Diagnostic measures for monitoring and follow-up in periodontology and implant dentistry.

This review discusses the role of diagnostic measures in the lifelong management of periodontal disease and peri-implant complications. After active treatment, these conditions require regular monitoring of the supporting structures of teeth and dental implants to assess bone and soft tissue health over time. Several clinical measures have been developed for the routine assessment of periodontal and peri-implant tissues, including periodontal and peri-implant probing, bleeding on probing, intraoral radiography, biomarker analysis, and microbiological testing. This review highlights the evolution of diagnostic practices, integrating traditional methods with emerging technologies such as resonance frequency analysis and ultrasound imaging to provide a holistic view of peri-implant health assessment. In addition to objective measurements, patient risk factors are considered. The goals of periodontal and peri-implant maintenance are to control disease activity and stabilize tissues through supportive care, which includes diagnostic measures at follow-up visits. This enables clinicians to monitor treatment outcomes, assess health status, and detect recurrence or progression early through routine evaluation, allowing additional interventions, including adjustment of supportive therapy intervals, to further improve and maintain periodontal and peri-implant stability over time.

Natural history of periodontal disease: The original Sri Lanka and Oslo studies.

Susceptibility to periodontal disease depends on individual factors within the host response to the bacterial challenge. The study of these factors requires longitudinal studies of an undisturbed development of the disease process. On the basis of the original longitudinal studies on the natural histology of periodontal disease staged in Sri Lanka and Oslo/Norway, several analyses of periodontal parameters and tooth status have been performed. The main findings were that in the first 20 years of complete absence of oral hygiene practices or preventive services attachment was lost at various rates. Three groups of subjects could be identified: rapidly progressing (RP) (8%), moderately progressing (MP) (81%), and subjects with no disease progression (NP) (11%). In the second two decades, the RP subjects have lost most of their teeth and no NP patients were identified anymore. The progression rate in these two decades was much slower, and the tooth mortality decreased. It could be predicted that subjects who had lost more than 2 mm at age 30 would not maintain a functional dentition at age 60. The corresponding control population in Oslo was used to study the influence of gingival inflammation on the initiation and progression of periodontal disease. The pattern and rates of attachment loss were identified in a population that was exposed to optimal and regular preventive services from age 3 onward. In the observation period of 26 years, it could be demonstrated that gingival inflammation varied little throughout adult life and always bleeding sites occurred consistently in 10% to 20%. The role of ongoing gingivitis in the pathogenesis of attachment loss was identified and also reflected stability whenever it was absent. Tooth mortality was only found in subjects with ongoing gingivitis. After 50 years of tooth age, 63% of the teeth were still maintained, while 99.8% were maintained after 50 years when gingival inflammation had been absent. Consequently, continuous gingivitis represented a risk factor for tooth loss.

Contemporary educational methods in periodontology.

AIM: The 1st European Workshop on Periodontal Education in 2009 made recommendations regarding the scope of periodontal education at undergraduate (UG), postgraduate (PG) and continuing professional development (CPD) levels, defining competencies and learning outcomes that were instrumental at the time in helping to define periodontal teaching curricula. The 19th European Workshop on Periodontology and 2nd European Consensus Workshop on Education in Periodontology (Education in Periodontology in Europe) was held in 2023 to identify changes and future developments in periodontal education (including those informed by the COVID-19 pandemic) and embracing methods and formats of periodontal teaching and training. The aim of this review was to assess current knowledge regarding education methods in periodontology, including traditional face-to-face (F2F) teaching and the move to student-centred methods, virtual learning methods and use of digital technology, as well as blended teaching and learning (including teaching delivery and assessment) at UG, PG and CPD levels. MATERIALS AND METHODS: Systematic searches were conducted to identify relevant studies from the literature. Data were extracted and descriptive summaries collated. RESULTS: The pandemic was a major disruptor of traditional F2F teaching but provided opportunities for rapid implementation of alternative and supplementary teaching methods. Although online learning has become an integral part of periodontal education, teachers and learners alike favour some form of F2F teaching. Blended teaching and learning are feasible in many areas of periodontal education, both for knowledge and skills acquisition as well as in assessment. Student-centred methods and blended approaches such as the flipped classroom seem highly effective, and online/virtual classrooms with both synchronous and asynchronous lectures are highly valued. Learning with haptic methods and virtual reality (VR) enhances the educational experience, especially when VR is integrated with traditional methods. The quality of the teacher continues to be decisive for the best knowledge transfer in all its forms. CONCLUSIONS: Live F2F teaching continues to be highly trusted; however, all types of student-centred and interactive forms of knowledge transfer are embraced as enhancements. While digital methods offer innovation in education, blended approaches integrating both virtual and traditional methods appear optimal to maximize the achievement of learning outcomes. All areas of periodontal education (UG, PG and CPD) can benefit from such approaches; however, more research is needed to evaluate their benefits, both for knowledge transfer and skills development, as well as in assessment.

