Lower Plaque Levels Research Articles

Single Implant Treatment in Healing versus Healed Sites of the Anterior Maxilla: A Clinical and Radiographic Evaluation

The aim was to document the Nobelreplace tapered TiUnite® (Nobel Biocare, Göteborg, Sweden) implant system used by experienced clinicians in daily practice for replacing single maxillary anterior teeth and to compare the clinical and radiographic outcome between implants installed in healing sites (early implant placement) and fully healed sites (conventional implant placement) after on average two and a half years of function. A cross-sectional study in patients who had been treated by two periodontists and two prosthodontists in 2006 and 2007 was conducted. Surgical treatment involved standard flap elevation without releasing incisions and restorative procedures included cemented crowns in all patients. Only straightforward single implant treatments in healing sites (6-8 weeks following tooth extraction) and fully-healed sites (≥6 months following tooth extraction) were considered with both neighboring teeth present and without the need for hard and/or soft tissue grafting. Clinical and radiographic analyses of all implants were performed by a blinded clinician who had not been involved in the treatment. Forty-nine of the 53 eligible single implants (22 early and 27 conventionally placed implants) in 44/48 patients were available for scrutiny. There was no significant difference in implant survival between early (95%) and conventionally (93%) installed implants (p = 1.000). Mean bone level to the implant-abutment interface was 1.25 and 1.02 mm for early and conventional implant placement, respectively (p = .220). In spite of fairly low plaque levels (26%), overall peri-implant bleeding was quite prevalent (36%). Mean peri-implant probing depth was 3.3 mm. Five restorations had experienced technical complications. Single Nobelreplace tapered TiUnite® implants installed in healing as well as in healed sites of the anterior maxilla are predictable. Both strategies seem equally successful in terms of implant survival, bone remodeling, clinical response, and risk for complications.

Can anti‐erosion dentifrices also provide effective plaque control?

Objective:While gingivitis and caries continue to be prevalent issues, there is growing concern about dental erosion induced by dietary acids. An oral hygiene product that protects against all these conditions would be beneficial. This study investigated the potential of two anti-erosion dentifrices to inhibit plaque.Methods:This was a randomized, three-period, two-treatment, double-blind, crossover study evaluating a stannous chloride/sodium fluoride dentifrice (SnCl2/NaF, blend-a-med® Pro Expert) and a popular anti-erosion dentifrice (NaF, Sensodyne® ProNamel™). During Period 3, subjects were randomized to repeat one treatment to evaluate any product carryover effects. Each treatment period was 17 days. Test dentifrices were used with a standard manual toothbrush. Digital plaque image analysis (DPIA) was employed at the end of each period to evaluate plaque levels (i) overnight (am prebrush); (ii) post-brushing with the test product (am post-brush); and (iii) mid-afternoon (pm). Analysis was conducted via an objective computer algorithm, which calculated total area of visible plaque.Results:Twenty-seven subjects completed the study. At all time points, subjects had statistically significantly (P ≤ 0.0001) lower plaque levels after using the SnCl2/NaF dentifrice than the NaF dentifrice. The antiplaque benefit for the SnCl2/NaF dentifrice versus the NaF dentifrice was: am prebrush = 26.0%; am post-brushing = 27.9%; pm = 25.7%.Conclusions:The SnCl2/NaF dentifrice provided significantly greater daytime and overnight plaque inhibition than the NaF toothpaste. When recommending dentifrice to patients susceptible to dental erosion, clinicians can consider one that also inhibits plaque.

Caries risk reduction in patients attending a caries management clinic

A Caries Management Clinic was established for patients at high risk of caries aiming to reduce caries incidence to close to zero. That is, to prevent new lesions on existing sound surfaces, along the susceptible restoration margins, and to remineralize existing cavitated and non-cavitated lesions. Twenty patients attended the clinic every two weeks from April to December 2005. The Caries Management System is a ten-step non-invasive strategy to arrest and remineralize early lesions and includes consideration of the patient at risk, the status of each individual lesion, patient management, clinical management, and monitoring. After six months, there was a 42 per cent increase in gingival sites having Gingival Index scores of zero, and a 21 per cent decrease in sites having Gingival Index scores of 2 compared to baseline (chi(2 )=( )137.67, 4 df, p = 0.00001). Ready to change (RTC) patients had significantly fewer sites scored GI <or= 2 compared to not-RTC patients (p = 0.01). Compared with the not-RTC patients, RTC patients were more than twice as likely to have fewer sites scored GI </= 2 (RR = 2.43, 95% CI (1.24, 4.71), p = 0.01). A total of 100 out of 146 smooth non-cavitated carious surfaces at baseline have remineralized after six months, 99 per cent of sound surfaces remained sound, and 23 new lesions were observed in six of the 20 patients (alpha(2 )=( )292, 7 df, p = 0.00001). About half of proximal surfaces showing bitewing scores of grade 1 or 2 had regressed (alpha(2 )=( )86.66, 56 df, p = 0.0001) and 95 per cent of proximal sound surfaces at baseline, as diagnosed via bitewing radiographs, remained sound. This audit revealed that the implementation of the non-invasive approach to caries management which combined intensive coaching in oral hygiene maintenance, special home care and intensive monitoring in a clinic for high-risk patients was able to reduce gingival inflammation and maintain low plaque levels, at least within the scope of this short-term review.

