Natural history of periodontitis: Disease progression and tooth loss over 40 years.

OBJECTIVES: To assess long-term attachment and periodontitis-related tooth loss (PTL) in untreated periodontal disease over 40 years. MATERIAL AND METHODS: Data originated from the natural history of periodontitis study in Sri Lankan tea labourers first examined in 1970. In 2010, 75 subjects (15.6%) of the original cohort were re-examined. RESULTS: PTL over 40 years varied between 0 and 28 teeth (mean 13.1). Four subjects presented with no PTL, while 12 were edentulous. Logistic regression revealed attachment loss as a statistically significant covariate for PTL (p < .004). Markov chain analysis showed that smoking and calculus were associated with disease initiation and that calculus, plaque, and gingivitis were associated with loss of attachment and progression to advanced disease. Mean attachment loss <1.81 mm at the age of 30 yielded highest sensitivity and specificity (0.71) to allocate subjects into a cohort with a dentition of at least 20 teeth at 60 years of age. CONCLUSIONS: These results highlight the importance of treating early periodontitis along with smoking cessation, in those under 30 years of age. They further show that calculus removal, plaque control, and the control of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss.

Do mucositis lesions around implants differ from gingivitis lesions around teeth?

BACKGROUND: The purpose of this review was to compare peri-implant mucositis and gingivitis with respect to the pathogenesis aspects. SEARCH STRATEGY: An electronic search was performed up to June 2010 based on the PubMed database of the National Library of Medicine and The Cochrane Library of the Cochrane Collaboration (CENTRAL). A hand search considered the bibliography of a recently published review on the same topic (Heitz-Mayfield & Lang 2010). RESULTS: The host response to biofilms does not differ substantially at teeth or implants. The most obvious sign clinically is the development of an inflammatory lesion as a result of the bacterial challenge. Gingivitis at teeth or peri-implant mucositis at implants are precursors for more detrimental lesions, and hence have to be diagnosed properly and prevented by applying anti-infective therapy. Non-surgical interventions are usually sufficient for the treatment of both gingivitis and mucositis. CONCLUSIONS: Gingivitis and peri-implant mucositis are not fundamentally different from pathogenesis and diagnosis points of view.

Factors influencing resonance frequency analysis assessed by Osstell mentor during implant tissue integration: II. Implant surface modifications and implant diameter.

OBJECTIVES: To monitor the development of the stability of Straumann tissue-level implants during the early phases of healing by resonance frequency analysis (RFA) and to determine the influence of implant surface modification and diameter. MATERIAL AND METHODS: A total of twenty-five 10 mm length implants including 12 SLA RN v4.1 mm implants, eight SLActive RN v4.1 mm implants and five SLA WN v4.8 mm implants were placed. Implant stability quotient (ISQ) values were determined with Osstell mentor at baseline, 4 days, 1, 2, 3, 4, 6, 8 and 12 weeks post-surgery. ISQ values were compared between implant types using unpaired t-tests and longitudinally within implant types using paired t-tests. RESULTS: During healing, ISQ decreased by 3-4 values after installation and reached the lowest values at 3 weeks. Following this, the ISQ values increased steadily for all implants and up to 12 weeks. No significant differences were noted over time. The longitudinal changes in the ISQ values showed the same patterns for SLA implants, SLActive implants and WB implants. At placement, the mean ISQ values were 72.6, 75.7 and 74.4, respectively. The mean lowest ISQ values, recorded at 3 weeks, were 69.9, 71.4 and 69.8, respectively. At 12 weeks, the mean ISQ values were 76.5, 78.8 and 77.8, respectively. The mean ISQ values at all observation periods did not differ significantly among the various types. Single ISQ values ranged from 55 to 84 during the entire healing period. Pocket probing depths of the implants ranged from 1 to 3 mm and bleeding on probing from 0 to 2 sites/implant post-surgically. CONCLUSIONS: All ISQ values indicated the stability of Straumann implants over a 12-week healing period. All implants showed a slight decrease after installation, with the lowest ISQ values being reached at 3 weeks. ISQ values were restored 8 weeks post-surgically. It is recommended to monitor implant stability by RFA at 3 and 8 weeks post-surgically. However, neither implant surface modifications (SLActive) nor implant diameter were revealed by RFA.

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals.

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

Role and models for compensation of tobacco use prevention and cessation by oral health professionals.

Appropriate compensation of tobacco use prevention and cessation (TUPAC) would give oral health professionals better incentives to provide TUPAC, which is considered part of their professional and ethical responsibility and improves quality of care. Barriers for compensation are that tobacco addiction is not recognised as a chronic disease but rather as a behavioural disorder or merely as a risk factor for other diseases. TUPAC-related compensation should be available to oral health professionals, be in appropriate relation to other dental therapeutic interventions and should not be funded from existing oral health care budgets alone. We recommend modifying existing treatment and billing codes or creating new codes for TUPAC. Furthermore, we suggest a four-staged model for TUPAC compensation. Stages 1 and 2 are basic care, stage 3 is intermediate care and stage 4 is advanced care. Proceeding from stage 1 to other stages may happen immediately or over many years. Stage 1: Identification and documentation of tobacco use is part of each patient's medical history and included into oral examination with no extra compensation. Stage 2: Brief intervention consists of a motivational interview and providing information about existing support. This stage should be coded/reimbursed as a short preventive intervention similar to other advice for oral care. Stage 3: Intermediate care consists of a motivational interview, assessment of tobacco dependency, informing about possible support and pharmacotherapy, if appropriate. This stage should be coded as preventive intervention similar to an oral hygiene instruction. Stage 4: Advanced care. Treatment codes should be created for advanced interventions by oral health professionals with adequate qualification. Interventions should follow established guidelines and use the most cost-effective approaches.

Nd:YAG (1064 nm) laser for the treatment of chronic periodontitis: a pilot study.

AIM: To evaluate the clinical and microbiological effects of neodymium: yttrium-aluminum-garnet laser therapy as an adjunct to scaling and root planing during the hygienic phase. METHODS: In eight patients, sites with a mean probing pocket depth (PPD) of ≥5 mm were treated by either scaling and root planing (n=28) (control) or by scaling and root planing and adjunctive laser therapy (n=28) (power: 5W). Re-evaluation was at 4-6 weeks. Thereafter, remaining pockets (mean PPD ≥5 mm) were eliminated by either laser surgery (power: 7 W) or gingivectomy (control). RESULTS: At baseline, the mean PPD of sites originally presenting with a mean PPD ≥4 mm were 4.69 and 4.73 mm in the test and control sites, respectively. Six months following surgery, there was a similar average mean PPD reduction in the test (1.18 mm, P<0.01) and control sites (1.35 mm, P<0.01). Also, the reduction in bleeding on probing in both groups was statistically significant (P<0.01, paired t-tests). No statistically-significant differences between the test and control sites were found for any clinical or microbiological parameters at baseline, after initial, and 3 or 6 months' post-surgical therapy. CONCLUSION: During the hygienic phase, neodymium: yttrium-aluminum-garnet (1064 nm) laser treatment yielded no superiority in clinical efficacy compared to conventional debridement. Laser gingivectomy resulted in similar treatment outcomes (mean PPD and bleeding on probing reduction), as did conventional gingivectomy.