Antimicrobial efficiency and cytocompatibility of different decontamination methods on titanium and zirconium surfaces.

OBJECTIVES: The purpose of this study was to investigate the efficiency of different implant-decontamination methods regarding biofilm modification and potential cytotoxic effects. Therefore, the amount of biofilm reduction, cytocompatibility, and elementary surface alterations were evaluated after decontamination of titanium and zirconium surfaces. MATERIAL AND METHODS: Titanium and zirconium disks were contaminated with a newly developed high-adherence biofilm consisting of six microbial species. Decontaminations were performed using titanium curette, stainless steel ultrasonic scaler (US), glycine (GPAP) and erythritol (EPAP) powder air-polishing, Er:YAG laser, 1% chlorhexidine (CHX), 10% povidone-iodine (PVI), 14% doxycycline (doxy), and 0.95% NaOCl solution. Microbiologic analysis was done using real-time qPCR. For assessment of cytocompatibility, a multiplex assay for the detection of cytotoxicity, viability, and apoptosis on human gingival fibroblasts was performed. X-ray photoelectron spectroscopy (XPS) was used to evaluate chemical alterations on implant surfaces. RESULTS: Compared with untreated control disks, only GPAP, EPAP, US, and Er:YAG laser significantly reduced rRNA counts (activity) on titanium and zirconium (p < .01), whereas NaOCl decreased rRNA count on titanium (p < .01). Genome count (bacterial presence) was significantly reduced by GPAP, EPAP, and US on zirconium only (p < .05). X-ray photoelectron spectroscopy analyses revealed relevant re-exposure of implant surface elements after GPAP, EPAP, and US treatment on both materials, however, not after Er:YAG laser application. Cytocompatibility was impaired by CHX, PVI, doxy, and NaOCl. CHX and PVI resulted in the lowest viability and doxy in the highest apoptosis. CONCLUSIONS: Within the limits of this in vitro study, air-polishing methods and ultrasonic device resulted in effective biofilm inactivation with surface re-exposure and favorable cytocompatibility on titanium and zirconium. Chemical agents, when applied on implant surfaces, may cause potential cytotoxic effects.

Comparison of three full-mouth concepts for the non-surgical treatment of stage III and IV periodontitis: A randomized controlled trial.

AIM: To evaluate the clinical efficacy of full-mouth scaling (FMS), full-mouth disinfection (FMD), and FMD with adjuvant erythritol air-polishing (FMDAP) compared to quadrant-wise debridement (Q-SRP) in patients with periodontitis stage III/IV. METHODS: In this four-arm parallel, prospective, randomized, controlled multi-centre study, changes of pocket probing depths (PPDs), clinical attachment level (CAL), bleeding on probing (BOP), and proportion of closed pockets (PPD ≤4 mm without BOP) were evaluated at baseline and after 3 and 6 months. RESULTS: From 190 randomly participating patients, 172 were included in the final analysis. All groups showed significant (p < .05) improvements in all clinical parameters over 3 and 6 months. During the study period, FMDAP showed significantly higher reductions of mean PPD in teeth with moderate (PPD 4-6 mm) and deep (PPD > 6 mm) pockets and significantly increased proportions of pocket closure than Q-SRP. Patients treated with FMD had significantly greater PPD reduction in deep pockets and a higher percentage of pocket closure after 3 months but not after 6 months compared to Q-SRP. CAL and BOP changes did not significantly differ among all groups. Efficiency of treatment (time effort to gain one closed pocket) was significantly higher for FMDAP, FMD, and FMS compared to Q-SRP (6.3, 8.5, 9.5 vs. 17.8 min per closed pocket; p < .05). CONCLUSIONS: All treatment modalities were effective, without significant differences between full-mouth approaches. FMDAP showed improved clinical outcomes over Q-SRP for moderate and deep pockets after 6 months. Full-mouth protocols were more time-efficient than conventional Q-SRP. CLINICAL SIGNIFICANCE: The trial was registered in a clinical trial database (ClinicalTrials.gov: NCT03509233).

