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Aim The aim of this systematic review was to evaluate the efficacy of anti-plaque chemical formulations for managing gingivitis, in 6-month, home-use, randomised clinical trials ( RCTs). Material and Methods A protocol was designed, including inclusion and exclusion criteria to identify RCTs assessing gingival and/or bleeding indices. Electronic and hand-searches identified relevant papers, which were screened and evaluated for inclusion. Full-papers were retrieved and relevant information was extracted (also plaque indices), including quality and risk of bias. Mean treatment effects were calculated to obtain weighted mean differences ( WMD) and 95% confidence intervals. Results After the process of screening and selection, 87 articles with 133 comparisons, were included in the review. The additional effects of the tested products were statistically significant in terms of Löe & Silness gingival index (46 comparisons, WMD −0.217), modified gingival index ( n = 23, −0.415), gingivitis severity index ( n = 26, −14.939%) or bleeding index ( n = 23, −7.626%), with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies, WMD −0.475), Silness & Löe ( n = 26, −0.109), and plaque severity ( n = 12, −23.4%) indices, with significant heterogeneity. Conclusion Within the limitations of the present study, formulations with specific agents for chemical plaque control provide statistically significant improvements in terms of gingival, bleeding and plaque indices. [ABSTRACT FROM AUTHOR]

Aims To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis. Material and Methods Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth ( PPD) and clinical attachment level ( CAL) and most in plaque index (PlI) and/or bleeding on probing ( BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria. Results The overall effect of the subgingival application of antimicrobials was statistically significant ( p = 0.000) for both changes in PPD and CAL with a weighted mean difference ( WMD) of −0.407 and −0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction ( WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo ( WMD between 0.1 and 0.4 mm). Conclusions The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial. [ABSTRACT FROM AUTHOR]

Aim To examine associations between periodontitis and developmental trajectories of glycated haemoglobin (HbA1c) during the third and fourth decades in an initially healthy sample. Materials and methods HbA1c data collected at ages 26, 32 and 38 in the prospective Dunedin Multidisciplinary Health and Development Study were used to assign study members ( n = 893) to trajectories applying group-based trajectory modelling ( GBTM). The model allowed the statistical linking of baseline demographic, smoking and waist-height ratio covariates to group membership probability; and added a time-varying covariate (periodontitis) to the trajectories themselves to examine whether events that occurred during the course of the trajectory altered its course. Results Three HbA1c trajectory groups were identified: 'Low' ( n = 98, 11.0%); 'Medium' ( n = 482, 54.0%); and 'High' ( n = 313, 35.0%) with mean HbA1c of 29.6, 34.1 and 38.7 mmol/mol, respectively, at age 38. Having periodontitis at 32 and 38 was associated with an upward shift in the trajectories. However, none of the associations were statistically significant. Conclusions Periodontitis was not found to be associated with dysglycaemia over 12 years from early adulthood into early middle age. This suggests that any influence periodontitis may have on dysglycaemia develops later in life. [ABSTRACT FROM AUTHOR]

Objectives To compare the use of sonic powered or manual toothbrush in patients with intellectual disability ( ID) in terms of plaque (PlI) and gingival ( GI) indices and adverse effects. Material and Methods Subjects with ID were recruited for this cluster-randomized, single blinded (examiner), 6-month clinical trial, comparing powered versus manual toothbrushing. Outcome variables included PlI and GI, evaluated at baseline and 3 months after supervised toothbrushing and after 3 additional months of unsupervised used. Clinical outcome variables were analysed by repeated measures ANCOVA considering time and group as factors and respective baseline values as covariates (generalized linear model). Results Sixty-four patients (34 male, mean age 34.5) in six clusters were included in the study. No statistically significant effect of toothbrushing group was observed for PlI or GI. A significant effect of time was identified ( p < 0.001) with mean reductions ranging 0.44-0.45 for PlI and 0.30-0.36 for GI from baseline to 3-6 months. No relevant adverse effect or technical problems were observed. Conclusion The tested sonic powered toothbrush was as effective and safe as the manual toothbrush. The use of powered or manual toothbrushes, together with fluoride toothpaste, may improve plaque and gingivitis levels, in patients with mild to limit ID. [ABSTRACT FROM AUTHOR]