Implementation of a communication curriculum in undergraduate dental education-students' opinions during a 5-year development phase.

INTRODUCTION: Communication training has become an essential part of the dental curriculum. The aim of this study was to evaluate the communication curriculum developed and introduced 2016-2021 at the University of Bern, School of Dental Medicine (SDM), Switzerland. MATERIALS AND METHODS: The curriculum was implemented cumulatively in three phases: (1) lectures and accompanying role plays, (2) forum theatre and trainer-based communication training and (3) self-assessment. Students were surveyed 2016-2021 at the end of each semester using anonymous online questionnaires with five-point Likert scales (0-4). RESULTS: A total of 191 fourth- and fifth-year students were surveyed, and 165 (86.4%) questionnaires were analysed. The mean age of the participants was 24.2 ± 1.4 and 45.5% were female. While students' opinions about the need to communicate increased during weekly lectures in phase 1, their opinions about their ability to communicate simultaneously decreased. During phase 2, fourth-year students' opinions on the need to communicate with dental patients increased from 3.22 ± 0.61 to 3.73 ± 0.45 (p = .001), anticipated benefits for dentists increased from 2.78 ± 0.71 to 3.43 ± 0.57 (p = .001) and for patients from 3.00 ± 0.76 to 3.47 ± 0.63 (p = .022). Only in phase 3, opinions on the ability to communicate statistically significantly increased for both fourth- (2.34 ± 0.71 to 2.72 ± 0.60, p = .033) and fifth-year (2.20 ± 0.63 to 2.86 ± 0.59, p = .001) students. Preferred teaching and assessment methods were trainer-based communication trainings (73.1%), lectures (67.3%) and self-assessments in the student clinic (59.6%). CONCLUSION: Communication curricula in dental education using methods such as lectures and trainer-based communication trainings may additionally need to include self-assessments to be effective from the students' perspective.

Spontaneous regeneration of keratinized tissue at implants and teeth.

AIM: To investigate the spontaneous regeneration of the implanto-mucosal and dento-gingival unit after complete removal of keratinized tissue (KT). MATERIALS AND METHODS: One hemi-mandible per dog (n = 4) was allocated to receive three dental implants (test sites, premolar region), whereas three premolars on the contralateral side were controls. After osseointegration, the entire KT (buccal + lingual) was surgically excised on all test and control sites, leaving the bone exposed. Clinical measurements were performed before excision (T0 ) and after 12 weeks (T1 ). Following healing, the animals were euthanized, and the specimens were histologically processed. Descriptive statistical analyses were performed. RESULTS: Clinical measurements revealed that at T1 , on all teeth, a band of KT was spontaneously regenerated (mean width: 2.60 ± 0.66 mm), whereas on implants, KT was detected only occasionally at mesial or distal but not at buccal sites (mean total: 0.35 ± 0.53 mm; p < .0001). Histologically, spontaneous regeneration of the dento-gingival unit was evident, displaying masticatory mucosa. At the implant sites, on the other hand, the implanto-mucosal unit was characterized by a non-keratinized epithelium and elastic fibres, indicating the characteristics encountered in alveolar mucosa. CONCLUSION: After excision of KT at implant sites, the spontaneous regeneration of the soft tissue is characterized by a non-keratinized epithelium typical for alveolar mucosa, while at tooth sites the spontaneous regeneration was characterized by soft tissue resembling gingiva.

