The impact of COVID-19 on Italian dentists: A cross-sectional survey on 2443 participants.

OBJECTIVE: To evaluate the impact of COVID-19 pandemic among a sample of Italian dentists in terms of infection, strategies for infection control, organization of the dental clinic, attitude, and behavior. MATERIAL AND METHODS: This was a cross-sectional survey. The sample consisted of 8000 Italian dentists selected among 63,375 using a computerized random sampling method. An electronic informed consent had to be signed. The questionnaire categories were on demographic, infection risk management, organization, and dentists' attitude and behavior. Geographic macro-areas were used for subgroup analysis. RESULTS: Among 8000 invited dentists, 2443 agreed to participate to the survey (30.6%). Mean age was 51.2 years, women were 34.5%. A total of 6.1% self-reported COVID-19 experience and higher rate of infection was reported in north Italy compared to the south (p < 0.05). FFP2/FFP3 respirators (97.1%) and visors (97.4%) were used by almost all dentists. While, natural ventilation and mouthwashes were the most frequent approaches used to reduce the infection risk. Most of the dentists reported positive attitude, nevertheless 83.6% felt an increased responsibility. CONCLUSION: The self-reported COVID-19 prevalence was 6.1% with some differences among geographic areas. COVID 19 had a deep impact on preventive strategies, dental office organization, and behavior within this sample.

Reliability assessment of the 2018 classification case definitions of peri-implant health, peri-implant mucositis, and peri-implantitis.

BACKGROUND: The purpose of this study was to evaluate the reliability and accuracy in the assignment of the case definitions of peri-implant health and diseases according to the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions. METHODS: Ten undergraduate students, 10 general dentists, and 10 experts in implant dentistry participated in this study. All examiners were provided with clinical and radiographic documentation of 25 dental implants. Eleven out the 25 cases were also accompanied by baseline readings. Examiners were asked to define all cases using the 2018 classification case definitions. Reliability among examiners was evaluated using the Fleiss kappa statistic. Accuracy was estimated using percentage of complete agreement and quadratic weighted kappa for pairwise comparisons between each rater and a gold standard diagnosis. RESULTS: The Fleiss kappa was 0.50 (95% CI: 0.48 to 0.51) and the mean quadratic weighted kappa value was 0.544. Complete agreement with the gold standard diagnosis was achieved in 59.8% of the cases. Expertise in implantology affected accuracy positively (p < 0.001) while the absence of baseline readings affected it negatively (p < 0.001). CONCLUSION: Both reliability and accuracy in assigning case definitions to dental implants according to the 2018 classification were mostly moderate. Some difficulties arose in the presence of specific challenging scenarios.

Oral Care and Quality Evaluation: A Multicentric Study on Periodontal Treatment.

PURPOSE: No information is available on the perception of the quality of care in patients treated for periodontitis. The purpose of this article was to assess how periodontitis-affected patients perceive the quality of periodontal treatment (PT) and to measure the factors which may influence it. MATERIALS AND METHODS: 306 subjects who completed PT were invited to participate. Questionnaires and visual analogic scales (VAS) evaluating perception of quality of care, symptoms, and oral health related quality of life (OHRQoL) were handed out. Oral and periodontal indicators were collected before and after treatment. The impact of different factors on perception of quality was assessed with a regression model. RESULTS: Quality evaluation was high yet unrelated for both patients and clinicians (p = 0.983). Quality was negatively influenced by the number of residual oral infections (p < 0.001), patient's age (p = 0.07) and presence of residual pain at completion of PT (p = 0.02). Professionalism, kindness of the staff and communication skills were the characteristics mostly appreciated. The OHRQoL was influenced by the number of residual teeth (p < 0.001), increasing age of patients (p = 0.08), number of residual infections (p < 0.01) and pain (p = 0.04). CONCLUSIONS: Patients' quality perception appeared to be influenced by clinical and emotional aspects. Oral care providers should be aware of the impact of non-clinical factors in patients' appreciation of quality of treatment.