Aim We aimed to assess changes of periodontal status in Germany. Materials & Methods The Studies of Health in Pomerania ( SHIP) are two cross-sectional population-based studies conducted during 1997-2001 ( SHIP-0, 20-81 years, n = 3736) and 2008-2012 ( SHIP-Trend, 20-84 years, n = 3622) in northeast Germany. The German Oral Health Studies ( DMS, 35-44 and 65-74 years) are national cross-sectional population-based surveys conducted in 1997 ( DMS III, n = 1454) and 2005 ( DMS IV, n = 1668), whose results were separately reported for West and East Germany. Prevalences, percentages and numbers of teeth affected were defined. Results In SHIP, prevalence of attachment loss ( AL) ≥3 mm decreased from 89.7% (95% confidence interval ( CI): 88.6-90.8) to 85.1% (95% CI: 83.9-86.3) ( p < 0.05) and the mean extent reduced from 62.8% (95% CI: 61.7-63.8) to 55.9% (95% CI: 54.9-56.9) ( p < 0.05). Probing depth ( PD) ≥4 mm and the respective extent remained unchanged. In West Germany, AL ≥3 mm decreased for 35-44-year-olds and increased for 65-74-year-olds ( p < 0.05). In SHIP and DMS, the number of teeth in dentates increased significantly in all age groups. Conclusions Prevalences and extents of AL improved almost in all age categories in SHIP and West German adults, whereas PDs remained unchanged. Nonetheless, the improvement of periodontal conditions implies an increase of treatment needs regarding moderately diseased teeth because of simultaneous increases of the number of present teeth. [ABSTRACT FROM AUTHOR]

Aim To understand degeneration of healthy sites and identify factors associated with disease progression in patients with chronic periodontitis. Material and Methods Data on healthy sites from 163 American and Swedish subjects were analysed using two-three-state (health, gingivitis, chronic periodontitis) Markov models based on bleeding on probing ( BOP), and either clinical attachment level ( CAL) + BOP or pocket depth ( PD) + BOP. Results In 2 years, 10% ( CAL + BOP) and 3% ( PD + BOP) of healthy sites developed chronic periodontitis. On average, healthy sites remained healthy for 32 months before transiting in both models. Most transitions (87-97%) from health were to the gingivitis state. The expected duration of the gingivitis lesion was 4-5 months and sites recovered with a high probability (96-98%). Disease severity as measured by number of sites with CAL/ PD > 4 mm at baseline and smoking, were associated with fast progression from health to chronic periodontitis within 6 months as were gingival redness in the PD + BOP model only. With age, the rate of disease progression to gingivitis decreased. Conclusion Transition probabilities for gingivitis and chronic periodontitis were higher with CAL + BOP than with PD + BOP. Smoking and disease severity were significant predictors for fast progression. [ABSTRACT FROM AUTHOR]

Aim There is a growing interest in comparing periodontal conditions between countries. This study compared periodontal disease conditions in three elderly populations- one from Japan and two from Germany. Materials and Methods We compared periodontal data of 70-year-old subjects from the Niigata Study with 65-74-year-old subjects from the Study of Health in Pomerania ( SHIP) and from West Germany ( DMS III). A total of 489, 399 and 549 dentate subjects were analysed, respectively. Recording protocols were standardized. Linear or logistic models were used to compare Niigata Study with SHIP. Results Elderly German subjects in SHIP and DMS III had significantly more severe periodontal conditions and fewer remaining teeth compared to those in Niigata Study, though differences were less pronounced for DMS III. German subjects showed a significantly different pattern of various periodontal risk factors compared to Japanese subjects. Even after adjustment for putative periodontal risk factors, SHIP subjects still presented significantly higher adjusted values for most periodontal parameters compared to Niigata Study subjects ( p < 0.05). Conclusions Periodontitis was more prevalent in SHIP compared with Niigata Study, even after comprehensive risk factor adjustment. Only to a very small extent, differences between studies could be explained by the risk factors explored. [ABSTRACT FROM AUTHOR]

