An In Vivo Investigation of Non-Metallic vs. Metallic Hand Scalers on Zirconia Implant-Supported Crowns: A Year-Long Analysis of Peri-Implant Maintenance.

This study examined whether the degree of abutment surface modification that may occur with regular periodontal instrumentation has a clinical impact in terms of increased plaque accumulation and increased peri-implant tissue inflammation on zirconia implant abutments. Thirteen patients who had zirconia implant crowns were recruited in this randomized clinical trial. Each patient acted as their control and had either the buccal or lingual surface of their screw-retained implant restoration scaled with a metallic scaler and the other surface with a non-metallic scaler at 3, 6, 9, and 12 months. Cytokine testing of the peri-implant crevicular fluid was completed at 0, 3, and 12 months for IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, or IFNγ. Implant crowns were removed at 12 months and evaluated under an atomic force microscope for the average roughness (Ra). The implant crowns were polished and re-inserted. The results were analyzed using the Kruskal-Wallis test, and post hoc tests were conducted with a significance level of α = 0.05. Significant differences in surface roughness (Ra) were observed between the metallic and non-metallic scalers. The median Ra values were 274.0 nm for metallic scalers and 147.1 nm for non-metallic scalers. However, there were no significant differences between the type of scaler used and the amount of clinical inflammation or cytokine production. Metallic scalers produced deeper, more aggressive surface alterations to the abutment/crown zirconia surface, but there was no statistically significant difference between the degree of surface alterations, amount of BOP, and the amplitude of cytokine inflammation produced.

Advances in novel therapeutic approaches for periodontal diseases.

Periodontal diseases are pathological processes resulting from infections and inflammation affecting the periodontium or the tissue surrounding and supporting the teeth. Pathogenic bacteria living in complex biofilms initiate and perpetuate this disease in susceptible hosts. In some cases, broad-spectrum antibiotic therapy has been a treatment of choice to control bacterial infection. However, increasing antibiotic resistance among periodontal pathogens has become a significant challenge when treating periodontal diseases. Thanks to the improved understanding of the pathogenesis of periodontal disease, which involves the host immune response, and the importance of the human microbiome, the primary goal of periodontal therapy has shifted, in recent years, to the restoration of homeostasis in oral microbiota and its harmonious balance with the host periodontal tissues. This shift in therapeutic goals and the drug resistance challenge call for alternative approaches to antibiotic therapy that indiscriminately eliminate harmful or beneficial bacteria. In this review, we summarize the recent advancement of alternative methods and new compounds that offer promising potential for the treatment and prevention of periodontal disease. Agents that target biofilm formation, bacterial quorum-sensing systems and other virulence factors have been reviewed. New and exciting microbiome approaches, such as oral microbiota replacement therapy and probiotic therapy for periodontal disease, are also discussed.

Diagnosis and non-surgical treatment of peri-implant diseases and maintenance care of patients with dental implants - Consensus report of working group 3.

The following consensus report is based on four background reviews. The frequency of maintenance visits is based on patient risk indicators, homecare compliance and prosthetic design. Generally, a 6-month visit interval or shorter is preferred. At these visits, peri-implant probing, assessment of bleeding on probing and, if warranted, a radiographic examination is performed. Diagnosis of peri-implant mucositis requires: (i) bleeding or suppuration on gentle probing with or without increased probing depth compared with previous examinations; and (ii) no bone loss beyond crestal bone level changes resulting from initial bone remodelling. Diagnosis of peri-implantitis requires: (i) bleeding and/or suppuration on gentle probing; (ii) an increased probing depth compared with previous examinations; and (iii) bone loss beyond crestal bone level changes resulting from initial bone remodelling. If diagnosis of disease is established, the inflammation should be resolved. Non-surgical therapy is always the first choice. Access and motivation for optimal oral hygiene are key. The patient should have a course of mechanical therapy and, if a smoker, be encouraged not to smoke. Non-surgical mechanical therapy and oral hygiene reinforcement are useful in treating peri-implant mucositis. Power-driven subgingival air-polishing devices, Er: YAG lasers, metal curettes or ultrasonic curettes with or without plastic sleeves can be used to treat peri-implantitis. Such treatment usually provides clinical improvements such as reduced bleeding tendency, and in some cases a pocket-depth reduction of ≤ 1 mm. In advanced cases, however, complete resolution of the disease is unlikely.

