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Females appear to show an elevated systemic inflammatory response to bacterial lipopolysaccharide (LPS) compared to males, while males appear to show elevated of cyto/chemokines in gingival crevicular fluid (GCF) of diseased sites, possibly suggesting the role of sex hormones in the prevalence and severity of C/MIP. BACKGROUND: Prevalence of grade C molar incisor periodontitis (C/MIP) in females (F) and males (M) is controversial, although some studies suggest higher prevalence in females. The objective of this study was to evaluate differences in clinical parameters, and levels of cyto/chemokines in gingival crevicular fluid (GCF) and peripheral blood response. METHODS: GCF and blood were collected from 79 C/MIP African-American participants (53F and 26M) and healthy controls (58F and 38M), aged 5 to 23. Blood was stimulated with ultrapure LPS from Escherichia coli (Ec) and Porphyromonas gingivalis (Pg) and we quantified levels of 14 cyto/chemokines. Clinical parameters were collected before and 12 months following treatment. RESULTS: No clinical parameters or age differences were found between males and females, although age was negatively correlated with response to treatment. GCF levels of TNFα, IFNγ, MIP1α and MCP1 from diseased and sites and healthy sites IFNγ levels were higher in M (p

The goal of this study was to retrospectively analyze a cohort of 136 patients who underwent dental implant placement in the posterior maxilla at the University of Connecticut Health Center to assess and identify predictors for implant failure in the posterior maxilla.Data were retrieved from patient charts to identify subjects older than 21 years of age who received dental implant(s) in the posterior maxilla. Patients without a postoperative baseline radiograph were excluded. A recall radiograph was taken 3 to 6 months after implant placement. If there was no recall radiograph, the subject was contacted for a recall visit that included a clinical evaluation and radiographs to determine the implant status. Based on a univariate screening, variables considered potential implant failure predictors included gender, diabetes, smoking, implant length, implant diameter, membrane use, sinus-elevation technique, and surgical complications. These parameters were further assessed, and a multivariable logistic regression was performed with implant failure as a dependant variable. All tests of significance were evaluated at the 0.05 error level.Two hundred seventy-three implants were placed in the posterior maxilla. Fourteen implants failed (early and late failures combined), resulting in a 94.9% overall survival rate. The survival rates for the sinus-elevation group and native bone group were 92.2% and 96.7%, respectively (P = 0.090). Based on the multivariable analysis, sinus floor-elevation procedures were not associated with increased risk for implant failure (P = 0.702). In contrast, smoking and surgical complications had a statistically significant effect on implant failure; the odds ratios for implant failure were 6.4 (P = 0.025) and 8.2 (P = 0.004), respectively.Sinus-elevation procedures with simultaneous or staged implant placement do not increase the risk for implant failure, whereas smoking and surgical complications markedly increase the risk for implant failure.

Background: Systemic inflammation is increasingly being recognized as a risk factor for adverse cardiovascular events. Evidence is accumulating that associates periodontal disease with a higher risk for atherosclerotic plaque formation. A positive association between circulating C-reactive protein (CRP) levels and periodontal disease may be responsible for these observations. We undertook a systematic review and conducted a meta-analysis of the available evidence to examine the effect of periodontal treatment on systemic CRP levels and to assess the quality of the available evidence. Methods: We conducted a systematic search of the English-language literature on the effect of periodontal treatment on CRP levels, as assessed by high-sensitivity assays, at least 2 months after periodontal treatment. The search was conducted in MEDLINE between 1966 and July 2005 and the Cochrane Central Register of Controlled Trials. We performed a meta-analysis using the DerSimonian and Laird random-effects model. Results: The literature search yielded 814 citations of which 10 met the inclusion criteria. The meta-analysis of the randomized controlled trials (RCTs) showed that the difference in serum CRP levels is not significantly different between the two arms. Similarly, results from the single-cohort studies showed that the difference on serum CRP levels was not significantly different before and after treatment. Conclusions: There is now a large body of evidence to indicate that systemic inflammation is present in patients with periodontal disease. Thus, information from RCTs and single-cohort studies does not support the hypothesis that periodontal treatment can reduce systemic CRP levels.

The osteotome sinus floor elevation is a conservative technique for sinus elevation and immediate implant placement. The purpose of this report is to present a case using the sinus floor elevation technique for placement of a non-submerged implant with 12 months follow-up after permanent restoration and to review the literature regarding sinus floor elevation. The osteotome sinus floor elevation technique may be used successfully for the placement of nonsubmerged implants. It allows for shorter post-treatment waiting times and provides a less invasive approach compared to 1- or 2-step antrostomy procedures.