Aim To evaluate the direct effects of periodontal therapy in Chronic Obstructive Pulmonary Disease ( COPD) patients with chronic periodontitis ( CP). Materials and Methods In a pilot randomized controlled trial, 60 COPD patients with CP were randomly assigned to receive scaling and root planing ( SRP) treatment, supragingival scaling treatment, or oral hygiene instructions only with no periodontal treatment. We evaluated their periodontal indexes, respiratory function, and COPD exacerbations at baseline, 6 months, 1, and 2 years. Results Compared with the control group, measurements of periodontal indexes were significantly improved in patients in two treatment groups at 6-month, 1-year, and 2-year follow-up (all p < 0.05). Overall, the means of forced expiratory volume in the first second/forced vital capacity ( FEV1/ FVC) and FEV1 were significantly higher in the two therapy groups compared with the control group during the follow-up ( p < 0.05). In addition, the frequencies of COPD exacerbation were significantly lower in the two therapy groups than in the control group at 2-year follow-up ( p < 0.05). Conclusions Our preliminary results from this pilot trial suggest that periodontal therapy in COPD patients with CP may improve lung function and decrease the frequency of COPD exacerbation. [ABSTRACT FROM AUTHOR]

Objective The purpose of this ongoing randomized study was to assess differences in bone level changes and success rates using implants supporting single crowns in the posterior mandible either with platform matched or platform switched abutments. Material and Methods Patients aged 18 and above, missing at least two teeth in the posterior mandible and with a natural tooth mesial to the most proximal implant site were enrolled. Randomization followed implant placement. Definitive restorations were placed after a minimum transgingival healing period of 8 weeks. Changes in crestal bone level from surgery and loading (baseline) to 12-month post-loading were radiographically measured. Implant survival and success were determined. Results Sixty-eight patients received 74 implants in the platform switching group and 72 in the other one. The difference of mean marginal bone level change from surgery to 12 months was significant between groups ( p < 0.004). Radiographical mean bone gain or no bone loss from loading was noted for 67.1% of the platform switching and 49.2% of the platform matching implants. Implant success rates were 97.3% and 100%, respectively. Conclusions Within the same implant system the platform switching concept showed a positive effect on marginal bone levels when compared with restorations with platform matching. [ABSTRACT FROM AUTHOR]