Trends in antibiotic use and microbial diagnostics in periodontal treatment: comparing surveys of German dentists in a ten-year period.

OBJECTIVES: The use of antibiotics and microbial tests in periodontal treatment among German dental practitioners was investigated in 2012-2013 and compared with 2002-2003 data. MATERIALS AND METHODS: One thousand four hundred representative German practitioners received a postal questionnaire requesting their prescribing habits concerning type, dose, frequency, and sequence of antibiotics adjunctive to mechanical debridement. Additionally, the use of local antimicrobials and microbial tests were recorded. RESULTS: The response rate was 29.1 % (407 reports). Drug combinations, especially amoxicillin plus metronidazole, were prescribed most frequently (32.8 %) with an increase of 7.4 % during the past decade, followed by clindamycin (29.3 %). Amoxicillin monotherapy was used unexpectedly frequently (17.0 %) and doxycycline (2.8 %) very infrequently. Then, 24.7 % prescribed antibiotics prior to mechanical therapy, while most dentists followed the recommended sequence. The use of local antimicrobials increased by 6.2 % and of microbial diagnostics by 20.8 %. CONCLUSIONS: Positive trends regarding position-paper-conform prescribing habits including the scheduling of systemic antibiotics and increasing use of local antimicrobials and microbial tests were observed. However, deficits and malpractice still exist in German practices. Unexpected is the widespread and increasing use of clindamycin. Continuing educational campaigns and strictly expressed real guidelines are needed. CLINICAL RELEVANCE: Indication and choice of antibiotic agents in causal periodontal therapy among German dentists have changed between 2003 and 2013 toward a more position-paper-based concept, but inappropriate prescriptions of second choice antibiotics still remain conspicuous.

Prevalence of periodontitis in individuals with human leukocyte antigens (HLA) A9, B15, A2, and B5.

OBJECTIVE: Human leukocyte antigens (HLA) have been associated with periodontitis. Previous studies revealed HLA-A9 and HLA-B15 as potential susceptibility factors, while HLA-A2 and HLA-B5 might have protective effects. The aim of the study was to verify these associations in a group of HLA-typed blood donors with previously unknown periodontal status. MATERIALS AND METHODS: In four German centers, 140 blood donors with known HLA class I status were enrolled and allocated to the following five groups: HLA-A9 (N = 24), HLA-B15 (N = 20), HLA-A2 (N = 30), HLA-B5 (N = 26), and controls (N = 40). Periodontal examination included the measurement of probing depths (PDs), clinical attachment level (CAL), bleeding on probing (BOP), and community periodontal index of treatment needs (CPITN). RESULTS: Carriers with HLA-A9 and HLA-B15 had higher values of mean PD (P < 0.0001), CAL (P < 0.0001), and BOP (P < 0.002) as well as sites with PD and CAL with ≥4 and ≥6 mm (P < 0.0003), respectively, than controls. Multiple regression analyses revealed HLA-A9, HLA-B15, and smoking as risk indicators for moderate to severe (CPITN 3-4; odds ratio (OR): 66.7, 15.3, and 5.1) and severe (CPITN 4; OR: 6.6, 7.4, and 3.8) periodontitis. HLA-A2 and HLA-B5 did not show any relevant associations. CONCLUSION: The present data support a role of HLA-A9 and HLA-B15 as susceptibility factors for periodontitis, whereas HLA-A2 and HLA-B5 could not be confirmed as resistance factors. CLINICAL RELEVANCE: Both HLA antigens A9 and B15 are potential candidates for periodontal risk assessment.

The gingival biotype: measurement of soft and hard tissue dimensions - a radiographic morphometric study.

