How Intraday Index Changes Influence Periodontal Assessment: A Preliminary Study.

It is reputed that periodontal indices remain unchanged over a 24-hour period, with great clinical significance. This preliminary study analyzes daily index changes. In 56 selected patients, full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), periodontal screening and recording (PSR) indices, and periodontal risk assessment (PRA) were recorded at baseline and three times per day (check-I: 08.30, check-II: 11.30, and check-III: 14.30), after appropriate cause-related therapy. Correlation between variables was statistically analyzed by Stata. All periodontal indices improved at the examination phase. Statistical differences were detected for FMPS comparing all thrice daily checks. Statistical differences were detected for FMBS and PRA comparing check-III with check-I and check-II. PSR showed no significant changes. The worst baseline indices produced the widest daily fluctuation at the examination phase. Significant variation of indices is directly related to clinical severity of periodontal conditions at baseline. Patients affected by severe periodontal disease may show significantly greater index changes. As indices are routinely recorded only once per day, the index daily variation has clinical significance. This greatly affects therapeutic strategy as correct periodontal assessment requires multiple evaluations at standardized times, particularly when baseline conditions are severe.

Immediate loading of single post-extractive implants in the anterior maxilla: 12-month results from a multicenter clinical study.

The purpose of the study was to evaluate survival and peri-implant bone levels of single, immediately loaded post-extractive implants in the anterior maxilla 12 months after implant placement. Thirty-six consecutive patients from 3 study centers were included in the study. The concerned sites were upper premolars, canines, and incisors. For each patient the following data were recorded: reason for tooth extraction, bone quality, implant size, and final insertion torque. Implants were placed using a flapless technique and immediately loaded with a nonoccluding temporary restoration. Final restorations were provided 4 months later. Peri-implant bone resorption was evaluated radiographically after 6 and 12 months. The average final insertion torque was 70.55 Ncm. One implant inserted in D3 quality bone with a 35-Ncm seating torque was lost. All other implants had a final insertion torque ranging between 50 and 80 Ncm. The average peri-implant bone loss was 0.437 and 0.507 mm at 6 and 12 months, respectively. All the sites maintained excellent papillae and peri-implant soft-tissue conditions. The resulting 1-year success rate was 97.2%. Immediate nonfunctional loading of single post-extractive implants in the anterior maxilla is a predictable treatment. And it seems that achieving high insertion torques by placing self-tapping/self-condensing implants in an underprepared osteotomy is favorable.

Survival and success rates of immediately and early loaded implants: 12-month results from a multicentric randomized clinical study.

Our objective was to compare survival and peri-implant bone levels of immediately nonocclusally vs early loaded implants in partially edentulous patients up to 12 months after implant placement. Eighty patients (inclusion criteria: general good health, good oral hygiene, 30-65 years old; exclusion criteria: head and neck irradiation/cancer, pregnancy, uncontrolled diabetes, substance abuse, bruxism, lack of opposing occluding dentition, smokers >10 cigarettes/day, need for bone augmentation procedures) were selected in 5 Italian study centers and randomized into 2 groups: 40 patients in the immediately loaded group (minimal insertion torque 30 Ncm) and 40 patients in the early loaded group. Immediately loaded implants were provided with nonoccluding temporary restorations. Final restorations were provided 2 months later. Early loaded implants were provided with a definitive restoration after 2 months. Peri-implant bone resorption was evaluated radiographically with software (ImageJ 1.42). No dropout occurred. Both groups gradually lost peri-implant bone. After 12 months, patients of both groups lost an average of 0.4 mm of peri-implant bone. There were no statistically significant differences (evaluated with t test) between the 2 loading strategies for peri-implant bone level changes at 2 (P = .6730), 6 (P = .6613) and 12 (P = .5957) months or for survival rates (100% in both groups). If adequate primary stability is achieved, immediate loading of dental implants can provide similar success rates, survival rates, and peri-implant bone resorption as compared with early loading, as evaluated in the present study.

Periodontal disease and nitric oxide levels in low risk women with preterm labor.

OBJECTIVES: The aims of the study were to evaluate the possible association between periodontal disease (PD) and preterm labor (PTL), to assess whether the presence of periodontal disease in women with PTL increases the risk of preterm birth (PTB), and to evaluate the role of nitric oxide (NO) in this possible association. STUDY DESIGN: This study included 820 nulligravid women with low risk socioeconomic status: 400 cases with PTL and 420 controls with normal pregnancy, between 25 and 33 weeks+6 days of weeks' gestation. At enrollment, periodontal examination and detection of plasma, gingival and cervical NO levels were performed. We compared the periodontal status of the two groups; we detected the presence of PD and compared NO levels. We then followed the outcome of women with PTL and compared obstetric status and PTB rate between patients with and without PD. RESULTS: Logistic regression analysis revealed a strong association between PD and PTL (adjusted odds ratio: 2.83, 95% confidence interval (CI) 1.86-4.23; P<0.0001). Non parametric Mann-Whitney U-test demonstrated significant differences in gingival and cervical NO levels between women with PTL and controls (respectively, median 85.1 µmol/L, interquartile range (i.r.) 51.2-177 vs median 50.5 µmol/L, i.r. 34.5-109.65, P<0.0001; and median 102 µmol/L, i.r. 53.05-182.7 vs median 38.9 µmol/L, i.r. 32.87-46.1, P<0.0001). The ability of mean-gingival NO levels to predict PTL was examined by ROC curve analysis: the area under the curve was 0.817 (95% CI 0.774-0.854; P<0.0001). The cut-off level for the greatest sensitivity and specificity for mean-gingival NO levels was 116.04 µmol/L (sensitivity 0.57, specificity 0.94). Positive and negative predictive values were, respectively, 90.65% and 69.73%. Among women with PTL, the risk of PTB increased in women with PD (adjusted relative risk: 3.85, 95% CI 2.11-6.06; P<0.0001). CONCLUSIONS: In this tested population, PTL is associated with PD. The presence of PD in women with PTL increases the risk of premature delivery. NO may be a new marker to explain this association.