Microbiota associated with peri-implantitis-A systematic review with meta-analyses.

AIM: To answer the following PECO question: "In systemically healthy human subjects (P), which are the differences between peri-implantitis (E) and peri-implant health/mucositis (C) in terms of bacterial presence/count (O)?" MATERIALS AND METHODS: Cross-sectional studies fulfilling specific inclusion criteria established to answer the PECO question were included. Two review authors independently searched for studies, screened the titles and abstracts, did full-text analysis, extracted the data from the included reports, and performed the risk of bias assessment through an adaptation of the Newcastle/Ottawa tool for cross-sectional studies and of the JBI critical appraisal checklist. In case of disagreement, a third reviewer author took the final decision. Study results were summarized using random effects meta-analyses. RESULTS: A total of 12 studies were included, involving 1233 participants and 1513 implants. Peri-implantitis was associated with the presence of S. epidermidis (Odds ratio, OR = 10.28 [95% Confidence interval, CI: 1.26-83.98]), F. nucleatum (OR = 7.83 [95% CI: 2.24-27.36]), T. denticola (OR = 6.11 [95% CI: 2.72-13.76]), T. forsythia (OR = 4.25 [95% CI: 1.71-10.57]), P. intermedia (OR = 3.79 [95% CI: 1.07-13.35]), and P. gingivalis (OR = 2.46 [95% CI: 1.21-5.00]). Conversely, the presence of A. actinomycetemcomitans (OR = 3.82 [95% CI: 0.59-24.68]), S. aureus (OR = 1.05 [95% CI: 0.06-17.08]), and C. rectus (OR = 1.48 [95% CI: 0.69-3.17]) was not associated with peri-implantitis. CONCLUSIONS: Peri-implantitis is associated with the presence of S. epidermidis and specific periodontopathogens (P. gingivalis, T. forsythia, T. denticola, F. nucleatum, and P. intermedia). (CRD42021254589).

Citric acid, but not tetracycline, improves the microscopic pattern of healing of particulate autogenous bone grafts in critical-size defects.

BACKGROUND: Bone demineralization has shown to be advantageous in autogenous onlay bone grafts and in pre-osteoblasts cultures, but such procedure has never been evaluated in particulate bone grafts. This study aimed to investigate the role of two demineralizing agents in the repair of the 8-mm critical-size defects in rats' calvaria. METHODS: Eighty adult male Wistar rats were randomly assigned to one of eight groups as follows: particulate autogenous bone demineralized with citric acid for 15 seconds (CA15), 30 seconds (CA30), or 60 seconds (CA60); particulate autogenous bone demineralized with tetracycline hydrochloride for 15 seconds (TCN15), 30 seconds (TCN30), or 60 seconds (TCN60); blood clot (NC), and non-demineralized autogenous bone (PC). The calvariae were harvested at 30 and 60 postoperative days (n = 5) for blinded histological and histometric analysis of the percentage area of newly formed bone within the defects. RESULTS: In the NC and TCN groups, bone formation was limited to the margins of the defects at 30 postoperative days, whereas complete closure was present in all the specimens from CA15 group. Both at 30 and 60 postoperative days, histomorphometry showed significant higher area of newly formed bone in specimens demineralized with CA than in those demineralized with TCN or non-demineralized (P < 0.05). TCN appeared to impair bone neoformation, as its use produced similar or inferior results compared to blood clot. CONCLUSIONS: Demineralization of particulate bone grafts with CA during 15s enhanced the regeneration of critical-size defects and may be a promising adjuvant in regenerative procedures. TCN seems to be improper for this purpose.

Effectiveness and surface changes of different decontamination protocols at smooth and minimally rough titanium surfaces.

