Effect of mandibular advancement appliance use on oral and periodontal health in patients with OSA: a systematic review.

STUDY OBJECTIVES: Use of a mandibular advancement appliance (MAA) is an effective treatment option for mild-to-moderate obstructive sleep apnea (OSA). MAA is well-tolerated but undesirable effects may be observed over time. The present systematic review aimed to assess the effect of MAA use on oral and periodontal health in patients with OSA. METHODS: MEDLINE (PubMed), Cochrane, and Scopus were searched for randomized and non-randomized controlled trials (RCTs, NRCTs), cohorts, and case-control studies reporting on side effects of MAA treatment in OSA patients during a follow-up of at least 6 months. RESULTS: From a total of 169 articles screened, 28 were selected. The most frequently reported MAA-related effects on oral health were: hypersalivation (weighted mean prevalence, 33.3%), occlusal changes (30.2%), muscle pain (22.9%), tooth discomfort or pain (20.2%), and xerostomia (18.3%). No MAA-related periodontal effect was reported. The periodontal status prior to MAA treatment was rarely assessed and described, but 5 studies (17.8%) stated that periodontitis was an exclusion criterion for MAA. Only one retrospective study specifically evaluated periodontal parameters and reported no significant changes in periodontally healthy patients with OSA using MAA for over 7 years. CONCLUSION: MAA use is associated with a number of clinical consequences on oral health, but there is no evidence to conclude whether or not MAA affects periodontal health in patients with OSA. This aspect appears to be under-evaluated and should be further investigated in relation to the type of MAA, the duration of treatment, and prior history of periodontitis.

Risk factors in periodontology: a conceptual framework.

AIM: The definition and assessment of risk factors, risk indicators and predisposing factors are of paramount importance in the understanding of the pathogenesis of periodontitis, as well as in its prevention and treatment. This article aims to emphasize the concepts of causal chains and the causal network of risk factors in periodontitis. MATERIALS AND METHODS: This is a narrative review focusing on two main questions: (1) what is a risk in periodontology? and (2) how can a risk be assessed? RESULTS: The probability of the occurrence of an adverse outcome following exposure is not sufficient to analyse the impact of a risk factor on the disease. A network model for the pathway of risk factors in the pathogenesis of periodontitis is described. This article emphasizes the concepts of causal chains and the causal network of risk factors in periodontitis. CONCLUSION: Chronic periodontal diseases are among the most complex non-communicable diseases. A conceptual framework intended to clarify the relationship between risk and causality may improve the understanding of the underlying mechanisms of chronic diseases. The proposed causal network may provide a model to assess the role of risk factors in periodontitis.

Clinical evaluation of two dental implant macrostructures on peri-implant bone loss: a comparative, retrospective study.

OBJECTIVES: To compare the effect of two implant macrostructures on peri-implant bone level. MATERIAL AND METHODS: This retrospective cohort study was conducted in a private practice. Patients received test (Nobel Speedy Groovy implants) or control implants (Mk III implants) or both. Baseline and corresponding follow-up radiographs, taken with a long-cone technique, were analyzed to evaluate mean bone level changes around implants during a mean follow-up of 69 ± 19 months. A chi-squared test was performed to compare the bone level changes between the two types of implants. A multivariate analysis was used to explain the difference between the two groups. RESULTS: After controlling for inclusion and exclusion criteria, 144 dental implants corresponding to 68 implants in the test group and 76 implants in the control group were placed in 59 patients. Nine dental implants (6.25%) were lost during the observation period: five implants in the test group and four implants in the control group. Consequently, a total of 135 implants placed in 58 patients were available for analysis. Our study shows a significant difference of peri-implant bone level overtime between the test and control groups (P < 0.01). At the end of the observation period, a bone growth was observed in the control group (0.02 ± 0.80 mm), whereas a bone loss was found in the test group (-0.43 ± 1.11 mm). The mean bone level at baseline and the type of periodontal therapy and the maintenance care program were involved in this difference (P < 0.001, P = 0.035, P < 0.001, respectively). CONCLUSION: Our study demonstrates a significant difference in peri-implant bone level between test and control groups. The mean bone level at baseline, the type of periodontal therapy, and the maintenance program may explain peri-implant bone level changes overtime.

Shared detection of Porphyromonas gingivalis in cohabiting family members: a systematic review and meta-analysis.

Introduction: Periodontitis is an inflammatory dysbiotic disease. Among putative dysbiosis causes, transmission of Porphyromonas gingivalis between individuals of the same family remains unclear. The aim of this systematic review and meta-analysis is to assess the likelihood of shared detection of Porphyromonas gingivalis among cohabiting family members. Methods: A literature search was conducted on different databases up to September 2018. Articles assessing the presence of P.gingivalis between members of the same family were screened. Only English literature was retrieved, whereas no limits were applied for bacterial sampling and detection methods. Results: Overall, 26 articles published between 1993 and 2017 met the inclusion criteria. Of these, 18 articles were used for meta-analyses. Based on bacterial culture, the likelihood of an intra-familial transmission of P.gingivalis once a member of the family harbors the bacterium is estimated at 63.5% (n = 132 pairs of family members); this drops to 45% when pooling together culture and Polymerase-Chain-Reaction (n = 481 pairs), whereas it is estimated at 35.7% when genotyping is applied (n = 137 pairs). Conclusion: Pooled results suggest that the likelihood of detecting P.gingivalis within within family members is moderately frequent. Personalized periodontal screening and prevention may consider intra-familial co-occurrence of P.gingivalis as feasible.

