Quality assessment of systematic reviews of the significance of keratinized mucosa on implant health.

The aim of this overview was to assess the methods, quality, and outcomes of systematic reviews conducted to evaluate the importance of keratinized mucosa (KM) for the maintenance of peri-implant tissue health in humans. An electronic search was conducted without date or language restriction using the MEDLINE/PubMed, Cochrane Library, Web of Science, and Embase databases up to December 2015. The eligibility criteria included systematic reviews with/without meta-analysis and with a focus on the influence of KM on peri-implant health around implants. Two independent authors performed the quality analysis of the reviews with the AMSTAR guidelines and another checklist proposed in 2003. After screening, four systematic reviews were selected. The present study demonstrated the existence of structural and methodological variability among the systematic reviews with/without meta-analysis. None of the systematic reviews that were included in the study obtained the maximum score in the two quality analyses performed. All systematic reviews included reported a positive association between an adequate KM width (≥2mm) and peri-implant health. There is still insufficient data on the long-term survival and success rates of dental implants. Prospective studies evaluating the importance of KM for the long-term maintenance of dental implants are needed.

Assessment of human gingival fibroblast interaction with dental implant abutment materials.

The biocompatibility of dental implant abutment materials depends on numerous factors including the nature of the material, its chemical composition, roughness, texture, hydrophilicity and surface charge. The aim of the present study was to compare the viability and adhesion strength of human gingival fibroblasts (HGFs) grown on several dental materials used in implant prosthodontics. Surfaces of the tested materials were assessed using an optical imaging profiler. For material toxicity and cellular adhesion evaluation, primary human gingival fibroblast cells were used. To evaluate the strength of cellular adhesion, gingival fibroblasts were cultured on the tested materials and subjected to lateral shear forces by applying 300 and 500 rpm shaking intensities. Focal adhesion kinase (FAK) expression and phosphorylation in cells grown on the specimens were registered by cell-based ELISA. There was a tendency of fibroblast adhesion strength to decrease in the following order: sandblasted titanium, polished titanium, sandblasted zirconium oxide, polished zirconium oxide, gold-alloy, chrome-cobalt alloy. Higher levels of total as well as phospho-FAK protein were registered in HGFs grown on roughened titanium. Material type and surface processing technique have an impact on gingival fibroblast interaction with dental implant abutment materials.

Assessment of human intraoral thermal sensitivity with simple devices in the clinic: implications for orofacial pain conditions.

AIMS: To use simple thermal devices with different diameters and temperatures to investigate reliability and magnitude of human intraoral thermal sensitivity. METHODS: Sixteen healthy volunteers participated. Six thermal devices with tapered circular ends (stimulus diameter 3, 5, and 10 mm) were used. Three different temperatures (room temperature, heat, and cold) were applied with each of the three diameters, ie, nine combinations. Participants were stimulated in randomized order at nine different sites: tongue, lip, maxillary attached gingiva adjacent to the left and right central incisors (without touching the lip) and to the left and right premolars (with or without touching the lip), and the left and right cheeks extraorally. Participants rated the perceived stimulus intensity on 0-50- 100 numeric rating scales (NRS). The number of paradoxical thermal sensations was also recorded. Ten volunteers were examined twice on the same day and recalled for a second session for assessment with the 5-mm-diameter device of within- and between-session reliability (interclass correlation coefficients [ICC]). The results were analyzed using a three-way analysis of variance. RESULTS: Reliability of NRS scores ranged from poor (ICC = 0.09, with cold stimulation at the premolar region) to excellent (ICC > 0.92, with cold stimulation at the cheek or tongue). NRS values varied with stimulus diameter (P < .050), temperature (P < .001), and sites (P < .001), with significant size x site and temperature x site interactions (P < .001). The tongue was the most sensitive site (P < .001) and the gingiva was the least sensitive site (P < .050). The 10-mm-diameter device produced higher NRS scores than the 3-mm-diameter device. CONCLUSION: The reliability of intraoral thermal sensitivity recorded with the 5-mm-diameter device varied greatly between different sites. Nonetheless, with this caveat in mind, the study did document that semiquantitative assessment of intraoral thermal sensitivity is feasible and applicable for clinical studies in different intraoral pain conditions.

Assessment of changes in the oral tactile function of the soft tissues by implant placement in the anterior maxilla: a prospective study.