Aim The aim of this exploratory study was to analyse prevalence of extraction sockets showing erratic healing and evaluate factors potentially impeding healing. Methods Erratic healing was defined as extraction sites showing clinical observations of fibrous scar tissue occupying the extraction site rather than bone following 12 or more weeks of healing. Computerized tomography was used to evaluate characteristics and calculate Hounsfield unit scores for sites showing erratic healing. Results A total of 1226 dental records from Seoul National University Dental Hospital archives including patients subject to extractions prior to implant placement were evaluated. Seventy subjects (5.71%) and 97 sites (4.24%) exhibited erratic extraction socket healing. Maxillary incisor/canine sites showed the lowest (0.47%), whereas mandibular molar sites the highest (5.41%) occurrence. In the multivariable analysis, erratic healing was more likely to occur in subjects <60 years old ( OR = 2.23, 95%CI = 1.26-3.94), subjects with hypertension ( OR = 2.37, 95%CI = 1.24-4.55), in molar sites ( OR = 4.91, 95% CI = 1.41-17.07), and following single tooth extractions ( OR = 2.98, 95% CI = 1.36-6.53). Computerized tomography showed the highest incidence of bone loss for the buccal wall (49.3%). Conclusion Erratic extraction socket healing appears a not uncommon sequel and local factors seem to be major contributors to its occurrence. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to evaluate the levels of a wide panel of cyto/chemokines in the gingival crevicular fluid ( GCF) of uncontrolled type 2 diabetic subjects as compared with non-diabetic subjects with periodontitis. Methods Twenty-six uncontrolled type 2 diabetic subjects (glycated haemoglobin levels >7.5%) and 20 non-diabetic subjects with chronic periodontitis were enrolled in this study. The levels of 14 cyto/chemokines were measured in the GCF of healthy and diseased sites of the diabetic and non-diabetic subjects using multiplex bead immunoassays. Results The concentrations of eotaxin, macrophage inflammatory protein-1α, granulocyte-macrophage colony-stimulating factor, interleukin ( IL)-6, tumour necrosis factor-α and IL-12 were higher in healthy and diseased sites of diabetic than non-diabetic subjects, after adjustment for multiple comparisons ( p < 0.0035). Conclusion Uncontrolled type 2 diabetes mellitus modulated the local levels of several cyto/chemokines at both healthy and diseased periodontal sites in favour of a proinflammatory profile, which may partially explain the greater susceptibility of diabetic subjects to periodontal breakdown. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim To use linked electronic medical and dental records to discover associations between periodontitis and medical conditions independent of a priori hypotheses. Materials and Methods This case-control study included 2475 patients who underwent dental treatment at the College of Dental Medicine at Columbia University and medical treatment at NewYork-Presbyterian Hospital. Our cases are patients who received periodontal treatment and our controls are patients who received dental maintenance but no periodontal treatment. Chi-square analysis was performed for medical treatment codes and logistic regression was used to adjust for confounders. Results Our method replicated several important periodontitis associations in a largely Hispanic population, including diabetes mellitus type I ( OR = 1.6, 95% CI 1.30-1.99, p < 0.001) and type II ( OR = 1.4, 95% CI 1.22-1.67, p < 0.001), hypertension ( OR = 1.2, 95% CI 1.10-1.37, p < 0.001), hypercholesterolaemia ( OR = 1.2, 95% CI 1.07-1.38, p = 0.004), hyperlipidaemia ( OR = 1.2, 95% CI 1.06-1.43, p = 0.008) and conditions pertaining to pregnancy and childbirth ( OR = 2.9, 95% CI: 1.32-7.21, p = 0.014). We also found a previously unreported association with benign prostatic hyperplasia ( OR = 1.5, 95% CI 1.05-2.10, p = 0.026) after adjusting for age, gender, ethnicity, hypertension, diabetes, obesity, lipid and circulatory system conditions, alcohol and tobacco abuse. Conclusions This study contributes a high-throughput method for associating periodontitis with systemic diseases using linked electronic records. [ABSTRACT FROM AUTHOR]

Aim The study was conducted to explore the potential association of Matrix metalloproteinases ( MMP) -9 -1562C>T with susceptibility to periodontitis. Materials and Methods Electronic literature searches of PubMed, EMBASE and EBSCO databases were performed. Fixed-effects or random-effects models were used to calculate the pooled odds ratios (ORs) for four genetic comparisons. Results Seven eligible studies with a total of 628 cases and 689 controls were recruited in the pooled analysis. We found MMP-9 -1562C>T contributed to decreased risk of chronic periodontitis. Furthermore, the polymorphism was associated with modified risk of periodontitis among Caucasian populations. Conclusions This study indicated that MP-9 -1562C>T might be involved in the development of periodontitis. A replication of our results in independent large analysis populations is necessary to give evidence to our observation. [ABSTRACT FROM AUTHOR]

