Autologous platelet concentrates after third molar extraction: A systematic review.

Surgical removal of impacted mandibular third molars is often followed by postoperative sequelae like pain, swelling, trismus, etc. This systematic review explored the benefits of applying different autologous platelet concentrates (APCs) in the extraction socket of third molars. For this systematic review, PubMed, EMBASE, Web of Science, and Scopus have been utilized, initially yielding 544 papers. The search was narrowed to randomized controlled trials (RCTs, n = 59) published before 2024, all comparing the outcome of applying APCs in the extraction socket of surgically removed impacted mandibular third molars with unassisted healing (blood clot). Most RCTs primarily assessed the impact of APCs on postoperative sequelae. Some RCTs looked at soft- and hard-tissue healing. Eleven studies used PRP, three PRGF, and 45 L-PRF. A detailed analysis revealed a large heterogeneity between studies rendering a meta-analysis impossible. Moreover, the risk of bias was considered high. In the majority of RCTs, the application of an APC resulted in statistically significant reductions of postoperative sequelae (lower pain intensity, lower consumption of analgesics, less postoperative edema, and a lower incidence of trismus and alveolar osteitis), as well as a faster soft tissue healing, and qualitatively and quantitatively better bone healing. A minority of studies reported significant differences in periodontal parameters distally from the second molar.

Ten-Year Follow-Up of Oral Implants in Bone With Limited Bucco-Oral Dimensions: A Prospective Case Series.

BACKGROUND: It has been suggested that 1-2 mm of bone width at the buccal and lingual aspect is required for a successful long-term implant outcome. Low levels of evidence support this minimum threshold of bone width. This prospective study aimed at evaluating the outcome of implants placed in alveolar ridges with limited bucco-oral dimensions. MATERIALS AND METHODS: One-hundred implants (dia. 3.5 mm) were placed in 28 patients with narrow alveolar ridge dimensions (<4.5 mm width) without augmentation procedures and conventionally loaded. Intra-oral radiographs were taken at implant placement and abutment connection and at 1, 2, 3, 5 and 10 years of follow-up. At the 10-year follow-up (21 patients; 75 implants), full-mouth periodontal charting was performed, and the peri-implant keratinized tissue width and attachment type were recorded. Two calibrated periodontists analysed the peri-implant bone changes. RESULTS: After 10 years, all implants showed successful osseointegration and a cumulative survival rate of 100%. The implants were placed 0.85 mm ± 0.89 mm subcrestally. After 10 years, the marginal bone was located 1.59 ± 2.11 mm apical to the implant shoulder. Throughout this period of follow-up, the mean annual marginal bone loss was 0.094 mm. Furthermore, 84% of implants in 72% of patients presented with bleeding on probing. CONCLUSION: After 10 years of functional loading, implants placed in alveolar ridges with limited bucco-oral dimensions (≤4.5 mm) exhibited only minimum marginal bone loss.

Comparative 16S rRNA gene sequencing study of subgingival microbiota of healthy subjects and patients with periodontitis from four different countries.

AIM: To investigate the differences between the subgingival microbiota of healthy subjects (HS) and periodontitis patients (PP) from four different countries through a metagenomic approach. MATERIALS AND METHODS: Subgingival samples were obtained from subjects from four different countries. Microbial composition was analysed through high-throughput sequencing of the V3-V4 region of the 16S rRNA gene. The country of origin, diagnosis and clinical and demographic variables of the subjects were used to analyse the microbial profiles. RESULTS: In total, 506 subgingival samples were analysed: 196 from HS and 310 from patients with periodontitis. Differences in richness, diversity and microbial composition were observed when comparing samples pertaining to different countries of origin and different subject diagnoses. Clinical variables, such as bleeding on probing, did not significantly affect the bacterial composition of the samples. A highly conserved core of microbiota associated with periodontitis was detected, while the microbiota associated with periodontally HS was much more diverse. CONCLUSIONS: Periodontal diagnosis of the subjects was the main variable explaining the composition of the microbiota in the subgingival niche. Nevertheless, the country of origin also had a significant impact on the microbiota and is therefore an important factor to consider when describing subgingival bacterial communities.

