Local drug delivery in the treatment of furcation defects in periodontitis: a systematic review.

OBJECTIVES: To evaluate the effect of subgingival administration of various antimicrobials and host-modulating agents in furcation defects as an adjunct to scaling and root planing (SRP) compared to SRP alone or combined with placebo. METHODS: A systematic review was carried out using MEDLINE-PubMed, Embase, and Scopus for articles up to October 2022 in addition to hand searches. All longitudinal studies that evaluated the effect of subgingival application of antimicrobial and host-modulating agents in furcation defects as adjuncts to SRP compared to SRP alone or SRP + placebo with at least 3 months of follow-up were eligible for inclusion. RESULTS: A total of eight studies were included. Superior clinical treatment outcomes were shown when alendronate, rosuvastatin, boric acid, simvastatin, and tetracycline (only at 3 months) were utilized in furcation defects in conjunction with SRP alone or SRP + placebo. Significant improvement was reported in radiographic bone defect depth and defect depth reduction when SRP was supplemented with alendronate, rosuvastatin, boric acid, and simvastatin. CONCLUSIONS: Within the limitations of this review, the adjunctive subgingival administration of medications and host-modulating agents in furcation defects may confer additional clinical and radiographic benefits than non-surgical periodontal treatment alone. Future investigations are needed to confirm their long-term effectiveness. CLINICAL RELEVANCE: Local host modulators and antimicrobials may be used supplementary to enhance the clinical and radiographic treatment outcomes of conventional periodontal therapy in furcation defects.

Complexity of Recent Earthquake Swarms in Greece in Terms of Non-Extensive Statistical Physics.

Greece exhibits the highest seismic activity in Europe, manifested in intense seismicity with large magnitude events and frequent earthquake swarms. In the present work, we analyzed the spatiotemporal properties of recent earthquake swarms that occurred in the broader area of Greece using the Non-Extensive Statistical Physics (NESP) framework, which appears suitable for studying complex systems. The behavior of complex systems, where multifractality and strong correlations among the elements of the system exist, as in tectonic and volcanic environments, can adequately be described by Tsallis entropy (Sq), introducing the Q-exponential function and the entropic parameter q that expresses the degree of non-additivity of the system. Herein, we focus the analysis on the 2007 Trichonis Lake, the 2016 Western Crete, the 2021-2022 Nisyros, the 2021-2022 Thiva and the 2022 Pagasetic Gulf earthquake swarms. Using the seismicity catalogs for each swarm, we investigate the inter-event time (T) and distance (D) distributions with the Q-exponential function, providing the qT and qD entropic parameters. The results show that qT varies from 1.44 to 1.58, whereas qD ranges from 0.46 to 0.75 for the inter-event time and distance distributions, respectively. Furthermore, we describe the frequency-magnitude distributions with the Gutenberg-Richter scaling relation and the fragment-asperity model of earthquake interactions derived within the NESP framework. The results of the analysis indicate that the statistical properties of earthquake swarms can be successfully reproduced by means of NESP and confirm the complexity and non-additivity of the spatiotemporal evolution of seismicity. Finally, the superstatistics approach, which is closely connected to NESP and is based on a superposition of ordinary local equilibrium statistical mechanics, is further used to discuss the temporal patterns of the earthquake evolution during the swarms.

The Predictive Role of the Triglyceride/Glucose Index in Patients with Hypercholesterolemia and Acute Ischemic Stroke.

Background: The triglyceride/glucose index (TyG) reflects insulin resistance and predicts the risk of acute ischemic stroke (aIS). However, it is uncertain if this index predicts the severity and outcome of aIS because studies that addressed this question are few and all were performed in Asian subjects. Moreover, there are no studies that focused on patients with hypercholesterolemia. Methods: We studied 997 Caucasian patients who were hospitalized for aIS and had hypercholesterolemia. aIS severity was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS) and severe aIS was defined as NIHSS ≥ 21. The outcome was assessed with the functional outcome at discharge and with in-hospital mortality. An unfavorable functional outcome was defined as modified Rank in scale (mRs) at discharge between 3 and 6. Results: The TyG index did not correlate with the NIHSS at admission (r = 0.032, p = NS) and was similar in patients with severe and non-severe aIS (8.7 ± 0.6 and 8.6 ± 0.6, respectively; p = NS). Risk factors for severe aIS were age, female gender, atrial fibrillation (AF) and diastolic blood pressure (DBP) at admission. The TyG index also did not correlate with the mRs(r = 0.037, p = NS) and was similar in patients who had unfavorable and favorable functional outcome (8.7 ± 0.6 and 8.6 ± 0.5, respectively; p = NS). Risk factors for unfavorable functional outcome were age, previous ischemic stroke, body mass index and the NIHSS at admission. The TyG index was similar in patients who died during hospitalization and patients who were discharged (8.7 ± 0.6 and 8.7 ± 0.6, respectively; p = NS). Risk factors for in-hospital mortality were AF and DBP and NIHSS at admission. Conclusions: The TyG index does not appear to be associated with the severity or the outcome of aIS. Nevertheless, since there are few relevant data in Caucasians and the TyG index is an inexpensive and widely available biomarker, more studies in this ethnic group are required to determine the predictive role of this index in patients with aIS.