Qualitative cosmetic evaluation after root-coverage procedures.

BACKGROUND: The purpose of the present study was to evaluate the esthetic outcome using four categories of root-coverage procedures (pedicle soft tissue grafts, non-submerged grafts, submerged grafts, and envelope techniques) and to identify factors associated with esthetic assessment. METHODS: A professional panel of three observers (two periodontists and one control) used a before-after panel scoring system to evaluate the esthetics of 162 root-coverage surgeries. A five-point ordinal scale was used to evaluate the overall esthetic improvement and seven variables that may be considered in the assessment. RESULTS: The intraobserver agreement of the two trained periodontists for the overall cosmetic assessment was almost perfect (kappa = 0.83), and substantial agreement was found between them (kappa = 0.68). Good to excellent overall esthetic results were found by the professionals and control in >70% of the surgical procedures. Analysis of variance indicated a statistical difference between the non-submerged grafts category and the three other surgical categories (P <10(-3)). Multivariate analysis showed that the degree of root coverage was not a significant predictive factor, whereas soft tissue appearance variables and the follow-up were significantly associated with cosmetic assessment. CONCLUSIONS: The present study demonstrated that non-submerged grafts are not recommended in cases of esthetic demand. Future root-coverage trials, basing their justification on esthetics, should include overall qualitative evaluation as the primary variable. The follow-up period should not be <12 months. The before-after panel scoring system is a tool that can be used to evaluate cosmetic outcomes.

Efficacy of the supraperiosteal envelope technique: a preliminary comparative clinical study.

The purpose of this clinical study was to compare the effectiveness of the supraperiosteal envelope technique as performed by three surgeons with different amounts of professional experience during a 6-month observation period. Sixty-eight gingival recessions in 35 healthy patients were selected and included in clinical recordings. They were statistically evaluated at baseline and 6 months later. First, clinical parameters (attachment level, pocket depth, recession height, recession width, and gingival keratinized tissue height) were calibrated between the three operators. Then, single or multiple gingival recessions were selected and surgical techniques were standardized by the surgeons (A, B, C). The root coverage percentages obtained by the three operators were 81% for operator A, 85% for operator B, and 89% for operator C, for an average of 85%; initial recession height values were 2.5 mm (A), 4.3 mm (B), and 4.4 mm (C). The preliminary results of this trial showed the capacity of this surgical technique to provide favorable clinical benefits irrespective of the initial dimensions of recession-type defects and irrespective of the learning curve and experience of operators.

A retrospective study of root coverage procedures using an image analysis system.

AIM: To investigate the efficacy of root coverage procedures and factors that may affect the clinical outcomes in non-experimental patients. MATERIAL AND METHODS: Two hundred and eighty-seven root coverage surgical procedures in 215 adult patients were evaluated retrospectively. Descriptive statistics were used to determine the patient profile. Comparisons between surgeries were assessed, and the impact of different parameters on the probability of mean/complete root coverage and gingival augmentation was explored. RESULTS: The mean percentage of root coverage was 72.29 (+/- 28)%. Complete root coverage was observed in 35.56% of the defects. The difference between the surgical procedures was not significant. The mean percentage of gingival augmentation was 106.18 (+/- 260)%. The difference between non-submerged grafts and the other techniques was significant (p<10(-3)). A significant negative impact of smoking, and maxillary teeth for both mean and complete root coverage were found. A significant positive impact of the tuberosity donor site was found for complete root coverage. Maxillary teeth and Miller's Class II and III were positive predictive factors for gingival augmentation. CONCLUSIONS: Under non-experimental conditions, root coverage procedures are effective. Smoking, maxillary teeth, donor site, and Miller's Classes are prognostic factors that may affect the results.

Generalized periodontitis associated with Chédiak-Higashi syndrome.

