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Background: The collection of subgingival plaque samples with paper points is time-consuming and accident-sensitive. However, the collection of saliva is simple and contains pathogens of all intraoral surfaces. The aim of this study is to investigate whether a sampling strategy with mouthrinse (mouthrinse sample [MSP]; test) leads to results comparable with standard sampling method (multiple site test from the deepest pocket of each quadrant [MT4]; control).Methods: In 50 patients with periodontitis, subgingival plaque was sampled from the deepest pocket of each quadrant by using paper points and by gaining saliva with saline mouthrinse. Analysis was performed using a commercially available polymerase chain reaction test for 11 periodontal pathogens.Results: Detection frequency of Aggregatibacter actinomycetemcomitans (MT4/MSP: 42%/36%), Porphyromonas gingivalis (78%/66%), Tannerella forsythia (98%/84%), Treponema denticola (94%/74%), Parvimonas micra (86%/62%), Campylobacter rectus (90%/76%), Eubacterium nodatum (64%/30%), Prevotella intermedia (58%/54%), and Eikenella corrodens (90%/82%) was higher with MT4 than MSP. For Fusobacterium nucleatum (100%/100%), there was no difference between test and control. Only detection frequency of Capnocytophaga species (68%/74%) was higher with MSP than MT4. Differences were significant for P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum.Conclusions: There is no significant difference between MT4 and MSP for detection frequency of key pathogen A. actinomycetemcomitans. Key pathogens P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum show statistically higher detection frequencies with MT4. [ABSTRACT FROM AUTHOR]

The article reports on position papers that were cancelled by the Board of Trustees of the American Academy of Periodontology (AAP) in May 2007. They include "Periodontal Considerations in the HIV Positive Patient," "Periodontal Considerations in the Management of the Cancer Patient" and "Sonic and Ultrasonic Sealers in Periodontics." It notes the removal of such papers from the Web site of the academy and sites of the "Journal of Periodontology." It encourages readers to refer to the literature for the latest information on those subjects.

The article announces that the board of trustees of the American Academy of Periodontology has decided to remove some position paper and clinical guidelines in May 2005. These are "Current Understanding of the Role of Microscope Monitoring, Baking Soda and Hydrogen Peroxide in the Treatment of Periodontal Disease" and "Position Statement and Guidelines for Soft Tissue Management Program." These papers have been removed from the web site of AAP.

Background: The proteome of the peri‐implant crevicular fluid (PICF) has not been systematically investigated. The aim of the present study was to reveal the proteome biology of dental implants affected with peri‐implantitis. Methods: Patients with at least one diseased implant were included (probing depth ≥6 mm, ≥3 mm peri‐implant radiological bone loss). Using sterile paper strips, samples were collected from healthy implants (I), healthy teeth (T) and peri‐implantitis affected implants (P). Proteome analysis was performed using liquid chromatography — tandem mass spectrometry (LC‐MS/MS) and data independent acquisition, allowing the identification and quantification of human and bacterial proteins as well as semi‐specific peptides. Results: A total of 38 samples from 14 patients were included in the study; 2332 different human proteins were identified across all samples. No differentially expressed proteins between T and I were found. Comparing P to I, 59 proteins were found upregulated and 31 downregulated in P with significance. Upregulated proteins included proinflammatory proteins such as immunoglobulins, dysferlin, and S100P, as well as antimicrobial proteins, for example, myeloperoxidase or azurocidin. Gene ontology analysis further revealed higher activity of immunological pathways. Proteolytic patterns indicated the activity of inflammatory proteins such as cathepsin G. A total of 334 bacterial proteins were identified and quantified. Peri‐implantitis showed elevated proteolytic activity. Conclusion: I and T share similarities in their proteome, while diseased implants deviate strongly from healthy conditions. The PICF proteome of peri‐implantitis affected sites exhibits an inflammatory fingerprint, dominated by neutrophil activity when compared with healthy implants. [ABSTRACT FROM AUTHOR]

A classification scheme for periodontal and peri‐implant diseases and conditions is necessary for clinicians to properly diagnose and treat patients as well as for scientists to investigate etiology, pathogenesis, natural history, and treatment of the diseases and conditions. This paper summarizes the proceedings of the World Workshop on the Classification of Periodontal and Peri‐implant Diseases and Conditions. The workshop was co‐sponsored by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) and included expert participants from all over the world. Planning for the conference, which was held in Chicago on November 9 to 11, 2017, began in early 2015. An organizing committee from the AAP and EFP commissioned 19 review papers and four consensus reports covering relevant areas in periodontology and implant dentistry. The authors were charged with updating the 1999 classification of periodontal diseases and conditions and developing a similar scheme for peri‐implant diseases and conditions. Reviewers and workgroups were also asked to establish pertinent case definitions and to provide diagnostic criteria to aid clinicians in the use of the new classification. All findings and recommendations of the workshop were agreed to by consensus. This introductory paper presents an overview for the new classification of periodontal and peri‐implant diseases and conditions, along with a condensed scheme for each of four workgroup sections, but readers are directed to the pertinent consensus reports and review papers for a thorough discussion of the rationale, criteria, and interpretation of the proposed classification. Changes to the 1999 classification are highlighted and discussed. Although the intent of the workshop was to base classification on the strongest available scientific evidence, lower level evidence and expert opinion were inevitably used whenever sufficient research data were unavailable. The scope of this workshop was to align and update the classification scheme to the current understanding of periodontal and peri‐implant diseases and conditions. This introductory overview presents the schematic tables for the new classification of periodontal and peri‐implant diseases and conditions and briefly highlights changes made to the 1999 classification. It cannot present the wealth of information included in the reviews, case definition papers, and consensus reports that has guided the development of the new classification, and reference to the consensus and case definition papers is necessary to provide a thorough understanding of its use for either case management or scientific investigation. Therefore, it is strongly recommended that the reader use this overview as an introduction to these subjects. Accessing this publication online will allow the reader to use the links in this overview and the tables to view the source papers (Table 1). [ABSTRACT FROM AUTHOR]

A classification scheme for periodontal and peri-implant diseases and conditions is necessary for clinicians to properly diagnose and treat patients as well as for scientists to investigate etiology, pathogenesis, natural history, and treatment of the diseases and conditions. This paper summarizes the proceedings of the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. The workshop was co-sponsored by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) and included expert participants from all over the world. Planning for the conference, which was held in Chicago on November 9 to 11, 2017, began in early 2015. An organizing committee from the AAP and EFP commissioned 19 review papers and four consensus reports covering relevant areas in periodontology and implant dentistry. The authors were charged with updating the 1999 classification of periodontal diseases and conditions and developing a similar scheme for peri-implant diseases and conditions. Reviewers and workgroups were also asked to establish pertinent case definitions and to provide diagnostic criteria to aid clinicians in the use of the new classification. All findings and recommendations of the workshop were agreed to by consensus. This introductory paper presents an overview for the new classification of periodontal and peri-implant diseases and conditions, along with a condensed scheme for each of four workgroup sections, but readers are directed to the pertinent consensus reports and review papers for a thorough discussion of the rationale, criteria, and interpretation of the proposed classification. Changes to the 1999 classification are highlighted and discussed. Although the intent of the workshop was to base classification on the strongest available scientific evidence, lower level evidence and expert opinion were inevitably used whenever sufficient research data were unavailable. The scope of this workshop was to align and update the classification scheme to the current understanding of periodontal and peri-implant diseases and conditions. This introductory overview presents the schematic tables for the new classification of periodontal and peri-implant diseases and conditions and briefly highlights changes made to the 1999 classification. It cannot present the wealth of information included in the reviews, case definition papers, and consensus reports that has guided the development of the new classification, and reference to the consensus and case definition papers is necessary to provide a thorough understanding of its use for either case management or scientific investigation. Therefore, it is strongly recommended that the reader use this overview as an introduction to these subjects. Accessing this publication online will allow the reader to use the links in this overview and the tables to view the source papers (Table 1). [ABSTRACT FROM AUTHOR]

