Treatment of peri-implantitis with a flapless surgical access combined with implant surface decontamination and adjunctive systemic antibiotics: A retrospective case series study.

AIM: To evaluate the effectiveness of a flapless surgical approach in the treatment of peri-implantitis and to explore the factors influencing its outcome. MATERIALS AND METHODS: The present retrospective study evaluated patients with at least one implant diagnosed with peri-implantitis and treated with a flapless surgical access, with or without systemic antimicrobials, curettage and, when needed, prostheses modification. Clinical and radiographic parameters were assessed at baseline and at 3 months and at least 12 months. The primary outcome was disease resolution (≤1 bleeding sites, probing depth [PD] ≤5 mm, no bone loss >0.5 mm). Multilevel regression analyses were used to identify predictors influencing the probability of attaining disease resolution. RESULTS: One hundred and seventeen patients with 338 implants were included. Disease resolution was attained in 54.4% of the 338 implants receiving flapless surgical access. At the end of the follow-up period, 111 patients (94.9%) with 295 implants (87.3%) did not require any further treatment, with 81.4% of these implants presenting PD ≤ 5 mm. History of periodontitis and PD at baseline were identified as negative predictors, while compliance with supportive peri-implant care, a machined surface and the adjunctive use of systemic azithromycin or metronidazole were identified as positive predictive factors for disease resolution. CONCLUSIONS: A flapless surgical approach led to disease resolution in 54.4% of the implants with peri-implantitis. Several risk/protective predictors for disease resolution were identified.

Cross-sectional association between severe periodontitis and diabetes mellitus: A nation-wide cohort study.

AIM: To evaluate the cross-sectional association between severe periodontitis and diabetes mellitus (DM), in a representative sample of Spanish population. MATERIALS AND METHODS: The di@bet.es epidemiological study is a population-based cohort study aimed to determine the prevalence and incidence of DM in the adult population of Spain. The at-risk sample at the final examination (2016-2017) included 1751 subjects who completed an oral health questionnaire. This questionnaire, together with demographic and risk factors, had been previously validated to build an algorithm to predict severe periodontitis in the Spanish population. Logistic regression models were used to evaluate the association between severe periodontitis and DM with adjustment for confounding factors. RESULTS: In total, 144 subjects developed DM, which yielded 8.2% cumulative incidence. Severe periodontitis was detected in 59.0%, 54.7% or 68.8% of the subjects depending on three different selected criteria at the 2016-2017 exam. All criteria used to define severe periodontitis were associated with DM in unadjusted analysis, but the magnitude of the association decreased after adjusting for significant confounders. The criteria '≥50% of teeth with clinical attachment loss ≥5 mm' presented an odds ratio of 4.9 (95% confidence interval: 2.2-10.7; p ≤ .001) for DM. CONCLUSIONS: Severe periodontitis is associated with DM in the Spanish population.

Minimal invasiveness in the reconstructive treatment of peri-implantitis defects.

Peri-implantitis is a plaque-associated pathologic condition occurring in tissues around dental implants, clinically characterized by increased peri-implant probing pocket depth and progressive loss of supporting bone. Consequently, to arrest further disease progression and to increase the chance to obtain re-osseointegration, surgical reconstructive procedures have been adopted. In particular, following a paradigm gathered from periodontal therapy, recent protocols have underlined the importance of a minimally invasive approach to optimize the outcomes of therapy while minimizing the risks of postoperative complications. The present review summarizes the level of evidence on the surgical reconstructive protocols focusing on the new approaches aiming to minimize surgical trauma and patients' postoperative discomfort, underlining the pros and cons of each treatment modality.

Complications and treatment errors in peri-implant hard tissue management.

