A brief motivational interviewing as an adjunct to periodontal therapy-A potential tool to reduce relapse in oral hygiene behaviours. A three-year study.

OBJECTIVES: To evaluate (ii) whether inclusion of a single motivational interviewing (MI) session, as an adjunct to periodontal therapy, might be beneficial for preventing relapse in oral hygiene behaviours among patients treated for chronic periodontitis and (ii) whether individual and clinical characteristics can be of predictive value for retention of sufficient oral hygiene behaviours. MATERIAL & METHODS: This 3-year follow-up of a previously reported randomized controlled trial (RCT) study of 6-month duration included 26 patients. Patients in the test group had received one MI session by a clinical psychologist before initiation of the periodontal treatment. Otherwise, all patients followed the same treatment protocol for conventional educational intervention and non-surgical periodontal therapy. Efficacy variables assessed for evaluation of the standard of self-performed periodontal infection control were marginal bleeding index (MBI; primary efficacy variable) and plaque score (PI). RESULTS: The patterns of change in MBI and PI scores were similar for test and control groups over the observation period. At 3 years, both groups showed a desirable mean full-mouth MBI of 15%, a figure that was comparable to that at the short-term evaluation after active periodontal treatment. The post-treatment MBI was the only variable identified as a predictor of retained adequate oral hygiene behaviours. CONCLUSION: A single MI session as an adjunct to conventional periodontal therapy could not be proven to be of long-term beneficial additive effect with regard to prevention of relapse in oral hygiene behaviour. Desirable standard of self-performed infection control after active periodontal treatment predicted the retention of sufficient oral hygiene behaviour over time.

Professional competencies and work-related support in relation to periodontal therapy and work satisfaction: A questionnaire study among Swedish Dental Hygienists.

OBJECTIVES: To analyse dental hygienists' (DHs) views on professional competencies and behavioural interventions in the treatment of periodontitis patients, perceived work-related support and work satisfaction. METHODS: A Web-based questionnaire was distributed to all DHs employed at the public dental service in the county of Västra Götaland, Sweden. 302 (83%) responded to the questionnaire; 291 of these DHs stated that they on regular basis treated periodontitis patients and thus constituted the sample for analyses. Based on initial correlation and bivariate analyses of the questionnaire data, multiple logistic regression models were formulated to estimate perceived competencies to treat patients with periodontitis and work satisfaction. RESULTS: The multiple analyses revealed that DHs who worked with specific methods for behavioural intervention, like motivational interviewing, were more likely to rate themselves as "definitely possessing the competencies required to treat patients with periodontitis" (OR 4.0). Likewise, this group of DHs did not consider it more difficult to charge their patients the financial costs for such a behavioural intervention than for scaling therapy (OR 3.1). The perception that one's professional competencies were utilized well in daily practice was associated with high work satisfaction (OR 4.1). More years in the profession (OR 1.03) and a good support by colleagues (OR 1.9) had also a positive impact on work satisfaction. CONCLUSIONS: Dental hygienists' considered that competencies in the treatment of periodontitis patients were related to the practice of behavioural interventions as part of therapy. A stimulating and supportive work environment, with opportunities for professional development, is important for work satisfaction.

Effectiveness of Implant Therapy Analyzed in a Swedish Population: Prevalence of Peri-implantitis.

Peri-implantitis is an inflammatory disease affecting soft and hard tissues surrounding dental implants. As the global number of individuals that undergo restorative therapy through dental implants increases, peri-implantitis is considered as a major and growing problem in dentistry. A randomly selected sample of 588 patients who all had received implant-supported therapy 9 y earlier was clinically and radiographically examined. Prevalence of peri-implantitis was assessed and risk indicators were identified by multilevel regression analysis. Forty-five percent of all patients presented with peri-implantitis (bleeding on probing/suppuration and bone loss >0.5 mm). Moderate/severe peri-implantitis (bleeding on probing/suppuration and bone loss >2 mm) was diagnosed in 14.5%. Patients with periodontitis and with ≥4 implants, as well as implants of certain brands and prosthetic therapy delivered by general practitioners, exhibited higher odds ratios for moderate/severe peri-implantitis. Similarly, higher odds ratios were identified for implants installed in the mandible and with crown restoration margins positioned ≤1.5 mm from the crestal bone at baseline. It is suggested that peri-implantitis is a common condition and that several patient- and implant-related factors influence the risk for moderate/severe peri-implantitis (ClinicalTrials.gov NCT01825772).

