, standard deviation (SD)=0.36]. We evaluated tooth site-level periodontitis progression [clinical attachment loss (CAL) worsening of > or =2 mm, periodontal probing depth (PPD) increases of > or =2 mm and bleeding on probing (BOP) from none to present] by glycaemic control status (well-controlled=HbA(1c)<7%, poorly-controlled=HbA(1c)> or =7%) using multivariable generalized estimating equations logistic regression, nesting tooth sites/person. RESULTS: Poorly-controlled T2DM (68.18%) was more prevalent than well-controlled T2DM (31.82%). Proportions of tooth sites/person with CAL progression between baseline and follow-up ranged 0.00-0.59 (mean=0.12, SD=0.12), while PPD and BOP progression ranged 0.00-0.44 (mean=0.09, SD=0.11) and 0.00-0.96 (mean=0.24, SD=0.18), respectively. Site-level PPD at baseline was a significant effect modifier of associations between poorly-controlled T2DM and site-level CAL and PPD progression [adjusted odds ratios (OR) according to poorly-controlled T2DM among PPD at baseline=3, 5 and 7 mm, respectively: CAL progression=1.93, 2.64, and 3.62, PPD progression=1.98, 2.76, and 3.84; p<0.05 for all]. Odds of site-level BOP progression were increased (OR=1.24) for poorly-controlled T2DM, yet the results were not significant (p=0.32). CONCLUSIONS: These findings from a distinct, homogenous population further support the clinical relevance of identifying patients with poor glycaemic control and periodontitis, particularly among those with disparities for both diseases.

Risk of aggressive periodontitis in adolescent carriers of the JP2 clone of Aggregatibacter (Actinobacillus) actinomycetemcomitans in Morocco: a prospective longitudinal cohort study.

BACKGROUND: Periodontitis is a loss of supporting connective tissue and alveolar bone around teeth, and if it occurs in an aggressive form it can lead to tooth loss before the age of 20 years. Although the cause of periodontitis in general remains elusive, a particular clone (JP2) of the gram-negative rod Aggregatibacter (Actinobacillus) actinomycetemcomitans is considered a possible aetiological agent of the aggressive form in adolescents living in or originating from north and west Africa, where the disease is highly prevalent. We did a population-based longitudinal study of adolescents to assess the role of the JP2 clone in the initiation of aggressive periodontitis. METHODS: A total of 700 adolescents from public schools in Rabat, Morocco, were enrolled in the study. We used PCR to detect A actinomycetemcomitans in plaque samples (taken from molar and incisor sites) and to differentiate between the JP2 clone and other non-JP2 genotypes of the bacterium. 18 individuals were found to already have periodontitis and were excluded. The 682 periodontally healthy adolescents (mean age 12.5 years; SD 1.0) were classified according to their A actinomycetemcomitans carrier status at baseline. After 2 years, 428 (62.8%) individuals returned for re-examination, which included recording of periodontal attachment loss measured from the cemento-enamel junction to the bottom of the periodontal pockets of all teeth present. FINDINGS: Individuals who carried the JP2 clone of A actinomycetemcomitans alone (relative risk 18.0; 95% CI 7.8-41.2, p<0.0001) or together with non-JP2 clones of A actinomycetemcomitans (12.4; 5.2-29.9, p<0.0001) had a significantly increased risk of periodontal attachment loss. A much less pronounced disease risk was found in those carrying non-JP2 clones only (3.0; 1.3-7.1, p=0.012). INTERPRETATION: The JP2 clone of A actinomycetemcomitans is likely to be an important aetiological agent in initiation of periodontal attachment loss in children and adolescents. Co-occurrence of non-JP2 clones of A actinomycetemcomitans reduces the risk of development of periodontitis, suggesting competition for the ecological niche between the JP2 and non-JP2 clones of this species.

Periodontal disease progression in subjects with orofacial clefts over a 25-year follow-up period.

