History Of Chronic Periodontitis Research Articles

Microscopic Alterations of the Dental Pulp in Surgically Extracted Teeth of Dogs.

Microscopic alterations in the dental pulp of dogs have not been extensively studied. The aim of this study was to investigate microscopic alterations of the dental pulp in dogs' teeth. One hundred and ten surgically extracted teeth (20 incisors, 23 canines, 28 premolars, and 39 molars) from 74 dogs, of different ages, with a history of chronic periodontitis (66 dogs), periapical abscesses (2 dogs), pulpitis (2 dogs), oral cavity neoplasms (2 dogs), dens invaginatus (1 dog), and dental fractures (1 dog) were included. Eight-one maxillary and 29 mandibular teeth were included. Coronal, radicular, and coronal plus radicular calculus were present in 28.2%, 17.3%, and 54.5% of the teeth, respectively. In total 78 teeth (71%) had pulp alterations, including fibrosis (26%), calcification (14%), necrosis associated with the absence of odontoblasts (14%), presence of predentin and dentin inside the cavity (8%), odontoblastic hyperplasia (3%), pigmentation (3%), pulpitis (2%), and pulp stones (1%). Forty-nine (60.5%) of the maxillary teeth and all of the mandibular teeth had pulp alterations. The premolars were most affected, and the molars least affected, by pulp alterations. Pulp fibrosis, calcification, and necrosis were observed in teeth irrespective of the distribution of dental calculus.

A three-year study on periodontal microorganisms of short locking-taper implants and adjacent teeth in patients with history of periodontitis

ObjectiveTo analyze the change of six periodontal pathogens around short locking-taper implants and adjacent teeth in patients with different periodontal conditions for three years. MethodsSixty implants and 62 adjacent teeth from 24 patients with different periodontal conditions were included: 5 patients with history of aggressive periodontitis (AgP group), 14 patients with history of chronic periodontitis (CP group), and 5 patients with healthy condition or slight gingivitis (H group). Subgingival samples were collected at five timepoints: before implant placement (T1); before second stage operation (T2); one month after restoration (T3); one year after functional loading (T4) and two years after functional loading (T5). Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans were detected by polymerase chain reaction (PCR). ResultsPathogens were hardly found around implants or adjacent teeth until T4. The detection rates of five pathogens other than A. actinomycetemcomitans raised up from T3 to T5. F. nucleatum and P. gingivalis were mostly detected followed by P. intermedia, T. forsythia, and T. denticola. The detection rate of P. gingivalis in implants were higher than natural teeth. There was significant correlation between pathogenic bacteria from implants and adjacent teeth. A. actinomycetemcomitans were only detected positively in peri-implant sites of AgP group. Peri-implantitis sites showed significantly higher detection rates of T. denticola, F. nucleatum at T4, and P. gingivalis, F. nucleatum at T5 than peri-implant mucositis and healthy groups. ConclusionThis three-year longitudinal study demonstrated that periodontal pathogens accumulate over time around short locking-taper implants and adjacent natural teeth after restoration. Adjacent teeth may become the microbial reservoir for peri-implant bacteria. Therefore, periodontally compromised patients may face higher risk for peri-implant disease. Clinical significancePlaque control of implant should be intensified with time instead of diminished. Patients with history of periodontitis need more frequent and individualized implant maintenance. Treatment and maintenance for adjacent teeth is as important as for implants..

Distribution of pathogens and risk factors of bacterial infections around dental implants

Objective To investigate the distribution of pathogenic bacteria and the risk factors of bacterial infections around dental implants. Methods From January 2017 to December 2018, 427 patients with oral implantation in Xixi Hospital were selected inthe study.According to the occurrence of bacterial infections around oral implants, the patients were divided into infection group(46 patients) and the non-infection group(381 patients). Pathogenic bacteria were isolated and identified from the bottom of gingival sulcus of infected patients.The risk factors of bacterial infection around dental implants were analyzed by multivariate logistic regression analysis. Results A total of 59 pathogenic bacteria were isolated from 46 patients with bacterial infection around dental implants, including 38 anaerobic bacteria, 17 aerobic bacteria and 4 beneficial bacteria.Univariate analysis showed that there were no statistically significant differences in sex, age, BMI and hypertension between the two groups (χ2=0.003, 3.393, 0.744, 0.200, all P>0.05). The infection group complicated with diabetes mellitus (19.57%), chronic periodontitis (30.43%), smoking (58.70%), drinking (69.57%), periimplantal alveolar bone defects (50.00%) and overloading (30.43%) were higher than those without infection (5.77%, 6.82%, 29.40%, 34.91%, 23.12%, 11.29%), there werestatistically significant differences (χ2=9.636, 24.241, 16.048, 20.793, 16.655, 13.011, all P<0.05). The results of logistic regression analysis showed that diabetes mellitus, history of chronic periodontitis, smoking, alcohol consumption, poor alveolar bone around implants and overloading were risk factors for bacterial infection around implants. Conclusion Anaerobic bacteria are the main pathogens of bacterial infection around dental implants.Infection is affected by many factors, including diabetes mellitus, history of chronic periodontitis, smoking, alcohol consumption, poor alveolar bone around implants and excessive load. Key words: Dental implants, single-tooth; Bacterial infections; Noxae; Risk factors

