Topical Agents in Biofilm Disaggregation: A Systematic Review and Meta-Analysis.

Background: to evaluate the effectiveness of different topical agents in biofilm disaggregation during non-surgical periodontal therapy. Methods: the search strategy was conducted according to the PRISMA 2020 on Pubmed, Cochrane Library, Scopus, and Web of Science, and it was registered in PROSPERO, ID: CRD42023474232. It included studies comparing non-surgical periodontal therapy (NSPT) with and without the application of topical agents for biofilm disruption. A risk of bias analysis, a qualitative analysis, and a quantitative analysis were performed. Results: out of 1583 records, 11 articles were included: 10 randomized clinical trials and one retrospective analysis. The total number of participants considered in the 11 articles included in the study was 386. The primary outcomes were probing pocket depth (PPD), clinical attachment level (CAL), and bleeding indices. The secondary outcomes were plaque indices, gingival recessions, and microbiological parameters. The meta-analysis revealed the following: [Weighted mean difference (WMD): -0.37; 95% confidence interval (CI) (-0.62, -0.12), heterogeneity I2: 79%, statistical significance p = 0.004]. Conclusions: the meta-analysis of probing pocket depth reduction (PPD) between baseline and follow-up at 3-6 months showed a statistically significant result in favor of sulfonated phenolics gel. The scientific evidence is still limited and heterogeneous; further randomized clinical trials are required.

Clinical outcomes and periodontal conditions of dental implants placed in free fibula flaps (FFF): a retrospective study with a mean follow-up of 6 years.

OBJECTIVES: Up-to-date literature regarding long-term success of implant rehabilitations after microvascular reconstructions with free fibula flap (FFF) is still very scarce. This study aimed to evaluate clinical outcomes, especially related to oral hygiene conditions, of patients rehabilitated with this technique. MATERIALS AND METHODS: A total of 25 patients who underwent maxillofacial reconstructive surgery with FFF were retrospectively evaluated for soft tissues conditions, oral hygiene habits, and implant survival and success, assessed with a mean follow-up of 6 (range 2-15) years after loading. RESULTS: Fourteen patients received full-arch fixed prostheses and 11 removable bar-supported overdentures. At the follow-up evaluation, 52% of prostheses did not allow proper accessibility for oral hygiene. Overall prosthetic survival was 100%, and implant survival and success were respectively 93.6% and 72%. Prevalence of peri-implantitis was 29% at implant level and that at patient level 96%. CONCLUSIONS: Six-year clinical outcomes of this study reveal that poor oral hygiene practices and compliance by patients who underwent maxillofacial reconstruction with FFF are significantly associated with peri-implant disease. CLINICAL RELEVANCE: Findings of the present study underline the need by clinicians for a careful assessment, in reference to a specific implant therapy, of patient's prosthetic accessibility for oral hygiene procedures.

Six-Month Soft Tissues Healing after Lower Third Molar Extraction: Comparison of Two Different Access Flaps.

BACKGROUND: As specific flap designs performed for lower third molar extractions usually influence periodontal healing of the adjacent first and second molars, this study aimed to evaluate the periodontal conditions of these sites after 6 months post-surgery. METHODS: Forty patients, aged 14-30 years, were included. Surgical extraction of the lower third molar was performed through a flap with papilla detachment (a modified envelope technique with detachment of gingival papilla between the first and second molars) or a trapezoidal flap (characterized by mesial- and distal-releasing incisions). Periodontal parameters at the first and second molar sites were assessed for visible plaque index, bleeding on probing, recession, probing pocket depth, and clinical attachment loss before surgery (T0), one month (T1), and six months after extraction (T2). RESULTS: No statistical differences were found for the plaque and bleeding indexes between the two flaps at each observation time and considering both time intervals. For recession, no statistical differences were found between the two flaps considering the final time interval. For probing pocket depth at the second molar site, both techniques registered a significant increase between T0 and T1, followed by a decrease up to T2. For clinical attachment loss, mean values assessed for the first and second molar sites demonstrated evidently increased values between T0 and T1, followed by moderate decreases up to T2. CONCLUSIONS: Considering short (T1) and mid-term (T2) follow-ups, a specific flap design does not seem to particularly influence periodontal healing six months after surgery.

