Multicentered epidemiological study of factors associated with total bacterial count in the saliva of older people requiring nursing care.

AIM: To clarify whether the number of present teeth, independent of other well-known factors, was associated with the total bacterial count in the saliva of older people requiring care at nursing homes in a multicentered epidemiological survey. METHOD: The participants were 618 older people (mean age 86.8 ± 6.9 years; 122 men, 496 women) residing in 14 nursing homes across Japan. The dependent variable was the participant's salivary bacterial count, and the independent variables were basic demographic data, oral conditions and activity of daily living (measured by Barthel Index). Statistical analysis was first carried out by Student's t-test, Pearson's correlation coefficient analysis and Spearman's rank correlation coefficient analysis. Independent variables found to have a significant relationship to their salivary bacterial count by the univariate analyses were further examined by stepwise multivariate analysis. RESULTS: The independent variables shown by univariate analysis to have a significant positive relationship with higher salivary bacterial count were presence of food residue (P = 0.001), absence of mouth dryness (P = 0.001), need of oral care assistance (P = 0.001), inability to keep the mouth opened (P = 0.009), inability to gargle (P = 0.002), denture use (P = 0.004), higher number of present teeth (P = 0.006) and lower Barthel Index (P = 0.001). Subsequent multivariate analysis identified presence of food residue (P = 0.031), higher number of present teeth (P = 0.043) and lower Barthel Index (P = 0.001) as independent associated factors for higher salivary bacterial count. CONCLUSIONS: The present study found that presence of food residue, higher number of present teeth and decreased activity of daily living were significantly related to higher bacterial count in the saliva of older people requiring care. Geriatr Gerontol Int 2017; 17: 219-225.

How do peri-implant mucositis and gingivitis respond to supragingival biofilm control - an intra-individual longitudinal cohort study.

PURPOSE: This single-arm study to compare the gingival with peri-implant mucosal inflammatory response to a mechanical supragingival-supramucosal biofilm control program. MATERIALS AND METHODS: Twenty-two participants (55.7 ± 11.2 years) with both gingivitis and periimplant mucositis were examined at days 0, 30 and 390 (full mouth/6 sites per tooth/implant [TTH/IMPL]) for visible plaque (VPI), gingival bleeding (GBI), modified plaque (mPlI) and bleeding indexes (mBI), probing depth (PD) and bleeding on probing (BOP). The biofilm control was carried out weekly in the first month and every 3 months thereafter. An intention-to-treat analysis was performed (drop-out rate = 8) and linear models were used against comparisons in order to look at the clustering of TTH/IMPL by each individual. RESULTS: VPI/mPlI and GBI/mBI reduced from day 0 onwards. Intra-group reductions (P < 0.05) were observed at day 30. PD values (in mm) were higher (P < 0.001) for IMPL than for TTH [mean difference (95% CI) at day 0: -1.10 (-1.58 to -0.63); day 30: -0.88 (-1.28 to -0.48); and day 390: -0.60 (-0.84 to -0.33)], where both groups showed reductions (P < 0.05) throughout the study. BOP was greater (P = 0.00001) for IMPL at baseline [mean difference (95% CI): -0.24 (-0.31 to -0.17)] but reduced (P = 0.00001) and showed similar levels to TTH from day 30 onwards. With regard to sites with the greatest PD, BOP reduced (P < 0.05) in both IMPL and TTH, with greater PD reductions observed for IMPL (P = 0.00001). CONCLUSIONS: The supragingival-supramucosal biofilm control benefited both teeth and implants.

Zirconia dental implants: a clinical, radiographic, and microbiologic evaluation up to 3 years.