[Innovative methods and developments in oral care. L-PRF: from evidence to clinical use]. / Serie: Innovatieve technieken en ontwikkelingen in de mondzorg. L-PRF: van evidence naar toepassingen in de praktijk.

Leukocyte- and platelet-rich fibrin (L-PRF) is a fully autologous biomaterial made from venous blood drawn from the patient. Due to its regenerative potency, antibacterial capacity, and analgesic activity, L-PRF can be used during surgical procedures as a sole biomaterial or as a bioactive additive along with other natural and synthetic biomaterials. There is sufficient scientific evidence available for applying L-PRF for various indications. The preparation protocol of L-PRF is simple, inexpensive and not time-consuming, making it possible to implement it in the daily practice. The type of centrifuge and blood collection tubes used, the settings of the centrifuge (rotation time and force) as well as the time between the different steps in the protocol have an influence on the biological and mechanical properties of L-PRF.

The OralChromaTM CHM-2: a comparison with the OralChromaTM CHM-1.

OBJECTIVES: Already decades ago, the diagnosis of halitosis was facilitated with the arrival of chair-side instruments to score the breath odor. These devices are used for a more objective assessment of halitosis compared with organoleptic scoring, but these too have their disadvantages. To overcome some of the drawbacks of the original model of the OralChromaTM (CHM-1), few years ago a second generation of this machine (CHM-2) was introduced. This study compared both devices in a clinical setting. MATERIALS AND METHODS: All records of the patients visiting a specialized halitosis consultation over a period of 5 years (2012-2017) were examined. The correlations of the OralChromaTM CHM-1 and CHM-2 with the organoleptic and Halimeter® measurements were analyzed. Additionally the sensitivity, specificity, and negative and positive predicted values were calculated. RESULTS: A total of 581 data points were included (CHM-1: 292, CHM-2: 289). The correlations between both models with the organoleptic measurements were not statistically significant different. The CHM-2 seemed superior to the CHM-1 in the quantification of dimethyl sulfide with a detection rate of 95% and 61%, respectively. Additionally, the CHM-2 was significantly more sensitive for dimethyl sulfide than the CHM-1. However the latter showed in turn a better sensitivity for hydrogen sulfide and methyl mercaptan. CONCLUSION: The CHM-2 showed a better sensitivity for dimethyl sulfide than its predecessor. However, its sensitivity for hydrogen sulfide and methyl mercaptan was worse. CLINICAL RELEVANCE: Dimethyl sulfide is the main volatile implicated in extra-oral blood-borne halitosis, this makes the OralChromaTM CHM-2 the instrument of choice when this is suspected.

Influence of tongue brushing and scraping on the oral microflora of periodontitis patients.

OBJECTIVE: To examine the effect of tongue cleaning with a tongue scraper (TS) or toothbrush (TB) in patients with periodontitis. BACKGROUND: The tongue is a possible reservoir for bacterial (re)colonization of the periodontal tissues in patients with periodontitis. To date, it is not known what the influence of tongue cleaning is on the tongue coating of patients with periodontitis. MATERIAL AND METHODS: Eighteen systemically healthy, untreated moderate to severe adult patients with periodontitis with some degree of tongue coating were randomly assigned to the use of a TS or TB for cleaning the tongue. Microbial load of the saliva and tongue dorsum, amount of tongue coating and patient perception about tongue cleaning were studied at baseline and 2 weeks later. RESULTS: Two weeks of tongue cleaning with either a TB or a TS, did not influence the microbiological counts, neither in the saliva, nor in the tongue coating, even though tongue coating was significantly less. The patients themselves experienced no differences in breath odour or taste sensation after 2 weeks of tongue cleaning; however, they felt that their tongue was cleaner at the end of the study compared to baseline. No differences could be detected between the uses of a TS vs a TB. CONCLUSION: In patients with periodontitis, tongue cleaning does not influence the bacterial load in the saliva or on the tongue dorsum.

Clinical concentrations of peroxidases cause dysbiosis in in vitro oral biofilms.