Clinical and histologic evaluation of heterotopic mucosa transpositioning at teeth and dental implants.

AIM: To investigate the healing after heterotopic mucosa transpositioning at dental implants and teeth. MATERIALS AND METHODS: One hemimandible per dog (n = 4) was allocated to receive 3 implants (test), whereby 3 premolars on the contralateral side served as controls. After osseointegration, a Z-plasty was performed on the buccal aspect of the test and control sites to heterotopically move the zone of keratinized tissue (KT) into a region with non-keratinized tissue (nKT) and vice versa. Clinical measurements were performed before (T0) and at 12 weeks following heterotopic transposition (T1). Thereafter, specimens were processed for histological analysis. RESULTS: Clinical measurements revealed that at T1, a band of KT was reestablished at teeth (mean: 2.944 ± 1.866 mm), whereas at implants, the transpositioned nKT resulted in a mucosa without any signs of keratinization (mean: 0 mm; p < .0001). At implant sites, the probing attachment level loss was more pronounced compared to tooth sites (-1.667 ± 1.195 mm and -1.028 ± 0.878 mm, respectively; p = .0076). Histologically, the transpositioned nKT, was accompanied by the formation of KT at the tooth but not at implant sites. The supracrestal soft tissues were statistically significantly higher at tooth compared to implant sites (2.978 ± 0.483 mm and 2.497 ± 0.455 mm, p = .0083). The transpositioned KT remained mostly unaltered in its morphological characteristics. CONCLUSIONS: The findings of this study indicate that: (a) transpositioned KT may retain its morphological characteristics; and (b) transpositioned nKM was accompanied by the formation of KT at the tooth but not at implant sites.

Behavioral strategies for periodontal health.

The impact of lifestyle factors has been increasingly studied and discussed in oral healthcare. Positive lifestyle factors are important in maintaining oral health or controlling disease, but they are not easy to adopt over the long term. Along with public health initiatives within communities and groups, there is a role for behavior change interventions delivered in dental practice settings to improve the periodontal health of individuals. Behavior management is now seen as a part of both prevention and therapy of periodontal diseases. This article summarizes the evidence on behavioral strategies for periodontal health to inform and assist oral healthcare professionals in implementing behavior change in their practice. In addition, strategies for education and training in communication and behavior change techniques are considered.

Evaluation of the implant disease risk assessment (IDRA) tool: A retrospective study in patients with treated periodontitis and implant-supported fixed dental prostheses (FDPs).

AIM: To evaluate the Implant Disease Risk Assessment (IDRA) tool for the prediction of peri-implantitis in treated periodontitis patients with implant-supported fixed dental prostheses (FDPs) after at least 5 years of function. MATERIAL AND METHODS: From the patient pool of implant patients enrolled in a regular supportive periodontal therapy programme (SPT) for at least 5 years, 239 patients were screened. Eighty patients met the inclusion criteria and underwent evaluation through the criteria of the IDRA tool. Areas under the curve (AUCs) for receiver operating characteristic (ROC) curves including 95% confidence intervals were estimated. RESULTS: Seventy-nine patients (43 males and 36 females, 8 smokers), aged on average 59.0 years (range: 40-79 years) at baseline (i.e. FDP delivery) were analysed. The calculated IDRA-risk was in 34 patients (42.5%) a moderate risk, while 45 patients (56.3%) were considered at high IDRA-risk. One patient categorized at low IDRA-risk was excluded from the analysis. The AUC was 0.613 (95% CI: 0.464-0.762) if the IDRA-risk was associated with prevalence of peri-implantitis at the most recent follow-up. Peri-implantitis was diagnosed in 4 patients (12%) at moderate and in 12 patients (27%) at high IDRA-risk, respectively. The calculated odds ratio for developing peri-implantitis in patients with high IDRA-risk compared with patients with moderate IDRA-risk was 2.727 with no statistically significant difference between the two groups (95% CI: 0.793-9.376). CONCLUSION: Within the limitations of the present retrospective study, the IDRA algorithm might represent a promising tool to assess patients at moderate or high risk of developing peri-implantitis.

