Radiographic bone loss around dental implants: a large-cohort, long-term follow-up revealing prevalence and predictive factors.

OBJECTIVE: This retrospective study analyzed radiographic bone levels of 10,871 dental implants in a cohort of 4,247 patients over a 22-year period. The objectives of the study were to assess and explore risk factors associated with the radiographic bone level of dental implants. METHOD AND MATERIALS: A longitudinal observational cohort study based on data collected from 1995 to 2019 was conducted on implants placed by a single periodontist. Inclusion criteria included both partially and fully edentulous sites. Exclusion criteria were patients who were considered ASA 3 or greater. Information on medical and dental status prior to implant placement such as diabetes and smoking were included in the analysis. Implant factors such as the implant characteristics (length and diameter) and surgical site were recorded. The outcome assessed was the prevalence of bone loss around implants and any associative factors related to the bone loss. RESULTS: Overall, dental implants lost an average of 0.05 ± 0.38 mm of bone 2 to 3 years after placement and 0.21 ± 0.64 mm 8 years after placement. The soft tissue condition was evaluated using the Implant Mucosal Index (IMI), and bone loss around dental implants was significantly higher when bleeding on probing was multi-point and moderate, multi-point and profuse, and when infection with suppuration was recorded. The mean difference in bone level between smokers and nonsmokers was 0.26 mm (P < .01) over a 4-year period. A mean difference of 0.10 mm (P = .04) in bone loss over 4 years was found between those with an autoimmune disease compared to those without. The diameter of the implant and immediate loading of the dental implant did not influence the radiographic bone levels over time. CONCLUSIONS: This large dataset of dental implants highlights predictive risk factors for bone loss around dental implants and the impact these risk factors have on the implant bone level. Consideration of these risk factors by both the dental team and the patient prior to dental implant placement will promote success of the treatment.

Evaluating cone cut in rectangular collimation in intraoral radiography: application of ALADA and radiation stewardship.

OBJECTIVE: Rectangular collimation is a popular method used in intraoral radiography to reduce patient exposure to ionizing radiation. One of the perceived drawbacks of rectangular collimation is the possibility of an increase in cone cut errors ultimately impacting the diagnostic value of the radiographs. Thus, the aim of this study was to explore the frequency of cone cut errors in radiographs taken using a rectangular collimator. MATERIALS AND METHODS: Radiographs taken using PSP plates at Academic Center for Dentistry Amsterdam in the Netherlands by staff and students from January to December 2015 were assessed for cone cut errors. The radiographs were grouped as bitewings, front teeth, inferior premolars and molars, and superior premolars and molars and categorized as no cone cut, cone cut but diagnostically usable, and cone cut but diagnostically not usable. The results were entered into Microsoft Excel and analyzed thereafter. RESULTS: A total of 53,684 radiographs were assessed, 79% had no cone cut errors and consequently 21% had some degree of cone cut. However, the diagnostic value was unaffected in 18% of the radiographs with cone cut. Only 3% of the radiographs were deemed diagnostically unusable due to cone cut. The most common area of cone cut was in the premolar and molar areas while cone cut in the front teeth was least likely to be diagnostically unusable. CONCLUSION: Cone cut from the use of a rectangular collimator does not seem to result in an increase of diagnostically unusable radiographs. Thus, rectangular collimation should be preferred as it decreases the amount of radiation exposure to the patient while producing diagnostically usable radiographs and thus allowing the dental professional to adhere to the ALADA principle and practice radiation stewardship. CLINICAL RELEVANCE: Scientific rationale for the study: rectangular collimation is a method used to reduce patient exposure to ionizing radiation; however, this benefit is negligible if radiographs must be retaken due to cone cut errors that make the radiograph diagnostically unusable. Therefore, the aim of this study was to explore the frequency of cone cut in radiographs taken using a rectangular collimator. PRINCIPAL FINDINGS: cone cut was observed in 21% of the radiographs; however, only 3% of the radiographs were considered diagnostically unusable. PRACTICAL IMPLICATIONS: rectangular collimation does not result in a high number of diagnostically unusable radiographs and should be used to reduce patient exposure to ionizing radiation.

