Adherence to supportive periodontal treatment.

Like any other chronic disease, periodontal disease can be treated, but not eradicated. Personal maintenance of periodontal health requires the continuous elimination of bacterial accumulation at the gingival level, which demands periodical professional assistance. Of upmost importance is the patient being able to actively follow the counsel of the care providers. Thus, patient compliance, adherence, and persistence are paramount for the long-term success of periodontal therapy. Unfortunately, in medicine as well as in dentistry, most studies show that, sooner rather than later, an unacceptable percentage of patients quit maintenance care. However, different studies have shown that there are behavioral techniques which may significantly improve the degree of motivation, compliance and persistence of patients with oral hygiene and supportive periodontal treatment. The right interval between maintenance visits has not been determined yet, but should be implemented according to patient needs, which do not necessarily coincide with the standard three-month interval historically accepted as adequate. Adherence to periodontal maintenance results in reduction of plaque and bleeding on probing, and potentially slowing down or halting the disease progression. Finally, based on numerous retrospective studies, patient compliance could be considered a disease-modifying factor positively affecting tooth survival. However, a lack of randomized clinical trials means this last statement is still open to question.

Treatment trends in periodontics.

This volume of Periodontology 2000, entitled "Treatment Trends in Periodontics", evaluates the importance of nonsurgical periodontal therapy and defines its role as the key etiologic treatment of the disease. The need for scaling and root planing is mandatory step during the initial phase of therapy, as is self-care by the patient. Only after reevaluation of the outcome achieved by nonsurgical procedures should surgery be considered, and the concept of "critical probing depth" is emphasized. The chapters in this volume discuss different aspects of periodontal surgery, including regeneration and plastic periodontal procedures, and, looking toward the future, cell therapy in periodontics is explored. The impact of periodontal therapy on systemic diseases is reviewed, and the role of occlusion in periodontal disease is revisited and discussed. Topics on implants include their placement in fresh extraction sockets, socket healing with or without implant placement, and research on osseointegration. The important topic of maintenance care of teeth and implants for long-term therapeutic success is thoroughly evaluated, as is the efficacy of dentifrices in oral hygiene. The editors convey a nutshell review of the concepts of what periodontal treatment should entail, based on scientific evidence generated during half-a-century of work in periodontics.

The comparison between implant stability quotient and bone-implant contact revisited: an experiment in Beagle dog.

BACKGROUND: Resonance frequency analysis (RFA) is applied clinically for the assessment of implant stability, and the relevance of this application is widely accepted. However, the relationship between resonance frequency (RF) and other parameters of implant stability, such as the histomorphometrical bone-to-implant contact (BIC) parameter, has become controversial in the last decade. OBJECTIVE: To analyse and clarify the controversial relationship between RF and histomorphometrical BIC measurements. MATERIAL AND METHODS: A total of 36 dental implants (9 mm length, Ø 4.0 mm; Biohorizons(®) Implant Systems Inc., Birmingham, AL, USA) with a soluble blasting media (sandblasting with soluble particles) surface were implanted in six beagle dog mandibles. RFA assessments were performed with a magnetic Osstel Mentor(®) device at the time of implant installation, and during the monitoring period at weeks 1, 2, 4, 6 and 8, before implant retrieval. The dogs were sacrificed and the implants were removed in block after 8, 6, 4, 2, 1 and 0 weeks, respectively. One group was obtained at time 0, immediately after the implantation. The samples were embedded in methyl methacrylate polymers (Technovit(®) ) and cut along their long axis. BIC values were assessed by a non-subjective and systematic method based on backscattered scanning electron microscopy (BS-SEM) images. BIC% at the different time points was compared with the corresponding implant stability quotient (ISQ) values of the RFA assessment. RESULTS: No statistically significant correlation between BIC and ISQ values (Osstell Mentor(®) ) was identified. The absence of a relationship between these two parameters is in agreement with several previous studies in humans and experimental animals. CONCLUSIONS: The lack of correlation between BIC and ISQ values suggests that ISQ as determined by RFA is not able to identify the relationship between RF and histomorphometrical data.

Retrospective study of the long-term survival of 980 implants placed in a periodontal practice.

PURPOSE: To assess the long-term behavior of 980 implants placed in a private practice and evaluate the influence of periodontitis history and smoking habit on implant survival rates. MATERIALS AND METHODS: A retrospective review of clinical records of consecutively treated patients with Astra Tech implants was conducted. This review included all patients treated between February 1994 and January 2005. Clinical histories were reviewed, and data were gathered on clinical and radiographic examinations. A record was kept on smoking habits, periodontitis history, length and diameter of implant(s), and whether the sinus was elevated. Cumulative survival proportions analysis was performed, and Cox regression multivariate analysis modified for correlated dependent observations was also used, with the implant as the unit of analysis. RESULTS: A total of 323 patients (185 [57.3%] female; mean age, 55.4 +/- 15.2 years) received 980 implants. Of the implants evaluated in this study, 71.1% were placed in patients who were undergoing periodontal maintenance care and 38.8% were placed in smokers. The cumulative survival rate was 96.2% at 5 years; 4.3% of implants failed; 57.1% of failures occurred before implant loading. Tobacco use and periodontitis did not affect the risk of failure, and their interaction did not show significance (P = .386). Implants from individuals with many implants and those placed in patients with sinus elevation showed a higher risk of failure (P < .05). Regression analysis showed no significant interaction between periodontitis history, tobacco use, and implant failure. CONCLUSIONS: Implant placement is an effective and reliable long-term treatment, even in periodontal patients under maintenance care and with a smoking habit. Combined analysis of tobacco use and history of periodontitis showed no significant interaction with implant failure in this sample.

