Clinical management of endo-perio lesion through guided tissue regeneration: a 5 year follow-Up / Manejo clínico de una lesión endo-perio a través de la regeneración tisular guiada: control post-operatorio de 5 años

ABSTRACT: Progressive periodontal disease causes loss of supporting structures of teeth resulting in deep bony defects. In this case a report of 22-year old female patient is being presented with clinical findings of vertical bone loss in two adjacent teeth, on distal surface of 2nd upper right premolar and mesial surface of upper right 1st molar. Root canal treatment, non-surgical periodontal therapy followed by guided tissue regeneration was carried out using decalcified freeze-dried bone allograft (DFDBA) and collagen membrane. Analysis of clinical and radiographic findings showed marked reduction in pocket depth up to 12mm with hard tissue repair on 3-month, 2-year and 5- year follow ups.

RESUMEN: La enfermedad periodontal progresiva provoca la pérdida de las estructuras de soporte de los dientes, lo que resulta en defectos óseos profundos. En este caso clínico se presenta un informe de una paciente de 22 años con pérdida ósea vertical en la superficie distal del segundo premolar superior derecho y en la superficie mesial del primer molar superior derecho. El tratamiento del conducto radicular, la terapia periodontal no quirúrgica seguida de la regeneración tisular guiada se llevó a cabo utilizando aloinjerto óseo liofilizado descalcificado (DFDBA) y membrana de colágeno. El análisis de los hallazgos clínicos y radiográficos mostró una marcada reducción en la profundidad de la bolsa de hasta 12 mm con reparación de tejido duro en seguimientos de 3 meses, 2 años y 5 años.

The use of crevicular fluid to assess markers of inflammation and angiogenesis, IL-17 and VEGF, in patients with solid tumors receiving zoledronic acid and/or bevacizumab.

PURPOSE: Crevicular fluid was used to assess interleukin-17 (IL-17) and vascular endothelial growth factor (VEGF) in cancer patients receiving zoledronic acid and/or bevacizumab. The markers were also assessed in the serum. METHODS: Twenty-five patients were included and comprised three groups: patients who received zoledronic acid (n = 9), patients who received bevacizumab (n = 9), and patients who received zoledronic acid combined with bevacizumab (n = 5). One patient received zoledronic acid and everolimus and another received zoledronic acid, bevacizumab, and temsirolimus. IL-17 and VEGF were measured by standard quantitative ELISA kits and assessed in two study points. RESULTS: Twenty-four patients maintained good periodontal health; one had asymptomatic osteonecrosis of the jaw. First assessment: 44 samples were collected; 21 from serum and 23 from crevicular fluid. Second assessment, 6 months later: 11 samples were collected; 6 from serum and 5 from crevicular fluid. IL-17 was detected in all samples, in serum and crevicular fluid, and remained unchanged at both time points. Serum VEGF in patients with bevacizumab alone or combined with zoledronic acid was significantly lower compared with that of patients who received zoledronic acid alone. VEGF was not detected in the crevicular fluid. CONCLUSIONS: Crevicular fluid might be an easy, non-invasive means to assess IL-17. The stable values of IL-17 in crevicular fluid and serum and the lack of VEGF in the crevicular fluid could be related to the good periodontal health of our patients. Further studies are needed to assess IL-17 and VEGF in the crevicular fluid in patients with and without periodontal disease.

Treatment of pathologic peri-implant pockets.

Peri-implant and periodontal pockets share a number of anatomical features but also have distinct differences. These differences make peri-implant pockets more susceptible to trauma and infection than periodontal pockets. Inadequate maintenance can lead to infections (defined as peri-implant mucositis and peri-implantitis) within peri-implant pockets. These infections are recognized as inflammatory diseases, which ultimately lead to the loss of supporting bone. Diagnostic and treatment methods conventionally used in periodontics have been adopted to assess and treat these diseases. Controlling infection includes elimination of the biofilm from the implant surface and efficient mechanical debridement. However, the prosthetic supra-structure and implant surface characteristics can complicate treatment. Evidence shows that when appropriately managed, peri-implant mucositis is reversible. Nonsurgical therapy, with or without the use of antimicrobials, will occasionally resolve peri-implantitis, but for the majority of advanced lesions this approach is insufficient and surgery is indicated. The major objective of the surgical approach is to provide access and visualize the clinical situation. Hence, a more informed decision can be made regarding whether to use a resective or a regenerative surgical technique. Evidence shows that following successful decontamination, surgical treatment to regenerate the bone can be performed, and a number of regenerative techniques have been proposed. After treatment, regular maintenance and good oral hygiene are essential for a predictable outcome and long-term stability.