Bone augmentation procedures aim to regenerate the deficient alveolar ridge to properly place dental implants that are completely surrounded by bone. However, these are invasive and technically demanding surgeries that are not free of either complications or treatment errors. Careful patient selection and preparation is a mandatory process to reduce the rate of complications in bone regeneration procedures, irrespective of the technique used. It is important to assess the cost benefit of the intervention and to evaluate the potential impact on the patient's quality of life, especially in the elderly and medically compromised patients. Most common postoperative complications are wound dehiscences, which may be reduced, at least partially, by proper knowledge of the surgical technique and the craniofacial anatomy. Other complications that may appear are postoperative infections or nerve injuries. The aim of this narrative review is to summarize the best available scientific evidence on the incidence of complications, as well as the ideal strategies for their prevention and management. Depending on the severity of the complication, treatment approaches may vary and can include drug prescription or even surgical re-entries to remove exposed barrier membranes or contaminated bone grafts. Adequate prevention and proper management of complications associated with bone augmentation interventions are a requirement for clinicians carrying out these demanding procedures. A series of cases illustrating proper management of complications in different clinical scenarios is presented.

Techniques on vertical ridge augmentation: Indications and effectiveness.

Vertical ridge augmentation techniques have been advocated to enable restoring function and esthetics by means of implant-supported rehabilitation. There are three major modalities. The first is guided bone regeneration, based on the principle of compartmentalization by means of using a barrier membrane, which has been demonstrated to be technically demanding with regard to soft tissue management. This requisite is also applicable in the case of the second modality of bone block grafts. Nonetheless, space creation and maintenance are provided by the solid nature of the graft. The third modality of distraction osteogenesis is also a valid and faster approach. Nonetheless, owing to this technique's inherent shortcomings, this method is currently deprecated. The purpose of this review is to shed light on the state-of-the-art of the different modalities described for vertical ridge augmentation, including the indications, the step-by-step approach, and the effectiveness.

Minimal invasiveness in vertical ridge augmentation.

Vertical ridge augmentation is one of the most challenging procedures in implant dentistry because of the advanced skills required by the operator and the fact that bone augmentation is aimed outside the bony contour, in an environment of reduced blood supply. What is more, the flap management required to ensure soft tissue closure frequently leads to associated comorbidities in terms of swelling and hematomas. For these reasons, and even if autologous onlay block grafts are still the gold standard, new techniques and biomaterials have favored the development of potentially less invasive approaches. The present work evaluates the most recent strategies in vertical ridge augmentation to reduce invasiveness and complications, including diagnostic/treatment planning considerations, surgical techniques, digital tools (eg, customized titanium meshes/membranes or bone blocks), and future trends in the field of tissue engineering and cell therapy.

The association between respiratory diseases and periodontitis: A systematic review and meta-analysis.

AIM: To evaluate (1) whether periodontitis has an influence on the prevalence/incidence of respiratory diseases (chronic obstructive pulmonary disease [COPD], asthma, community-acquired pneumonia [CAP], obstructive sleep apnoea [OSA] and COVID-19), and (2) what is the impact of periodontal therapy on the onset or progression of respiratory diseases. MATERIALS AND METHODS: An electronic search was performed on Pubmed, Cochrane Library and Scopus databases up to October 2021, to identify studies answering the PECOS and PICOS questions. RESULTS: Seventy-five articles were selected. Meta-analyses identified statistically significant associations of periodontitis with COPD (nstudies  = 12, odds ratio [OR] = 1.28, 95% confidence interval [CI] [1.16; 1.42], p < .001), and OSA (ns  = 6, OR = 1.65, 95% CI [1.21; 2.25], p = .001), but not for asthma (ns  = 9, OR = 1.53, 95% CI [0.82; 2.86], p = .181). For acute conditions, two studies were found for CAP, while for COVID-19, significant associations were found for the need of assisted ventilation (ns  = 2, OR = 6.24, 95% CI [2.78; 13.99], p < .001) and COVID-related mortality (ns  = 3, OR = 2.26, 95% CI [1.36, 3.77], p = .002). Only four intervention studies were found, showing positive effects of periodontal treatment on COPD, asthma and CAP. CONCLUSIONS: A positive association between periodontitis and COPD, OSA and COVID-19 complications has been found, while there is a lack of intervention studies.

Efficacy of adjunctive measures in the non-surgical treatment of peri-implantitis: A systematic review.