Expression of Wnt signaling agonists and antagonists in periodontitis and healthy subjects, before and after non-surgical periodontal treatment: A systematic review.

Periodontitis is a preventable and treatable multifactorial chronic inflammatory disease that can lead to irreversible periodontal destruction and tooth loss. Wnt signaling and its regulators play an important role in periodontal inflammation, destruction, regeneration, and reconstruction. This systematic review aimed at investigating the involvement of Wnt signaling agonists and antagonists in periodontitis and healthy subjects, before and after periodontal treatment. Electronic searches were carried out using MEDLINE/PubMed, EMBASE, and Cochrane Library databases in addition to hand searches. Studies having different designs assessing the levels of Wnt signaling antagonist and agonist levels in gingival crevicular fluid, serum, and tissue in patients diagnosed with periodontitis or gingivitis, compared with healthy individuals were included. In addition, studies compared these levels in periodontitis patients before and after non-surgical periodontal therapy were also eligible. Sixteen studies met the eligibility criteria. Sclerostin (SOST) has been mainly investigated in the literature (8 publications). Sclerostin (5 studies), Wnt-5a (2 studies), secreted frizzled-related protein 1 (SFRP1) (3 studies), and ß-catenin (3 studies) show increased levels in periodontitis compared with periodontal health. Strong correlations between marker levels and periodontal clinical parameters were identified for SOST (5 studies), SFRP1 (2 studies), and ß-catenin (2 studies). SOST (3 studies) and SFRP1 (1 study) levels significantly decrease following non-surgical periodontal treatment. The present systematic review demonstrated an association between Wnt signaling agonist and antagonist levels and periodontitis. Wnt agonists and antagonists may serve as valuable diagnostic and prognostic markers for periodontitis onset and progression. Further case-control and longitudinal studies should be conducted for different Wnt signaling agonists and antagonists.

Postextraction ridge preservation by using dense PTFE membranes: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: The use of dense polytetrafluoroethylene (dPTFE) membranes in alveolar ridge preservation may help reduce the risk of bacterial contamination and infection, maintaining the soft-tissue anatomy. However, systematic reviews on their efficacy in postextraction sites are lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the efficacy of alveolar ridge preservation with dPTFE membranes when used alone or in combination with bone grafting materials in postextraction sites. MATERIAL AND METHODS: An electronic search up to February 2021 was conducted by using PubMed, Embase, and the Cochrane library to detect studies using dPTFE membranes in postextraction sites. An additional manual search was performed in relevant journals. Clinical and radiographic dimensional changes of the alveolar ridge, histomorphometric, microcomputed tomography, implant-related findings, and rate of complications were recorded. One-dimensional meta-analysis was performed to calculate the overall means and 95% confidence intervals (α=.05). RESULTS: A total of 23 studies, 14 randomized controlled trials, 4 retrospective cohort studies, 3 case series, and 2 prospective nonrandomized clinical trials, met the inclusion criteria. Five studies were included in the quantitative analysis. The meta-analysis revealed that the use of dPTFE membranes resulted in a statistically significant (P=.042) increase in clinical keratinized tissue of 3.49 mm (95% confidence interval [CI]: 0.16, 6.83) when compared with extraction alone. Metaregression showed that the difference of 1.10 mm (95% CI: -0.14, 2.35) in the radiographic horizontal measurements was not significant (P=.082), but the difference of 1.06 mm (95% CI: 0.51, 1.62) in the radiographic vertical dimensional change between dPTFE membranes+allograft and extraction alone was statistically significant (P<.001). CONCLUSIONS: The use of dPTFE membranes was better than extraction alone in terms of keratinized tissue width and radiographic vertical bone loss.

