Mean Attachment Level Research Articles

Association of periodontitis with cerebral small vessel disease in hypertensive patients – A pilot study

Objectives: Cerebral small vessel disease is a chronic, progressive disorder of arterioles, capillaries, and small veins supplying the brain’s white matter and deep structures of gray matter. The latest evidence seems to suggest that chronic oral infections such as periodontitis contribute to cerebral small vessel disease progression. This study evaluated the relationship between periodontal disease and brain white matter hyperintensities. Methods: Forty-three hypertensive patients, aged between 38-82, without previous cardiovascular events, of which 42% were female and 50% diabetic, were evaluated. An association between mean probing depth, mean attachment level, bleeding on probing, total periodontal inflamed surface area, and white matter hyperintensities diagnosed by magnetic resonance was studied. A significance level (α) of 0.05 was considered, and Pearson’s chi-square and Mann–Whitney tests were applied. Results: Data analysis revealed an inverse correlation between mean probing depth, bleeding on probing, total periodontal inflamed surface area, and white matter hyperintensities. A positive correlation was found between mean attachment level and white matter hyperintensities. Conclusions: In our study and within our sample, lower values of mean probing depth, bleeding on probing, and total periodontal inflamed surface area were associated with more white matter hyperintensities. Contrarily, mean attachment level was positively associated with white matter hyperintensities.

Biofilm Formation Capability of Cowpea Nodular Bacterial Isolates in Static Microcosms

Bacteria are known to form microbially derived sessile communities that are irreversibly attached to biotic or abiotic surfaces known as biofilms. Biofilm formation is an adaptive strategy for the successful colonization of plant surfaces. Forty bacterial isolates of cowpea nodules from 12 smallholder farms in Northern Nigeria were evaluated for biofilm growth, attachment and strength in static microcosms. Replicate King’s B (KB) microcosms (n = 8) were incubated statically for 7 days before assessments. Growth and attachment were determined by measuring optical density (OD600nm) and absorbance (A570 nm) respectively. Strength (grams) was determined by maximum deformation mass (MDM) assay using glass balls (mean weight of 0.0115g). A significant MDM was recorded when more than one replicate retained at least one ball for at least 5 seconds. One-way Analysis of Variance (ANOVA) was used to determine significant mean differences (p<0.05). Similarities and variations in biofilm formation were assessed by Hierarchical Cluster Analysis (HCA) using the Ward method. Half of the isolates showed good biofilm growth and attachment. Twelve of the 40 isolates showed various levels of strength. Isolates 16F and 39L were rated well in all three biofilm parameters. There were significant differences in the mean values of the assessed biofilm parameters among the isolates. Mean growth ranged between 1.493 (Isolate 32K) and 2.101 OD600 (Isolate 19G). Mean attachment levels (A570) ranged from 0.084 (Isolate 9D) to 1.543 (Isolate 30K). Only isolate 2A had significantly higher biofilm strength (2.412g) than the rest of the isolates. HCA analysis indicated similarities as well as variations in biofilm formation by isolates within and between sites. Isolates from all the study sites were positive for at least one of the tested biofilm parameters. The ability of the isolates to form biofilms indicated that some of them could be suitable for biotechnological applications such as in biofertilizer production

Combined Periodontal and Orthodontic Treatment of Severely Compromised Teeth in Stage IV Periodontitis Patients: How Far Can We Go?

This retrospective study evaluated the effect of combined periodontal-orthodontic treatment in terms of clinical, radiographic, and patient-reported outcomes in 40 stage IV periodontitis patients with advanced attachment loss and pathologic migration of anterior teeth. Full-mouth periodontal parameters were recorded at baseline (after diagnosis; T0), at the end of active periodontal therapy (APT; T1), at completion of orthodontic tooth movement (OTM; T2), and at the last supportive periodontal care (SPC) visit (T3). Radiographic analysis was performed at T0, T2, and T3. A total of 115 teeth were lost during APT, including 5 molars at T2 (used as orthodontic anchorage) and 10 premolars at T3 (due to root fracture). All anterior migrated teeth were in function at T3 (mean duration: 9.5 years). Significant mean probing pocket depth reduction (1.5 ± 1.1 mm) and attachment level gain (0.9 ± 1.0 mm) were observed after APT, whereas OTM and SPC were associated with furthering small changes. The alveolar bone level at T3 was slightly increased from T0 values. Patient-reported outcome measurements significantly improved in terms of esthetics and masticatory function. OTM should be considered an essential part of the comprehensive treatment plan to change the prognosis of severely compromised teeth in stage IV periodontitis patients.