Effects of 810-nanometer diode laser as an adjunct to mechanical periodontal treatment on clinical periodontal parameters and gingival crevicular fluid volume of residual periodontal pockets.

BACKGROUND: Aim of this randomized controlled parallel-designed study was to evaluate the effects of diode laser as an adjunct to mechanical periodontal treatment on clinical parameters and gingival crevicular fluid (GCF) volume of the residual pockets diagnosed following initial periodontal treatment in chronic periodontitis (CP) patients. MATERIALS AND METHODS: A total of 84 residual pockets on single-rooted teeth in 11 CP patients were included and randomly assigned into three groups. Residual pockets were treated either only by mechanical treatment (Group M) (n = 28) or only by diode laser disinfection (Group L) (n = 28) or by a combination of these techniques (Group M + L) (n = 28). Plaque index, gingival index (GI), bleeding on probing (BoP), probing depth (PD), clinical attachment level and gingival recession were assessed at baseline and 8 weeks after treatment of residual pockets. GCF samples were collected at baseline, 1 and 8 weeks after treatment. RESULTS: All treatment modalities resulted in significant reductions in PD and attachment gain. GI and BoP showed a greater reduction in both Group M and Group M + L than Group L (P < 0.001), but there was no difference between the Groups M and M + L (P > 0.05). No difference was also found among groups for other clinical parameters. GCF volume decreased significantly in the Groups M and M + L (P < 0.05) but there was no difference among the groups (P > 0.05). CONCLUSION: Results demonstrated clinical improvements on residual pockets in CP patients treated with all three modalities. Moreover, our findings suggest that application of diode laser as an adjunct to mechanical periodontal treatment doesn't demonstrate any additional clinical effect on the residual pockets.

Terapia fotodinámica como adyuvante en el tratamiento periodontal no quirúrgico: evaluación clínica / Photodynamic therapy as an adjuvant in nonsurgical periodontal treatment:A clinical evaluation

La terapia fotodinámica es considerada como un procedimiento no invasivo dentro de la práctica periodontal, reduciendo la morbilidad e incrementando la comodidad del paciente. Objetivo: el objetivo del presente estudio fue evaluar la eficacia clínica del uso de terapia fotodinámica como adyuvante al raspado y alisado radicular en periodontitis crónica. Material y métodos: se realizó un estudio comparativo, correlacional, aplicado a 20 pacientes con periodontitis crónica moderada-avanzada (pérdida de inserción clínica >- 6 mm) durante el raspado y alisado radicular no quirúrgico, con la adición de azul de metileno, donde se administró la terapia fotodinámica en dos sesiones, evaluando los parámetros clínicos (profundidad de bolsa, nivel de inserción clínico, índice de placa, sangrado al sondeo y recesión gingival). Resultados: tras cuatro semanas de evaluación postratamiento, no se observaron diferencias significativas en los parámetros clínicos entre el grupo experimental y control, aunque se encontró un mayor aumento de recesión gingival con el uso de la terapia fotodinámica (p=0,353). Conclusión: el uso de la terapia fotodinámica como adyuvante durante el raspado y alisado radicular convencional no proporciona beneficios adicionales al tratamiento periodontal convencional.