PURPOSE: To retrospectively evaluate the clinical performance of zirconia endosseous implants. MATERIALS AND METHODS: Partially edentulous patients with adequate bone volume to fit yttria tetragonal zirconia polycrystal (Y-TZP) implants at least 3.5 mm wide and 8.0 mm long were included. Full-mouth probing pocket depth (PPDs) and percentage bleeding on probing (BOP) scores around teeth and implant(s) were assessed and compared. Marginal bone loss/gain relative to baseline was measured on intraoral radiographs, and the prevalence and quantities of seven periodontal bacteria were assessed around implants and teeth in the same patient. RESULTS: Seventy-four consecutively treated patients with 121 zirconia implants (66 two-piece implants and 55 one-piece implants) were clinically evaluated after a mean observation period of 18 months. Three implants had failed and had been removed, for a cumulative implant survival rate of 96.5% (± 2.0%) after 3 years. The 118 surviving implants demonstrated healthy mucosal conditions, with low mean PPDs (1.8 ± 0.4 mm) and mean BOP scores (4.1% ± 4.2%). PPD and BOP were statistically significantly lower around implants than around teeth. BOP and PPD around implants and teeth were significantly correlated. Stable marginal bone levels were observed (mean bone loss of 0.1 ± 0.6 mm after 3 years). The frequency of isolation of all marker bacteria was similar at tooth and implant sites. CONCLUSION: Zirconia endosseous implants can achieve a 3-year implant survival rate in partially edentulous patients, similar to that of titanium implants, with healthy and stable soft and hard tissues.

Differences in peri-implant microflora between fully and partially edentulous patients: a systematic review.

BACKGROUND: The current evidence suggests that the oral microflora differs between individuals who are fully edentulous (FES) and those who are partially edentulous (PES). It is unknown whether this leads to differences in peri-implant microflora when implants are installed. The aim of the study is to compare the submucosal peri-implant microflora between FES and PES. METHODS: A systematic review was conducted. The MEDLINE, Embase, and Cochrane databases were searched for publications up to September 1, 2012. To reduce methodologic variations, only studies reporting in the same article about the submucosal peri-implant microflora of FES and PES were selected. RESULTS: Eleven publications describing 10 studies were selected. Because of numerous differences among the selected studies, no meta-analysis could be performed. Six of 10 studies showed a significant difference in the composition of the submucosal peri-implant microflora in healthy and peri-implant mucositis conditions between FES and PES, with the latter showing a potentially more pathogenic composition. However, microbiologic results were not unanimous among the studies. CONCLUSIONS: In healthy and peri-implant mucositis conditions, PES harbor a potentially more pathogenic peri-implant microflora than FES. The current data are insufficient for a clear conclusion regarding peri-implantitis cases. Overall, because of the lack of a meta-analysis, the variability in microbiologic outcomes and the limited number of studies available, the current evidence seems not to be robust.

Patient-specific analysis of periodontal and peri-implant microbiomes.

Periodontally involved teeth have been implicated as 'microbial reservoirs' in the etiology of peri-implant diseases. Therefore, the purpose of this investigation was to use a deep-sequencing approach to identify the degree of congruence between adjacent peri-implant and periodontal microbiomes in states of health and disease. Subgingival and peri-implant biofilm samples were collected from 81 partially edentulous individuals with periodontal and peri-implant health and disease. Bacterial DNA was isolated, and the 16S rRNA gene was amplified and sequenced by pyrotag sequencing. Chimera-depleted sequences were compared against a locally hosted curated database for bacterial identification. Statistical significance was determined by paired Student's t tests between tooth-implant pairs. The 1.9 million sequences identified represented 523 species. Sixty percent of individuals shared less than 50% of all species between their periodontal and peri-implant biofilms, and 85% of individuals shared less than 8% of abundant species between tooth and implant. Additionally, the periodontal microbiome demonstrated significantly higher diversity than the implant, and distinct bacterial lineages were associated with health and disease in each ecosystem. Analysis of our data suggests that simple geographic proximity is not a sufficient determinant of colonization of topographically distinct niches, and that the peri-implant and periodontal microbiomes represent microbiologically distinct ecosystems.

Metagenomic analysis of the peri-implant and periodontal microflora in patients with clinical signs of gingivitis or mucositis.