Inflammation is associated with the deterioration of solid-organ transplants. Chronic periodontitis is linked to systemic inflammation, although it is unknown whether it plays a causative or comorbid role. We hypothesized that transplant subjects have a greater prevalence of severe periodontitis, accompanied by higher levels of serum interleukin-6 (IL-6) and C-reactive protein (CRP), compared to systemically healthy subjects.We recruited 90 renal and cardiac transplant recipients and 72 age-matched controls and compared their periodontal and systemic inflammatory status.The prevalence of severe periodontitis was not statistically significantly different between transplant and control subjects. Serum IL-6 and CRP were higher in transplant subjects compared to control subjects and in subjects with severe periodontitis compared to subjects without periodontitis, but multivariate analysis showed that severe periodontitis was a significant positive predictor of serum IL-6 in the control group only. In the test group, significant predictors of systemic inflammation were age, diabetes, higher body mass index, and a cadaveric transplant donor.Despite the presence of higher levels of systemic markers of inflammation in transplant subjects with severe periodontitis compared to transplant subjects without periodontitis, periodontal parameters were not statistical predictors of systemic inflammation in this population in a multivariate model.

The number of transplanted solid organs and life expectancy after transplantation are steadily rising worldwide. Inflammation is widely recognized as playing a pivotal role in transplant rejection, and several studies have shown that serum interleukin-6 (IL-6) levels can identify individuals who are at greater risk for rejection. Given the known association between IL-6 and chronic periodontitis, the aim of our study was to assess the periodontal status of solid-organ transplant subjects compared to systemically healthy controls, to quantify the IL-6 levels in the serum and periodontal tissues, and to explore their association.Forty-seven heart and kidney transplant and 18 systemically healthy age-matched individuals were recruited. Subjects received a complete periodontal examination, and blood and periodontal tissue samples were collected for quantification of IL-6 protein and mRNA levels, respectively.Transplant subjects had significantly higher serum IL-6 levels and slightly but statistically significantly increased mean probing depths than healthy controls. Multivariable linear regression analysis adjusting for gender, diabetes, smoking, and immunosuppressant dose showed that the mean probing depth, number of missing teeth, and mean percentage of sites withor =4 mm attachment loss were independent predictors for elevated serum IL-6 levels. Transplant subjects with chronic periodontitis had higher mean serum IL-6 levels than those without chronic periodontitis, and there was a positive correlation between periodontal IL-6 gene expression levels and serum IL-6 protein levels.Periodontal tissue destruction and local IL-6 synthesis are associated with elevated serum IL-6 levels in transplant recipients. This may have serious implications in solid-organ transplant deterioration and chronic rejection.

Considerable controversy exists as to whether immediate or early implant loading is associated with a higher failure rate compared to conventional loading. Numerous trials conducted have yielded inconsistent results, partly due to low statistical power. Thus, we sought to determine whether combining results from all published trials would provide a better estimate of the impact of implant loading time on survival.We carried out a meta-analysis of all previously published prospective trials comparing conventional with early or immediate implant loading. The outcome of interest was implant failure rate. The Q statistics test was used to assess the presence of heterogeneity. We identified relevant studies through a search of the MEDLINE database and the Cochrane Registry of Controlled Trials.We found 13 prospective trials (1,266 implants) in which early or immediate implant loading was compared to conventional loading. Overall there was no difference in implant failure rate between loading techniques (odds ratio [OR] 0.91; 95% CI: 0.41 to 2.03; P=0.41). Implant failure occurred slightly, although not statistically significant, less often with early implant loading (OR 0.52; 95% CI: 0.22 to 1.24; P=0.07). Immediate implant loading was associated with slightly, although not statistically significant, worse outcomes (OR 1.26; 95% CI: 0.38 to 4.13; P=0.35). Pooling of randomized controlled trials (RCTs) confirmed these results.In a meta-analysis of 13 prospective trials, early implant loading was not associated with worse outcomes compared to conventional loading. Further evaluations in adequately powered large prospective trials are needed to confirm these findings.

Gingival overgrowth is the enlargement of the attached gingiva due to an increased number of cells. The most prevalent types of gingival overgrowth in children are drug-induced gingival overgrowth, hereditary gingival fibromatosis (HGF), and neurofibromatosis I (von Recklinghausen disease). Gingival overgrowth induced by drugs such as phenytoin, nifedipine, and cyclosporin develops due to an increase in the connective tissue extracellular matrix. According to epidemiologic studies, it is more prevalent in male children and adolescents. There is an additive effect of those drugs on the degree of gingival overgrowth. Genetic heterogeneity seems to play an important role in the development of the disease. Functional difficulties, disfigurement, increased caries, and delayed eruption of permanent teeth are the main complications of drug-induced gingival overgrowth. HGF is the most common syndromic gingival enlargement in children. This autosomal dominant disease usually appears at the time of eruption of permanent dentition. Histologically, it is characterized by highly collagenized connective tissue. The most important complications are drifting of teeth, prolonged retention of primary dentition, diastemata, and poor plaque control. Neurofibromatosis I is an autosomal dominant disease more common in mentally handicapped individuals. Gingival overgrowth is caused by the formation of plexiform neurofibromas in the connective tissue of the gingiva. Plexiform neurofibromas are pathognomonic of the disease and consist of hypertrophic nerves arranged as lobules in the connective tissue. Complications of the disease are multiple and severe due to neurofibromas and their occasional malignant transformation.