The aim of the present study was to assess the somatosensory function in the peri-implant soft tissues in the anterior jaw bone by means of two psychophysical tests. Light-touch sensation (LTS) and two-point discrimination (2PD) were performed before, and at planned intervals until 18 months after the placement of one or two implants in the anterior maxilla. The same tests were used on the contralateral control sites. The psychophysical threshold was determined by performing the staircase method. The mean values and standard deviation of LTS and 2PD, pooled over the four sessions at each test area, were calculated. Despite a large intersubject variation in both the LTS and 2PD, significantly high intra-individual correlations were found (P < 0.005). For LTS, the thresholds were not significantly affected over time (P > 0.05) on both implant and control sites. The 2PD increased significantly after surgery and maintained the higher discriminatory sense for 1 year (P-value 0.005). The control sites remained stable over time. However, no correlation was revealed between LTS and 2PD perception (Pearson correlation test). In this prospective study, no major differences between the different sites and testing sessions were reported; except for the 2PD thresholds which were lowered after implant surgery. These findings suggest that the regenerated nerves may be responsible for the increased 2PD sensitivity in the peri-implant soft tissue. The unchanged LTS thresholds did not allow confirming this hypothesis.

The use and assessment of ketamine-medetomidine-butorphanol combinations for field anaesthesia in wild European badgers (Meles meles).

OBJECTIVE: To evaluate the effectiveness of four ketamine-based anaesthetics in badgers using a quantitative anaesthesia assessment technique. STUDY DESIGN: Prospective randomized 'blinded' experimental trial. METHODS: The quality of induction, of anaesthesia (at 5-minute intervals) and of recovery were assessed in 93 badgers, given either one of three ketamine (K)-medetomidine (M)-butorphanol (B) combinations: group A - M K B at 20/40/80 microg kg(-1); group B - M K B at 20/40/60 microg kg(-1); and group C - M K B at 20/60/40 microg kg(-1), or ketamine (K) alone at 2 mg kg(-1) (group D). The assessor was ignorant of the combination administered. Physiological variables (heart and respiratory rates and rectal temperature) were measured at 5-minute intervals during anaesthesia. Gingival mucus membrane colour was also recorded. RESULTS: Induction to anaesthesia was most rapid with ketamine (2 mg kg(-1)) although induction quality did not differ between techniques. Ketamine used alone gave the poorest score for anaesthesia quality. Heart rate (HR) and scores for gingival mucus membrane colour were higher in animals anaesthetized with ketamine alone. Rectal temperature did not differ significantly between the techniques at any time during anaesthesia. Ketamine used alone produced the poorest quality of recovery. CONCLUSION AND CLINICAL RELEVANCE: The M-K-B combinations investigated overcame several side effects associated with ketamine anaesthesia, but at the expense of more variable induction times, lower HRs, and poorer mucus membrane coloration.

Factors influencing the clinical composite assessment of denture-supporting tissues.

PURPOSE: This study attempted to (1) clarify the factors influencing the clinical composite assessment of denture-supporting tissues in edentulous patients by experienced prosthodontists and (2) develop a method for quantitative assessment of supporting tissue. MATERIALS AND METHODS: Seven three- or four-grade scales for clinical factors were used to evaluate supporting tissue in 317 complete denture patients. The general assessment of supporting tissue was conducted with a 10-point scale. The contribution of each grade of the seven factors to the general assessment level was determined by a multiple regression analysis. RESULTS: Based on the contributions of the seven factors, a method for quantitative assessment of supporting tissue was established, category scores for these factors were calculated, and the sums of the category scores were converted to an integer between 0 and 100. The resulting quantification score was closely correlated with the general assessment of the supporting tissue by experienced prosthodontists. CONCLUSION: The factors influencing the clinical composite assessment of denture-supporting tissues in edentulous patients by experienced prosthodontists were clarified. The quantitative assessment method developed in this study is simple and might be used for preoperative diagnosis and treatment planning.

A comparative assessment of subgingival temperature in bleeding and non-bleeding sites before and after periodontal treatment.

Periodontal disease has affected human kind since times unknown. Various parameters are available to determine whether the tissue has been affected by the disease or not. In this study the reliance of subgingival temperature to be one of the parameters to determine the same has been evaluated.

Pain threshold values during periodontal probing: assessment of maxillary incisor and molar sites.