The long-term success of osseointegrated oral implants is endangered by inflammation of peri-implant hard and soft tissues caused by bacterial biofilms that may have been initiated by bacterial transmission from the adjacent dentition. The present study aimed to compare the bacterial communities at inflamed implant and tooth sites by broad-range PCR techniques to evaluate the etiological processes of peri-implant and periodontal diseases and potential future therapeutic strategies. Eighteen samples of peri-implant and periodontal microflora were collected from nine partially edentulous patients with implant-retained crowns or bridges revealing clinical signs of gingivitis or mucositis. The clinical parameters plaque index (PI), probing depth (PD), and bleeding on probing were recorded. Amplified fragments of bacterial 16S rRNA genes were separated by use of single-strand conformation polymorphism analysis, and sequences were determined to identify the predominant bacterial genera. The clinical parameters PI and PD were significantly different at implants (PI = 0.4 ± 0.7, PD = 3.1 ± 0.6 mm) compared with teeth (PI = 1.8 ± 0.8, PD = 2.5 ± 0.2 mm). A total of 20 different genera were found at the inflamed tooth and implant sites. The microbial diversity of the microflora surrounding the remaining dentition (12.0 ± 3.8) was significantly higher (p = 0.01) than the diversity of the peri-implant microflora at implant-retained crowns or bridges (6.3 ± 2.3). Within the limitations of the present study, the microbial diversity of the investigated implants and teeth with clinical signs of mucositis or gingivitis exhibits substantial differences, demonstrating that transmission of the complete bacterial microflora from teeth to implants could be excluded. Furthermore, broad-range molecular biological detection methods specify bacterial genera and species in the peri-implant and periodontal microflora which were not in the focus of research interests so far.

Identification of periodontal pathogens in healthy periimplant sites.

PURPOSE: : The aim of this study was to evaluate the presence of periodontopathogens in subgingival periimplant sites in partially edentulous patients using polymerase chain reaction procedures, with regard to areas with clinical and radiographic signs of health and areas presenting periimplant disease. MATERIALS AND METHODS: : Thirty nonsmoking, partially edentulous patients, aged 30 to 76 years, were included in this study and divided in 3 groups according their clinical and radiographic characteristics. Group A (n = 10) presented periimplant health, group B (n = 10) presented periimplant mucositis, and group C (n = 10) were patients with periimplantitis. Periimplant tissues were clinically examined as regards the color of mucosae, presence of bacterial plaque, depth and bleeding on probing, and local suppuration. History of periodontal disease was also considered. Radiographic analysis evaluated the presence of bone loss around the implant. Samples of periimplant crevicular fluid were collected to analyze the presence of periodontal pathogens, Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tannerella forsythensis (Tf), and Treponema denticola (Td). RESULTS: : The results showed that the history of periodontal disease is associated with periimplant disease. The bacteria Aa, Pg, Pi, Td, and Tf were present in periimplant sites clinically and radiographically characterized, as healthy periimplant tissues, mucositis, and periimplantitis. CONCLUSIONS: : We concluded that Aa, Pg, Pi, Td, and Tf are present in healthy and diseased conditions. Therefore, these periodontal pathogens are not strictly related to periimplant disease sites.

Bacterial adhesion and colonization differences between zirconium oxide and titanium alloys: an in vivo human study.

PURPOSE: The purpose of this study was to compare zirconium oxide and titanium alloys with respect to their tendency to adhesion and colonization of two periodontal pathogens on both hard surfaces and on soft tissues in vivo. MATERIALS AND METHODS: The present study was designed as a prospective stratified randomized controlled clinical trial. Patients were scheduled to receive two implants with different types of abutments in the posterior mandible. Three months after implant placement, titanium and zirconium abutments were connected. Five weeks after abutment connections, the abutments were removed, probing depth measurements were recorded, and gingival biopsy samples were obtained. Abutments and biopsy specimens were analyzed by reverse-transcriptase polymerase chain reaction to compare the DNA copy numbers of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and total bacteria. The surface free energy of the abutments was calculated by sesile water drop before replacement. RESULTS: No statistically significant differences were found between probing depths or DNA copy numbers of A actinomycetemcomitans, P gingivalis, and total bacteria both for both titanium alloys and zirconium oxide surfaces and the biops specimens obtained from their buccal gingival. With respect to the surface free energy of zirconium and titanium abutments, zirconium abutments showed lower surface free energy than titanium abutments. CONCLUSION: The results of this study showed that zirconium oxide surfaces have comparable properties to titanium alloy surfaces in their tendency to adhesion and colonization of two periodontal pathogens on both hard surfaces and in soft tissues.