AIMS: To assess rates of periodontal disease progression in subjects with cleft lip, alveolus and palate (CLAP) over a 25-year period without regular maintenance care in a specialist setting and to compare those with those of subjects without alveolar clefts, i.e. cleft lip (CL) or cleft palate (CP). MATERIAL AND METHODS: Ten subjects with CLAP and 10 subjects with CL/CP were examined in 1979, 1987, 1993 and 2004. Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP) and plaque control record (PCR) scores were recorded in all 20 subjects. RESULTS: High plaque and BoP scores were recorded at all examinations in both groups. Over 25 years, a statistically significant loss of mean full-mouth CAL of 1.52 +/- 0.12 mm (SD) and 1.66 +/- 0.15 mm occurred in the CLAP and CL/CP group respectively (p<0.05). A statistically significant increase (p<0.05) in mean full-mouth PPD of 0.35 +/- 0.12 mm was observed in the CL/CP group, whereas only a trend for a mean full-mouth increase in PPD of 0.09 +/- 0.11 mm was observed in the CLAP group. In subjects with CLAP, a statistically significant increase (p<0.05) in PPD of 0.92 +/- 1.13 mm at cleft sites was observed compared with that of 0.17 +/- 0.76 mm at control sites. With respect to CAL, the loss at the corresponding sites amounted to 2.71 +/- 1.46 and to 2.27 +/- 1.62 mm, respectively (p=0.36). CONCLUSIONS: When stringent and well-defined supportive periodontal therapy was not provided, subjects with orofacial clefts were at high risk for periodontal disease progression. Over 25 years, alveolar cleft sites tended to have more periodontal tissue destruction compared with control sites.

Effects of ovariectomy and aging on tooth attachment in female mice assessed by morphometric analysis.

OBJECTIVE: Non-human primates, dogs, rats, hamsters and ferrets, have frequently been used as laboratory animals in periodontal biology and pathology. In the past, mice have been used less for this purpose, but nowadays attract a lot of interest because gene knockout and transgenic technologies utilize mice primarily. In this study, we investigate the effects of ovariectomy and aging on tooth attachment in female mice. MATERIAL AND METHODS: Eight-week-old mice (n=15) were divided into three experimental groups (control, n=5; sham-operated, n=5; ovariectomy, n=5) and ovaries removed bilaterally. Attachment level, assessed by measuring alveolar bone height and apical termination of the junctional epithelium, was determined 6 weeks post-ovariectomy by digital morphometric analysis in sagittal sections of the mandible. The plasma level of the inflammation marker serum amyloid A (SAA) was determined by ELISA. In another series of experiments, tooth attachment was determined in female mice (n=7) at 8-26 weeks of age. RESULTS: Withdrawal of female sex hormone production by ovariectomy had no effect on alveolar bone height and apical termination of the junctional epithelium. The SAA level in plasma was unaffected by removal of the ovaries, suggesting that systemic inflammation is not induced by ovariectomy. Bone height was similar in mice sacrificed at 8-26 weeks of age and apical termination of the junctional epithelium was at the cemento-enamel junction at all ages. CONCLUSIONS: Removal of ovarian production of female sex hormones by ovariectomy has no influence on tooth attachment, and further tooth attachment is preserved with age in female mice.

No alteration in bone mineral density in patients with periodontitis.

Alveolar bone destruction can be magnified in the presence of generalized skeletal disorders. We questioned whether severe generalized periodontitis patients display signs of bone metabolism disturbances. Our objective was to assess skeletal bone mineral density (BMD) and biochemical bone parameters in premenopausal women with periodontitis. Forty-five patients and 40 control individuals were included in the study. We measured BMD by dual-energy x-ray absorptiometry. The results showed no difference in BMD values between the periodontitis and control groups (p > 0.05). A positive relationship between the clinical attachment level and Body Mass Index (BMI) scores was observed (p = 0.03). Increased serum creatinine levels were noted in the periodontitis group (p = 0.04). Analysis of the data suggests that there is no evidence for an association between skeletal BMD and severe periodontitis in premenopausal women. There may be a link between elevated creatinine levels and periodontitis. The persons with high BMI scores seemed to be at risk for periodontitis.

Correlation between periodontal status and biting force in patients with chronic periodontitis during the maintenance phase of therapy.