Maxillary labial frenum and malocclusion: An overriding or an overlooked tissue?

The influence of the maxillary labial frenum in relation to the midline diastema has been a proven fact to clinicians for many years. A pilot study was carried out to investigate the relationship between a low maxillary labial frenum attachment and skeletal malocclusions (class I, II, and III). Astonishingly, it was observed that the class III malocclusion had a statistically high number of cases with low frenum attachments. The objective of the study was to understand the underlying skeletal class III dysplasia in these cases. A comparative cross-sectional study was performed on 300 consecutive subjects between 13-30-years of age. Based on the cephalometric parameters the participants were categorized into 98 skeletal class I, 102 class II, and 100 class III subjects. Variations in the frenum attachment were clinically evaluated using Placek classification. The insertion level and width of the frenum were also measured by using a caliper and the data were statistically analyzed for determining the association between the frenum attachment and skeletal malocclusion. The prevalence of low frenum attachment in class III subjects was found to be 64%. Also, the mean attachment level of the frenum was significantly closer to the gingival margin in skeletal class III subjects compared with that of the other groups (p<0.01). The study identified that the subjects with a low frenum attachment had a tendency towards a retruded maxilla in terms of linear dimension. Therefore the present study supports the hypotheses that the skeletal Class III malocclusion may be associated with low frenum attachment.

Impact of Mesioangular Mandibular Impacted 3rd Molar on Peridontal Health of Adjacent Tooth

Objective: The aim of this study is to determine the impact of mesioangular mandibular 3rd molar impaction on periodontal health of adjacent tooth in patients. Study Design: Retrospective/observational study Place and Duration: Department of Oral & Maxillofacial Surgery, MMDC Multan, during from Oct 2020 to September 2021. Methods: Total of seventy patients of both genders was presented in this study. Detailed demographic data of enrolled cases age, sex, body mass index, symptoms and complications were recorded after taking informed written consent. All the patients had mesioangular impactions of mandibular third molars. The impaction depth, relationship with ramus, and angulation of 70 IMTMs and their association with 2nd molar distal caries and root resorption, pathological states, and closeness to the mandibular canal were assessed on panoramic radiographs. Pell and Gregory classification was used to determine position of impacted third molar. The odds ratio (OR) and 95% confidence interval (CI) of IMTM's position on the related complications (credible interval for Bayesian models). Statistical significance was defined as a two-tailed p-value 0.05. SPSS 24.0 version was used to analyze complete data. Results: There were 42 (60%) males and 28 (40%) females with mean BMI 23.13±6.46 kg/m2. Most of patients 31 (44.3%) were aged between 20-35 years. Mean attachment level was 3.03±2.34 and probing depth was 3.34±3.35. Caries, pain and swelling were the most common symptoms found among cases. Distal second molar root caries 21 (30%) and pocket formation 17(24.3%) were the most common pathologies. As per histological findings periapical inflammation was majority found in 37 (52.9%) cases followed by dental follicle in 19 (27.1%) and cyst in 11 (15.7%). Conclusion: In this study, we found that the impacted mandibular third molar was most linked with distal second molar root caries and the creation of a pocket between the impacted tooth and the second molar tooth. The most common pathology associated with the impacted molar was distal second molar root caries and the creation of a pocket between the affected tooth and the second molar. Keywords: Mesioangular, Impacted mandibular third molar, Pathology, Complication

Impact of the Mesioangular Mandibular on the Peridontal Health of Adjacent Tooth by the Third Molar