Microbiota around teeth and dental implants in periodontally healthy, partially edentulous patients: is pre-implant microbiological testing relevant?

This study aimed to assess the prevalence of seven periodontal marker pathogens, before implant placement and 1 yr after loading, in periodontally healthy individuals and to assess the long-term effectiveness of pre-implant reduction of pathogens to below threshold levels. In 93 individuals needing single tooth replacement, pooled subgingival microbiological samples from standard sites were cultured and analyzed before implant treatment and 1 yr after loading. Threshold levels commonly used in periodontology to predict periodontal breakdown were applied. Subjects with levels of pathogens above these thresholds received initial periodontal treatment including systemic antibiotics when indicated. At baseline, 49.5% of periodontally healthy subjects harboured one or more marker pathogens above threshold levels. Periodontal treatment reduced the pathogen levels below threshold values in 78.3% of these initially colonized subjects. In all cases Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were reduced to below threshold. At 1 yr after loading, periodontal pathogens were present above threshold levels in 74.1% of all subjects. It is concluded that in almost half of periodontal healthy individuals the subgingival biofilm harbours periodontal pathogens above threshold values. Long-term effectiveness of pre-implant reduction of the selected marker pathogens appeared limited in our patient population, making pre-implant reduction unpredictive for post-implant levels of these pathogens. Thus, considering the applied microbiological criteria, generalized pre-implant microbiological testing is not contributory in periodontally healthy subjects.

Characterization of the normal bacterial flora in peri-implant sulci of partially and completely edentulous patients.

PURPOSE: To characterize the normal bacterial flora and evaluate the presence of periodontopathogenic bacteria around dental implants and to correlate them with the periodontal flora or, in completely edentulous patients, the alveolar gingival flora. MATERIALS AND METHODS: Clinical and radiographic parameters were recorded to exclude peri-implantitis in 34 partially edentulous and 19 completely edentulous patients. Partially edentulous patients were subdivided into two subgroups based on the depth of the periodontal pocket: ≤ 4 mm (n = 19) and > 4 mm (n = 15). Microbial samples were collected from peri-implant sulci, the deepest periodontal sulci, and, for completely edentulous patients, from the alveolar gingiva. Predominant aerobic bacteria were determined by microbiologic culturing, and multiplex polymerase chain reaction was used to detect five periodontopathogenic bacteria: Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. RESULTS: In all the examined patients, oral streptococci were the most frequent aerobic peri-implant bacteria. The frequency of four periodontopathogenic bacteria in tooth sulci (A actino?mycetemcomitans, P gingivalis, T forsythensis, T denticola) was significantly higher around natural teeth with deeper periodontal pockets, but there was no significant difference in the frequency of the same bacteria in peri-implant sulci in the two partially edentulous subgroups. In contrast, there were no such bacteria in the peri-implant sulci or the alveolar gingiva of completely edentulous patients. CONCLUSIONS: In healthy peri-implant sulci, oral streptococci constitute the predominant bacterial flora. In partially edentulous patients four periodontopathogenic bacteria were detected around implants, and none of these bacteria were found around implants in completely edentulous patients.