BACKGROUND: The objective of this study is to evaluate titanium decontamination after different protocols while assessing changes in surface roughness, chemical composition, and wettability. METHODS: Ninety-six smooth (S) and 96 minimally rough (R) titanium microimplants were used. Pristine microimplants were reserved for negative control (S-nC/R-nC, n = 9), while the remaining microimplants were incubated in Escherichia coli culture. Non-decontaminated microimplants were used as positive control (S-pC/R-pC, n = 3). The other microimplants were divided into seven different decontamination protocols (12 S/R per group): 24% EDTA, 2% chlorhexidine (CHL), gauze soaked in 2% chlorhexidine (GCHL), gauze soaked in ultrapure water (GMQ), scaling (SC), titanium brush (TiB), and implantoplasty (IP). Contaminated areas were assessed by scanning electron microscope images, chemical composition by energy dispersive X-ray spectroscopy, wettability by meniscus technique, and roughness by an optical profiler. RESULTS: Higher residual bacteria were observed in R-pC compared with S-pC (P <0.0001). When comparing S and R with their respective pC groups, the best results were obtained with GCHL, SC, TiB, and IP, with no difference between these protocols (P >0.05). Changes in surface roughness were observed after all treatments, with S/R-IP presenting the smoother and a less hydrophilic surface (P <0.05). Apart from IP protocol, all the other groups presented a more hydrophilic surface in R than in S microimplants (P <0.003). All decontamination protocols resulted in a lower percentage of superficial Ti when compared with S/R-nC (P <0.002). CONCLUSIONS: All decontamination protocols resulted in changes in roughness, wettability, and chemical composition, but GCHL, SC, TiB, an IP presented the best decontamination outcomes.

Bone demineralization improves onlay graft consolidation: A histological study in rat calvaria.

BACKGROUND: Previous data suggest that bone demineralization may promote bone graft consolidation as well as proliferation and differentiation of pre-osteoblasts, but the biological mechanisms involved in this process need to be clarified. This study investigated the effects of bone demineralization with citric acid (CA) and tetracycline (TCN) on the repair of onlay bone grafts. METHODS: Onlay bone grafts were performed on the calvaria of 126 Wistar rats. The contacting surfaces between bone graft and receptor bone bed were demineralized for 15, 30, and 60 seconds with TCN (50 mg/mL), or 10% CA, (pH 1), constituting the following test groups (n = 18): TCN15, TCN30, TCN60, CA15, CA30, and CA60. Control grafts (C) were performed without demineralization (n = 18). After 7, 30, and 60 days, biopsies were obtained for quantitative and qualitative histological analysis (a = 6). RESULTS: Demineralization accelerated the bone repair early from 7 days of healing. Higher percentage area of newly formed bone was observed in CA15 and TCN60 groups when compared to C in all evaluation periods (P = 0.02). At 30 days, C specimens had lower percentage of consolidated surfaces than TCN60, TCN30 and CA15 (P = 0.0015). At 60 days, CA15, CA60, and TCN60 presented bone surfaces almost completely filled by newly formed bone, against about 75% in C specimens (P = 0.0015). CONCLUSIONS: Both CA and TCN were effective in accelerating osteogenesis at the interface between bone grafts and receptor bone beds, especially when applied for 15 seconds and 60 seconds, respectively.

Host-Microbial Interactions in Systemic Lupus Erythematosus and Periodontitis.

Background: Systemic lupus erythematosus (SLE) is a potentially fatal complex autoimmune disease, that is characterized by widespread inflammation manifesting tissue damage and comorbidities across the human body including heart, blood vessels, joints, skin, liver, kidneys, and periodontal tissues. The etiology of SLE is partially attributed to a deregulated inflammatory response to microbial dysbiosis and environmental changes. In the mouth, periodontal environment provides an optimal niche for local and systemic inflammation. Our aim was to evaluate the reciprocal impact of periodontal subgingival microbiome on SLE systemic inflammation. Methods: Ninety-one female subjects were recruited, including healthy (n = 31), SLE-inactive (n = 29), and SLE-active (n = 31). Patients were screened for probing depth, bleeding on probing, clinical attachment level, and classified according to CDC/AAP criteria with or without periodontal dysbiosis. Serum inflammatory cytokines were measured by human cytokine panel and a targeted pathogenic subgingival biofilm panel was examined by DNA-DNA checkerboard from subgingival plaque samples. Results: The results showed significant upregulation of serum proinflammatory cytokines in individuals with SLE when compared to controls. Stratification of subject's into SLE-inactive (I) and SLE-active (A) phenotypes or periodontitis and non-periodontitis groups provided new insights into SLE pathophysiology. Ten proinflammatory cytokines were upregulated in serum of SLE-I only and one in SLE-A only. Four molecules overlapped in SLE-A and SLE-I. Anti-inflammatory cytokines included IL-4 IL-10, which were upregulated in SLE-I sera (but not SLE-A), controlling clinical phenotypes. Out of 24 significant differential oral microbial abundances found in SLE, 14 unique subgingival bacteria profiles were found to be elevated in SLE. The most severe oral pathogens (Treponema denticola and Tannerella forsythia) showed increase abundances on SLE-A periodontal sites when compared to SLE-I and healthy controls. Inflammation as measured by cytokine-microbial correlations showed that periodontal pathogens dominating the environment increased proinflammatory cytokines systemically. Conclusions: Altogether, low-grade systemic inflammation that influenced SLE disease activity and severity was correlated to dysbiotic changes of the oral microbiota present in periodontal diseases.