Objective: The purpose of this study is to assess the impact of mesioangular mandibular 3rd molar impaction on the periodontal health of neighbouring teeth in patients. Study Design: Dental College HITEC-IMS Taxilla/Gulraiz Dental Clinic Quaid Avenue Main Road, Gulraiz 3, Rawalpindi. Jan 2021-Aug 2021 Place and Duration: Methods: Total of ninety patients of both genders was presented in this study. After receiving informed written consent, detailed demographic information about the recruited cases was collected, including age, gender, body mass index, symptoms, and complications. All of the patients experienced mesioangular third molar impactions on their mandibular teeth. A total of 90 IMTMs were evaluated using panoramic radiographs to determine their impaction depth, relationship with the ramus, and angulation, as well as their association with 2nd molar distal caries and root resorption, pathological states, and proximity to the mandibular canal. The position of the impacted third molar was determined using the Pell and Gregory categorization system. The odds ratio (OR) and 95 percent confidence interval (CI) of IMTM's position on the associated problems are shown in the table below (credible interval for Bayesian models). P-values with two-tailed confidence intervals of less than 0.05 were considered statistically significant. SPSS 27.0 version was used to analyze complete data. Results: There were 55 (61.1%) males and 35 (38.9%) females with mean BMI 24.61±5.22 kg/m2. Most of patients 41 (45.6%) were aged between 20-35 years. Mean attachment level was 2.99±4.74 and probing depth was 3.78±4.61. Caries, pain, and swelling were the most often reported symptoms, according to our research. The most common diseases were distal second molar root caries, which accounted for 30 (33.3%) of all cases, and pocket development, which accounted for 21 (23.3%). According to histological findings, periapical inflammation was the most common finding in 46 (51.1%) of the cases, followed by dental follicle in 24 (26.7%), cyst in 16 (17.8%), and other malignancies in 4 (4.4%) cases. Conclusion: According to the findings of this study, the impacted mandibular third molar was most closely associated with distal second molar root caries and the formation of a pocket between the impacted tooth and the second molar tooth in the lower jaw. Most common pathology linked with the impacted molar was distal second molar root caries and the formation of a pocket between the affected tooth and the second molar. Keywords: Mesioangular, Impacted mandibular third molar, Pathology, Complication

Analysis of Vitamin D Receptor Gene Polymorphism in Chronic Periodontitis among Saudi Population

Abstract Objective Genetic and environmental factors have important roles in the development of periodontitis. We aimed to assess the relation of vitamin D receptor (VDR) ApaI and TaqI polymorphisms and the susceptibility of periodontitis in Saudi population in Makkah region. Materials and Methods In total, 86 unrelated patients with moderate-to-severe periodontitis and 86 controls were enrolled in this study. Evaluation of the periodontal state was performed by using plaque index, bleeding on probing, probing depth, and attachment loss. Extraction of genomic DNA from peripheral blood and genotyping of VDR gene ApaI G/T (rs7975232) and TaqI T/C (rs731236) polymorphisms were performed by utilizing polymerase chain reaction and restriction digestion. Results There were statistically significant differences between both groups regarding the mean bleeding on probing, mean probing depth, mean plaque index, and the mean attachment level (p < 0.001) indicating that the matching based on the investigated groups was adequate. The examined populations were in Hardy-Weinberg equilibrium. Analysis of the genotype and allele frequencies of both VDR ApaI and TaqI single nucleotide polymorphisms revealed that they were statistically indifferent between the control group and the periodontitis subjects (p> 0.05). Conclusion These results suggested that VDR ApaI and TaqI polymorphisms might not be related to the susceptibility of periodontal disease in the Saudi subjects in Makkah region.

Clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patients' age: An exploratory sub-analysis of the ABPARO trial.