Background: Periodontitis is a chronic inflammatory disease that occurs in periodontal tissues and can cause tooth loosening and loss in severe cases. As the main effector of downstream of Hippo signaling pathway, yes-related protein 1 (YAP1) plays an important role in cell proliferation and differentiation. However, the role of YAP1 in periodontitis has not been reported.Methods: Cell activity was detected by Cell Counting Kit-8 (CCK-8). YAP1 was overexpressed by cell transfection, and then RT-qPCR and western blot were used to detect the expression of YAP1. The cell proliferation was determined by clone formation assay, and the expression of proliferation-related proteins was determined by western blot. The cell differentiation was detected by ELISA kit of alkaline phosphatase activity (ALP) and alizarin red staining. Finally, western blot was used to detect the expression of differentiation-related protein and Hippo signaling pathway-related proteins. Apoptosis was detected by flow cytometry.Results: With the increase of concentration induced by TNF-α, the cell survival rate of human periodontal ligament stem cells (HPDLSCs) decreased significantly. After the overexpression of YAP1, cell proliferation and proliferation-related protein expression increased. Overexpression of YAP1 can improve the differentiation and the formation of osteoblasts of HPDLSCs induced by TNF-α. The expression of Hippo signaling pathway-related proteins transcriptional coactivators with PDZ binding domains (TAZ), TEA domain family member (TRED) increased and proliferation-related protein P27 decreased, whereas there was no significant change in the expression of MST1.Conclusion: TNF-α can inhibit proliferation and osteogenic differentiation of HPDLSCs, which can be ameliorated by the YAP1 gene through the Hippo signaling pathway. Our paper suggested that YAP1 may be a potential therapeutic target for periodontitis. [ABSTRACT FROM AUTHOR]

Background: Poor awareness of periodontal diseases and their consequences has been reported as the most frequent reason for periodontal treatment failure on a community basis. This study aims to identify the most relevant gaps of knowledge about periodontal diseases among the general public and to disclose whether these gaps are culturally consistent.Methods: Systematic searches were conducted of the EMBASE, PubMed, and SciELO databases (1998 to November 2014). The search strategy was "periodontitis OR periodontal disease" and "knowledge OR awareness" as keywords and free text. Papers were included if they reported on community-based, quantitative studies undertaken on adult individuals.Results: A total of 2,330 references were identified (1,567 single papers), and six papers were finally selected. Raw data were grouped into nine dimensions of periodontal knowledge: 1) awareness; 2) etiology; 3) associated risks; 4) signs and symptoms; 5) risk factors; 6) treatment; 7) general knowledge; 8) prevention; and 9) attitudes. This classification recognized disease awareness (80%), etiology (75%), and periodontal-related risks (71.43%) as the most important knowledge deficits among the general public. These findings were confirmed by weighted data analysis.Conclusions: The number of available community-based investigations on periodontal knowledge is scarce and restricted to areas with a very high level of human development. Gaps of knowledge exist in every geographic area, with the most relevant issues of low awareness and poor knowledge about the etiology of periodontal diseases and their relation with systemic disorders. These results highlight the need for local, community-based investigations about periodontal knowledge and barriers hampering early diagnosis, as well as for adequate educational interventions focused on these issues. [ABSTRACT FROM AUTHOR]

Background: This paper systematically reviews the MEDLINE and SCOPUS literature to answer the following question: Is there any evidence that bruxism may cause periodontal damage per se? Methods: Clinical studies on humans, assessing the potential relationship between bruxism and periodontal lesions (i.e., decreased attachment level, bone loss, tooth mobility/migration, altered periodontal perception) were eligible. Methodologic shortcomings were identified by the adoption of the Critical Appraisal Skills Program quality assessment, mainly concerning the internal validity of findings according to an unspecific bruxism diagnosis. Results: The six included articles covered a high variability of topics, without multiple papers on the same argument. Findings showed that the only effect of bruxism on periodontal structures was an increase in periodontal sensation, whereas a relationship with periodontal lesions was absent. Based on the analysis of Hill criteria, the validity of causation conclusions was limited, mainly owing to the absence of a longitudinal evaluation of the temporal relationship and dose-response effects between bruxism and periodontal lesions. Conclusions: Despite the scarce quantity and quality of the literature that prevents sound conclusions on the causal link between bruxism and the periodontal problems assessed in this review, it seems reasonable to suggest that bruxism cannot cause periodontal damage per se. It is also important to emphasize, however, that because of methodologic problems, particularly regarding sleep bruxism assessment, more high-quality studies (e.g., randomized controlled trials) are needed to further clarify this issue. [ABSTRACT FROM AUTHOR]

Background: Historically, periodontal regeneration has focused predominantly on bone substitutes and/or barrier membrane application to provide for defect fill and/or selected cell repopulation of the lesion. More recently, a number of technologies have evolved that can be viewed as emerging therapeutic approaches for periodontal regeneration, and these technologies were considered in the review paper and by the consensus group. The goal of this consensus report on emerging regenerative approaches for periodontal hard and soft tissue reconstruction was to develop a consensus document based on the accompanying review paper and on additional materials submitted before and at the consensus group session. Methods: The review paper was sent to all the consensus group participants in advance of the consensus conference. In addition and also before the conference, individual consensus group members submitted additional material for consideration by the group. At the conference, each consensus group participant introduced themselves and provided disclosure of any potential conflicts of interest. The review paper was briefly presented by two of the authors and discussed by the consensus group. A discussion of each of the following topics then occurred based on the content of the review: a general summary of the topic, implications for patient-reported outcomes, and suggested research priorities for the future. As each topic was discussed based on the review article, supplemental information was then added that the consensus group agreed on. Last, an updated reference list was created. Results: The application of protein and peptide therapy, cell-based therapy, genetic therapy, application of scaffolds, bone anabolics, and lasers were found to be emerging technologies for periodontal regeneration. Other approaches included the following: 1) therapies directed at the resolution of inflammation; 2) therapies that took into account the influence of the microbiome; 3) therapies involving the local regulation of phosphate and py-rophosphate metabolism; and 4) approaches directed at harnessing current therapies used for other purposes. The results indicate that, with most emerging technologies, the specific mechanisms of action are not well understood nor are the specific target cells identified. Patient-related outcomes were typically not addressed in the literature. Numerous recommendations can be made for future research priorities for both basic science and clinical application of emerging therapies. The need to emphasize the importance of regeneration of a functional periodontal organ system was noted. The predictability and efficacy of outcomes, as well as safety concerns and the cost-to-benefit ratio were also identified as key factors for emerging technologies. Conclusions: A number of technologies appear viable as emerging regenerative approaches for periodontal hard and soft tissue regeneration and are expanding the potential of reconstructing the entire periodontal organ system. The cost-to-benefit ratio and safety issues are important considerations for any new emerging therapies. Clinical Recommendation: At this time, there is insufficient evidence on emerging periodontal regenerative technologies to warrant definitive clinical recommendations. [ABSTRACT FROM AUTHOR]