AIM: The aim of this systematic review was to evaluate the efficacy of patient-performed or administered adjunctive measures to non-surgical peri-implantitis therapy in terms of probing depth (PD) and/or bleeding on probing (BoP) reductions. MATERIALS AND METHODS: Randomized and controlled clinical trials with at least 6 months of follow-up were searched in three databases. Secondary outcomes included implant loss, disease resolution, recurrence of peri-implantitis, need of re-treatment, changes in marginal bone levels, patient-reported outcomes and adverse effects. RESULTS: Of 567 titles, 10 publications, reporting 9 investigations, were included. Three types of adjunctive measures were found (local/systemic antimicrobials and probiotics). Four studies evaluated the effects of local antimicrobials (i.e., minocycline microspheres, chlorhexidine chips or a metronidazole + amoxicillin gel), three studies evaluated systemic antimicrobials (either amoxicillin + metronidazole or metronidazole alone) and two studies evaluated probiotics (Lactobacillus reuteri strains). The addition of local antimicrobials led to modest improvements in PD reduction. Systemic antimicrobials showed significantly greater reductions in PD and BoP, especially at initially deep sites (PD > 6 mm). Due to the large heterogeneity among included studies, no meta-analyses were performed. CONCLUSIONS: Different adjunctive measures in the non-surgical treatment of peri-implantitis have different impact in terms of PD and BoP reductions. Improved PD reductions result after the use of systemic antimicrobials, and to a lesser extent, after the use of local antimicrobials.

Bone preservation or augmentation simultaneous with or prior to dental implant placement: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years.

AIM: To evaluate outcome measures and methods of assessment in clinical studies on bone augmentation/preservation procedures for the placement of dental implants. MATERIALS AND METHODS: A systematic search was performed on three databases from January 2011 to April 2021 to identify clinical studies reporting on any type of bone augmentation/preservation procedure. The outcomes that have been used to assess efficacy or performance in each study were registered and assigned to different domains (group of outcomes). The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. RESULTS: Seven-hundred and eighty-three publications were included. Only 81.8% of the papers had a clear definition of their primary outcome. The rate of complications (59.3%), implant survival (58.2%), 3D radiographic bone gain/change (30%), marginal bone level (MBL; 29%), and histological outcomes (25.5%) were the most frequently reported outcome domains. The most commonly used primary outcome was 3D radiographic bone gain/change (25.8%), followed by implant survival (13.0%). Patient-reported outcome measures (PROMs) were reported in 15.7% of studies. Differences in the reported outcomes were observed among different types of bone preservation/augmentation interventions (i.e., alveolar ridge preservation, immediate implants, horizontal and/or vertical ridge augmentation, and sinus floor augmentation). CONCLUSION: Within the past decade, great heterogeneity was observed among the outcomes considered in studies evaluating bone preservation/augmentation procedures. Three-dimensional radiographic bone gain/change was the most routinely reported main outcome variable, while PROMs were rarely reported.

Neuroinflammation related to the blood-brain barrier and sphingosine-1-phosphate in a pre-clinical model of periodontal diseases and depression in rats.

AIM: To explore the potential mechanisms of neuroinflammation (microglia, blood-brain barrier [BBB] permeability, and the sphingosine-1-phosphate [S1P] pathways) resulting from the association between periodontitis and depression in rats. MATERIALS AND METHODS: This pre-clinical in vivo experimental study used Wistar rats, in which experimental periodontitis (P) was induced by using oral gavages with Porphyromonas gingivalis and Fusobacterium nucleatum. Then, a chronic mild stress (CMS) model was implemented to induce a depressive-like behaviour, resulting in four groups: P with CMS (P+CMS+), P without CMS (P+CMS-), CMS without P (P-CMS+), and control (P-CMS-). After harvesting brain samples, protein/mRNA expression analyses and fluorescence immunohistochemistry were performed in the frontal cortex (FC). Results were analysed by ANOVA. RESULTS: CMS exposure increased the number of microglia (an indicator of neuroinflammation) in the FC. In the combined model (P+CMS+), there was a decrease in the expression of tight junction proteins (zonula occludens-1 [ZO-1], occludin) and an increase in intercellular and vascular cell adhesion molecules (ICAM-1, VCAM-1) and matrix metalloproteinase 9 (MMP9), suggesting a more severe disruption of the BBB. The enzymes and receptors of S1P were also differentially regulated. CONCLUSIONS: Microglia, BBB permeability, and S1P pathways could be relevant mechanisms explaining the association between periodontitis and depression.