Short and Ultra-Short Implants, in Association with Simultaneous Internal Sinus Lift in the Atrophic Posterior Maxilla: A Five-Year Retrospective Study.

Recent short-term studies suggested the use of short and ultra-short implants in association with a modified osteotome sinus floor elevation (internal sinus lift) technique for the treatment of edentulous resorbed posterior maxilla. The aim of this retrospective study was to investigate this hypothesis in locking-taper implants with a mid-term follow-up of 5 years. Overall, 155 implants (32, 100, and 23 of, respectively, 5.0 mm, 6.0 mm, and 8.0 mm length) were positioned in the atrophic upper maxilla of 79 patients, and 151 implants were loaded with single crowns. Overall implant survival after 5 years was 94.84%. Implant survival for each length group was 93.75%, 94%, and 100% for 5.0, 6.0, and 8.0 mm length, respectively. Preoperative residual crestal bone height of 4.45 (1.3) mm increased to 9.25 (2.13) mm after implant placement and settled at 6.35 (1.73) mm after loading and at 5.25 (1.68) mm at follow-up. Elevation of the Schneiderian membrane was 4.8 (2.46) mm after implant placement, 3.06 (1.3) mm after loading, and 1.46 (1.06) mm at follow-up. Mean variations of peri-implant crestal bone loss and first bone-to-implant contact point were, respectively, -0.36 (1.3) mm and -0.62 (1.15) mm. It can be confirmed that internal sinus lift procedure revealed stable bone gain and negligible resorption at mid-term follow-up for atrophic upper crests with reduced height.

Periodontal Healing after Lower Third Molars Extraction: A Clinical Evaluation of Different Flap Designs.

Periodontal healing after third molars extraction seems to be influenced by the choice of different flap techniques. The purpose of the present study was to assess the clinical condition of adjacent first and second molar sites, after the extraction of lower third molars, performed through different flap designs. Eighty patients, aged between 14 and 30 years, were analyzed for periodontal parameters of VPI, PPD, and CAL, pre-operatively (T0), after 15 days (T1), after 1 month (T2), and after 2 months (T3) from extraction. Techniques performed were trapezoidal flap (TRAP), marginal flap (MARG), flap with papilla detachment (DETP), and flap with papilla decapitation (DEC). No significant differences were found between the four flaps at each observation time and considering the interval between T0 and T3, for VPI, PPD at first molar site, PPD at second molar site, and CAL at second molar site. Significant variations for CAL were registered, for each flap, between T0 and T3, in all cases for buccal site, in three cases for buccal-distal site. After 2 months of follow-up, no strong evidence can be assumed for or against the use of a particular flap design for the extraction of lower third molars.

Short and ultra-short (<6-mm) locking-taper implants supporting single crowns in posterior areas (part II): A 5-year retrospective study on periodontally healthy patients and patients with a history of periodontitis.

BACKGROUND: Short and ultra-short implants implants supporting single crowns seem to demonstrate high percentages of survival and stable marginal bone levels at a mid-term follow-up. Nevertheless, insurgence of peri-implant complications still represents a critical issue, especially for patients with history of periodontitis. PURPOSE: The aim of this retrospective study was to evaluate implant survival, marginal bone loss and peri-implant complications in 333 short and ultra-short implants, placed in periodontally healthy patients and patients with a history of periodontitis. MATERIALS AND METHODS: Implants were placed in the maxillary and mandibular posterior regions of 142 patients with (PP) and without (NPP) a history of periodontitis. Clinical and radiographic examinations were performed at 5-year recall appointments. RESULTS: Implants respectively placed in PP and NPP were: 35.68% and 42.50% in 8.0 mm-length group, 33.33% and 36.67% in 6.0 mm-length group, and 30.99% and 20.83% in 5.0 mm-length group. Implant-based survival after 5 years of follow-up was 95.77% for PP and 96.67% for NPP (p = 0.77). Regarding crestal bone level variations, average crestal bone loss was statistically different (p = 0.04) among PP (0.74 mm) and NPP (0.61 mm). Implants presenting signs of mucositis were 6.86% in PP and 7.76% in NPP (p = 0.76). Setting the threshold for excessive bone loss at 1 mm after 60 months, peri-implantitis prevalence was 7.84% in PP and 2.59% in NPP (p = 0.08). Overall implant success was 92.16% and 97.41%, respectively, for PP and NPP. CONCLUSIONS: Under strict maintenance program, five-year outcomes suggest that short and ultra-short locking-taper implants can be successfully restored with single crowns in the posterior jaws both in PP and NPP.