AimThe aim was to identify benefit thresholds for clinical variables. We hypothesize, if variables fall below or exceed these threshold levels, systemic amoxicillin/metronidazole may contribute to reducing progression of periodontitis.Material & MethodsThis is an explorative per‐protocol collective analysis (n = 345) conducted on the placebo‐controlled, multi‐centre ABPARO trial (ClinicalTrials.gov NCT00707369). Patients received debridement with systemic amoxicillin 500 mg/metronidazole 400 mg (3×/day, 7 days, n = 170) or placebo (n = 175) and maintenance therapy every three months. To identify thresholds, each of the following baseline characteristics was classified into two groups (≥threshold value/<threshold value): bleeding on probing, extent of pocket probing depth (PPD) ≥ 5 mm, mean clinical attachment level and age. Treatment effect (% of sites with new attachment loss ≥ 1.3 mm at 27.5 months post‐treatment) was calculated.ResultsAdjunctive antimicrobials reduced median new attachment loss in patients < 55 years (5.2%), or with ≥ 35% PPD ≥ 5 mm (4.5%) or with a mean attachment level > 5 mm (5.2%) at baseline compared to the placebo (9.0%, 11.6%, and 12.5%, respectively; p < 0.005).ConclusionsThe clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patients' age.

Cross-sectional association between oral health and retinal microcirculation.

To investigate the relation between oral health status and microcirculation, we analysed the association between periodontitis and number of teeth with retinal vessel diameters in a population-based study. We analysed data from the Study of Health in Pomerania-TREND (SHIP-TREND). All subjects (3,183 for number of teeth, 3,013 for mean probing depth and 2,894 for mean attachment level) underwent nonmydriatic funduscopy and dental examination. We measured central retinal arteriolar (CRAE), venular (CRVE) vessel diameters and calculated arterio-venous ratio (AVR) from static vessel analysis (SVA). Periodontal status was assessed using the case definition of the Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP). Data were analysed by linear (CRAE, CRVE, AVR) and logistic regression (AVR<0.8) adjusted for age, sex, smoking status, alcohol consumption, body mass index, systolic blood pressure, hsCRP and type-2-diabetes mellitus. Only in men, significant associations were found between periodontal and retinal conditions. Severe periodontitis [β=-0.0120 (-0.0218; -0.0007 95%-CI)] and mean probing depth [β=-0.0054 (-0.0105; -0.0002 95%-CI)] were inversely associated with AVR; severe periodontitis [β=3.80 (0.61; 6.98 95%-CI)], mean probing depth [β=1.86 (0.23; 3.49 95%-CI)] and mean attachment level [β=1.31 (0.34; 2.27 95%-CI)] with CRVE and mean attachment level with CRAE [β=0.91 (0.14; 1.69 95%-CI)]. Our results point towards an association between periodontal conditions and AVR in men. Periodontitis may impact microvascular endothelium function. Improving oral health to reduce periodontitis might lead to reduced risk for other age-related diseases.

Impact of combined non-surgical and surgical periodontal treatment in patients with type 2 diabetes mellitus-a preliminary report randomized clinical study

Background/objectives: Scientific evidence regarding the effects of chronic periodontitis on Type 2 Diabetes Mellitus (T2M) is fragmentary and not definitive. This intervention study was designed to evaluate the effects of a Non-Surgical Procedure (NSP) in addition to a surgical procedure on systemic inflammation and glycaemic control in patients with T2M and periodontitis and Non-Diabetic (ND) patients with periodontitis. Material and Methods: A total of 100 patients with diabetes were randomly allocated to a treatment group and a control group. At least one tooth was extracted from each patient. After extraction, the control group (n=50) did not receive any other treatment until the 3-month follow-up. Patients in the treatment group (n=50) received Full-Mouth Scaling and Root Planing (FM-SRP).The Mean Probing Depth (MPD), Mean Attachment Level (MAL), Plaque Index (PI), Bleeding on Probing (BOP), fasting blood samples for the measurement of high-sensitivity C-Reactive Protein (hs-CRP), and glycated hemoglobin (HbA1c) were measured or taken at baseline and 3 months after treatment. To investigate the effect of diabetes on the therapeutic procedure’s outcome, ND patients with periodontitis (n=60) were divided into two equal groups and subjected to the same procedures and analysis. Results: HbA1c and hs-CRP decreased significantly in the diabetic groups and decreased more markedly when FM-SRP was added to tooth extraction (P<0.001). For ND patients, all of the examined periodontal parameters were in favor of the combination therapy (P<0.001). Conclusion: Non-surgical periodontal treatment can help improve the outcome of surgical periodontal procedures by reducing systemic inflammatory status and improve glucose metabolism.

