Periodontal disease, tooth loss and dementia: Is there a link? A systematic review.

BACKGROUND: It has been suggested that dementia is caused by neuronal damage due to chronic inflammation from peripheral sources such as the oral cavity in periodontal disease. OBJECTIVE: The aim of our review was to assess the risk of dementia or cognitive impairment associated with chronic periodontitis and multiple tooth loss. MATERIALS AND METHODS: An extensive search of electronic databases of articles on the relation between periodontitis, tooth loss and dementia published on or before April 2016 was conducted. Experimental and human studies that provided a description consistent with multiple tooth loss, chronic periodontal disease and cognitive impairment obtained by validated methods were selected. The data extracted from the articles included study design, country of origin, sample size, methods used to assess periodontitis and cognition, average age at the baseline and number of years of follow-up. The Newcastle-Ottawa scale was used to assess the quality of human studies. RESULTS: The literature search yielded 756 articles which were independently screened, and 16 articles were included in the review. Four human studies reported an association of subsequent dementia with multiple tooth loss. One human study reported that chronic periodontal disease was associated with dementia. Eight experimental studies demonstrated an association between cognitive impairment and tooth loss. CONCLUSION: The literature on chronic periodontitis and multiple tooth loss as risk factors to dementia remains inconclusive. More randomised clinical trials on the association between periodontitis and dementia with uniform criteria for evaluation and diagnosis of periodontitis are warranted.

Comparison of Osteotome and Conventional Drilling Techniques for Primary Implant Stability: An In Vitro Study.

It may be difficult to achieve primary stability in the posterior maxilla because of poor quality and quantity of bone. Studies have shown that the osteotome technique immediately increases bone density thereby increasing primary stability. An in vitro study was conducted to compare the stability achieved by the osteotome and conventional drilling techniques in low density bone. Forty endosseous implant fixtures (n = 40) were inserted in a solid rigid polyurethane block simulating low density (D3) bone. The implants were divided into 4 groups to test 2 variables: (1) implant length (10 mm or 13 mm) and (2) preparation of osteotomy (conventional drilling or osteotome technique). Insertion torque (IT) and resonance frequency analysis (RFA) were measured for each implant. Statistical analysis using one-way ANOVA and Tukey post hoc test was done to study IT and RFA data of the 4 groups. Pearson Correlation test was used to determine the correlation between IT and RFA values of the implants. The IT and RFA values were statistically significant higher using the osteotome technique as compared to conventional drilling (P < 0.0001). Statistically significant higher values were also found for IT and RFA of 13 mm implants as compared to 10 mm implants. A significant correlation was found between insertion torque and RFA values in all 4 groups (r = 0.86, P < 0.0001). The conclusion was that the osteotome technique significantly increased primary stability.