Survival rates of ultra-short (<6 mm) compared with short locking-taper implants supporting single crowns in posterior areas: A 5-year retrospective study.

BACKGROUND: Short and ultra-short implants represent a predictable treatment, in terms of implant survival, with patients presenting insufficient available bone volumes. Moreover, single crown restorations represent a gold standard in terms of oral hygiene. PURPOSE: The aim of this retrospective study was to evaluate implant survival, marginal bone loss, and peri-implant complications in 333 locking-taper short and ultra-short implants. MATERIALS AND METHODS: Implants were placed in the maxillary and mandibular posterior regions of 142 patients. Clinical and radiographic examinations were performed at 5-year recall appointments. RESULTS: All implants placed consisted of 8.0-, 6.0-, and 5.0-mm length, 38.14%, 34.53%, and 27.33%, respectively. Three hundred thirty-two implants (one early failure) were rehabilitated with single crowns in 141 patients. In 45.48% of the implants the crown-to-implant ratio was ≥2, with a mean value of 1.94. Overall implant-based survival after 5 years of follow-up was 96.10%: 96.85%, 95.65%, and 95.60% for 8.0-, 6.0-, and 5.0-mm length implants, respectively (p = 0.82). Overall patient-based survival was 91.55%. Regarding crestal bone level variations, average crestal bone loss and apical shift of the "first bone-to-implant contact point" position were 0.69 and 0.01 mm, respectively. Setting the threshold for excessive bone loss at 1 mm, during the time interval from loading to follow-up, 28 implants experienced loss of supporting bone greater than 1 mm: 19 of them (67.85%) were surgically treated with a codified surgical regenerative protocol. After 60 months, a peri-implantitis prevalence of 5.94% was reported, with an overall implant success of 94.06%: 95.93%, 92.73%, and 93.10% for 8.0-, 6.0-, and 5.0-mm length implants, respectively (p = 0.55). CONCLUSION: Long-term outcomes suggest that short and ultra-short locking-taper implants can be successfully restored with single crowns in the posterior area of the maxilla and mandible.

Detection of Periodontal Pathogens in Oral Samples and Cardiac Specimens in Patients Undergoing Aortic Valve Replacement: A Pilot Study.

This observational study aimed to: (i) assess the presence of periodontal disease among patients requiring aortic valve replacement; (ii) investigate the presence of oral pathogens in aortic valve specimens and compare them with the microorganisms detected in the oral cavity. Twenty-six patients (15 men and 11 women) were scheduled to be visited the day before the cardiac surgery: periodontal conditions were accurately registered through clinical and radiographic examinations; dental plaque or salivary samples were collected. Valve specimens were collected during surgical aortic valve replacement and analyzed for pathogens detection through microbiological 16SrRna gene sequencing. Bacteria found in plaque samples and valve specimens were assessed according to oral and periodontal conditions. A qualitative comparison between oral and cardiac profiles of the microorganisms detected was performed. The overall number of patients examined for soft tissues conditions was 19, as 7 patients were edentulous. Twelve and three individuals, respectively, presented moderate and severe periodontitis. Nine valves were found to be positive for the presence of oral and periodontopathic bacterial DNA. The microbial species found in valve samples of patients with periodontitis suggest that the presence of these microorganisms in valvular tissue seems to be not coincidental.

Complications related to zygomatic implants placement: A retrospective evaluation with 5 years follow-up.