Flapless application of enamel matrix derivative in non-surgical periodontal treatment: A systematic review.

BACKGROUND AND OBJECTIVE: To assess the effects of the flapless application of enamel matrix derivative (EMD) in combination with non-surgical periodontal treatment (NSPT) when compared to non-surgical periodontal treatment alone in adult patients. MATERIAL AND METHODS: An electronic literature search was conducted in MEDLINE, Scopus and Cochrane Library up to March 2021 complemented by a manual search. Human longitudinal studies of >5 participants and at least 3 months follow-up were eligible for inclusion in the review. Clinical outcomes were extracted and pooled. Meta-analysis of the included studies was not possible due to methodological differences. RESULTS: A total of 1199 publications were identified and reviewed for eligibility. Nine of them fulfilled the inclusion criteria. Eight studies were randomized clinical trials. The clinical findings of the majority of the included studies demonstrated that the adjunctive use of EMD with NSPT could lead to significantly improved treatment outcomes including higher PPD reduction, more CAL gain, more robust BOP reduction, higher number of sites with PPD < 5 mm and more frequent pocket closure which reduces the need for further periodontal surgical treatment. Limited biological, microbiological and histological findings were reported. Minimal adverse events were observed. CONCLUSION: The flapless application of EMD during NSPT leads to an improved clinical outcome in regards to CAL gain and PPD reduction when compared to conventional treatment alone. The potential effect on the biological and microbiological outcome is unclear.

Strong Ground Motion Sensor Network for Civil Protection Rapid Decision Support Systems.

Strong motion sensor networks deployed in metropolitan areas are able to provide valuable information for civil protection Decision Support Systems (DSSs) aiming to mitigate seismic risk and earthquake social-economic impact. To this direction, such a network is installed and real-time operated in Chania (Crete Island, Greece), city located in the vicinity of the seismically active south front of the Hellenic Subduction Zone. A blend of both traditional and advanced analysis techniques and interpretation methods of strong ground motion data are presented, studying indicative cases of Chania shaking due to earthquakes in the last couple years. The orientation independent spectral acceleration as well as the spatial distribution of the strong ground motion parameters such as the Peak Ground Acceleration (PGA), Peak Ground Velocity (PGV), Peak Ground Displacement (PGD) and Arias Ιntensity observed at the urban area of Chania are presented with the use of a Geographic Information System (GIS) environment. The results point to the importance of the strong ground motion networks as they can provide valuable information on earthquake hazards prior to and after detrimental seismic events to feed rapid systems supporting civil protection decisions for prevention and emergency response.

WNT-5a and SOST Levels in Gingival Crevicular Fluid Depend on the Inflammatory and Osteoclastogenic Activities of Periodontal Tissues.

Background and Objectives: Wnt signaling leads to stimulation of osteoblasts and it reduces osteoclastogenesis and bone resorption via the regulation of the osteprotegrin and receptor activator of nuclear factor kappa-Β ligan (RANKL). Wnt signaling pathways are regulated by their physiological antagonists such as sclerostin (SOST) as well as WNT-5a. The aim of this study was to determine the total amount of Sclerostin and WNT-5a in the gingival crevicular fluid (GCF) in sites with a continuum from a healthy to diseased periodontium. Materials and Methods: In this cross-sectional study, a total of 20 patients with generalized periodontitis, 10 subjects with gingivitis as well as 14 individuals with a healthy periodontium were recruited upon clinical and radiographic periodontal examination. In patients diagnosed with periodontitis, GCF samples were collected from periodontitis, gingivitis and healthy sites, while gingivitis patients provided samples from gingivitis and healthy sites. In healthy patients, only healthy sites were sampled. Protein total amount of SOST and WNT-5a were quantified by sandwich enzyme-linked immunosorbent assay (ELISA). Results: A total of 108 GCF samples were collected from a total of 44 individuals. When all periodontitis (n = 51), gingivitis (n = 12) and healthy (n = 45) sites were analyzed regardless of the patient diagnosis, periodontitis sites demonstrated significantly elevated WNT-5a total amounts (p = 0.03) when compared to gingivitis sites. Gingivitis sites demonstrated a trend of more total SOST (p = 0.09) when compared to periodontitis and healthy sites. Within each patient diagnostic category, sites showed similar SOST and WNT-5a total amounts (p > 0.05). Conclusions: WNT-5a levels in GCF depend on the stage of periodontitis sites. SOST trended higher in the GCF of gingivitis sites but similar in chronic periodontitis and healthy sites. WNT-5a and SOST play a crucial role in periodontal tissue remodeling and depend on the inflammatory and osteoclastogenic activities.