Bone preservation or augmentation simultaneous with or prior to dental implant placement: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years.

AIM: To evaluate outcome measures and methods of assessment in clinical studies on bone augmentation/preservation procedures for the placement of dental implants. MATERIALS AND METHODS: A systematic search was performed on three databases from January 2011 to April 2021 to identify clinical studies reporting on any type of bone augmentation/preservation procedure. The outcomes that have been used to assess efficacy or performance in each study were registered and assigned to different domains (group of outcomes). The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. RESULTS: Seven-hundred and eighty-three publications were included. Only 81.8% of the papers had a clear definition of their primary outcome. The rate of complications (59.3%), implant survival (58.2%), 3D radiographic bone gain/change (30%), marginal bone level (MBL; 29%), and histological outcomes (25.5%) were the most frequently reported outcome domains. The most commonly used primary outcome was 3D radiographic bone gain/change (25.8%), followed by implant survival (13.0%). Patient-reported outcome measures (PROMs) were reported in 15.7% of studies. Differences in the reported outcomes were observed among different types of bone preservation/augmentation interventions (i.e., alveolar ridge preservation, immediate implants, horizontal and/or vertical ridge augmentation, and sinus floor augmentation). CONCLUSION: Within the past decade, great heterogeneity was observed among the outcomes considered in studies evaluating bone preservation/augmentation procedures. Three-dimensional radiographic bone gain/change was the most routinely reported main outcome variable, while PROMs were rarely reported.

Efficacy and risks of tooth-supported prostheses in the treatment of partially edentulous patients with stage IV periodontitis. A systematic review and meta-analysis.

AIM: The aim was to evaluate the efficacy and effectiveness of tooth-supported fixed prostheses in partially edentulous patients with stage IV periodontitis. MATERIAL AND METHODS: Randomized and controlled clinical trials (RCTs and CCTs) and prospective/retrospective cohort studies or case series were searched in three databases. Survival rate of abutment teeth was considered the primary outcome. Meta-analyses were performed whenever possible. RESULTS: Twenty-four publications were included. No RCTs or CCTs compared the efficacy of tooth-supported fixed prostheses between patients with severe periodontitis or non-periodontitis patients. Most of the data retrieved were derived from case series. The incidence of abutment-tooth loss after a follow-up period from 2 to 35.4 years was low (n = 17 studies; weighted mean incidence (WMI) = 4.8%; confidence interval (CI) [3.2, 6.5]). The corresponding figure for prostheses failure was WMI = 6.9% (n = 18; 95% CI [4.1, 9.7]). Technical complications seemed to be more frequent than biological complications (caries, endodontic failure, root fracture, etc.). Periodontal outcomes tended to remain stable over time. CONCLUSION: Tooth-supported fixed prostheses seemed to be a valid treatment approach to restore masticatory function in patients with stage IV periodontitis once periodontal therapy has been accomplished. However, the comparative efficacy of this treatment among periodontitis and non-periodontitis patients is unclear due to the absence of clinical trials.

One-year outcomes of dental implants with a hybrid surface macro-design placed in patients with history of periodontitis: A randomized clinical trial.