BACKGROUND: Gingival biotypes have been reported to influence the outcome of restorative therapies. The aim of this study was to evaluate the correlation of different morphometric parameters with the thickness of the buccal gingiva and alveolar bone at different apico-coronal levels. METHODS: In 60 periodontally healthy subjects, the central maxillary incisor was examined. Clinical parameters included the crown width/crown length ratio (CW/CL), gingival width (GW), gingival scallop (SC) and transparency of the periodontal probe through the gingival sulcus (TRAN). Gingival and alveolar bone dimensions were assessed on parallel profile radiographs. RESULTS: Crown width/crown length ratio was positively correlated with the thickness of the gingiva at the cementoenamel junction (G3) (r = 0.47) and to the thickness of the alveolar crest (A1) (r = 0.46); whereas SC had a weak negative and GW had a moderate positive correlation with all radiographic measurements. TRAN had a stronger negative relation to the thickness at the free gingiva (r = -0.42) than to other tissue thicknesses. All gingival thickness values were correlated with A1 value. Multivariate models identified CW/CL and GW as significant predictors for G3 value, whereas CW/CL was a significant predictor for A1 value. CONCLUSION: Crown width/crown length ratio and GW could represent surrogate parameters to anticipate the gingival thickness at the cementoenamel junction, whereas CW/CL might also be an indicator for alveolar bone crest thickness. Periodontal probing has a limited prognostic value for these tissue dimensions.

Detection of oral bacterial DNA in synovial fluid.

OBJECTIVES: As periodontal bacteria might be involved in the aetiology of rheumatic diseases, we analysed synovial fluid obtained from patients with rheumatoid arthritis (RA) and controls for the presence of DNA of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola. METHODS: In all, 42 patients suffering from RA (mean age 53.8 ± 16.7 years, 40.4% females) and 114 controls with no rheumatic diseases (mean age 56.1 ± 15.2 years, 52.4% females) were included. DNA from synovial fluid was isolated by QiaAmp kit (Qiagen, Hilden, Germany). Polymerase chain reactions (PCRs) specific for the 16S rRNA genes of the above specified bacteria were developed. Subgingival bacterial colonization was analysed using micro-Ident(®) test (HAIN-Diagnostik, Nehren, Germany). RESULTS: In patients with RA DNA of P. gingivalis was detected in synovial fluid more often than in controls (15.7% versus 3.5%, p = 0.045). More patients than controls harboured DNA from P. gingivalis in both, oral plaque and synovial fluid (11.9% versus. 0.9%, p = 0.030). Among the patients group the number of missing teeth was correlated with the number of joints with movement restrictions caused by RA. CONCLUSIONS: DNA of periodontopathogens can be found in synovial fluid and oral bacteria may play a role in the pathogenesis of arthritis.

Failure to detect an association between aggressive periodontitis and the prevalence of herpesviruses.

BACKGROUND: Herpes simplex virus type 1 (HSV-1), human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) have been suspected to play a causal role in periodontitis pathogenesis. The aim of this study was to determine the prevalence of these viruses in subgingival plaque samples of Caucasian patients with generalized aggressive periodontitis compared to periodontally healthy controls. METHODS: A total of 65 patients with aggressive periodontitis and 65 unmatched controls from Germany were investigated in the study. Subgingival plaque samples were analysed for the presence of HSV-1, EBV and HCMV by quantitative real-time polymerase chain reaction assays. Viral antibody titres were determined quantitatively by immunosorbent assays. RESULTS: DNA of HSV-1 and HCMV were detected in 1.5% of the patients and controls, whereas EBV DNA was present in 10.8% and 13.9% respectively. Detection rates of serum IgG against HSV-1 (76.1% versus 73.9%), EBV (98.5% versus 96.9%), HCMV (47.7% versus 46.2%) and IgM levels against HSV-1 (6.2% versus 1.5%), EBV (0% versus 0%), HCMV (0% versus 1.5%) did not significantly differ between patients and controls. CONCLUSION: The data of our study do not suggest any contribution of HSV-1, EBV or HCMV to aggressive periodontitis in a German population. Ethnic and methodological aspects might have caused conflicting results of previous studies.