This retrospective study assessed zygoma implants in patients treated for upper maxilla extreme atrophy, trauma, cleft palate, or failed reconstruction. The implants were placed using Quad (4 zygoma implants) or mixed (zygoma and conventional implants in premaxilla) surgical technique, with intra-sinus or extra-sinus approach, followed by immediate or deferred loading. Clinical and radiographic evaluations were carried out at 5-year follow-up from loading. Implant survival, symptoms and signs of sinusitis, radiological alterations in terms of mucosal thickening or obliteration of the maxillary sinuses, oroantral communications, and peri-implant soft tissues were examined. A total of 42 patients, with 116 zygoma implants, were included in the study. The cumulative survival rate was 97.41%. One zygomatic bone fracture was assessed. Eight patients reported sinusitis, and two showed oro-antral communications. A comparison between mean pre- and post-operative Lund-Mackay scores showed a statistically significant increase of sino-nasal disease in the post-operative scores (p = 0.0019). Mucositis and gingival recession was observed in 21 and 8 implants respectively. Average recession was 2.52 ± 2.35 mm. According to our results, placement of zygoma implants has proved to be a predictable procedure, with a lower rate of severe complications compared to other treatment options in extreme upper jaw atrophy.

Assessment of Peri-Implant Soft Tissues Conditions around Short and Ultra-Short Implant-Supported Single Crowns: A 3-Year Retrospective Study on Periodontally Healthy Patients and Patients with a History of Periodontal Disease.

The aim of this retrospective study was to evaluate implant survival, marginal bone loss and peri-implant complications in 326 short and ultra-short implants. Implants were placed in the maxillary and mandibular posterior regions of 140 patients with (PP) and without (NPP) a history of periodontal disease. Clinical and radiographic examinations were performed at 3-year recall appointments. The 8.0, 6.0 and 5.0 mm-length implants placed in PP and NPP were respectively 43.75% and 38.46%, 35.10% and 34.19%, 21.15% and 27.35%; 325 implants (one early failure) were rehabilitated with single crowns in 139 patients. Overall implant survival after 3 years of follow-up was 97.55%, 98.08% and 96.61% for PP and NPP (p = 0.46). Crestal bone level variations were not statistically different among PP and NPP; 15.41% of implants presented signs of mucositis, 14.71% and 16.67% in PP and NPP (p = 0.64). Setting the threshold for bone loss at 2 mm after 36 months, peri-implantitis prevalence was 2.2%, 1.96% and 2.63% in PP and NPP (p = 0.7). Overall implant success was 82.39%, 83.33% and 80.7% for PP and NPP (p = 0.55). Short-term outcomes suggest that short and ultra-short locking-taper implants can successfully be restored with single crowns in the posterior jaws both in PP and NPP.

Hyperbaric oxygen therapy for the treatment of moderate to severe periodontitis: a clinical pilot study.

Objectives: To clinically and microbiologically evaluate the effects of hyperbaric oxygen (HBO2) therapy in addition to full-mouth ultrasonic subgingival debridement (FM-UD), in the initial treatment of chronic periodontitis. Methods: Twenty patients presenting moderate to severe generalized forms of chronic periodontitis were included in a three-month randomized, parallel-group, single-blinded, prospective study. At baseline patients were randomly assigned to two treatment groups [Test Group (FM-UD+HBO2) and Control Group (FM-UD)]. Both groups were treated with an FM-UD session. Ten HBO2 sessions (one session per day for 10 days at a pressure of 2.5 ATA) were additionally administered to the Test Group. Soft tissues parameters [probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL) and visible plaque index (VPI)] were assessed at baseline (immediately before FM-UD treatment), after two weeks, after six weeks and at three months. For each patient, a site presenting PPD ≥ 6mm and positive BOP was selected as a qualifying site (QS), to be monitored clinically (at T0, T1, T2 and T3) and microbiologically (at T0, T1 and T3). Results: There were no statistically significant differences between the two groups for any clinical parameter analyzed after three months, except for BOP, which was significantly (p < 0.05) reduced in the Test Group. Reductions in bacterial levels were detected in both groups after therapy. Faster bacterial recolonization occurred after three months in the Control Group. Conclusion: HBO2 therapy in combination with FM-UD may represent an efficacious approach to the treatment of moderate to severe forms of periodontitis.