The effect of elevated ovarian hormones on periodontal health: oral contraceptives and pregnancy.

The most common oral manifestation of elevated levels of ovarian hormones, as seen in pregnancy or oral contraceptive usage, is an increase in gingival inflammation with an accompanying increase in gingival exudate. This gingivitis can be avoided or at least minimized by establishing low plaque levels at the beginning of pregnancy or the beginning of oral contraceptive therapy. It would appear that bacteria are not solely responsible for the gingivitis seen during these times, nor are the ovarian hormones solely responsible for the condition. Data from numerous studies suggest that the ovarian hormones alter the microenvironment of the oral bacteria so as to promote their growth and shifts in their populations. The present article reviews the current state of knowledge concerning the relationship of gingivitis to elevated levels of ovarian hormones, and describes the role that these hormones may play in the gingivitis associated with pregnancy or oral contraceptive usage.

A 2-year study of adjunctive minocycline-HCl in Actinobacillus actinomycetemcomitans-associated periodontitis.

To study the effects of a step-wise treatment regimen on Actinobacillus actinomycetemcomitans-(Aa) associated periodontitis, 4 clusters among 33 patients harboring the organism were followed during successive periods of systemic minocycline plus mechanical debridement and minocycline plus modified Widman flap treatment. Localized periodontitis was found in 2 clusters, one with 7 localized juvenile periodontitis patients and a 24-year old male with localized destruction and extremely low plaque levels (LJP), and the other consisting of 10 patients with plaque and gingivitis and a wider age range (16 to 54 years, LP). Generalized severe and moderate periodontitis was found in 2 clusters which were further discriminated by severe gingivitis and high levels of supragingival plaque (9 patients, GSP), and mild inflammation and low plaque levels (6 patients, GMP). Mean percentages of Aa, as determined by selective cultivation of microbiota from at least 2 periodontal pockets of 6 mm or more were 63, 16, 33, and 7.8% in the clusters (P < 0.01). Six months after active treatment, Aa was present in 6/9 patients and 50% of sites in GSP, and 3/6 patients and 46% of sites in GMP patients. In contrast, the organism was virtually eliminated by scaling and flap procedures in the localized periodontitis clusters, and did not reappear after 6 months (P < 0.05). Combined antibiotic, mechanical, and surgical therapy resulted in a persistence of 20% of sites with residual probing depth of > or = 4 mm in GMP patients after active therapy. At this point, 3 of the GMP patients and 1 GSP patient left the study. Multiple regression analysis showed a significant influence of log-transformed numbers in Aa in cheek and saliva samples at the end of the study, and cluster on the percent residual number of sites with periodontal probing depth of > or = 7 mm (P < 0.001). The present results suggest that the applied therapy would be appropriate in localized forms of Aa periodontitis, but inappropriate in more severe and generalized forms to predictably eliminate Aa. Controlled long-term studies with larger groups of patients will be needed to establish the difference in treatment response suggested by these studies.

Using parents to maintain improved dental flossing skills in children.

An experimenter-administered intervention involving prompts, self-monitoring, permanent product collection, rewards for plaque reduction, and corrective feedback was used to improve the flossing skills of four 7- to 11-year-old children. Parents were subsequently trained in the reward and feedback procedures to facilitate maintenance. In a multiple baseline across subjects design, all four subjects showed improvement in plaque between teeth during experimenter-administered intervention. Three subjects maintained low plaque levels during the 3- to 4-month parent-administered rewards and feedback follow-up condition. Improved plaque levels on nontargeted tooth surfaces also were observed. Pediatric dentistry applications are discussed.

Tissue response to overdenture therapy

Patients who had received overdenture treatment provided with uniform standards were recalled and studied. Two examiners simultaneously and independently evaluated the tissue response using a variety of indices. Data comparisons were made between overlaid teeth and control teeth and between overlaid teeth as a function of time to assess any effects of the treatment. Patients who did not apply fluoride to retained tooth roots had a high incidence of caries. No other significant differences were noted between the health of overlaid teeth compared to control teeth. Patients demonstrated large variations in their ability to maintain low plaque levels and healthy tissues. Despite this, on a longitudinal basis over 2 years, patients were able to maintain plaque levels and gingival response at clinically acceptable standards.