The effect of factors related to periodontal status toward peri-implantitis.

To investigate the association between periodontal status and peri-implant diseases in patients with osseointegrated dental implants of different implant systems. This cross-sectional study evaluated 200 consecutive implant patients using clinical and radiographic examinations during periodontal maintenance visits. The demographic data and treatment history were obtained from history taking and chart record review. The association between periodontal status and peri-implant diseases was analyzed using chi-square and logistic regression analysis. Patients with a history of chronic periodontitis had a significantly higher prevalence of peri-implantitis compared with those without a history of periodontal disease (25% vs. 10.9%). The highest prevalence of peri-implantitis was observed in patients with a history of severe chronic periodontitis. Data analysis revealed that peri-implant health status was significantly associated with past periodontal status, maintenance status, and present periodontal status. However, multivariate analysis indicated that only a history of chronic periodontitis was significantly associated with peri-implantitis (adjusted OR=2.55, 95% CI 1.14-5.70, p=0.02). Patients with a history of chronic periodontitis, especially those with severe periodontal disease had a 2.5-fold increased risk of peri-implantitis.

Evaluation of peri-implant marginal tissues around tissue-level and bone-level implants in patients with a history of chronic periodontitis.

To evaluate clinical and radiographic characteristics in peri-implant marginal tissues in patients with a history of chronic periodontitis, rehabilitated using tissue-level or bone-level implants. Using a split-mouth design, 20 patients with a history of chronic periodontitis were selected and received two different implants, tissue-level group (n=20) and the bone-level group (n=20). Peri-implant probing depth, relative peri-implant mucosal margin position, relative peri-implant clinical attachment level, peri-implant plaque index and peri-implant bleeding on probing were evaluated at prosthesis installation, 1, 3, 6, 12 and 24months after implant loading. Radiographic marginal bone level was evaluated at implant insertion, prosthesis installation, 6 and 24months after implant loading. The mean difference of peri-implant marginal bone resorption from implant installation to 24months in function was 0.75±1.12mm for the tissue-level group and 0.70±0.72mm for the bone-level group. No statistically significant difference was found between groups at all assessment periods for clinical and radiographic peri-implant evaluation. Under a rigid supportive therapy, both approaches performed likewise regarding clinical and radiographic parameters for rehabilitation of patients with a history of chronic periodontitis.

Peri-implantitis.

This narrative review provides an evidence-based overview on peri-implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. A literature review was conducted addressing the following topics: 1) definition of peri-implantitis; 2) conversion from peri-implant mucositis to peri-implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri-implantitis, 5) risk factors/indicators for peri-implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation. 1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.

Peri-implantitis.

This narrative review provides an evidence-based overview on peri-implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. A literature review was conducted addressing the following topics: 1) definition of peri-implantitis; 2) conversion from peri-implant mucositis to peri-implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri-implantitis, 5) risk factors/indicators for peri-implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation. 1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.

A retrospective study on the crestal bone loss associated with different implant surfaces in chronic periodontitis patients under maintenance.