Condição clínica e microbiológica periodontal e periimplantar em edentados parciais: revisão de literatura / Periodontal and peri-implant conditions and microbiological composition in partially edentulous patients: review of literature

As doenças periodontal e periimplantar apresentam o mesmo fator etiológico (biofilme bacteriano subgengival/submucoso), muito embora análises detalhadas da microbiota associadas a estas duas patologias sejam ainda escassas. Objetivo: identificar a condição física e a composição microbiológica periodontal e periimplantar em pacientes edentados parciais. Metodologia: A busca eletrônica foi realizada por um revisor na base de dados em literatura médica e odontológica internacional MEDLINE e Cochrane Oral Health Group até abril de 2008. Foram incluídos na presente revisão estudos observacionais transversais e de caso-controle que realizaram avaliação microbiológica periodontal e periimplantar nos mesmos pacientes. Resultados: A aplicação das estratégicas de busca resultou em um total de 259 resumos. Destes, dez artigos foram selecionados, compondo a amostra da presente revisão. Considerações finais: Uma das maiores causas de perdas dentárias entre a população adulta são formas avançadas de periodontite e um grande número de pessoas que recebe implantes apresenta história passada de perda dentária por doença periodontal. Portanto, as observações desta revisão sugerem um prognóstico cauteloso para os implantes, indicado, assim, um monitoramento do status periodontal/periimplantar acurado.

A comprehensive and critical review of dental implant prognosis in periodontally compromised partially edentulous patients.

OBJECTIVES: The outcome of implant treatment in periodontally compromised partially edentulous patients has not been completely clarified. Therefore, the aim of the present study was to perform, applying a systematic methodology, a comprehensive and critical review of the prospective studies published in English up to and including August 2006, regarding the short-term (<5 years) and long-term (>or=5 years) prognosis of osseointegrated implants placed in periodontally compromised partially edentulous patients. MATERIAL AND METHODS: Using The National Library Of Medicine and Cochrane Oral Health Group databases, a literature search for articles published up to and including August 2006 was performed. At the first phase of selection the titles and abstracts and at the second phase full papers were screened independently and in duplicate by the three reviewers (I. K. K., S. K., I. F.). RESULTS: The search provided 2987 potentially relevant titles and abstracts. At the first phase of evaluation, 2956 publications were rejected based on title and abstract. At the second phase, the full text of the remaining 31 publications was retrieved for more detailed evaluation. Finally, 15 prospective studies were selected, including seven short-term and eight long-term studies. Because of considerable discrepancies among these studies, meta-analysis was not performed. CONCLUSIONS: No statistically significant differences in both short-term and long-term implant survival exist between patients with a history of chronic periodontitis and periodontally healthy individuals. Patients with a history of chronic periodontitis may exhibit significantly greater long-term probing pocket depth, peri-implant marginal bone loss and incidence of peri-implantitis compared with periodontally healthy subjects. Even though the short-term implant prognosis for patients treated for aggressive periodontitis is acceptable, on a long-term basis the matter is open to question. Alterations in clinical parameters around implants and teeth in aggressive periodontitis patients may not follow the same pattern, in contrast to what has been reported for chronic periodontitis patients. However, as only three studies comprising patients treated for aggressive periodontitis were selected, more studies, specially designed, are required to evaluate implant prognosis in this subtype of periodontitis. As the selected publications exhibited considerable discrepancies, more studies, uniformly designed, preferably longitudinal, prospective and controlled, would be important.

Analysis of early biofilm formation on oral implants in man.

Biofilm formation on oral implants can cause inflammation of peri-implant tissues, which endangers the long-term success of osseointegrated implants. It has been reported previously that implants revealing signs of peri-implantitis contain subgingival microbiota similar to those of natural teeth with periodontitis. The purpose of the first part of this study was an atraumatic, quantitative investigation of biofilm formation on oral implant abutments; the objective of the second part was to investigate whether Haemophilus actinomycetemcomitans and Porphyromonas gingivalis were present in the crevicular fluid around oral implants. Biofilm formation on 14 healing abutments, inserted for 14 days in 10 patients, was analysed quantitatively by use of secondary-electron and Rutherford-backscattering-detection methods. A 16S rRNA-based polymerase chain reaction detection method was used to detect the presence of H. actinomycetemcomitans and P. gingivalis in the crevicular fluid. For this investigation, samples of sulcus fluid were collected with sterile paper points at four measurement points per abutment. The difference between biofilm coverage of supragingival surfaces (17.5 +/- 18.3%) and subgingival surfaces (0.8 +/- 1.0%) was statistically significant (P < 0.05). By use of universal primers, bacteria were found in all the samples taken, although the two periodontal pathogens were not found in any of the samples. The absence of periodontal pathogens from the sulcus fluid during initial bacterial colonization, despite massive supragingival biofilm formation, substantiates the assumption that cellular adherence of peri-implant tissue by means of hemidesmosoma, actin filaments and microvilli reduces the risk of formation of anaerobic subgingival pockets.