Single-Crown, Short and Ultra-Short Implants, in Association with Simultaneous Internal Sinus Lift in the Atrophic Posterior Maxilla: A Three-Year Retrospective Study.

As the atrophic posterior maxilla often presents serious limitations for dental implant procedures, a minimally invasive technique was proposed. The study aimed to retrospectively evaluate the outcomes of short and ultra-short locking-taper implants, placed in combination with a modified osteotome sinus floor elevation procedure (internal sinus lift technique) in the posterior maxilla. A total of 31 patients received 51 locking-taper implants. Clinical and radiographic examinations were performed before treatment, at loading time, and after three years. Seven implants of 8.0 mm, 23 implants of 6.0 mm, and 21 implants 5.0 mm in length were rehabilitated with single-crown restorations. Implant survival at three-year follow-up was 96.08%. Pre-operative residual crestal bone height of 5.2 (1.41) (median (interquartile range)) mm increased to 7.59 (1.97) mm at the 36-month follow-up, with an average intra-sinus bone height gain of 3.17 ± 1.13 (mean ± standard deviation) mm. Mean peri-implant crestal bone loss was 0.29 (0.46) mm and mean first bone-to-implant contact point shifted apically to 0.12 (0.34) mm. It can be suggested with confidence that implants used in the study, placed in conjunction with an internal sinus floor elevation technique, can be restored with single crowns as a predictable treatment for the edentulous regions of the posterior maxilla.

Survival of Short and Ultra-Short Locking-Taper Implants Supporting Single Crowns in the Posterior Mandible: A 3-Year Retrospective Study.

The purpose of this retrospective study was to determine survival and peri-implant marginal bone loss of short and ultra-short implants placed in the posterior mandible. A total of 98 patients received 201 locking-taper implants between January 2014 and January 2015. Implants were placed with a 2-stage approach and restored with single crowns. Clinical and radiographic examinations were performed at 3-year recall appointments. At that time, the proportion of implant survival by length, and variations of crestal bone levels (mean crestal bone loss and mean apical shift of the "first bone-to-implant contact point" position) were assessed. Significance level was set at 0.05. The total number of implants examined 36 months after loading included: 71 implants, 8.0 mm in length; 82 implants, 6.0 mm in length; and 48 implants, 5.0 mm in length. Five implants failed. The overall proportion of survival was 97.51%, with 98.59% for the 8.0-mm implants, 97.56% for the 6.0-mm implants, and 95.83% for the 5.0-mm implants. No statistically significant differences were found among the groups regarding implant survival (P = .73), mean crestal bone loss (P = .31), or mean apical shift of the "first bone-to-implant contact point" position (P = .36). Single-crown short and ultra-short implants may offer predictable outcomes in the atrophic posterior mandibular regions, though further investigations with longer follow-up evaluations are necessary to validate our results.

Assessment of Oral Conditions in Individuals Treated with Methadone: A Research Report.

PURPOSE: Oral health is essential in everyone's daily life, and becomes particularly important for those individuals who have been previously drug addicted. The aim of this study was to assess oral health in patients almost at the end of a methadone-detoxification process due to heroin dependency, identifying their treatment needs. MATERIALS AND METHODS: Seventeen patients, aged between 22 and 51 years, were admitted to the University Hospital of Verona after at least 6 months of being drug-free, except for standard methadone therapy (20 mg/day). Data concerning medical history, social status, drugs and nutritional habits were collected. Restorative conditions and periodontal status were evaluated clinically and radiographically. RESULTS: The duration of illicit drug consumption ranged from 2 to 20 years; methadone treatment duration ranged from 1 to 17 months. A total of 392 teeth were evaluated: 2 patients were diagnosed with periodontitis, whereas dental caries was widespread, affecting most frequently interproximal surfaces of the anterior teeth. Some 185 teeth needed restorations, 15 decayed teeth endodontic treatments, 21 teeth extraction, and 84 teeth were suitable for prosthetic rehabilitations. Caries and periodontal indexes were analysed according to years of heroin consumption (HYC) and months of methadone therapy (MMT), without any statistical differences (p > 0.05) found for both phases. Social and individual factors were investigated in relation with the indexes: no correlations were demonstrated. Regarding irregular food ingestion during HYC, a statistically significant difference (p < 0.05) between the full-mouth visible bleeding on probing index (FM-VBOP) and diet was found. CONCLUSION: A large carbohydrate intake consequent to methadone therapy increased caries prevalence, despite a more regular diet.