Photodynamic therapy is considered a non-invasiveprocedure in periodontal practice, one which reduces morbidity andincreases patient comfort. Objective: The aim of this study was toevaluate the clinical effi cacy of photodynamic therapy as an adjuvantto scaling and root planing in chronic periodontitis. Material andmethods: A comparative and correlational study was carried out on 20patients with moderate to advanced chronic periodontitis (attachmentloss ≥ 6 mm) during nonsurgical scaling and root planing, including theaddition of methylene blue. The photodynamic therapy was applied intwo sessions, during which the clinical parameters (pocket depth, clinicalattachment level, plaque index, bleeding on probing, and gingivalrecession) were assessed. Results: After four weeks of post-treatmentassessment, no signifi cant diff erences were found between the clinicalparameters of the experimental and control groups, although a greaterincrease in gingival recession was found when photodynamic therapywas used (p = 0.353). Conclusion: The use of photodynamic therapyas an adjuvant in conventional scaling and root planing provides noadditional benefi ts to conventional periodontal treatmen.

Tratamiento de defectos periodontales con matriz derivada del esmalte: serie de casos / Treatment of periodontal defects with enamel matrix derivative: case series

Objetivo: Presentar los resultados clínicos y radiográficos obtenidos a 6 meses del tratamiento de defectos intraóseos con la técnica quirúrgica mínimamente invasiva y el uso de matriz derivada del esmalte sola o en combinación con hueso bovino desmineralizado. Casos clínicos: se seleccionaron 13 sitios con profundidad de sondaje mayor a 5 mm y pérdida ósea vertical. Se evaluaron los siguientes párámetros clínicos: profundidad de sondaje, nivel de inserción clinica y recesión gingival. Los defectos se trataron con matriz derivada del esmalte sola o en combinación con hueso bovino desmineralizado. La profundidad de sondaje inicial promedio era de 6,31 (rango: 5-9) y a los 6 meses, de 3,15 (rango 1-4), lo que significa que la reducción en el promedio de la profundidad de sondaje fue de 3,16. La ganancia en el nivel de inserción clínica fue de 2,9 mm. La evaluación radiográfica evidenció llenado óseo en los sitios tratados. Conclusiones: en la serie de casos presentados, los resultados fueron exitosos y coinciden con los informados en la literatura. La estabilidad del colgajo y el cierre primario son requisitos fundamentales para el éxito y la predictibilidad de cualquier procedimiento regenerativo. Las técnicas quirúrgicas mínimamente invasivas -en comparación con el abordaje tradicional- mejoran notablemente estos parámetros, al reducir los tiempos quirúrgicos y la morbilidad, disminuyendo el malestar del paciente.

Hallazgos citológicos de la enfermedad gingivo-periodontal pre y post-tratamiento en pacientes atendidos en la Cátedra de Periodoncia de la FOUNNE / Pre- and post-treatment findings of gingivo-periodontal disease in patients who attended the Department of Periodontics, FOUNNE

Describir y comparar las alteraciones citológicas encontradas en la pared blanda de la bolsa periodontal y margen gingival vestibular de pacientescon enfermedad gíngivo-periodontal en el pre y post tratamiento. Material y métodos: Se estudiaron 38 pacientesmayores de 24 años y menores de 61 años, de ambos sexos, quienes acudieron a la Cátedra de Periodoncia de la Facultad de Odontología de la UNNE. Las muestras citológicas fueron tomadas con cureta de Gracey, se fijaron en alcohol de 96 grados y se colorearon con la técnica de Papanicolaou. En la evaluación citológica se consideró: tipos celulares, grado de queratinización y otros elementos acompañantes del fondo. Resultados: Se observó un mayor porcentaje deperiodontitis moderada (63 por ciento), predominando en el sexo masculino (56 por ciento) y el promedio de edad fuede 49 y 61 años (53 por ciento). Los extendidos pre- tratamiento presentaron mayor celularidad con células superficiales de núcleos picnóticos, células reactivas y abundantes células inflamatorias. En los posttratamiento predominó la mayor queratinización con escamas epiteliales y células con características reparativas (metaplásicas) y menor porcentaje decélulas inflamatorias y hematíes. Conclusiones: la citología exfoliativa gingival constituye un método diagnóstico complementario sencillo en la evaluación y seguimiento del tratamiento y evolución de pacientes con periodontitis...