Periodontal disease definition may determine the association between periodontitis and pregnancy outcomes.

AIM: The aim of this secondary analysis is to explore whether the application of different definition criteria of periodontitis, used in other similar studies, has an influence on the significance of the association between periodontitis and prematurity or low birth weight. MATERIAL AND METHODS: Fourteen periodontitis definitions and more than 50 periodontal disease continuous measurements, found in 23 published studies, were applied to a cohort study that included 1296 pregnant women. The associations with adverse pregnancy outcomes were analysed using logistic regression analysis. RESULTS: Six of the 14 tested definitions of periodontitis resulted in statistically significant adjusted odds ratios (ORs) for some of the adverse pregnancy outcomes, while no significance was found for the other eight case definitions. Out of more than 50 periodontal continuous measurements tested, only 17 demonstrated statistically significant ORs. CONCLUSIONS: Our results support the hypothesis that the significance of the association between periodontal disease and pregnancy outcomes may be determined by the periodontal disease definition or measurement used.

Periodontal disease as a risk factor for adverse pregnancy outcomes: a prospective cohort study.

AIM: The aim of this study was to determine the association between periodontitis and the incidence of preterm birth (PB), low birth weight (LBW) and preterm low birth weight (PLBW) MATERIAL AND METHODS: One thousand and ninety-six women were enrolled. Periodontal data, pregnancy outcome variables and information on other factors that may influence adverse pregnancy outcomes were collected. Data were analysed using a logistic regression model. RESULTS: The incidence of PB and LBW was 6.6% and 6.0%, respectively. The incidence of PLBW was 3.3%. PB was related to mother's age, systemic diseases, onset of prenatal care, previous PBs, complications of pregnancy, type of delivery, the presence of untreated caries and the presence of periodontitis (odds ratio 1.77, 95% confidence interval: 1.08-2.88). LBW was related to mother's smoking habits, ethnicity, systemic diseases, previous LBW babies, complications of pregnancy and type of delivery. PLBW was related to mother's age, onset of prenatal care, systemic diseases, previous LBW babies, complications of pregnancy and type of delivery. CONCLUSIONS: The factors involved in many cases of adverse pregnancy outcomes have still not being identified, although systemic infections may play a role. This study found a modest association between periodontitis and PB. Further research is required to establish whether periodontitis is a risk factor for PB and/or LBW.

Incomplete adherence to an adjunctive systemic antibiotic regimen decreases clinical outcomes in generalized aggressive periodontitis patients: a pilot retrospective study.

AIM: The objective of this study was to explore the effect of incomplete adherence to the prescribed antibiotic regimen, amoxicillin and metronidazole, in the non-surgical treatment of generalized aggressive periodontitis (GAP). METHODS: This retrospective study included 18 GAP subjects who received a conventional course of full-mouth non-surgical periodontal treatment using machine-driven and hand instruments and an adjunctive course of systemic antibiotics (500 mg amoxicillin and 500 mg metronidazole three times a day for 7 days). Clinical parameters were collected at baseline and at 2 months post-treatment. Self-reported adherence to the prescribed medication regimen was recorded at 2 months. RESULTS: All clinical parameters, except for the mean clinical attachment level (CAL) in sites with initial probing pocket depth (PPD) < or = 3 mm, improved at 2 months in all subjects. PPD reduction was 3.7 mm [95% confidence interval (CI) 3.2, 4.3 mm] in deep pockets (> or = 7 mm) and 2.2 mm (95% CI 1.9, 2.4 mm) in moderate pockets (4-6 mm), while CAL gain was 2.2 mm (95% CI 1.7, 2.6 mm) and 1.2 mm (95% CI 0.8, 1.5 mm), respectively. However, only 11 subjects (61.1%) reported full adherence to the medication. In deep pockets (> or = 7 mm), the difference between an adherent and non-adherent/partially adherent subject was 0.9 mm (95% CI 0.1, 1.7 mm, ancova, p=0.027) in PPD reduction and 0.8 mm (95% CI -0.2, 1.9, p=0.129) in CAL gain at 2 months. In moderate pockets (4-6 mm) this difference was smaller in magnitude: 0.4 mm (95% CI 0.1, 0.9 mm, p=0.036) in PPD reduction and 0.2 mm (95% CI -0.3, 0.9 mm, p=0.332) in CAL gain. CONCLUSIONS: Within the limits of this design, these data suggest that incomplete adherence to a 7-day adjunctive course of systemic metronidazole and amoxicillin is associated with decreased clinical outcomes in subjects with generalized aggressive periodontitis.

Exostosis following a free gingival graft.

BACKGROUND: There have been few cases reported of exostoses following a free gingival graft. In 1980, a free gingival graft was placed on the facial level of 33-34, developing over the years a significant enlargement. In 1999, since the patient felt progressively uncomfortable with the enlarged area, its surgical reduction was proposed. METHOD: Under local anesthesia, the hard tissue developed under the previously-grafted area, was significantly reduced. The specimen, together with a fragment of the covering soft tissue, was sent for histological analysis. RESULTS: The surgical wound healed uneventfully, and the patient was satisfied with the results. The histology showed the presence of mature bone surrounded by a dense connective tissue, whereas the gingival tissue showed acanthosis and fibrosis. CONCLUSION: The development of exostoses following a free gingival graft can be considered an unpredictable, albeit infrequent side-effect of this procedure. The fact that most of these exostoses appear in the cuspid-premolar area, deserves further consideration.