Biological aspects: Summary and consensus statements of group 2. The 5th EAO Consensus Conference 2018.

OBJECTIVES: This publication reports the EAO Workshop group-2 discussions and consensus statements which provided the scientific evidence on the influence of biological parameters on implant-related clinical outcomes. MATERIAL AND METHODS: The first publication was a systematic review on the biological effects of abutment material on the stability of peri-implant marginal bone levels and the second, a critical narrative review on how peri-implant diagnostic parameters correspond with long-term implant survival and success. The group evaluated the content of both publications, made corrections and recommendations to the authors and agreed on the consensus statements, clinical recommendations and recommendations for future research, which are described in this consensus report. RESULTS: Tested abutment materials can be considered appropriate for clinical use according to the observation period studied (mean 3.5 years). Mean peri-implant bone loss and mean probing pocket depths are not adequate outcomes to study the prevalence of peri-implantitis, while the reporting of frequency distributions is considered more appropriate. CONCLUSIONS: Titanium is currently considered the standard of care as abutment material, although other materials may be more suitable for aesthetic locations. Peri-implantitis should be diagnosed through composite evaluations of peri-implant tissue inflammation and assessment of marginal bone loss with different thresholds.

Immediate implant placement and provisionalisation in the aesthetic zone.

The aim of this retrospective study was to assess the outcome of immediate single-tooth implant placement and provisionalisation in the aesthetic zone regarding hard and soft peri-implant tissue parameters and patient-related outcome measures in a private practice. All consecutively treated patients with single-tooth immediate implant placement and provisionalisation between the period 1 January 2006 and 1 April 2013 in a referral practice in Amsterdam, the Netherlands, were included in the study. Fifty-one patients of a total of 64 could be examined at follow-up (Tfollow-up ). Radiographs were present from implant placement (Tplacement ), after definitive crown placement (Tdefinitive ), and new radiographs were taken at the follow-up appointment (Tfollow-up ). Next to this, soft tissue parameters, patients' satisfaction and professionals' aesthetic scores were measured at Tfollow-up . Implant survival was 96·9% after a mean follow-up period of 4 years following implant placement. At definitive crown placement, mean marginal bone-level loss was 0·25 mm (SD 0·19). Mean marginal bone-level loss following definitive crown placement was 0·06 mm (SD 0·10) (Tdefinitive to Tfollow-up ) after a mean follow-up period of 4 years. Plaque index, bleeding index and gingival index scores were low. Patients' satisfaction was rated very high: 9·0 (SD 0·7). Professionals aesthetic score was 16·49 (SD 1·86). From this study can be concluded that immediate placement of implants followed by immediate provisionalisation resulted in a high survival rate, minimum peri-implant bone loss, very good aesthetics and satisfied patients after a mean follow-up period of 4 years.

Impact of periodontal disease experience on oral health-related quality of life.

BACKGROUND: Periodontal research has traditionally focused on the site level, regarding etiology, pathogenesis, and treatment outcome. Recently, some studies have indicated that the presence of periodontal disease is associated with reduced quality of life. The aim of this study is to investigate the impact of periodontal disease experience on the quality of life. METHODS: This cross-sectional study includes 443 individuals. Clinical and radiographic examinations were performed; in conjunction, the oral health-related quality of life of all participants was assessed using the Swedish short-form version of the Oral Health Impact Profile (OHIP-14). Based on marginal bone loss, measured on radiographs, three different groups were identified: participants with loss of supporting bone tissue of less than one third of the root length (BL-), loss of supporting bone tissue of one third or more of the root length in <30% of teeth (BL), or loss of supporting bone tissue of one third or more of the root length in ≥ 30% of teeth (BL+). RESULTS: The effect of periodontal disease experience on quality of life was considerable. For the BL- group, the mean OHIP-14 score was 3.91 (SD: 5.39). The corresponding mean values were 3.81 (SD: 5.29) for the BL group and 8.47 (SD: 10.38) for the BL+ group. The difference among all groups was statistically significant (P ≤ 0.001). A comparison among the mean OHIP-14 scores in the different groups (BL-, BL, and BL+) revealed significant differences in six of seven conceptual domains. CONCLUSIONS: The BL+ individuals experienced reduced quality of life, expressed as the OHIP-14 score, compared with the BL and BL- participants.

Fluoxetine reduces periodontal disease progression in a conditioned fear stress model in rats.