AIM: The association between periodontal status and biting force is unclear. The aim of this study was to investigate the relation between periodontal status and biting force in patients with chronic periodontitis during the maintenance phase of periodontal treatment. MATERIAL AND METHODS: A total of 198 patients, who had entered a periodontal maintenance programme, were examined for the presence of restorations on the occlusal surface, probing pocket depth, clinical attachment loss (CAL), bleeding on probing, and mobility of teeth. Quantitative analysis of total biting force, occlusal contact area and biting pressure (defined by biting force per 1 mm(2) of occlusal contact area) was performed using microcapsular pressure-sensitive sheets. RESULTS: A multiple stepwise regression analysis showed that total biting force and occlusal contact area were positively associated with the number of present teeth and negatively associated with female gender, mean CAL and mean probing pocket depth. Biting pressure was positively associated with CAL. CONCLUSIONS: Reduced periodontal support was found to be associated with decreased total biting force and with increased biting pressure (defined as force per 1 mm(2) of occlusal contact area).

Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance.

BACKGROUND: Limited evidence exists on the significance of residual probing pocket depth (PPD) as a predictive parameter for periodontal disease progression and tooth loss. AIM: The aim of this study was to investigate the influence of residual PPD >or=5 mm and bleeding on probing (BOP) after active periodontal therapy (APT) on the progression of periodontitis and tooth loss. MATERIAL AND METHODS: In this retrospective cohort, 172 patients were examined after APT and supportive periodontal therapy (SPT) for 3-27 years (mean 11.3 years). Analyses were conducted using information at site, tooth and patient levels. The association of risk factors with tooth loss and progression of periodontitis was investigated using multilevel logistic regression analysis. RESULTS: The number of residual PPD increased during SPT. Compared with PPDor=7 mm 37.9 and 64.2, respectively. At patient level, heavy smoking, initial diagnosis, duration of SPT and PPD>or=6 mm were risk factors for disease progression, while PPD>or=6 mm and BOP>or=30% represented a risk for tooth loss. CONCLUSION: Residual PPD>or=6 mm represent an incomplete periodontal treatment outcome and require further therapy.

Intrusion of teeth with class III furcation: a clinical, histologic and histometric study in dogs.

AIM: To assess orthodontic intrusion effects on periodontal tissues in dogs' pre-molars with class III furcations treated with open flap debridement (OFD) or with guided tissue regeneration (GTR) associated to bone autograft (BA). MATERIAL AND METHODS: Class III furcations were created in the pre-molars of seven mongrel dogs. After 75 days, teeth were randomly treated with OFD or GTR/BA. After 1 month, metallic crowns were assembled on pre-molars and connected apically to mini-implants by nickel-titanium springs. Teeth were randomly assigned to orthodontic intrusion (OFD+I and GTR/BA+I) groups or no movement (OFD and GTR/BA) groups. Dogs were sacrificed after 3 months of movement and 1 month retention. RESULTS: All class III furcations were closed or reduced to class II or I in the intrusion groups, while 50% of the lesions in non-moved teeth remained unchanged. Intruded teeth presented higher probing depth and lower gingival marginal level than non-moved teeth (p<0.01). Clinical attachment gain was reduced in the intrusion groups by the end of retention (p<0.05). OFD+I presented smaller soft tissue area and larger bone tissue area than other groups (p<0.05). CONCLUSION: Orthodontic intrusion with anchorage via mini-implants improved the healing of class III furcation defects after OFD in dogs. GTR/BA impaired those results.

The effects of a calorie-reduced diet on periodontal inflammation and disease in a non-human primate model.

BACKGROUND: Low-calorie diets are commonplace for reducing body weight. However, no information is available on the effects of a reduced-calorie diet on periodontal inflammation and disease. The purpose of this study was to evaluate the clinical effects of a long-term calorie-restriction (CR) diet on periodontitis in an animal model of periodontitis. METHODS: Periodontitis was induced in 55 young, healthy, adult rhesus monkeys (Macaca mulatta) by tying 2.0 silk ligatures at the gingival margins of maxillary premolar/molar teeth. Animals on a CR diet (30% CR; N = 23) were compared to ad libitum diet controls (N = 32). Clinical measures, including the plaque index (PI), probing depth (PD), clinical attachment level (CAL), modified gingival index (GI), and bleeding on probing (BOP) were recorded at baseline and 1, 2, and 3 months after ligature placement. RESULTS: Significant effects of CR were observed on the development of inflammation and the progression of periodontal destruction in this model. Compared to controls, CR resulted in a significant reduction in ligature-induced GI (P <0.0001), BOP (P <0.0015), PD (P <0.0016), and CAL (P <0.0038). Periodontal destruction, as measured by CAL, progressed significantly more slowly in the CR animals than in the controls (P <0.001). CONCLUSIONS: These clinical findings are consistent with available evidence that CR has anti-inflammatory effects. Moreover, these experimental findings are the first observations, to the best of our knowledge, that CR dampens the inflammatory response and reduces active periodontal breakdown associated with an acute microbial challenge.