Sclerostin and WNT-5a gingival protein levels in chronic periodontitis and health.

BACKGROUND AND OBJECTIVE: Wnt signaling pathways regulate osteoblast differentiation and bone formation and are associated with inflammatory responses driven by innate and adaptive immunity via the NF-κB pathway. The aim of this study was to compare the levels of sclerostin (SOST), WNT-5a, and TNF-α between chronic periodontitis and periodontally healthy sites and determine their value as diagnostic markers of chronic periodontitis. MATERIAL AND METHODS: In a cross-sectional assessment 25 chronic periodontitis cases and 25 periodontally healthy controls were selected upon clinical and radiographic periodontal evaluation. Gingival crevicular fluid (GCF) was collected cross-sectionally from diseased and healthy sites in periodontitis patients and from healthy sites in each control subject. In a subgroup analysis, ten patients with generalized moderate and severe chronic periodontitis and ten generalized periodontally healthy individuals were included. The protein levels of SOST, WNT-5a, and TNF-α in GCF were measured by sandwich ELISA. The Shapiro-Wilk test was utilized to assess the normality of the distribution and non-parametric comparisons were performed. RESULTS: The protein levels of SOST were significantly higher in the generalized moderate and severe chronic periodontitis subgroup when compared to the generalized healthy (P = 0.002), while the WNT-5a and TNF-α GCF total amounts were similar (P > 0.05). Diseased sites in the periodontitis patients exhibited significantly higher total protein levels of WNT-5a than in healthy sites (P = 0.017), whereas no differences were detected for SOST and TNF-α (P > 0.05). The total protein levels of SOST, WNT-5a, and TNF-α in GCF were similar in periodontitis and non-periodontitis patients (P > 0.05). CONCLUSIONS: Sclerostin and WNT-5a gingival protein levels demonstrated a high diagnostic value for generalized moderate and severe chronic periodontitis, while a low accuracy was detected for localized chronic periodontitis.

Factors associated with delayed presentation at the emergency department in patients with acute ischemic stroke.

Background and aims: Pre-hospital delay is a crucial factor that determines the eligibility for intravenous thrombolysis in patients with acute ischemic stroke. We aimed to evaluate the time to presentation at the emergency department (ED) and the factors that affect this time. Patients and methods: We prospectively studied 682 patients who were admitted with acute ischemic stroke (43.3% men, age 79.9 ± 6.6 years). Results: The median time to presentation at the ED was 2.1 h (range 0.15 to 168 h); 68.8% of the patients arrived within 4.5 h and 56.5% arrived within 3 h from the onset of symptoms. Independent predictors of presentation within 4.5 h were the use of emergency medical services (EMS) for transportation to the hospital (OR 2.61, 95% CI 1.38-4.94, p = .003), family history of cardiovascular disease (CVD)(OR 4.0 0,95%CI 1.61-12.23, p = .006) and the absence of history of smoking (OR 2.49, 95% CI 1.13-5.42, p = .021). Independent predictors of presentation within 3 h were the use of EMS for transportation to the hospital (OR 6.24, 95% CI 2.52-16.63, p = .0001), family history of CVD (OR 3.07, 95% CI 1.14-9.43, p = .03), and a moderately severe stroke at admission (OR vs. minor stroke 0.38, 95% CI 0.16-0.87, p = .02). Conclusions: A considerable proportion of patients with acute ischemic stroke arrives at the ED after the 4.5-h threshold for performing intravenous thrombolysis. Non-smokers, patients with a family history of CVD, with moderately severe stroke and those who use the EMS are more likely to arrive on time.

Quantification of facial and smile esthetics.