Association of -1082 interleukin-10 gene polymorphism in Peruvian adults with chronic periodontitis.

Objectives: The aim of this study was to assess association of the -1082 IL-10 gene polymorphism with chronic periodontitis CP in a Peruvian population. Study Design: Samples of venous blood and DNA were obtained from 106 Peruvian subjects: a) 53 periodontally healthy; and b) 53 with CP. The association of the -1082 IL-10 promoter sequences was assessed by Polymerase chain reaction-restriction fragment length polymorfism (PCR-RFLP). Student’s t test were used to assess the clinical parameters, as well as the χ2 test and the odds ratio (OR), with 95% confidence intervals (CI) used performed for estimates regarding genotype and allele frequencies. Results: There were statistically significant differences between groups regarding the mean bleeding on probing, mean attachment level and mean probing depth (p < 0.00001) indicating that the matching based on the evaluated groups was adequate. The χ2 test found a statistically significant imbalance of genotypes between groups (p = 0.0172). The prevalence of CP was significantly higher in subjects harboring at least one A allele at position -1082 (AA and GA genotypes) in comparison to patients with the GG genotype (OR = 2.96; CI: 0.52; 5.41; p = 0.0099). Equally, subjects with the AA genotype were significantly associated to a diagnosis of CP (OR = 2.71; CI: 0.38; 5.04; p = 0.0231). On the other hand, subjects presenting a healthy periodontal status presented at least one G allele in comparison with the AA genotype (OR = 0.37; CI: 0.05, 0.69; p = 0.0231). For subjects with the GG genotype, the same positive association was observed (OR = 0.34; CI: 0.06, 0.62; p = 0.0099). There were no significant differences between groups amongst subjects with the GA genotype (OR = 1.19; CI: 0.22, 2.16; p = 0.6774). Conclusions: Within the limits of this study, IL-10 gene polymorphism at position -1082 does not appear to be associated to CP. Conversely, subjects with AA genotype seem to be at an increased risk of developing CP. Key words:According to MeSH documentation, chronic periodontitis, cytokines, genetic polymorphism, interleukin-10, periodontal disease.

The Presence of Visible Third Molars Negatively Influences Periodontal Outcomes in the Maternal Oral Therapy to Reduce Obstetric Risk Study

To assess the relationship between the presence or absence of visible third molars and outcomes for periodontal inflammatory disease. Obstetric subjects, at enrollment in an institutional review board-approved, multisite study, Maternal Oral Therapy to Reduce Obstetric Risk (N= 1,798), were divided into 2 groups, those with no visible third molars (n= 692) and those with at least 1 visible third molar (n= 1,106), the predictor variables for this study. The principal outcome variables were the patient-level periodontal status of the first/secondmolars: mean periodontal probing depths, mean attachment levels, and mean extent scores. Periodontal disease severity also was assessed by criteria from the Oral Conditions and Pregnancy trial and the Centers for Disease Control and Prevention/American Academy of Periodontology. Outcomes according to the presence or absence of third molars were compared with χ(2) statistics and multivariable analyses. Significance was set at P < .05. Significantly more subjects had at least 1 third molar (62%) as compared with subjects with novisible third molar (38%) (P < .01). Ethnic characteristics of the 2 groups were similar. Overall, more subjects were white (61%), with most identifying their ethnicity as Latino. African-American subjects were well represented (37%). Subjects with a visible third molar were more likely to be significantly older, to be receiving medical assistance, and to have used tobacco before pregnancy. If subjects had at least 1visible third molar, the mean first/second molar probing depths, attachment levels, and scores for bleeding on probing were significantly greater even after adjustment for covariates. On the basis of either Oral Conditions and Pregnancy criteria or Centers for Disease Control and Prevention/American Academy of Periodontology criteria, subjects were significantly more likely to have moderate or severe periodontal disease if a third molar was detected. If at least 1 visible third molar was detected in subjects in the Maternal Oral Therapy to Reduce Obstetric Risk study at enrollment as compared with no detected third molars, periodontal outcomes were significantly worse.