To analyze retrospectively interproximal crestal bone loss (CBL) on external-hex "non-identical" (NI) dental implants with different surface topography, when placed in the same intra-oral location in patients with a history of chronic periodontitis following maintenance care. The patient population consisted of 206 consecutive patients with a history of chronic periodontitis who underwent implant surgery between 2007 and 2010; 755 NI implants with different implant surfaces were placed at posterior mandibular sites: 72 machined, 145 acid-etched/machined (hybrid), and 538 anodized. Crestal bone loss measurements were carried out analyzing the calibrated digital X-rays taken at 1-year intervals as part of the maintenance program, being the time of this retrospective examination from 1 to 3years. At 3years (51 patients), the mean CBL was 1.36/1.35mm at implant/patient level (range: 0-6mm). A higher CBL was observed at anodized surface implants, when compared to machined and hybrid implants, being the mean CBL 1.48, 0.96, and 0.77mm, respectively (p=.005). CBL between 2 and 3.9mm was found in 10.6% of the implants at 3years (95% CI: 6%-15%), ≥4mm in 5% (95% CI: 2%-8%). Anodized surface implants had CBL >2mm at 2years of 9% (95% CI: 6%-12%) and at 3years of 18% (95% CI: 12%-24%), which were 2.5 times higher than hybrid implants with 3.6% (95% CI: 0.8%-4%) and 7.4% (95% CI: 0%-17%), respectively. A higher CBL was observed in the anodized surface implants group, when compared to the hybrid implants group in patients with a history of chronic periodontitis followed during 1-3years.

Is History of Periodontitis a Risk Factor for Peri-implant Disease? A Pilot Study.

The aim of this pilot study was to evaluate clinical outcomes of implant treatment in periodontally compromised patients. Partially edentulous patients who were diagnosed and treated for chronic periodontitis and later rehabilitated with implant-supported single crowns or fixed partial dentures were enrolled in this study. At the final follow-up, data on probing pocket depth and bleeding on probing were collected, and changes in peri-implant bone levels were assessed on periapical radiographs. Accordingly, patients were categorized into peri-implant disease-free (PID-free), peri-implant mucositis (PIM), or peri-implantitis (PI) groups. Additionally, information on the history of systemic diseases was obtained and correlated with the findings. Seven females and six males with a mean age of 55.2 (standard deviation [SD] ± 8.38) years were included in this study. Fifty-five implants were placed in 13 partially edentulous patients with a history of chronic periodontitis. The mean follow-up in the study was 35.1 (SD ± 2.40) months. No implants were lost in the 13 patients, for a cumulative survival of 100%. PI was confirmed in 3 patients and PIM in 8 patients, while 2 patients were found to be PID-free. Diabetes and hypertension were found to be the predominant systemic factors among patients affected by peri-implant diseases. Patients with a history of periodontitis are at considerable risk of being affected by peri-implant mucositis, if not by peri-implantitis.

Microbiome of peri-implantitis affected and healthy dental sites in patients with a history of chronic periodontitis

ObjectiveTo determine the composition of the microbiome of peri-implantitis sites and corresponding dental sites in subjects with a history of chronic periodontitis. DesignClinical and radiographic examination assessed the periodontal/peri-implant disease status. Plaque samples were collected from one diseased implant with peri-implantitis, functional for at least two years and healthy sites in ten non-smokers who had received periodontal treatment prior to implant placement. Following DNA extraction, the bacteria present in each sample were determined by high-throughput sequencing of V3-V4 region of the 16S rRNA gene using the Illumina MiSeq platform. OTUs were picked using QIIME. Differences between dental and implant sites were determined using linear discriminant analysis, effect size and diversity analyses were conducted using PAST v3.02. ResultsThe microbiomes of healthy samples were more diverse than those found in disease, although disease was associated with a higher abundance of taxa relative to health. The genera Actinobacillus and Streptococcus were most closely associated with health, whereas Prevotella and Porphyromonas were most discriminative for disease. Synergistetes were highly associated with peri-implantitis. ConclusionIn patients with a history of periodontitis, putative periodontal pathogens prevailed in the microbiome of diseased implants. Diseased implants and corresponding healthy sites appear to have distinct microbiological ecosystems.

Patients with a history of chronic periodontitis and high compliance with supportive periodontal therapy do not have different implant survival than patients without periodontitis

Graetz C, El-Sayed KF, Geiken A, et al. Effect of periodontitis history on implant success: a long-term evaluation during supportive periodontal therapy in a university setting [published online ahead of print March 28, 2017]. Clin Oral Investig. http://dx.doi.org/10.1007/s00784-017-2104-4.

Microbiological and clinical outcomes of fixed complete-arch mandibular prostheses supported by immediate implants in individuals with history of chronic periodontitis.