Anti-TNF-alpha immunotherapy is associated with increased gingival inflammation without clinical attachment loss in subjects with rheumatoid arthritis.

BACKGROUND: Because periodontitis presents many similarities with rheumatoid arthritis (RA) with regard to tumor necrosis factor-alpha (TNF-alpha)-induced bone resorption, the benefits of TNF-alpha blockade in RA prompted us to determine its efficacy in treating coexisting periodontitis. METHODS: Periodontal status was evaluated in 40 subjects with RA who were divided into two groups: Group I contained 20 subjects who had received infliximab every 6 weeks for > or =22 months at the time of periodontal evaluation. The 20 subjects in group II were evaluated before their first infusion with infliximab. Nine subjects in group II had periodontitis. These subjects were reevaluated after they received nine infusions of infliximab. RESULTS: Infliximab tended to aggravate gingival inflammation as indicated by differences in the modified gingival and papillary bleeding indices between subjects in groups I and II with coexisting periodontitis before and after treatment. Methotrexate had no effect on periodontal status. Although the plaque index revealed that bacterial infection persisted, the probing depth was equal in groups I and II and equivalent before and after treatment in subjects with periodontitis, whereas attachment loss was decreased after infliximab treatment. CONCLUSIONS: Inflammation and destruction constitute two interrelated yet separate components of periodontitis in patients with RA. Therefore, TNF-alpha blockade could be beneficial in the treatment of periodontitis.

Association between involuntary smoking and salivary markers related to periodontitis: a 2-year longitudinal study.

BACKGROUND: Insufficient data exist regarding the longitudinal influence of involuntary smoking on periodontitis progression. This study examined the relationship between involuntary smoking and periodontitis progression and the effects of involuntary smoking on salivary inflammatory and microbiologic markers related to periodontitis. METHODS: Participants were recruited during annual health checkups in 2003 and 2005. In 2005, 200 of 273 (73%) Japanese employees examined at baseline underwent periodontal measurements, including clinical attachment level (CAL) and probing depth (PD). Periodontitis progression was identified when a subject displayed one or more teeth with an increase > or = 2.0 mm in CAL and PD during the 2 years. Salivary marker levels, including cotinine, were determined by enzyme assay, including enzyme-linked immunosorbent assay. The proportions of six periodontal pathogens in saliva were assessed using real-time polymerase chain reaction methodology. Based on receiver-operating characteristic analysis, non-, involuntary, and active smokers were defined as subjects exhibiting salivary cotinine levels of 0, 1 to 7, and > or = 8 ng/ml, respectively. RESULTS: By simple logistic regression analysis, age, alcohol consumption, smoking, breakfast habits, and working hours were related to the risk for significant periodontitis progression. Multiple logistic regression analysis revealed significantly higher periodontitis odds ratios (OR) in involuntary (OR = 2.23; 95% confidence interval [CI]: 1.03 to 4.83) and active (OR = 2.27; 95% CI: 1.02 to 5.04) smokers relative to non-smokers following adjustment for covariates. Levels of salivary markers, including albumin, aspartate aminotransferase, and lactoferrin, were significantly elevated in involuntary smokers relative to non-smokers. In contrast, the percentages of periodontal pathogens did not differ between the smoking groups, with the exception of Prevotella nigrescens, which displayed significantly lower levels in involuntary smokers compared to non-smokers. CONCLUSION: Involuntary smoking increased the inflammatory response and was associated with a greater risk for periodontitis progression.