Verification of nerve integrity after surgical intervention using quantitative sensory testing.

PURPOSE: The aim of this study was to apply a standardized Quantitative Sensory Testing (QST) approach in patients to investigate whether oral surgery can lead to sensory changes, even if the patients do not report any sensory disturbances. Furthermore, this study determines the degree and duration of possible neuronal hyperexcitability due to local inflammatory trauma after oral surgery. PATIENTS AND METHODS: Orofacial sensory functions were investigated by psychophysical means in 60 patients (30 male, 30 female) in innervation areas of infraorbital nerves, mental nerves and lingual nerves after different interventions in oral surgery. The patients were tested 1 week, 4 weeks, 7 weeks, and 10 weeks postoperatively. As controls for bilateral sensory changes after unilateral surgery, tests were additionally performed in 20 volunteers who did not have any dental restorations. RESULTS: No differences were found between the control group and the control side of the patients. Although not 1 of the patients reported paresthesia or other sensory changes postoperatively, QST detected significant differences between the control and the test side in the mental and lingual regions. Test sides were significantly less sensitive for thermal parameters (cold, warm, and heat). No differences were found in the infraorbital region. Patients showed significantly decreased pain pressure thresholds on the operated side. QST monitored recovery over time in all patients. CONCLUSIONS: The results show that oral surgery can lead to sensory deficits in the mental and lingual region, even if the patients do not notice any sensory disturbances. The applied QST battery is a useful tool to investigate trigeminal nerve function in the early postoperative period. In light of the increasing forensic implication, this tool can serve to objectify clinical findings.

Impact of Three Nonsurgical, Full-Mouth Periodontal Treatments on Total Bacterial Load and Selected Pathobionts.

For the treatment of periodontitis stage III/IV, a quadrant/week-wise debridement (Q-SRP) was compared with three full-mouth approaches: full-mouth scaling (FMS, accelerated Q-SRP within 24 h), full-mouth scaling with chlorhexidine-based disinfection (FMD), and FMD with adjuvant erythritol air polishing (FMDAP). The objective of this prospective, randomized study (a substudy of ClinicalTrials.gov, identifier: NCT03509233) was to compare the clinical and microbiological effects of the treatments. In total, 105 patients were randomized to one of the four aforementioned treatment groups, with n = 25, 28, 27, and 25 patients allocated to each group, respectively. At baseline and 3 and 6 months after treatment, the clinical parameters, including the pocket probing depths, clinical attachment level, and bleeding on probing, were recorded, and the prevalence of the total bacteria and four periodontal pathobionts (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia) was determined using real-time quantitative PCR. Concerning the clinical outcomes, all the treatment modalities were effective, but the full-mouth approaches, especially FMDAP, were slightly superior to Q-SRP. Using the FMD approach, the reduction in the bacterial load and the number of pathobionts was significantly greater than for FMS, followed by Q-SRP. FMDAP was the least effective protocol for microbial reduction. However, after a temporary increase 3 months after therapy using FMDAP, a significant decrease in the key pathogen, P. gingivalis, was observed. These findings were not consistent with the clinical results from the FMDAP group. In conclusion, the dynamics of bacterial colonization do not necessarily correlate with clinical outcomes after full-mouth treatments for periodontitis stage III/IV.

Nonsurgical Periodontal Treatment Options and Their Impact on Subgingival Microbiota.