STATEMENT OF PROBLEM: Whether deviations in alignment discrepancy, width-to-length ratio, application of the golden proportion, or number of teeth revealed in smile affect attractiveness is yet unknown. PURPOSE: The purpose of this analytical study was to quantify dental and facial esthetics to determine whether individuals identified as having superior smiles display differences in alignment discrepancies (angulation between interpupillary and commissure line); width-to-length ratios of maxillary anterior teeth; application of the golden proportion (approximately 1.618:1); and number of teeth revealed in an animated smile when compared with an average population. MATERIAL AND METHODS: An Internet search for "best smile" and "celebrity" identified 108 celebrities. Photographs showing smiles within 10 degrees of a frontal view were collected, while photographs of dental students were used for the control group. Alignment discrepancies, widths and lengths of the anterior teeth, and number of teeth revealed in an animated smile were measured with photo-editing software, and ratios were calculated. The groups were compared with repeated-measures ANOVA, the Mann-Whitney U test, and the Wilcoxon signed-rank test (α=.05). RESULTS: Usable photographs were obtained for 90 celebrities (58 women, 32 men) and compared with photographs of 97 dental students (54 women, 43 men). Statistically significant differences were found for alignment discrepancies (celebrities 0.97, students 1.25, P=.034) and for the number of teeth displayed (P=.049); 22.2% of the celebrities revealed 12 teeth, versus 6.2% of the students. In both groups, significant differences from the golden ratio (1.618:1) for the width of the central incisor/lateral incisor right and left and for the width of the lateral incisor/canine right and left were observed through 95% confidence intervals. Sex and left-right were nonsignificant factors. CONCLUSIONS: Celebrities identified as having a best smile had smaller mean alignment discrepancies and revealed a greater number of teeth in an animated smile than dental students.

A Complexity View into the Physics of the Accelerating Seismic Release Hypothesis: Theoretical Principles.

Observational indications support the hypothesis that many large earthquakes are preceded by accelerating-decelerating seismic release rates which are described by a power law time to failure relation. In the present work, a unified theoretical framework is discussed based on the ideas of non-extensive statistical physics along with fundamental principles of physics such as the energy conservation in a faulted crustal volume undergoing stress loading. We define a generalized Benioff strain function Ω ξ ( t ) = ∑ i = 1 n ( t ) E i ξ ( t ) , where Ei is the earthquake energy, 0 ≤ ξ ≤ 1 . and a time-to-failure power-law of Ω ξ ( t ) derived for a fault system that obeys a hierarchical distribution law extracted from Tsallis entropy. In the time-to-failure power-law followed by Ω ξ ( t ) the existence of a common exponent mξ which is a function of the non-extensive entropic parameter q is demonstrated. An analytic expression that connects mξ with the Tsallis entropic parameter q and the b value of Gutenberg-Richter law is derived. In addition the range of q and b values that could drive the system into an accelerating stage and to failure is discussed, along with precursory variations of mξ resulting from the precursory b-value anomaly. Finally our calculations based on Tsallis entropy and the energy conservation give a new view on the empirical laws derived in the literature, the associated average generalized Benioff strain rate during accelerating period with the background rate and connecting model parameters with the expected magnitude of the main shock.

Influence of Body Mass Index and Other Periodontitis-associated Risk Factors and Risk Indicators on Periodontal Treatment Needs: A Cross-sectional Study.

PURPOSE: To record periodontal treatment needs in a randomised sample and evaluate the association between body mass index (BMI) and periodontal treatment needs, as well as the association between diabetes, smoking, BMI and periodontal treatment needs. MATERIALS AND METHODS: The study sample comprised 633 patients aged 18 to 85 years visiting an outpatient clinic. Body mass index (BMI) and periodontal status were recorded. Demographic data including gender, year of birth, smoking habits and medical history were collected from each patient. RESULTS: 216 subjects (36%) were overweight, while 188 subjects (31.3%) were obese. CPITN (Community Periodontal Index of Treatment Needs) scores of 2 and 3 (minimal to moderate periodontal treatment needs) were widespread among this population (68.2%). Using model-based clustering, the total sample of 600 subjects was divided into four clusters of 202, 241, 111 and 46 subjects. CONCLUSION: The periodontal treatment needs of the sample were generally minimal to moderate, with only a weak association between the BMI and treatment needs. However, diabetics, smokers and older subjects classified as overweight or obese needed moderate to complex periodontal treatments.

Photodynamic therapy in the treatment of aggressive periodontitis: A systematic review.