The aim of this study was to assess the microbiological and clinical outcomes of immediate implants placed in chronically infected sockets for rehabilitation with fixed full-arch mandibular prostheses. Fourteen individuals (mean age 60.14±7.69years) were enrolled in this investigation and followed up until 8months of function. Microbiological (microbial count and profile) and clinical (probing depth, clinical attachment level, bleeding on probing, and bone resorption) parameters were conducted before teeth extraction (T0 - baseline) and after 4 (T1 ) and 8 (T2 ) months of loading. Thirty-nine microbial species including periodontopathogenic species and Candida spp. were detected and quantified by DNA checkerboard analysis. Moderate to high levels of pathogenic and non-pathogenic species were found colonizing teeth and implant-related sites. No significant differences in total or individual microbial counts and microbial profile were found over time (P=0.4929). Probing depth values from teeth (T0 : 3.05±1.45) were significantly higher when compared with implants (T1 : 1.81±0.56; T2 : 1.66±0.53; P<0.0001). High percentages of bleeding sites were found for both teeth and implants, with the highest values recorded for teeth (P<0.05). No significant differences were detected comparing marginal bone resorption over time. Total and individual counts of target species did not differ between teeth and implants for 8months of investigation. The mean proportions of pathogenic and non-pathogenic species remained unaltered, and no clinical complications were reported over time. Data obtained suggest that immediate loading of complete mandibular prostheses retained by implants placed immediately after extraction may be a viable treatment option for edentulous individuals with previous history of periodontal disease.

MMP13, TIMP2 and TGFB3 Gene Polymorphisms in Brazilian Chronic Periodontitis and Periimplantitis Subjects.

Subjects susceptible to chronic periodontitis (CP) show a high risk for the development of periimplantitis (PI). Both diseases are multifactorial, presenting similarities in their pathophysiology and polygenic profile. MMP-13 (matrix metalloproteinases 13/ collagenase 3) is a collagenolytic enzyme, which expression is induced by TGF beta 3 (transforming growth factor type 3) in human gingival fibroblasts and inhibited by TIMP-2 (tissue inhibitor of metalloproteinase type 2). The aim of this study was to investigate the occurrence of periimplantitis (PI) in subjects with history of chronic periodontitis (CP) and polymorphisms frequency in MMP13, TIMP2 and TGFB3 genes. One hundred and sixty-three volunteers received dental implant placement were submitted to oral and radiographic examination in order to identify past history of CP or presence of PI. Volunteers were divided into 4 groups: Control (without PI and CP, n=72), CP (with CP and without PI, n=28), PI (with PI and without CP, n=28) and diseased (with CP and PI, n=35). The chi-square test correlated genotypes in specific regions of MMP13 (rs2252070), TIMP2 (rs7501477) and TGFB3 (rs2268626) genes, considering the interaction between CP and PI. The results showed that volunteers with CP had 3.2 times more susceptibility to develop PI (p=0.0004) compared to those without CP. No significant association was observed in MMP13, TIMP2 and TGFB3 genes with CP or PI. CP is a risk factor to develop PI, however, there is no association of both diseases with polymorphisms in the MMP13, TIMP2 and TGFB3 genes.

Salivary IL-1β and red complex bacteria as predictors of the inflammatory status in sub-peri-implant niches of subjects with peri-implant mucositis.

Salivary biomarkers may enhance diagnostic sensitivity for peri-implant disease assessment. This study aimed to investigate the association of salivary periodontopathogen count and salivary interleukin-1beta (IL-1β) level with the peri-implant crevicular fluid IL-1β response at peri-implant mucositis (PM) sites among subjects with differing periodontal disease susceptibility. Eighty-seven partially edentulous subjects having at least one implant with peri-implant mucositis were included: 40 with history of chronic periodontitis (P) and 47 with no history of periodontitis (NP). Salivary IL-1β, peri-implant crevicular fluid (PICF) IL-1β, and salivary red complex pathogen counts were recorded. Subjects were scored according to a threshold salivary pathogen level of more than 5log (10) counts and assigned a "red complex score." Quartiles of salivary and PICF IL-1β levels were also scored. Area under receiver operating curve (AUC) was computed to predict the highest PICF IL-1β score using salivary biomarker as predictors and age-adjusted logistic regression performed for the significant predictors. In the NP group, red complex score (AUC=0.758 P=0.010) (odds ratio=1.377) and salivary IL-1β (AUC=0.708 P=0.038) (odds ratio=2.506) were significant predictors of highest PICF IL-1β quartile score. In the P group, no significant associations were noted. Salivary biomarkers could distinguish the "high" pro-inflammatory responders at PM sites only in subjects without inherent periodontal disease susceptibility. Periodontal susceptibility may impact the immuno-inflammatory response in sub-peri-implant niches of those with peri-implant mucositis.