Five‐year change of periodontal diseases in the Study of Health in Pomerania (SHIP)

To assess the extent of remission and progression of periodontal diseases among adults in a Northeast German Region. The Study of Health in Pomerania (SHIP) is a population-based cohort study with baseline examinations conducted in 1997-2001 and 5-year-follow-up in 2002-2006. The study comprised 2558 subjects aged 20-81years. Periodontal status was assessed by probing depth (PD) and attachment level (AL), measured at four surfaces per tooth, half-mouth. An event was defined as AL progression or remission of ≥3mm on ≥2 sites. Average change in mean AL (mean PD) was 0.10mm (-0.05mm) during follow-up, equalling 0.02mm/year (-0.01mm/year). Adjusted for gender and follow-up time, change in mean AL was significantly higher in 20-29- and 60-69-year-old patients compared with 50-59-year-old patients (p<0.05). 6.5 (7.5) events of progression (remission) in AL per 100 person-years were observed. In multivariate models, risk factors for progression comprised current smoking, middle or low education, being single or divorced and diabetes (p<0.05). Enhanced progressive attachment loss seen in 20-29- and 60-81-year-old patients was explained through unfavourable risk factors distributions. Periodontal progression was moderate. Periodontal prophylaxis and motivation to reduce risk factors should especially be addressed to patients having unfavourable risk factor distributions.

Are Teeth Close to the Cleft More Susceptible to Periodontal Disease?

To evaluate whether teeth close to the cleft area present higher prevalence and severity of periodontal disease than teeth in other regions. Cross-sectional. Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo. There were 400 individuals with complete unilateral or bilateral cleft lip and palate, aged 15 to 49 years, without any previous periodontal treatment. All clinical parameters were evaluated in six sites for each tooth. The arithmetic means were calculated for each sextant. Of the sextants, 86.75% presented means of probing depth smaller than or equal to 3 mm. No sextant exhibited means of probing depth greater than or equal to 6 mm. There was a statistically significant difference (p < .001) in probing depth according to age, types of cleft, and sextant; 95.87% of sextants presented mean attachment levels smaller than or equal to 3 mm. The sextant with cleft did not present higher means of probing depth, clinical attachment level, plaque index, and gingival index. There was gingival bleeding in 99.08% of the sample and plaque in 97.40%. The type of cleft was not an important factor influencing the prevalence of periodontal disease. Age seems to be an important factor influencing the prevalence and severity of periodontal disease for all aspects investigated. Periodontal disease in individuals with clefts occurred in a similar manner as observed in other populations. The presence of the cleft does not seem to increase the prevalence of the disease.

Performance of dental implants after staged sinus floor elevation procedures: 5‐year results of a prospective study in partially edentulous patients

The aim of this prospective study was to evaluate the 5-year performance and success rate of titanium screw-type implants with the titanium plasma spray (TPS) or the sand-blasted, large grit, acid-etched (SLA) surface inserted in a two-stage sinus floor elevation (SFE) procedure in the posterior maxilla. A total of 59 delayed SFEs were performed in 56 patients between January 1997 and December 2001, using a composite graft with autogenous bone chips combined with deproteinized bovine bone mineral (DBBM) or synthetic porous beta-tricalcium phosphate (beta-TCP). After a healing period averaging 7.75 months, 111 dental implants were inserted. After an additional 8-14-week healing period, all implants were functionally loaded with cemented crowns or fixed partial dentures. The patients were recalled at 12 and 60 months for clinical and radiographic examination. One patient developed an acute infection in the right maxillary sinus after SFE and did not undergo implant therapy. Two of the 111 inserted implants had to be removed because of a developing atypical facial pain, and 11 implants were lost to follow-up and were considered drop-outs. The remaining 98 implants showed favorable clinical and radiographic findings at the 5-year examination. The peri-implant soft tissues were stable over time; the mean probing depths and mean attachment levels did not change during the follow-up period. The measurement of the bone crest levels (DIB values) indicated stability as well. Based on strict success criteria, all 98 implants were considered successfully integrated, resulting in a 5-year success rate of 98% (for TPS implants 89%, for SLA implants 100%). This prospective study assessing the performance of dental implants inserted after SFE demonstrated that titanium implants can achieve and maintain successful tissue integration with high predictability for at least 5 years of follow-up in carefully selected patients.