Background: Historically, periodontal regeneration has focused predominantly on bone substitutes and/or barrier membrane application to provide for defect fill and/or selected cell repopulation of the lesion. More recently, a number of technologies have evolved that can be viewed as emerging therapeutic approaches for periodontal regeneration, and these technologies were considered in the review paper and by the consensus group. The goal of this consensus report on emerging regenerative approaches for periodontal hard and soft tissue reconstruction was to develop a consensus document based on the accompanying review paper and on additional materials submitted before and at the consensus group session. Methods: The review paper was sent to all the consensus group participants in advance of the consensus conference. In addition and also before the conference, individual consensus group members submitted additional material for consideration by the group. At the conference, each consensus group participant introduced themselves and provided disclosure of any potential conflicts of interest. The review paper was briefly presented by two of the authors and discussed by the consensus group. A discussion of each of the following topics then occurred based on the content of the review: a general summary of the topic, implications for patient‐reported outcomes, and suggested research priorities for the future. As each topic was discussed based on the review article, supplemental information was then added that the consensus group agreed on. Last, an updated reference list was created. Results: The application of protein and peptide therapy, cell‐based therapy, genetic therapy, application of scaffolds, bone anabolics, and lasers were found to be emerging technologies for periodontal regeneration. Other approaches included the following: 1) therapies directed at the resolution of inflammation; 2) therapies that took into account the influence of the microbiome; 3) therapies involving the local regulation of phosphate and pyrophosphate metabolism; and 4) approaches directed at harnessing current therapies used for other purposes. The results indicate that, with most emerging technologies, the specific mechanisms of action are not well understood nor are the specific target cells identified. Patient‐related outcomes were typically not addressed in the literature. Numerous recommendations can be made for future research priorities for both basic science and clinical application of emerging therapies. The need to emphasize the importance of regeneration of a functional periodontal organ system was noted. The predictability and efficacy of outcomes, as well as safety concerns and the cost‐to‐benefit ratio were also identified as key factors for emerging technologies. Conclusions: A number of technologies appear viable as emerging regenerative approaches for periodontal hard and soft tissue regeneration and are expanding the potential of reconstructing the entire periodontal organ system. The cost‐to‐benefit ratio and safety issues are important considerations for any new emerging therapies. Clinical Recommendation: At this time, there is insufficient evidence on emerging periodontal regenerative technologies to warrant definitive clinical recommendations. [ABSTRACT FROM AUTHOR]

The risk of transmitting airborne pathogens is an important consideration in dentistry and has acquired special significance in the context of recent respiratory disease epidemics. The purpose of this review, therefore, is to examine (1) what is currently known regarding the physics of aerosol creation, (2) the types of environmental contaminants generated by dental procedures, (3) the nature, quantity, and sources of microbiota in these contaminants and (4) the risk of disease transmission from patients to dental healthcare workers. Most dental procedures that use ultrasonics, handpieces, air-water syringes, and lasers generate sprays, a fraction of which are aerosolized. The vast heterogeneity in the types of airborne samples collected (spatter, settled aerosol, or harvested air), the presence and type of at-source aerosol reduction methods (high-volume evacuators, low volume suction, or none), the methods of microbial sampling (petri dishes with solid media, filter paper discs, air harvesters, and liquid transport media) and assessment of microbial bioload (growth conditions, time of growth, specificity of microbial characterization) are barriers to drawing robust conclusions. For example, although several studies have reported the presence of microorganisms in aerosols generated by ultrasonic scalers and high-speed turbines, the specific types of organisms or their source is not as well studied. This paucity of data does not allow for definitive conclusions to be drawn regarding saliva as a major source of airborne microorganisms during aerosol generating dental procedures. Well-controlled, large-scale, multi center studies using atraumatic air harvesters, open-ended methods for microbial characterization and integrated data modeling are urgently needed to characterize the microbial constituents of aerosols created during dental procedures and to estimate time and extent of spread of these infectious agents. [ABSTRACT FROM AUTHOR]

Background: Root resection has been considered a viable treatment option for molars with furcation defects. However, need of a multidisciplinary approach could potentially deem this procedure less successful. The aim of the present article was to determine survival rates of root resection procedure and reasons for failure in an academic setting.Methods: Patient-related demographic data, medical history information, and relevant data pertaining to the root-resected teeth performed from January 1990 to September 2017 were reviewed through electronic and paper chart. Survival rates were analyzed using Kaplan-Meier estimate. Association between the reasons for failure and independent variables was established by a Pearson Chi-squared and Kruskal-Wallis test.Results: A total of 85 patients with an average follow-up of 5 ± 4.3 years (range: 1 to 16.8 years) were included in the present article. A total of 47 molar teeth treated with root resection remained as part of the dentition (55.3%) and 38 (44.7%) failed. The mean survival time with the Kaplan-Mayer analysis was 109.9 months (9.1 years). Fracture (39.5%), caries (26.3%), and periodontal disease (23.7%) were the most common causes for failure. Interestingly, the majority of failures occurred in the first 4 years after therapy (n = 31; 81.5% of all failures).Conclusions: Root resection therapy remains a treatment solution for molars with furcation defects. In an academic setting, >50% of teeth remained functional after 9 years of root resection therapy. [ABSTRACT FROM AUTHOR]

Background: Incidence and severity of postoperative complications are key elements in determining the risk-benefit relationship of any surgical procedure. The aim of this retrospective study was to assess and categorize the postoperative complications that occur following, and are associated with, oral, periodontal, and implant surgeries.Methods: A total of 3,900 patients who underwent surgical procedures including, but not limited to, sinus floor elevation, guided tissue regeneration, crown lengthening, implant placement, soft tissue graft, open flap debridement or surgical removal of impacted teeth were included. Postoperative complications were recorded and graded based on impedance to routine daily activity and favorable surgical outcomes. Regression models were generated to evaluate correlations between complication types, as well as between patient/surgical characteristics and the incidence of complications.Results: Surgical removal of impacted teeth and lateral sinus floor elevation had the highest incidence and severity of complications. Postoperative dentinal hypersensitivity (5.7%) was the most frequent complication, followed by excessive pain (4.1%), and moderate postoperative bleeding (3.5%). Based on the devised grading system described in this paper, the complications were 11.1% of Grade I, 3.3% of Grade II, 8.3% of Grade III, 0.1% of Grade IV, and no complications recorded under Grades V or VI.Conclusions: Surgical removal of impacted teeth and lateral sinus floor elevation are more prone to more severe complications compared with other procedures. Additionally, complications that do not impede favorable surgical outcomes and/or routine daily activity are the most likely to occur. Smoking and diabetes are generally associated with postoperative complications. [ABSTRACT FROM AUTHOR]

Background: While leukocytosis is a common feature of severe periodontitis, a smaller amount of evidence has been produced on erythrocytes counts in periodontitis, suggesting a possible tendency to anemia. The aim of this study was to investigate the associations between periodontitis and circulating leukocytes, erythrocytes, and platelets.Methods: The study included 471 patients with periodontitis (including aggressive periodontitis [AgP], and chronic periodontitis [CP]) and periodontal health. A separate sample of 333 patients from a previous study (127 AgP and 206 periodontally healthy) was used as replication. Periodontal clinical data were collected and a blood sample was obtained from each participant for hematological analysis of leukocytes, erythrocytes and platelets.Results: Adjusted linear regression analyses revealed associations between periodontitis and total leukocytes counts (p < 0.001), neutrophil counts (P <0.001) and hematocrit (HCT) levels (P = 0.045). Sub-analysis revealed no statistically significant differences between AgP and CP. Disease severity was correlated with total leukocyte and neutrophil counts and HCT (P <0.001, P <0.001 and P = 0.004, respectively). In the replication sample, adjusted linear regression analysis revealed associations between periodontitis and decreased hemoglobin (HB) (P = 0.009), mean corpuscular hemoglobin (MCH) (P = 0.023), and MCH concentration (P <0.001). A subset of patients included in these studies (14% to 15.7% of periodontitis versus 8.4% to 10.2% of healthy, respectively, in the two cohorts) were anemic based on the World Health Organization criteria.Conclusion: This paper, reporting results of periodontal examination and blood sampling in over 800 patients, suggest that not just leukocytosis but also tendency to "anemia of inflammation" are typical features of periodontitis. [ABSTRACT FROM AUTHOR]