Generalized aggressive periodontitis: microbiological composition and clinical parameters in non-surgical therapy / Periodontitis agresiva generalizada: composición microbiológica y parámetros clínicos en la terapia no quirúrgica

The aim of this study was to determine the variations in periodontal parameters and microbiological composition in periodontal pockets at the baseline and 3 and 6 months posttreatment in patients with Generalized Aggressive Periodontitis (GAP) undergoing nonsurgical periodontal treatment combined with chlorhexidine and systemic antibiotics. Medical and dental history was taken from 10 subjects, average age 30.62.7 years, diagnosed with GAP. A nonsurgical periodontal treatment combined with 0.12% chlorhexidine, 875 mg amoxicillin and 500 mg metronidazole every 12 hours for ten days was conducted. At each visit, the following measurements were recorded: bacterial plaque (BP), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), hypermobility, and furcation lesions, and a sample of subgingival plaque was taken from the site of the deepest probing depth of each sextant to identify Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia and Aggregatibacter actinomycetemcomitans using molecular biology techniques. After 6 months, the Wilcoxon test showed an increase of 0.97 mm in CAL (p=0.0047) and 2.54 mm in PD (p=0.009). A healthy site was defined as having a PD <5 mm, negative BOP and no pathogenic bacteria detected at 6 months, indicating significant improvement (p=0.008), with OR (95% CI) =4.7 (1.102220.11). With the treatment protocol used in this study, 6 months after treatment, patients had an approximately 4fold higher possibility of presenting PD <5 mm and periodontal pockets without periodontal pathogenic bacteria.

En este trabajo, nos propusimos determinar las variaciones de los parámetros periodontales y la composición microbiológica de las bolsas periodontales al inicio, a los 3 y 6 meses después del tratamiento en pacientes con periodontitis agresiva generalizada (GAP), sometidos a tratamiento periodontal no quirúrgico combinado con clorhexidina y antibióticos sistémicos. Se elaboró historia médica y dental en 10 sujetos, con una edad media de 30,6 2,7 años, con diagnóstico de GAP. Se les practicó tratamiento periodontal no quirúrgico combinado con clorhexidina al 0,12%, 875 mg de amoxicilina y 500 mg de metronidazol. Los antibióticos se prescribieron cada 12 horas durante diez días. Se registraron: la placa bacteriana (BP), sangrado al sondaje (BOP), la profundidad de sondaje (PD), el nivel de inserción clínica (NIC), hipermovilidad y lesiones de furcación. En cada visita, se tomaron las mediciones, y se tomó una muestra de la placa subgingival en sitio de la mayor profundidad al sondaje en cada sextante para identificar mediante técnica de biología molecular: Porphyromonas gingivalis, Treponema denticola, forsythia Tannerella, Prevotella intermedia, y Aggregatibacter actinomycetemcomitans. Después de 6 meses, el análisis de la prueba de Wilcoxon mostró un aumento de 0,97 mm de CAL (p = 0,0047) y 2,54 mm en la PB (p = 0,009). Se definió sitio sano, cuando se determinó un PD <5 mm, BOP negativo, y no se detectaron bacterias patógenas a los 6 meses, lo que indicó una mejora significativa (p = 0,008), con (IC 95%) = 4,7 (1,1022 a 20,11). Con el protocolo de tratamiento presentado, es posible especular que a los 6 meses después del tratamiento, un paciente puede tener aproximadamente 4 veces más posibilidades de presentar una PD<5 mm y bolsillos periodontales sin bacterias patógenas.

Subgingival microbiome in patients with healthy and ailing dental implants.