BACKGROUND AND OBJECTIVE: Little is known about the initiation of dysbiosis in oral biofilms, a topic of prime importance for understanding the etiology of, and preventing, periodontitis. The aim of this study was to evaluate the effect of different concentrations of crevicular and salivary peroxidase and catalase on dysbiosis in multispecies biofilms in vitro. MATERIAL AND METHODS: The spotting technique was used to identify the effect of different concentrations of myeloperoxidase, lactoperoxidase, erythrocyte catalase, and horseradish peroxidase in salivary and crevicular fluid on the inhibitory effect of commensals on pathobiont growth. Vitality-quantitative real-time PCR was performed to quantify the dysbiotic effect of the peroxidases (adjusted to concentrations found in periodontal health, gingivitis, and periodontitis) on multispecies microbial communities. RESULTS: Agar plate and multispecies ecology experiments showed that production of hydrogen peroxide (H2 O2 ) by commensal bacteria decreases pathobiont growth and colonization. Peroxidases at concentrations found in crevicular fluid and saliva neutralized this inhibitory effect. In multispecies communities, myeloperoxidase, at the crevicular fluid concentrations found in periodontitis, resulted in a 1-3 Log increase in pathobionts when compared with the crevicular fluid concentrations found in periodontal health. The effect of salivary lactoperoxidase and salivary myeloperoxidase concentrations was, in general, similar to the effect of crevicular myeloperoxidase concentrations. CONCLUSIONS: Commensal species suppress pathobionts by producing H2 O2 . Catalase and peroxidases, at clinically relevant concentrations, can neutralize this effect and thereby can contribute to dysbiosis by allowing the outgrowth of pathobionts.

L-PRF for increasing the width of keratinized mucosa around implants: A split-mouth, randomized, controlled pilot clinical trial.

BACKGROUND: This study aims to evaluate the use of the leukocyte- and platelet-rich fibrin (L-PRF) membranes in increasing the width of the keratinized mucosa (KM) around implants. MATERIAL AND METHODS: Eight patients in need for bilateral widening of the KM around implants in the lower jaw were recruited for a spit-mouth randomized controlled trial. At the control site, a free gingival graft (FGG) was used, whereas at the other side (test), L-PRF membranes were applied. The primary outcome was the increase in width of KM around the implants. As secondary outcomes, the postoperative pain and surgical time were assessed. The follow-up period was 6 weeks. RESULTS: A significant increase in the total bucco-lingual width of KM in both groups was observed, with 1.3 mm ± 0.9 extra gain (P < .05) for the FGG sites. Shrinkage of the widened areas in this period was 32.1% at the test site and 23.6% at the control site. All values of the postoperative pain scores at the control site were higher than at the test site. The mean surgery time in the test and control group was 29.1 ± 4.8 and 48.1 ± 7.7 minutes, respectively. CONCLUSION: Within the limitations of this randomized controlled trial with split mouth design, it can be concluded that L-PRF can increase the width of KM around implants. Furthermore, the use of L-PRF results in a lower surgical time with less postoperative discomfort and pain for the patients in comparison to the FGG.

Healing of toothbrush-induced abrasions to keratinized mucosa of the palate in humans: A pilot study.

BACKGROUND AND OBJECTIVE: To the best of our knowledge, the healing time for toothbrush-induced gingival abrasions in humans has not yet been explored. The aim of this study was to evaluate the time needed to heal for toothbrush-induced abrasions of the keratinized mucosa of the palate. MATERIAL AND METHODS: In patients without, with mild periodontitis or with periodontitis, gingival abrasion lesions were induced at the keratinized mucosa of the palate by brushing up to 2 minutes. Healing as observed clinically was followed via calibrated digital photographs of the lesion after staining, every 24 hours until the lesion had resolved. In patients without or with only mild periodontitis, the healing time of lesions caused by 30 seconds and 1 minute of brushing was also recorded. RESULTS: Thirty-one participants (11 without or with mild periodontitis, 20 with periodontitis) met the inclusion criteria. In patients without or with mild periodontitis, the lesions induced by brushing for 2 minutes diminished by 48.7% of their original surface area within 24 hours. In patients with periodontitis the respective outcome was 45.4% (P = .87). Abrasions caused by 2 minutes of brushing needed more than 24 hours to heal completely. When decreasing the time exposed to trauma, fewer lesions were visible at baseline and the time needed to heal decreased. The subgroup of smokers was too small to evaluate any effect. CONCLUSION: The longer the exposure time of the keratinized mucosa of the palate to trauma, the more lesions were visible, the larger the abrasions were and the more time they needed to heal completely. More studies are needed to investigate the role of smoking, gingival biotype and to link these findings with gingival recessions.

