Influence of sterilization on the retention forces of lithium disilicate and polymer-infiltrated ceramic-network crowns bonded to titanium base abutments: An in-vitro study.

OBJECTIVES: The aim of this study was to evaluate the effect of sterilization on the retention forces of lithium disilicate (LD) and polymer-infiltrated ceramic network (PICN) crowns bonded to titanium base (Ti-base) abutments. MATERIALS AND METHODS: Forty LD and 40 PICN crowns were milled and then bonded to 80 Ti-bases with two resin composite cements: Multilink Hybrid Abutment (mh) and Panavia V5 (pv) for a total of 8 groups (n = 10). Half of the specimens (test) underwent an autoclaving protocol (pressure 1.1 bar, 121°C, 20.5 min) and the other half not (control). Restorations were screw-retained to implants, and retention forces (N) were measured with a pull-off testing machine. The surfaces of the Ti-bases and the crowns were inspected for the analysis of the integrity of the marginal bonding interface and failure mode. Student's t-test, chi-square test, and univariate linear regression model were performed to analyze the data (α = 0.05). RESULTS: The mean pull-off retention forces ranged from 487.7 ± 73.4 N to 742.2 ± 150.3 N. Sterilized groups showed statistically significant overall higher maximum retention forces (p < .05), except for one combination (LD + mh). Sterilization led to an increased presence of marginal gaps and deformities compared to no-sterilization (p < .001), while no statistically significant relationship was found between failure mode and sterilization (p > .05). CONCLUSIONS: Sterilization may have a beneficial effect on the retention forces of LD and PICN crowns bonded to titanium base abutments, although it may negatively influence the integrity of the marginal bonding interface.

The co-occurrence of the two main oral diseases: periodontitis and dental caries.

OBJECTIVES: Limited studies are available testing through multiple regression models the association between the two main oral diseases: dental caries and periodontitis. The aim of this cross-sectional population-based study was to verify whether dental caries and periodontitis co-occur in a representative sample of the South Korea population. MATERIALS AND METHODS: A total of 23,405 subjects representative of 36.2 million of adults (KNHANES) were examined. Univariate and multiple regression analyses using 7 different models were applied, controlling for age, gender, smoking status, frequency of toothbrushing, use of interproximal toothbrushes and flossing, educational level, income, gum diseases treatment and tooth filling in the previous year, BMI, Vitamin D serum levels, alcoholism, diabetes status, stress and carbohydrates dietary intake. RESULTS: In the fully adjusted model, participants with periodontitis had, respectively, a mean of 0.82 (95% CI: 0.41-1.23) and of 0.36 (95% CI: 0.22-0.50) more untreated decayed surfaces and teeth than participants without periodontitis, with an OR to have at least one untreated decayed surface of 1.96 (95% CI: 1.66-2.32). However, cumulative caries experience (DF scores) and periodontitis were not associated. CONCLUSIONS: In this large nationally representative population, periodontitis and untreated dental caries co-occur. However, when considering cumulative caries experience (DF scores), the two diseases do not appear related. CLINICAL RELEVANCE: In light of their possible co-occurrence, clinicians should implement integrative diagnostic, preventive and treatment strategies for both diseases.

Air Pollution as a Risk Indicator for Periodontitis.

BACKGROUND: Air pollutants can influence local and systemic inflammation, oxidative stress and microbiome composition. Therefore, air pollution may potentially represent an unexplored modifiable risk indicator for periodontitis. The aim of the current cross-sectional study was to investigate the epidemiological association between outdoor air pollution and periodontitis in a representative sample of the South Korean population. METHODS: A total of 42,020 individuals, which were representative of 35.2 million South Koreans, were examined. The mean annual levels of particulate matter of 10 µm (PM10), ozone, sulfur dioxide (SO2), nitrogen dioxide (NO2) and humidity, were studied. Periodontitis was defined according to the Community Periodontal Index (CPI ≥ 3). Simple and multiple regression analyses using four different models were applied. RESULTS: Every 5-µg/m3 increase in PM10 (OR = 1.17; 95% confidence interval-CI: 1.11-1.24) and of 0.005 ppm in ozone levels (OR = 1.4; 95% CI: 1.00-1.30) were positively associated with periodontitis prevalence. Conversely, every 5% increase in humidity (OR = 0.94; 95% CI: 0.90-0.99) and 0.003 ppm increase in NO2 levels (OR = 0.93; 95% CI: 0.89-0.96) were inversely associated with periodontitis occurrence. CONCLUSIONS: In this nationally representative population several air pollutants were found to be associated with periodontitis occurrence. Hence, the present results suggest that air pollution may be a new modifiable risk indicator for periodontitis.