BACKGROUND: Different periodontal treatment methods (quadrant-wise debridement, scaling and root planing (Q-SRP), full-mouth scaling (FMS), full-mouth disinfection (FMD), and FMD with adjuvant erythritol air-polishing (FMDAP)) were applied in periodontitis patients (stage III/IV). The study objective (substudy of ClinicalTrials.gov Identifier: NCT03509233) was to compare the impact of treatments on subgingival colonization. METHODS: Forty patients were randomized to the treatment groups. Periodontal parameters and subgingival colonization were evaluated at baseline and 3 and 6 months after treatment. RESULTS: Positive changes in clinical parameters were recorded in every treatment group during the 3-month follow-up period, but did not always continue. In three groups, specific bacteria decreased after 3 months; however, this was associated with a renewed increase after 6 months (FMS: Porphyromonas gingivalis; FMD: Eubacterium nodatum, Prevotella dentalis; and FMDAP: uncultured Prevotella sp.). CONCLUSIONS: The benefit of all clinical treatments measured after 3 months was associated with a decrease in pathogenic bacteria in the FMS, FMD, and FMDAP groups. However, after 6 months, we observed further improvement or some stagnation in clinical outcomes accompanied by deterioration of the microbiological profile. Investigating the subgingival microbiota might help appraise successful periodontal treatment and implement individualized therapy.

Peri-implant bone level around implants with platform-switched abutments.

PURPOSE: The purpose of this clinical trial was to evaluate whether the crestal bone height around dental implants could be influenced by the use of a platform-switching protocol. MATERIALS AND METHODS: All implants placed in the year 2006 in healed bone without any need for ridge augmentation were included in this study. The following groups were created: (1) wide-diameter implants were placed subcrestally and regular-diameter cover screws were connected; (2) regular-diameter implants were placed at the crest and regular-diameter cover screws were connected. Standardized radiographs were obtained after insertion of the definitive prosthesis and after 1 year. Calibrated measurements were conducted initiating from the mesial and distal bone peaks to the implant-abutment junction. The average value of the mean medial and mean distal values was calculated and analyzed with an unpaired two-tailed t test. P values < .05 were regarded as statistically significant. RESULTS: In all, 89 dental implants in 36 patients were evaluated. The implants with a platform-switched configuration (n = 75) exhibited statistically significantly less bone loss at time of insertion of the definitive prosthesis (0.30 +/- 0.07 mm versus 0.68 +/- 0.17 mm; P < .05) and at 1 year (0.39 +/- 0.07 mm versus 1.00 +/- 0.22 mm, P < .01) when compared to the nonplatform-switched implants (n = 14). CONCLUSION: Platform-switched implants seem to limit crestal bone remodeling.

Assessment of trigeminal nerve functions by quantitative sensory testing in patients and healthy volunteers.

PURPOSE: Orofacial sensory dysfunction plays an important role in oral and maxillofacial surgery. Quantitative sensory testing (QST) is a psychophysical approach to evaluate thermal and mechanical somatosensation. PATIENTS AND METHODS: The present human study 1) collected normative QST data in extraoral and intraoral regions, 2) analyzed effects of age, gender, and anatomical sites on QST, and 3) applied QST in 11 patients with iatrogenic inferior alveolar nerve lesions. Sixty (30 male and 30 female) healthy volunteers were tested bilaterally in the innervation areas of infraorbital, mental, and lingual nerves. Ten patients with sensory disturbances in innervation areas of the mental nerve were investigated at 1, 4, and 8 weeks after surgery. Another patient with a complete sensory loss after surgery was repetitively tested within 453 days after primary surgery (dental implant) and subsequent surgical reconstruction of the inferior alveolar nerve by autologous graft. RESULTS: Older subjects were significantly less sensitive than younger subjects for thermal parameters. Thermal detection thresholds in infraorbital and mental regions showed higher sensitivity in women. Sensitivity to thermal stimulation was higher in the infraorbital region than in the mental and lingual regions. QST monitored somatosensory deficits and recovery of inferior alveolar nerve functions in all patients. CONCLUSIONS: Age, gender, and anatomic region affect various QST parameters. QST might be useful in the diagnosis of inferior alveolar nerve disorders in patients. In dentistry, the monitoring of afferent nerve fiber functions by QST might support decisions on further interventions.

The role of the composite interleukin-1 genotype in the association between periodontitis and acute myocardial infarction.