Can degradation products released from dental implants affect peri-implant tissues?

This study aimed to assess the literature available on the effects, on peri-implant tissues, of degradation products released from dental implants as a consequence of therapeutic treatment for peri-implantitis and/or of wear-corrosion of titanium. A literature review of the PubMed medline database was performed up to December 31, 2016. The following search terms were used: "titanium wear and dental implant"; "titanium corrosion and dental implant"; "bio-tribocorrosion"; "peri-implantitis"; "treatment of peri-implantitis"; "titanium particles release and dental implant"; and "titanium ion release and dental implant". The keywords were applied to the database in different combinations without limits of time period or type of work. In addition, the reference lists of relevant articles were searched for further studies. Seventy-nine relevant scientific articles on the topic were retrieved. The results showed that pro-inflammatory cytokines, infiltration of inflammatory response cells and activation of the osteoclasts activity are stimulated in peri-implant tissues in the presence of metal particles and ions. Moreover, degenerative changes were reported in macrophages and neutrophils that phagocytosed titanium microparticles, and mutations occurred in human cells cultured in medium containing titanium-based nanoparticles. Debris released from the degradation of dental implants has cytotoxic and genotoxic potential for peri-implant tissues. Thus, the amount and physicochemical properties of the degradation products determine the magnitude of the detrimental effect on peri-implant tissues.

Periodontal screening and referral behaviour of general dental practitioners in Flanders.

OBJECTIVES: The objective of this study was to investigate the screening and referral behaviour of Flemish dentists concerning periodontitis and more specific, the use of the Dutch Periodontal Screening Index (DPSI). MATERIALS AND METHODS: An online questionnaire was electronically distributed through the different professional dental societies. It consisted of two parts: the first aimed at describing the profile of the dentist. The second part inquired the screening method, when this was applied, periodontal risk factors and referral behaviour. RESULTS: One thousand fifty dentists attended to the questionnaire. One hundred fifty-nine questionnaires were excluded since they did not match the target audience. Sixty-four percent of Flemish dentists used DPSI as a periodontal screening method, 28% screened based on probing pocket depth, 4% used solely radiographs and 4% had no screening method at all. The usage of DPSI is influenced by the year of graduation: the longer the dentists were graduated, the less they used DPSI. No influence of sex, education centre and location was found. Referral behaviour is influenced by different patient- and dentist-related factors. CONCLUSIONS: Regarding the screening behaviour, there seems a consensus among Flemish dentists that a periodontal probe should be used. For referral, there is no consensus about if and when to refer to a specialist. CLINICAL RELEVANCE: It is encouraging that 92% of the Flemish general dental practitioners use a probe when screening for periodontitis. However, DPSI is mainly used by younger dentists. An effort should be made to encourage all dentists to use this, so that in every patient, periodontitis can be detected timely, securing the best treatment outcome.

Clinical effects of probiotics containing Bacillus species on gingivitis: a pilot randomized controlled trial.

BACKGROUND AND OBJECTIVE: Lactobacillus spp. and bifidobacteria are the most frequently used probiotics in oral health research. However, although probiotic effects have been suggested for other genera, such as bacilli, no trials are available to describe the effect of bacilli probiotics on gingivitis in humans. The aim of the present study was to evaluate the clinical effects of a bacilli-containing toothpaste, a mouthrinse and a toothbrush cleaner versus a placebo in patients with generalized gingivitis. MATERIAL AND METHODS: In this double-blind placebo-controlled randomized clinical trial, nonsmoking, systemically healthy patients with generalized gingivitis were included. They used a placebo or an experimental probiotic Bacillus subtilis-, Bacillus megaterium- and Bacillus pumulus-containing toothpaste, mouthrinse and toothbrush cleaner for 8 wk. Primary outcome measures of interest were plaque and gingivitis index, and the secondary outcome measures were pocket probing depth and bleeding on probing. RESULTS: Twenty male and 20 female patients were randomized over the two groups. All participants could be included in the final analysis. Although plaque and gingivitis indices were significantly reduced after 8 wk, no intergroup differences could be found at any time point. Also, for the secondary outcome measure, intragroup but no intergroup differences could be detected. No harm or unintended effects were reported by the patients after using the study products. CONCLUSIONS: This study did not show any statistically significant differences between a placebo and a bacilli-containing toothpaste, mouthrinse and toothbrush cleaner on gingivitis parameters.