Oral flora in independent over 80-year-olds with more than 20 teeth.

The purpose of this study was to investigate oral flora in independent persons aged over 80 years with more than 20 remaining teeth. The subjects were 22 participants of the 8020 campaign (6 males and 16 females) with a mean age of 81.3+/-1.6 years and an average of 24.7 teeth (Independent 8020 group). This group was compared with a group of 38 elderly people residing in nursing homes (10 males and 28 females) who had a mean age of 81.3+/-8.5 years and an average of 4.2 teeth (Nursing group with fewer teeth). Saliva samples were collected from the vestibular areas of the maxilla and mandible using cotton swabs. Cell numbers of microorganisms were expressed as colony forming units/ml (CFUs/ml) and compared between the two groups. The average number of Staphylococcus species was 65.2+/-74.4 CFUs/ml in the Independent 8020 group and 400.3+/-352.1 CFUs/ml in the group with fewer teeth (p<0.01); that of Candida albicans was 18.0+/-37.7 CFUs/ml in the Independent 8020 group and 152.9+/-211.9 CFUs/ml in the Nursing group with fewer teeth (p<0.05). Both species showed statistically significant differences between the two groups. This suggests that the Independent 8020 achiever group had better oral hygiene and that the presence of many teeth may be associated with an increased awareness of dental health.

Dynamics of initial subgingival colonization of 'pristine' peri-implant pockets.

BACKGROUND: Periodontitis and peri-implantitis are linked to the presence of several key pathogens. The treatment of these infectious processes therefore involves the reduction/eradication of bacteria associated with periodontitis. METHODS: This prospective, split-mouth, single-blind study followed the colonization of 'pristine' sulci created in 42 partially edentulous patients during implant surgery (e.g. abutment connection). The hypothesis was that the composition of the maturing subgingival plaque in these 'fresh' peri-implant pockets would soon (within 2 weeks) be comparable to the subgingival microbiota of teeth with similar clinical parameters (reference sites), including the presence of bacteria associated with periodontitis. Per patient, four subgingival plaque samples were taken from shallow and medium pockets around implants (test sites), and teeth within the same quadrant (undisturbed microbiota as control sites), 1, 2, 4, 13, 26 and 78 weeks after abutment connection, respectively. The samples were analysed by either checkerboard DNA-DNA hybridization, or cultural techniques, or real-time polymerase chain reaction (PCR) for intra-subject comparisons (teeth vs. implant, for comparable probing depths). RESULTS: Checkerboard DNA-DNA hybridization and real-time PCR revealed a complex microbiota (including several pathogenic species) in the peri-implant pockets within 2 weeks after abutment connection. After 7 days, the detection frequency for most species (including the bacteria associated with periodontitis) was already nearly identical in samples from the fresh peri-implant pockets (5% and 20% of the microbiota belonging to red and orange complex, respectively) when compared with samples from the reference teeth. Afterwards (e.g. between weeks 2 and 13), the number of bacteria in peri-implant pockets only slightly increased (+/-0.1 log value), with minor changes in the relative proportions of bacteria associated with periodontitis (8% and 33% of the microbiota belonging to red and orange complex, respectively). Although small differences were seen between teeth and implants at week 2 with cultural techniques, a striking similarity in subgingival microbiota was found with this technique from month 3 on, with nearly identical detection frequencies for bacteria associated with periodontitis for both abutment types. CONCLUSIONS: This study indicates that the initial colonization of peri-implant pockets with bacteria associated with periodontitis occurs within 2 weeks.