BACKGROUND: Recent data indicate that interleukin (IL)-1 polymorphism may influence the susceptibility to periodontitis and coronary heart diseases. The aim of this study was to evaluate the impact of the composite IL-1 genotype (allele 2 at IL-1A -889 and IL-1B +3954) in the association between acute myocardial infarction (AMI) and periodontitis. METHODS: One hundred four white subjects (54 patients with AMI and 50 healthy controls) were studied; each received a comprehensive periodontal examination, including measurement of periodontal probing depth (PD) and clinical attachment level (CAL). The extent of periodontitis was assessed by the percentage of sites with clinical AL >3 mm. Polymorphisms in the IL-1 gene cluster were assessed using a reverse hybridization assay. RESULTS: Compared to controls, mean values for PD (4.6 mm versus 3.7 mm; P <0.0001) and CAL (5.4 mm versus 4.5 mm; P = 0.0001) were significantly increased among patients with AMI. Significantly more subjects with moderate or severe periodontitis (> or =33% of sites with clinical AL >3 mm) were found in the AMI group compared to controls (31.5% versus 8%; P = 0.0016). These differences remained statistically significant after adjustment for smoking, age, and gender. No significant differences were observed in the allele frequencies of the gene loci IL-1A -889 and IL-1B +C3954 between patients with AMI and controls. Also, there was no difference in the frequency of the composite IL-1 genotype. IL-1 genotype-positive patients with AMI had slightly increased PD and AL compared to IL-1 genotype-negative patients with AMI. CONCLUSIONS: The results confirmed an association between periodontitis and AMI but failed to detect a modifying impact of the composite IL-1 genotype. Although the IL-1 genotype was only weakly associated with compromised periodontal health, it was not associated with AMI.

Human leukocyte antigen polymorphism in chronic and aggressive periodontitis among Caucasians: a meta-analysis.

AIM: Multiple studies have reported associations between periodontitis and particular human leukocyte antigens (HLA). Because associations are inconsistent, we conducted a systematic literature review and a meta-analysis focusing on Caucasian case-control studies. MATERIAL AND METHODS: A literature search reporting on the distribution of HLA class I and II phenotypes in Caucasian patients with chronic periodontitis (CP) and aggressive periodontitis (AP) was performed. Data sources included electronic databases and bibliographies of published articles. Screening and data abstraction were conducted independently by different reviewers. RESULTS: Out of 174 publications, 12 studies were considered to be suitable for meta-analysis. In patients with CP, no significant HLA associations were found. Patients with AP showed a positive association with HLA-A9 [odds ratio=2.59 (95% confidence interval 1.36-4.83), p=0.004] and HLA-B15 [1.90 (1.15-3.16), p=0.01] as well as a negative association with HLA-A2 [0.72 (0.56-0.94), p=0.01] and -B5 [0.49 (0.30-0.79), p=0.004]. On grouping all patients into one periodontitis group (AP+CP), the same deviations were confirmed with higher statistical significance. For HLA-A9 and -B15, significant heterogeneity was found between the studies. No significant associations were found with HLA class II antigens. CONCLUSIONS: HLA-A9 and -B15 seem to represent susceptibility factors for AP whereas HLA-A2 and -B5 are potential protective factors against periodontitis among Caucasians.

Dimensional changes of the alveolar ridge contour after different socket preservation techniques.