Effectiveness of implant therapy analyzed in a Swedish population: early and late implant loss.

Treatment outcomes in implant dentistry have been mainly assessed as implant survival rates in small, selected patient groups of specialist or university clinical settings. This study reports on loss of dental implants assessed in a large and randomly selected patient sample. The results were aimed at representing evaluation of effectiveness of implant dentistry. Using the national data register of the Swedish Social Insurance Agency, 4,716 patients were randomly selected. All had been provided with implant-supported restorative therapy in 2003. Patient files of 2,765 patients (11,311 implants) were collected from more than 800 clinicians. Information on patients, treatment procedures, and outcomes related to the implant-supported restorative therapy was extracted from the files. In total, 596 of the 2,765 subjects, provided with 2,367 implants, attended a clinical examination 9 y after therapy. Implant loss that occurred prior to connection of the supraconstruction was scored as an early implant loss, while later occurring loss was considered late implant loss. Early implant loss occurred in 4.4% of patients (1.4% of implants), while 4.2% of the patients who were examined 9 y after therapy presented with late implant loss (2.0% of implants). Overall, 7.6% of the patients had lost at least 1 implant. Multilevel analysis revealed higher odds ratios for early implant loss among smokers and patients with an initial diagnosis of periodontitis. Implants shorter than 10 mm and representing certain brands also showed higher odds ratios for early implant loss. Implant brand also influenced late implant loss. Implant loss is not an uncommon event, and patient and implant characteristics influence outcomes (ClinicalTrials.gov NCT01825772).

Patient satisfaction with mini-implant stabilised full dentures. A 1-year prospective study.

The purpose of this study was to evaluate patient-centred outcomes with regard to function and comfort after placement of mini-implants for stabilisation of complete dentures. The trial was designed as a prospective cohort of 12-months duration and involved 21 subjects in the age of 50-90 years having a full denture in the maxilla or the mandible with poor stability during function. Flapless installation of 2-4 narrow-body Dentatus Atlas(®) implants was performed and retention for the existing denture was obtained by the use of a silicone-based soft lining material (Tuf-Link(®)). Patients' judgement of perceived satisfaction with function and comfort of the dentures was recorded at baseline, 1- and 12-months post-treatment using 10-centimetre visual analogue scales (VAS) and a questionnaire. Clinical examination of the conditions of the peri-implant soft tissues was performed at 12 months. Nineteen of the 21 patients were available for the 12-month follow-up examination. The two drop-out subjects lost all implants within 1 month and rejected retreatment. Further six subjects lost 1-2 implants, but were sucessfully retreated by insertion of new implants. Overall satisfaction, chewing and speaking comfort were all markedly improved from pre-treatment median VAS scores of around 4-5 to median scores of 9·0-10 (10 = optimal) at the final examination. The prevalence of positive answers to questions regarding stability/function of the denture increased significantly to almost 100% for all questions. Treatment involving maxillary dentures and the use of short implants (7-10 mm) was associated with an increased risk of implant failure. The results indicate that placement of mini-implants as retentive elements for full dentures with poor functional stability has a marked positive impact on the patients' perception of oral function and comfort as well as security in social life.

Changes in molar position associated with missing opposed and/or adjacent tooth: a 12-year study in women.