ACCURACY OF CLINICAL AND RADIOGRAPHIC MEASUREMENTS OF PERIODONTAL INFRABONY DEFECTS OF DIAGNOSTIC TEST ACCURACY (DTA) STUDIES: A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: The aim of this study was to determine the accuracy of clinical and radiographic measurements of infrabony periodontal defects. METHODS: The MEDLINE-Pubmed and Cochrane-CENTRAL electronic databases were searched from initiation to May 2020. The inclusion criteria were clinical trials, human subjects with at least one infrabony defect, measurements of clinical attachment level (CAL), radiographic bone level (rBL), and intraoperative bone level (iBL) used as the reference standard. RESULTS: In total, 11 studies including 17 comparisons were included in this meta-analysis. All 17 comparisons showed that the values of the CAL and rBL measurements underestimated the iBL values. For CAL, the analysis showed a significant difference of means of -1.22 (P < .00001; 95%CI: [-1.49; -0.95]) and for rBL -1.10 (P < .00001; 95%CI: [-1.34; -0.85]). No significant DiffM were observed between the CAL and rBL measurements (DiffM -0.05; P = .76; 95%CI: [-0.39; 0.28]). CONCLUSION: The results of this systematic review and meta-analysis show that both clinical and radiographic measurements substantially underestimate the bone level when compared to intraoperative level measurements. However, there was no significant difference in the results between the clinical attachment level measurements and the radiographic observation.

Use of a Novel In Situ Hardening Biphasic Alloplastic Bone Grafting Material for Guided Bone Regeneration Around Dental Implants: A Prospective Case Series.

INTRODUCTION: The novel bioresorbable polymer poly (lactide-co-glycolic acid) (PLGA) coated biphasic calcium phosphate material (BCP) hardens into a stable and porous hard tissue scaffold when exposed to body fluids. The self-containable, stable bone graft material might be beneficial for facilitating guided bone regeneration (GBR) around dental implants, especially for a defect with an absence of bony wall(s). The aim of this prospective case series is to evaluate the post-surgical implant survival and success where the in situ hardening BCP was used for GBR around dental implants. CASE SERIES: Ten patients received 13 implants with simultaneous bone augmentation. Dehiscence and/or fenestration type of bony defect was detected in nine surgical sites, and three surgical sites exhibited a suprabony defect. In nine out of the 13 implants, a membrane was used in conjunction with the bone grafting. Patients were evaluated at the day of the surgery as well as 2 weeks, and 1, 3, 6, and 12 months postoperatively. All post-surgical wounds were uneventfully healed. Radiographic bone levels showed stability over time with an average bone loss/remodeling of 0.19 ± 0.6 mm (range, -0.5-1.5 mm) from implant placement to the last follow-up at 12 months. All implants survived after 12 months. CONCLUSIONS: Implant placement with simultaneous bone grafting using the in situ hardening BCP, was shown to be a viable and safe procedure with stable clinical and radiographic results over the follow-up period. Further long-term studies are warranted, however, the combination of the ease of handling and the favorable results are promising.

Do root coverage procedures affect the longevity of teeth? A systematic review.

OBJECTIVE: The objective of this study was to systematically review the literature regarding the effect of root coverage procedures on tooth survival and periodontal outcomes. DATA SOURCES: A systematic search of the literature was performed according to the PRISMA guidelines. A PICO-based search strategy was performed in six databases. Eligibility criteria included studies comparing tooth survival and periodontal outcomes of teeth treated with root coverage procedures versus teeth that had no treatment. The search resulted in 3,646 articles; 212 articles were downloaded for review, and six articles (three studies) were included. Only a single study reported on tooth survival and found no difference between teeth that underwent root coverage procedures versus those that did not. Although the surgeries described in each study were mostly successful in reducing recession and increasing keratinized gingiva, teeth which did not undergo surgery did not seem to have a clinically significant change in recession. The study with the longest follow-up (18 to 35 years) showed an average increase in recession of 0.5 ± 0.9 mm and a decrease in keratinized tissue of 0.3 ± 0.8 mm in the control group. CONCLUSION: This systematic review highlights the need for randomized controlled trials to assess the influence of root coverage surgeries on tooth longevity in order to better inform evidence-based practice. When compared to no surgical intervention, there is presently no evidence to suggest that root coverage surgeries increase tooth longevity. Furthermore, the amount of recession does not appear to increase a clinically significant amount over time without surgical intervention in the presence of proper maintenance and home care.