Effects of metronidazole plus amoxicillin as the only therapy on the microbiological and clinical parameters of untreated chronic periodontitis

To determine the effect of metronidazole plus amoxicillin (M+A) as the sole therapy, on the subgingival microbiota of chronic periodontitis. Twenty-two patients with untreated chronic periodontitis were randomly assigned to a group that received M+A for 7 days, or to a group receiving scaling and root planing (SRP) and two placebos. Clinical measurements including sites with plaque, bleeding on probing (BOP), probing depth (PD) and attachment level (AL) were made at baseline, 3, 6, 9 and 12 months. Subgingival plaque samples were taken from all teeth at baseline 3, 6, 9 and 12 months for the counts of 40 subgingival species using checkerboard DNA-DNA hybridization. Mean PD was reduced from 2.80+/-0.45 at baseline to 1.95+/-0.05 at 12 months (P<0.001) and from 2.39+/-0.41 to 1.95+/-0.10 (P<0.001) in the M+A- and SRP-treated patients, respectively. Corresponding values for relative mean AL were 10.07+/-1.30-9.77+/-0.34 (P<0.001) and 9.94+/-0.28-9.77+/-0.26 (P<0.001). Percentage of sites exhibiting BOP were 40.6+/-18.3-14.0+/-1.4 (P<0.001), and 38.5+/-5.1-19.0+/-2.8 (P<0.001) in the M+A and SRP groups, respectively. Mean total DNA probe counts and counts of the majority of the 40 test species were significantly reduced over time in both groups, with no significant differences detected at any time point between groups. At 12 months many of the species were still present at significantly lowered levels compared with their baseline counts in both groups. Changes in clinical and microbiological parameters were similar after receiving systemically administered M+A as the sole therapy or after receiving SRP only.

A preliminary study on the relationship between stimulated saliva and periodontal conditions in community-dwelling elderly people

The purpose of this study was to explore the relationship between flow rate and spinnbarkeit of stimulated whole saliva and periodontal conditions in healthy elderly people. Three hundred and fifty-five dentate subjects aged 76 years were included. The pocket probing depth (PD), attachment level (AL), and bleeding on probing (BOP) were measured. Stimulated whole saliva was collected and the salivary flow rate (SFR) was calculated. Then, salivary spinnbarkeit (SS) was immediately measured. The mean SFR and SS were 1.44 ml/min and 1.91 mm, respectively. SFR was not significantly related to each periodontal parameter. On the other hand, subjects with SS<or=2.00 mm had a significantly lower mean AL (p<0.05). When subjects were divided into four groups according to a combination of SFR and SS, subjects with SFR<0.7 ml/min and SS>2.00 mm exhibited a significantly higher mean PD (p<0.05), % of sites with PD>or=4mm (p<0.05), mean AL (p<0.01), % of site with AL>or=4mm (p<0.05) and % of sites with AL>or=6mm (p<0.01) than subjects in the other three groups (one-way ANOVA). In the logistic regression analysis, the factors significantly associated with the highest quintile of PD>or=4mm were: the low salivary flow and the high salivary spinnbarkeit (OR 3.84), current smokers (OR 5.08), cleaning interdental spaces rarely/never (OR 2.12), and frequent BOP (OR 5.20). These findings suggest that high salivary spinnbarkeit in addition to a low salivary flow rate might be a high risk for periodontal disease in elderly people.