The aim of this study was to radiographically analyse long-term changes in (i) overeruption of unopposed molars and (ii) tipping of molars with a mesial edentulous space, and whether there is an interaction between the two events. A further aim was to analyse if loss of alveolar bone height might influence overeruption and tipping. The sample consisted of panoramic radiographs taken at an interval of 12 years of 292 subjects from a prospective population study of women. The panoramic radiographs were scanned and analysed. Changes in tipping, overeruption and alveolar bone height of molars and control teeth were measured. The results showed that unopposed molars were more commonly found in the upper jaw and that unopposed molars showed 4·9 times higher risk of overeruption of ≥2 mm (95% CI 1·5-15·3) than opposed molars during the 12-year observation period. The average overeruption for the unopposed molars was 4·5% (s.d. 7·6), which corresponds to approximately 0·9 mm. The degree of overeruption increased with decreased bone support. Molars with a mesial edentulous space were most prevalent in the lower jaw, but neither an edentulous space nor alveolar bone level/bone level change were found to have a significant effect on tipping of the molars. The average mesial tipping was 0·8° (s.d. 5·6). In conclusion, unopposed molars showed a significantly increased risk for overeruption. Molars facing a mesial edentulous space showed a low risk for mesial tipping, but a significant interaction between overeruption and tipping was identified.

Dental hygienists' views on communicative factors and interpersonal processes in prevention and treatment of periodontal disease.

OBJECTIVE: The aim of this study was to explore views of DHs on communicative issues and interpersonal processes of importance in the prevention and treatment of periodontal disease. METHOD: The qualitative method of Grounded Theory (GT) was chosen for data sampling and analysis. Audio-taped and open-ended interviews were conducted with 17 dental hygienists. The interviews were transcribed verbatim and analysed in a hierarchical coding process, according to the principles of GT. RESULT: In the analysis a core category was identified as 'to be successful in information and oral health education and managing desirable behavioural changes'. The core concept was related to four additional categories and dimensions; (i) 'to establish a trustful relationship with the patient', (ii) 'to present information about the oral health status and to give oral hygiene instructions', (iii) 'to be professional in the role as a dental hygienist' and (iv) 'to have a supportive working environment in order to feel satisfaction with the work and to reach desirable treatment results'. CONCLUSION: The results describe a psychosocial process that elucidates the importance of building a trustful relationship with the patient, feeling secure in one's professional role as a DH and last but not least, the importance of having support from colleagues and the clinical manager to be successful in the prevention and treatment of periodontal diseases.

Longevity of teeth and implants - a systematic review.

The objective of this systematic review was to describe the incidence of tooth and implant loss reported in long-term studies. Prospective longitudinal studies reporting on teeth or implants survival with a follow-up period of at least 10 years were considered. Papers were excluded if the drop out rate exceeded 30% or if <70% of the initial subject sample was examined at 10 years of follow-up. Seventy publications on teeth were identified as potentially relevant for the focussed question. The analysis of the abstracts yielded 37 studies eligible for full-text analysis. The inclusion criteria were met in 11 of the publications that included in all 3015 subjects. The initial search on implant studies generated 52 publications that possibly could be included. Following the evaluation of the abstracts and full-text analysis nine publications were found to fulfil the inclusion criteria. The nine studies included 476 subjects. The incidence of tooth loss among subjects with a follow-up period of 10-30 years varied from 1.3% to 5% in the majority of studies, while in two epidemiological studies on rural Chinese populations the incidences of tooth loss were 14% and 20%. The percentage of implants reported as lost during the follow-up period varied between 1% and 18%. In clinically well-maintained patients, the loss rate at teeth was lower than that at implant. Bone level changes appeared to be small at teeth as well as at implants in well-maintained patients. Comparisons of the longevity at teeth and dental implants are difficult due to heterogeneity among the studies.

A three-year prospective study of adult subjects with gingivitis II: microbiological parameters.

AIM: To investigate whether the clinical benefits obtained with a periodontal prevention programme in subjects with periodontal health or minimal disease were accompanied by beneficial changes in the subgingival microbiota. MATERIAL AND METHODS: One hundred and twenty-four subjects completed the study. Subjects were clinically and microbiologically monitored at baseline, 1, 2 and 3 years. Subgingival plaque samples were taken from the mesiobuccal aspect of every tooth and were analysed for the levels of 40 bacterial species using checkerboard DNA-DNA hybridization (total samples=13,477). The mean counts of each of the 40 test species were calculated for each subject at each time point. Significance of differences over time was sought using the Friedman test. p values were adjusted for multiple comparisons. RESULTS: All clinical parameters, at the microbiologically sampled sites, improved over time. The clinical changes were accompanied by statistically significant decreases in the mean counts of 35 of the 40 test species. Major reductions occurred by year 2 for Actinomyces, Capnocytophaga, Campylobacter, Fusobacterium and Prevotella species. At year 3, there was a modest re-growth of the majority of the species. CONCLUSIONS: The clinical improvements obtained through preventive measures were accompanied by a shift to a more host-compatible subgingival microbiota.