Adjunctive laser or antimicrobial photodynamic therapy to non-surgical mechanical instrumentation in patients with untreated periodontitis: A systematic review and meta-analysis.

AIM: To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis patients. MATERIALS AND METHODS: Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, (a) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non-surgical instrumentation alone? and (b) does application of aPDT provide adjunctive effects on PPD changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta-analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines. RESULTS: Out of 1,202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta-analysis including 2 articles (total n = 42; split-mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI: -0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650-700 nm). In terms of adjunctive laser application, a high variability of clinical outcomes at 6 months was noted. Two articles included patient-reported outcomes and 10 reported on the presence/absence of harms/adverse effects. CONCLUSIONS: Available evidence on adjunctive therapy with lasers and aPDT is limited by (a) the low number of controlled studies and (b) the heterogeneity of study designs. Patient-reported benefits remain to be demonstrated.

Impact of risk factor control interventions for smoking cessation and promotion of healthy lifestyles in patients with periodontitis: A systematic review.

AIM: The aim of this systematic review was to identify the most recent widely accepted guidelines for risk factor control interventions and to assess their impact in patients with periodontitis. MATERIALS AND METHODS: The electronic search strategy included a first systematic search to identify guidelines for interventions for smoking cessation, diabetes control, physical exercise (activity), change of diet, carbohydrate (dietary sugar) reduction and weight loss in the general population and a second systematic search to identify the studies evaluating these interventions in periodontitis patients. RESULTS: A total of 13 guidelines and 25 studies were selected. Most guidelines included recommendations for all healthcare providers to provide interventions and follow-up counselling with the risk factors considered in the present review. In patients with periodontitis, interventions for smoking cessation and diabetes control were shown to improve periodontal health while the impact of dietary interventions and the promotion of other healthy lifestyles were moderate or limited. CONCLUSIONS: While aiming to improve treatment outcomes and the maintenance of periodontal health, current evidence suggests that interventions for smoking cessation and diabetes control are effective, thus emphasizing the need of behavioural support in periodontal care.

Promoting behavioural changes to improve oral hygiene in patients with periodontal diseases: A systematic review.

AIM: This systematic review investigates the impact of specific interventions aiming at promoting behavioural changes to improve oral hygiene (OH) in patients with periodontal diseases. METHODS: A literature search was performed on different databases up to March 2019. Randomized and non-randomized controlled trials evaluating the effects of behavioural interventions on plaque and bleeding scores in patients with gingivitis or periodontitis were considered. Pooled data analysis was conducted by estimating standardized mean difference between groups. RESULTS: Of 288 articles screened, 14 were included as follows: 4 studies evaluated the effect of motivational interviewing (MI) associated with OH instructions, 7 the impact of oral health educational programmes based on cognitive behavioural therapies, and 3 the use of self-inspections/videotapes. Studies were heterogeneous and reported contrasting results. Meta-analyses for psychological interventions showed no significant group difference for both plaque and bleeding scores. No effect was observed in studies applying self-inspection/videotapes. CONCLUSIONS: Within the limitations of the current evidence, OH may be reinforced in patients with periodontal diseases by psychological interventions based on cognitive constructs and MI principles provided by oral health professionals. However, no conclusion can be drawn on their specific clinical efficacy as measured by reduction of plaque and bleeding scores over time.

Clinical and radiographic outcomes of implant-supported fixed dental prostheses with cantilever extension. A retrospective cohort study with a follow-up of at least 10 years.