BACKGROUND AND OBJECTIVE: Recent evidence suggests that the use of fluoxetine could reduce periodontal disease severity. However, the effect of fluoxetine on periodontal disease has not been tested in the context of conditioned fear stress (CFS). We hypothesized that inhibition of chronic stress by fluoxetine might decrease the levels of bone loss in periodontal disease. The aim of the present study was to analyze the effect of fluoxetine on bone loss in chronic periodontitis. MATERIAL AND METHODS: Fourteen Wistar rats were submitted to ligature-induced periodontal disease and divided into four groups (A-D). Groups A (n = 3) and B (n = 4) were not stressed, while Groups C (n = 3) and D (n = 4) were submitted to a CFS paradigm for 38 d. Daily fluoxetine (20 mg/kg) was administered to Groups B and D from day 20 to day 39, at which point the rats were submitted to an open field test and killed on day 40. Mandibles were removed for histological and immunohistochemical analyses. RESULTS: Stress was associated with a higher level of bone loss in Group C compared with Group A. Additionally, no differences in bone loss were observed among Groups A, B and D. CONCLUSION: We showed that stress is associated with the progression of bone loss in a CFS model in rats and that fluoxetine treatment reduces the bone loss.

Impact of anxiety on pain perception associated with periodontal and implant surgery in a private practice.

BACKGROUND: There are limited data on pain perception after periodontal or implant surgery or how pain perception is affected by presurgical anxiety. METHODS: Presurgical anxiety and surgical pain perceptions were measured by visual analog scale (VAS) scores and by interview of patients (N = 102) undergoing periodontal or implant therapy in a private periodontal specialty practice in Norway. RESULTS: Patients reported that bad taste, receiving the local anesthetic, and excessive fluid in the mouth were the most uncomfortable experiences associated with periodontal or implant surgery. Analysis of identical responses to these questions showed that there was low intrapatient agreement for uncomfortable experiences (κ = 0.18), but there was reasonably good agreement for comfortable experiences (κ = 0.76). There were no significant differences between repeated VAS scores for pain perception (P = 0.91) or anxiety (P = 0.75) from two consecutive surgeries. There were no significant differences of VAS scores for perception of discomfort for periodontal surgery (9.9 ± 17.0) compared to implant surgery (16.7 ± 24.2; P >0.2). Presurgical anxiety scores were higher for implant surgery (45.5 ± 33.4) than for periodontal surgery (19.5 ± 28.1; P <0.01). Patients with high pretreatment anxiety scores reported that periodontal and implant surgery were more uncomfortable than patients with low anxiety scores (20.5 ± 25.6 versus 0.45 ± 1; P <0.001). VAS perception and anxiety scores did not change on first-time through fourth-time surgeries, but retreatment surgery patients recorded higher perception and anxiety VAS scores than patients undergoing surgery for the third or fourth time (P <0.01). Females recorded significantly higher anxiety scores than males (P = 0.04). CONCLUSION: For periodontal surgery and implant treatments pain perception is affected by the level of presurgical anxiety.

Association of self-perceived periodontal status with oral hygiene, probing depth and alveolar bone level among young adults.

The literature regarding self-reported dental/oral health data suggests that certain self-reported information is valid. The objective of this study was to show whether self-perceived periodontal conditions can predict actual periodontal status measured by probing depth and radiographic bone level. Participants completed a questionnaire regarding systemic health, education, smoking status, oral hygiene habits and self-perception of their own periodontal status using a visual analog scale (VAS); they were examined clinically and radiographically. More than two-thirds self-perceived their periodontal status as between 5 and 8 (out of 10). Smoking was related to radiographic bone loss, but not to the number of sites with PD > or = 5mm. Periodontal self-assessment correlated with the number of sites with PD > or = 5mm (p = 0.013), the number of sites with radiographic bone loss > or = 3 mm (p = 0.045), as well as with plaque index (p = 0.003) and daily flossing (p = 0.022). For a cutoff of 5 in the VAS score, sensitivity of 84% and specificity of 22% were found for high PD and sensitivity of 85% and specificity of 24% for bone loss.

HIV infection and bone loss due to periodontal disease.