Relative effectiveness of powered and manual toothbrushes in elderly patients with implant-supported mandibular overdentures.

AIM: The aim of this study was to compare the clinical effectiveness of a powered toothbrush (Braun Oral-B Plaque Remover 3-D) and a manual soft toothbrush (Oral-B Squish-grip brush) for the control of supragingival plaque and soft tissue inflammation around implants supporting mandibular overdentures. MATERIAL AND METHODS: The study sample involved 40 edentulous subjects, aged 55-80 years, having 2 unsplinted mandibular implants supporting a complete removable overdenture opposed by a maxillary complete denture. In this single-blinded, randomised, cross-over clinical trial, two 6-week experimental phases were separated by a 2-week wash-out period. 2 weeks prior to each experimental phase (pre-entry visits), implant abutments were polished to remove all plaque and a standardised instruction in the use of the toothbrush was given. Modified plaque and bleeding indices were recorded at the start and end of each experimental period. Mean index scores at each phase were analysed using paired t-test, and the mean number of sites showing a change in plaque or mucositis were compared using the Mann-Whitney U-test. Combined data from 2 different implant systems were considered after controlling for implant type. RESULTS: Only minor changes in plaque and bleeding scores were observed following the two test periods. There were no statistically significant differences between the manual and powered toothbrushes. CONCLUSION: Manual and powered brushes were found to be of comparable efficacy with regard to improvement in peri-implant bleeding and plaque indices.

Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis. A comparative multi-centre trial of 2 treatment approaches.

AIM: In the present 6-month multicentre trial, the outcome of 2 different approaches to non-surgical treatment of chronic periodontitis, both involving the use of a locally delivered controlled-release doxycycline, was evaluated. MATERIAL AND METHODS: 105 adult patients with moderately advanced chronic periodontitis from 3 centres participated in the trial. Each patient had to present with at least 8 periodontal sites in 2 jaw quadrants with a probing pocket depth (PPD) of > or =5 mm and bleeding following pocket probing (BoP), out of which at least 2 sites had to be > or =7 mm and a further 2 sites > or =6 mm. Following a baseline examination, including assessments of plaque, PPD, clinical attachment level (CAL) and BoP, careful instruction in oral hygiene was given. The patients were then randomly assigned to one of two treatment groups: scaling/root planing (SRP) with local analgesia or debridement (supra- and subgingival ultrasonic instrumentation without analgesia). The "SRP" group received a single episode of full-mouth supra-/subgingival scaling and root planing under local analgesia. In addition, at a 3-month recall visit, a full-mouth supra-/subgingival debridement using ultrasonic instrumentation was provided. This was followed by subgingival application of an 8.5% w/w doxycycline polymer at sites with a remaining PPD of > or =5 mm. The patients of the "debridement" group were initially subjected to a 45-minute full-mouth debridement with the use of an ultrasonic instrument and without administration of local analgesia, and followed by application of doxycycline in sites with a PPD of > or =5 mm. At month 3, sites with a remaining PPD of > or =5 mm were subjected to scaling and root planing. Clinical re-examinations were performed at 3 and 6 months. RESULTS: At 3 months, the proportion of sites showing PPD of < or =4 mm was significantly higher in the "debridement" group than in the "SRP" group (58% versus 50%; p<0.05). The CAL gain at 3 months amounted to 0.8 mm in the "debridement" group and 0.5 mm in the "SRP" group (p=0.064). The proportion of sites demonstrating a clinically significant CAL gain (> or =2 mm) was higher in the "debridement" group than in the "SRP" group (38% versus 30%; p<0.05). At the 6-month examination, no statistically significant differences in PPD or CAL were found between the two treatment groups. BoP was significantly lower for the "debridement" group than for the "SRP" group (p<0.001) both at 3- and 6 months. The mean total treatment time (baseline and 3-month) for the "SRP" patients was 3:11 h, compared to 2:00 h for the patients in the "debridement" group (p<0.001). CONCLUSION: The results indicate that simplified subgingival instrumentation combined with local application of doxycycline in deep periodontal sites can be considered as a justified approach for non-surgical treatment of chronic periodontitis.