AIM: To report the clinical and radiographic outcomes of implant-supported fixed dental prostheses with cantilever extensions (FDPCs) after a function time ≥10 years. MATERIAL AND METHODS: Patients with FDPCs in posterior areas were clinically and radiographically re-evaluated. Mesial and distal radiographic marginal bone levels (mBLs) from baseline (i.e. delivery of FDPC) to the follow-up examination were calculated and compared between implant surfaces adjacent to and distant from the cantilever extension. Implant survival rate, pocket probing depth (PPD), presence/absence of bleeding on probing (BoP) and presence/absence of mechanical/technical and biological complications were recorded. RESULTS: Twenty-six patients with 30 FDPCs supported by 60 implants were re-evaluated after a mean loading time of 13.3 ± 2.7 years (range: 10-18.6 years). One diameter-reduced implant carrying a cantilever extension fractured, yielding a patient-based survival rate of 96.2% (95% CI: 0.95/1.0). The mean marginal bone level change was not statistically significantly different from baseline to follow-up (1.2 mm ± 0.9 to 1.6 mm ± 1.7; 95% CI: -0.1/0.9; p > .05). The mean PPD changed statistically significantly from 3.4 mm ± 0.7 to 3.7 mm ± 0.7 (95% CI: 0.04/0.6; p = .02). Loss of retention occurred ≥ 1x in 9 patients (34.6%, 95% CI: 0.44/0.83). At follow-up, peri-implant health was diagnosed in 12 (46.2%), peri-implant mucositis in 7 (26.9%) and peri-implantitis in 7 (26.9%) patients, respectively. CONCLUSION: Despite a high rate of loss of retention, the use of implant-supported FDPCs in posterior areas represents a reliable long-term treatment option with a high implant survival rate and minimal peri-implant bone level changes irrespective of the location of the cantilever extension.

Anti-inflammatory potential of an essential oil-containing mouthwash in elderly subjects enrolled in supportive periodontal therapy: a 6-week randomised controlled clinical trial.

OBJECTIVES: Essential oils and other plant extracts have evoked interest as sources of natural medicinal products. They have been proven to exert antibacterial, antifungal, antiviral and antioxidant properties, but the mechanism of action has not been fully elucidated. AIM: This study aims to evaluate the potential of a sage-containing mouthwash to alleviate inflammatory signs of intra-oral mucosa and gingiva in comparison with a water/alcohol-based placebo. MATERIAL AND METHODS: This study was conducted as a randomised, placebo-controlled, double-blind, parallel design clinical study. Forty-eight dentate subjects were randomly assigned to a test (sage-containing mouthwash) or a placebo group (water/alcohol-based solution). Subjects rinsed once daily for 30 s over a period of 6 weeks. Sulcus Bleeding Index (SBI), Plaque Index (PLI), tooth staining, xerostomia and degree of stomatitis were assessed at baseline and after 6 weeks. RESULTS: Subjects' mean age was 77.5 ± 7.3 years. SBI was reduced from 1.3 ± 0.9 to 0.8 ± 0.7 (test, p = 0.0029) and 1.4 ± 0.9 to 1.1 ± 0.7 (placebo, p = 0.0105). Similarly, PLI was reduced from 1.2 ± 0.5 to 1.0 ± 0.3 (test, p = 0.0080) and 1.3 ± 0.4 to 1.1 ± 0.6 (placebo, p = 0.0087); no between-group differences were found (p > 0.05). Stomatitis, xerostomia and tooth staining revealed no change after 6 weeks. CONCLUSION: The irrigation with a sage-containing mouthwash did not result in a superior beneficial effect on inflammatory parameters and plaque indices compared with the placebo. The expected contribution of the plant extracts to their potential impact on oral health may need further investigation. CLINICAL RELEVANCE: The proposed mouthwash might be suitable for patients with inflammatory signs of the gingiva who prefer natural remedies.

Time between recall visits and residual probing depths predict long-term stability in patients enrolled in supportive periodontal therapy.

AIM: To relate the time between recall visits and residual periodontal probing depths (PPDs) to periodontal stability in patients enrolled in supportive periodontal therapy (SPT). MATERIALS AND METHODS: Retrospective data on residual PPDs from 11,842 SPT visits were evaluated in SPT patients at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland, 1985-2011. A residual PPD-based algorithm was developed to compute SPT intervals with no expected change of residual PPD. RESULTS: A total of 883 patients aged 43.9 (±13.0) years and 55.4% (n = 489) being females were identified. Linear mixed model analysis yielded highest statistically significant impact on PPD change with time between SPT visits, presence of residual PPD ≥4 mm, and bleeding on probing (p < 0.0001). Patients returning for SPT five times consecutively earlier than computed presented mean % PPDs ≥4 mm of 5.8% (±3.9) compared with patients returning later (19.2%, ±7.6) (p < 0.0001). Additionally, patients attending >50% of their SPT visits earlier versus later demonstrated increased periodontal stability after 5 years (p = 0.0002) and a reduced frequency of tooth loss (0.60, ±0.93 versus 1.45, ±2.07) after 20 years (p < 0.0001). CONCLUSIONS: To reach and maintain periodontal stability during SPT, individual quantitative data from comprehensive residual PPD profiles may contribute to the improved planning of SPT intervals.