Dental implants are commonly used to replace missing teeth. However, the dysbiotic polymicrobial communities of peri-implant sites are responsible for peri-implant diseases, such as peri-implant mucositis and peri-implantitis. In this study, we analyzed the microbial characteristics of oral plaque from peri-implant pockets or sulci of healthy implants (n = 10), peri-implant mucositis (n = 8) and peri-implantitis (n = 6) sites using pyrosequencing of the 16S rRNA gene. An increase in microbial diversity was observed in subgingival sites of ailing implants, compared with healthy implants. Microbial co-occurrence analysis revealed that periodontal pathogens, such as Porphyromonas gingivalis, Tannerella forsythia, and Prevotella intermedia, were clustered into modules in the peri-implant mucositis network. Putative pathogens associated with peri-implantitis were present at a moderate relative abundance in peri-implant mucositis, suggesting that peri-implant mucositis an important early transitional phase during the development of peri-implantitis. Furthermore, the relative abundance of Eubacterium was increased at peri-implantitis locations, and co-occurrence analysis revealed that Eubacterium minutum was correlated with Prevotella intermedia in peri-implantitis sites, which suggests the association of Eubacterium with peri-implantitis. This study indicates that periodontal pathogens may play important roles in the shifting of healthy implant status to peri-implant disease.

Laser supported reduction of specific microorganisms in the periodontal pocket with the aid of an Er,Cr:YSGG laser: a pilot study.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a radial firing tip of an Er,Cr:YSGG laser as an adjunct to a nonsurgical periodontal treatment. METHODS: Twelve patients with chronic or aggressive periodontitis were treated by conventional periodontal treatment using ultrasonic devices and hand instruments and, additionally, in two quadrants with an Er,Cr:YSGG laser. A new radial firing tip (RFPT 14-5, Biolase) was used with 1.5 W, 30 Hz, 11% air, 20% water, and pulse duration 140 µs. Microbiological smears were taken before treatment, one day after lasing, and three and six months after lasing. Pocket depths of all periodontal sites were measured before and six months after treatment. RESULTS: The total bacterial load of Prevotella intermedia, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans inside the pocket was reduced significantly throughout the whole examination time. Greater pocket depth reductions were observed in all groups. There was a slight higher reduction of pocket depth in the lased group after six months. CONCLUSIONS: These results support the thesis that Er,Cr:YSGG laser supported periodontal treatment leads to a significant reduction of periopathogenes and thereby helps the maintenance of periodontal health.

Validity of screening methods for periodontitis using salivary hemoglobin level and self-report questionnaires in people with disabilities.

BACKGROUND: The aim of this study is to evaluate the validity of screening methods in predicting periodontitis in people with disabilities using the objective salivary hemoglobin level, a subjective self-report questionnaire, and a combined model of the two methods with demographic characteristics. METHODS: The participants were 195 patients with disabilities aged >18 years who were examined using the community periodontal index (CPI), salivary hemoglobin level, and answers to 10 self-report questions (n = 192). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to evaluate the validity of the methods and the combined model in predicting the prevalence of ≥CPI 3 (probing depth [PD] ≥4 mm) or CPI 4 (PD ≥6 mm). RESULTS: Overall, 75.9% of the study group (148 of 195) were diagnosed with ≥CPI 3, and 38.5% of the study group (75 of 195) were diagnosed with CPI 4. The areas under the ROC curve (AUCs) of the salivary hemoglobin level were 0.578 (sensitivity of 41% and specificity of 77%) and 0.662 (sensitivity of 53% and specificity of 75%) for predicting the prevalence of ≥CPI 3 and CPI 4, respectively. Multivariable modeling incorporating four different questions for predicting ≥CPI 3 or CPI 4 indicated higher AUCs of 0.710 and 0.732, respectively, yielding higher sensitivity (55% for ≥CPI 3 and 69% for CPI 4) than that of salivary hemoglobin level. The most useful prediction models for ≥CPI 3 or CPI 4 were combined models, which yielded AUCs of 0.773 and 0.807, respectively, with sensitivity values of 70% and specificity values >75%. CONCLUSION: The salivary hemoglobin level, self-report questionnaire, and the combined method demonstrated screening potential that could predict the population prevalence of ≥CPI 3 or CPI 4.

Six-month outcomes in dental patients identified with hyperglycaemia: a randomized clinical trial.