Successful Management of Peri-Implantitis around Short and Ultrashort Single-Crown Implants: A Case Series with a 3-Year Follow-Up.

INTRODUCTION AND AIM: In case of peri-implantitis, resective surgery is contraindicated for short and ultrashort implants, limiting the treatment options to regenerative surgery or to implant removal. This retrospective case series presents the clinical and radiographic outcomes of a surgical regenerative procedure to treat peri-implantitis around short and ultrashort implants. MATERIALS AND METHODS: The study is a retrospective evaluation of patients suffering from peri-implantitis and those who underwent access flap surgery, concomitant chemical and mechanical decontamination of implant surface, and bone grafting using a self-hardening mixture of bone substitutes and biphasic calcium sulfate. No membranes were applied to cover the grafting material, and primary tension-free closure was achieved. The retrospective protocol was reviewed and approved by the Ethics Committee for Clinical Sperimentation (CESC) of Verona and Rovigo, Italy (based in the University of Verona) (Prog. 1863CESC. Date of approval: 2018-07-04). RESULTS: 15 patients (17 implants) have been diagnosed with peri-implantitis after a mean follow-up of 24 months after loading. Implant length was between 5 and 8 mm. 8 patients (10 implants) had a history of periodontitis. At baseline, the mean PD (probing pocket dept) at the deepest site was 8.12 mm, with an average mBI (modified bleeding index) of 2.35 and a mean BD (bone defect depth) of 3.04 mm. At the 3-year follow-up, the CSR was 100%, the mean mBI was 0.88 (average reduction: -1.47), the mean PD was 3.35 mm (mean PD reduction: 4.77 mm), and the mean bone defect was reduced by 1.74 mm, with a mean bone fill of 55%. CONCLUSIONS: The results of the present case series suggest that if accurate surface decontamination is achieved, high survival rate and good clinical and radiographic results can be obtained after 3 years. However, only the histological examination could confirm the growth of new bone in direct contact with the implant surface or if the grafted material only fills the space left by the peri-implant defect.

A Topical Desiccant Agent in Association with Manual Debridement in the Initial Treatment of Peri-Implant Mucositis: A Clinical and Microbiological Pilot Study.

In patients presenting mucositis, effective sub-gingival debridement is crucial to prevent peri-implantitis. The aim of this randomized study was to assess the three-month (T1) effects of a locally delivered liquid desiccant agent with molecular hygroscopic properties, in association with manual debridement, at sites with peri-implant mucositis. Twenty-three patients presenting at least one implant with no radiographically detectable bone loss, a pocket probing depth (PPD) ≥ 4 mm, and bleeding on probing (BOP), were included. At baseline (T0), patients were randomly assigned to receive the aforementioned desiccant agent before debridement (Test-Group), or a Chlorhexidine 1% disinfectant gel after debridement (Control-Group). Treatments were repeated after seven and 14 days. Peri-implant soft tissue assessment [PPD, BOP, Modified Bleeding Index (mBI), Visible Plaque Index (VPI), and Modified Plaque Index (mPLI)] and microbial sampling were performed at T0 and T1. At T1 the Test-Group presented significantly greater reductions for BOP, mBI, VPI, and mPLI. Concerning the deepest sites of the treated implants, both groups showed statistically significant reductions for BOP and mBI between T0 and T1. Furthermore, the Test-Group exhibited a significant decrease in anaerobic bacteria. Despite these valid outcomes, a complete resolution of the inflammatory conditions was not achieved by any of the groups.