Root-dentin sensitivity following non-surgical periodontal treatment.

BACKGROUND, AIMS: Little clinical data exist on the incidence and severity by which root dentin sensitivity (RDS) results from periodontal therapy. The aim of the present clinical trial was to study the degree to which a sample of patients requiring non-surgical periodontal treatment develops RDS. MATERIAL AND METHODS: Alterations in RDS was followed in 35 patients (29-65 years of age) requiring non-surgical treatment for moderate to advanced periodontal disease. Inclusion criteria for participation were need for periodontal treatment in at least 2 quadrants comprising a minimum of 4 teeth with vital pulps, no open caries lesions, no dental treatment in the last 3 months and no ongoing treatment for RDS. Baseline and follow-up recordings included responses of teeth to pain stimuli (directed compressed air) at buccal surfaces as graded by the patient on a 10-cm visual analogue scale (VAS). Periodontal therapy consisted of oral hygiene instruction (OH) followed by supra- and subgingival scaling/root planing by hand and ultrasonic instrumentation of one quadrant per each of the subsequent weeks. Thus, follow-up data included pain assessment after 1-3 weeks of OH alone, and 1-4 weeks post-instrumentation. RESULTS: There was a statistically significant reduction in mean VAS scoring over time in quadrants where only meticulous plaque control had been maintained, while VAS mean values increased significantly after instrumentation (p<0.001). Also the % of subjects reporting higher mean VAS values increased after instrumentation. Changes in mean VAS scores were generally moderate and only 9 patients gave an increase on VAS of >2 cm for 3 or more teeth. A statistically significantly higher increase of RDS was observed for initially sensitive teeth (VAS>0) than for teeth not responding at baseline (p<0.001). Although a reduction in the intensity of RDS could be noticed during the later phase of the 4-week follow-up period after scaling and root planing, the percentage of sensitive teeth remained unchanged. CONCLUSION: The data confirm that meticulous plaque control will diminish RDS problems and that scaling and root planing procedures in periodontal therapy result in an increase of teeth that respond to painful stimuli. However, pain experiences in general appeared minor and only a few teeth in a few patients developed highly sensitive root surfaces following instrumentation.

Periodontal treatment decisions for molars: an analysis of influencing factors and long-term outcome.

BACKGROUND: The purpose of this retrospective study was 1) to analyze factors influencing the treatment decision for periodontitis-affected molars and 2) to evaluate the long-term outcome of the decision. The treatment alternatives included in the analysis were maintenance of the tooth with only non-surgically/surgically performed scaling/root planing with or without furcation plasty, root separation/resection, and tooth extraction. METHODS: Data collected from a total of 1,313 first and second molars in 222 patients (mean age 45 years; range 14 to 73 years), referred for periodontal treatment, were analyzed with respect to treatment decisions for furcation-involved teeth. The patients had been examined with respect to oral hygiene status, gingival conditions, probing depth, furcation involvement, and radiographic bone height before and after active periodontal treatment. Frequencies, mean values and standard deviations were calculated for the various variables assessed. Multiple regression models were formulated in order to analyze the influence of various variables on treatment decisions. One-hundred and sixty (72%) of the patients agreed to participate in a follow-up examination to determine the clinical and radiographic status of the molars 8 to 12 years after the active phase of treatment for evaluation of the long-term outcome of the treatment decision. RESULTS: Twenty-eight percent of the molars were extracted and 4% were root separated/resected. Factors found to significantly influence the decision of tooth extraction were tooth mobility, tooth position, lack of occlusal antagonism, degree of furcation involvement, and remaining bone support. Of the factors analyzed with respect to root separation/resection, molar position and degree of furcation involvement showed the strongest influence on the treatment decision. The 8- to 12-year follow-up examination revealed that 96% of the molars subjected to non-resective therapy were still in function. The corresponding figure for root separated/resected molars was 89%. Loss of radiographic bone support during the 10-year follow-up period was 0.1 to 0.6 mm for the various molars with the highest value for maxillary second molars. CONCLUSIONS: A conservative approach to the treatment of molars with even deep furcation invasions may show a high long-term success rate, provided maintenance care is offered.