Photogrammetry as an alternative for acquiring digital dental models: A proof of concept.

Photogrammetry is a mathematical technique that generates three-dimensional coordinates of specific points identified from multiple images of the same object obtained at different angles. This technique may be a low-cost alternative for traditional scanning. The objective of this proof of concept was to evaluate the accuracy and precision in obtaining digital models (DM) from a plaster model (PM) using photogrammetry. Five DM were generated from 50 photographs taken surrounding the PM. The photographs were taken by a single operator on five consecutive days using natural light. The images obtained were processed on 3DF Zephyr Free software. The height and width of all teeth were recorded on both PM and DM, as well as the distance between the canine cusps (C-C) and between the mesiobuccal cusps of the first molars (1 M-1 M). For the PM the measurements were taken with a digital caliper, whereas the DM was measured using the software Blender. The DM and PM measurements presented a limit of agreement between -0.433 and 0.611 mm. The accuracy of DM measurements showed a SD of ±0.171 mm and a repeatability coefficient of 0.474. In the superimposition of all DM, it was possible to notice a greater discrepancy in the posterior region of the arch and palate, but this difference decreased when the region was segmented. It can be concluded that photogrammetry appears to be a viable technique for the digitization of dental models. Further studies need to be performed to evaluate its clinical application.

Osteogenic cells transfer improving root coverage: A randomized clinical trial.

BACKGROUND AND OBJECTIVE: The aim of this interventional, parallel-assignment, single-blinded, randomized, efficacy study was to investigate the efficacy of the treatment of gingival recessions by osteogenic cell transfer. This is the first randomized clinical trial of this nature. MATERIAL AND METHODS: Treatment of Miller class I or II gingival recessions >4 mm was randomly defined by casual sorting and performed by newly forming bone graft (NFBG) and coronally advanced flap (CAF) or subepithelial connective tissue graft (SCTG) and CAF (control). Clinical examinations were performed by a single blinded examiner at baseline and at 3, 6, and 9 months after surgery. Parameters investigated were recession height (REC), probing depth (PD), clinical attachment level, gingival bleeding index (GBI), plaque index (PlI), and keratinized gingiva width (KGW). RESULTS: Both techniques achieved similar percentage of root coverage, but NFBG was more effective in pocket depth reduction, attachment level gain, and reduction of plaque accumulation and of bleeding on probing. CONCLUSIONS: These findings suggest that the transfer of osteogenic cells by NFBG is able to improve clinical attachment level and to cover denuded roots. NFBG can be used as an alternative treatment of deep recessions (≥4 mm), where the restoration of lost periodontal tissues is intended.

Oral health impact profile of head and neck cancer patients after or before oncologic treatment: an observational analytic case-control study.