Detection of toxic elements using laser-induced breakdown spectroscopy in smokers' and nonsmokers' teeth and investigation of periodontal parameters.

A laser-induced breakdown spectrometer (LIBS) was built and optimized to detect levels of toxic elements such as lead, cadmium, and arsenic present in the roots of extracted teeth of smokers and nonsmokers. Sixty extracted teeth from patients having a history of chronic periodontitis were divided into two groups of 30 teeth each for smoker and nonsmoker patients and, as controls, a third group of 30 patients who did not have a history of chronic periodontitis. The respective elemental concentration (Pb, Cd, and As) 23-29, 0.26-0. 31, and 0.64-11ppm are for nonsmokers, 35-55, 0.33-0.51, and 0.91-1.5ppm are for smokers, and lastly 0.17-0.31, 0.01-0.05, and 0.05-0.09ppm are for control group. In order to test the validity of the results achieved using our LIBS system, a standard inductively coupled plasma (ICP) technique was also applied for the analysis of the same teeth samples, and ICP results were found to be in excellent agreement with our LIBS results. In addition to this, the gingival index, plaque index, clinical attachment loss (CAL) and probing pocket depth were also recorded. Our LIBS spectroscopic analysis showed high levels of lead, cadmium, and arsenic concentration on root surfaces of teeth, which may be due to CAL.

History of Chronic Periodontitis Is a High Risk Indicator for Peri-Implant Disease

The success rates in implant dentistry vary significantly among patients presenting previous history of periodontitis. The aim of this study was to evaluate if patients with history of chronic periodontitis (CP) are more susceptible to peri-implant disease (PID) than those without history of CP. Two hundred and fifteen individuals, under periodontal maintenance, presenting 754 osseointegrated implants, were selected for this study. The patients were divided into two groups according to the peri-implant status: Control group (patients without PID; n=129) and PID group (patients with PID; n=86). All peri-implant regions were clinically evaluated, including analyses of mucosa inflammation, edema and implant mobility. Periapical radiography assessed the presence of peri-implant bone loss. According to the clinical/radiographic characteristics, patients in Control and PID groups were diagnosed as having CP or not. Nominal variables were evaluated by the chi-square test. The distribution of numeric variables was analyzed by Shapiro-Wilk test. Student's t-test and Mann-Whitney test were used to analyze significant differences for parametric and non-parametric data. A p-value <0.05 was considered significant. There was a highly significant correlation between CP history and PID (p<0.0001). Patients with CP had 4 times more chance of developing PID than patients with healthy periodontal tissues. Also, CP patients showed higher bleeding on probing (p=0.002) and bone loss around implant (p=0.004) when compared with patients without CP. In conclusion, history of CP is a high risk factor for the development of PID, irrespective of gender or region of implant placement.

Supportive periodontal therapy and periodontal biotype as prognostic factors in implants placed in patients with a history of periodontitis

Objectives: To evaluate bone loss around implants placed in patients with a history of treated chronic periodontitis and who did or did not attend supportive periodontal therapy, after one year in function. Furthermore, the influence of periodontal biotype and level of plaque was also evaluated. Material and Methods: Forty-nine patients participated voluntarily in the study. All subjects had a history of chronic periodontitis, which had been previously treated. After the active treatment, 27 patients attended supportive periodontal therapy (SPT) and the rest did not (No SPT). The O’Leary plaque index and periodontal biotype were recorded for each subject and 246 Astra Tech® OsseospeedTM implants were radiographically analysed (123 placed in SPT patients and 123 in No SPT patients) at the time of loading and one year later, measuring marginal bone loss with the program Dental Studio NX 6.0®. The statistical analysis was performed with Windows SPSS, applying Pearson’s correlation index and the Kruskal-Wallis and U-Mann Whitney non-parametric tests. Results: Six patients were found to have periimplantitis and sixteen mucositis. The survival rate was 99.59% (100% SPT and 99.18% No SPT). Mean bone loss was 0.39 mm (range [-0.71 - 8.05]). Among SPT patients, 95% of the implants had losses less than or equal to the mean (mean bone loss of 0.16 mm) compared to 53.7% for the No SPT group (mean bone loss of 0.62 mm). A statistically significant relationship was demonstrated between bone loss around the implant and the patient’s periodontal biotype and plaque index. Conclusions: The marginal bone loss around implants in patients with treated chronic periodontitis is minimal if they are in a controlled SPT programme and there is individual control of plaque index. Moreover, the presence of a thin periodontal biotype represents a risk factor for additional bone loss. Key words:Peri-implantitis, chronic periodontitis, bacterial plaque, periodontal biotype.