BACKGROUND: The goal of this study is to determine whether HIV infection or high-risk behaviors associated with HIV infection are related to alveolar bone loss in a sample of subjects screened at a dental school clinic. METHODS: Subjects were included in this study (N = 355) if they were HIV positive or had high-risk behaviors associated with HIV infection as identified by health risk behavior screening questionnaire. Bone loss measurements were obtained from radiographs. Both bivariate relationships and multivariate relationships between alveolar bone loss and three sets of variables were evaluated: high-risk behavior questions, demographic variables, and HIV infection. RESULTS: The following variables were found related to alveolar bone loss in bivariate relationships: age (P < or = 0.0001); smoking (pack-years) (P < or = 0.0001); race (P < or = 0.002); gender (P < or = 0.032); male-male sex (P <0.001); diabetes (P < or = 0.015); sharing of needles (P < or = 0.02); and hepatitis C positive (P < or = 0.05). In the multiple regression model, age, smoking, race, gender, and male-male sex remained significant. In both analyses, HIV-positive individuals had similar bone loss compared to those who were HIV negative. CONCLUSIONS: These results suggest that HIV infection is not related to alveolar bone loss in individuals with high-risk behaviors for HIV infection. These results also suggest that previously reported relationships between HIV infection and increased alveolar bone loss may be explained by other factors, such as smoking. Individuals in this study population with risk behaviors associated with HIV infection smoked at a high rate and, because of the smoking behavior, have a high rate of periodontal disease.

Case report of self-injurious behaviour (SIB) presenting as gingivitis artefacta major.

The case report described here discusses gingivitis artefacta major, an oral presentation of self-injurious behaviour, in an adolescent. On presentation, the patient knew well the ramifications of her gum scratching behaviour, however, was unable to stop. At further presentations new lesions had appeared with further bone loss. The cause of her behaviour seemed to be of psychological origin and therefore no interventive dental treatment was possible until this issue was resolved. A more preventive approach was adopted in the meantime. Referral to appropriate services from the dental profession also proved to be challenging. In conclusion, gingivitis artefacta, although rarely seen to this extent, is extremely challenging to diagnose and treat fully in a dental setting.

The role of psychoneuroimmune interactions in the pathogenesis of ligature-induced periodontal disease in Wistar rats.

The aim of the present study was to determine the role of chronic stress in the pathogenesis of ligature-induced periodontal disease in rats. Fifty-three Wistar rats were randomly assigned to 4 experimental groups: 1--ligature; 2--ligature + stress; 3--stress only; 4--control. After 30 days the animals were sacrificed, blood samples were collected and histological sections were made for histometric analysis. The stress parameters evaluated were weight of thymus, spleen, adrenal glands and plasma glucocorticoid levels. Analysis of adrenal glands showed statistically significant differences between stressed and non-stressed groups (one-way ANOVA, p < 0.05). Plasma glucocorticoid levels were higher in Group 3 and lower in Group 2 (81.1 nmol/I versus 62.5 nmol/l, p < 0.05). Histometric measurements from the bone crest and from the first attached fiber were taken for all groups and for Groups 1 and 2 for the sites with and without ligatures. The ligature sites always displayed higher mean values than non-ligated sites (paired sample t test, p < 0.05). No statistically significant differences were observed between Groups 1 and 2 with regard to the ligated sites. However, differences were observed between Groups 1 and 2 in histometric bone levels in the non-ligated sites (mean values of 0.81 and 0.55 mm, respectively, p < 0.05). It may be concluded that stress can have a possible role in the activation of the hypothalamus-pituitary-adrenal (HPA) axis, with different levels of glucocorticoid release.

[Correlation between psychosocial factors and periodontal disease--a systematic review of the literature]. / Werden parodontale Erkrankungen durch psychosoziale Belastungsfaktoren beeinflusst? Eine systematische Literaturübersicht.

OBJECTIVES: This is a systematic review of the available empirical studies up to 2004 which deal with the question of the correlation between psychosocial factors/stress and gingival and periodontal disease. METHOD: The three medical and psychological databases Medline, PsycInfo und Psyndex were searched systematically for relevant literature between 1946 and 2004. RESULTS: 34 empirical studies on humans (16 with and 18 without a control group) and ten empirical studies on animals are presented. DISCUSSION: Despite serious methodological flaws in many studies, most (particularly the methodologically solid ones) indicated associations between a variety of psychosocial factors and periodontitis incidence and severity. The pathomechanisms between stress and periodontitis should therefore be the subject of further research.

Psychosocial factors as risk indicators of periodontitis.