PURPOSE: The objective of this study was to investigate the impact of oral health on the quality of life of patients with head and neck cancer (HNC) before and after oncologic treatment. METHODS: Forty cancer-free individuals (Cf group) and 40 HNC patients (Hnc group) were included in this study. Hnc group was also divided into two subgroups: Hnc 1 (pre-cancer therapy, n = 20) and Hnc 2 (post-cancer therapy, n = 20). Participants were asked to complete a short form of Oral Health Impact Profile (OHIP-14). The results were statistically analyzed with the multivariate analysis of variance with post-hoc Scheffé multiple comparison. RESULTS: It was observed a moderate impact on the quality of life on HNC patients, with values on Hnc 2 group significantly higher in the functional limitation when compared to the Hnc 1 group (p < 0.05). When compared to the Cf group, the values found on Hnc group were higher on functional limitation (p < 0.01) and at the total score (p < 0.05), whereas Hnc 2 group had significant superior values on functional limitation (p < 0.01), physical pain (p < 0.05), and total score (p < 0.01) CONCLUSION: These results show that there is an oral impairment that depreciates the quality of life of patients with an experience of HNC, principally after treatment, indicating the importance of the inclusion of professionals responsible for dental and oral care with the oncologic team to monitor the oral condition of these patients.

Salivary biomarkers as tools for oral squamous cell carcinoma diagnosis: A systematic review.

BACKGROUND: The oral squamous cell carcinoma (OSCC) survival rate is influenced by the fact that diagnoses occur mostly in late stages of the disease. Thus, there is a clear contribution in the early findings, making the use of minimally invasive techniques for diagnosis, such as analysis of salivary markers, interesting tools. METHODS: A systematic review was performed with all studies that establish a comparison between the levels of saliva-based markers found in patients with OSCC compared with cancer-free individuals. RESULTS: Twenty-eight studies were included. Of them, only 12 showed some caution with oral conditions before sample collection. A wide range of potential markers was evaluated; however, the comparison between studies was impaired because each marker was hardly explored by more than 1 article. CONCLUSION: The lack of methodological criteria within studies and the absence of consensus on marker choice are obstacles for future researches. © 2016 Wiley Periodicals, Inc. Head Neck 39: 797-811, 2017.

Bone demineralization with citric acid enhances adhesion and spreading of preosteoblasts.

BACKGROUND: Previous studies have demonstrated that bone demineralization can improve consolidation in bone grafts. The biologic mechanisms underlying this phenomenon remain unclear. METHODS: Twelve adult male guinea pigs were used in this experiment. Forty-five bone samples removed from the calvaria of nine animals were divided in groups (n = 9) according to the time of demineralization with citric acid (50%, pH 1): 15, 30, 90, and 180 seconds and non-demineralized samples (control). Preosteoblasts (MC3T3-E1) were cultured on the bone samples for 24, 48, and 72 hours (n = 3). Fifteen samples removed from the remaining three animals were analyzed by scanning electron microscopy/energy dispersive spectrometry (SEM/EDS) after demineralization (n = 3). RESULTS: The number of preosteoblasts increased significantly with time in all groups. The bone surface area covered by these cells increased with time, except in the control group. Intragroup differences occurred between 24 and 72 hours (P < 0.05). Samples demineralized for 30 seconds showed greater area covered by preosteoblast cells than for the other times of demineralization in all periods of cell culture (P < 0.05) without a statistically significant difference compared with 15 seconds. SEM/EDS showed diminished content of calcium (Ca) after 15 seconds of demineralization, but the Ca content increased after 180 seconds of demineralization (P < 0.05). The phosphorus (P) amount increased significantly only after 30 seconds of demineralization (P < 0.5). The sulfur (S) content was increased in demineralized samples in relation to non-demineralized ones, reaching the highest level after 90 seconds, when the difference became significant in relation to all the other times of demineralization (P < 0.05). Magnesium (Mg) content did not differ significantly between demineralized and non-demineralized samples. CONCLUSIONS: Bone surfaces demineralized for 30 seconds increased the spreading of preosteoblasts as well as the surface area covered by these cells. Bone demineralization deserves to be studied in periodontal and maxillofacial regenerative procedures.

Laser therapy as an effective method for implant surface decontamination: a histomorphometric study in rats.