BACKGROUND: Chédiak-Higashi syndrome (CHS) is a rare immunodeficient disorder. Patients with CHS are prone to severe periodontitis. To date, limited improvement following periodontal therapy has been reported. Thus, successful clinical outcomes in patients with CHS are of interest. METHODS: A 12-year-old girl was referred to the Department of Pediatric Dentistry, Hôtel-Dieu/Garancière Hospital, for acute gingival inflammation and periodontal destruction. After a periodontal examination, the patient was sent to the Department of Medicine, Robert Debré Hospital, for a hematologic examination and was diagnosed with CHS. She has been receiving medical and dental treatments since that time. The medical treatment consisted of continuous, long-term antibiotherapy. Supportive periodontal therapy was initiated with 4-month recall periods. We report the diagnosis process and the 9-year follow-up. RESULTS: Radiographs and a periodontal examination showed deep probing pockets and extensive alveolar bone resorption. Hematologic and immunologic investigations showed normal values. Peripheral blood smears showed giant granules in neutrophils and leukocytes characteristic of CHS. Clinical improvement was observed after the initial periodontal therapy. No periodontitis recurrence was noted over a period of 9 years. CONCLUSIONS: This case report shows that it is possible to treat periodontitis and maintain the periodontal health of a patient with a mild CHS phenotype over a long period. Patient compliance, regular dental follow-ups, and long-term systemic antibiotic treatments may be useful in stabilizing the periodontal condition of patients with CHS. Dentists must be aware that aggressive periodontitis, combined with general clinical signs, in young patients may reflect rare systemic disorders requiring biologic investigation.

Comparative study of manual and ultrasonic instrumentation of cementum surfaces: influence of lateral pressure.

The goal of periodontal treatments is to eliminate bacteria and their products without damaging cementum surfaces. Nonsurgical treatments are often limited by the inability of curettes to access the most apical zone of the pocket. While ultrasonic mini-inserts have been used for nearly 10 years now, their effect on dental tissues has not been tested. The purpose of the present study was to compare a new series of mini-inserts to Gracey curettes, which are the reference in nonsurgical treatments. Two experienced periodontists conducted root treatments on teeth destined for extraction using regular clinical criteria. One face of each root was instrumented using a Gracey curette, and the opposite face was instrumented using an ultrasonic mini-insert. After the instrumentation procedure, the teeth were prepared for examination by secondary electron (topographic features) and backscattered electron (organic and mineral composition) microscopy. Differences in surface composition between teeth treated by the two periodontists were noted and were related to the lateral pressure exerted. Calculus removal was less effective when strong lateral pressure was exerted using the ultrasonic mini-inserts, while more cementum was removed and more scratching occurred with both manual and ultrasonic instruments. In all cases, the ultrasonic mini-inserts allowed greater apical access. The new ultrasonic mini-inserts were as effective as manual curettes in eliminating plaque and calculus. The shape of the mini-inserts made them more effective in apical zones. The amount of damage to the cementum depended on the lateral pressure exerted by the periodontist.

Risk assessment for buccal gingival recession defects in an adult population.

BACKGROUND: Little is known about systemic, environmental, and periodontal risk factors of gingival recessions. This study identifies variables related to buccal gingival recessions in an adult French population; this study uses data collected in the First National Periodontal and Systemic Examination Survey. METHODS: This cross-sectional survey includes 2,074 subjects (age range: 35 to 65 years) from a nationally representative sample obtained by a quota method stratified by age, gender, socioeconomic status, and geographic areas. The subjects had undergone a full-mouth periodontal examination, assessment of missing teeth, laboratory tests, and questionnaires. In the present analysis, the buccal gingival recession status of each subject was the outcome of interest and was assessed by criteria based on the severity and extent of gingival recessions. RESULTS: A total of 84.6% of the sample had at least one gingival recession. A multivariate linear regression model with backward selection showed that age (P >0.001), gender (P = 0.003), plaque index (P <0.001), and tobacco consumption (P <0.001) were associated with the extent of gingival recession. In addition to these variables, the number of missing teeth (P <0.001) and the gingival bleeding index (P = 0.010) were also associated with the severity of gingival recession. CONCLUSIONS: This study indicates that the risk factors for gingival recessions are similar to the traditional risk factors for periodontitis. However, the present model indicates that diabetes, increase of the body mass index, and alcohol intake are not associated with gingival recessions.

Root coverage assessment: validity and reproducibility of an image analysis system.

AIM: The aim of this methodological study was to validate a new method for root coverage evaluation following periodontal plastic surgery. MATERIAL AND METHODS: Thirty recessions were treated in 21 consecutive patients, using a subepithelial connective tissue graft technique. Clinical measurements and photographs were taken at baseline and 12+/-6 months after treatment. The mean percentage of root coverage for linear and surface area measurements was calculated using conventional clinical evaluation, and compared with ImageJ, a public domain Java image processing program. Bland-Altman plots were used for assessing repeatability and agreement between clinical and ImageJ measurements. The strength of the relationship was calculated using the Pearson product moment correlation coefficient. RESULTS: The repeatability of ImageJ was excellent for both linear and surface area measurements. The agreement between clinical and ImageJ measurements was good for the linear evaluation, showing lower and upper limits of -13.14% and 17.42%, respectively. Significant correlations (p<0.001) were found between clinical and ImageJ measurements, ranging from 0.93 to 0.94 for linear evaluation, and from 0.89 to 0.90 for surface evaluation. CONCLUSIONS: The outcomes of this study show that the ImageJ analysis is a reliable, reproducible method to evaluate the percentage of root coverage after periodontal plastic surgery, when a midfacial linear measurement is used.