Comparison of new formulas of stannous fluoride toothpastes with other commercially available fluoridated toothpastes: A systematic review and meta-analysis of randomised controlled trials.

AIM: The aim of this study was to systematically review and analyse the difference in efficacy of stannous fluoride toothpaste formulations in comparison to other fluoridated toothpastes without stannous fluoride. MATERIALS AND METHODS: A systematic search of the literature was performed according to PRISMA guidelines. A search strategy was developed to answer the study question and was performed in PubMed-Medline databases. Inclusion criteria were randomised controlled clinical trials comparing stannous fluoride toothpaste formulations with other fluoridated toothpastes not containing stannous fluoride. RESULTS: The search in PubMed-Medline databases resulted in 384 articles; 23 articles were downloaded for review, 16 articles were included in the report and six could be used for meta-analysis. All studies were randomised controlled clinical trials that compared clinical outcomes between toothpastes with stannous fluoride combinations and toothpastes with only fluoride. The overall results of the 16 studies favoured the stannous fluoride formulations. However, in a meta-analysis of the randomised controlled clinical trials, it was demonstrated that stannous fluoride toothpaste formulations provided significantly better outcomes based on the Gingival Index (SMD -0.14, 95% CI -0.20, -0.07, P = 0.0001), but not the Modified Gingival Index (SMD -0.30, 95% CI -0.7, 0.09, P = 0.13). PRACTICAL IMPLICATIONS: The antibacterial properties of stannous seem to provide favourable results when formulated with a fluoridated toothpaste. This systematic review highlights the lack of homogenous research available to rigorously compare stannous fluoride toothpaste formulations with other fluoridated toothpastes without stannous fluoride.

Systematic review and meta-analysis of randomized controlled studies comparing oscillating-rotating and other powered toothbrushes.

BACKGROUND: The aim of this study was to systematically review and analyze the difference in efficacy of oscillating-rotating toothbrushes compared with other powered toothbrushes. METHODS: The authors performed a systematic search of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors used the population, intervention, comparison, and outcome format to develop a search strategy to answer the study question. The authors searched PubMed-MEDLINE databases. Inclusion criteria were randomized controlled clinical trials comparing oscillating-rotating (OR) toothbrushes with other powered toothbrushes published from January 1, 2009 through March 1, 2019. RESULTS: The authors' search resulted in 454 articles; 21 articles were downloaded for review, 15 articles were included in the report, and 12 could be used for meta-analysis. All of the studies were randomized controlled clinical trials that assessed plaque removal and gingival inflammation indexes. Results of the meta-analysis of the randomized controlled clinical trials showed that OR toothbrushes had superior, statistically significant outcomes for whole-mouth plaque reduction, assessed using the Rustogi Modified Navy Plaque Index (P < .01), and gingivitis, assessed by using number of bleeding sites (P < .001), but not for the modified gingival index (P > .05) or gingival bleeding index (P > .05). PRACTICAL IMPLICATIONS: There is some evidence to suggest that OR powered toothbrushes might remove more plaque and reduce the number of bleedings sites better than other powered toothbrushes, specifically, sonic action toothbrushes.

Life-threatening maternal and fetal macrocytic anemia from antiretroviral therapy.

BACKGROUND: Antiretroviral therapy is recommended for human immunodeficiency virus (HIV)-infected patients during pregnancy to reduce the vertical transmission to the newborn. Complications from this therapy are uncommon. CASE: A 38-year-old HIV-positive pregnant woman was treated with lamivudine and zidovudine. At 28 weeks of gestation, her hemoglobin had fallen to 4.6 g/dL with an mean corpuscular volume (MCV) of 126 microm. At 36 weeks the fetal biophysical profile was abnormal. A pale hydropic infant was delivered via emergency cesarean, with a hemoglobin of 2.1 gm and MCV of 131 microm. The newborn hemoglobin normalized after withdrawal of the neonatal retroviral therapy. CONCLUSION: Maternal-fetal macrocytic anemia may complicate antiretroviral therapy.

Exhaled nitric oxide and tracheal endothelin-1 in preterm infants with and without RDS.