Implant supported single-tooth replacements compared to contralateral natural teeth. Crown and soft tissue dimensions.

The aim of this study was to make a comparative evaluation of crown and soft tissue dimensions between implant-supported single-tooth replacements and the contralateral natural tooth. Twenty patients, who had been treated with an implant-supported single-tooth replacement in the esthetic zone of the maxillary jaw and had i) a non-restored contralateral natural tooth and ii) completed the implant-supported crown restoration at least 6 months prior to the scheduled follow-up examination, were included in the study. At the re-examination various variables describing crown form, soft tissue dimensions and soft tissue conditions were assessed. In addition, the patient's overall satisfaction with the esthetic outcome of the implant-supported single crown was scored using a Visual Analogue Scale (VAS). In 12 of the subjects clinical photographs were available from the time of crown insertion for evaluation of longitudinal alterations of the papilla height. The results revealed that, in comparison to the contralateral natural crown, the implant supported crown i) was longer, ii) had a smaller facio-lingual width, iii) was bordered by a thicker facial mucosa, iv) had a lower height of the distal papilla, v) showed a higher frequency of mucositis and bleeding on probing and vi) showed greater probing depths. The longitudinal evaluation of the papillae adjacent to the implant crown showed an improved proximal soft tissue fill at the follow-up examination. The VAS scoring of the patients' satisfaction with the appearance of their single implant-supported restorations revealed a median value of 96% with a range from 70 to 100%. Hence, observed differences in clinical crown height and soft tissue topography between implant-supported single-tooth replacements and the contralateral natural tooth may in most patients be of minor importance for the appreciation of the esthetic outcome of implant therapy.

Esthetic outcome of implant-supported single-tooth replacements assessed by the patient and by prosthodontists.

PURPOSE: The objective of this study was to assess and compare patients' and clinicians' judgments of the esthetic outcome of implant-supported single-tooth replacements. MATERIALS AND METHODS: In all, 29 patients with 41 single implant-supported crowns in the maxillary anterior region participated in the study. The esthetic outcome of the implant-supported crowns was assessed by the patients and by 5 prosthodontists by means of a questionnaire in which various esthetics-related variables were addressed and responded to using visual analogue scales. Multiple regression analyses were used to evaluate the influence of the variables on the "overall satisfaction" with the implant-supported crown. RESULTS: Most variables in the patients' assessments revealed mean values above 90% and median values close to 100%. No single factor used in the multiple regression analysis was found to influence a patient's satisfaction with appearance of the crown at a statistically significant level. The clinicians' degree of satisfaction was for all variables lower than that of the patients. In 89% of the cases the clinicians could correctly locate the single implant-supported crown. Among the variables assessed, surrounding soft tissue appearance and form of the crown had the strongest influence on the clinician's overall satisfaction with the appearance of the crown. CONCLUSION: Appreciation of the esthetic outcome of the single implant-supported crowns was rated higher by the patients than by the prosthodontists. Furthermore, factors considered by professionals to be of significance for the esthetic result of the restorative treatment may not be of decisive importance for the patient's satisfaction.

Impact of endodontic conditions on marginal bone loss.

This study was undertaken to examine the extent to which the marginal alveolar bone may be influenced by the condition of the dental pulp. A total of 115 pairs of contralateral teeth were observed in 87 patients (25 to 45 years old) in which the test tooth, but not the control tooth, was either endodontically treated or not treated but with a periapical radiolucency. The distance from the cemento-enamel junction to the marginal bone level was measured using intraoral radiographs. The condition of the endodontic filling, the periapical status, and the presence of root canal post were also assessed. With clinical parameters similar between teeth in the two groups in terms of visible plaque, bleeding on probing, probing depth, and attachment level, the results showed a somewhat (mean value 0.1 mm; SD 0.7) larger reduction of the alveolar bone support in test than control teeth. This difference was not statistically significant on a patient level. Hence, this study failed to demonstrate a correlation between a reduced marginal bone support and endodontic status.