Effect of sub-marginal instrumentation before surgical treatment of peri-implantitis: A multi-centre randomized clinical trial.

AIM: The present multi-centre randomized clinical trial with 12 months of follow-up aimed at studying the added effect of sub-marginal instrumentation before surgical treatment of peri-implantitis. MATERIALS AND METHODS: Forty-two patients diagnosed with peri-implantitis were recruited. After a behavioural intervention phase including oral hygiene instructions, patients were randomized to either receiving supra- and sub-marginal instrumentation on their affected implants (control group: 21 patients and 29 implants) or only supra-marginal instrumentation (test group: 21 patients and 24 implants), before undergoing surgery. Changes in the deepest probing pocket depth (PPD) with respect to baseline and a composite outcome of treatment success (no implant loss, no bone loss > 0.5 mm, no bleeding or suppuration on probing [BoP/SoP], and PPD ≤ 5 mm) at the 12-month examination were regarded as the primary outcomes of the trial. RESULTS: At the 12-month examination, changes in the deepest PPD with respect to baseline amounted to -2.96 mm in the control group and to -3.11 mm in the test one (MD = -0.16; SE = 0.56; p = .769), while 21.4% of the implants in the control group and 33.3% in the test group presented treatment success (OR = 1.83; SE = 1.15; p = .338). With the exception of a longer non-surgical treatment duration in the control group (differences in  = -14.29 min; SE = 2.91; p < .001), no other secondary (e.g., soft-tissue recession, keratinized mucosa height, and bone level changes, as well as BoP, SoP, profuse bleeding and implant loss rates) or exploratory (i.e., early wound healing, aesthetics, surgical and total treatment duration, surgery difficulty, intra-operative bleeding, and adverse events) outcome demonstrated statistically significant differences between groups. CONCLUSIONS: The present multi-centre randomized clinical trial did not demonstrate an added effect of performing sub-marginal instrumentation 6 weeks before the surgical treatment of peri-implantitis. Larger clinical trials are however needed to confirm the present findings (Clinicaltrials.gov: NCT03620331).

The Association Between Suppuration on Palpation and Diagnosis of Peri-implantitis: A Cross-sectional Study.

PURPOSE: The aim of this study was to evaluate suppuration on palpation, used as a diagnostic test, in the detection of peri-implantitis. MATERIALS AND METHODS: A total of 65 patients with 267 implants were examined. Clinical inspection was performed by two blinded examiners: The first measured suppuration on palpation, and the second conducted a complete clinical examination. A third examiner combined the previously collected information with radiographic data and diagnosed the patients according to the European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classification system. Calibration was conducted previously to the fourth examiner on a set of five patients not belonging to the study sample. RESULTS: When suppuration on palpation was associated with diagnosis of peri-implantitis, the specificity and negative predictive value were high (88% and 84%, respectively), meaning that an implant that was negative to suppuration on palpation had a high chance of not being affected by peri-implantitis. Conversely, the sensitivity and positive predictive value were low (45% and 54%), demonstrating that a suppurating implant will be affected by peri-implantitis in only half of the cases. Area under the curve was calculated as 60.4 (P = .012), and accuracy was found to be 78%. CONCLUSION: Suppuration on palpation alone, as with any other clinical sign, does not allow a precise diagnosis of peri-implantitis. An implant without suppuration on palpation shows a high chance of being free of peri-implantitis, while an implant that suppurates upon palpation is not necessarily affected by peri-implantitis. Suppuration on palpation may be a valuable clinical sign, especially when evaluating implants that are difficult to examine via probing.

Hormone-related events and periodontitis in women.