Early loading of non‐submerged titanium implants with a sandblasted and acid‐etched surface

AbstractObjectives: The aim of this prospective cohort study was to evaluate the success rate of titanium screw‐type implants with the sandblasted and acid‐etched (SLA) surface loaded early, after 6 weeks of healing.Material and methods: A total of 104 implants were inserted into posterior sites of 51 partially edentulous patients exhibiting bone densities of class I–III. After a healing period of 6 weeks, all implants were functionally loaded with cemented crowns or fixed partial dentures. The patients were recalled at 3, 12, 24, 36, 48 and 60 months for clinical and radiographic examination.Results: One implant failed to integrate during healing, and three implants were lost to follow‐up and were considered drop‐outs. The remaining 100 implants showed favorable clinical and radiographic findings at the 5‐year examination. The peri‐implant soft tissues were stable over time; the mean probing depths and mean attachment levels did not change during the follow‐up period. None of the radiographs exhibited signs of continuous peri‐implant radiolucency, which confirmed ankylotic stability for all 100 implants. The measurement of the bone crest levels (DIB values) indicated stability as well. Based on strict success criteria, all 100 implants were considered successfully integrated, resulting in a 5‐year success rate of 99%.Conclusion: This prospective study using an early loading protocol with 6 weeks of healing demonstrated that titanium implants with the SLA surface can achieve and maintain successful tissue integration with high predictability for at least 5 years of follow‐up in selected patients and sites.

Prospective Assessment of the Use of Enamel Matrix Proteins With Minimally Invasive Surgery

Minimally invasive surgery (MIS) is a surgical technique using very small incisions, indicated for performing regenerative therapy in periodontal defects. Enamel matrix proteins (EMP) have been shown to enhance periodontal regeneration. This study was undertaken to determine the effect of using EMP in combination with an MIS approach. Patients from two private periodontal practices with chronic periodontitis who, following non-surgical therapy, had one or more sites with probing depths (PD) of > or =6 mm were included in the study. An MIS approach was utilized for surgical access. Following surgical debridement, EMP was placed into the bony defect. The surgical sites were reevaluated after at least 11 months. Surgical treatment was performed at 160 sites in 16 patients. No significant differences were noted in the results between the two offices and the data were combined. Mean PD reduction (P = 0.002) and attachment level improvements (P = 0.012) were significantly greater than 3 mm with mean post-surgical PD of 3.17 mm and attachment levels of 4.05 mm, based on subject means. Mean change in recession following surgery was negligible (0.01 mm). All sites were considered to be clinically successful. The combination of MIS and EMP yields significant reductions in probing depths and improvements in attachment levels while producing little or no increase in recession.

Scaling and root planing, systemic metronidazole and professional plaque removal in the treatment of chronic periodontitis in a Brazilian population

The current investigation evaluated the clinical effects of scaling and root planing (SRP) alone or in combination with systemic metronidazole and/or repeated professional removal of supragingival plaque in subjects with chronic periodontitis. Fourty-four adult subjects (mean age: 45+/-6 years) with periodontitis were randomly assigned to four treatment groups; a control (C, n=10) that received SRP and placebo and three test groups treated as follows: Test 1 (T1) (n=12) received SRP and metronidazole (400 mg t.i.d., M) for 10 days; Test 2 (T2) (n=12) received SRP, weekly professional supragingival plaque removal for three months (professional cleaning (PC)) and placebo; and Test 3 (T3) (n=10) received SRP, M and PC. Pocket depth (PD), attachment level (AL), bleeding on probing (BOP) and presence of visible plaque and suppuration were measured at six sites per tooth at baseline and at 90 days post-therapy. Significance of differences over time was determined using the Wilcoxon test, and among groups using ancova. A reduction in full-mouth mean clinical parameters was observed at 90 days after all therapies. Sites with baseline PD<4 mm showed an increase in mean PD in the control group and in mean AL in all treatment groups. Sites with baseline PD of 4-6 mm in subjects who received PC as part of therapy (T2, T3) showed a marked reduction in PD, AL and in the % of sites with BOP. Subjects who received metronidazole (T1 and T3) showed the best clinical response at sites with an initial PD of >6 mm. The major clinical benefit occurred when the combination of SRP, M and PC was used. Group T3 showed the least attachment loss in initially shallow pockets. This group also exhibited the greatest reduction in the % of sites with BOP and suppuration as well as in mean PD and AL at sites with baseline PD>4 mm. The data suggest a significant clinical benefit in combining SRP, systemic metronidazole and weekly professional supragingival plaque removal for the treatment of chronic periodontitis.