Microbiological findings and host response in patients with peri-implantitis.

The aim of the present study was to characterise microbiota and inflammatory host response around implants and teeth in patients with peri-implantitis. We included 17 partly edentulous patients with a total of 98 implants, of which 45 showed marginal bone loss of more than three fixture threads after the first year of loading. Nineteen subjects with stable marginal tissue conditions served as controls. Oral hygiene, gingival inflammation, and probing pocket depth were evaluated clinically at teeth and implants. Microbiological and crevicular fluid samples were collected from five categories of sites: 1) implants with peri-implantitis (PI), 2) stable implants (SI) in patients with both stable and peri-implantitis implants, 3) control implants (CI) in patients with stable implants alone, 4) teeth in patients (TP) and 5) controls (TC). Crevicular fluid from teeth and implants was analysed for elastase activity, lactoferrin and IL-1 beta concentrations. Elastase activity was higher at PI than at CI in controls. Lactoferrin concentration was higher at PI than at SI in patients with peri-implantitis. Higher levels of both lactoferrin and elastase activity were found at PI than at teeth in patients. The concentrations of IL-1 beta were about the same in the various sites. Microbiological DNA-probe analysis revealed a putative periodontal microflora at teeth and implants in patients and controls. Patients with peri-implantitis harboured high levels of periodontal pathogens, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus and Treponema denticola. These findings indicate a site-specific inflammation rather than a patient-associated specific host response.

The effects of an immediately pre-surgical chlorhexidine oral rinse on the bacterial contaminants of bone debris collected during dental implant surgery.

Dental implant surgery produces bone debris that can be used in the "simultaneous augmentation" technique. Although this debris is contaminated with oral bacteria, a stringent aspiration protocol has been shown to reduce the levels of contamination. Chlorhexidine mouthrinse is a well-proven antibacterial rinse that has been shown to reduce infectious complications associated with dental implants. This study examined the effect of pre-operative rinsing with a 0.1% chlorhexidine digluconate mouthrinse on the bacterial contaminants present in collected bone debris bone (CBD). Twenty partially edentate patients were randomly allocated into equal groups and underwent bone collection using the Frios Bone Collector (FBC) during the insertion of two dental implants. In group T a pre-operative chlorhexidine rinse was used, whilst in group C sterile water was used. For both groups, a stringent bone collection protocol was used. Bone samples were immediately transported for microbial analysis. Colonial and microscopic morphology, gaseous requirements and identification kits were utilised for identification of the isolated microbes. Thirty-nine species were identified including a number associated with disease, in particular Actinomyces odontolyticus, Clostridium bifermentans, Prevotella intermedia, and Propionibacterium propionicum. Samples from group T (chlorhexidine mouthrinse) yielded significantly fewer organisms (P < 0.001) than in group C (sterile water mouthrinse). Gram-positive cocci dominated the isolates from both groups. It is concluded that if bone debris is to be used for the purpose of immediate simultaneous augmentation, a preoperative chlorhexidine mouthrinse should be utilised in conjunction with a stringent aspiration protocol to reduce further the bacterial contamination of CBD.

Periodontal status and serum antibody titers for Porphyromonas gingivalis fimbriae in a rural population in Japan.