Background: The incidence of a peri-implant soft tissue dehiscence/deficiency (PSTD) is not a rare finding. Despite multiple previous attempts aimed at correcting the PSTDs, a classification of these conditions has not yet been proposed. This lack in the literature may also lead to discrepancies in the reported treatment outcomes and thus misinform the clinician or the readers. The aim of the present article was therefore to present a classification of peri-implant PSTD at a single implant site.Methods: Four classes of PSTDs were discussed based on the position of the gingival margin of the implant-supported crown in relation to the homologous natural tooth. In addition, the bucco-lingual position of the implant head was also taken into consideration. Each class was further subdivided based on the height of the anatomical papillae.Results: Subsequently, for each respective category a surgical approach (including bilaminar techniques, the combined prosthetic-surgical approach or soft tissue augmentation with a submerged healing) was also suggested.Conclusion: This paper provides a new classification system for describing PSTDs at single implant sites, with the appropriate recommended treatment protocol. [ABSTRACT FROM AUTHOR]

Background: The control and management of many oral health conditions highly depend on one's daily self-care practice and compliance to preventive and curative measures. Conventional (health) education (CE), focusing on disseminating information and giving normative advice, is insufficient to achieve sustained behavioral changes. A counseling approach, motivational interviewing (MI), is potentially useful in changing oral health behaviors. This systematic review aims to synthesize the evidence on the effectiveness of MI compared with CE in improving oral health. Methods: Four databases (PubMed MEDLINE, Web of Science, Cochrane Library, and PsycINFO) were searched to identify randomized controlled trials that evaluated the effectiveness of MI compared with CE in changing oral health behaviors and improving oral health of dental patients and the public. The scientific quality of the studies was rated, and their key findings were qualitatively synthesized. Results: The search yielded 221 potentially relevant papers, among which 20 papers (on 16 studies) met the eligibility criteria. The quality of the studies varied from 10 to 18 out of a highest possible score of 21. Concerning periodontal health, superior effect of MI on oral hygiene was found in five trials and was absent in two trials. Two trials targeting smoking cessation in adolescents failed to generate a positive effect. MI outperformed CE in improving at least one outcome in four studies on preventing early childhood caries, one study on adherence to dental appointments, and two studies on abstinence of illicit drugs and alcohol use to prevent the reoccurrence of facial injury. Conclusions: Reviewed randomized controlled trials showed varied success of MI in improving oral health. The potential of MI in dental health care, especially on improving periodontal health, remains controversial. Additional studies with methodologic rigor are needed for a better understanding of the roles of MI in dental practice. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study is to perform a systematic review of the literature on the use of titanium grids for implant surgery before and simultaneously with implant placement and to assess the success rate of the procedure, as well as survival and success rates of implants placed in the regenerated areas. Methods: Medline was used to identify studies in English published from 1996 to 2011. An additional hand search was performed of the relevant journals and of the bibliographies of the papers identified. Articles retrieved by two independent authors were screened using specific inclusion criteria: randomized controlled trials (RCTs), controlled clinical trials, and prospective clinical studies regarding vertical and/or horizontal regeneration of the alveolar ridge using titanium grids, in association or not with biomaterials, before and simultaneously with implant placement. Results: Six articles were selected, including a total of 79 patients, 87 titanium grids, and 141 implants. Twenty-four implants were placed simultaneously with titanium grids, and 117 implants were inserted after a period of 4 to 9 months. Titanium grids in combination with autogenous bone were used in 43 cases, 25 in combination with a mixture of autogenous bone and bone substitutes, 14 in association with bone substitutes, five using only titanium grids. The overall success rate of the regenerative procedures was 98.86%; the overall survival and success rates of implants were 100% and 93.2%, respectively. Conclusions: The main limit of the present systematic review is the scarcity of papers with an adequate and consistent methodology regarding the data collection and analysis and the lack of RCTs and large well-designed long-term trials. Survival and success rates of implants placed in the areas treated with titanium grids were comparable to those of implants placed in native, non-regenerated bone and of implants placed in bone regenerated with resorbable and non-resorbable membranes. [ABSTRACT FROM AUTHOR]

Background: There is a large body of evidence using cells and animal models demonstrating the effectiveness of growth factors in periodontal regeneration. However, there appears to be minimal literature comparing the efficacy of growth factors in human periodontal regeneration compared to other techniques and procedures. Therefore, the aim of this study is to perform a systematic review of human studies using growth factors for periodontal regeneration and to compare the efficacy of these growth factors to other accepted techniques for periodontal regeneration. Methods: An electronic and manual search based on agreed search phrases between the primary investigator and a secondary investigator was performed to identify the use of growth factors in periodontics for the literature review. The articles that were identified by this systematic review were analyzed in detail, which included the study of their inclusion and exclusion criteria, outcome measures determination and analysis, risk of bias, adverse events, and conclusions or inference of the efficacy of growth factors to the general population. Results: Five papers fulfilled the inclusion criteria. Two papers were identified that had sufficiently similar study design that a meta-analysis of their outcomes was possible. Most of the reported outcomes from the selected papers were descriptive. The articles demonstrated periodontal regeneration at least comparable to their respective positive controls, with only a couple of articles demonstrating significantly greater outcomes compared to their respective positive controls. Histologic evidence demonstrated greater periodontal regeneration when using growth factors compared to other regenerative techniques and an increased healing and bone maturation rate compared to other regenerative and bone augmentation techniques in these human studies. Conclusions: Within the limits of this systematic review, the use of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) led to greater clinical attachment level gain of ≈1 mm compared to an osteoconductive control, β-tricalcium phosphate (β-TCP). The use of rhPDGF-BB led to greater percentage bone fill of ≈40% compared to the osseoconductive control, β-TCP. Last, the use of rhPDGF-BB led to an increased rate of bone growth of ≈2 mm compared to the osseo-conductive control, β-TCP. [ABSTRACT FROM AUTHOR]

Biologically guided implant therapy is based on the new periodontitis classification system recently released by the American Academy of Periodontology and the European Federation of Periodontology that uses staging and grading for the diagnosis of periodontitis. This paper proposes that periodontitis staging and grading should be used in dental implant therapy as a means to ensure maximum conservation of teeth and maximum preservation of alveolar bone. These biologic principles should guide the treatment planning process and supersede a mechanically based, restoratively driven rationale that should be secondary to the biologic principles of conservation and preservation but part of the collaborative treatment planning process. And treatment alternatives throughout the patient's lifetime should be provided for in case of prosthesis loss due to peri-implantitis. The use of grading will help with recognition of systemic aspects that can have a negative impact. [ABSTRACT FROM AUTHOR]