AIM: To evaluate the radiological, clinical, and microbiological outcomes of implants with a hybrid surface macro-design in patients with a history of periodontitis. MATERIAL AND METHODS: The study was designed as a 12-month, parallel-arm, randomized controlled trial where patients with a history of treated periodontitis in need of dental implants for single-unit or short-span prosthesis were randomly allocated to a test [implants with a machined titanium surface in the coronal collar (hybrid; HS)] or a control group [conventional implants with moderately rough surface up to the implant shoulder (RS)]. Patients were followed at 3, 6, and 12 months after loading with assessment of radiological, clinical, and microbiological outcomes, as well as patient-related outcome measures (PROMs). RESULTS: Forty patients were randomly assigned to either the RS group (n = 20) or the HS (n = 20) group. At 1 year, the mean marginal bone level changes were 0.22 [standard deviation (SD) 0.36] mm for the HS group and 0.22 (SD 0.29) mm for the RS group, with no significant differences between them (p = .961). Similarly, no significant differences in clinical, microbiological, or PROMs were observed between groups. CONCLUSIONS: HS implants demonstrated radiographic, clinical, and microbiological characteristics equal to RS implants in patients with a history of periodontitis. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (identifier NCT05010382).

Efficacy of soft tissue substitutes, in comparison with autogenous grafts, in surgical procedures aiming to increase the peri-implant keratinized mucosa: A systematic review.

OBJECTIVES: The aim of this systematic review was to evaluate the efficacy of soft tissue substitutes compared to autogenous gingival grafts in surgical procedures aimed at increasing the width of keratinized mucosa (KM) around dental implants. MATERIALS AND METHODS: Two focused questions were developed: PICOS #1) "What is the efficacy of surgical procedures using soft tissue substitutes, as compared to autogenous grafts, to increase the amount of peri-implant keratinized mucosa, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; and PICOS #2) "What is the effectiveness of soft tissue substitutes to increase the amount of peri-implant keratinized mucosa, in RCTs, CCTs, cohort studies or case series?". Besides KM augmentation, other relevant outcomes such as clinical and radiographic peri-implant outcomes, incidence of biological complications, surgical time, or patient-reported outcome measures (PROMs) were collected. Meta-analyses were performed whenever possible. RESULTS: Ten publications and an unpublished study were included. KM augmentation was significantly greater for autogenous grafts (n = 6; weighted mean difference (WMD) = -0.9 mm; 95% confidence interval (CI) [-1.4; -0.3]; p = .001). However, no significant differences between autogenous grafts and soft tissue substitutes were observed when exclusively xenografts were considered (n = 5; WMD=-0.8 mm; 95% CI [-1.6; 0.0]; p = .062). Surgical time and postsurgical pain seemed to be reduced by the use of soft tissue substitutes. CONCLUSIONS: Free gingival grafts (FGG) are more effective in the augmentation of KM mucosa around dental implants than soft tissue substitutes. However, substitutes of xenogeneic origin may be an alternative to autogenous tissues.

Efficacy of keratinized mucosal augmentation with a collagen matrix concomitant to the surgical treatment of peri-implantitis: A dual-center randomized clinical trial.

AIM: The aim of this study was to evaluate the efficacy of a xenogeneic collagen matrix to augment the width of keratinized mucosa (KM), concomitantly to the surgical treatment of peri-implantitis, when compared to the use of an autologous soft tissue graft. MATERIAL AND METHODS: In this 12-month parallel-arm randomized controlled clinical trial, patients with peri-implantitis were randomly assigned, one month after non-surgical therapy, to surgical resective treatment of peri-implantitis consisting on an apically positioned flap (APF) in combination with a KM augmentation procedure, either with an autologous free gingival graft (FGG) or a collagen matrix (CM). Primary outcomes were the increase in the width of KM and probing pocket depth (PPD) reduction at 12 months. As secondary outcomes, peri-implant radiographic and patient-reported outcomes were assessed. RESULTS: The intention-to-treat population consisted of 49 subjects, assigned to either the APF + FGG (n = 23) or APF + CM (n = 26) group. PPDs were reduced by 1.6 mm (SD 1.0) and 1.7 mm (SD 1.2), respectively, being these differences non statistically significant (p = .782). However, the increase in KM was significantly higher in the APF + FGG compared with APF + CM (2.5 mm [SD 1.6] vs. 1.6 mm [SD 1.2], respectively (p = .033). CONCLUSION: The tested surgical modalities resulted in similar improvements of the clinical parameters. Both free gingival graft and collagen matrix significantly increased the peri-implant keratinized mucosa, but this KM gain was significantly higher with the free gingival graft. Use of CM, however, was better appreciated by the patients, in terms of pain perception and analgesic consumption, although the surgical time was similar.