Probing pain threshold (PPT) assessments were conducted in the facial and oral sulci of maxillary central incisors and first molars of 10 periodontally healthy adults. All subjects were systemically healthy, free of pain, and reported no current medication usage. A computer-linked electronic probe, modified to deliver steadily increasing forces up to 200 grams, was used to collect the data. The system contained a subject operated "off-switch" which, upon activation, signaled the computer to record the subject's PPT. Assessments of each subject's PPTs were conducted on 3 separate occasions at 7-day intervals. Results indicated that the facial sulci of the incisors were the most pain sensitive. They displayed a mean PPT of 50.9 +/- 26.6 grams. The oral sulci of the incisors exhibited a mean PPT of 76.5 +/- 45.2 grams. Facial and oral sulci of the molars evidenced mean PPT values of 102.6 +/- 52.1 grams and 113.5 +/- 51.3 grams, respectively. These data suggest that sulci associated with incisor teeth are nearly twice as pain sensitive as sulci associated with molar teeth. In addition, facial sulci are significantly more pain sensitive than oral sulci. Data did not indicate a visit effect nor a side-of-mouth effect on PPT values.

[Assessment of marginal tissue around HA-coated titanium implants for orthodontic anchorage in dogs].

12 two-stage HA-coated titanium implants placed in dogs' mandibles were loaded with an orthodontic force of 150 g for 3 month. Gingival bleeding index, plague and calcucus index, mobility index, probing depth and marginal bone were investigated. The results showed that the implants were stable and peri-implant soft tissue displayed slight inflammation, but no marginal bone absorption and no difference of bone quantity between the tension side and compression side were found. It can be concluded that the clinical trials of marginal tissue around the HA-coated titanium implants are satisfactory when the implants are used as anchorage for short-term orthodontic treatment.

Clinical assessment of injuries in orthodontic movement of impacted teeth. II. Surgical recommendations.

Adverse effects on periodontal tissues have been associated with surgical techniques used to expose impacted teeth that are to undergo orthodontic tooth movement. The purpose of this study was to compare the effects on the periodontium of two of the more commonly used surgical techniques for labially impacted canines--(1) exposure of the entire labial aspect of the anatomic crown with total excision of all keratinized tissue (the window approach) and (2) a technique which exposes only 4 to 5 mm of the most superficial portion of the labial aspect of the cusp tip while maintaining 2 to 3 mm of keratinized tissue. Twelve patients were selected who had undergone comprehensive orthodontic therapy for a unilateral labial impaction of an upper canine, and who had the impacted canine surgically exposed with a window approach. This group's periodontal status after orthodontic therapy was compared to that of another group of twelve patients who had also undergone comprehensive orthodontic therapy for a unilaterally impacted labial upper canine but in whom the surgical exposure of the impacted tooth had been performed in a manner which preserved 2 to 3 mm of keratinized tissue on the labial aspect. The results indicated that the twelve subjects in whom the window approach had been used had statistically more gingival recession, gingival inflammation, and loss of attachment on the labial and labioproximal surfaces of the impacted teeth than the other group that had 2 to 3 mm keratinized tissue maintained after surgical exposure (p less than 0.05).

Quantitative assessment of free gingival grafts with and without periosteum and osseous perforation.

Forty free gingival grafts were performed on 5 adult Rhesus monkeys as follows: 10 grafts were placed on recipient sites with periosteum; 10 grafts on periosteum and perforated cortical plate; 10 grafts on bared bone; and 10 grafts on perforated bared bone. All free autografts (7 X 5 X 1 mm) were taken from the palatal mucosa and were sutured in place. Clinical evaluation and photographs were taken at 1, 2, 4, 8, 12, 16, 20 and 24 weeks postoperatively. At 24 weeks, a device was used to measure quantitatively the amount of force necessary to pull the graft 2 mm away from the underlying bone. Biopsy of two grafts of each type were taken for histologic examination. The following conclusions were drawn: 1. There was no difference in the survival or healing pattern of grafts placed on periosteum and grafts placed on bared bone.

Assessment of attached gingiva using the tension test and clinical measurements.

The attached gingiva on the facial surface of the mandibular central incisors was evaluated by measurements and the "tension test" on 226 subjects between the ages of 8 and 22 years. Findings of significance were: 1. As age increased a definite increase in width of attached gingiva occurred. 2. There was no increase in the frequency of a positive tension test in older age groups. 3. No relationship was observed when results of the tension test were compared with clinical measurements of attached gingiva.