In vivo electrical application on titanium implants stimulating bone formation.

BACKGROUND AND OBJECTIVE: The aim of the present in vivo study was to measure the bone implant contact area after electrical stimulation of dental implants. MATERIAL AND METHODS: Ninety titanium dental implants (6 mm × 11.5 mm) with a smooth surface were placed in six male Beagle dogs and then the implant-bone interfaces was assessed by histological analyses after 7 and 15 d. The 12-mo-old dogs, with a weight of 15 kg, were randomly divided into two groups based on the duration of bone healing: 7 and 15 d. Also, implants were divided into three groups based on electrical stimulation: group A, 10 µA; group B, 20 µA; and group C, control group. The electrical current was applied by an electrical device coupled to the implant connection. RESULTS: After 7 d of electrical stimulation, no statistical differences in bone-implant interface contact area were observed. However, a significantly higher bone-implant interface contact area was recorded for group B than for groups A and C (p < 0.01) after 15 d. No statistical difference was observed between groups A and C (p > 0.05). CONCLUSION: The electrical stimulation of dental implants can generate a larger area of bone-implant interface contact as a result of bone formation. Factors such as different electrical current intensity and duration should be studied in further work to clarify the potential of this method.

Synergistic interactions between corrosion and wear at titanium-based dental implant connections: A scoping review.

Two-piece implant systems are mainly used in oral implantology involving an osseointegrated implant connected to an abutment, which supports prosthetic structures. It is well documented that the presence of microgaps, biofilms and oral fluids at the implant-abutment connection can cause mechanical and biological complications. The aim of this review paper was to report the degradation at the implant-abutment connection by wear and corrosion processes taking place in the oral cavity. Most of the retrieved studies evaluated the wear and corrosion (tribocorrosion) of titanium-based materials used for implants and abutments in artificial saliva. Electrochemical and wear tests together with microscopic techniques were applied to validate the tribocorrosion behavior of the surfaces. A few studies inspected the wear on the inner surfaces of the implant connection as a result of fatigue or removal of abutments. The studies reported increased microgaps after fatigue tests. In addition, data suggest that micromovements occurring at the contacting surfaces can increase the wear of the inner surfaces of the connection. Biofilms and/or glycoproteins act as lubricants, although they can also amplify the corrosion of the surfaces. Consequently, loosening of the implant-abutment connection can take place during mastication. In addition, wear and corrosion debris such as ions and micro- and nanoparticles released into the surrounding tissues can stimulate peri-implant inflammation that can lead to pathologic bone resorption.

Oral implant placement and restoration by undergraduate students: clinical outcomes and student perceptions.

INTRODUCTION: Universities are developing and implementing implant dentistry training to prepare dental professionals for the growing treatment needs. This study describes how implant dentistry is taught at the KU Leuven and focuses on implant-related clinical outcomes. Perspectives of participating undergraduate students are analysed with a view to improve oral implant dentistry training. MATERIALS AND METHODS: Implant dentistry training at the KU Leuven consists of theoretical lectures, pre-clinical hands-on workshops and clinical (surgical/prosthetic) experience. Questionnaires were used to investigate the perceptions of students on the educational programme. Radiographs were taken at implant insertion, at healing abutment connection, at restoration/prosthesis insertion and after 1 and 2 years of functional loading. The marginal bone level was measured from the implant-abutment connection to the first visible bone-to-implant contact. RESULTS: One hundred and twelve implants were placed by 56 undergraduate students (61.5% of the total students) in 56 patients. After a follow-up time of 3 years, the cumulative implant survival rate, at implant level, was 97.1%. The mean marginal bone loss after 1 and 2 years in function was 0.35 mm and 0.39 mm, respectively. Eighty percentage of students were satisfied with the training, and they considered this sufficient preparation to perform implant placement under close supervision. CONCLUSIONS: The clinical outcome of implant treatment performed by undergraduate students under close supervision is similar to that reported by experienced clinicians/research teams. Clinical, surgical as well as restorative experience in addition to theoretical and pre-clinical training seems beneficial when implementing implant dentistry in the undergraduate programmes.

Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) compared to SRP alone in patients with untreated aggressive periodontitis. BACKGROUND: In patients with aggressive periodontitis, SRP is often combined with the use of systemic antibiotics. However, the effectiveness of these antibiotics over time and differences in effectiveness between different antibiotics are hardly known. MATERIAL AND METHODS: The MEDLINE-PubMed database was searched from their earliest records until January 20, 2014. Several journals were hand searched and some authors were contacted for additional information. The following outcome measures were analysed: mean probing pocket depth reduction, mean clinical attachment level gain and mean bleeding on probing change. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed. RESULTS: The search yielded 296 abstracts. Ultimately, 101 articles were selected of which 14 articles met the eligibility criteria. Systemic antibiotics showed a significant (p < 0.05) additional pocket depth reduction for moderate (0.36 ± 0.22 mm at 3 mo, 6 mo 0.42 ± 0.22 mm and 12 mo 0.88 ± 0.27 mm) and deep pockets (0.74 ± 0.36 mm at 3 mo, 6 mo 0.85 ± 0.55 mm and 12 mo 1.26 ± 0.81 mm) and a significant clinical attachment gain for moderate (0.26 ± 0.18 at 3 mo, 6 mo 0.52 ± 0.15 and 12 mo 0.83 ± 0.38) and deep pockets (0.59 ± 0.18 at 3 mo, 0.96 ± 0.21 at 6 mo and 1.00 ± 0.80 at 12 mo). CONCLUSION: For the treatment of patients with aggressive periodontitis, systemic antibiotics combined with non-surgical periodontal therapy resulted in a significant additional effect compared to non-surgical therapy alone. There is a visible trend that showed metronidazole + amoxicillin is the most potent antibiotic combination.

Non-surgical periodontal therapy with systemic antibiotics in patients with untreated chronic periodontitis: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this meta-analysis is to evaluate the effectiveness of different systemic antibiotics in combination with scaling and root planing (SRP) when compared to SRP alone in patients with untreated chronic periodontitis. BACKGROUND: Although chronic periodontitis is mostly treated without adjunctive systemic antibiotics, some recent meta-analyses have shown clinical benefit for some systemic antibiotics when used as an adjunct to SRP. However, there is a wide variety of systemic antibiotic regimens used today. It remains unclear if the selected type of systemic antibiotic influences the magnitude of clinical benefit. MATERIAL AND METHODS: The MEDLINE-PubMed database was searched from their earliest records through May 16, 2013. Several journals were hand searched and some authors were contacted for additional information. Outcome measures analysed were mean bleeding on probing change, mean clinical attachment level gain and mean probing pocket depth reduction. Extracted data were pooled using a random effect model. Weighted mean differences were calculated and heterogeneity was assessed. RESULTS: The search yielded 281 abstracts. Ultimately, 95 studies were selected, describing 43 studies meeting the eligibility criteria. Systemic antibiotics showed a significant (p < 0.05) additional pocket depth reduction for moderate (at 3 mo 0.27 mm ± 0.09, at 6 mo 0.23 mm ± 0.10 and at 12 mo 0.25 mm ± 0.27) and deep pockets (at 3 mo 0.62 mm ± 0.17, at 6 mo 0.58 mm ± 0.16 and at 12 mo 0.74 mm ± 0.30). Statistically, no specific type of antibiotic was superior over another. However, when analysing the clinical data for initially moderate pockets or deep pockets, some trends became apparent. CONCLUSION: Systemic antibiotics combined with SRP offer additional clinical improvements compared to SRP alone. Although there were no statistically significant differences, there was a trend that for initially moderate and deep pockets, metronidazole or metronidazole combined with amoxicillin, resulted in clinical improvements that were more pronounced over doxycycline or azithromycin. Additionally, there was a trend that the magnitude of the clinical benefit became smaller over time (1 year).

Depth and lateral deviations in guided implant surgery: an RCT comparing guided surgery with mental navigation or the use of a pilot-drill template.