Dental Implant Maintenance for the Oral Healthcare Team.

As dental implants have become a popular treatment modality for edentulous sites, there is a need for a peri-implant maintenance protocol. This article reviews the anatomy of peri-implant tissues, examines the etiology and risk factors of peri-implant diseases, and outlines nonsurgical and surgical treatment of these diseases. The clinical and radiographic steps necessary to diagnose peri-implant diseases during the phase of peri-implant maintenance, along with available treatment protocols to maintain or recover peri-implant health will be discussed.

The Relation Between Periodontal Disease and Vitamin D.

BACKGROUND: There is conflicting evidence regarding the association between vitamin D and periodontal disease. The purpose of this study was to explore that relation. METHODS: This cross-sectional study used data from the Canadian Health Measures Survey for respondents 13-79 years of age. Vitamin D status was determined by measuring plasma 25-hydroxyvitamin D (25(OH)D) concentrations. Periodontal disease was defined by gingival index (GI) and calculated loss of attachment (LOA). Statistical analyses included bivariate tests and multiple logistic regression. RESULTS: At the bivariate level, 25(OH)D concentrations below the cutoff levels of 50 nmol/L and 75 nmol/L were associated with GI. However, multiple regression analyses for GI revealed no association with mean 25(OH)D level or either concentration. Although no significant association between LOA and 25(OH)D status was identified at the bivariate level, a statistically significant association was observed between LOA and 25(OH)D levels < 75 nmol/L on multiple regression analysis. However, mean 25(OH)D concentrations and those < 50 nmol/L were not associated with LOA on multiple regression analysis. CONCLUSION: Vitamin D status was inversely associated with GI at the bivariate level, but not at the multivariate level. Conversely, vitamin D status was not associated with LOA at the bivariate level, but it was inversely associated with LOA at the multivariate level. These results provide modest evidence supporting a relation between low plasma 25(OH)D concentrations and periodontal disease as measured by GI and LOA.

Maintenance of Implant Patients: A Narrative Review.

PURPOSE: Patient-administered and professionally administered periimplant maintenance have been recommended to ensure long-term periimplant tissue health. In this narrative review, the effectiveness of patient and professionally administered interventions and the current level of evidence that periimplant maintenance therapy is effective in preventing the occurrence of periimplant disease were examined. MATERIALS AND METHODS: A systematic literature search was performed in Ovid MEDLINE, EMBASE, Cochrane Library, and Web of Science, for evidence-based articles in support of the above topics. RESULTS: Twenty-six clinical trials were included and stratified into categories based on topics. CONCLUSIONS: The following conclusions were reached: (a) mechanical plaque removal is the foundation of successful periimplant therapy; (b) patient- and professionally administered plaque control has been shown to reduce periimplant inflammation, although complete resolution of inflammation is not always evident; (c) the use of adjunctive chemical agents in maintaining periimplant health still remains to be determined; and (d) regular periimplant maintenance plays a significant role in maintaining periimplant soft and hard tissue health.

A randomized clinical trial of cyanoacrylate tissue adhesives in donor site of connective tissue grafts.