BACKGROUND, AIMS: The present study was undertaken to assess the periodontal status of a rural Japanese population and to study the correlation between the periodontal status and the serum antibody titers for Porphyromonas gingivalis (Pg) fimbriae. METHOD: A total of 236 individuals were examined for their periodontal conditions by the use of the community periodontal index for treatment needs (CPITN), and serum antibody titers for Pg fimbriae in their peripheral blood samples were evaluated using the enzyme-linked immunosorbent assay. RESULTS: There was a substantially larger proportion of edentulous subjects in the age group older than 60 years. The remaining teeth were 24.1, 23.2, 11.1 and 10.1 per person in the 40-49, 50-59, 60-69 and > or = 70 age groups, respectively. The % of sextants with a CPITN code of missing sextant (MS) increased towards elderly and reached >60% in the age group of > or = 70 years, as the % of the CPITN 2, 1 or 0 sextant decreased. The % of CPITN 4 and 3 sextants did not differ between different age groups and were about 6-8% and 15-20%, respectively. The % of CPITN 1 or 0 sextants was higher in female subjects than in male subjects in the 60-69 and > or = 70 age groups, while the % of CPITN 4 or 3 sextants was higher in male subjects than in female subjects in all age groups. There was no significant difference between various age groups in the mean serum antibody titers for Pg fimbriae. The mean anti-Pg fimbriae antibody titers was significantly higher for the subjects with a maximum CPITN code 4 (max.-CPITN 4 subject) than for the subjects with lower maximum CPITN codes. The antibody titers varied extensively among the max.-CPITN 4 or 3 subjects, but not among the max.-CPITN 2/1/0 or MS subjects. CONCLUSIONS: The present study demonstrated that tooth loss is a remarkable event in elderly subjects and that oral prophylaxis and mechanical debridement should be mandatory in the population examined. It was also demonstrated that the serum antibody titers against Pg fimbriae could be useful for screening individuals with moderate to severe periodontitis.

Microbial analysis of bone collected during implant surgery: a clinical and laboratory study.

Dental implant surgery produces bone debris which can be used to correct bone defects in the "simultaneous-augmentation" technique. However, this debris is potentially contaminated with oral bacteria. Therefore, this study examined bone debris collected during dental implant surgery in order 1) to identify the microbial contaminants and 2) to compare the effects of two different aspiration protocols on the levels of microbial contamination. Twenty-four partially dentate patients were randomly allocated into two equal groups and underwent bone collection using the Frios Bone Collector during surgery to insert two endosseous dental implants. In group S (using a stringent aspiration protocol), bone collection occurred within the surgical site only. In group NS (utilizing a non-stringent aspiration protocol), bone collection and tissue fluid control was achieved using the same suction tip. Bone samples were immediately transported for microbial analysis. Colonial and microscopic morphology, gaseous requirements and identification kits were utilized for identification of the isolated microbes. Twenty-eight species were identified including a number associated with disease, in particular, Enterococcus faecalis and Staphylococcus epidermidis as well as the anaerobes Actinomyces odontolyticus, Eubacterium sp., Prevotella intermedia, Propionibacterium propionicum and Peptostreptococcus asaccharolyticus. In group S (stringent aspiration protocol), significantly fewer organisms were found than in group NS, the non-stringent aspiration protocol (P=0.001). Gram-positive cocci dominated the isolates from both groups. It is concluded that if bone debris is collected for implantation around dental implants, it should be collected with a stringent aspiration protocol (within the surgical site only) to minimize bacterial contaminants.

Actinobacillus actinomycetemcomitans-associated peri-implantitis in an edentulous patient. A case report.

BACKGROUND: Peri-implantitis is a risk factor for implant loss. Late bacterial infection of the peri-implant tissues and loss of alveolar bone in edentulous patients is caused by commensal oral anaerobic bacteria. In partially edentulous patients, Porphyromonas gingivalis and occasionally Actinobacillus actinomycetemcomitans are associated with peri-implantitis lesions. AIMS: To investigate the microbiology of a peri-implantitis case in an edentulous patient. METHODS: Anaerobic culture techniques and selective culture techniques for A. actinomycetemcomitans were used to study the peri-implant microflora at sites with and without bone loss. RESULTS: An anaerobic peri-implant microflora with several putative periodontal pathogens was found at sites with bone loss. Furthermore, a metronidazole-resistant A. actinomycetemcomitans was isolated. The A. actinomycetemcomitans infection did not respond to systemic doxycycline therapy, despite good susceptibility in vitro. CONCLUSIONS: The present case of severe A. actinomycetemcomitans-associated peri-implantitis shows the importance of pre-operative infection control. The findings in this case show that remaining teeth affected by periodontitis can be a serious risk factor for peri-implantitis.