Background: The analysis of samplings from periodontal pockets is important in the diagnosis and therapy of periodontitis. In this study, three different sampling techniques were compared to determine whether one method yielded samples suitable for the reproducible and simultaneous determination of bacterial load, cytokines, neutrophil elastase, and arginine-specific gingipains (Rgps). Rgps are an important virulence factor of Porphyromonas gingivalis, the exact concentration of which in gingival crevicular fluid (GCF) has not been quantified. Methods: GCF was sampled from four sites per patient (one sample per quadrant using two samples per method) in 36 patients with chronic periodontitis. One week later, the procedure was repeated with alternative methods. Variables determined were loads of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) and P. gingivalis, levels of interleukin-6 and -8, activity of neutrophil elastase, and level of Rgps. Results: The detected cytokine levels were higher using paper strips compared to paper points. Bacteria were found in similar loads from paper strips and paper points. Rgps were only detectable in high quantities by washing the periodontal pocket. The level of Rgps correlated with the load of P. gingivalis. Conclusions: The use of paper strips was suitable for the simultaneous determination of microbial and immunologi parameters. Obtaining GCF by washing can be useful for special purposes. The gingipain concentration in periodonta pockets was directly determined to be ≤1.5 µM. This value indicated that most of the substrates of these proteases by in vitro assays identified until now can be easily degraded in P. gingivalis-infected sites. [ABSTRACT FROM AUTHOR]

This supplement contains papers presented at the 2006 International Association of Dental Research (IADR) symposium entitled “Development of Self‐Reported Measures for Population‐Based Surveillance of Periodontitis.” These papers highlight activities of an independent periodontal disease surveillance workgroup convened by the Division of Oral Health (DOH), Centers for Disease Control and Prevention (CDC), in collaboration with the American Academy of Periodontology, to examine the feasibility of using self‐reported measures for population‐based surveillance of periodontal disease in the United States. This workgroup was convened in 2003 as part of a CDC periodontal disease surveillance project. [ABSTRACT FROM AUTHOR]

This supplement contains papers presented at the 2006 International Association of Dental Research (IADR) symposium entitled "Development of Self-Reported Measures for Population-Based Surveillance of Periodontitis." These papers highlight activities of an independent periodontal disease surveillance workgroup convened by the Division of Oral Health (DOH), Centers for Disease Control and Prevention (CDC), in collaboration with the American Academy of Periodontology, to examine the feasibility of using self-reported measures for population-based surveillance of periodontal disease in the United States. This workgroup was convened in 2003 as part of a CDC periodontal disease surveillance project. [ABSTRACT FROM AUTHOR]

Background: The outcome of microbiological diagnostics may depend on the sampling technique. It was the aim of the present study to compare two widely used sampling techniques for subgingival bacteria using quantitative real-time polymerase chain reaction. Methods: Twenty patients with chronic periodontitis were randomized into two groups. [n group A, samples were taken first with a paper point and then with a curet at the same site (single-rooted teeth with probing depth >5 mm) before scaling and root planing and after 10 weeks. The sampling sequence was reversed in group B. The analysis enabled the quantification of Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivaIis, Prevotella intermedia, Treponema denticola, and Tannerella forsythensis and total bacteria! counts (TBCs). Statistical analysis included t test, kappa, and Spearman correlation. Results: Higher TBC was harvested with curets than by paper points (P = 0.008). The plaque composition with regard to total target pathogens was similar for both sampling techniques. A strong positive correlation was found between curet and paper point samples for TBC and single target bacteria. Conclusions: Overall, there was a relatively good agreement for the results of paper point and curet sampling. Thus. both techniques seem to be suitable for microbiological diagnostics. [ABSTRACT FROM AUTHOR]

Background: The advent of osseointegration and advances in biomaterials and techniques have contributed to increased application of dental implants in the restoration of partial and completely edentulous patients. Often, in these patients, soft and hard tissue defects result from a variety of causes, such as infection, trauma, and tooth loss, These create an anatomically less favorable foundation for idea] implant placement. For prosthetic-driven dental implant therapy, reconstruction of the alveolar bone through a variety of regenerative surgical procedures has become predictable; it may be necessary prior to implant placement or simultaneously at the time of implant surgery to provide a restoration with a good long term prognosis. Regenerative procedures are used for socket preservation, sinus augmentation, and horizontal and vertical ridge augmentation. Methods: A broad overview of the published findings in the English literature related to various bone augmentation techniques is outlined. A comprehensive computer-based search was performed using various databases that include Medline and PubMed. A total of 267 papers were considered, with non-peer-reviewed articles eliminated as much as possible Results: The techniques for reconstruction of bony defects that are reviewed in this paper include the use of particulate bone grafts and bone graft substitutes, barrier membranes for guided bone regeneration, autogenous and allogenic block grafts, and the application of distraction osteogenesis. Conclusions: Many different techniques exist for effective bone augmentation. The approach is largely dependent on the extent of the defect and specific procedures to be performed for the implant reconstruction. It is most appropriate to use an evidenced-based approach when a treatment plan is being developed for bone augmentation cases. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the results of microbiological RNA-probe analysis after subgingival plaque sampling applying two different strategies. Methods: in 220 patients, clinical examinations were obtained prior to commencement of therapy for aggressive or generalized severe chronic periodontitis (n = 113), after combined mechanical and antibiotic anti-infective periodontal therapy (n = 43), or because of periodontal pockets despite adequate therapy (n = 64). Subgingival plaque samples were obtained from the three pockets with the deepest probing depths. Two sterile paper points were inserted simultaneously into the periodontal pockets. One paper point from each pocket was put into a separate transport vial; the second paper point was pooled (multiple site test [MT3]) with paper points from each of the two other sampling sites from the respective patient into a transport vial. The content of each vial was analyzed separately for Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, and Treponema denticola (Td) with a commercially available RNA-probe test. Results: For all tested pathogens, log-transformed numbers of bacteria were higher in pooled samples compared to the mean values for the separate samples (P≤0.01). However, for Td only, statistically significant differences in frequency were seen between the separate samples and MT3. These findings were observed over all samples as well as after evaluation of subgroups separately. Conclusions: Pooling of plaque samples increased the bacterial counts per analysis compared to separate samples and thus may increase the probability of detecting existing pathogens. However, this observation only was statistically significant for the frequency of Td. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the effect of periodontal therapy plus amalgam overhang removal (PT+AOR) on periodontal status and the presence of Actinobacillus actinomycetemcomitans and Streptococcus mutans and compared two microbiological sampling techniques. Methods: Molar teeth with Class II overhang restorations were selected as the test group, and homologous sound teeth were selected as the control group. Periodontal probing depth (PD), clinical attachment level (CAL), and plaque and gingival indices were measured, and restorations were evaluated using radio graphs and clinical exploration at baseline (T1) and 90 days after PT+AOR (T2). Microbial samples were taken with dental floss and paper points at T1 and T2. S. mutans and A. actinomycetemcomitans were detected using culture and commercial kits. Results: Mean values of plaque and gingival indices did not show statistically significant differences between test and control teeth between T1 and T2. At T2, the mean CAL decreased among test teeth, and the number of test teeth positive for A. actinomycetemcomitans showed a decrease, whereas positive samples for S. mutans increased, At T1, an association between the two sampling techniques for both bacteria was found. At T2, dental floss presented low sensitivity values for A. actinomycetemcomitans, whereas paper points showed low sensitivity for S. mutans. Conclusions: PT+AOR showed a beneficial effect on clinical parameters and a decrease of A. actinomycetemcomitans. At T1, both sampling techniques showed appropriate results. At T2, the use of paper points was a more sensitive sampling technique for isolate A. actinomycetemcomitans, whereas dental floss was found to be an alternative sampling method for isolate S. mutans. [ABSTRACT FROM AUTHOR]