AIM: To assess an approach to improving behavioural and glycaemic outcomes in dental patients who present with diabetes risk factors and previously unrecognized hyperglycaemia. METHODS: We randomized 101 individuals identified with potential diabetes or pre-diabetes into two interventions. In the basic/control intervention, participants were informed about their diabetes risk factors and blood test result, and advised to see a physician. In the enhanced/test intervention, patients received a detailed explanation of findings and their implications, a written report for the physician, and were contacted at 2 and 4 months to inquire whether medical follow-up had occurred. At a 6-month re-evaluation, outcome measures included visit to physician, positive lifestyle changes and reduction in HbA1c. RESULTS: Seventy-three subjects returned for the 6-month visit. The two intervention groups did not significantly differ in any of the outcome variables. Eighty-four percent of subjects reported having visited a physician post-randomization, and 49% reported at least one positive lifestyle change as a result of our intervention. In subjects identified with potential diabetes (baseline HbA1c ≥ 6.5%), HbA1c was reduced 1.46 ± 0.28% compared to baseline (p < 0.01). CONCLUSION: Diabetes risk assessment and education by dental professionals of affected individuals unaware of their status may contribute to improved patient outcomes.

Performance of self-reported measures for periodontitis in rheumatoid arthritis and osteoarthritis.

BACKGROUND: This study evaluates the performance of self-report against the reference standard of clinically defined periodontitis in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) after accounting for factors associated with periodontitis. METHODS: Six self-report periodontitis questions were evaluated in patients with RA and OA. Questions were validated against a reference standard of severe and moderate-to-severe periodontitis based on full-mouth examination. Multivariable logistic regression was used to evaluate the performance of: 1) self-report alone; 2) age, sex, education, and smoking status; and 3) a combination of the above. Model performance was assessed using the c-statistic. Convergent validity of self-reported "bone loss/deep pockets" and "loose teeth" was assessed; associations of self-report with RA disease characteristics were explored. RESULTS: Self-report performed similarly in RA and OA, with individual question specificity for periodontitis ≥ 68% and sensitivity from 9.8% to 45%. Question-only models yielded c-statistics of 0.66 to 0.72, whereas risk factor-only models yielded c-statistics of 0.74 to 0.79. The highest-performing models incorporated both self-report questions and periodontitis risk factors, with c-statistics ≥ 0.79. Greater radiographic alveolar bone loss was observed among participants reporting "bone loss/deep pockets" (P < 0.001) and "loose teeth" (P < 0.001). Among patients with RA, "loose teeth," but not other self-report items, was associated with rheumatoid factor positivity (P = 0.047) and higher disease activity (P < 0.001). CONCLUSIONS: Patient self-report, when combined with other risk factors, performs well in identifying periodontitis among patients with RA and OA. Self-report questions related to alveolar bone loss exhibit excellent convergent validity in these patient subsets.

Non-surgical management of peri-implant diseases.

There are similarities between peri-implant diseases and periodontal diseases in terms of aetiology, pathogenesis and management. Patients with a past history of periodontitis are at greater risk of peri-implantitis and it is essential in partially dentate patients to ensure that control of periodontitis has been achieved before implants are placed. Careful maintenance and monitoring of implant patients should be performed on a regular basis to identify, at the earliest opportunity, the clinical and radiographic markers of peri-implant disease. Good self-performed biofilm control and professional maintenance of implants is essential to prevent the onset of peri-implant diseases. Once peri-implantitis has become established, it can initially be managed non-surgically, although surgical intervention may be required for more severe lesions.

Inter-rater agreement in the diagnosis of mucositis and peri-implantitis.