AIM: While the short-term effects of hormonal events on gingival inflammation have been well described, long-term effects on the periodontium have received less attention. The aim of this cross-sectional population-based study was to evaluate the association between hormone-related events and periodontitis in a representative sample of the postmenopausal women of South Korea. MATERIALS AND METHODS: A total of 10,273 postmenopausal women representative of 6.1 million of Koreans were examined. Periodontitis and severe periodontitis were defined according to the Community Periodontal Index (CPI â‰§ 3 and CPI = 4, respectively). Univariate and multivariate regression analyses using 3 different models were applied controlling for age, smoking, marital status, educational level, income, BMI, hypertension, stress and frequency of toothbrushing. RESULTS: Severe periodontitis was directly associated with a longer reproductive life (p-trend = .027) and with a longer duration of breastfeeding (48-72 vs. 1-17 months: OR = 1.49; 95% CI: 1.01-2.21). Conversely, early menopausal age (<46 vs. 49-50 years: OR = 0.74; 95% CI: 0.56-0.97), history of artificial menopause (OR = 0.72; 95% CI: 0.53-0.97), having had more than 6 pregnancies (vs. 4: OR = 0.73; 95% CI: 0.55-0.97), having had more than three abortions (vs. 0: OR = 0.51; 95% CI: 0.28-0.93) and having had the first birth age >26 years (vs. <21 years: OR = 0.71; 95% CI: 0.52-0.97) were inversely associated with severe periodontitis. CONCLUSIONS: In this large nationally representative population, severe periodontitis was related to menopausal age, reproductive life length, number of pregnancies/abortions, first birth age and breastfeeding duration, while it was not to oral contraceptive and hormone replacement therapy usages.

Antibiotic prophylaxis at dental implant placement: Which is the best protocol? A systematic review and network meta-analysis.

AIM: This systematic review of randomized controlled trials (RCTs) aims to answer to the following question: "In patients undergoing dental implant placement, which is the best antibiotic prophylaxis protocol to prevent early failures?" MATERIALS AND METHODS: The MEDLINE, SCOPUS, CENTRAL and Web of Knowledge electronic databases were searched in duplicate for RCTs up to July 2017. Additional relevant literature was identified through (i) handsearching on both relevant journals and reference lists, and (ii) searching in databases for grey literature. A network meta-analysis (NMA) was conducted, and the probability that each protocol is the "Best" was estimated. RESULTS: Nine RCTs were included, with a total of 1,693 participants. Due to the few events reported, it was not possible to conduct a NMA for adverse events, therefore it was conducted only for implant failures (IF). The protocol with the highest probability (32.5%) of being the "Best" one to prevent IF was the single dose of 3 g of amoxicillin administered 1 hr pre-operatively. Even if the single pre-operative dose of 2 g of amoxicillin is the most used, it achieved only a probability of 0.2% to be the "Best" one. CONCLUSIONS: Basing on the available RCTs, the use of antibiotic prophylaxis is protective against early implant failures. Whenever an antibiotic prophylaxis is needed, there is still insufficient evidence to confidently recommend a specific dosage. The use of post-operative courses does not seem however to be justified by the available literature. Prospero registration number: CRD42015029708.

Periodontitis and platelet count: A new potential link with cardiovascular and other systemic inflammatory diseases.

AIM: As an infection-driven inflammatory disease, periodontitis could lead to a reactive increase in platelet count. This mechanism could partially mediate the well-documented association between periodontitis and atherosclerotic cardiovascular disease. The aim of this cross-sectional study was to test the presence of an association between periodontitis and platelet count in a representative sample of the South Korea population. MATERIALS AND METHODS: A total of 5,197 subjects representative of 34.9 million of adults were examined. Multivariate regression analyses were applied controlling for age, gender, smoking status, educational level, body mass index, alcoholism, diabetes and hypertension status, vitamin D serum levels and total cholesterol, triglycerides, HDL and LDL blood levels. RESULTS: Compared to the non-severe periodontitis group, subjects with severe periodontitis (CPI = 4) displayed 13,048.93 more platelets for µl of blood (95% CI: 3,296.26-22,801.61, p = 0.009) in the fully-adjusted model. The association between severe periodontitis and platelet count has shown to be highlighted in subjects aged more than 60 years, females, non-smokers and with normal HDL blood levels. A systemic inflammatory biomarker (white blood cell count) explained the 19.25% of this association. CONCLUSIONS: Within the limitations of this study, periodontitis-especially severe-is independently associated with a considerable increase in platelet count which is explained, at least in part, by an increase in the systemic inflammation.