Background: Gingival invagination is a relatively common occurrence following orthodontic closure of extraction sites. The present paper reports a combined periodontal and orthodontic treatment in a patient with a severe gingivo-alveolar cleft due to orthodontic closure of maxillary central incisor extraction space. Methods: A definite interdental gingival cleft, extending 8 mm into the alveolar bone, required the correction of the gingival deformity as a first step, followed by guided bone regeneration (GBR). The GBR approach included the emptying of the incisive foramen to ∼5 mm in depth followed by the insertion of bioabsorbable hydroxyapatite and covering with a bioabsorbable barrier membrane. Sic months after ward, the orthodontic therapy was resumed. Results: Radiographs and clinical examination 4 years after the completion of therapy indicates functionally and aesthetically satisfactory and stable results. Conclusion: The present paper illustrates an additional application for the guided bone regeneration technique. [ABSTRACT FROM AUTHOR]

Background: An odontogenic ketatocyst can develop at virtually any site in the jaws and is of concern because of its aggressive clinical behavior. It represents 3% to 12% of all odontogenic cysts. This paper describes the rare peripheral presentation of an odontogenic keratocyst localized to the maxillary anterior gingiva and its differential diagnosis. Methods: A patient presented with a round yellow nodule on the maxillary gingiva between the left canine and first premolar. Clinical examination ruled out periapical abscess, periodontal abscess, and lateral periodontal cyst. A differential diagnosis included a gingival cyst, neuroma, neurilemoma, and mesenchymoma. The cyst ruptured during excisional biopsy revealing contents typical of an odontogenic keratocyst (OKC). Histology confirmed the peripheral OKC diagnosis, A conservative surgical treatment was performed assuming a less aggressive clinical course for the peripheral odontogenic keratocyst, Close follow-up was planned. Results: To our knowledge, only 13 cases of peripheral OKC have been reported in the literature. Presently it is unknown if the peripheral variant shares the aggressive clinical behavior and recurrence rate of intraosseous OKC. Conclusion: This paper may contribute to the limited clinical knowledge base for the peripheral odontogenic keratocyst and assist clinicians in the identification and management of such lesions. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis and osteopenia are characterized by reductions in bone mass and may lead to skeletal fragility and fracture. The purpose of this paper is to review studies to determine the relationship between oral bone loss and osteoporosis. In addition, the major modes of therapy for osteoporosis are discussed. Methods: In this convenience review, papers studying the possible correlation between oral bone loss and osteoporosis in humans, written in the English language since 1983, were reviewed. Results: The methods used to assess oral and systemic bone varied greatly from study to study. Therefore, the results were not amenable to meta-analysis. Thirteen of the 15 studies did show a positive correlation between systemic bone mass and oral bone mass (or bone loss). Conclusion: Studies to date indicate a possible correlation between systemic and oral bone loss. [ABSTRACT FROM AUTHOR]

This position paper addresses the role of supra- and subgingival irrigation in the treatment of periodontal diseases, it was prepared by the Committee on Research, Science and Therapy of the American Academy of Periodontology. The document is divided into two portions, consisting of supragingival irrigation and subgingival irrigation. In their respective segments, these treatment techniques are assessed as mono-therapies and as adjuncts to conventional treatment. The conclusions drawn in this paper represent the position of the American Academy of Periodontology regarding irrigation therapy in the treatment of periodontal diseases. [ABSTRACT FROM AUTHOR]

Untreated periodontal disease leads to tooth loss through destruction of the attachment apparatus and tooth-supporting structures. The goals of periodontal therapy include not only the arrest of periodontal disease progression, but also the regeneration of structures lost to disease where appropriate. Conventional surgical approaches (e.g., flap debridement) continue to offer time-tested and reliable methods to access root surfaces, reduce periodontal pockets, and attain improved periodontal form/architecture. However, these techniques offer only limited potential towards recovering tissues destroyed during earlier disease phases. Recently, surgical procedures aimed at greater and more predictable regeneration of periodontal tissues and functional attachment close to their original level have been developed, analyzed, and employed in clinical practice. This paper provides a review of the current understanding of the mechanisms, cells, and factors required for regeneration of the periodontium and of procedures used to restore periodontal tissues around natural teeth. Targeted audiences for this paper are periodontists and/or researchers with an interest in improving the predictability of regenerative procedures. This paper replaces the version published in 1993. [ABSTRACT FROM AUTHOR]

This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. It is intended to provide information for the dental profession and other interested parties. The purpose of this paper is to provide a general overview of oral reconstructive and corrective procedures used in periodontal therapy. It is not intended to be a comprehensive review of this subject. [ABSTRACT FROM AUTHOR]

This position paper addresses the role of systemic antibiotics in the treatment of periodontal disease. Topical antibiotic therapy is not discussed here. The paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. The document consists of three sections: 1) concept of antibiotic periodontal therapy; 2) efficacy of antibiotic periodontal therapy; and 3) practical aspects of antibiotic periodontal therapy. The conclusions drawn in this paper represent the position of the American Academy of Periodontology and are intended for the information of the dental profession. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide an overview of the role of periodontal maintenance procedures in the treatment of periodontal diseases. Reliance on this position paper in patient management will not guarantee a successful outcome, as periodontal diseases typically involve complex causes and symptoms. Ultimately, decisions regarding the diagnosis, treatment, and management of disease as well as subsequent preventive therapy, must be made by the treating practitioner based on specific circumstances presented by the patient. [ABSTRACT FROM AUTHOR]

Background: A number of surgical procedures are effective in covering denuded root surfaces. The first paper in this series evaluated the subepithelial connective tissue graft and the coronally advanced flap with enamel matrix derivative (EMD). That paper revealed no significant difference in the percent of root coverage between the two treatments (P = 0.82). There is limited human histological evidence of the type of attachment achieved with these types of procedures This paper presents a human case report detailing the histological nature of the attachment of these two treatments to the root surfaces previously exposed by recession. Methods: One patient presented with two hopeless teeth that were randomized to receive either a subepithelial connective tissue graft or a coronally advanced flap plus EMD. The surgery was accomplished in accordance to the protocol previously described. The teeth and a small collar of tissue were removed at 6 months and underwent histological analysis. Results: Histological evaluation of the subepithelial connective tissue graft revealed a connective tissue attachment between the tooth and graft, and no histological evidence of cementum, bone, or periodontal ligament (PDL) and, therefore, regeneration. In addition, there appeared to be some resorption of the dentin adjacent to the graft. Histological evaluation of the coronally advanced flap with EMD revealed new cementum, organizing PDL fibers and islands of condensing bone at a constant distance from the root surface. Conclusions: The subepithelial connective tissue graft in this study was found to have adhered to the root surface primarily by a connective tissue attachment with some evidence of root resorption. The coronally advanced flap with EMD was found histologically to have all the tissues necessary for regeneration: new cementum, organizing PDL fibers, and islands of condensing bone. These histologic sections strongly suggest that enamel matrix derivative works in a biomimetic fashion by mimicking the natural process of tooth development. [ABSTRACT FROM AUTHOR]