OBJECTIVE: Cross-sectional investigation of associations between psychosocial and periodontal parameters. METHODS: One hundred and ten patients 18-76 years of age were examined clinically and 57 radiographically at the Department of Conservative Dentistry of the University Hospital of Heidelberg: probing depths (PDs) and attachment level (PAL-V) were obtained at six sites per tooth. Inter-proximal bone loss was assessed in 57 patients on panoramic radiographs. Further chemical and general environmental sensitivity, somatization, and smoking status were assessed by several questionnaires. RESULTS: Significant correlations between severe bone loss and age (r=0.38, p=0.004) were observed. PAL-V and PD also correlated with age (r=0.45, p<0.001; r=0.37, p<0.001) and pack years (r=0.21, p=0.031; r=0.3, p=0.002). After adjustment for age, smoking, and sex a negative correlation between chemical odour sensitivity and bone loss, PD=4 mm as well as PAL-V=4 mm was observed. Further, a negative correlation was observed between gastrointestinal sensitivity and PAL-V=4 mm. Psychological stress correlated positively with bone loss. CONCLUSION: The results give evidence for associations of psychosocial factors and periodontal disease. Some environmental traits seem to be related to more favourable periodontal status.

Effect of lifestyle on periodontal disease status in diabetic patients.

Lifestyle and socioeconomic status have been associated with the disease status of diabetic patients. However, there have been few reports on the relationship between these factors and the periodontal condition of diabetics. We assessed the association between disease status and lifestyle of diabetic patients and clinical features of advanced periodontitis such as deep probing depths and severe alveolar bone loss. Fifty-seven diabetic patients were examined in this study. Clinical assessment of probing pocket depth and radiographic alveolar bone loss was performed. Data regarding diabetic status and lifestyle of the diabetic patients were also recorded and statistically analysed by logistic regression. Drinking habits and high values of hemoglobin A1c (HbA1c) (>9.0%) were significantly associated with deep probing depth. The odds ratios (OR) of these factors were 7.72 (95% confidence interval (CI), 1.80 to 33.19), and 6.10 (95% CI = 1.23 to 30.25), respectively. Presence of complications such as retinopathy (OR = 8.86, 95% CI, 1.99 to 39.40), irascible behaviour (OR = 8.40, 95% CI = 1.33 to 53.17) and high value of HbA1c (OR = 4.94, 95% CI = 1.14 to 21.46) were significantly related to mean advanced alveolar bone loss. Only the high value of HbA1c (OR = 3.53, 95% CI = 1.06 to 11.73) was detected as a significant factor related to advanced periodontitis, characterised by more than 50% mean alveolar bone loss, or two or more teeth with probing depth greater than 6 mm. In conclusion, drinking habit and irascible behaviour are correlated with the periodontal disease condition of diabetic patients, in addition to a high value of HbA1c (>9.0%). Lifestyle and psychosocial stress may affect the periodontal disease status of diabetic patients.

Dental implants in the atrophic maxilla: measurements of patients' satisfaction and treatment experience.

Maxillary bone reconstruction in combination with placement of dental implants is a treatment modality reported since 1980 for patients suffering from maxillary atrophy and difficulties with wearing removable prosthesis. This study reports on patient experience and satisfaction among 88 consecutive patients concerning surgical and prosthetic aspects of their treatment. A questionnaire was used to gather the data. Patient satisfaction was measured on a scale from 1 to 5 (1 = bad/few, 5 = very good/much). The satisfaction index with regard to the total treatment was 4.1 +/- 0.9. A total of 90% of the patients responded that they would go through the treatment again or recommend the treatment to a friend if necessary. The post-operative pain index scored 2.6 +/- 1.2. The acceptation of the post-operative pain at the crista iliaca was 86.1% and of the maxilla 89.9%. It is concluded that the results of measurements of patient satisfaction after maxillary bone reconstruction in combination with placement of dental implants were acceptable.

[The extent of mandibular bone resorption in edentulous subjects in relation to their psychological profile]. / Indagine sull'entità del riassorbimento osseo mandibolare in soggetti edentuli in relazione al loro profilo psicologico.

The resorption of edentulous alveolar crests has been correlated to a variety of factors which may be briefly summarised as anatomic, metabolic, functional and prosthetic factors. With regard to functional factors, some researchers have found that some psychological aspects in edentulous subjects may be indicative of a parafunctional damaging habit leading to consequent alterations of the physical characteristics of forces applied to the bone. The aim of this study was to evaluate whether alveolar crest resorption in edentulous subjects was correlated to aspects of their psychological status, such as trait anxiety and the presence of psychosomatic symptoms. A group of 70 totally edentulous subjects were examined and trait anxiety and the presence of psychosomatic symptoms were evaluated. The orthopantomographies of the 70 subjects were then analysed in order to assess the degree of edentulous crest resorption. The present study showed the absence of statistically significant correlations between edentulous crest resorption and trait anxiety and between edentulous crest resorption and the presence of psychosomatic symptoms. These results appear to indicate that "anxious" subjects might not have parafunctional habits or that the latter play a minor role in the process of edentulous mandibular crest resorption.