Treatment of periodontal disease in older adults.

The literature does not indicate that older adults differ from younger individuals in their response to periodontal treatment. However, in older adults, it is more common to find compromised general conditions that may negatively affect the patient's ability to maintain an adequate standard of self-performed plaque control. Although this can be compensated for partly by a carefully designed program for supportive therapy, the prevention and/or elimination of clinical signs of periodontal inflammation may not always be a reachable goal of periodontal therapy in older adults, particularly in those who are frail and functionally dependent. For many patients, a more realistic goal may be the control of disease progression in order to preserve a functional and comfortable dentition throughout life and hence, the decision making process regarding therapeutic levels for the individual patient must include factors such as the amount of remaining periodontal support, the risk for disease progression, demands for oral health and life expectancy.

Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study.

The aim of this study was to longitudinally evaluate alterations in the position of the periimplant soft tissue margin, occurring during a 2-year period after insertion of fixed prostheses. 41 patients, subjected to treatment with partial or full-arch implant supported fixed prostheses based on a total of 163 standard Brånemark oral implants, were included in the study. A baseline examination was performed at time of insertion of the prosthetic construction and involved assessments of plaque, mucositis, probing depth, bleeding on probing marginal soft tissue level, width of masticatory mucosa and marginal soft tissue mobility. All patients were re-examined after 6 months, and after 1 and 2 years, respectively. A regression analysis was performed to evaluate if alterations, occurring in the position of the periimplant soft tissue margin during the 2 years, could be predicted by various variables recorded at time of the installation of the fixed prosthesis. The descriptive analysis showed a slight decrease in mean probing depth (0.2 mm) and width of masticatory mucosa (0.3 mm) during the follow-up period. Apical displacement of the soft tissue margin mainly took place during the first 6 months of observation. Lingual sites in the mandible showed the most pronounced soft tissue recession, decrease of probing depth, and decrease of width of masticatory mucosa. The statistical analysis revealed that lack of masticatory mucosa and mobility of the periimplant soft tissue at time of bridge installation were poor predictors of soft tissue recession occurring during the 2 years of follow-up, but indicated in greater amount of recession in women than men, in the mandible than in the maxilla, at lingual than at facial sites and with increased initial probing depth. It was suggested that the recession of the periimplant soft tissue margin mainly may be the result of a remodelling of the soft tissue in order to establish "appropriate biological dimensions" of the periimplant soft tissue barrier, i.e., the required dimension of epithelial-connective tissue attachment in relation to the faciolingual thickness of the supracrestal soft tissue.

Prevalence of furcation involvements in patients referred for periodontal treatment.

The aim of this study was to evaluate the prevalence of furcation-involved molars in a patient sample referred for periodontal treatment. A total of 222 patients aged, 14-73 years (mean age 45 years), and with signs of destructive periodontal disease in at least 2 quadrants of the dentition were included in the study. The clinical examination involved assessments of oral hygiene status, gingival conditions, probing pocket depth and presence/degree of furcation involvement. In addition, a full mouth intraoral radiographic examination was performed. The results revealed that 4% of the patients presented with all 12 molars, while 3% had lost all molars. 52% of the individuals had at least 8 molars; 95% of subjects < 30 years of age and 19% in the age 60+ years. In patients aged > or = 40 years, every 2nd molar showed advanced periodontal destruction in the furcation area. The prevalence of furcation involved molars was higher in the maxilla than in the mandible. From the age of 30 years, about 50% of the 1st and 2nd molars in the maxilla showed at least 1 furcation site with deep involvement, while in the mandible a similar prevalence was observed first after the age of 40 years. The highest frequency of furcation involvement was found at the distal site of the maxillary 1st molar (53%), and the mesial aspects of the maxillary 2nd molar showed the lowest frequency (20%). Furcation sites with a probeable trunk region were observed at a frequency of 17-22% at the various tooth sites. It was concluded that tooth morphology may be an important factor that accounts for the variability in prevalence of molar furcation involvement.