BACKGROUND: To the best of the authors' knowledge, a standard protocol for treating peri-implantitis is not yet established. METHODS: A total of 150 titanium disks with smooth or rough surfaces contaminated with microbial biofilm were implanted subcutaneously in rats after undergoing one of three treatments: 1) low-intensity laser (LIL); 2) antimicrobial photodynamic therapy (aPDT); or 3) toluidine blue O (TBO). Sterile and contaminated disks served as negative (NC) and positive (C) control groups, respectively. After days 7, 28, and 84, tissue inflammation was evaluated microscopically by measuring the density of collagen fibers (degree of fibrosis) and concentration of polymorphonuclear neutrophils. RESULTS: Surface texture did not affect the degree of inflammation, but the area of reactive tissue was significantly greater for rough implants (2.6 ± 3.7 × 10(6) µm(2)) than for smooth ones (1.9 ± 2.6 × 10(6) µm(2); P = 0.0377). Group C presented the lowest and group NC presented the highest degree of fibrosis with significance only after day 7; these groups had the highest and lowest scores, respectively, for degree of inflammation. Group C showed the largest area of reactive tissue (9.11 ± 2.10 × 10(6) µm(2)), but it was not significantly larger than group LIL (P = 0.3031) and group TBO (P = 0.1333). Group aPDT showed the smallest area (4.34 ± 1.49 × 10(6) µm(2)) of reactive tissue among the treatment groups. After day 28, groups LIL, aPDT, TBO, and C resembled group NC in all the studied parameters. CONCLUSION: Group aPDT showed more favorable results in parameter area of reactive tissue than the other methods after day 7, but over longer time periods all methods produced outcomes equivalent to sterile implants.

Princípios ortodôntico-periodontais para homeostasia periodontal e harmonia estética / Orthodontic-periodontal principles for periodontal homeostasis and aesthetic harmony

Introdução: a reabilitação de pacientes periodontais encontra sérios inconvenientes devido ao aumento da coroa clínica gerado por procedimentos cirúrgicos quando se almeja sulco gengival fisiológico. Objetivos: apresentar, por meio de casos clínicos, uma metodologia de tratamento que inclui a integração de Ortodontia, Periodontia e Odontologia Reconstrutiva para preencher requisitos de estética, fonética, função oclusal, fisiologia periodontal e higiene na reabilitação de pacientes periodontais. Métodos: serão apresentados quatro casos clínicos ilustrando como a tração coronal lenta e rápida de dentes com envolvimento das distâncias biológicas pode possibilitar a cirurgia periodontal sem alterar suas coroas clínicas, porém levando ao restabelecimento de sulco gengival raso, viabilizando a obtenção dos requisitos propostos com a reconstrução dentária. Resultados: achados clínicos e radiográficos longitudinais mostraram que pode-se mobilizar a topografia óssea e gengival com o movimento ortodôntico, favorecendo a recomposição das estruturas periodontais de conformidade com os desígnios da natureza, culminando com a obtenção de condições propícias para a reconstrução odontológica restauradora. Conclusões: as metodologias de tração coronal lenta e rápida são meios eficazes para viabilizar o tratamento periodontal restaurador da homeostasia marginal dos tecidos, favorecendo a reconstrução restauradora dentro dos princípios mecânicos, estéticos, fonéticos, funcionais e preventivos e, com isso, reintegrando o paciente à sociedade.

Effects of TGF-beta1, PDGF-BB, and IGF-1 on the rate of proliferation and adhesion of a periodontal ligament cell lineage in vitro.