OBJECTIVES: The aim of the following study was to assess contour changes after socket preservation techniques. MATERIAL AND METHODS: In five beagle dogs, the distal root of the third and fourth mandibular premolars was extracted. The following treatments (Tx) were randomly assigned for the extraction socket. Tx 1: BioOss Collagen. Tx 2: BioOss Collagen and a free soft tissue graft. Tx 3: No treatment. Tx 4: The internal buccal aspect was covered with an experimental collagen membrane, the extraction socket was filled with BioOss Collagen and the membrane folded on top of the graft. Impressions were obtained at baseline, 2 and 4 months after surgery. Bucco-lingual measurements were performed using digital imaging analysis. RESULTS: All groups displayed contour shrinkage at the buccal aspect. Only the differences between the two test groups (Tx 1, Tx 2) and the control group (Tx 3) were significant at the buccal aspect (p< or =0.001). No measurements of the Tx 4 group could be performed. CONCLUSION: Socket preservation techniques, used in the present experiment, were not able to entirely compensate for the alterations after tooth extraction. Yet, incorporation of BioOss Collagen seems to have the potential to limit but not avoid the post-operative contour shrinkage.

Psychiatrists' and dentists' knowledge and attitudes regarding adverse drug reactions of psychotropic drugs.

Psychotropic drugs may induce impairments in the mouth, jaw and face area. Currently, appropriate pharmacoepidemiologic data are missing. Therefore, a questionnaire-based telephone survey of two non-representative samples of psychiatrists and dentists was conducted. Most of the psychiatrists (79.7%) and dentists (76.5%) indicated that psychotropic drugs may induce dental adverse drug reactions (ADR); in both samples there was an approximately equally sized, relevant proportion of participants who did not believe in the risk of dental ADR of psychotropic drugs (psychiatrists 20.3%; dentists 23.5%). About one third of the participants of both samples (psychiatrists 34.9%; dentists 35.9%) felt that dental ADRs of psychotropic drugs are a serious health problem. The majority of both groups (psychiatrists 97.8%; dentists 97.0%) had never reported a dental ADR. Most psychiatrists and dentists appeared to be aware of the risk of dental ADRs by psychotropic drugs. A relevant proportion of participants of both groups considered psychotropic drugs to be irrelevant regarding dental ADRs; therefore, there may be information needs in both groups. The willingness to report dental ADRs of psychotropic drugs was low in both groups; the evaluation of the actual relevance of this drug-related risk is impeded by the absence of reports of suspected ADRs.

Combination of Ultrasonic Decontamination, Soft Tissue Curettage and Submucosal Air Polishing With Povidone-Iodine Application for Non-Surgical Therapy of Peri-Implantitis: 12 Months Clinical Outcomes.

BACKGROUND: The aim of this study was to evaluate the clinical outcomes of a concept for non-surgical peri-implantitis combining stepwise mechanical debridement measures with adjuvant Povidone-iodine application with and without systemic antibiotics. METHODS: 45 patients with chronic periodontitis comprising 164 screw-typed implants with peri-implantitis were included. Peri-implantitis was defined as radiographic bone loss of >2 mm, probing pocket depth (PD) ≥5 mm with bleeding on probing (BOP). Stepwise treatment of implants was performed with ultrasonic debridement, soft tissue curettage (STC), glycine powder air polishing (GPAP) and a repeated submucosal application of Povidone-iodine. Teeth with PD >4mm were treated simultaneously according to the same concept except STC. In cases with severe periodontitis (N = 24), amoxicillin and metronidazole (AM) were prescribed for 7 days. RESULTS: After 12 months, implants treated without AM showed significant reductions (p<0.05) of mean PD (1.4 ± 0.7 mm), CAL (1.3 ± 0.8 mm) and BOP (33.4 ± 17.2%). In deep pockets (PD >6mm) changes of mean PD (2.3 ± 1.3 mm), CAL (2.0 ± 1.6 mm) and BOP (44.0 ± 41.7%) were more pronounced. Intake of AM did not significantly influence the changes of these parameters. However, the reduction of implant sites with PD >4 mm and BOP was significantly higher in patients with AM than in those without AM (31.8 ± 12.6% vs. 20.8 ± 14.7%; p<0.05). CONCLUSIONS: The combination of ultrasonic debridement, STC and GPAP with adjuvant Povidone-iodine led to significant clinical improvements at implants. Systemic antibiotics had limited effects on the reduction of persisting implant sites with treatment need.