We measured exhaled nitric oxide and tracheal aspirate endothelin-1 to determine relationships between these substances and alterations in pulmonary gas exchange during respiratory distress syndrome (RDS) in comparison to those obtained from control preterm infants without RDS. Eight infants with RDS had measurements made at 24 hr and again at 48-72 hr. Eight control infants were studied once at 24-48 hr of life. Exhaled gas was analyzed on-line, and minute excretion of NO (V(NO)) was calculated. ET-1 was determined by immunoassay. Median V(NO) at 24 hr in RDS was 0.405 nl/min/kg (range, 0.30 -0.79), which subsequently declined by 48-72 hr to 0.166 nl/min/kg (P < 0.01). The V(NO) in RDS infants was significantly higher than time-matched V(NO) in controls, with a median of 0.099 nl/min/kg (range, 0.03-0.27; P < 0.001). ET-1 was not correlated with initial V(NO) in the RDS or control patients. In conclusion, in RDS, V(NO) decreases as gas exchange improves. ET-1 is detectable in tracheal aspirate samples in both groups of infants.

Endogenous production of nitric oxide in endotoxemic piglets.

We sought to assess the relation between endotoxin-induced pulmonary hypertension and the production of nitric oxide (NO) in neonatal animals. Adult animals respond to endotoxin by increasing exhaled NO and plasma NO metabolites. The response of neonatal animals has not previously been reported. We administered 20 microg/kg of Escherichia coli lipopolysaccharide (LPS) to 12- to 18-day-old and to 5- to 7-week-old piglets. Pulmonary vascular resistance increased significantly in both age groups. Exhaled NO in the 12- to 18-day-old animals and in the 5- to 7-week-old piglets did not increase significantly. A similarly treated group of adult rats did show a significant increase in exhaled NO (2.6 +/- 1.0 to 109.5 +/- 54.3 ppb; p = 0.028). Plasma NO metabolite measurements followed the same pattern of no increase in both porcine groups, and a large increase in the rat group. However, immunostaining of lungs from 12- to 18-day-old piglets did reveal an increase in inducible NO synthase. These results suggest that piglets demonstrate a limited ability to modulate LPS-induced pulmonary hypertension by elevations in exhaled NO. They also demonstrate the differential response to LPS between species.

Interaction of endogenous endothelin-1 and inhaled nitric oxide in term and preterm infants.

The peptide endothelin-1 (ET-1) plays an unknown role in the pathogenesis and progression of two important neonatal pulmonary disorders, chronic lung disease (CLD) of prematurity and persistent pulmonary hypertension of the newborn (PPHN). Inhaled nitric oxide (INO) is a proven vasodilator therapy in PPHN and is an experimental therapy in CLD. We sought to determine the effects, if any, of the interaction of inhaled INO with ET-1 in these two separate disorders. Infants (n=21) with PPHN (mean gestation age, 39.4 weeks; mean birth weight, 3470 g) were treated with INO. All infants were <72 h of age at baseline. Plasma obtained at baseline and after 24 h of INO therapy was assessed for ET-1. The change in ET-1 levels with INO was inversely correlated with change in arterial partial pressure of O(2) (r=-0.71, P=0.0003). A separate group of 33 patients with CLD (mean gestational age, 27 weeks; mean birth weight, 740 g; mean age, 19 days) had tracheal aspirate levels of ET-1 obtained before, during, and after 7 days' administration of INO. Values were normalized by soluble secretory component of IgA. Tracheal aspirate ET-1 levels were detectable before INO therapy. There was no significant change during or after treatment with INO. There was not a significant correlation between baseline fractional inspired O(2) and ET-1 levels. There was a non-significant trend in the correlation between the change in ET-1 and the change in interleukin-8 levels in tracheal aspirate. This report confirms the presence of ET-1 in tracheal aspirate of premature infants who are developing CLD and reaffirms the presence of ET-1 in plasma of infants with PPHN. Short-term INO therapy was associated with a decrease in plasma ET-1 levels in PPHN, but did not affect tracheal aspirate ET-1 in CLD. Given the vasconstrictive, profibrotic, and proinflammatory properties of ET-1, specific ET-1 receptor antagonists could be considered as candidates for trials as adjunct therapy in either or both of these disorders.