Importance of keratinized mucosa around dental implants: Consensus report of group 1 of the DGI/SEPA/Osteology Workshop.

OBJECTIVES: To assess the literature on (i) the relevance of the presence of a minimum dimension of keratinized peri-implant mucosa (KPIM) to maintain the health and stability of peri-implant tissues, and; (ii) the surgical interventions and grafting materials used for augmenting the dimensions of the KPIM when there is a minimal amount or absence of it. MATERIAL & METHODS: Two systematic reviews complemented by expert opinion from workshop group participants served as the basis of the consensus statements, implications for clinical practice and future research, and were approved in plenary session by all workshop participants. RESULTS: Thirty-four consensus statements, eight implications for clinical practice, and 13 implications for future research were discussed and agreed upon. There is no consistent data on the incidence of peri-implant mucositis relative to the presence or absence of KPIM. However, reduced KPIM width is associated with increased biofilm accumulation, soft-tissue inflammation, greater patient discomfort, mucosal recession, marginal bone loss and an increased prevalence of peri-implantitis. Free gingival autogenous grafts were considered the standard of care surgical intervention to effectively increase the width of KPIM. However, substitutes of xenogeneic origin may be an alternative to autogenous tissues, since similar results when compared to connective tissue grafts were reported. CONCLUSION: Presence of a minimum width of KPIM should be assessed routinely in patients with implant supported restorations, and when associated with pathological changes in the peri-implant mucosa, its dimensions may be surgically increased using autogenous grafts or soft-tissue substitutes with evidence of proven efficacy.

Screening of undiagnosed hyperglycaemia in the dental setting: The DiabetRisk study. A field trial.

AIM: To evaluate the efficacy of different screening protocols for undiagnosed hyperglycaemia in a Research Network of Dental Clinics coordinated by the Spanish Society of Periodontology (SEPA). MATERIAL AND METHODS: A total of 1143 patients were included in the study. Participants filled a questionnaire considering diabetes risk factors (FINDRISC) and received a periodontal screening examination. Patients with a slightly elevated score according to the Findrisc (≥7), received a point-of-care HbA1c and were eventually referred to their physician for confirmatory diagnosis. Receiver Operating Characteristic (ROC) curves were used to assess the performance of various predictive models with confirmed hyperglycaemia as outcome. RESULTS: From this population, 97 (8.5%) were finally diagnosed of diabetes (n = 28; 2.5%) or prediabetes (n = 69; 6.0%). When only including the results from the FINDRISC questionnaire, the model reported an area under the curve (AUC) of 0.866 (95% confidence interval - CI [0.833; 0.900]). This model significantly improved when a basic periodontal examination (EPB Code; AUC = 0.876; 95% CI [0.845: 0.906]; p = .042) or a point-of-care HbA1c were added (AUC = 0.961; 95% CI [0.941; 0.980]; p < .001). CONCLUSIONS: The tested protocol, combining the FINDRISC questionnaire and a point-of-care HbA1c, showed to be feasible when carried out in a dental clinic setting and was efficient to identify subjects with undiagnosed diabetes or prediabetes.

The association between metabolic syndrome and periodontitis in Spain: Results from the WORALTH (Workers' ORAL healTH) Study.