BACKGROUND: Aggressive periodontitis (AgP) is a severe form of periodontal diseases with rapid destruction of the supporting bone around teeth. The efficacy of PDT in suppressing periodontal pathogens may be crucial in adopting new protocols for the treatment of AgP. Thus, the aim of this systematic review was to investigate the possible role of PDT in the treatment of AgP as an adjunctive therapy or monotherapy. MATERIAL AND METHODS: A systematic search of the literature was performed. Additionally, the references from all the selected full-text studies were searched for relevant articles. Two reviewers screened independently titles and abstracts or full text copies. Quality assessment of all the included studies was held. RESULTS: Initial screening of electronic databases yielded 418 potentially relevant publications. After screening of the titles and full-text examination, five studies were included in the systematic review. Four publications evaluated the effects of PDT adjunctive to SRP in patients with AgP: two of them compared the clinical outcomes of SRP and PDT with a control group that received therapy with SRP and antibiotics (metronidazole and amoxicillin); two publications included SRP and PDT in the test group, and SRP alone in the control group. In one study, PDT was tested as a monotherapy compared with SRP alone. CONCLUSIONS: Within the limitations of this review, PDT may exhibit a beneficial role in the therapy of aggressive periodontitis after repeated applications. In the future, more methodologically sound, long-term randomized clinical trials are needed to be conducted.

Association of susceptible genotypes to periodontal disease with the clinical outcome and tooth survival after non-surgical periodontal therapy: A systematic review and meta-analysis.

BACKGROUND: The real clinical utility of genetic testing is the prognostic value of genetic factors in the clinical outcome of periodontal treatment and the tooth survival. A meta-analysis was undertaken to estimate the effect of a susceptible genotype to periodontitis on the clinical outcomes of non-surgical periodontal therapy and the tooth survival. MATERIAL AND METHODS: A systematic search of MEDLINE-Pubmed, Cochrane Library and Scopus was performed. Additionally, a hand search was done in three journals. No specific language restriction was applied. Two reviewers screened independently titles and abstracts or full text copies. Quality assessment of all the included studies was held. RESULTS: Initial screening of electronic databases resulted in 283 articles. Ten studies met the inclusion criteria, nine of them examined the clinical outcome, while the other one investigated the tooth survival in susceptible individuals after non-surgical periodontal therapy. Eight of included studies were selected for the meta-analysis. IL-1 positive genotypes increase the risk of tooth loss, while no association found between the bleeding on probing (BOP), clinical attachment loss (CAL) and plaque index (PI) with the genotype status. Probing pocket depth (PPD) reduction in the first three months and in long-term results found to have a significant association with the genotype. CONCLUSIONS: There is no difference in the clinical measurements after non-surgical periodontal treatment, apart from PPD. More publications are needed to identify a cause-effect relationship.

Survival rate of implants performed at sites of previously failed implants and factors associated with failure: A retrospective investigation.

Background/purpose: Although reimplantation is currently a common treatment procedure, little information on reimplantation success or failure is available in the literature. The purpose of the present investigation was to evaluate the survival rate of dental implants that were performed in sites of previously failed implants and identify factors associated with the treatment outcome. Materials and methods: This retrospective study is based on a cohort of patients rehabilitated with dental implants in the dental clinics of the universities contributing data to the BigMouth network between 2011 and 2022. Implants replacing a previously failed implant at the same site were included. Cases of first and second reimplantations were included Information regarding patients' characteristics including age, gender, ethnicity, race, tobacco use, and systemic medical conditions were extracted from patients' files. Results: Records of 50,333 dental implants placed in 20,842 patients over a 12-year period were screened. Three hundred seventy implants placed in 284 patients were replaced by another implant at the same site. The cumulative survival rates of implants inserted for the first time was 98.6 %, for the first replacements was 96.1 % and for the second replacements was 91.7 %. First reimplants exhibited a significantly higher risk of failure than initial implantation (P < 0.001). Similarly, second reimplants demonstrated significantly greater risk of failure (P = 0.05) when compared to initial implants. No significant associations were detected between replaced implant failures with any of the patient related parameters evaluated (P > 0.05). Conclusion: Within the limitations of the present study, dental implants replacing failed implants exhibited lower survival rates than the rates reported for the previous attempts of implant placement. No risk indicators for implant failure were identified. Additional factors should be examined in future studies.

Periodontal Disease, Tooth Loss, and Systemic Conditions: An Exploratory Study.