AIM: The objective was to assess the inter-rater agreement in the diagnosis of mucositis and peri-implantitis. MATERIAL AND METHODS: Adult patients with ≥ 1 dental implant were eligible. Three operators examined the patients. One examiner allocated the patients to three groups of nine as follows: nine implants with peri-implantitis, nine implants with mucositis, and 9 implants with healthy mucosa. Each examiner recorded on all 27 patients (one implant per patient) recessions, probing depth, bleeding on probing, suppuration, keratinized tissue depth and bone loss, leading to a final diagnosis of mucositis, peri-implantitis or healthy mucosa. Examiners were independent and blinded to each other. RESULTS: Fleiss k-statistic with quadratic weight in the diagnosis of peri-implantitis and mucositis was 0.66 [CI95%: 0.45-0.87]. A complete agreement was obtained only in 14 cases (52%). Fleiss k-statistics in bleeding on probing and bone loss were respectively 0.31 [CI95%: 0.20-0.41] and 0.70 [CI95%: 0.45-0.94]. Intra-class correlation coefficients for recession, probing depth and keratinized tissue depth were respectively 0.69 [CI95%: 0.62-0.75], 0.54 [CI95%: 0.44-0.63] and 0.56 [CI95%: 0.27-0.77]. CONCLUSIONS: The inter-rater agreement in the diagnosis of peri-implant disease was qualified as merely good. This could also be due in part to the unclear definition of peri-implantitis and mucositis.

Relationship between Community Periodontal Index and Fecal Hemoglobin Concentration, an Indicator for Colorectal Neoplasm.

Periodontal disease and colorectal cancer have inflammatory processes in common. It is therefore worthwhile to investigate whether there is an association between periodontal probing depth and fecal hemoglobin concentration (FHbC), an indicator of colorectal neoplasms, in 40- to 44-year-old Taiwanese. We enrolled a total of 6,214 attendees aged 40 to 44 yr who were participating in a community-based integrated screening program and who received both periodontal and FHbC examinations between 2003 and 2008. A proportional odds logistic regression model was used to estimate the odds ratios of different FHbC levels in treating an increased level of community periodontal index (CPI) measuring periodontal probing depth as ordinary data from 0 to 4. Periodontal probing depth with the order of CPI was in parallel with an increase in the mean values of FHbC: 21.3 ± 156.3, 26.0 ± 167.7, 27.2 ± 151.1, and 39.5 ± 255.7 ng/mL for CPI 0, CPI 1, CPI 2, and CPI 3/4, respectively. The log-FHbC varied across the categories of CPI (p = .0078). After adjusting for age, sex, education level, smoking, alcohol intake, exercise, body mass index, and intake of meat and vegetables, subjects with positive fecal immunochemical test results (FHbC ≥ 100 ng/mL) had a 33% higher risk of deteriorating to severe CPI than did those within the normal range of fecal immunochemical test (FHbC < 100 ng/mL) (adjusted odds ratio = 1.33, 95% confidence interval: 1.03-1.73). A positive association was demonstrated between FHbC and periodontal probing depth assessed by CPI among 6,214 Taiwanese aged 40 to 44 yr who participated in a community-based integrated health screening program. These results could have significant implications for early identification of high-risk individuals, as those with deep periodontal pockets should be advised to undergo screening for colorectal cancer at a younger age than commonly recommended.

Peri-implantitis diagnosis and treatment by New Zealand periodontists and oral maxillofacial surgeons.

OBJECTIVES: This study aimed to investigate the understanding, diagnosis and management of peri-implantitis by New Zealand periodontists and oral maxillofacial surgeons (OMFS). DESIGN: Telephone interviews (in combination with a postal and electronic survey) were conducted of all 25 periodontists and 32 OMFS listed as specialists on the New Zealand Dental Register. A seven item multi-choice and short answer questionnaire was used to investigate: their definition of peri-implantitis; the number of annual referrals received in their practice for this condition; their diagnostic, preventive and treatment strategies for peri-implantitis; and their perception of the role of general dental practitioners in its management. RESULTS: The participation rate was 84.6%. Most respondents defined peri-implantitis as a disease of multifactorial aetiology that leads to destruction of the bone supporting an implant. The average number of cases seen annually differed between periodontists (11 cases/year) and OMFS (4 cases/year). The criteria used by the respondents to diagnose peri-implantitis included increased probing depths and radiographic evidence of bone loss. Each type of specialist used mechanical debridement for treatment, but a higher proportion of OMFS performed surgical procedures as treatment. The prevention strategies used smoking cessation advice and ensuring good plaque control. All respondents agreed that peri-implantitis is an important disease that can lead to implant failure, and all acknowledged the role of general dental practitioners in diagnosis, referral for treatment and long-term implant maintenance. CONCLUSION: The definition, diagnostic criteria and management strategies used by New Zealand specialists are generally consistent with those found in the literature. No evidence-based, gold standard treatment protocol for peri-implantitis has been identified in the literature, and New Zealand specialists use a range of treatment modalities.