Microbiological analysis and the outcomes of periodontal treatment with or without adjunctive systemic antibiotics-a retrospective study.

OBJECTIVES: The purpose of this retrospective study was to assess the impact of microbiological diagnostics on the outcomes of periodontal treatment with or without adjunctive use of systemic antibiotics. MATERIALS AND METHODS: Patient files were screened for microbiological analysis before (T1) and after non-surgical periodontal therapy (T2). Medical history, diagnosis, clinical data, and results of the microbiological analysis were extracted from the patient's file. After descriptive statistics, logistic regression analysis was performed to model the presence of 90 and 50% reductions of numbers of sites with probing depths (PD) of ≥ 5 mm at T2 (90%-PD5 and 50%-PD5), respectively, against the presence of bacterial species, clinical diagnosis, and adjunctive use of systemic antibiotics. RESULTS: Eighteen patients diagnosed with aggressive periodontitis (AP, 17 with adjunctive antibiotics) and 84 with chronic periodontitis (CP, 31 with adjunctive antibiotics) were included in the analysis. Logistic modeling of bacteria at T1 to 90%-PD5 failed to show any statistical significance. Using 50%-PD5, presence of all Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola and in particular of T. denticola at T1 was associated with good response to therapy. Modeling of bacterial presence to 90-%PD5 and to 50-%PD5 at T2 found an association with absence of T. forsythia (90-%PD5 and 50-%PD5) and of T. denticola and Campylobacter rectus (50%-PD5). Modeling bacteria at T1, antibiotic group and oral hygiene at T2 on 50%-PD5 revealed odds ratio (OR) of the adjunctive antibiotic group between 2.70 and 52.4, of the oral hygiene between 3.27 and 4.11, and of the bacteria at T1 up to 28.6 (Porphyromonas gingivalis, T. forsythia, or T. denticola). CONCLUSION: Microbiological analysis of the most important species associated with periodontal diseases appears to support a clinically based decision for the adjunctive use of systemic antibiotics. CLINICAL RELEVANCE: The present findings appear to support the use microbiological testing to strengthen the clinical decision making process for either using or not using systemic antibiotics in conjunction with non-surgical periodontal therapy.

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

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

Persistence of Porphyromonas gingivalis is a negative predictor in patients with moderate to severe periodontitis after nonsurgical periodontal therapy.

OBJECTIVES: The aim of this study was to evaluate the quality of prediction for stable results after nonsurgical periodontal therapy by several microbiological variables of the subgingival biofilm and biomarkers of gingival crevicular fluid or oral lavage. MATERIAL AND METHODS: Forty-six individuals with moderate or severe chronic periodontitis receiving nonsurgical periodontal therapy were monitored for clinical variables, selected microorganisms, and biomarkers at baseline and 3 and 6 months thereafter. Logistic regression analysis and general linear model (GLM) were applied for analysis of variance and covariance. RESULTS: At 6 months, 20 patients showed a high response (HR) to treatment (at least 60 % of reduction of numbers of sites with PD >4 mm), whereas 26 did not (low response, LR). All clinical variables were significantly improved at 3 and 6 months within each group (p < 0.001, each compared with baseline). Modeling the impact of Porphyromonas gingivalis, Treponema denticola, and median of MMP-8 on to the response to treatment as continuous variables by GLM showed a significant influence of these variables (p = 0.045) with the strongest influence of P. gingivalis (p = 0.012) followed by T. denticola (p = 0.045) and no association with MMP-8 (p = 0.982). Samples tested positively for P. gingivalis decreased only in HR (3 months: p = 0.003; 6 months: p = 0.002). Calprotectin levels in GCF were lower in the HR group compared with the LR group at 3 months (p = 0.008) and at 6 months (p = 0.018). CONCLUSION: Persistence of P. gingivalis combined with a high GCF level of calprotectin may have a negative predictive value on response to periodontal therapy. CLINICAL RELEVANCE: Microbiological diagnostics for P. gingivalis before and 3 months after SRP may have a predictive value on response to periodontal therapy. The combination with MMP-8 in oral lavage or preferably calprotectin in GCF might give additional information.