Combination of ultrasonic decontamination, soft tissue curettage, and submucosal air polishing with povidone-iodine application for non-surgical therapy of peri-implantitis: 12 Month clinical outcomes.

BACKGROUND: The aim of this study is to evaluate clinical outcomes of a concept for non-surgical peri-implantitis combining stepwise mechanical debridement measures with adjuvant povidone-iodine application with and without systemic antibiotics. METHODS: Forty-five patients with chronic periodontitis and a total of 164 screw-typed implants with peri-implantitis were included. Peri-implantitis was defined as radiographic bone loss of > 2 mm, probing depth (PD) ≥5 mm with bleeding on probing (BOP). Stepwise treatment of implants was performed with ultrasonic debridement, soft tissue curettage (STC), glycine powder air polishing (GPAP), and a repeated submucosal application of povidone-iodine. Teeth with PD > 4 mm were treated simultaneously according to the same concept except STC. In cases with severe periodontitis (n = 24), amoxicillin and metronidazole (AM) were prescribed for 7 days. RESULTS: After 12 months, implants treated without AM showed significant reductions (P < 0.05) of mean PD (1.4 ± 0.7 mm), clinical attachment level (CAL) (1.3 ± 0.8 mm), and BOP (33.4% ± 17.2%). In deep pockets (PD > 6 mm) changes of mean PD (2.3 ± 1.3 mm), CAL (2.0 ± 1.6 mm), and BOP (44.0% ± 41.7%) were more pronounced. Intake of AM did not significantly influence the changes in these parameters. However, the reduction of implant sites with PD > 4 mm and BOP was significantly higher in patients with AM than in those without AM (31.8% ± 12.6% versus 20.8% ± 14.7%; P < 0.05). CONCLUSIONS: The combination of ultrasonic debridement, STC, and GPAP with adjuvant povidone-iodine led to significant clinical improvements at implants. Systemic antibiotics had limited effects on the reduction of persisting implant sites with treatment need.

Accuracy of Bone Measurements in the Vicinity of Titanium Implants in CBCT Data Sets: A Comparison of Radiological and Histological Findings in Minipigs.

PURPOSE: The aim of this animal study was the determination of accuracy of bone measurements in CBCT (cone-beam computed tomography) in close proximity to titanium implants. MATERIAL AND METHODS: Titanium implants were inserted in eight Göttingen minipigs. 60 implants were evaluated histologically in ground section specimen and radiologically in CBCT in regard to thickness of the buccal bone. With random intercept models, the difference of histologic measurements and CBCT measurements of bone thickness was calculated. RESULTS: The mean histological thickness of the buccal bone was 5.09 mm (CI 4.11-6.08 mm). The four raters measured slightly less bone in CBCT than it was found in histology. The random effect was not significant (p value 1.000). Therefore, the Intraclass Correlation Coefficient (ICC) was 98.65% (CI 100.00-96.99%). CONCLUSION: CBCT is an accurate technique to measure even thin bone structures in the vicinity of titanium implants.

Postextraction Socket Seal Surgery with an Epithelized Connective Tissue Graft Using a Subpapillar Tunneling Procedure.

Ridge preservation in the esthetic area is still a challenging procedure. The aim of the present case series was to introduce a technique for postextraction socket seal surgery using an epithelized connective tissue graft and socket filling with a xenogeneic biomaterial. Using a tunneling approach, the buccal gingiva and interdental papillae are undermined and augmented with the soft tissue graft. This method was applied and evaluated in 16 sites in 13 patients with need for extraction of at least one maxillary anterior tooth. Five months postoperative, the mean reduction of the horizontal width of the alveolar ridge was 0.5 mm, while the height of the mesial and distal papillae were reduced by 0.2 mm and 0.4 mm, respectively. The buccogingival margin of the alveolar ridge showed a vertical gain of 0.5 mm. Therefore, the presented technique seems appropriate for preservation of the alveolar ridge in esthetically relevant areas.