BACKGROUND: The purpose was to compare patient-centered outcomes, early wound healing, and postoperative complications at palatal donor area of subepithelial connective tissue grafts (CTG) between cyanoacrylates tissue adhesives and polytetrafluoroethylene (PTFE) sutures. METHODS: Thirty-six patients who required harvesting of CTG were enrolled in this randomized clinical trial and assigned to one of two groups. In the "suture" group, wound closure was achieved with standardized continuous interlocking 6-0 PTFE sutures, while in the "cyanoacrylate" group, a high viscosity blend of n-butyl and 2-octyl cyanoacrylate was applied until hemostasis was achieved. The primary outcome was the discomfort (eating, speaking, etc.) from the donor site during the first postoperative week; this was self-reported on a visual analog scale questionnaire. Secondary outcomes were the time required for suture placement or cyanoacrylate application, patient self-reported pain on the first day and the first week after surgery, the analgesic intake and the modified early-wound healing index (MEHI). RESULTS: The median value of discomfort was 1.49 in the "suture" group and 1.86 in the "cyanoacrylate" (P = 0.56). The mean time required for suture placement was 7.31 minutes and for cyanoacrylate application 2.16 minutes (P < 0.0001). No statistically significant differences were found between the two methods in reported pain level, analgesic intake, and MEHI. CONCLUSIONS: Cyanoacrylate performs similarly to sutures and can be used for wound closure of the donor site of CTG. The application was about 5 minutes faster than conventional suture placement, reducing the total time of the surgical procedure.

Successful treatment of generalized refractory chronic periodontitis through discontinuation of waxed or coated dental floss use: A report of 4 cases.

BACKGROUND AND OVERVIEW: Generalized refractory chronic periodontitis is a periodontal condition that is resistant to conventional therapy. Management of this condition often is frustrating to both the patient and the clinician. CASE DESCRIPTIONS: The authors present 4 cases of generalized refractory chronic periodontitis characterized by an inflammatory gingival response and progressive bone loss that did not respond to extensive periodontal treatments and regular periodontal care. Histologic examination of affected gingival tissue revealed an abundance of plasma cells, a feature seen in certain oral contact hypersensitivity reactions. The authors suspected that waxed or coated dental floss was the offending contactant, and its removal from the patients' oral hygiene regimens resulted in a dramatic improvement of the periodontal characteristics. CONCLUSIONS AND PRACTICAL IMPLICATIONS: In cases of periodontal disease as described in this report, dental practitioners should consider the possibility of a contact hypersensitivity reaction to waxed or coated dental floss, whereby the floss exacerbates the condition instead of assisting in its resolution.

Guidance for the maintenance care of dental implants: clinical review.

As implant treatment becomes part of mainstream dental therapy, dental offices should implement protocols for individualized, systematic and continuous supportive care of the peri-implant tissues. This review article suggests guidelines for maintenance care of dental implants. The preliminary assessment should begin with updating the patient's medical and dental histories. The clinical implant should be examined to evaluate the following: condition of the soft tissues, plaque index, clinical probing depth, bleeding on probing, suppuration, stability of soft-tissue margins, keratinized tissue, mobility and occlusion. If the clinical signs suggest the presence of peri-implantitis, radiography of the site is advisable, to confirm the diagnosis. Appropriate treatment should be pursued according to any diagnosis reached during the examination, including (but not limited to) instructions on oral hygiene, removal of supra- and sub-gingival plaque and calculus, occlusal adjustment, relining of a removable prosthesis or surgery.

Treatment and long-term follow-up of a patient with hereditary gingival fibromatosis: a case report.

This report addresses the complex nature of oral diagnosis, treatment and long-term case management in the hereditary form of recurrent gingival fibromatosis. Case management is discussed in relation to a 13-year-old girl who presented with recurrent, progressive gingival enlargement requiring consecutive periodontal and orthodontic treatment. The initial course of treatment included 4-quadrant gingivectomy with reverse bevel incisions, followed by orthodontics. Microscopic examination of the gingivectomy specimens supported the clinical diagnosis. Three years later, recurrence of the condition was observed in all quadrants. To facilitate orthodontic tooth movement and to achieve optimal esthetics, another full-mouth gingivectomy was performed. There was no recurrence of the condition a year later. It is recommended that patients with this condition be monitored closely after gingivectomy, so that the treatment requirements of localized areas can be addressed as needed.