The association between periodontitis and sleep duration.

AIM: Due to its potential to influence systemic inflammation and oxidative stress, and to predispose to bacterial infections, sleep duration could potentially be a risk factor for periodontitis. The aim of this cross-sectional study was to evaluate if there was in 2012 an association between periodontitis and sleep duration in a representative sample of the South Korean population. MATERIALS AND METHODS: A total of 5812 subjects representative of 39.4 million of adults were examined. Multivariate logistic regressions were applied controlling for age, gender, education, smoking status, alcoholism and consumption frequency of coffee, tea, chocolate and red wine. RESULTS: Compared to the group sleeping ≤5 h/day, the adjusted odds ratios for periodontitis prevalence defined as Community Periodontal Index (CPI) = 4 were OR = 2.46 (95% CI: 1.20-5.06) in the 6 h/day sleepers group, OR = 2.66 (95% CI: 1.35-5.25) in the 7 h/day sleepers group, OR = 2.29 (95% CI: 1.13-4.63) in the 8 h/day sleepers group and OR = 4.27 (95% CI: 1.83-9.97) in the ≥9 h/day sleepers group. The association has shown to be highlighted in middle-aged people, females, non-smokers, lower educated, with lower lead and higher cadmium blood levels and with higher carotene dietary intake ones and to be partially mediated by lipid profile alterations, diabetes, serum Vitamin D levels and WBC count. CONCLUSIONS: A novel, direct and independent association between sleep duration and the prevalence of periodontitis was found. However, it needs to be investigated how the factors influencing the sleep duration affect this association.

Navigation System Approach in Zygomatic Implant Technique.

In some patients, the resolution of severe maxillary atrophies can be hardly achieved without the use of zygomatic implants. Although many scientific studies have already demonstrated the excellent immediate stability in long term, the use of zygomatic implants is not yet widespread. Among the complications of this technique, the most threatening is the risk of damaging the eyeball or the maxillary nerve.The use of the navigator system as a surgical aid for implant placement allows to control, at any time, the position of the drill in the bone, avoiding any injury to ocular and nervous structures. The authors present a clinical report which shows a patient affected by a very severe form of post-traumatic maxillary atrophy that has been solved through the of zygomatic implants placement using the "Implant Bone Navigation" system. This procedure allows both to cut down the risks on ocular and nervous structures of the maxilla and also to reach excellent rehabilitation results in such severely compromised patients.

Diagnostic Accuracy of Obstructive Airway Adult Test for Diagnosis of Obstructive Sleep Apnea.

RATIONALE: The gold standard for the diagnosis of Obstructive Sleep Apnea (OSA) is polysomnography, whose access is however reduced by costs and limited availability, so that additional diagnostic tests are needed. OBJECTIVES: To analyze the diagnostic accuracy of the Obstructive Airway Adult Test (OAAT) compared to polysomnography for the diagnosis of OSA in adult patients. METHODS: Ninety patients affected by OSA verified with polysomnography (AHI ≥ 5) and ten healthy patients, randomly selected, were included and all were interviewed by one blind examiner with OAAT questions. MEASUREMENTS AND MAIN RESULTS: The Spearman rho, evaluated to measure the correlation between OAAT and polysomnography, was 0.72 (p < 0.01). The area under the ROC curve (95% CI) was the parameter to evaluate the accuracy of the OAAT: it was 0.91 (0.81-1.00) for the diagnosis of OSA (AHI ≥ 5), 0.90 (0.82-0.98) for moderate OSA (AHI ≥ 15), and 0.84 (0.76-0.92) for severe OSA (AHI ≥ 30). CONCLUSIONS: The OAAT has shown a high correlation with polysomnography and also a high diagnostic accuracy for the diagnosis of OSA. It has also been shown to be able to discriminate among the different degrees of severity of OSA. Additional large studies aiming to validate this questionnaire as a screening or diagnostic test are needed.