INTRODUCTION: Evidence of an association between periodontitis and MetS (metabolic syndrome) remains controversial. The objective of this study is to evaluate the association between periodontitis and MetS in a cross-sectional population survey. MATERIAL AND METHODS: WORALTH (Workers' ORAL healTH) Study is a cross-sectional survey, conducted on a representative sample of the Spanish employed population, including 5154 participants. An oral examination following the World Health Organization (WHO) criteria evaluated the periodontal status using the Community Periodontal Index (CPI) and Clinical Attachment Levels (CAL). Logistic regression analysis with adjustment for potential confounders was used to evaluate the association between periodontitis and MetS, and its individual components. RESULTS: Participants presenting a CPI = 4 were more likely to have MetS than subjects with CPI < 4 [odds ratio, OR = 1.41; 95% confidence interval (CI) 1.10-1.81; p < 0.001]. High blood pressure was the component with stronger association with periodontal status (OR = 1.94 for CAL ≥6 mm; 95% CI 1.49-2.53; p < 0.001). After stratifying for sex, the association was higher in women (OR = 2.20 for CPI = 4; 95% CI 1.31-3.62; p < 0.001). Non-metabolically healthy subjects, obese or not, presented a worse periodontal condition. CONCLUSION: Severe periodontitis (CPI = 4) was associated with MetS in a representative sample of the Spanish employed population. This association seems to be independent of body mass index and other potential confounders.

Periodontal diseases and depression: A pre-clinical in vivo study.

AIM: To analyse, through a pre-clinical in vivo model, the possible mechanisms linking depression and periodontitis at behavioural, microbiological and molecular levels. MATERIALS AND METHODS: Periodontitis (P) was induced in Wistar:Han rats (oral gavages with Porphyromonas gingivalis and Fusobacterium nucleatum) during 12 weeks, followed by a 3-week period of Chronic Mild Stress (CMS) induction. Four groups (n = 12 rats/group) were obtained: periodontitis and CMS (P+CMS+); periodontitis without CMS; CMS without periodontitis; and control. Periodontal clinical variables, alveolar bone levels (ABL), depressive-like behaviour, microbial counts and expression of inflammatory mediators in plasma and brain frontal cortex (FC), were measured. ANOVA tests were applied. RESULTS: The highest values for ABL occurred in the P+CMS+ group, which also presented the highest expression of pro-inflammatory mediators (TNF-α, IL-1ß and NF-kB) in frontal cortex, related to the lipoprotein APOA1-mediated transport of bacterial lipopolysaccharide to the brain and the detection of F. nucleatum in the brain parenchyma. A dysregulation of the hypothalamic-pituitary-adrenal stress axis, reflected by the increase in plasma corticosterone and glucocorticoid receptor levels in FC, was also found in this group. CONCLUSIONS: Neuroinflammation induced by F. nucleatum (through a leaky mouth) might act as the linking mechanism between periodontal diseases and depression.

Association between caries and periodontal diseases in a sample of employed adults in Spain: a cross-sectional study.

OBJECTIVES: To study whether there is an association between caries and periodontitis in a representative sample from employed Spanish adults. MATERIALS AND METHODS: This cross-sectional study is part of a wide epidemiological survey (WORALTH, Workers' ORAL healTH). Oral examination was carried out in 5130 dentate subjects. Periodontal status was assessed by clinical attachment level (CAL) and Community Periodontal Index (CPI) in index teeth. For caries, all teeth were classified as healthy, decayed (D), filled (F), or missed (M), and DMFT index and prevalence of cavitated caries were calculated. ANOVA, Chi-square tests, and regression models were performed. RESULTS: DMFT increased with CAL values, being 7.8, 9.6, and 10.5 for CAL 0-3 mm, 4-5 mm, and ≥ 6 mm, respectively. After adjustment for confounders, subjects with CPI ≥ 3 showed an odds ratio of 1.6 (95% confidence interval (CI) [1.3; 1.8]; p < 0.001) for presenting cavitated caries, and patients with CAL ≥ 6 mm had 0.8 higher mean DMFT (95% CI [0.2; 1.5]; p = 0.015), and 0.3 higher mean DFR (95% CI [0.2; 0.5]; p < 0.001) than those with CAL < 6 mm. CONCLUSIONS: The presence of CAL ≥ 6 m mm was associated with an increased DMFT and DFR, and the presence of CPI ≥ 3 was associated with a higher prevalence of cavitated caries in this representative sample. CLINICAL RELEVANCE: There is a tendency to present higher prevalence of dental caries among patients with periodontitis. Therefore, common preventive measures in dentistry, such as oral hygiene practices, should ideally include actions aimed to prevent at the same time dental caries and periodontitis.