The Impact of Brief Interventions for Tobacco Cessation on Patients' Awareness of Cigarette Smoking as a Risk Factor for Chronic Periodontitis.

PURPOSE: To evaluate the awareness of cigarette smoking as a risk factor for chronic periodontitis in patients either undergoing active periodontal treatment (APT) or enrolled in supportive periodontal therapy (SPT). MATERIALS AND METHODS: Comprehensive tobacco use history was collected with a questionnaire in 50 patients before and after APT (test) and in 50 patients (control) enrolled in SPT at the School of Dental Medicine, University of Bern. Carbon monoxide (CO) exhalation levels were measured in both APT and SPT patients. RESULTS: In the test group, 94% (n = 47) completed the study. Before APT, 48% of these (n = 24) knew about the association between smoking and periodontal disease, while 42% (n = 21) assumed a possible association and 10% (n = 5) did not. Following APT, 53% (n = 25) knew about the association, while 34% (n = 17) still assumed a possible association and 10% (n = 5) did not. In the control group, 60% (n = 30) of SPT patients knew about the association of smoking with periodontal disease, while 30% (n = 15) assumed an association and 10% (n = 5) were not aware of any association. In both APT and SPT patients, neither between-group nor baseline to follow-up differences were detected (p > 0.05). CONCLUSIONS: Brief interventions for tobacco cessation during APT or SPT failed to increase periodontal patients' awareness of smoking as a risk factor for chronic periodontitis. In order to both increase awareness and motivation to quit tobacco use, more counseling than conventional brief interventions may be needed. Key words: chronic periodontitis, exhaled carbon monoxide, patient education, risk factor, smoking, smoking cessation.

Host-derived biomarkers at teeth and implants in partially edentulous patients. A 10-year retrospective study.

OBJECTIVES: To assess a selection of host-derived biomarkers in peri-implant sulcus fluid (PISF) and gingival crevicular fluid (GCF) from adjacent teeth 10 years following implant placement. MATERIAL AND METHODS: Peri-implant sulcus fluid and GCF samples obtained from the deepest sites of 504 implants and 493 adjacent teeth were analysed for levels of interleukin (IL)-1ß, matrix metalloproteinase (MMP)-3, MMP-8, MMP-1, and MMP-1 bound to tissue inhibitor of MMP (TIMP)-1 (MMP-1/TIMP-1) by enzyme-linked immunosorbent assay (ELISA) technique. RESULTS: Overall, MMP-8 was detected in 90% of the sites. In more than 50% of the sites, IL-1ß was identified while in 30% of the sites MMP-1, MMP-1/TIMP-1 and MMP-3 were found over the detection level. Increased biomarkers levels from PISF and GCF were positively correlated (r = 0.375-0.702; P < 0.001). However, no qualitative and quantitative differences were found between PISF and GCF. The levels of MMP-1 were negatively correlated with those of MMP-1/TIMP-1 at implants (r = -0.644; P < 0.001). Median MMP-1 levels at implants were high (5.17 pg/site) in subjects with severe chronic periodontitis and low in patients with mild-to-moderate chronic periodontitis (0 pg/site; P = 0.026) or gingivitis (0 pg/site; P = 0.034). Levels of IL-1ß were found to be different in GCF according to the periodontal conditions (P = 0.001) with the highest level found in mild-to-moderate periodontitis (6.2 pg/site). Clinical attachment levels at implants demonstrated an inverse correlation with MMP-1/TIMP-1 (r = -0.147; P = 0.001). CONCLUSIONS: Increased levels of MMP-8 and IL-1ß in PISF or GCF may be associated with inflammation around teeth and implants while lower levels of MMP-1/TIMP-1 may be an indicator of disease progression around implants.