Association between ankylosing spondylitis and chronic periodontitis: A population‐based study

Ankylosing spondylitis (AS) is one type of chronic inflammatory rheumatic disease. It has been suggested that rheumatic diseases may have additional underlying factors in common with chronic periodontitis. However, few studies have addressed the possible link between AS and chronic periodontitis. We undertook the present case-control study to investigate the possible association between AS and chronic periodontitis using a population-based data set in Taiwan. We conducted this study by using administrative claims data sourced from the Taiwan National Health Insurance program database. Our study included 6,821 AS patients and 34,105 randomly selected controls. Conditional logistic regression analyses were performed to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for prior chronic periodontitis among AS patients and matched controls. There was a significant difference in the prevalence of prior chronic periodontitis between patients and controls (41.5% versus 25.9%; P<0.001). Conditional logistic regression analysis revealed that patients were more likely than controls to have been previously diagnosed as having chronic periodontitis (adjusted OR 1.84 [95% CI 1.74-1.98]). We further found that patients were only 1.70 (95% CI 1.56-1.89) times more likely than controls to have undergone a gingivectomy or periodontal flap operation (all patients had a history of chronic periodontitis) within the 5 years preceding the index date. After excluding those who had undergone either a gingivectomy or periodontal flap surgery, patients were even more likely than controls to have been previously diagnosed as having chronic periodontitis (adjusted OR 2.04 [95% CI 1.93-2.15]). This study detected an association between AS and a prior diagnosis of chronic periodontitis.

Maxillary rehabilitation of periodontally compromised patients with extensive one-piece fixed prostheses supported by natural teeth: a retrospective longitudinal study

This study aims to evaluate the long-term success and stability of periodontal tissue around extensive one-piece prostheses supported by natural teeth in periodontally compromised maxillae. A total of 28 fixed dental prostheses (FDPs) fabricated by different technologies were inserted in 28 patients with a history of chronic periodontitis after successful periodontal treatment. Subsequently, a program of supportive periodontal therapy (SPT) was instituted. Clinical parameters were evaluated in each patient after insertion of the FDP and during a follow-up examination. The reported follow-up examinations took place after a mean clinical service of 75.7 (9.9–232.7) months. Probing depths had remained essentially unchanged by that time (2.6 ± 0.8 mm at baseline versus 2.7 ± 0.6 mm at follow-up). Significant deteriorations were observed based on plaque index scores (from 24.8% to 33.2%) and bleeding on probing (from 8.5% to 26.2%). One case of framework fracture was noted. Restorative treatment with extensive one-piece FDPs resulted in long-term stability of the periodontal outcomes. Gingival conditions were shown to deteriorate mildly despite periodic recalls for SPT. An association between deterioration and compliance was observed, suggesting that periodic examinations are essential for maintaining oral hygiene and hence to the success of treatment. Given a favorable distribution of potential abutment teeth, treatment with tooth-supported extensive FDPs is desirable even in patients with a history of periodontitis. Removable dentures would involve a number of shortcomings, including functional problems and severe degradation of oral ecology. Tooth-supported FDPs are capable of restoring function, esthetics, phonation, and mastication.

Supportive Periodontal Care for Patients with Chronic Periodontitis May Produce Better Clinical Outcomes When Delivered by a Specialist Instead of a General Practitioner, but at a Higher Cost

The cost-effectiveness of supportive periodontal care for patients with chronic periodontitis Gaunt F, Devine M, Pennington M, Vernazza C, Gwynnett E, Steen N, et al. J Clin Periodontol 2008;35(Suppl 8):67-82. Khady Ka, DDS, MSc, Marie-Claude Rousseau, PhD, and Belinda Nicolau, DDS, PhD What is the effect of supportive periodontal care in specialist practice versus general dental practice in terms of clinical and economic outcomes for patients with a history of chronic periodontitis? Self-supported by the authors and Newcastle University Systematic Review Level 2: Limited-quality, patient-oriented evidence Grade B: Inconsistent or limited-quality patient-oriented evidence