Peri-implantitis: etiology, diagnosis and treatment: an update.

Peri-implant mucositis is described as the presence of inflammation in the mucosa around implants without any bone loss. By contrast, in peri-implantitis, besides the inflammation in the peri-implant mucosa, loss of supporting bone is also seen. The probing depth, the presence of bleeding on probing, suppuration and radiographs should be assessed regularly for the diagnosis of peri-implant diseases. Poor oral hygiene, smoking and previous history of periodontitis are known risk factors for the disease. The occlusion and longevity of fixed partial dentures around implants, whether connected to the natural teeth or not, is still an area of investigaton, but studies show that long-term results are acceptable for both. Various treatment modalities are discussed in relation to the management of periimplantitis. The predictable outcome of peri-implantitis management is not yet known.

Salivary biomarkers of bacterial burden, inflammatory response, and tissue destruction in periodontitis.

AIM: Chronic periodontitis has an episodic and multifactorial character, with fluctuations in bacterial burden, inflammatory response, and tissue destruction. We investigated the association of selected salivary biomarkers with periodontal parameters and validated the use of a novel salivary diagnostic approach, the cumulative risk score (CRS), in detection of periodontitis in subjects with angiographically verified coronary artery disease diagnosis. MATERIALS AND METHODS: The concentrations of matrix metalloproteinase (MMP)-8, interleukin (IL)-1ß, and Porphyromonas gingivalis were analysed from saliva of 493 subjects. The subjects participated in a detailed clinical and radiographic oral examination. The CRS index, combining the three salivary biomarkers, was calculated for each subject. RESULTS: High salivary concentrations of MMP-8, IL-1ß, and P. gingivalis were associated with deepened periodontal pockets and alveolar bone loss, and MMP-8 and IL-1ß with bleeding on probing. The CRS index had a stronger association with moderate to severe periodontitis (OR 6.13; 95% CI 3.11-12.09) than any of the markers alone. CONCLUSIONS: Salivary concentrations of MMP-8, IL-1ß, and P. gingivalis are associated with various clinical and radiographic measures of periodontitis. The CRS index, combining the three salivary biomarkers, is associated with periodontitis more strongly than any of the markers alone regardless of the coronary artery disease status of the patients.

Langerhans cell histiocytosis in childhood - review, symptoms in the oral cavity, differential diagnosis and report of two cases.

BACKGROUND: Langerhans cell histiocytosis is a rare disease characterized by monoclonal proliferation and migration of special dendritic cells. This disease primarily affects bones, but occurs less frequently in other organ systems or may manifest as a multisystem disease. CASE REPORTS: Extraoral and intraoral symptoms of Langerhans cell histiocytosis are described in a 13-month-old female and a 5-month-old male infant. Dermatitis was found on the scalp, abdomen, flexures and in intertrigineous areas in both patients. The intraoral examination of the 13-month-old infant showed premature eruption of all maxillary deciduous molars, loosening and significant damage of periodontal tissues (gingivitis with bleeding, swelling of palatal mucosa, periodontal pockets) resembling severe periodontitis. In the oral cavity of the 5-month-old predentate infant bilateral swellings of maxillary alveolar mucosa with deep ulcerations were seen. The oral and skin symptoms in both infants were indications for biopsy. Langerhans cell histiocytosis was confirmed histologically and immunohistochemically. CONCLUSION: Oral findings in Langerhans cell histiocytosis may be the only clinical symptom of the disease; therefore the role of dentists in establishing diagnosis is very important.