Background: It has been recently observed that in implants with screw-retained abutments, in in vitro as well as in vivo conditions, bacteria can penetrate inside the internal cavity of the implant as a consequence of leakage at the implant-abutment interface An alternative to screw-retained abutments is represented by implants that can receive cemented abutments. In this case, the abutment goes through a transmucosal friction implant extension (collar) and is cemented inside the internal hexagonal portion of the implant. The aim of the present research was to compare fluids and bacteria] penetration in 2 different implant systems, one with cement-retained abutment; (CRA) and the other with screw-retained abutments (SRA). Methods: Twelve CRA dental implants and 12 SRA implants were used in this study. The research was done in 3 steps; scanning electron microscopic (SEM) analysis, fluid penetration analysis, and bacterial penetration analysis. Results: 1) Under SEM it was possible to observe in the SRA implants a mean 2 to 7 µ gap between implant and abutment, while in the CRA implants, the gap was 7 µ. In the latter group, however, the gap was always completely filled by the fixation cement. All the spaces between abutment and implant were filled by the cement. 2) With SRA implants, it was possible to observe the presence of toluidine blue at the level of the fixture-abutment interface and the internal threads; the absorbent paper was stained in all cases. With CRA implants, the absorbent paper inside the hollow portion of the implants was never stained by toluidine blue. No penetration of toluidine blue was observed at the implant-abutment interface and inside the hollow portion of the implants. 3) In all the SRA implant assemblies, bacterial penetration was observed at the implant-abutment interface. No bacteria were detected in the hollow portion of the CRA implants. Conclusion: On the basis of the results obtained in the present study using 2 different implant systems, we conclude that CRA implants offer better results relating to fluid and bacterial permeability compared to SRA implants. [ABSTRACT FROM AUTHOR]

In this time of heightened awareness of periodontal diseases and the potential consequences of untreated disease, a deterrent in the delivery of periodontal care continues to be patient anxiety concerning treatment and the fear of pain. These guidelines are intended for periodontists in the in-office use of enteral, inhalation, and/or parenteral conscious sedation in the delivery of care. The definitions, educational guidelines, and policies presented in these guidelines are consistent with the most current American Dental Association (ADA) documents Guidelines for the Use of Conscious Sedation. Deep Sedation and General Anesthesia for Dentists and the Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry available from the American Dental Association, 211 E. Chicago Avenue, Chicago, IL 60611 or http://www.ada.org, and for Revisions to Anesthesia Care Standards Comprehensive Accreditation Manual for Ambulatory Care, effective January 1, 2001, Joint Commission on Accreditation of Health Care Organizations, available through http//www.jcaho.org/standard/anesamb.html. This paper replaces the former position paper entitled "Guidelines for the Use of Conscious Sedation in Periodontics." [ABSTRACT FROM AUTHOR]

This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. It is intended to review the safety, efficacy, and role of sonic and ultrasonic sealers in mechanical periodontal therapy. The conclusions presented in this paper represent the position of the American Academy of Periodontology. This information is intended for use by the dental profession. [ABSTRACT FROM AUTHOR]

This paper was prepared by the Research, Science and Therapy Committee of The American Academy of Periodontology and is intended for the information of the dental profession. The purpose of the paper 15 to provide the reader with a general overview of the relationship of tobacco use and periodontal diseases. This paper will review the epidemiological and clinical findings that have led to our understanding of the role of tobacco use in relation to periodontal diseases and their treatment. In addition, this paper will review the possible underlying mechanisms for these effects from tobacco use. The practitioner can use this information in treatment decisions and in giving advice to the patients who use tobacco products. [ABSTRACT FROM AUTHOR]

This informational paper was prepared by the Research, Science, and Therapy Committee of The American Academy of Periodontology, and is intended for the information of the dental profession. The purpose of the paper is to provide an overview of current knowledge relating to the pathogenesis of periodontal diseases. The paper will review biological processes thought to provide protection against periodontal infections, it will further discuss the mechanisms thought to be responsible for both overcoming and subverting such protective mechanisms and those that lead to destruction of periodontal tissues. Since an understanding of pathogenic mechanisms of disease is one foundation upon which new diagnostic and therapeutic modalities are based, the practitioner can use this information to help make decisions regarding the appropriate application of such new modalities in patient care settings. [ABSTRACT FROM AUTHOR]

Background: Site-specific attachment level change, detected from sequential physical probing measurements, is currently the most common method of determining the progression/regression or stability of disease status in subjects with chronic adult periodontitis. The sensitivity and accuracy of detection is dependent on the type of probe used, the recording method, the measurement error, and the method of data analysis. In recent years, there has been world-wide interest in developing instruments and methods to minimize measurement error. Published data report disturbingly wide variation in the prevalences and rates of site-specific attachment level change which are difficult to reconcile with biological likelihood. The present paper aims to summarize the salient points from the key studies and to compare the results. Methods: The literature between 1982 and 1997 was reviewed for studies in which site-specific attachment level change was detected by physical probing methods in patients with chronic adult periodontitis. Results: The review documents 23 studies by probe generation, compares methods and results and summarizes the results according to the thresholds and probe type used. The 23 studies used an array of probe types from the 3 probe generations. Conclusions: From this review, we conclude that: 1) There are surprisingly few papers which have addressed the question of site-specific attachment level change in untreated chronic adult periodontitis. 2) There are considerable differences in the probes used, in the thresholds achieved, in the number of measurements taken, in the number of subjects and sites studied, and in the duration of the studies. Valid comparisons between studies are, therefore, rarely possible. 3) Only 8 out of 23 papers from 1982 to 1997 have adequate data. Most papers report only losing sites and therefore ignore many of the measurements recorded. Only one paper describes losing sites, gaining sites, and sites showing exacerbation/remission patterns of change. 4) The range of changes described show such variation that it has to be concluded that we cannot reliably detect site-specific attachment level change by physical probing and thus, at the end of the 20th century, we have no clear idea of the natural history of this disease. [ABSTRACT FROM AUTHOR]

Background: This systematic review evaluates the efficacy of antimicrobial photodynamic therapy (aPDT), as an adjunct to non-surgical or surgical therapy, on clinical and patient-centered outcomes in patients with periodontitis or peri-implantitis.Methods: Randomized controlled trials (RCTs) with a follow-up duration ≥ 3 months that evaluated mechanical root/implant surface debridement (i.e., scaling and root planing [SRP] or implant surface scaling [ISS]) versus SRP or ISS plus aPDT for the treatment of adult patients (≥ 18 years old) with moderate-to-severe chronic (CP)/aggressive periodontitis (AgP) or peri-implantitis, respectively, were considered eligible for inclusion. The MEDLINE, EMBASE, and CENTRAL databases were searched for articles published up to and including March 2017. Random-effects meta-analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences with their associated 95% confidence intervals. Additionally, summaries are presented of the included RCTs, critical remarks of the literature, and evidence quality rating/strength of recommendation of laser procedures.Results: Of 729 potentially eligible articles, 28 papers (26 studies) were included in the review. Individual study outcomes and four sets of meta-analysis showed potential statistical significant benefit of aPDT in improving clinical attachment level (CAL) (non-surgical treatment of AgP) and probing depth (PD) (non-surgical treatment of AgP and CP). However, the comparative differences in clinical outcomes were modest (< 1 mm), and the level of certainty for different therapies was considered low-to-moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the strengths of clinical recommendations of aPDT were guided by the expert opinion.Conclusions: aPDT may provide similar clinical improvements in PD and CAL when compared with conventional periodontal therapy for both periodontitis and peri-implantitis patients. The restricted base of evidence for some treatment approaches and conditions precludes additional conclusions. [ABSTRACT FROM AUTHOR]