Endodontic retreatment vs dental implants of teeth with an uncertain endodontic prognosis: 1-year results from a randomised controlled trial.

PURPOSE: To ascertain whether in the presence of a previously endodontically treated tooth with a periapical pathology and/or symptoms and an uncertain prognosis, it is better to endodontically retreat it or to replace the tooth with a single implant-supported crown. MATERIALS AND METHODS: Forty patients requiring the treatment of a previously endodontically treated tooth, with a periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis, as judged by the recruiting investigators, were randomly allocated to endodontic retreatment (endo group; 20 patients) or tooth extraction and replacement with an implant-supported crown (implant group; 20 patients) according to a parallel group design at two different centres. Patients were followed to 1 year after completion of the treatment. Outcome measures were: failure of the procedure, complications, marginal bone level changes at both teeth and implants, endodontic radiographic success (teeth only), number of patients' visits and days to complete the treatment, patients' chair time, costs, aesthetics assessed using the pink esthetic score (PES) for the soft tissues and the white esthetic score (WES) for the tooth/crown recorded by independent assessors. RESULTS: No patient dropped out and no complications occurred during the entire follow-up; however, one endodontically retreated tooth (5%) and one implant (5%) fractured, the difference for treatment failures being not statistically significant (difference in proportions = 0; 95% CI -0.14 to 0.14; P Fisher's exact test) = 1.000). The mean marginal bone levels at endo retreatment/implant insertion were 2.34 ± 0.88 mm for the endo and 0.23 ± 0.35 mm for the implant group, which was statistically significantly different (mean difference = 2.11 mm; 95% CI: 1.68 to 2.55; P (t-test) < 0.001). One year after completion of the treatment, teeth lost on average 0.32 ± 0.53 mm and implants 0.48 ± 0.72, the difference not being statistically significant (mean difference = -0.16 mm; 95% CI: -0.58 to 0.27; P (t-test) = 0.457). One year after completion of the endodontic retreatment, of the 13 teeth that originally had a periapical radiolucency, one was lost, six showed complete healing; four a radiographic improvement; and two showed no changes/worsening. Two of the teeth originally without a lesion developed a lesion. There were no statistically significant differences for the number of patients' visits (endo = 5.2 ± 1.8; implant = 5.5 ± 1.1; mean difference = -0.03 95% CI: -1.24 to 0.64; P (t-test) = 0.522). It took significantly more days to complete the implant rehabilitation (endo = 48.9 ± 19.5; implant = 158.5 ± 67.2; mean difference = -109.60; 95% CI: -141.26 to -77.94; P (t-test) < 0.001), but less patients' chair time (endo = 405.5 ± 230.3 min; implant = 260.0 ± 154.6 min; mean difference = 45.50; 95% CI: 19.35 to 271.65; P (t-test) = 0.025). Implant treatment was significantly more expensive (endo = 1195 ± 503.7 €; implant = 1907.5 ± 232.4 €; mean difference = -712.50; 95% CI: -963.59 to -461.41; P (t-test) < 0.001). One year after treatment completion, the mean PES was 10.92 ± 1.93 and 7.07 ± 2.87 and the mean WES was 7.67 ± 1.83 and 7.60 ± 2.32 in the endo group and implant group, respectively. Soft tissues aesthetics (PES) was significantly better at endodontically retreated teeth (mean difference 3.85; 95% CI 1.94 to 5.76; P (t-test) < 0.001) whereas no significant differences were observed for tooth aesthetics (WES) (mean difference 0.07; 95% CI -1.62 to 1.76; P (t-test) = 0.936) between treatments. CONCLUSIONS: The preliminary results suggest that both endodontic retreatment and replacement of previously endodontically treated teeth with persisting pathology and a dubious endodontic prognosis provided similar short-term success rates. Aesthetics of the soft tissues and time needed to complete treatment were in favour of endodontic retreatment, whereas implant rehabilitation required half of the chair time than endodontic retreatment, but was significantly more expensive. Although much larger patient populations and longer follow-ups are needed to fully answer this question, in this scenario the less invasive endodontic retreatment could be the first therapeutic option to be considered.