BACKGROUND: Considering the role of growth factors in periodontal regeneration, the aim of this study was to evaluate the influence of platelet-derived growth factor (PDGF)-BB, insulin-like growth factor (IGF)-1, and transforming growth factor-beta 1 (TGF-beta1), alone or in combination, on the rate of proliferation and adhesion of periodontal ligament (PDL) cells in vitro. METHODS: After establishment and characterization of a primary culture of PDL cells, 72 culture dishes were plated with 10(3) cells distributed among four test groups and a control group. Test groups had PDGF-BB, TGF-beta1, IGF-1, or a combination of all three added to the culture medium, whereas the control group received no growth factor. The samples were counted in triplicate 1, 3, 5, and 7 days after seeding. For the adhesion assay, 14 patients provided 30 root fragments distributed among 10 groups: scaling and root planing (SRP), SRP + growth factors, SRP + citric acid plus tetracycline (CA+T), and SRP + (CA+T) + growth factors. The data were evaluated statistically by analysis of variance complemented by Tukey, Dunnett, and Student-Newman-Keuels methods. RESULTS: Maximum rates of proliferation were observed at day 3 for all groups. TGF-beta1 induced a 344.17% +/- 58.80% increased proliferation rate over control (P < 0.05), followed by the combination (277.5% +/- 29.38%), PDGF-BB (238.79% +/- 5.79%), and IGF-1 (233.16% +/- 19.19%). Groups treated by (CA+T) showed increased numbers of cells attached to root fragments, especially SRP + (CA+T) + combination (13.25 +/- 1.79), with significant differences (P < 0.05) from groups treated only by SRP. CONCLUSION: This combination of growth factors stimulated a mitogenic response and favored the adhesion of PDL cells in vitro, suggesting its possible role in periodontal regeneration.

Effects of TGF-ß1, PDGF-BB, and IGF-1 on the Rate of Proliferation and Adhesion of a Periodontal Ligament Cell Lineage In Vitro.

BACKGROUND: Considering the role of growth factors in periodontal regeneration, the aim of this study was to evaluate the influence of platelet-derived growth factor (PDGF)-BB, insulin-like growth factor (IGF)-1, and transforming growth factor-beta 1(TGF-ß1), alone or in combination, on the rate of proliferation and adhesion of periodontal ligament (PDL) cells in vitro. METHODS: After establishment and characterization of a primary culture of PDL cells, 72 culture dishes were plated with 103 cells distributed among four test groups and a control group. Test groups had PDGF-BB, TGF-ß1, IGF-1, or a combination of all three added to the culture medium, whereas the control group received no growth factor. The samples were counted in triplicate 1, 3, 5, and 7 days after seeding. For the adhesion assay, 14 patients provided 30 root fragments distributed among 10 groups: scaling and root planing (SRP), SRP + growth factors, SRP + citric acid plus tetracycline (CA+T), and SRP + (CA+T) + growth factors. The data were evaluated statistically by analysis of variance complemented by Tukey, Dunnett, and Student-Newman-Keuels methods. RESULTS: Maximum rates of proliferation were observed at day 3 for all groups. TGF-ß1 induced a 344.17% ± 58.80% increased proliferation rate over control (P <0.05), followed by the combination (277.5% ± 29.38%), PDGF-BB (238.79% ± 5.79%), and IGF-1 (233.16% ± 19.19%). Groups treated by (CA+T) showed increased numbers of cells attached to root fragments, especially SRP + (CA+T) + combination (13.25 ± 1.79), with significant differences (P <0.05) from groups treated only by SRP. CONCLUSION: This combination of growth factors stimulated a mitogenic response and favored the adhesion of PDL cells in vitro, suggesting its possible role in periodontal regeneration.

Histomorphometric study of the healing of human oral mucosa after gingivoplasty and low-level laser therapy.

BACKGROUND AND OBJECTIVES: The aim of the present study was to analyze the effects of diode laser irradiation on the healing of human oral mucosa. MATERIALS AND METHODS: After gingivoplasty, the right hemi-arch (test group) of 16 patients was irradiated with a diode laser. The left side (control group) was not irradiated. Incisional biopsies were performed on both sides at 7, 14, 21, and 60 days after surgery and morphometrically analyzed by light microscopy. RESULTS: Epithelium width ranged from 260.6 to 393.5 microm. Volume densities of basal (20.2%), prickle cell (55.6%), and cornified (24.2%) layers remained stable. The peak number of neutrophils were 6 cells/mm(2) and the mononuclear cells were 44 cells/mm(2). Collagen fibers (80%) and fibroblasts (14%) occupied the main volume of connective tissue. The one-way ANOVA and the paired Student's t-test were used for statistical analysis (P < 0.05). CONCLUSION: Low-level laser therapy did not accelerate the healing of oral mucosa after gingivoplasty.