BACKGROUND: Although systemic medical conditions are associated with periodontitis and tooth loss, large-scale studies that include less prevalent systemic conditions are needed. The purpose of the study was to investigate the link between periodontal disease and tooth loss with systemic medical conditions in a large and diverse population. METHODS: Dental charts of adult patients who had attended the dental clinics seeking dental therapy of the universities contributing data to the BigMouth network and accepted the protocol of the study were included. Dental Procedure Codes and Current Procedural Terminology procedures were utilised to identify patients with and without periodontitis. Data were extracted from patients' electronic health records including demographic characteristics, dental procedural codes, and self-reported medical conditions as well as the number of missing teeth. RESULTS: A total of 108,307 records were ultimately included in the analysis; 42,377 of them included a diagnosis of periodontitis. The median age of the included population was 47.0 years, and 55.2% were female. Older and male individuals were significantly more likely to be in the periodontitis group and have higher number of missing teeth. A number of systemic conditions are associated with periodontitis and a higher number of missing teeth. High blood pressure, smoking, drug use, and diabetes were all found to be significant. Other significant conditions were anaemia, lymphoma, glaucoma, dialysis, bronchitis, sinusitis hepatitis, and asthma. CONCLUSIONS: Within the limitations of this retrospective study that utilised the BigMouth dental data repository, the association of a number of systemic conditions such as smoking, diabetes, and hypertension with periodontitis and tooth loss has been confirmed. Additional connections have been highlighted for conditions that are not commonly reported in the literature.

Dental implant failure and factors associated with treatment outcome: A retrospective study.

PURPOSE: The purpose of the present study was to retrospectively 1) investigate the association between implant-, patient- and bone-related parameters with the risk of implant failure; 2) analyze the survival rates of dental implants placed in a university clinical setting. METHODS: Data were retrieved from patient charts from the University of Minnesota School of Dentistry to identify patients older than 18 years of age who received dental implant treatment by faculty, residents or students in the university dental clinics. Implant-, patient- and bone-related parameters such as implant system, length, diameter, jaw, region, installation protocol, gender, smoking, medical history, history of periodontal disease, self-reported oral parafunctions, type of bone, and operator were manually retrieved and analyzed. RESULTS: Five hundred and fifty-three implants were randomly selected from a total of 4,424. Of these 553 implants, 440 (79.6%) were associated with a >10 mm length, 371 (67.1%) with a >4 mm diameter and 431 (77.9%) had replaced a single tooth. Submerged healing mode was followed in 363 (65.6%) of the implants with the mean healing time being 3.2 months. History of periodontal disease was identified in 294 (53.2%) of these cases. A total of 17 implants failed after a mean time of 6.29 ± 6.75 months, resulting in an overall survival rate of 96.9%. Based on a univariate analysis, implant system, operator, time between extraction and implant surgery, time between bone grafting and implant placement, tobacco use as well as clenching and grinding were considered potential implant failure predictors and were further included in the multivariate logistic regression analysis. Tobacco use (p < 0.001) was significantly associated with implant failure. CONCLUSION: Within the limitations of this retrospective randomly selected university-treated sample tobacco use increased the risk for implant failure. Failure occurred in 17 implants representing a 3.1% failure rate.

Dental implant failure and bone augmentation: A retrospective study.

Background: To retrospectively assess the failure rate of implants placed in augmented and non-augmented sites and to investigate whether the time of implant and bone placement are associated with the risk of implant failure in a university setting. Material and Methods: In this retrospective study, data were retrieved from the electronic patient database of the University of Minnesota School of Dentistry, USA to identify patients older than 18 years of age who received dental implant treatment. Patient characteristics and the adequacy of available bone were retrieved from the patients' dental records and analyzed. Performing sinus lift and/or alveolar ridge augmentation in stages or simultaneously with implant placement and the need for multiple bone regeneration procedures were recorded. Kaplan-Meier plots and Cox regression models were created to analyze the data. Results: Data from 553 implants were analyzed in the study. More than half of the implants were placed in the maxilla (56.8%) and posterior regions (74.3%). The overall survival rate was 96.9%. Sinus augmentation was performed in 19.5% of the cases, while in 12.1% of the included treatments an implant was placed simultaneously. Staged and simultaneous ridge augmentation occurred in 45.2% and 18.8% of the cases, respectively. Implants placed in an area following (p=0.018) or simultaneously (p=0.025) with sinus augmentation showed a significantly reduced survival. Cox regression analysis showed that smoking and simultaneous ridge augmentation and implant placement increased failure rates. Conclusions: Within the limitations of this study, implants placed in tobacco users as well as in augmented maxillary sinuses, simultaneously or in stages, and in augmented ridges lead to higher implant failure rates. Key words:Bone grafting, dental implant, osseointegration, risk factor, survival rate, treatment outcome.