The influence of smoking on the survival of dental implants: a 5-year pragmatic multicentre retrospective cohort study of 1727 patients.

PURPOSE: To evaluate the influence of cigarette smoking on the survival of dental implants with a retrospective observational study of 5 years. MATERIALS AND METHODS: A total of 1727 consecutively treated patients at four private practices were divided into non-smokers (NS group, 1178 patients) and smokers (S group; 549 patients) according to what they declared prior to implant placement. Non-smokers received 4460 implants and 2583 implant-supported prostheses, whereas smokers received 2260 implants and 1292 implant supported prostheses. Various implant systems and procedures were used. Outcome measures were prosthesis and implant survival. RESULTS: Over the 5 years after loading, 159 (17%) non-smokers and 91 (13%) smokers were lost to follow-up; 20 (0.9%) prostheses could not be placed or failed in 15 non-smokers and 12 prostheses (1.2%) could not be placed or failed in 12 smokers. One hundred and twelve (2.9%) implants failed in 105 non-smokers and 107 (5.5%) implants failed in 75 smokers. Most of the implant failures (90%) occurred before implant loading. Fitting a logistic regression for early implant failures and total implant failures, taking into account the clustering of implants in patients, there were no statistically significant differences for prosthesis failures (P value not calculated as too few failures) and early implant failures between the two groups (P = 0.13). However, when considering all implant failures up to 5 years after loading, significantly more failures (5.5%) occurred in smokers compared with non-smokers (2.9%) (OR 1.72; 95% CI 1.20 to 2.50; P = 0.003). CONCLUSIONS: Due to the retrospective nature of this study, conclusions have to be interpreted with caution. Five years after loading, smokers experienced almost twice as many implant failures compared with non-smokers. Non-statistically significant trends in favour of non-smokers were observed for early implant failures and prosthesis failures.

Outcome of dental implants in patients with and without a history of periodontitis: a 5-year pragmatic multicentre retrospective cohort study of 1727 patients.

AIM: To evaluate the outcome of dental implants placed in patients with a history of periodontitis. Patients with no or mild history of periodontitis served as controls. MATERIALS AND METHODS: A total of 1727 patients were consecutively treated in four private practices. Patients were divided into three groups according to their initial periodontal conditions assessed with a modified periodontal screening and recording (PSR) index: 630 patients were in the severe periodontitis (SP) group, 839 in the moderate periodontitis (MP) group, and 258 had no periodontitis (NP). Patients requiring periodontal treatment were treated prior to implantation. Various implant systems and procedures were used. In total, 3260 implants and 1707 implant-supported prostheses were placed in the SP group, 2813 implants and 1744 implant-supported prostheses in the MP group, and 647 implants and 424 implant-supported prostheses in the NP group. Mixed implant­tooth supported prostheses (98 prostheses in 89 patients) were not considered. Outcome measures were prosthesis and implant survival. RESULTS: Two-hundred and fifty patients were lost to follow-up 5 years after loading. Regarding prosthesis failures, 13 prostheses could not be placed or failed in 13 patients of the SP group (0.8%), 11 prostheses could not be placed or failed in 9 patients of the MP group (0.7%), and 3 prostheses failed in 3 patients of the NP group (0.9%). For implant failures, 130 (4.5%) implants failed in the SP group, 74 (3.1%) implants failed in the MP group, and 15 (3.0%) implants failed in the NP group. Most of the implant failures (90%) occurred before implant loading. Fitting a logistic regression for early implant failures and total implant failures, taking into account the clustering of implants in patients, there were no statistically significant differences between the three PSR groups (P > 0.05). CONCLUSIONS: Owing to the retrospective nature of this study, conclusions need to be interpreted with caution. A previous history of periodontal disease may not have a significant impact on implant failures up to 5 years after loading.