Background: Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state‐of‐the‐art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance. Methods: Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis. Results: The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis‐associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A‐C). Risk factor analysis is used as grade modifier. Conclusions: The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present paper was to review factors and conditions that are associated with hard and soft‐tissue deficiencies at implant sites. Importance: Hard‐ and soft‐tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft‐tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft‐tissue deficiencies with the aim of improving clinical outcomes of implant therapy. Findings: A large number of etiological factors have been identified that may lead to hard and soft‐tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft‐tissue defects or may appear in conjunction with other factors. Conclusions: Hard‐ and soft‐tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri‐implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft‐tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing. [ABSTRACT FROM AUTHOR]

Objectives: This narrative review was prepared for the 2017 World Workshop of the American Academy of Periodontology and European Federation of Periodontology to address key questions related to the clinical condition of peri‐implant mucositis, including: 1) the definition of peri‐implant mucositis, 2) conversion of peri‐implant health to the biofilm‐induced peri‐implant mucositis lesion, 3) reversibility of peri‐implant mucositis, 4) the long‐standing peri‐implant mucositis lesion, 5) similarities and differences between peri‐implant mucositis at implants and gingivitis at teeth, and 6) risk indicators/factors for peri‐implant mucositis. Methods: A literature search of MEDLINE (PubMed) and The Cochrane Library up to and including July 31, 2016, was carried out using the search strategy (peri‐implant[All Fields] AND ("mucositis"[MeSH Terms] OR "mucositis"[All Fields])) OR (periimplant[All Fields] AND mucosits[All Fields]). Prospective, retrospective, and cross‐sectional studies and review papers that focused on risk factors/indicators for peri‐implant mucositis as well as experimental peri‐implant mucositis studies in animals and humans were included. Findings: Peri‐implant mucositis is an inflammatory lesion of the soft tissues surrounding an endosseous implant in the absence of loss of supporting bone or continuing marginal bone loss. A cause‐and‐effect relationship between experimental accumulation of bacterial biofilms around titanium dental implants and the development of an inflammatory response has been demonstrated. The experimental peri‐implant mucositis lesion is characterized by an inflammatory cell infiltrate present within the connective tissue lateral to the barrier epithelium. In long‐standing peri‐implant mucositis, the inflammatory cell infiltrate is larger in size than in the early (3‐week) experimental peri‐implant mucositis lesion. Biofilm‐induced peri‐implant mucositis is reversible at the host biomarker level once biofilm control is reinstituted. Reversal of the clinical signs of inflammation may take longer than 3 weeks. Factors identified as risk indicators for peri‐implant mucositis include biofilm accumulation, smoking, and radiation. Further evidence is required for potential risk factors, including diabetes, lack of keratinized mucosa, and presence of excess luting cement. Conclusions: Peri‐implant mucositis is caused by biofilm accumulation which disrupts the host–microbe homeostasis at the implant–mucosa interface, resulting in an inflammatory lesion. Peri‐implant mucositis is a reversible condition at the host biomarker level. Therefore, the clinical implication is that optimal biofilm removal is a prerequisite for the prevention and management of peri‐implant mucositis. An understanding of peri‐implant mucositis is important because it is considered a precursor for peri‐implantitis. [ABSTRACT FROM AUTHOR]

Background: Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance.Methods: Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis.Results: The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis-associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). Risk factor analysis is used as grade modifier.Conclusions: The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites.Importance: Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy.Findings: A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors.Conclusions: Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing. [ABSTRACT FROM AUTHOR]

Objectives: This narrative review was prepared for the 2017 World Workshop of the American Academy of Periodontology and European Federation of Periodontology to address key questions related to the clinical condition of peri-implant mucositis, including: 1) the definition of peri-implant mucositis, 2) conversion of peri-implant health to the biofilm-induced peri-implant mucositis lesion, 3) reversibility of peri-implant mucositis, 4) the long-standing peri-implant mucositis lesion, 5) similarities and differences between peri-implant mucositis at implants and gingivitis at teeth, and 6) risk indicators/factors for peri-implant mucositis.Methods: A literature search of MEDLINE (PubMed) and The Cochrane Library up to and including July 31, 2016, was carried out using the search strategy (peri-implant[All Fields] AND ("mucositis"[MeSH Terms] OR "mucositis"[All Fields])) OR (periimplant[All Fields] AND mucosits[All Fields]). Prospective, retrospective, and cross-sectional studies and review papers that focused on risk factors/indicators for peri-implant mucositis as well as experimental peri-implant mucositis studies in animals and humans were included.Findings: Peri-implant mucositis is an inflammatory lesion of the soft tissues surrounding an endosseous implant in the absence of loss of supporting bone or continuing marginal bone loss. A cause-and-effect relationship between experimental accumulation of bacterial biofilms around titanium dental implants and the development of an inflammatory response has been demonstrated. The experimental peri-implant mucositis lesion is characterized by an inflammatory cell infiltrate present within the connective tissue lateral to the barrier epithelium. In long-standing peri-implant mucositis, the inflammatory cell infiltrate is larger in size than in the early (3-week) experimental peri-implant mucositis lesion. Biofilm-induced peri-implant mucositis is reversible at the host biomarker level once biofilm control is reinstituted. Reversal of the clinical signs of inflammation may take longer than 3 weeks. Factors identified as risk indicators for peri-implant mucositis include biofilm accumulation, smoking, and radiation. Further evidence is required for potential risk factors, including diabetes, lack of keratinized mucosa, and presence of excess luting cement.Conclusions: Peri-implant mucositis is caused by biofilm accumulation which disrupts the host-microbe homeostasis at the implant-mucosa interface, resulting in an inflammatory lesion. Peri-implant mucositis is a reversible condition at the host biomarker level. Therefore, the clinical implication is that optimal biofilm removal is a prerequisite for the prevention and management of peri-implant mucositis. An understanding of peri-implant mucositis is important because it is considered a precursor for peri-implantitis. [ABSTRACT FROM AUTHOR]

Background: This paper focuses on the Periodontal Profile Class (PPC) System that may be more informative and representative of periodontitis phenotypes than current case definitions of periodontitis. This study illustrates the unique aspects of the PPC compared with other periodontal indices for studying associations between periodontal disease and prevalent systemic conditions.Methods: We computed odds ratios and 95% confidence intervals to compare associations between periodontal disease and prevalent systemic conditions using our new PPC and two traditional indices. We used the Bayesian Information Criterion (BIC) to determine the fit of the model and the magnitude of the contribution attributable to periodontal disease beyond traditional risk factors. The Atherosclerosis Risk in Communities (ARIC) Study (1996-1998) results were compared with results from the combined National Health and Nutrition Examination Survey 2009-2014 datasets.Results: In the ARIC Study, high gingival inflammation, tooth loss, severe tooth loss, and severe disease PPC components were significantly associated with diabetes, coronary heart disease (CHD), high-sensitivity C-reactive protein, and interleukin (IL)-6, while only severe disease was associated with stroke. Severe disease was associated with CHD using the Centers for Disease Control/American Academy of Periodontology index, and the European Periodontal index was associated with CHD and IL-6.Conclusions: The addition of the PPC to traditional variables associated with prevalent diabetes, stroke, CHD, and systemic measures of inflammation resulted in very strong improvement of the overall models, while the traditional indices were less likely to be associated and, if present, the associations were weaker. The PPC system provides specific insight into the individuals and periodontal characteristics of the phenotype that are associated with systemic conditions that may be useful in designing treatment interventions. [ABSTRACT FROM AUTHOR]