Objectives To compare the prevalence of periodontal disease between two randomly selected population-based studies (the Oral Infections and Vascular Disease Epidemiology Study ( INVEST) and the Study of Health in Pomerania ( SHIP)) and address relevant methodological issues. Methods Comparison was restricted to 55- to 81-year olds. Attachment loss ( AL), probing depth ( PD) and tooth count were assessed in INVEST (full-mouth, six sites) and SHIP (half-mouth, four sites). Subjects were classified according to the CDC/ AAP case definition. Recording protocols were standardized. Mixed linear or logistic models were used to compare INVEST with SHIP. Results Mean half-mouth AL was lower in INVEST versus SHIP ( INVEST: 2.9 mm versus SHIP: 4.0 mm, p < 0.05). Findings were similar across multiple periodontal disease definitions. After equalization of recording protocols and adjustment for periodontal risk factors, mean AL and PD were 1.2 and 0.3 mm lower in INVEST versus SHIP ( p < 0.001). The odds for severe periodontitis ( CDC/ AAP) was 0.2-fold in INVEST versus SHIP ( p < 0.001). Confounding effects of age, gender, race/ethnicity, education and use of interdental care devices were highest as indicated by change-in-estimate for study. Conclusion Implementation of the proposed method for comparison of epidemiological studies revealed that periodontitis was less prevalent in INVEST compared with SHIP, even after extensive risk-factor adjustment. [ABSTRACT FROM AUTHOR]

Aim Current literature on chronic periodontitis genetics encompasses numerous single nucleotide polymorphisms-focused case-control studies with inconsistent and controversial results, which typically disregards the exposure concept embraced by case-control definition. Herein, we propose a case-control design reappraisal by clear phenotype selection, where chronic gingivitis represents a genetically resistant phenotype/genotype opposing the susceptible cohort. Material and methods The hypothesis was tested in healthy, chronic periodontitis and gingivitis groups through Real-time PCR-based allelic discrimination of classic variants IL1B-3954, IL6-174, TNFA-308, IL10-592 and TLR4-299. Results Observed allele/genotype frequencies characterize the healthy group with an intermediate genetic profile between periodontitis and gingivitis cohorts. When comparing genotype/allele frequencies in periodontitis versus healthy and periodontitis versus gingivitis scenarios, the number of positive associations (2-4) and the degree of association (p and odds ratio values) were significantly increased by the new approach proposed (periodontitis versus gingivitis), suggesting the association of IL1B-3954, TNFA-308, IL10-592 and TLR4-299 with periodontitis risk. Power study was also significantly improved by the new study design proposed when compared to the traditional approach. Conclusions The data presented herein support the use of new case-control study design based on the case-control definition and clear resistance/susceptibility phenotypes selection, which can significantly impact the study power and odds of identification of genetic factors involved in PD. [ABSTRACT FROM AUTHOR]

Charalampakis G, Rabe P, Leonhardt A˚, Dahlén G. A follow-up study of peri-implantitis cases after treatment. J Clin Periodontol 2011; 38: 864-871. doi: 10.1111/j.1600-051X.2011.01759.x. Abstract Aim: The aim of this retrospective study was to follow patient cases in a longitudinal manner after peri-implantitis treatment. Materials and Methods: Two hundred and eighty-one patient cases were selected consecutively from the archives of the Oral Microbiological Diagnostic Laboratory, Gothenburg, Sweden based on microbial analysis of bacterial samples taken from diseased implants. It was feasible to follow-up 245 patients after treatment for a period ranging from 9 months to 13 years. Results: In 54.7% of the patients it was not feasible to arrest progression of peri-implantitis. Smoking and smoking dose were found to be significantly correlated to failure of peri-implantitis treatment ( p<0.05). Early disease development was also significantly associated with failure ( p<0.05). Bone plasty in conjunction to antibiotics during surgery was significantly associated with arrested lesions ( p<0.05). In a multiple regression model disease development was the only independent variable to significantly predict the likelihood of treatment success. Conclusions: Peri-implant health may not be easy to establish, especially in cases that develop disease early. Homogenous treatment protocols rather than empirical treatment attempts should be adopted. [ABSTRACT FROM AUTHOR]