AIM: To assess the accuracy of guided surgery compared with mental navigation or the use of a pilot-drill template in fully edentulous patients. MATERIAL AND METHODS: Sixty consecutive patients (72 jaws), requiring four to six implants (maxilla or mandible), were randomly assigned to one of the following treatment modalities: Materialise Universal(®) mucosa, Materialise Universal(®) bone, Facilitate(™) mucosa, Facilitate(™) bone, mental navigation, or a pilot-drill template. Accuracy was assessed by matching the planning CT with a postoperative CBCT. Deviations were registered in a vertical (depth) and horizontal (lateral) plane. The latter further subdivided into BL (bucco-lingual) and MD (mesio-distal) deviations. RESULTS: The overall mean vertical deviation for the guided surgery groups was 0.9 mm ± 0.8 (range: 0.0-3.7) and 0.9 mm ± 0.6 (range: 0.0-2.9) in a horizontal direction. For the non-guided groups, this was 1.7 mm ± 1.3 (range: 0.0-6.4) and 2.1 mm ± 1.4 (range 0.0-8.5), respectively (P < 0.05). The overall mean deviation for the guided surgery groups in MD direction was 0.6 mm ± 0.5 (range: 0.0-2.5) and 0.5 mm ± 0.5 (range: 0.0-2.9) in BL direction. For the non-guided groups, this was 1.8 mm ± 1.4 (range: 0.0-8.3) and 0.7 mm ± 0.6 (range 0.0-2.9), respectively. The deviation in MD direction was significantly higher in the non-guided groups (P = 0.0002). CONCLUSION: The most important inaccuracy with guided surgery is in vertical direction (depth). The inaccuracy in MD or BL direction is clearly less. For non-guided surgery, the inaccuracy is significantly higher.

Long-term changes in microbiology and clinical periodontal variables after completion of fixed orthodontic appliances.

OBJECTIVES: The aim of this prospective study was to monitor patients' microbiological and clinical periodontal parameters prior and up to 2 years after orthodontic treatment. MATERIAL AND METHODS: Twenty-four adolescents were treated with brackets. Fourteen of them received bands on upper first molars for extra-oral force application before bonding brackets to the remaining teeth. Microbiology, periodontal probing depth, bleeding on probing (BOP), and gingival crevicular fluid (GCF) flow were assessed at baseline (T1), bracket removal (T2), and 2 years post-treatment (T3). A statistical comparison was made over time and between bands and brackets. RESULTS: A significant increase from T1 to T2 and a decrease from T2 to T3 in pathogenicity of plaque were noted. No significant difference was observed concerning supragingival colony-forming units (CFU) ratio (aerobe/anaerobe) between T3 and T1. However, the subgingival CFU ratio (aerobe/anaerobe) at T3 did significantly differ from the ratio at T1. Periodontal probing depth, BOP and GCF flow showed a significant increase between T1 and T2 and a reduction between T2 and T3, resulting in the absence of significant differences between T3 and T1, except for BOP at banded sites. CONCLUSION: Placement of fixed appliances has an impact on periodontal parameters. The results showed that not all parameters were normalized at T3, indicating that the changes are only partially reversible.

Effects of dental implant surface biomodification with Limosilactobacillus reuteri on early bone healing: an experimental animal study.

The aim of this animal study was to compare the primary/secondary stability and micro-CT bone and tissue volumes of implants that were immersed in Limosilactobacillus reuteri, cholecalciferol-D3 (vitamin D) and injectable platelet-rich fibrin (i-PRF) suspensions/solutions before placement in bone. 40 implants (10 in each group) were placed in the iliac crest of 5 sheep. The implants were immersed in L. reuteri, vitamin D or i-PRF solutions for five minutes before placement or left unsoaked as controls. Implant stability was determined by ISQ values and bone volume around implants was histomorphometrically analysed by micro-CT evaluation. At 4 weeks, implants in the L. reuteri group showed the highest secondary stability and 2- and 3D BV/TV values. Both L. reuteri and vitamin D immersed implants had higher osseointegration values compared to the implants in the i-PRF group and controls. There were no statistical differences between L. reuteri and vitamin D immersed implants. Within the limits of the study, the results suggest that immersing implants in L. reuteri or vitamin D suspensions/solutions before implant placement in bone may have beneficial effects on osseointegration.